Addressing Domestic Violence

1. AddressingDomestic Violence Elizabeth W Bierer, MD

2. Domestic Violence • Deliberate • Pattern of controlling and assaultive behavior • Effort to gain power and maintain control

3. Types of Abuse • Physical • Psychological • Sexual • Verbal/emotional • Economic • Financial • Legal

4. Risk Factors • Poverty • Unemployment • Substance abuse • Homelessness • Exposure to other violence in the community IMPORTANT: knows NO boundaries

5. National Statistics • On average, more than three women are murdered by their husbands or boyfriends in this country every day. (Bureau of Justice Statistics Data Brief, Intimate Partner Violence, 1993-2001, February 2003). • Thirty seven percent of women who sought treatment in an emergency room for violence-related injuries were injured by a current or former intimate partner. (U.S. Department of Justice, Violence by Intimates: Analysis of Data on Crimes by Current or Former Spouses, Boyfriends, and Girlfriends, March 1998). • Abuse in relationships exists among all classes, races and cultural groups, although women between ages 16 and 24 are nearly three times more vulnerable to intimate partner violence (Intimate Partner Violence & Age of Victim, U.S. Department of Justice, Bureau of Justice Statistics, 1999). • A recent National Crime Victimization survey found that women were 6 times more than men to experience violence at the hands of an intimate partner. http://www.cpedv.org/stats.html

6. California Statistics • Every year, almost 6% of California ’s women suffer physical injuries from domestic violence. (California Women’s Health Survey, 1998-99). • In 2002, 153 murders were the result of intimate partner violence in California . (California Department of Justice [DOJ], Criminal Justice Statistics) • In 2002, 128 women in California were killed by their husbands, ex-husbands or boyfriends, and 25 men were killed by their wives, ex-wives or girlfriends. (DOJ, Criminal Justice Statistics Center ) • California law enforcement received 196,569 domestic violence calls in 2002 --- 119,850 involved weapons, including firearms and knives. (DOJ, Criminal Justice Statistics Center ) • About 916,000 children were exposed to intimate partner violence at home in 1998. (Department of Health Services, California Women’s Health Survey, 1998-99). • Nearly 1 in 5 women who went hungry because they did not have enough money to buy food was also a victim of intimate partner violence (Department of Health Services, California Women’s Health Survey, 1998-99). http://www.cpedv.org/stats.html

7. Contra Costa County • Most at risk cities in the three regions (east,west,central): • Richmond • Antioch • Concord

8. Tracking system • Office of the Sheriff maintains: • Automated Regional Information Exchange System “ARIES” database and the • Domestic Violence Relational Database • Linked to vital criminal justice records • Can be accessed by multiple agencies • Increasing investigative capacity • Tracks active warrants, restraining orders, case disposition, terms of parole, injury specifics • Access more info at: www.cocosheriff.org

9. Zero Tolerance • Program created in 2000 to address domestic, family and elder abuse/violence in Contra Costa County • FIRST Zero Tolerance county in California! • Develops and delivers direct services to people through partnerships • Advances policy change • Collaborate with, amongst many, STAND! against domestic violence

10. Zero Tolerance Projects • Supervised Visitation • The DELTA Project • Prevent first time domestic violence • Grants to encourage arrest • Safe and Bright Futures http://contracostazt.org/documents/posters.pdf

11. Originated as a volunteer crisis line in 1977 (CALL) • Became Battered Women’s alternatives with addition of resources/shelters. • Started opening shelter centers (emergency and transitional) • Margaret Lesher Housing and Employment Center • Rollie Mullen Center • Now has offices in all regions of the county • Antioch, Richmond, Pittsburg being the newest in 2002/2003 • 60 Staff and 150+ volunteers

12. More on STAND! • Provide • Support • Shelter • Training to people who are abused, • Treatment programs to people who abuse, • Preventive education programs to youth, children and adults who might experience abuse in the future.

13. My Project • Acquired Domestic violence posters and referral cards from STAND! • Distributed them to residents with clinics outside of Martinez • In Martinez, placed them in the Family Medicine clinic bathrooms • Distributed referral cards to several residents (I have more, and will be getting more!!)

14. Continuing my project • Getting STAND! to give a presentation to our staff – Physicians, Nurses, Social workers • Become more cognizant  screen my patients, and recognize features suggestive of violence • Familiarize myself with Healthy People 2010 initiatives

15. Healthy People 2010 • Studies have demonstrated a link between intimate partner violence (IPV) and 8 out of 10 the Leading Health Indicators (LHIs) • IPV significant risk factor for • Chronic health problems • Headaches, GI problems, depression, anxiety, sleep problems, PTSD • Health risk behaviors • Substance abuse, irresponsible sexual behavior

16. Leading Health Indicators and Intimate Partner Violence • Include • Overweight and obesity • Tobacco use • Substance abuse • Sexual behavior • Mental health • Injury and violence • Immunization • Access to health care

17. Clues to violence • Questions you may consider asking? • Does your partner act extremely jealous of others who pay attention to you, or use jealousy to justify his/her actions? • Control your finances, behavior and even whom you socialize with? • Threaten to kill you or commit suicide? • Make you afraid by using looks, actions, and gestures like smashing things, destroying your property or displaying weapons? • Make all the decisions? • Stop you from seeing or talking to friends, family or limits your outside involvement? • Act like the abuse is no big deal; it's your fault or even denies doing it? • Threatens to kill your pets? • Puts you down in front of other people, humiliates you, plays mind games and makes you feel as if you are crazy? • Prevents you from getting or keeping a job? • Takes your money or does not let you know about or have access to the family income? • Blame drugs or alcohol for his violent behavior? • Threatens to take the children away?

18. Somewhere we can all start • Prenatal care! • Those who are victims of IPV are less likely to access healthcare, but this is a time they do access it

19. Violence in Pregnancy • Homicide is the second leading cause of traumatic death for pregnant and recently pregnant women in the U.S., accounting for 31 percent of maternal injury deaths. • Women experiencing abuse in the year prior to and/or during a recent pregnancy are 40 to 60 percent more likely than non-abused women to report high-blood pressure, vaginal bleeding, severe nausea, kidney or urinary tract infections and hospitalization during pregnancy and are 37 percent more likely to deliver preterm. • Children born to abused mothers are 17 percent more likely to be born underweight and more than 30 percent more likely than other children to require intensive care upon birth. • Few doctors screen their patients for abuse, even though up to one in 12 pregnant women are battered. • Women who were screened for abuse and given a wallet sized referral reported fewer threats of violence, assaults or even harassment at work.

20. Goal • Personal: • Screening all my prenatal patients at least once while following them during their pregnancy • For the residency: • Get an area on the prenatal record that indicates we (not Healthy Start) have addressed it in prenatal care at least once.

21. Family Medicine Practice • These are our patients!! • I urge everyone to remind yourself to: • screen patients, • talk with them, • give them the information they need to prevent, treat and escape a harmful situation

22. Resources • Treatment: • Anger Management for Families - Center for Human Dev. 391 Taylor Boulevard, Suite 120 Pleasant Hill, CA  94523 (925) 687-8844 Ext. 224 • Asian Pacific Psychological Services - Richmond 3905 MacDonald Street Richmond, CA  94805 (510) 233-7555  • Domestic Violence Support Group 3919 Roosevelt Ave. Richmond, CA  94805 (510) 233-8595 Information   • Domestic Violence Treatment Program - Alpha Family Services 31 Raye Avenue Oakley, CA  94561 (925) 625-9318 Confidential Line • Familias Seguras - ECMHP 4101 Macdonald Avenue Richmond, CA  94805 (510) 412-9200  • Korean Community Center of the East Bay 4390 Telegraph Avenue, Suite A Oakland, CA  94609 (510) 547-2662  • Peace Creations 2960 Camino Diablo, Suite 200 Walnut Creek, CA  94597 (925) 988-9505  • POCOVI - Centro de Educacion Familiar 474 Valencia Street, Suite 150 San Francisco, CA  94103 (415) 552-1361  • Riley Center - Community Office - St. Vincent De Paul 3543-18th Street, # 4 San Francisco, CA  94110 (415) 255-0165 Crisis line • Saving Our Sons and Daughters - Concord 3039 Willow Pass Road Concord, CA  94519 (925) 432-4200    • Saving Our Sons and Daughters - Pittsburg 3330 Loveridge Road Pittsburg, CA  94565 (925) 432-4200    • Saving Our Sons and Daughters - Richmond 598 Nevin Avenue Richmond, CA  94801 (510) 215-0130 

23. Resources • Legal: • Bay Area Legal Aid - East/Central County 1901 Railroad Avenue, Suite D Pittsburg, CA  94565 (800) 551-5554 Toll free Advice Line   • Bay Area Legal Aid - West County 1025 Macdonald Avenue Richmond, CA  94801 (510) 233-9954 Office • Domestic Violence Restraining Order Clinic - Pittsburg - STAND! ***CONFIDENTIAL*** Pittsburg, CA  94563 (888) 215-5555 Crisis hotline   • Domestic Violence Restraining Order Petitioners Clinic Richmond Superior Court 100-37th Street Richmond, CA  94805 (510) 965-4048 Clinic   • Domestic Violence Restraining Order Respondents Clinic Richmond Superior Court 100-37th Street Richmond, CA  94805 (510) 965-4048 Clinic • Legal Advocacy Program - STAND! ***CONFIDENTIAL*** Concord, CA  94524 (888) 215-5555 Crisis hotline

24. Resources • Shelter: • Asian Women's Shelter (AWS) 3543-18th Street, Suite 19 San Francisco, CA  94110 (877) 751-0880 Crisis • Emergency Shelter - STAND! ***CONFIDENTIAL*** Concord, CA   (888) 215-5555 Crisis hotline • Homeless Assistance Program - CCCEHSD 400 Ellinwood Way Pleasant Hill, CA  94523 (925) 602-9379 Pleasant Hill • Korean Community Center of the East Bay 4390 Telegraph Avenue, Suite A Oakland, CA  94609 (510) 547-2662  • La Casa de Las Madres 1663 Mission Street, Suite 225 San Francisco, CA  94103 (415) 503-0500  • Riley Center - Brennan House - St. Vincent De Paul ***CONFIDENTIAL*** San Francisco, CA  94110 (415) 255-2894  • Riley Center - Rosalie House - St Vincent De Paul ***CONFIDENTIAL*** San Francisco, CA  94110 (415) 255-0165 Crisis line • Safe At Home Confidential Address Program 1500 11th Street Sacramento, CA  95814 (877) 322-5227  • Shelter Against Violent Environments, Inc. (SAVE) 39155 Liberty Street, Suite C310 Fremont, CA  94538 (510) 794-6055 24 hour Crisis Hotline   • Sister Me Home Safe House - Building Futures for Women & Children 1385 Bancroft, Suite 13 San Leandro, CA  94577 (866) 292-9688 866-A-WAY-OUT   • Tri-Valley Haven 3663 Pacific Avenue Livermore, CA  94550 (800) 884-8119 Toll-Free

25. Resources • Multiple Services: • Maitri 234 East Gish Road, Suite 200 Sunnyvale, CA  95112 (888) 862-4874 (888) 8 MAITRI   • Narika P.O. Box 14014 Berkeley, CA  94712 (800) 215-7308 Helpline • Korean Community Center of the East Bay 4390 Telegraph Avenue, Suite A Oakland, CA  94609 (510) 547-2662  • La Casa de Las Madres 1663 Mission Street, Suite 225 San Francisco, CA  94103 (415) 503-0500  • STAND! Against Domestic Violence - Central County 1410 Danzig Plaza, 2nd Floor Concord, CA  94520 (888) 215-5555 Crisis Hotline   • STAND! Against Domestic Violence - East County 2400 Sycamore Street, #6 Antioch, CA  94509 (888) 215-5555 Crisis Hotline • STAND! Against Domestic Violence - West County 12230 San Pablo Ave Richmond, CA  94805 (888) 215-5555 Crisis Hotline

26. References • Zero Tolerance for Domestic Violence http://contracostazt.org/background.php • California Partnership to end domestic violence (CPEDV) http://www.cpedv.org/stats.html • Family Violence Prevention Fund http://www.endabuse.org/content/action_center/detail/754 • Family Violence Prevention Fund Facts on Reproductive Health and Violence against women http://www.endabuse.org/userfiles/file/Children_and_Families/Reproductive.pdf • STAND! Against Domestic Violence http://www.standagainstdv.org/aboutdomviolence.php • Safe Network http://www.safenetwork.net/ • 211 Database http://www.irissoft.com/cccc/search.asp