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Domestic Violence (Intimate Partner Violence) Self-Learning Packet 2007 This self-learning packet is approved for 2.0 contact hours for the following professionals: 1. Registered Nurses 2. Licensed Practical Nurses 3. Radiology ( 2 Personal Development Hours) 4. Licensed Clinical Social Worker, Licensed Mental Health Therapist, and Licensed Marriage and Family Therapist 5. Certified Nursing Assistants (2 in-service hours) © Copyright 2007 Orlando Regional Healthcare, Education & Development

Domestic Violence

(Intimate Partner Violence)

Self-Learning Packet

2007

This self-learning packet is approved for 2.0 contact hours for the following professionals:

1. Registered Nurses

2. Licensed Practical Nurses

3. Radiology ( 2 Personal Development Hours)

4. Licensed Clinical Social Worker, Licensed Mental Health Therapist, and Licensed

Marriage and Family Therapist

5. Certified Nursing Assistants (2 in-service hours)

Domestic Violence

Table of Contents

Introduction ...................................................................................................... 4

What is Domestic Violence? .............................................................................. 4

Overview and Definitions ......................................................................................... 4

History of Domestic Violence .................................................................................... 5

Statistics and Demographics ............................................................................. 6

Lethality of Domestic Violence .................................................................................. 9

Dynamics of Domestic Violence....................................................................... 10

Power and Control................................................................................................. 10

Cycle of Violence / Phases of Behavior .................................................................... 11

Why Women Stay.................................................................................................. 12

Effects of Battering on Others ................................................................................ 13

Screening, Assessment, and Intervention....................................................... 14

Screening ............................................................................................................. 14

Assessment........................................................................................................... 15

Intervention.......................................................................................................... 17

Resources for Victims of Domestic Violence.................................................... 19

Phone Numbers..................................................................................................... 19

Websites .............................................................................................................. 19

Batterer’s Intervention Programs ................................................................... 20

Conclusion ....................................................................................................... 20

Post Test.......................................................................................................... 21

Appendix ......................................................................................................... 25

Safety/Escape Plan Checklist .................................................................................. 25

References....................................................................................................... 27

Purpose

Domestic Violence

The purpose of this self-learning packet is to educate patient care providers about the issues related

to domestic violence. This packet meets the Florida state requirement for Domestic Violence

education. Orlando Regional Healthcare is an Approved Provider of continuing nursing education

by Florida Board of Nursing (Provider No. FBN 2459) and the North Carolina Nurses Association,

an accredited approver by the American Nurses Credentialing Center’s Commission on

Accreditation (AP 085).

Objectives

After completing this packet, the learner will be able to:

1. Define domestic violence based on the Florida Statutes.

2. Explain the law as it pertains to arresting abusers.

3. Describe the prevalence of domestic violence.

4. Analyze domestic violence statistics.

5. Classify behaviors that occur as part of the cycle of violence.

6. Summarize common traits of abusers.

7. List the dynamics of domestic violence.

8. Identify the cycle of violence and phases of behavior.

9. Describe the effects of abuse on women, children, and society.

10. Identify risks to the victim when leaving an abusive relationship.

11. List appropriate screening strategies.

12. Identify common assessment findings.

13. Document findings of abuse in the medical record.

14. Describe ways to help victims of domestic violence.

15. Explain important elements of a safety plan.

Instructions

In order to receive 2.0 contact hours, you must: 1) Complete the posttest at the end of this packet

2) Achieve an 84% on the posttest

For Non-ORH employees: Complete the test using the bubble sheet provided. Be sure to complete

all the information at the top of the answer sheet. You will be notified if you do not pass, and you

will be asked to retake the posttest.

Return to: ORH Education & Development, MP14, 1414 Kuhl Ave, Orlando, FL 32806

For ORH Team Member: Complete testing via Online Testing Center. Log on to: SWIFT

Departments E-Learning Testing Center. Use your ORH Network Login and password. Select

“SLP” under type of test; choose correct SLP Title. Payroll authorization is required to download

test.

Introduction

Domestic Violence

Domestic violence touches as many as 25% of all American families. Estimates suggest that

approximately four million women are victims of a “serious” assault by a partner during an average

year. Although battering occurs in many different forms (male against female, female against male,

male against male, and female against female), 85% occurs in relationships where the male batters

the female partner. Therefore, this packet will mainly address violence against females by males.

“Violence against women harms more than its direct victim. It also harms children, the abuser and

the entire health of all of our families and communities. For the health of our country, it is critical

that we stop the cycle now.”

What is Domestic Violence?

Overview and Definitions

- Former Health and Human Services Secretary Tommy G. Thompson

Domestic Violence

The legal definition of domestic violence for the state of Florida is as follows:

FS 741.28: Domestic violence is any assault, aggravated assault, battery, aggravated battery, sexual

assault, sexual battery, stalking, kidnapping, false imprisonment, or any criminal offense resulting

in physical injury or death of one family or household member by another family or household

member.

In the state of Florida, an officer may arrest the alleged abuser if he/she sees any physical findings

on the victim. The officer does not need the victim to press charges to do this. Charges can be filed

without consent and the alleged abuser tried in a court of law. This is based on FS 741.29: The

decision to arrest and charge shall not require the consent of the victim or consideration of the

relationship of the parties.

According to The National Domestic Violence Hotline, domestic violence is defined as: a pattern

of behavior in any relationship that is used to gain or maintain power and control over an intimate

partner. These acts of violence include abuse that is physical, sexual, emotional, economic or

psychological actions or threats of actions that impact another person. This would include

behaviors meant to frighten, intimidate, terrorize, manipulate, hurt, humiliate, blame, injure or

wound someone.

Battering

Battering is a pattern of behavior that seeks to establish power and control over another person

through fear and intimidation. It often includes the threat or use of violence. Battering happens

when abusers believe that they are entitled to control their partner and that violence is an acceptable

way to control their partner.

Battering occurs without regard to age, race, socioeconomic status, or education. Not all battering is

physical. It also includes emotional abuse, verbal abuse, economic abuse, sexual abuse, threats to

and about children, use of “male privilege,” intimidation, isolation, and behaviors used to induce

fear and establish power in the relationship.

Domestic Violence

Battering usually escalates. It may begin with name-calling, punching a wall, or kicking a pet.

Then it may escalate to behaviors such as pushing, slapping, or pinching. Anger further escalates to

more violent behavior such as punching, kicking, biting, tripping, throwing, or restraining and often

sexual assault. Ultimately it can lead to life-threatening injuries.

Intimate Partner Violence

The U.S. Department of Justice has recently termed battering and domestic violence as intimate

partner violence (IPV). Intimate partner violence can be categorized into non-lethal or lethal

violence. Non-lethal violence is usually psychological or verbal in nature. Rape, robbery,

aggravated assault and simple assault are also considered part of this category. Physical injuries can

be very severe, but not life threatening. Lethal violence always leads to the death of the victim and,

in some cases, to the perpetrator themselves. Although the victim is usually a significant other,

many times the batterer will also include children in the violent act. For purposes of this packet,

domestic violence, battering, and intimate partner violence will be used synonymously.

History of Domestic Violence

Domestic violence is not a recent issue. Domestic violence is a global issue that has existed for

centuries. In 48 population-based surveys from around the world, 10-69% of women reported being

physically assaulted by an intimate male partner at some point in their lives. However, it was not

until the women’s movement in the 1970’s that the problem started to receive public attention in the

United States. Historically, violence against women has not been treated as a “real” crime. In the

past, it has actually been condoned worldwide as evidenced by the proverbs and laws listed below.

• Roman first law of marriage: A wife is to conform to the temper of her husband and the

husband is to have full legal right to control his wife either by chastising, divorce, or killing.

• Russian proverb: A wife may love a husband who never beats her, but she does not respect him.

• Spanish proverb: Never hit your woman with the petal of a rose, but with the thorny stem.

• English proverb: A woman, a horse, and a hickory tree, the more you beat’em, the better they

be.

• Chinese proverb: Feet are bound, not to make them beautiful as a curved bow, but to restrain

women when they go outdoors.

• French proverb: Women, like walnut trees, should be beaten every day.

• Pennsylvania law 1776: No husband shall beat his wife after 10pm at night or on Sundays.

• Supreme Court of North Carolina 1874: If no permanent injury has been inflicted, nor malice,

cruelty, nor dangerous violence shown by the husband, it is better to draw the curtain, shield the

public gaze, and leave the parties to forget and forgive.

For many years, both society and the justice system have treated domestic violence as a personal

and private matter, instead of a crime. Even today, it is estimated that less than half of all episodes

are reported to police. Reasons given for not reporting include the belief that this is a private or

personal matter, fear of reprisal, or belief that police will not do anything.

The justice system is however making progress in how it handles domestic violence cases. Laws

have been developed to better prosecute batterers. In 1999, the State of Florida passed a law (FS

741.30) that permitted injunctions (restraining orders) to be granted on a permanent basis in

domestic violence cases. Prior to this, the victim had to renew the order every year. Florida

Governor Jeb Bush signed into law the “Family Protection Act” in 2001. The act mandates a jail

term for any crime of domestic battery in which the perpetrator deliberately injured the victim.

Domestic Violence

Additionally, if the perpetrator is charged with a second battery crime, then it is a felony offense,

and he is treated as a serious criminal. More recent bills related to domestic violence include

Senate Bills 716 and 1974 which were signed into law in 2002. Senate Bill 716 adds to the

definition of domestic violence laws to include those in dating relationships of 6 months or more.

Senate Bill 1974 mandates judges to inform victims of their rights. Some of these rights include the

right to appear in court, to be notified of court dates, to seek restitution, and to make a victimimpact

statement.

Many domestic violence organizations provide legal assistance and court advocates which assist

women with the legal processes. In addition, some agencies notify victims before a batterer is

released from jail so they can provide for their own safety. There are also several programs that

provide women with free cell phones to make emergency calls in case the batterer tries to harm her.

Recently the Violence Free Florida campaign has been initiated to increase public awareness of

domestic violence issues. One of the objectives of the Public Health Services’ Healthy People is to

reduce the rate of physical assault by current or former intimate partners to a rate of 4 per 1000

women 12 years and older by the year 2010.

On January 5, 2006, President George W. Bush signed into effect the Violence Against Women Act

(VAWA) of 2005. This act established the federal government’s commitment to helping ensure the

safety and security for the victims of domestic and sexual violence and their families. This act

addresses many different aspects of the problems surrounding domestic violence. There are

conditions in the VAWA that provide grants to combat violence against women in public and

assisted housing; develop programs aimed at ending violence against women with disabilities and

women in later life; and strengthens the National Domestic Violence Hotline. The VAWA of 2005

also enabled new initiatives to be established such as prevention strategies, protection from unfair

eviction for individuals who are domestic violence victims, funding for rape crisis centers, and the

development of culturally and linguistically specific services. Additionally, the scope of provisions

was expanded to include children and teens.

Statistics and Demographics

Four million American women are the victim of a serious assault by an intimate partner each year.

There are an average of three women murdered by their intimate partner every day. Every fifteen

seconds an American woman is battered by her intimate partner (4 women every minute, 240

women every hour, and 5,760 women every day). Worldwide, one out of three women has been

beaten, coerced into sex or otherwise abused during her lifetime. Pregnant women are particularly

vulnerable to incidents of domestic violence, in 30% of women who experience abuse, the first

incident occurred during pregnancy. It is estimated that as many as 324,000 women each year are

victimized during pregnancy. In a June 2005 report, the National Domestic Violence Hotline

reported a 15% increase in the preceding year for services for family violence.

Teenage girls are also at risk for abuse. One in five female high school students report they have

been physically and/or sexually abused by a dating partner. This translates into additional issues for

these teens. Abused girls are more likely to participate in risky behaviors. These girls are four to

six times more likely to get pregnant and suicide attempts are eight to nine times higher than teen

girls who have not been abused.

Domestic Violence

As noted by the National Domestic Violence Hotline, anyone can be a victim of domestic violence

regardless of age, race, sexual orientation, religion or gender. Domestic violence occurs in married

couples, couples living together and in dating couples. All socioeconomic groups and people of all

education levels are affected by domestic violence. Although all races are equally susceptible to

violence by an intimate partner, the prevalence does vary among race. The ethnic groups most at

risk are American Indian/Alaskan native women, African-American women, and Hispanic women.

Also, young women and women living below the poverty level are disproportionately victims of

domestic violence.

According to the Centers for Disease Control (CDC), statistics on domestic violence vary based on

the different sources that define domestic violence/intimate partner violence. Some sources don't

include stalking and psychological abuse, only physical and sexual violence in their definition.

Also, not all domestic violence incidents are reported to the police. Approximately 20% of rapes

and sexual assaults, 25% of physical assaults, and 50% of stalking against women are not reported.

This under-reporting of incidents creates an underestimate of the significance of the problem.

Florida's Crime Rate at a Glance

Ten Year Trend

1996-2005

Domestic Violence

Total Domestic Violence, 1992 - 2005

(Click on specific year for by county details)

Year Population Murder

Manslaughter

Forcible

Rape

Forcible

Sodomy

Forcible Aggravated

Fondling Assault

Aggravated

Stalking

Simple

Assault

Threat/

Intimid

ation

Arson

Simple

Stalking

Total

%

Change

Rate per

100,000

population

Rate

Chang

e

1992 13,424,416 245 10 1,622 475 1,233 23,906 * 79,722 2,136 100 * 109,449 -- 815.3 --

1993 13,608,627 234 16 1,636 527 1,430 23,649 * 82,301 2,678 114 * 112,585 2.9 827.3 1.5

1994 13,878,905 230 10 1,667 578 1,190 23,765 * 89,583 2,808 99 * 119,930 6.5 864.1 4.4

1995 14,149,317 195 14 1,465 526 1,138 25,817 * 98,628 3,273 96 * 131,152 9.4 926.9 7.3

1996 14,411,563 192 17 1,426 408 1,021 25,680 255 99,116 4,022 ** 567 132,704 1.2 920.8 -0.7

1997 14,712,922 161 9 1,365 460 932 26,561 298 101,305 4,681 ** 610 136,382 2.8 927.0 0.7

1998 15,000,475 190 22 1,440 411 955 25,162 247 99,428 4,817 ** 673 133,345 -2.2 888.9 -4.1

1999 15,322,040 186 13 1,186 409 989 23,414 241 94,765 4,378 ** 463 126,044 -5.5 822.6 -7.5

2000 15,982,378 168 10 1,266 341 939 23,484 227 93,475 4,261 ** 458 124,629 -1.1 779.8 -5.2

2001 16,331,739 193 18 1,154 447 1,183 22,658 256 92,893 4,786 ** 428 124,016 -0.5 759.4 -2.6

2002 16,674,608 188 6 1,210 495 1,179 21,987 268 91,299 4,673 ** 529 121,834 -1.8 730.7 -3.8

2003 17,071,508 179 11 1,196 447 1,146 21,440 254 90,939 4,602 ** 483 120,697 -0.9 707.0 -3.2

2004 17,516,732 184 14 1,146 407 1,146 21,494 255 90,079 4,551 ** 496 119,772 -0.8 683.8 -3.3

2005 17,918,227 176 17 1,240 434 1,137 21,676 254 90,455 4,157 ** 840 120,386 0.5 671.9 -1.7

* Data not collected until 1996 ** Data not collected after 1995

SOURCE: Florida Statistical Analysis Center: FDLE (1992-2005). Crime in Florida, Florida uniform crime report

[Computer program]. Tallahassee, FL.

Common Traits of Abusers

Perpetrators of domestic violence come from all backgrounds, education levels and socioeconomic

groups. Psychologists have identified some common characteristics. Some of these characteristics

include: low self-esteem, low income, low academic achievement, heavy alcohol and drug use,

anger and hostility, jealousy, depression, history of being abusive, belief in strict gender roles,

desire for power and control, and economic stress. One of the strongest risk factors for someone to

be a perpetrator of domestic violence is they themselves have been a victim of physical or

psychological abuse.

Jealousy and obsession are significant warning signs. Abusers often mistrust their partner and

obsess about what their partner is doing and who they are with when they are not at home. He will

frequently accuse his partner of cheating or looking for other sexual partners. The batterer often

“checks up” on the victim several times a day, such as calling her frequently or checking the

mileage on the car. This jealousy often persists even after the relationship is over.

Another key sign is controlling behaviors. The abuser controls most of the decisions in the

relationship and there is little or no sharing of power. He will decide how the woman will dress,

when she will work, whom she can spend time with, and when she can leave the house. The abuser

Domestic Violence

may try to isolate the victim in order to maintain control. This controlling behavior becomes most

evident when the batterer feels threatened. He will attempt to obtain a position of power through

whatever means is necessary. An example of a statement from someone who is controlling is “I am

the one bringing home a paycheck, so you better….”. This behavior may be observed during the

interview with the victim. The batterer will often answer all the questions and demand to be with

the victim at all times.

Abusers also tend to become quickly and intensely involved with a partner. Their relationships may

progress from dating to living together in a matter of a few weeks. They become possessive of their

partner and obsess about the relationship.

Furthermore, abusers tend to blame others for their problems and justify their actions. Often they

refuse to accept responsibility for their actions and will make numerous excuses to avoid

accountability. Batterers will often minimize what happened and will downplay or deny their role

in the abuse. Examples of statements are, “If she would have made dinner right, I wouldn’t have

had to hit her,” “I only pushed her because I was drunk,” or “She fell down and broke her arm.”

In general, the batterer often uses force or violence to solve problems. Additionally, he may have a

history of substance abuse, a prior arrest record, a poor driving record, frequent employment

changes, and financial problems. Mental health problems, such as depression, suicidal ideation,

mania, or homicidal ideation, may also be present.

When displayed (especially with unexplained injuries to a partner), these characteristics should be

red flags that domestic violence may be occurring. The partner should be interviewed privately.

Also, behaviors exhibited must be documented objectively in the medical record. An example of

objective documentation is as follows: “The patient’s husband, John Doe, answered most of the

questions for the patient. He refused to leave the treatment area when asked to wait in the waiting

area while the patient was examined.”

Lethality of Domestic Violence

In the state of Florida, there were 176 deaths related to domestic violence in 2005. Overall, the

Florida statistics mirror a national trend of decline in deaths related to domestic violence.

Studies have determined factors that increase the risk of homicide. The risk factors include:

• Threats of homicide or suicide

• Access to guns or other weapons

• History of weapon use in prior violent incidents

• Substance abuse

• Forced sex

• Extreme jealousy or dominance

• Property damage

• Increase in violence over time

• Violence toward children or pets

Domestic Violence

Dynamics of Domestic Violence

Power and Control

Most healthy relationships are based on trust and

equality. However, due to the traits of the

abuser, it is clear that power and control are a

main component of an abusive relationship.

Abusers use violence and other means to

maintain power and control. There are eight

main categories of behaviors that abusers use to

gain power and control. These behaviors are

exemplified as the Domestic Violence wheel as

pictured.

Intimidation: The abuser tries to intimidate the

victim through aggressive gestures such as

throwing items, destroying property, or abusing

pets. Another way he instills fear is by keeping

weapons within view. The abuser uses these

intimidating gestures to try to “keep her in her

place.” Intimidation is often used in conjunction with coercion and threats.

Coercion and Threats: The abuser may make verbal threats to hurt the victim. He may threaten to

kill her, kill himself, or harm her children or family. He may also threaten to take away children.

These threats may be used to get the victim to return home or drop charges. Essentially threats are

used so that the abuser can get his way and maintain control, but in a fit of anger the perpetrator

may carry out these threats.

Emotional Abuse: It is not uncommon for the abuser to make the victim feel insecure about

herself by calling her names, putting her down, or humiliating her. He may also try to make her

think she is going crazy, or make her feel guilty. The abuser does this to decrease her self-esteem

and make her dependent on him for support. It is often the most difficult part of abuse to overcome.

Isolation: Another way the victim is made to feel dependent is by isolating her from the outside

world. He controls what she does, whom she sees and talks to, what she reads, and where she goes.

He may refuse to let her work or go to school. The abuser may limit contact with friends and

family. This makes it very difficult for the woman to leave the relationship since she has no outside

support system.

Economic Abuse: The abuser usually prohibits the woman from working. Often the abuser will

give only a small allowance, make her ask for money, and forbid access to family finances. If she

does work, the batterer will take her wages. He may not allow her to have any credit cards, debit

cards, or bank accounts. This also makes it very difficult for her to leave since she has no

independent finances.

Children: The abuser may use children as a means to gain control. He may threaten to harm them

or take them away. If the couple is separated or divorced, he may use visitation to harass the victim

or to relay messages. The abuser will often find ways to make the woman think she is not a good

mother. Frequently, women state that threats their against children are one of the main reasons that

they stay in the relationship.

Domestic Violence

Minimizing, Denying, and Blaming: After an abusive episode, the batterer may blame the victim

for the violence and say it is not that serious, or deny that it happened at all. Most often he finds

ways to shift the blame to the victim. He may say, “If you had cooked dinner better or if you would

have kept the kids quiet, I would not have had to hit you.” The victim often believes that the

violence is her fault and tries to avoid situations that trigger violent outbursts. It is often very

difficult to convince the victim that it is not her fault and that no one deserves this treatment.

Male Privilege: This is when the abuser treats the woman like a servant and acts like he is the

“master of the castle.” Abusers often have very rigid definitions of gender roles and view the male

as being the controller of the relationship and household. He will make all the decisions about

finances and household matters. This behavior also further reduces the woman’s self-esteem.

Cycle of Violence / Phases of Behavior

Episodes of domestic violence tend to be

cyclical. In at least 50% of violent relationships,

there are three phases of behavior. They are:

Build-up/Escalation, Explosion/Abusive

Behavior, and Honeymoon/Sorrow. The

behaviors for both the batterer and the

victim/survivor are presented below.

Phase I: Build-up/Escalation

The batterer blames the victim, makes unreasonable demands, and has small outbursts. Tension and

battering start to increase during this phase, which may last for hours, days, weeks or longer. This

portion of the cycle tends to get shorter as the cycle repeats itself.

The victim senses the increase in tension and tries to calm the batterer. She believes that she can

control her partner’s anger. She blames external forces, such as work, children, or in-laws, for the

outbursts and tries to control them. During this time, she may avoid friends and family, try to keep

the children quiet, or avoid the batterer. As the battering starts to increase, the woman may also

further withdraw in order to minimize her danger.

Phase II: Explosion/Abusive Behavior

Generally, in this phase, the batterer initially wants to teach his partner a lesson and to prove that he

is still in control of their relationship. The increase in tension builds until a violent episode of

battering occurs.

Eventually, the victim knows that the battering will occur and that she will not be able to change the

outcome. If she tries to defend herself, it will only result in more serious injury. She will try to find

a safe place to hide before it starts, but when it does happen she tries to minimize the harm.

Immediately afterwards, the victim may have feelings of denial, disbelief, helplessness, and

depression. She will try to rationalize why the episode occurred and will often delay seeking

medical treatment for injuries.

Domestic Violence

Phase III: Honeymoon/Sorrow

The batterer wants the victim’s forgiveness and promises that it won’t happen again. He places

blame on others, but he rarely blames himself for the violent episode. He believes it will not

happen again. The abuser may charm the victim with gifts and attempt to enlist other family

members and friends to convince her that he will not hurt her again.

At the beginning of this phase, the victim will likely flee and seek help from professionals. She

accepts that she cannot control the batterer’s behavior. The abused woman wants to believe his

promises that this will never happen again. The victim may return to the batterer because she wants

to give him another chance, is afraid, or because she feels she is safer knowing where the batterer is

and what he is doing. This phase is especially important to healthcare workers since many victims

seek medical help for minor injuries as this time. It is important that healthcare workers provide the

victim with information on safety and escape planning so that when she needs it, she will have it.

Why Women Stay

This is often a very frustrating issue for healthcare providers. It is

difficult to understand why a person would choose to stay. When

someone is in an abusive relationship, it is important to understand

that leaving can be very dangerous. Over 70% of victims killed by

their partners are killed when trying to leave or after they have left.

There are many reasons why women stay in these abusive

relationships. Some of the reasons are: love for their partner, fear

due to threats of harm to the victim, their children, family or pets, fear

of losing their children, threats of suicide from their abuser,

religious/cultural beliefs, low self-esteem, finances, and believing that

the abuse is somehow their fault.

Leaving is often a process. Initially the abused woman may believe

that the batterer will change. The continued cycle of violence is often

kept in motion by love, hope and fear. She loves her partner and

believes that the relationship has more good times than bad. The

woman has hoped that the relationship and the abuser will change.

However, some of the fears include his threats to kill her, her friends,

or her family or to take her children away.

70% of victims killed

by their partners are

killed when trying to

leave or after they

have left

Even if the victim does decide that she wants to leave, it can take months or years to put a plan into

place that will protect both her and her children. The abuser may control all of the finances.

Sometimes the woman may initially leave to test whether the abuser will seek help or stop the

abuse. Others may leave several times to gather resource information. It is not uncommon for

women to leave 5-7 times before leaving permanently. Once the victim has a plan, a job, childcare,

housing, etc., she may finally leave for the last time. Most battered women do eventually leave.

Health care providers can help by asking about abuse, being non-judgmental and offering

information on resources and safety planning. Understand that only she can know when the right

time is to leave since she knows the abuser better than anyone.

Effects of Battering on Others

The effects of battering are far reaching. Many think that the woman

is the only victim, however there are effects not only on the children

living in the home, but also on society as a whole.

Domestic Violence

Many people, including abused women, think that children are

unaware of the violence. Some believe that since the children are not

actually being abused, they are not affected by the violence.

However, when questioned, children report that “dad hurts mom”, or

they will draw pictures depicting this violence. Most often though,

intimate partner violence is not isolated, in an estimated 40-60% of

families, and overlaps with child abuse. Children, even infants, may

exhibit behaviors consistent with abuse within the home. As a health

care provider, if child abuse is suspected, it must be reported to1-800-96-ABUSE. It is the LAW.

Infants and toddlers are sensitive to violence in the home. Some examples of signs and symptoms

exhibited by infants include irritability, sleep disturbances, or digestive problems. Toddlers may

either be more aggressive or more withdrawn than other children. They may have speech and motor

delays, lack of bowel/bladder control after age 3, and lack confidence in beginning new tasks.

Toddlers may also exhibit anxiety and fear, which frequently presents as nightmares and

psychosomatic complaints such as stomach-ache.

School-age children and adolescents react in very similar ways. They may experience difficulty in

school resulting in poor grades and failing courses. They usually have few friends and refuse to

bring friends home for fear that a violent episode may occur. Children from abused settings may

also have violent outbursts and be aggressive toward others. It is not uncommon for them to have

low self-esteem, poor communication skills, or act immature. The stress and anxiety this age group

encounters can cause physical symptoms such as complaints of headaches, digestive problems,

ulcers, bed wetting, and nightmares. Research has found that children who see domestic violence in

the home tend to bully others, be more physically aggressive and are at greater risk for anxiety and

depression. Children raised in abusive households need assistance, regardless of whether or not

they were directly abused.

There can even be effects on children before birth since many women are battered during

pregnancy. Violence continues during pregnancy in up to 30% of abused women. Abuse during

pregnancy can result in miscarriage, early labor, and low birth weight. Even if not physically hurt,

the victim may be denied access to prenatal care or adequate food. Since an obstetrician is

frequently a woman’s primary care physician, health care providers working in this area need to be

aware of the importance of identifying abuse.

Society is also affected economically by domestic violence. There are increased costs associated

with legal, police, medical, and counseling services related to domestic violence. The CDC

estimates that the health-related costs of intimate partner violence exceed $5.8 billion each year.

There are also costs related to decreases in work productivity and increases in absenteeism. Work

productivity is decreased secondary to continued harassment from the abuser. Injuries lead to

frequent absences; additionally, the abuser may forbid the victim from going to work. She may also

have frequent absences as a result of injuries that may have occurred or her partner forbidding her to

work.

Screening, Assessment, and Intervention

Domestic Violence

Health care providers must look at their own attitudes about domestic violence. One’s attitudes

about abuse often reflect a great deal of victim blaming, especially if the woman decides to return to

the abusive situation.

Although helping victims of domestic violence can seem like an impossible task, it may be as

simple as recognizing that abuse is occurring. Ways healthcare providers can help the victim

include a mental rehearsal of an escape plan, providing her with resource numbers, and most of all

being supportive of her and her decision.

Screening

The best way to identify domestic violence is to ask all patients, especially female patients greater

than 14 years of age, about abuse in all clinical settings such as primary care offices, OB/GYN

offices, and emergency departments. Most victims will not spontaneously volunteer information

about abuse, but they are more likely to discuss it if they are directly asked. In a recent study, 83%

of abused women were in favor of being asked about abuse. Unfortunately, few women are

screened.

It is best to ask questions about abuse privately when the provider is alone with the patient. It is

extremely important for the patient to know that the conversation with them will remain

confidential. If at all possible, the screening should be done in the patient’s native language. If an

interpreter is needed for communication it is best that a professional be used and not a friend or

patient family member. If a partner is present, defer asking about abuse since this could lead to an

abusive episode later. If it is difficult obtaining privacy because the male partner refuses to leave

the exam room, nurses can ask questions in the restroom.

Screening for domestic violence should be done as part of a general assessment (i.e., review of body

systems), new patient assessment, a visit for a new compliant, a standard health assessment, and

during every periodic comprehensive health visit.

Other subtle indicators of abuse include frequent visits to the emergency room, multiple healthcare

visits for vague, somatic complaints, frequently missed appointments, and statements such as, “I’m

just so clumsy” and “I’m just so accident prone.”

There are a number of ways in which one can ask about abuse. When asking questions, health care

providers should avoid the terms violence or abuse and focus on the behaviors. The victim may

have different interpretations. Providers should choose a style that works best for them. Questions

can be incorporated with routine procedures or walking through the hallway. They are to be nonjudgmental.

Some common direct questions include:

• Do you feel safe in your current relationship?

• Has anyone ever forced you to have sex when you didn’t want to? If yes, do you currently have

any contact with him?

• Has anyone ever hit you or hurt you? If yes, do you currently have any contact with him?

• Are you in a relationship where you are being threatened or hurt?

Domestic Violence

The American College of Obstetricians and Gynecologists have developed a checklist for screening

for victims of domestic violence.

Does the person you love...

• Threaten to hurt you or your children?

• Say it's your fault if he or she hits you, then promises it won't happen again (but it does)?

• Put you down in public or keep you from contacting family or friends?

• Throw you down, push, hit, choke, kick or slap you?

• Force you to have sex when you don't want to?

By answering yes to even only one of these questions means you are involved in an abusive

relationship.

Examples of indirect questions include:

• Many women in our area have been hit or punched by their partner. Has anything like this ever

happened to you?

• We see many women with injuries or complaints like yours and often they are hit or punched by

their partner. Has that ever happened to you?

Approaches to communication on this difficult topic can be improved if the healthcare provider sits

down next to the patient during the examination or interview. This allows for open and

approachable communication and demonstrates a caring attitude. Eye contact should be made and

open-ended questions asked. If a language barrier exists, try to find a interpreter who is the same

gender as the victim and who is familiar with her cultural background. Never ask the person

accompanying the patient to interpret since they may be the abuser or may want to protect the

abuser.

A tool that can be used to predict risk of homicide from abuse is the Danger Assessment

instrument. The first part of the instrument assesses severity and frequency of battering by showing

the woman a calendar of the past year. The woman is asked to mar the approximate days when

abusive incidents occurred. The woman is then asked to rank the severity of the incidents using a 1-

5 scale (1=slap, push, no injuries and/or lasting pain through 5= use of weapon, wounds from a

weapon). The second part of the Danger Assessment consists of a 20 item instrument which uses a

weighted scoring system to count yes/no responses of risk factors associated with homicide.

Samples of questions from the instrument are listed below:

• Has the physical violence increased in frequency over the past year?

• Is there a gun in the house?

• Is he drunk every day or almost every day?

• Does he threaten to kill you and/or do you believe he is capable of killing you?

This tool helps women become more aware of the lethal risks of abuse.

Assessment

Signs of abuse are not always obvious, however a careful assessment often reveals evidence or cues

of abuse. Findings can be emotional/psychological or physical. To begin the physical assessment,

try to examine the patient without the partner present and note the patient’s chief complaint and

injuries. Pay special attention to multiple injuries at various stages of healing. Record any

statements as a direct quote. Be suspicious of abuse if there are inconsistencies between the stated

Domestic Violence

cause of the injury and the actual injury present. For example: if the patient states that she ran into a

door and has a black eye and facial fracture, the injury does not match the stated cause. Injuries

from abuse often occur to the face, neck, chest, breasts, abdomen, and genitalia. In order to be

consistent and accurate, use a systems approach such as that listed below and document objectively,

clearly and completely. It is recommended to accurately record all injuries using a body map.

General Appearance

The patient may seem anxious, especially if the partner is present. Other possible signs of domestic

abuse include a flat affect and fatigue. The patient could be either underweight or overweight. She

may also flinch or seem uncomfortable when touched during the examination.

Emotional/Psychological

In addition to the above findings, the patient may exhibit psychological evidence of abuse. These

include signs of depression, suicidal ideation, or low self-esteem. She might report insomnia and

other vague somatic symptoms. A result of the prolonged stress, women often manifest

psychosomatic symptoms – backaches, headaches, digestive problems, anxiety, restlessness, etc.

These symptoms have been termed “Battered Women’s Syndrome.” There also might be evidence

of drug or alcohol abuse as a means to “self-medicate.” There might be a history of noncompliance

with care or follow-up. The patient may report that she has no independent

transportation and lack of access to finances. She also might not have a phone, or may refuse to

give out her number. Often abusers use isolation as a method to control the victim.

Skin

Burns, bruises, and/or scars may be present in various stages of healing.

All of the skin should be examined since injuries are commonly found in

areas covered by undergarments. Note any symmetrical bruising or pattern

injury, such as bruising on both sides of the neck that might indicate

choking. Make note of any bruises that have an obvious shape, such as a

horseshoe, since this may match up to jewelry or other objects used to hit

the victim.

Head

A complaint of headaches could be related to direct trauma such as a

subdural hematoma or may be caused by the stress of the situation. She

may have impaired hearing or a perforated eardrum secondary to multiple

head blows. Eyes may be swollen and bruised; a subconjunctival

hemorrhage (broken blood vessel in sclera of eye) or a detached retina may

also be noted. Also check for clumps of hair that might be missing, which

she may be covering with bangs or hidden by a hat.

Gastrointestinal

The patient may report heartburn or stomach pain that is not related to an ulcer. She may also

report irritable bowel syndrome. Because the abdomen is a common site of injury, there could also

be damage to internal organs; therefore, a thorough assessment is imperative.

Domestic Violence

Musculoskeletal

Common fracture sites include the face, radius, ulna, and ribs. Dislocation of the shoulder is also

common since the abuser may have forcefully pulled on the victim’s arm. In addition, old fractures

should be reviewed on the x-ray films. Even if fractures are not present, the patient may have

limited mobility due to soft tissue injuries and may report chronic pain, particularly fibromyalgia.

Genital/Urinary/Rectal

Non-consensual sex is fairly common in abusive relationships, so there may be evidence of this in

the form of bruising, tenderness, vaginal wall tears, and bleeding. If rape is reported, the patient

should be examined and evidence gathered based on the protocol/policy. There may also be

evidence of rectal trauma, such as swelling, irritation, and bleeding. Due to lack of condom use,

sexually transmitted diseases may be present. Pregnant women are also at high risk for abuse, so

there may be a history of miscarriage, preterm labor, or low birth weight delivery.

Intervention

First, if abuse is suspected, ask the patient if she is being abused. If you have asked and she denies

abuse, ask again. Point out that the injuries she has are consistent with abuse and that you are

concerned for her safety. If she still denies abuse, record her statements and indicate that injuries

are not consistent with stated cause. Remember to only record objective findings and statements.

If the patient states that another person has injured her, get the

exact name of the person whom she states caused the injuries.

Do NOT write only the word husband or boyfriend in the

record. Instead, list the entire name as follows: Patient states

that “my husband, John W. Doe, hit me in the back with a

baseball bat…” This places the statement of accusation as part

of the victim’s report, rather than your opinion.

If possible, obtain the victims consent to photograph the injuries

using a Polaroid-type camera. (Do not take photos without

consent.) When taking photos, try to get very close to the injury

when taking the picture. On the back of each photo, document

the date, time, body location, your signature and the victim’s

signature. Number the photographs and then indicate in the

documentation the number of the correlating picture. These

photographs should be kept as a permanent part of the chart, for

use as evidence in court.

10/30/02 2100

Left upper arm

Nancy Nurse, RN

Jane Doe

Unlike child and elder abuse, there is not a Florida law

mandating that domestic violence is reported. However, Florida

law does require healthcare workers to call the police for gunshot wounds or other life-threatening

injuries indicating an act of violence. If the injuries do not meet the above criteria, it is not

mandatory to notify the police. However, you should ask the woman if she would like you to call

the police. Call only if it meets the Florida law criteria or if she wants you to do so. She may not

want to call the police because she fears what will happen when the abuser is released. If the

injuries do meet the criteria, make sure to let the victim know you are notifying the police so she

can prepare for her safety needs.

Domestic Violence

Women who are being abused can benefit from learning about abuse. A teaching plan can include

the cycle of violence, effects of battering on children, how batterers use power and control, and an

emphasis that no one deserves to be beaten. Be sure to give

the woman only the information she can handle at that

time. Do not overwhelm her with statistics and details.

Often receiving the basic information about domestic

violence, realizing that she is not alone, and making a

safety plan is enough. Basic knowledge of domestic

violence can help her to better protect herself and make an

informed decision about her options. Consult clinical

social work for further assistance.

Mandatory to report

gunshot wounds or

other life-threatening

injuries indicating an

act of violence

If the victim is going to be treated and released, discuss the

safety of her and her children. Ask the victim if she would

like assistance finding a shelter or if she would like the

number for a domestic violence hotline. The hotline

number in Florida, 1-800-500-1119, provides assistance in

English, Spanish, and Creole. If she does not want the numbers, show her where she can find them

in the phone book for future use. Do not try to slip the phone numbers in her pocket or purse, since

the abuser may find them and become violent. A list of resources is included at the end in this

packet.

Make sure to inform patients about Internet safety and security. If the victim is accessing the

Internet from home to get information about services and escape plans, the abuser may be able to

track this information. It is very difficult to completely clear the history of the computer. It may be

safer for the victim to use a computer at a more secure location such as a friend’s house or the

public library.

Remember it is up to the victim to decide what she wants to do. She knows best what the safest

option is at this time. Leaving can actually escalate the violence and may put those she stays with,

such as friends or family, at risk for injury. In fact, 75% of domestic violence attacks occur

between people who are separated or divorced and 70% of women killed by a partner are killed

while leaving or after they leave.

Some questions to ask in order to assess her safety status are:

• Where is he (the abuser) now?

• Does he know you are here?

• Has he threatened you with any weapons? Are weapons available to him?

• Is he intoxicated or taking drugs?

• Does he have a criminal record?

• Do you have children? Are they safe at this time? Is there somewhere they can go?

• Are the children being abused?

If she decides to return home with the abuser, support her decision and let her know if she needs to

return for treatment. At this time, the most important thing is to assist her in developing a safety

plan. A safety plan includes recognizing the signs that violence might occur, how to get help,

which rooms to avoid because there are many weapons (kitchen or bathroom), developing a signal

to alert others that she is in danger, planning an escape route, and having an escape plan in place.

Review the escape plan with her, so when and if she decides to leave, she will have what she needs.

Some examples of items that need to be collected are identification (driver’s license, passport); birth

Domestic Violence

certificates for self and children; social security cards; extra car and house keys; checkbook/ATM

card; car registration; food stamps; Medicaid/health information cards; prepaid long distance card;

and proof of income for partner. A comprehensive list is available in the appendix. These items

should be kept in a bag or container away from home and in a safe place. They should not be

placed in a purse or car. Often copies should be made so the abuser will not notice any documents

missing.

If the victim is admitted to the healthcare facility, the nursing unit should know of:

• The alleged abuser and his emotional state, if known

• If visitor restriction or an alias name for the victim is needed

• Whether police and/or hospital security have been notified

• Referral to clinical social work for assessment, education and resource information or to case

management for follow-up and arrangements post-discharge is needed.

Resources for Victims of Domestic Violence

Phone Numbers

Florida Abuse Hotline: 1-800-962-2873

Florida Statewide Hotline for Spouse Abuse: (407) 886-2856 or 1-800-500-1119

Harbor House (Orange County): (407) 886-2856

Help Now of Osceola, Inc. WIN (For Women in Need): (407) 847-8562

National Hotline: 1-800-799-SAFE (7233)

Safe House of Seminole/Domestic Violence Hotline: (407) 330-3933

Salvation Army DV Shelter (Orange County): (407) 856-5797

Spouse Abuse, Inc. (800) 892-2849

Women's Residential & Counseling Center: (407) 425-2502

Websites

Women should be careful about going to web sites using a family computer since a history of sites

visited is recorded on the computer. It is probably best to use a computer at a library or other public

place if there is danger of the abuser finding out.

Domestic Violence Survival Kit: http://www.dvguide.com/content.html

Numerous resources and legal information

Family Violence Prevention Fund: http://endabuse.org/

Numerous resources and personal stories

National Coalition Against Domestic Violence: http://www.ncadv.org/

Numerous resources

National Domestic Violence Hotline: http://www.ndvh.org/

Numerous resources

Site for men who are being battered: http://www.batteredmen.com/

Batterer’s Intervention Programs

Domestic Violence

There are numerous state-certified batterers programs. There have been mixed reports on

effectiveness, but the State of Florida has found them to be effective and often men are ordered by

the court to attend these programs as part of their sentence. The programs are certified by the

Florida Department of Corrections and range from 26 to 52 weeks in duration and consist of weekly

psycho-educational groups, which strive to hold abusers accountable for their behavior. Topics

include negative impact of their violence, power and control issues, alternatives to violence, and

expression of feelings.

To find out more and to obtain a list of certified programs, go to:

http://www.dcf.state.fl.us/domesticviolence/bip/index.html.

Local Services for Batterers:

National Safety Council Central Florida Chapter

Group Counseling for Domestic Violence Perpetrators

(407) 897-4400

No Abuse, Inc.

(407) 999-9703

Conclusion

The key to helping victims of domestic violence is using a caring, nonjudgmental approach. Begin

by asking all female patients about violence. Then provide the needed resources, information, and

treatment. Through better education about domestic violence, healthcare workers can have a

tremendous positive impact on the care of victims.

Post Test

Directions: In order to receive 2.0 contact hours, you must:

• Complete the posttest at the end of this packet

• Achieve an 84% on the posttest

Domestic Violence

For Non-ORH employees: Complete the test using the bubble sheet provided. Be sure to complete

all the information at the top of the answer sheet. You will be notified if you do not pass, and you

will be asked to retake the posttest.

Return to: ORH Education & Development, MP14, 1414 Kuhl Ave, Orlando, FL 32806

For ORH Team Member: Please complete testing via Online Testing Center. Log on to:

SWIFT Departments E-Learning Testing Center. Use your ORH Network Login and

password. Select “SLP” under type of test; choose correct SLP Title. Payroll authorization is

required to download test.

1. According to Florida Statue 741.28, which of the following would be considered domestic

violence?

A. Live-in boyfriend pushes his girlfriend down the steps.

B. Man hits his female next door neighbor over the head with a bottle.

C. Husband does not allow his wife to work outside the home.

D. Husband calls his wife names and tells her she is stupid.

2. In the state of Florida, police

A. Cannot arrest an abuser even if there is physical evidence of abuse unless the victim

wants to press charges.

B. Can arrest an abuser if there is physical evidence of abuse even if the victim does not

want to press charges.

C. Can question the abuser but not arrest him unless the victim files charges.

D. Cannot arrest the abuser even if there is physical evidence present. If the victim does

not want to press charges, the officer must counsel the victim and try to convince her

to leave the abusive relationship.

3. Which of the following statements reflects the prevalence of domestic violence?

A. Domestic violence is a recent issue and is largely confined to the United States.

B. Domestic violence is a centuries old issue that has affected women worldwide.

C. Less than 10% of women worldwide report being physically assaulted by a male

partner.

D. Domestic violence occurs infrequently in the United States but quite often in

underdeveloped countries.

4. In the United States, an episode of domestic violence occurs every:

A. 15 seconds.

B. 30 seconds.

C. 60 seconds.

D. 5 minutes.

Domestic Violence

5. What percentage of domestic violence victims are women who are battered by men?

A. 55%

B. 65%

C. 75%

D. 85%

6. Select the most accurate statement regarding statistics collected by the Department of

Justice.

A. Statistics clearly show that some groups have higher rates of domestic violence, only

those groups with high rates should be considered at risk.

B. Statistics show that women from higher socioeconomic groups do not need to be

screened as it is very unlikely that they would be abused.

C. Statistics report less domestic violence incidents to those living in rural areas.

D. Although statistics show some groups have higher rates of domestic violence, all

women should be considered at risk for domestic violence.

7. Which of the following analyses is correct?

A. Those over the age of 35 are at greatest risk for domestic violence attacks.

B. The majority of domestic violence attacks occur among women who have never

married.

C. Over the past several years, there has been a decline in the rate and number of

domestic violence offenses in Florida.

D. There are no major differences in rates of domestic violence based on income or

race.

8. It is common for an abuser to display the characteristic or trait of:

A. Developing relationships slowly over time.

B. Trusting his partner to be faithful.

C. Letting his partner share in decisions.

D. Blaming others for his problems.

9. An example of how the abuser uses power and control in a relationship is:

A. He encourages the victim to spend time with friends and family so he knows where

she is at during all times.

B. He forces the victim to work two jobs in order to support the family.

C. He may display weapons as a threat to “keep her in her place.”

D. He says everything is his fault and that he will do better.

10. A batterer may make the following statement to the victim after a violent episode:

A. “I just had a bad day at work, it won’t happen again.”

B. “I think you should visit your family until I get some help.”

C. “I’m sorry that I hit you, I should not have done that.”

D. “I feel like I am losing my temper, maybe I should get some help.”

11. According to the cycle of violence, which of the following best represents a behavior of the

batterer during the build-up/escalation phase?

A. Says he is sorry and that it will never happen again.

B. Hits partner and shoves her down the stairs.

Domestic Violence

C. Sends her flowers and gifts.

D. Slams the door because dinner is 5 minutes late.

12. According to the cycle of violence, which of the following best represents a behavior of the

victim during the honeymoon/sorrow phase?

A. Tries to calm the batterer

B. Leaves home to seek treatment

C. Tries to minimize harm from episode of violence

D. Avoids friends and family

13. A toddler raised in a household where the mother is abused will typically:

A. Be a quick learner.

B. Be very well behaved.

C. Exhibit anxiety and fear.

D. Play well with others.

14. A school-aged child or adolescent raised in a household where the mother is abused will

typically:

A. Have many friends.

B. Have low self-esteem.

C. Get good grades in school.

D. Be more mature than peers.

15. A child is admitted to the hospital with a broken arm and multiple bruises. He states “My

Dad hit me!” Which intervention is required by law?

A. Discuss the event with the parent.

B. Interview the mother and father separately.

C. Instruct the mother to contact the Child Abuse Hotline 1-800-96-ABUSE.

D. Call the Child Abuse Hotline 1-800-96-ABUSE and notify appropriate personnel.

16. What percent of women who are killed by their partners are killed when they try to leave or

after they leave the abuser?

A. 30%

B. 50%

C. 60%

D. 70%

17. Reasons women stay in an abusive relationship include all of the following EXCEPT:

A. They don’t mind being hit

B. Threats to children

C. Lack of finances

D. No other support

18. Who should be screened for abuse?

A. Hispanic women

B. Pregnant women

C. Women between the ages of 16 and 34

D. All women

Domestic Violence

19. When performing a domestic violence interview, the health care provider should:

A. Ask the partner to interpret, if the victim does not speak English.

B. Ask “Why don’t you leave him?”

C. Ask about abuse when the patient is alone.

D. Insist that the victim call the police and have him arrested.

20. When interviewing a patient, which of the following statements is the most appropriate

technique?

A. “Are you a victim of domestic violence?”

B. “Has your husband ever hit you?”

C. “I can see that your husband is abusing you.”

D. “If you don’t leave your husband, you will be sorry!”

21. A 22-year-old female comes in for treatment and denies abuse on routine screening. Which

of the following would make you most suspicious that abuse may be occurring?

A. Presence of a gastric ulcer with active GI bleeding.

B. Bruises at various stages of heeling on her back, abdomen, and breasts.

C. Patient’s desire to have partner stay in room with her during procedures.

D. History of a broken collar bone and broken wrist from a bike accident.

22. When documenting statements about abuse, which of the following would be the most

appropriate?

A. Patient says that her boyfriend pushed her down the steps last night.

B. Patient denies abuse, but this nurse does not believe her statement.

C. Patient states that “my boyfriend, John Doe, Jr., pushed me down the steps last

night.”

D. Patient denies abuse, but it is obvious that someone has been hitting her.

23. When photographing injuries caused by abuse, one should:

A. Take pictures only if a police report is filed by the woman.

B. Avoid taking close-up pictures of the injury since it is hard to see location of injury

on body.

C. Label each picture with date, time, location, your signature, and the victim’s

signature.

D. Give all pictures to the victim to keep in case she needs them for evidence later.

24. A key item that should be included in a safety plan is:

A. How to get help and escape if needed.

B. How to defend herself and fight back when attacked.

C. Rooms she can go to get weapons.

D. List of places that the batterer can get counseling.

25. If the victim decides to stay with the abuser, which of the following is the most appropriate

set of instructions?

A. Try to convince her she should leave.

B. Help her develop a safety plan.

C. Call the police and have them arrest the abuser.

D. Slip her a card with shelter numbers into her pocket.

Domestic Violence

Appendix

Safety/Escape Plan Checklist

This list can be used to help you prepare for a time when you may need to leave. Make sure you

keep this list and any of the items you will need in a safe place that the abuser will not find. You

may want to keep it with a neighbor or close friend/relative. Do not take a car that does not belong

to you since the abuser can report it as stolen, and then the police will be looking for you also.

Important Numbers:

Police:

Hotline:

Friends:

Shelter:

Items to Take:

___ Identification

___ Drivers license and registration

___ Car title if you are car owner

___ Birth certificates for you and each child

___ Social Security cards

___ Passport(s), Green Card(s), work permits

___ Welfare identification (if appropriate)

___ Divorce papers

___ Lease/rental agreement or house deed

___ School and medical records

___ Insurance papers

___ Money, bankbooks, credit cards (only those in your name)

___ Mortgage payment book, current unpaid bills

___ Keys – house, office, car

___ Medications

___ Address book

___ Change of clothes

___ Travel kit – shampoo, toothbrush, etc.

___ Pictures, jewelry, etc.

___ Children’s favorite toys

Domestic Violence

The National Domestic Violence Hotline offers many suggestions for the victim who is planning to

leave their abuser. Some of the suggestions include:

• Practice how to get out safely. Practice with your children.

• Let a trusted friend or neighbor know of your situation and develop a plan and a visual

signal for if you need help.

• Keep any evidence of physical abuse (pictures) and keep a journal of incidents.

• Acquire job skills as you can.

• Keep your car full of gas, park it in a backed in position leaving the drivers door unlocked

but locking the other doors to assist with a quick escape if needed.

• Set aside money if possible, or ask friends/family to hold money for you.

• Find out what resources are available to you before you need them in a crisis.

• If you are injured, seek treatment.

• Plan with your children a safe place for them to go, making sure they know their job is to

stay safe themselves, not trying to protect you.

• Leave a set of clothes for you and your children with a trusted friend or relative.

• Gather important documents (marriage license, drivers license, titles and/or deeds to

property, school records, medical records, social security cards, citizenship records, bank

account records, credit cards and insurance information.)

• After you leave, create a false trail of where you are. Call places such as schools, banks,

real estate agencies, apartments, etc. that are at least 6 hours away. Ask for a call back to

your home phone number.

• If after you have left you have a restraining order, have a certified copy on yourself at all

times. Give copies of it to friends, neighbors and co-workers along with a photo of the

abuser. Make sure they know to call the police.

• Inform schools, daycares, babysitters of who may pick up your children. Provide them with

a copy of your restraining order.

• Change as many things as possible: your work hours, places you shop, routines, even your

children's school if possible.

• Alert your workplace. Have your calls screened, if possible always by the same person.

• Call the phone company and get caller id. Make sure your number is blocked when you

make calls.

• Try to always have a phone with you.

• Protect your new address and phone number. Consider using a post office box or friends

address.

References

Domestic Violence

Aggeles, T. B. (2002). Domestic Violence Advocacy: Florida Update 2002. Nursing Spectrum.

Retrieved 8/19/03 from http://nsweb.nursingspectrum.com/ce/ce294.htm

Berlinger, J. (2001). Domestic Violence: How You Can Make a Difference. Nursing2001,

August. Retrieved 8/14/03 from http://www.springnet.com/ce/p108a.htm

Campbell, J.C. (1992). Ways of Teaching, Learning, and Knowing about Violence Against

Women. Nursing & Healthcare, 13(9), 464-470.

CDC (2003). Intimate Partner Violence Fact Sheet. Retrieved on 10/31/06 from

http://www.cdc.gov/ncipc/factsheets/ipvfacts.htm

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