Stop, Look, and Listen Assessment of Domestic Violence Emergency Medicine Review in the Rural and Urban Setting June 10, 2007 Kathy Bell MS, RN

… Ask me. I’d have told them everything, I swear to God I would have. If they’d asked. I’d have whispered it. If they’d asked first. He pulled my arm behind my back and lifted me off the floor. It would have been easy after that, watching them listen. He hit me. He burned me. He did it. He did it. Save me. I’d have told them everything. I just had to be brought behind the curtain, asked the right question. ….

Screening in Oklahoma  35% of 61 respondents queried reported that a health care provider had asked them about domestic violence some, most, or all of the time when treated for IPV injuries; 65% had never been asked about domestic violence by a health care provider when treated for IPV injuries.

When not to screen  If the provider cannot secure a private space  If there are concerns that screening the patient is unsafe for either the patient or the provider  When children ages 3-12 are present.  If the provider is unable to obtain an appropriate interpreter Salber and Taliaferro 2006

They have a choice. What might happen??

Stay  Kiled  Killed  Injury PhysicalPhysical Emotional  Child abuse  Lose children  Modeling behavior to children  Suicide  Depression  Poverty  Loss of: Credibility Family Friends Job Self  Health Physical Mental

‘Staying’ implies that the person is in some way inviting, allowing, or tolerating the abuse rather than acknowledging that women are resisting the abuse all the time in ways that are generally invisible to people outside of their situation. It also implies that the woman’s ‘staying’ is at the heart of the problem rather than the abuser’s behavior toward her.

Leave  Kiled  Killed  Injury PhysicalPhysical Emotional  Child abuse  Lose children  Modeling behavior to children  Suicide  Depression  Poverty  Loss of: Credibility Family Friends Job Self  Health Physical Mental

Leaving’ implies that someone can leave an abuser like they would leave an apartment they choose not to rent anymore, while the reality is that leaving an abuser is extremely difficult. A perpetrator of domestic abuse seeks to maintain control over their partner and children – even after their partner leaves. Having children creates a legal bond between parents that often provides the framework for ongoing abuse after separation. Rarely do abusers disappear or victims relocate and change their identities. In the common reality of abused women, the men who abuse them continue to intersect with their lives in a variety of ways: living in the same town, working for the same employer, visitation with children, friends in common, etc.

Challenges in the community  Lack of real alternatives for employment and financial assistance  Lack of affordable legal assistance to obtain a divorce, custody order, or permanent protection from abuse order  Limited availability of subsidized housing and lack of public transportation, particularly in rural communities

Challenges continued  The structure of family law, which approaches parental rights and responsibilities with the presumption that joint custody is best, and that spouse abuse is an exception that requires careful proof.  Public disdain for single parents  Lack of affordable childcare and health care

Domestic Violence Nurse Examiner Program

On-Site Partners   Domestic Violence Intervention Services DVIS/Call Rape Advocates DVIS legal services   RSVP Safety Shepherd Volunteers   Tulsa County DA office   Tulsa County Sheriff Office   Tulsa Metropolitan Ministries   Tulsa Police Department Family Violence Unit Forensic Nurse   YWCA of Tulsa Multicultural Center

Services  Advocates  Chaplain Services  Counseling  District Attorneys Office  Forensic Nurses  Lawyers for Family Matters  Law Enforcement

Additional Services   Children’s play area   Interpretation services   Referral for children   Referral to immigration services   Referral to shelter services   Safety and prevention education

Assessment  Physical  Emotional  Social

 Documentation  Danger Assessment  Safety Planning  Referral  Photography  Evidence collection