Connecting Domestic Violence Victims with Housing and Community Resources

1. Connecting Domestic Violence Victims with Housing and Community Resources Presented by Shannon Nix, B.A. Kaiser Permanente

2. OUTLINE • What is Domestic Violence (DV) • Prevalence of DV • Who are the victims • Types of abuse • Effects of abuse on victims and children • How case managers can facilitate communication with victims and assist victims through transitions • Connection to resources

3. I am Domestic Violence KP physician and employees who were victims of domestic homicide “An Equal Opportunity Destroyer” Lisa Munoz1976-1999Optical Services Cassandra Floyd, MD1966-2001OB/GYN Stephanie Zalot1966-2003Quality Outcomes

4. Why focus on domestic violence prevention? • Domestic violence is an important health care concern because… • DV is extremely common and pervasive • The health effects are devastating • The health care costs are substantial • DV has a considerable impact on workplace safety and productivity • Impacts future generations • Exposure to DV as a child increases health care utilization throughout life and is associated with poorer health outcomes as an adult Because it’s not just a bruise….

5. What is Domestic Violence • “Domestic Violence can be defines as a pattern of behavior in any relationship that is used to gain or maintain power and control over an intimate partner.” • “Abuse is physical, sexual, emotional, economic, or psychological actions or threats of actions that influence another person. This includes any behaviors that frighten, intimidate, terrorize, manipulate, hurt, humiliate, blame, injure or wound someone.” • Non-discrimatory of gender, race, age, sexual orientation, social or economic status, martial or relationship status. • National Domestic Violence Hotline

6. October is Domestic Violence Awareness Month source: California State Domestic Violence Interagency Collaboration • This month we mourn the lives of those who died from domestic violence, celebrate the lives of those who have survived, and allow community workers to help end violence. • Domestic Violence is one of the most critical public health issues facing women and children; every person in our society feels its impact • Violence can be emotional, sexual, physical, verbal , or financial. • Violence is based on through generations, from one relationship to the next. Children of abuse are more likely to become abusers themselves or end up in an abusive relationship. • Many crimes committed are a direct result of intimate partner violence. • We all must make a commitment to help prevent and bring hope and healing to those affected by violence.

7. Silent No More…. • “Bruises everywhere all the time. And he would tie my hands and make me stand with my hands hooked up above my head for 2 or 3 hours. And give a stick to my sons and say, “if she moves, beat her.”

8. The Journal of Social Work Education found that majority of surveyed social workers felt that they had “none to a little” academic preparation in learning about domestic violence issues and how to address victim needs (2003) • YET • 50% of Social workers admitted to either witness some form of domestic abuse within their own families, have been in an abusive relationship, or know someone who is in a violent relationship

9. VICTIMS 3 out of 4 of us personally know someone who is or has been a victim of DV

10. WHO ARE THE VICTIMS: IT CAN HAPPEN TO ANYONE KP physician and employees who were victims of domestic homicide “An Equal Opportunity Destroyer” Cassandra Floyd, MD1966-2001OB/GYN Lisa Munoz1976-1999Optical Services Stephanie Zalot1966-2003Quality Outcomes

11. Did you Know… • More than 3 women are murdered by their husband or boyfriend each day? • One half of all women homicide victims in the world were killed by a former spouse or partner? • 1 out of 3 women in the world have been beaten, abused, or coerced into having sex in within their lifetime

12. Domestic violence is common • New cases of breast cancer: 211,000 • Number of women dying from cardiovascular disease: 484,000 • Number of women who are victimized by DV each year: 1,500,000

13. Dating violence • 18-25% of high school girls report physical and/or sexual violence by a dating partner • 25-36% of college students report dating violence AND • Adolescent girls who experienced physical or sexual dating violence were 6 times more likely to become pregnant than their non abused counterparts.

14. IPV is very common - The prevalence of IPV has been significantly under-estimated: 4-8% current IPV 15% IPV in last 5yrs 44% lifetime - Highest prevalence occurs in working age and parenting women

15. DV is common during pregnancy • 7%-20% of pregnant women are victims of DV = 324,000 yearly • DV is a leading cause of pregnancy-associated mortality • DV is more common than many conditions for which most pregnant women are routinely screened • Associated with: • Delayed entry into prenatal care • Premature labor • Trauma to the abdomen • Low birth weight infant

16. DV Stats • Among homeless domestic violence victims, approx 34% women have experience major violence within the last 23 months • 1 in 4 women, 1 in 14 men will be physically assaulted by an intimate partner during his or her lifetime.

17. California Women’s Health Survey, 1998Prevalence of current PHYSICAL IPV 6 % of California women age 18+- 669,755 California women in 1998

18. International DV • Over 71% of women in rural areas of Ethiopia, and over 50% of women in Peru, Tanzania, and Bangladesh have been victims of physical or sexual violence from their partners • Less than 20% of women in Japan reported incidents of Domestic Violence (may not be accurate due to cultural role and shame) • According to United Nations Development Fund for Women…. • 1 out of 3 worldwide has been beaten, abused, or coecered into having sex within her lifetime. • Rape and domestic violence are of greater concern for women ages 15-44; even higher than malaria, cancer, and war • In 2003, it was estimated that DV costs the US $5.8 Billion • Pakistan: Criminal Justice system does not believe that domestic violence is a crime and it is not recognized in the court system • Jordan: “Honor Killings” are socially accepted, where family members can murder a woman if they feel her behavior is “improper.” • Russia and Uzbekistan: Police will often harass victims to stop them from filing reports and will usually not respond to any filed reports • Peru: No law implemented to protect victims against stalking and marital rape

19. DV has a considerable impact on workplace safety and productivity “Liz Claiborne, Kaiser Permanente, State Farm Insurance and Verizon Wireless are among the companies that have instituted domestic violence policies. …[and] believe they have saved both lives and money.”

20. Economic and Workplace Impact of Domestic Violence • It is estimated that domestic violence acts and intervention services cost over $5.8 billion each year in the U.S. alone. $4.1 billion of this is for direct medical and mental health care fees • $1.8 billion per year In lost business productivity • 50-85% abused women will miss work to DV • 60% abused women are late to work due to DV • $990 annual loss per employee

21. Victim and the Abuse

22. Joyce Shaw, RN Survivor

23. Domestic Violence does not discriminate against gender, age, religion, sexuality, ethnicity, educational level….. It can happen to anyone!!

24. Silent No More…. “ I was kept in one room for 6 years. 6 years of my life was in one room and kitchen. He kept me there. He wouldn’t let me go out except sometime with him…And if anything he didn't like about the cooking and the shopping, he’s start doing the beating. Just like I was his slave…”

25. What puts one at risk for DV • Poor self-image • Strict gender roles • Childhood experiences of : • Poverty • Isolation • Neglect or Abuse • ETOH/Substance Abuse • POVERTY: • According to CDC, Households earning less than $15,000 (36% women, 21% men) suffer from IPV Common Characteristics

26. DV and Race

27. TYPES OF ABUSE Physical, Financial, Sexual, Emotional

28. TYPES OF ABUSE PHYSICAL FINANCIAL Controls family finances Refuses victim to have access to financial accounts Sabotage victim's work performance by forcing victim to miss work or will call frequently at work • Sexual assault or rape • Intentionally trips or shoves, punch, hit, choke, slap, threatens with violence or weapons • Threatened to hurt or kill himself if you leave • Destroys your personal things • Hurts pets • Stalking • Shows up unexpectantly to your work, school, or elsewhere to checkup on you

29. Types of Abuse Emotional or Verbal Sexual • Objectification & reinforces rigid gender roles • Accuses victim of infidelity • Demeans and insults victim, calls you hurtful sexual names • Forced or manipulated victim to perform sexual acts • Physically held victim down during sex • Inflicted pain, including using weapons or objects during sex • Involved other people in sexual activities with victim • Disregard or ignore victim’s feelings about sexual behaviors and practices • Isolation • Criticizes you on your appearance and actions • Blames you for his actions, calls you “crazy” • Restricts you on where you can go, who you see, what you do • Calls you names , humiliates or embarrasses you deliberately • Controls finances • Condemns victim as being a bad parent

30. CYCLE OF ABUSE

31. A Survivor said…. • “Stand by your man. We can make it work. So a lot of those beliefs were there that you just felt, well, if I just hang in there, everything will be okay. Everything will turn around, Things will change…It’s just that the break never comes. It never comes and you have to make the break. Something clicks inside that just says, you know, if I have to be evicted, I might as well do it on my own. Why am I here doing bad with somebody, you know? I began to say, ok, if I’m gonna be homeless, ok, it’s gonna be a choice. I’m not gonna be homeless with a husband. So I think when it came to homelessness, it was almost voluntary.”

32. Common Characteristics of Abuser:POWER POWER POWERCONTROL CONTROL CONTROL • Reckless driving • Looks at partner in a threatening or frightening manner • Wants or demands victim to get permission from him/her • Decides what abuser will wear, how she will spend her time • Blames the victim for his violent behavior • INTIMIDATION • COERCION AND THREATS • USES CHILDREN AS A BARGAINING TOOL • Threatens to report victim to CPS • Forces children to rely messages to victim • Tells victim that if she does not follow through with his request, then he will harm children • Controlling and/or manipulative behavior • Behaviors can occur abruptly or gradually evolve in frequency and severity • Denies any wrong-doing or actions

33. Thoughts of the Victim… After being hospitalized from being beaten, one victim stated, “No matter what goes on in life, that’s my baby. And nobody can have him. It’s as simple as that. I’ll die over him. There isn't no way.”

34. RED FLAGS for Case Managers • Fall Hx • Recent hospitalizations or clinic visits with unexplained injuries or bruising • Personality changes • Increased isolative behaviors • Not purchasing or taking medications • Missing clinical appointments • ETOH/substance abuse • Hx of battery or abuse, including childhood abuse • Complex behavioral management problems of children • Homeless • Arrests or imprisonment records • Psychiatric Hx/Dx

35. Thoughts of a Victim “He was the sweetest one. I think he did pull a gun and a knife on me, but he didn’t use it. But he was in my life and helped me a lot…He never hit me. He is a sweet guy but he really is not responsible.”

36. HEALTH EFFECTS OF DOMESTIC VIOLENCE

37. Women who have experienced DV are likely to have chronic health problems • 60% more likely to have asthma • 70% more likely to have heart disease • 80% more likely to have a stroke • Twice as likely to be a current smoker Center for Disease Control (CDC) Feb 2008

38. Domestic violence: The health effects • Most common cause of injury in women aged 18-44 • Associated with higher rates of: • Headaches • Chronic Pain Syndromes • Stress, insomnia • Chronic Gastrointestinal Disorders • Palpitations, chest pain • Sexually transmitted disease/HIV • Associated with ongoing mental health problems: • Depression • Anxiety disorders • Post Traumatic Stress Disorder • Substance abuse • Suicide attempts • Associated with 4 times higher risk of severe depression

39. Study of 184 fibromyalgia patients in KP Colorado (1998) Fibromyalgia was 2nd most common reason for Rheumatology consults in KP Colorado 92% of patients were women 74% had history of emotional trauma 53% had history of abuse 34% had major depressive disorder

40. CHRONIC PAIN Did you know that many patients with chronic pain have a history of violence or abuse? Be mindful of this when assessing a possible victim

41. Why do dv victims become homeless?

42. Why do DV victims become homeless • Need to escape the violence within home and relationship • VICE VERSA: Homeless women are at a high risk for experiencing domestic violence, w/ common correlated risk factors of : • Childhood Abuse (physical, emotional, and sexual) • ETOH or Substance abuse • Illnesses • Poverty • Dislocation • Mental Health problems

43. Thoughts of Victims facing Homelessness • Leaving and/or losing home can leave a victim to have feelings of regret, anger, sadness, belief that situation is unfair or unjust “I am the one who has suffered. Why do I have to leave?

44. Homeless DV • “I thought it was the way life was. Because in the neighborhood I grew up in, it was nothing to see a woman dragged, knocked down, stomped, or beat, And there was no safe house, there was no shelter that a wife or woman could run to and be protected. So many women, including my mother – they just stood there and took it. But I saw a lot of women die as a result of being abused. I would tell my mother, he’s killing her over there, Ma. And She’d say, leave it alone. So I took on that generational trait. You were just supposed to take it.” (Wesley 2005)

45. “ Homeless women unaccompanied by children, as when compared to homeless women with children, have higher rates of past psychiatric hospitalizations and past inpatient chemical dependency, and experience longer durations in their current spell of homelessness.” – Journal of Family Issues, 1999

46. HOMELESS STATS • Difficult to have truly accurate statistics since many homeless individuals remain hidden or undocumented. • In 2007, Orange County had approx 35,065 homeless citizens • Orange County is equipped with approx 68 emergency and transitional shelters that have a combined total of 3400 beds available for homeless • 80% of homeless households w/ children are headed by a single mother • 64% homeless women reported violence with adult partner (Metraux 375)

47. Types of Homelessness:Short term and Long term • Living with peers • Moving from hotel to hotel • Streets

48. Reasons DV Victims Choose to Stay in Violent Relationships • Financial Dependence • “Financially supporting a partner was not the immediate cause of a woman’s homelessness but rather one important factor in the trajectory toward economic vulnerability and social exclusion (Wesely, p 7) • Even when remaining at home, DV Victims may struggle financially due to partner’s drug and alcohol expenses • In reality, victims may have financial independence and gain more financial stability if he/she chose to leave the relationship • Fear of becoming homeless • Power and control • The abuser has shown so much control that the victim lives in fear and begins to only focus on his or her ability to survive day to day. • Isolation • Threats

49. Children and Domestic Violence

50. Children and DV Domestic violence happens at home. Help happens here