Domestic abuse

Question 1

What is domestic abuse

Answer 1

Any form of physical, verbal, sexual, psychological or financial abuse from a partner/ ex partner

Question 2

What are the different types of domestic abuse

Answer 2

Situational couple violence-fighting
Coercive and controlling behaviour-violence

Physical
Emotional
Verbal
Sexual
Financial (controlled access to money- difficult to escape)

Question 3

What is the domestic abuse act 2018

Answer 3

Created a specific criminal offence of domestic abuse
Recognises can be over a period of time
Criminalises coercive and controlling behaviour

Question 4

What is the prevelenceof domestic abuse in Scotland

Answer 4

Affects 1 in 5 women at some point in their lives and up top 1 in 6 men.

60,000 cases reported annually (however many cases unreported)

Question 5

Where is the most common place for domestic abuse to take place

Answer 5

In a private residence

Question 6

What is gender based violence

Answer 6

Violence based against a person on the basis of gender
Reflects and reinforces inequalities between men and women

Eg. Rape and sexual assault, sexual harassment, stalking, coerced marriage, trafficking and sexual exploitation

Question 7

What is coercive control behaviour

Answer 7

A pattern of behaviour
Aim to isolate victim
Degradation of victim
Micro-regulation of all aspects of life (money, clothes, surveillance)
Abusers are often charming to everyone else which serves to increase the isolation

Question 8

Who is most at risk of domestic abuse

Answer 8

Age 16-24 (f), 16-19 (m)
Long term illness/ disability
Mental health problems
Pregnancy (elevation during pregnancy)
Elevated risk at time of separation from partner

Question 9

What are the health consequences

Answer 9

Fatal- suicide, murder
Non fatal- physical harm, reproductive health, mental health, chronic conditions (TMJ etc), health harming behaviours (drinking, smoking, drugs).

Question 10

How many women were killed by a partner in UK in 2018

Answer 10

80

Question 11

How many children were murdered by their parents in 2007?

Answer 11

33

Question 12

What are some effects of physical harm on children?

Answer 12

Anxiety/ depression
Sleeping issues, nightmares
Heightened startle response
Physical symptoms
Behavioural issues
Health harming behaviours
Low sense of self worth/ feel guilty
Truanting

Question 13

What is ACE

Answer 13

Adverse childhood events
Abuse, neglect, household dysfunction

4 or more- more likely to have medical issues, be involved in violence, binge drink

This is a factor but can be overcome by resilience

Question 14

How many attempts does it take for someone to leave an abusive relationship?

Answer 14

6-7

Question 15

How to recognise abuse?

Answer 15

Low self-esteem
Anxiety
Constant communication with partner if not present
If partner present, they may do all the talking
Alcohol
May insist on female clinician
Missed or frequent appointments

Some of these things may be for other reasons

Question 16

Physical signs of domestic abuse

Answer 16

Repeated injuries
Bruises at different stages of healing
Dental/ maxilofacial injuries, orofacial pain (69% has history of abuse)
TMJ problems (chronic pains)
Facial bruising/ on neck
Unlikely explanation for injury
Delay in seeking help for injury

Question 17

What are some effects off at attempted strangulation

Answer 17

Can cause infarction in brain

Question 18

How often does physical abuse occur in domestic abuse

Answer 18

40% of cases
50-90% are facial injuries

Always question facial injuries

Question 19

What are some barriers to domestic abuse screening?

Answer 19

Patient accompanied
Lack of training, time, knowledge where to refer
Concern about offending patient
Patient’s cultural norms

Question 20

Which act protects vulnerable adults and allows you to make a referral on their behalf

Answer 20

Adult Support and protection (Scotland) Act 2007

Question 21

What is the definition of a vulnerable adult?

Answer 21

Adult unable to safeguard their own interest through disability, mental disorder, illness or physical or mental infirmity, and who is at risk of harm or self-harm, including neglect

Question 22

What is AVDR

Answer 22

Ask
Validate
Document
Refer - signpost, Scottish Domestic Abuse Helpline

Framework to help clinicians to ask about domestic abuse.
Quick and easy.
Limits enquirers involvement to very simple tasks - let patient decide what they would like to do and when.

Question 23

What are some things you can do in your practice?

Answer 23

Put cards/ posters in toilets/ waiting room
Have staff wear ASC badges
Allow patient to use the phone in the surgery
Link with local domestic abuse agencies and have their materials available
Develop a protocol to allow you to get people on their own if partners are present eg code word.