Domestic Abuse Flashcards
What is the definition of domestic abuse?
Any incident or pattern of incidents of CONTROLLING , COERCIVE, THREATENING behaviour, violence or abuse between those aged 16 or over who are, or have been intimate partners or family members regardless of gender or sexuality. Can encompass, but not limited to:
- psychological
- physical
- sexual
- financial
- emotional
In what ways does domestic abuse cost society?
Hospital and ambulance GP visits Prescriptions Lost wages for GP visits Mental Health
How does domestic abuse impact on health?
- traumatic injuries
- Somatic problems
- Psychological/psychosocial problems
Give examples of traumatic injury that may result from domestic abuse
- fractures
- miscarriage
- bruises
- haemorrhage
Give examples of somatic problems from abuse
- headache
- GI problems
- chronic pain
- low birth weight
- premature delivery
Give examples of psychological or psychosocial problems secondary to abuse
- PTSD
- suicide
- substance misuse
- depression and anxiety
- eating disorders
- impact on children’s mental health
What is the best indicator of domestic violence?
Injury/incident reported as ‘unwitnessed by anyone else’
How do domestic abuse victims present to health services?
- in the evenings
- saying they could only come in when heir partner drives them in
- delayed presentation for serious injury
What is a risk factor for domestic abuse start/escalation?
Pregnancy
What are the risk levels of domestic abuse?
- STANDARD
- MEDIUM
- HIGH
What does standard risk mean?
current evidence does NOT indicate likelihood of causing serious harm
What is medium risk?
There are identifiable indicators of serious harm. Offender has potential to cause serious harm, but unlikely unless change in circumstances
What is high risk?
There are identifiable indicators of IMMEDIATE RISK of serious harm, which could happen at any time.
What factors in a patient’s history would point to domestic violence? These are the factors included in the DASH assessment
- patient is FRIGHTENED
- isolation
- depression/suicidal
- separated or tried to separate (ex-partners)
- conflict over child contact
- stalking/harassment
- pregnancy or recent baby
- children/step children
- has hurt dependents in the house
- death threats
- violence
- controlling/jealous
- sexual abuse
- partner has hurt someone else before
- animal abuse
- financial abuse
- drug/alcohol problems
- mental health issues in the perpetrator or has tried to commit suicide
- perpetrator has a criminal record/been in trouble with the police
- abuse happening more often/getting worse
- weapons and accomplices
What is the DASH form?
Domestic Abuse, Stalking and Harassment
The form used by non-police agencies when domestic abuse is disclosed
The form determines a risk level and hence the referral pathway for the patient
Complete the form with the patient in private
What factors in the victim may point towards domestic violence?
- pregnancy/new babcy
- children/step children
- isolation
- frightened
- depressed/suicidal
What about the relationship or victim may hint towards domestic violence?
- criminal history
- animal abuse
- drugs alcohol/mental health
- weapons
- accomplices
- controlling/jealous
- suicidal
- death threats
- stalking/harassment
- separation
- child contact conflict
- sexual abuse
- escalation
- financial issues
- strangling/choking/drowning
What can a doctor do to help victims of domestic abuse?
- Ask proactively about whether the patient is subject to abuse
- pick up these patients as they present to health services a lot, but often do not disclose abuse
- record what the patient has said if they disclose anything that may be of concern
- display helpline posters and contact cards
- ask direct questions
- acknowledge that the behaviour is not ok
- identify and act on abuse
What should you do if the patient is at standard or medium risk?
Give them contact details for domestic abuse services
- Local helpline for Sheffield
- National Helpline
- Men’s Advice Line
If the patient does not provide consent, then just encourage them and review again in clinic
What should you do if someone is at high risk of serious harm?
refer to MARAC/IDVAS wherever possible with consent, but can break confidentiality for high risk cases only if the patient does not provide consent.
What is MARAC?
The domestic abuse Multi-agency Risk Assessment Conference - a victim focused information sharing and risk management meeting attended by all key agencies, where high risk cases are discussed.
Aims to share information to increase the safety, health and wellbeing of victims and to make a risk management plan
Who attends a MARAC?
- police
- children’s social care
- independent domestic violence advisors
- health representatives (midwifery, health visitors, child protection nurse and hospital staff)
- housing
- education
- mental health
- alcohol and drug services
- the victim and perpetrator do not attend
Who are the IVDA?
Independent Domestic Abuse Advisors
They work as women’s advocates and help them navigate the support system.
Serving as a victim’s primary point of contact, IDVAs normally work with
their clients from the point of crisis to assess the level of risk, discuss the range of suitable options
and develop safety plans.
They are pro-active in implementing the plans, which address immediate safety, including practical
steps to protect themselves and their children, as well as longer-term solutions. These plans will include
actions from the MARAC as well as sanctions and remedies available through the criminal and civil
courts, housing options and services available through other organisations.
What is a domestic homicide review?
a review of the circumstances in which the death of a person aged 16 or over has, or appears to have, resulted from violence, abuse or neglect by:(a) a person to whom (s)he was related or with whom (s)he was or had been in an intimate personal relationship, or (b) a member of the same household as himself. Held with a view to identifying the lessons to be learnt from the death.
