1. The Health System Response to Gender-Based Violence in EECA: A programmatic package Understanding the Signs

2. The Health System Response to Gender-Based Violence in EECA: A programmatic package Identifying Survivors Principles 1.Victims come from all ages, races, classes, religions, occupations, sexual orientations, and personality diagnoses. 2.Sometimes health care providers can be misled because the batterer doesn’t look like a “typical batterer.” (For example, the batterer may be elderly, upper class, charming, or a professional): 3.The one defining similarity among batterers is their use of tactics of control, not their demographics or personality traits.

3. The Health System Response to Gender-Based Violence in EECA: A programmatic package Identifying Survivors 4.In health care settings, victims may appear: indirect, ill, depressed, passive, angry, afraid, reluctant to disclose, eager to tell everyone, waiting to tell someone, etc. Much of what health care providers see or hear from domestic violence victims reflect the effects of living in abusive relationships and the victims’ survival strategies when they get little or no support. It is helpful to view the victim’s emotions and behaviors as normal reactions to the perpetrators’ abuse and as the victims attempts to protect themselves and their children.

4. The Health System Response to Gender-Based Violence in EECA: A programmatic package Identifying Survivors The goal of intervening with victims is not to make them separate from abusers, but to give them the information and support they need to make their own decisions. Therefore, if a perpetrator accompanies a victim (or is in the health system as the patient), clinicians may hear the minimizing, denying, or lying about the domestic violence as well as the victim-blaming. Source: Department of Health, United Kingdom (2005): Responding to Domestic Abuse: A Handbook for Health Professionals.

5. The Health System Response to Gender-Based Violence in EECA: A programmatic package Examples 1. Examples of minimizing or denying: “It’s no big deal.”... “My partner bruises easily.”... “She hit a door/fell.” 2. Examples of blaming or justifying violence: Sometimes the perpetrator acknowledges the incident, but either blames the victim (“She was drunk.” “She hit me first.”) or another cause (“I was drunk/under a lot of stress/having flashbacks.”) to avoid taking responsibility for the domestic violence. 3. Perpetrators are able to continue abusive conduct by avoiding responsibility for the abuse.

6. The Health System Response to Gender-Based Violence in EECA: A programmatic package Examples Sometimes perpetrators will use the health care provider to control the victim by a variety of coercive tactics –accompanying the victim to appointments, –canceling the victim’s appointments, –or being intimidating or cajoling, so that the provider will withdraw from the patient.

7. The Health System Response to Gender-Based Violence in EECA: A programmatic package Possible Survivor Behavior Identifying factors include self-blaming, shame, fear, shock, distress, depression, emotional incapacity, isolation, sleep or eating disorders, nightmares, phobias, panic attacks, chronic headaches, or Post Traumatic Stress Disorder, etc. Children also very often show signs of the abuse if they witness violence against their mothers at home: fear, nightmares, hyperactivity, depression and isolation etc. -> See also: Handout 1 “Health outcomes of violence” and Handout 2 „ Red flags and warning signs”