1. Is your relationship affecting your health? HAVEN at MGH Elizabeth Speakman, LICSW Director, HAVEN Sandra Elien HAVEN Advocate November 12, 2009

2. What is Domestic Violence? Domestic Violence is characterized by a pattern of coercive control used by one intimate partner over the other, which may include sexual and physical assault, social isolation, economic, emotional and psychological abuse, threats and harassment to establish and maintain control. Domestic Violence is characterized by a pattern of coercive control used by one intimate partner over the other, which may include sexual and physical assault, social isolation, economic, emotional and psychological abuse, threats and harassment to establish and maintain control.

3. Who is affected by DV? DV occurs in heterosexual as well as same sex relationships DV occurs in heterosexual as well as same sex relationships Abuse can occur at any point in the life cycle Abuse can occur at any point in the life cycle Approximately 85% of those affected are female Approximately 85% of those affected are female Marginalized groups face additional risks Marginalized groups face additional risks

4. Statistics 1 in 4 women will experience intimate partner abuse at some point in their lives 1 in 4 women will experience intimate partner abuse at some point in their lives Between 10/1/08 and 9/18/09 13 women, 4 men and 3 children have been killed in cases of DV homicide in Massachusetts Between 10/1/08 and 9/18/09 13 women, 4 men and 3 children have been killed in cases of DV homicide in Massachusetts In the US, the cost of DV exceeds $5.8 billion each year, $4.1 is for direct medical and mental health services In the US, the cost of DV exceeds $5.8 billion each year, $4.1 is for direct medical and mental health services

5. Impacts of Abuse on Health Physical injuries due to violence Physical injuries due to violence Chronic Health Problems: Depression, alcohol and substance abuse, STD’s and PTSD Depression, alcohol and substance abuse, STD’s and PTSD Arthritis, chronic neck and back pain, migraine, chronic pelvic pain and ulcers Arthritis, chronic neck and back pain, migraine, chronic pelvic pain and ulcers Complications during pregnancy Complications during pregnancy

6. HAVEN Services Consultations Consultations Direct services to survivors of DV Direct services to survivors of DV Training for staff Training for staff Development of DV protocol Development of DV protocol Educational and awareness activities Educational and awareness activities

7. HAVEN Direct Services Safety planning Safety planning Counseling and Advocacy Counseling and Advocacy Linking survivors with resources Linking survivors with resources Support groups and Workshops Support groups and Workshops Accompaniment to community appointments and court Accompaniment to community appointments and court

8. Possible Indicators of Abuse Failure to keep medical appts or comply with medical protocols Failure to keep medical appts or comply with medical protocols Partner won’t leave pt alone, speaks for pt Partner won’t leave pt alone, speaks for pt Physical injuries during pregnancy Physical injuries during pregnancy An unusually high number of visits to health care providers An unusually high number of visits to health care providers Unexplained injuries or delay in seeking treatment Unexplained injuries or delay in seeking treatment

9. Assessment of DV Set the stage Set the stage “Since many patients we see have experienced abuse and because abuse impacts our health, we now ask all our patients some routine questions.”

10. Assessment of DV Ask the questions Ask the questions “Do you ever feel unsafe or afraid of a partner or ex-partner?” “Do you ever feel unsafe or afraid of a partner or ex-partner?” “Does your partner ever physically hurt or threaten you?” “Does your partner ever physically hurt or threaten you?” “Does your partner put you down, call you names or harm you emotionally?” “Does your partner put you down, call you names or harm you emotionally?” “Does your partner try to control you, where you go or the things you do?” “Does your partner try to control you, where you go or the things you do?”

11. How to respond to a disclosure Supportive Response Supportive Response Validating Validating Reassuring Reassuring Non-judgmental Non-judgmental Empathic Empathic

12. How to respond to a disclosure “I’m glad you told me.” or “Thank you for telling me.” “I’m glad you told me.” or “Thank you for telling me.” “We see many patients in similar situations.” “We see many patients in similar situations.” “You are not alone.” “You are not alone.” “We have services here that can help.” “We have services here that can help.”

13. Assessment of DV Safety assessment Safety assessment Further questions Further questions Referral to HAVEN Referral to HAVEN

14. Impacts Employees  74 percent of employed battered women reported being harassed by their partner while they were at work (Family Violence Prevention Fund, 1998)  A 2005 national telephone survey by the Corporate Alliance to End Partner Violence found that 21% of full-time employed adults were victims of domestic violence

15. Indicators of DV in the Workplace Frequent absences from work Frequent absences from work Appears “absent on the job” Appears “absent on the job” Excessive phone calls/visits from partner Excessive phone calls/visits from partner Injuries Injuries Appears “accident prone” Appears “accident prone” Signs of stress and anxiety Signs of stress and anxiety Tardiness or early arrival at work Tardiness or early arrival at work Distracted, difficulty in making decisions Distracted, difficulty in making decisions No indicators… No indicators…

16. Resources HAVEN HAVEN Boston: 617-724-0054 Revere: 781-485-6108 Chelsea: 617-887-3513 EAP: 617-726-6976 EAP: 617-726-6976 Police and Security: 617-726-2121 Police and Security: 617-726-2121 Mass Statewide DV Hotline: 1-877-785-2020 Mass Statewide DV Hotline: 1-877-785-2020