Microsoft Word - IPV Guide for providers.January.2013

IntimatePartnerViolence



MakingtheConnectionwithHealth



IntimatePartner

Violence(IPV)

Aguideforhealthcareproviders



Aguidefor

healthcare

providers

Women’sHealth,MaternalandChildHealth

MarylandDepartmentofHealthandMentalHygiene

UpdatedJanuary2013



TableofContentspage



Definition……………………….………………………………………………..3

Prevalence……………………………………………………………………….4

Homicide………………………….………………………………………………4

Specialpopulations

Male,immigrant,same‐sex,disabled…………………………..5

Associationswithhealth………………………………………………….6

Economictoll…………………………………………………………………..6 

Marylandlaw…………………………………………………………………..7 

IPVAssessmentandEducation…………………………………………8

IPVassessmenttool………………………………………………………9

Safetyassessment………………………………………………………….10

SafetyPlanning………………………………………………………………11

Documentationandcoding..………………………………………….13

ChildrenwhowitnessIPV……………………………………………….13 

Marylandhospitalbasedprograms………………………………..14

References…………………………………………………………………….15

Marylanddomesticviolenceservice

programs………………16

Hotline…..………………………………………………………………………17

Resources………………………………………………………………………17





Intimatepartnerviolence(IPV)istheactualorthreatenedphysical,sexual,or

psychologicalharmbyacurrentorformerpartnerorspouse.Thepatternofassaultive

orcoercivebehaviorsischaracterizedbythecontrolordominationofonepersonover

another.

ExamplesofIPVinclude:

 Physicalviolence

o hit,slap,scratch,choke(strangle),bite,push,kick,

o useofrestraintsorone’sstrengthagainstanother

person,

 Sexualviolence

o unwantedkissingorfondling

o rapeorforcedsexualacts

 Psychologicalabuse

o stalking,harassment,degradation,intimidation,name‐calling,isolation,

o threatsofphysicalorsexualviolence(using

words,gestures,weapons)

o limitingorcontrollingaccesstomoney,family,friends,food,

transportation,medicine,healthcare

HighlyassociatedwithIPV

 Reproductivecoercion

o refusaltousecontraceptionorcondoms

resultinginunintendedpregnancyor

exposuretosexuallytransmittedinfections

o controloverpregnancyoptions



TheprecisedefinitionofIPV

hasvariedamongdifferentorganizationsandresearchers

makingcomparisonsofprevalence,epidemiology,associatedeffects,andtrends

inconsistentandconfusing.Definitionscanbenarrowandlimitedsuchaspertaining

onlytospouses,onlytophysicalviolence,onlytofemales,oronlytoheterosexual

couples.Whilethesenarrowdefinitionscanbeuseful

forcertainresearchpurposes,the

widerangeofcoercivebehaviorsinIPVthatimpactsvariouspopulationsisignored.



Intimatepartnerviolence(IPV)isoftenreferredtoasdomesticviolence(DV).However

DValsoincludesviolenceamongfamilymembers(parentsorstepparents,childrenor

stepchildren,siblings,grandparents,in‐laws,orotherfamily

members)aswellasIPV.

Definition

IntimatePartnerViolenceandHealth

IsIPVthesameasdomesticviolence?



Morethanone‐thirdofwomenandone‐fourthofmenintheU.S.haveexperienced

rape,physicalviolence,and/orstalkingbyanintimatepartneratsomepointintheir

lifetime.NearlythreeintenwomenandoneintenmenintheU.S.reportedatleast

onemeasured

impact(suchassymptomsofposttraumaticstressdisorder,being

injuredorneedinghealthcareorlegalservices)relatedtotheviolentbehavior

.

Violenceoccursinallsocioeconomicgroupsandtoindividualsamongeveryculture,

race,ethnicity,gender,andreligion.



Althoughwomencanbeviolentintheirrelationshipswithmen,relativelylittleresearch

hasbeendoneinthisareaandmoreisneeded.Moststudiesshowthatthemajorityof

IPVisperpetratedbymalestowardstheirfemalepartners.A2002reviewreportedthat

morethan90%of"systematic,persistent,andinjurious"violenceisperpetratedbymen

primarilyintheireffortstomaintaincontrol.

2

AccordingtotheU.S.Departmentof

Justice,BureauofJusticeStatistics,womenarefivetimesmorelikelythanmentobe

victimizedbytheirpartners.

InMaryland,femaleswerethevictimsin74%(n=13,241)

ofall2010Marylandcrimes(n=17,931)associatedwithIPV.Assaultaccountedfor91%

ofallIPVcrimesagainstwomen.Theratesofviolenceamongsamesexcouplesis

similartothatamongheterosexualcouples,howevermoreresearchisneeded.



Pregnancy:Data

fromthemulti‐statePregnancyRiskAssessmentMonitoringSystem

(PRAMS)surveyshowedthat5.3%ofwomenreportedphysicalabusefromacurrentor

formerpartnerfortheyearbeforepregnancyand3.6%reportedabuseduring

pregnancy.Theprevalenceofabusebyaformerpartnerwashigherthanbyacurrent

partner.Womenwhosepartnersdidnotwantthepregnancy

reportedhighlevelsofphysicalabusebefore(19%)andduring

(14%)pregnancy.

4



MarylandPRAMSreportedthat7.2%ofmotherswerephysically

abusedbyacurrentorformerpartner duringthe yearbefore

pregnancyorwhiletheywerepregnant.

5



AsshownintheWorldHealthOrganizationposter,"1in2female

murdervictimsarekilledbytheirmalepartners,oftenduringan

ongoingabusiverelationship”.Byconservativeestimates,atleast

22%ofthe69femalehomicidesinMarylandin2010wereattributed

toIPV.Incontrast<1%ofmale

homicideswereattributedtoIPV.

6



Pregnancy:Inthe16‐yearperiodfrom1993to2008,theleading

causeofdeathamongpregnantandpostpartumwomeninMaryland

washomicide.Ofthesolvedhomicidecases,63%wereperpetrated

bycurrentorformerintimatepartners.



Prevalence

Intimatepartnerhomicide

SomepopulationsmayexperienceIPVdifferentlyormayhavebarrierstodisclosure.



1) Malevictim

a. Littletonoresearchorfocusonmalevictimsdespiteneed

b. Shelters/programsmaynotacceptmen;notsensitivetomaleissues

2) Immigrantandrefugee

a. Limitedlanguageproficiency

b. Stressofadaptationtonewculture,socialisolation

c. Disparitiesineconomicorsocialresourcessuchasinternationally

brokeredmarriagesormarriagetoU.S.militarypersonnel

d. Immigrationstatusandconcernaboutdeportation

3) Lesbian,Gay,Bisexual,Transgender(LGBT)population

a. IPVisasleastascommoninLGBTgroupsasinthegeneralpopulation

b. Lackofastrongsupportsystemandperceivedsocietalstigmamaydeter

LGBTvictimsfromreportingIPV

c. IPVperpetratorsmaythreatento“out”theirpartner’ssexualitytocoerce

hertostayintherelationshiporcontrolher

4) Disabled

a. Twiceaslikelytobeabusedaswomenwithoutdisabilities

b. Dependencyoncaregivers(possibleaspouse,familymemberor

employee)whomayhaveissuesofpowerandcontrol

c. Leavinganabusivesituationrendersthedisabledwomanhelplessand

withoutneededsupportservices

d. Manysheltersdonotacceptwomenwithdisabilitiesorarenottrainedto

adequatelyaddresstheirneeds.

e. Otherformsofabusearemorecommoninthispopulation

i. Withholdingmedication

ii. preventinguseofassistiveequipment(canes,wheelchairs)

iii. sabotagingpersonalneeds(bathing,bathroomfunctionsfood)

5) Teens

a. Highratesofunintendedpregnancy,STIs,depression,andtobacco,

alcohol,druguse

b. digitaldatingabuse(includingpostingnude picturesagainstherwill,

stalkingher

throughsocialnetworks,andhumiliationthroughsocial

networks),controllingwhatpartnerwears,whetherthepartnergoesto

schoolthatday,manipulatingcontraceptiveuse

6) Military

a. Highratesof“militarysexualtrauma”(MST)occuramongwomenduring

militaryserviceandiscommonlyassociatedwithpost‐traumaticstress

disorder(PTSD),tobacco/alcohol/druguse,

STIs,medicaldisorders

b. WomenveteranscanreceiveMST‐relatedcareatanyVAnationallyfor

unlimitedlengthoftimeandwithoutcost

Specialpopulations:male,immigrant,same‐sex,disabled

CurrentorpastIPVcanresultinacuteinjuries,behavioralhealth

problems,andchronicmedicaldisordersasshowninthefollowingtable:

HealthEffectsAssociatedwithIntimatePartnerViolenceAmongWomen

PhysicalInjuries



‐Bruisesandpetechia,lacerations,fractures,bites‐(especially

tohead,neck,face[eyes,cheeks,lips,nose],arms,and

breasts)andabdomenwhenpregnant

‐strangulation,looseorbrokenteeth

‐Death(homicide)

MentalHealth‐Depression

‐Anxiety

‐PostTraumaticStressDisorder(PTSD)

‐Eatingdisorders

‐Phobias

‐Panicattacks

‐Insomnia

‐Death(suicide)

SubstanceAbuse‐Alcoholandillicitdrugabuse

‐Cigarettesmoking

‐Tranquilizerandsleepingpillabuse

ChronicDisorders‐Chronicpainsyndromes

‐Anemia

‐Asthma

‐Obesity

‐Headaches,migraines

‐Hearingloss

‐Temporo‐mandibulardisorders

‐Fibromyalgia

‐Heart/bloodpressure/chestpainproblems

‐Arthritis

‐Gastrointestinaldisorders(irritablebowelsyndrome,

indigestion,spasticcolon,ulcers)

ReproductiveHealth‐Unintendedpregnancy

‐Pelvicpain,dysmenorrheal,dyspareunia

‐Vagninits

‐Urinarytractinfections

‐Pelvicinflammatorydisease

‐Sexuallytransmittedinfections(STI)andHIV

‐Abnormalcervicalcancerscreeningtests(Pap)

‐Non‐viablepregnancies(miscarriage,abortion,stillbirth)

‐Poorprenatalbehaviors(lateornoprenatalcare,poor

nutrition,smoking)

‐Poorpregnancyoutcomes(prematurity)

Associationswithhealth



ThecostofIPVwasestimatedat5.8billiondollarsin1995.Updatedto

2003dollars,IPVisestimatedtocostover$8billionannuallyintheU.S.

Two‐thirdsofthatamountisfordirectmedicalandmentalhealthservices.

Additionalcostsareassociatedwithtreatmentfor

alcoholism,substance

abuse,attemptedsuicide,unintendedpregnancyandlostproductivityfromwork.



UnderMarylandlaw,donotreportsuspectedorconfirmeddomesticviolenceorsexual

assaultunlesstheadultvictimconsentsexceptforthefollowing3exceptions:

Exceptions‐Disclosureisrequiredorauthorizedinthefollowingthreeconditions:

1. Childabuse

a. Ifthecaseinvolvesphysicalorsexualabuseofachilduptoage18by

aparent,guardian,otherpersonwithpermanentortemporary

custody,orfamilyorhouseholdmember,thenanyoneshouldreport

toChildProtectiveServices(CPS)orlawenforcement.

2. Vulnerableadultabuse

a. Ifthecaseinvolvesneglect,self‐abuse,orexploitationofavulnerable

adult(adultaged18orolderlackingthephysicalormentalcapacity

toprovidefordailyneeds),thenmedicalpersonnel,police,and

humanserviceworkersshouldreporttoAdultProtectiveServices

(APS)orlawenforcement.

3. Treatmentofaninjurybyhealthcareprovider

a. Iftheinjurywascausedbyagunshotormovingvessel,thenmedical

personnelmustreporttolawenforcement.

b. InAllegany,AnneArundel,Charles,Kent,Montgomery,Prince

George’s,Somerset,TalbotandWicomicocounties,ifinjuryiscaused

byan“autoaccidentor

lethalweapon”,thenmedicalpersonnelmust

reporttolawenforcement.



Toreportabuseofchildren,call1‐800‐422‐4453(1‐800‐4‐A‐Child)or911.

Toreportabuseofavulnerableadult,call1‐800‐917‐7383or911.

LocalofficesoftheMarylandDepartmentofHumanResourcescanbefoundat

http://www.dhr.state.md.us/blog/?page_id=805

ApamphletabouttheMarylandlawcanbefoundat:

http://healthymaryland.org/wp‐content/uploads/2011/05/66090_DomVio_D_Confid.pdf



EconomictollofIPV

Marylandlaw

Domesticviolenceassessmentisnotanoption;itisastandardofcare.

WomendonotmindbeingaskedaboutIPV.

In1984,theSurgeonGeneraldeclareddomesticviolenceastheleadinghealthhazardto

womenintheU.S.Routinescreeningforintimatepartnerviolenceisrecommendedby

everymajorprofessionalmedicalorganizationincludingtheAmericanMedical

Association(AMA),AmericanAcademyofFamilyPhysicians(AAFP),AmericanCollegeof

Physicians(ACP),AmericanCollegeofObstetriciansandGynecologist(ACOG),American

AcademyofPediatrics(AAP)andtheAmericanPsychiatricAssociation(APA).In2013,

theU.S.PreventiveServicesTaskForce(USPSTF)recommendedscreening

womenof

childbearingageandprovidinginterventionservicestothosewhoscreenpositive.



Theassessmentshouldbedoneinprivate,withoutanyonepresentwhoaccompanied

thepatient.Ifaninterpreterisneeded,donotusefriendorfamilymembers.



AroutineassessmentforIPVshouldavoidtheuseofstigmatizingtermssuchas

“abuse”,“rape”,or“battered”.Developastrategythatisnonjudgmentalandemploys

culturallyrelevantlanguage.Theassessmentquestionscaneasilybeintegratedaspart

ofthemedicalhistoryform.Alternatively,theassessmentcanbefilledoutbythe

patientorself‐administeredonacomputerinaprivatearea.

AsampleIPVassessmentisonpage9.Aone‐pagepdfwithresourcesonthebackmaybe

foundatwww.dhmh.maryland.gov/ipv(seeIPVassessmenttool).Otherevidence‐basedtools

suchas“HITS”maybefoundatwww.cdc.gov/ncipc/pub‐res/images/ipvandsvscreening.pdf

Whentoassess–duringhealthcarevisitsforallwomenaged15to50(earlierifalready

dating):

 primarycare,gynecology,mentalhealth,pediatrics(assessmothersofpatients

duringchildvisitsaswellasteenswhoarepatients)

o initialvisit

o interimvisit–wheneveraroutinemedicalhistoryistakenorifvisitis

newfor:

 physicalinjury

 sexuallytransmittedinfection

 preconceptionor

inter‐conceptioncare

 familyplanningorabortion

 mentalillness

 dentalinjuries

 smoking,alcoholorsubstanceabuse

 urgentcare–wheneverafullmedicalhistoryistaken

o Overathirdofallwomenseenintheemergencyroomforviolence‐

relatedinjurieswereinjuredbyacurrentorformerintimatepartner

 Obstetrics‐initialvisit,eachtrimesterandpostpartumvisit

IPVassessmentandeducation

Sample Intimate Partner Violence Assessment

– assess privately, without family/friends; use interpreter (not family/friend) if needed;

Assess females, ages 15-50, at every new, interval comprehensive, or urgent care health visit – as part of routine health history. Assess

obstetric patients each trimester and postpartum. Ask directly or have patient self-administer the questions by computer or paper.

Assess anyone when signs and symptoms raise concerns about violence (injuries, drug/alcohol use, STIs, psych disorders).or at provider discretion.

Introductory statements:

 "Because violence is so common and help is available, I now ask every patient if they are being hurt by a

current or former partner.”

 “I won’t tell anyone else about what is said unless you give me permission.”

[Exceptions for Maryland: abuse of vulnerable adults, children < 18 years of age by a guardian, or certain injuries, e.g. inflicted by gun or moving vessel]

Sample questions

1. ”Has your current or former partner threatened you or made you feel afraid?”

(stalked you, insulted you, threatened you with a weapon, threatened to hurt you or your children if you did or

didn’t do something, controlled whom you talk to/where you go/how you spend money)

2. “Has your partner hit, strangled or physically hurt you?”

(“hurt” includes being hit, slapped, kicked, “choked” [or strangled], bitten, shoved)

3. ”Has your partner made you have sex when you didn’t want to?”



No Yes (to any of above 3 questions)

“It is not your fault. You are not alone. Help is available. I’m concerned about your safety (and safety of your children).

Abuse tends to increase in frequency/intensity and it can impact your health”

Sample questions to quickly assess: Is it safe to go home?

a. Has the physical violence increased over the past 6 months?

b. Has your partner used a weapon or threatened you with a weapon?

c. Do you believe your partner is capable of killing you?

d. Have you been beaten while pregnant?

e. Is your partner violently and constantly jealous of you?

Drug or alcohol use intensifies all situations

Note: Patient may be a danger to herself. Assess for depression/suicidality

“Yes” to >3 out of 5 questions** or concern for safety - “From what you’ve told me, you are at

high risk for severe injury or even being killed by your abuser. Let’s make a call to help you

decide some safe options for you and your family.” (Remember that the goal may not be

leaving at once but discussing safety with a DV expert. Document if help is declined but respect

patient autonomy for making decision.)

Offer to call National Hotline 800-799-SAFE or the local DV Program (see back) for safety assessment/planning,

counseling, legal advice, shelter. Make other referrals (mental health) as needed; Schedule a follow up visit

Emphasize the need to keep information private and away from abuser.

A safety planning fact sheet is available at www.ndvh.org/wp-content/uploads/2008/10/Safety-Planning-2.pdf

 Educate and counsel as needed; discuss healthy relationships and give out safety cards

/women’s health resource

list (with local DV contact information)

 By providing brochures, cards, resources and information to all women or for their “friends or family who may be

dealing with violence” women can receive important information without disclosure.

Intimate Partner Violence: A guide for Health Care Providers”, available at www.dhmh.maryland.gov/ipv/ has more information about IPV

assessment, documentation, reporting requirements, special populations, resources and how to order safety cards

Confidentiality and Reporting Requirements in Maryland, http://healthymaryland.org/wp-content/uploads/2011/05/66090_DomVio_Confid.pdf

Other IPV assessment tools such as “HITS” may be found at www.cdc.gov/ncipc/pub‐res/images/ipvandsvscreening.pdf

adapted from

Academic Emergency Medicine 2009; 16:1208–1216

Option for on-site

safety assessment

Assessforreproductivecoercion(familyplanning,abortion,pregnancytestdiscussions):

 “Doesyourpartnersupportyourdecisionaboutwhenorifyouwanttobecomepregnant?”

 “Hasyoupartnereverinterferedwithyourbirthcontrolortriedtogetyoupregnantwhen

youdidn’twanttobe?”

Educate

Evenifabuseisnotacknowledged,providingallpatientswitheducationalmaterials

normalizestheconversation,makingitacceptableforwomentoreceiveinformation

withoutdisclosure.Conveytoallwomenthat:

 informationisavailable(keepbrochures/postersinbathroom,examroom,

waitingroom)andhandoutasmallIPVresourcecardthat

canfitinpatient’s

shoeorotherconcealablearea

 you/staffareavailableforhelpandsupport

 abuseiswronganditisnotthevictim’sfault

 everyonehastherightfeelsafe





Whenapatientdisclosessheisbeingabused,alwaysvalidateherexperiencebytelling

hersheisnotaloneandnoonedeservestobeabused.



Ifthereisanyindicationorsuspicionthatabuseisoccurring,asafetyassessmentshould

bedonetoevaluateifthewomanisinanyimmediatedangerandifshefeelsitissafeto

gohome.ThelocalDVprogram(page14)orhospitalprogram(page12)canhelp

determinetheneedforsafetyplanningandcanprovideinformationaboutlocal

resources.TrytocontactthelocalDVprogrambeforethewomanleavesthefacility.Or

thesafetyassessmentmaybedoneon‐siteiftheproviderfeelscomfortable:

Askwhethershefeelsherpartneriscapableofkillingher.Determineifthe

battererhasaweapon,whethertherehasbeenanescalationinviolence,if

therearegunsinthehome,substanceuse,historyofstrangulation,jealous

violentrages,abuseduringpregnancy,orsuicidalideation.A5‐questionsafety

assessmentscreenisonthesampleIPVassessmenttool(page

9).



The“LethalityAssessmentProgram(LAP)–MarylandModel”isacopyrightedseriesof

questionstohelpidentifywomenathighriskofseriousinjuryorbeingkilled.LAPhas

beenusedmostlybylawenforcementandconnectsthoseathighriskwithalocalDV

provider.Learnmoreatwww.mnadv.org/lethality.html/



Asafety

planningfactsheetisatwww.ndvh.org/wp‐content/uploads/2008/10/Safety‐

Planning‐2.pdf/includesstepstotakeifthevictimweretoleaveherabusivesituation

suchasidentificationofplacesshecouldgoifshewereinimminentdanger,making

copiesofimportantpersonalandfamilydocuments(driverslicense,passport,paystubs,

birthcertificates,healthrecords),notinghersocialsecurity,bankaccountandcredit

cardnumbers,preparingclothes,carkeys,andotheritemsfora“quickescape”.

Safetyassessment



AdaptedfromtheDomesticViolenceHotline

Yourlocaldomesticviolenceagencymaybeabletohelp.Inanemergency,call911.



Safety

in an

Abusive



 Ifweaponsarekeptinyourhome,trytohideguns,ammunition,knives,andany

otherweapons,unlesshidingtheweaponswouldfurtherjeopardizeyoursafety.

Ifthisisn’tpossible,trytomaketheminaccessible.

 Identifytheareasinyourhomethatareeasiesttoescapefromandare

freeof

potentialweapons.Movetothoseareasduringanargument. Avoidgoingto

roomslikethekitchenwherethereareknivesandotherpotentialweaponsand

thebathroomthathashardsurfacesandmostlikelydoesn’thaveasecondexit.

Makeyourselfphysicallysmallerbycurlingintoaballandcoveringyour

headand

facewithyourhands.



 Trytohaveaphoneaccessibleatalltimes.Considerhidingaprepaidcell

phonetouseinemergencies.

 Createacodewordwithfriendsandfamilyinordertocommunicatetothem

thatyouneedhelp.

 Trustyourjudgment.Sometimesitisbesttoleave;sometimesitisbestto

placatetheabuser.

 Makeahabitofbackingyourcarintothedriveway.Trytoalwayshavesome

gas.Keepthedriver’sdoorunlockedandlockallotherdoors.Haveacopyofthe

carkeymadeandhideoneinthecar.



Safety

PreparingtoLeavean

Abusive



 BeawarethatcellularphonescancontainGPStrackingdevices.Ifpossible,

plantogetanewphoneandnewserviceplanwhenyouleave,andleaveyour

originalphonebehind.

 Knowthatleavinganabusiverelationshipcanbethemostdangeroustime

foryou.Trytosetasidemoney,eveninsmallamounts. Startyourown

savingsorcheckingaccount.Usetheaddressofatrustedfriendorfamily

memberwhensettinguptheaccount.

 Keepawrittenlistofimportantphonenumberswithyou.

 Haveapackedbagready.Keepithiddeninyourhome

orleavethebag

withfriends,family,oratwork.

 Itemsanddocumentstotake:

Birthandmarriagecertificates

,

IDandsocialsecuritycards

,

keys

,

schooland

medicalrecords

,

passports,greencards,workpermits

,

protectiveorder,

divorcepapers,custodyorders

,

bankpapersandcreditcards

,

medicine



SafetyPlanning

AfterLeaving an

Abusive



 Ifyouhaveaprotectiveorder,alwayscarryacopywithyou.Makeandkeep

copiesforwork,yourcar,andyourhome.Callthepoliceanddocumentwhen

theprotectiveorderisbroken.

 Considerlettingfriends,neighbors,andco‐workersknowaboutyoursituation

andhowtheycanhelpyoustaysafe.

 Trytocarryacellphonewithyou,andprogramittodial911.

 Changeregulartravelhabits.Trynottofrequentthesamestoresor

businessesyoudidwhenwithyourabuser.

Ifyouaremoving:

 Considertalkingtoyourlocalshelterprogramabouttemporaryshelteror

otherservicestheycouldprovide.

 Ifyouneedtoconcealyournewlocation,consideranaddressconfidentiality

program.

 Ifyouarestayinginyourhome,

considerchangingyourlocksorinstalling 

strongerdoors.Iftheexchangeofchildrenisnecessary,arrangeasafe,neutral

placetodo



theexchange.

Ifyourabusercomestoyourhome,youdonothaveto

lethimin. Keepthedoorsclosedandlocked,andcallthepolice.



Safetyand



Computeractivitycanbemonitoredorcheckedwithout

yourknow

edge

.Itisnot

possibletodeleteorclearallofthe“footprints"fromyourcomputeroronline

activities.Ifyouarebeingmonitored,itmaybedangeroustochangeyourcomputer

behaviorssuchassuddenlydeletingyourentireInternet

story

thatisnotyour

regularhabit.Ifyouthinkyoumaybemonitoredonyourhomecomputer,becareful

howyou

useyour

computersinceanabusermightbecomesuspicious.Youmaywantto

keep

ngthe

monitoredcomputerfornon‐personalactivities,likelookingup the

weatherornews.Useasafercomputertoresearchanescapeplan,lookfornewjobsor

apartments,bustickets,oraskforhelp.

 Consideropeningafreeemailaccountthatyourabuserdoesn’tknowabout.

Checkitfrom

publicorotherwisesafecomputers(libraries,schools,friend’s

home).Ifyouuseacellphone,evencallsthataretoll‐freewilllikely

showup

onyourphone bill.Ifyouareonajointplanoraccessyourphonebillonline,

othersmayaccessit.Makecallstoshelters,lawyers,orotherconfidential

servicesfrompayphonesorprepaidcellphones.Yourlocaldomesticviolence

programmayhavefreecellphoneprograms.Thesephonesoftenallowyou

todial911.



Themedicalrecordmaybeanaidintheprosecutionoftheabuserinacourtoflaw.Itis

thereforeimportanttoincludeadescriptionoftheabuseasrecountedbythepatient.

Includeinthemedicalchart:

1.fullnameofperpetratorandrelationshiptovictim,

2.exacttimeandlocationofinjuryoccurrence

3.fullnamesandrelationshiptowitnessesofthetrauma

4.descriptionofinjuryusing

 a.directquotationsfromthepatient(use“patientstates”insteadof“alleges”)

 b.Polaroidcameraphoto

 c.diagramorbodymaptodocumentnatureand

locationofallinjuries

ICD‐9codeforadultphysicalabuseis995.81;E‐codesmaybeusedasmodifiercodeto

provideinformationastowhen,where,howandtowhomabusehappened(E‐967.3is

injurybyspouse/partner,E‐968.2isassaultbebluntorthrownobject).V‐codesgive

informationabouthistoryofabuseorneedforcounseling(V15.41isphysical

abuse/rape).



Exposuretoviolenceinthehomepredisposeschildrentonumerous

socialandphysicalproblems,includingdepression,anxiety,post‐

traumaticstressdisorder(PTSD),substanceabuse,asthma,headaches,

andstress.Itmayalsoteachthemthatviolenceisanormalwayoflife‐

therefore,increasingtheirriskofbecomingviolentorvictimsofviolence

inthefuture.

Documentationandcoding

ChildrenwhowitnessIPV



TheJointCommissiononAccreditationofHealthcareOrganizations(JCAHO)requires

accreditedhospitalstoimplementpoliciesandproceduresforidentifying,treating,and

referringvictimsofabuseaswellasprovidingdomesticviolenceeducationprogramsfor

hospitalstaff.TheMarylandDomesticViolenceHealthCareScreeningandresponse

Initiative,a2010Executive

OrdersignedbyGovernorO’MalleyinSeptember2010,

seekstoincreasethenumberofhealthfacilitiesthathavespecializedDVprograms.



Currently,sevenhospitalshaveon‐site domestic violenceprogramswith

dedicatedstaffwhoareavailableforhelpwithIPVservicessuchascrisis

counseling,screening,dangerassessment,safetyplanning,counseling,

advocacy,forensicexams,propermedicalrecorddocumentation,servicecoordination

andresourcelinkage.Thefollowinghospitalsof feravarietyofservicesdesignedto

workwiththeneedsofthecommunity.

 AnneArundelMedicalCenter,Annapolis,AbuseandDomesticViolenceProgram,

443‐481‐1209

 GreaterBaltimoreMedicalCenter,Towson,SAFEDVProgram,443‐849‐3323

 MercyMedicalCenter,Baltimore,FamilyViolenceResponseProgram,410‐332‐

9470

 MeritusHospitalCenter,Hagerstown,301‐790‐8000

 NorthwestHospitalCenter,Randallstown,DomesticViolenceProgram,410‐496‐7555

 PrinceGeorge’sHospitalCenter,Cheverly,DomesticViolenceandSexualAssault

CenteratDimensionsHealthcare,301‐618‐3154

 SinaiHospitalofBaltimore,FamilyViolenceProgram,410‐601‐8692



Marylandhospitalbasedprograms

1. Black MC, Basile KC, Breiding MJ, Smith SG, Walters ML, Merrick MT, Chen J,

Stevens MR. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010

Summary Report. Atlanta, GA: National Center for Injury Prevention and Control,

Centers for Disease Control and Prevention; 2011.

2. Kimmel, Michael S. Gender Symmetry' in Domestic Violence: A Substantive and

Methodological Research Review. Violence Against Women 2002; 8(11):1332–

1363.

3. Catalano S. U.S. Department of Justice, Bureau of Justice Statistics. Intimate

partner violence in the U.S. 2007, available at

http://bjs.ojp.usdoj.gov/content/intimate/ipv.cfm

4. Chu SY, Goodwin MM, D’Angelo DV. Physical violence against U.S.

women around the time of pregnancy, 2004-2007. Am J Prev Med

2010;38 (3):317-322.

5. Maryland Department of Health and Mental Hygiene, Center for Maternal

and Child Health. Focus on Intimate Partner Homicide Among Maryland

Women Giving Birth 2004-2008. March 2011, available at

www.marylandprams.org

6. Maryland Department of State Police. 2010 Uniform Crime Report, Crime

in Maryland. July 2011.

7. Cheng D and Horon IL. Intimate Partner Homicide Among Pregnant and

Postpartum Women. Obstetrics & Gynecology 2010; 115(6): 1181-6.

8. Max W, Rice DP, Finklestein E, Bardwell RA, Leadbetter S. The economic

toll of intimate partner violence against women in the United States.

Violence and Victims 2004;19(3):259-72.

9. Intimate Partner Violence. Committee Opinion No. 518. American College

of Obstetricians and Gynecologists 2012;119:412-7.

References

County Program

Daytime Number

Allegany Family Crisis Resource Center 301-759-9946

Anne Arundel YWCA Domestic Violence Services 410-626-7800

Baltimore City House of Ruth MD 410-889-0840

TurnAround, Inc. 410-837-7000

Baltimore

County

Family and Children’s Services of Central MD 410-281-1334

Family Crisis Center of Baltimore County, Inc. 410-285-4357

TurnAround, Inc. 410-377-8111

Calvert Crisis Intervention Center 410-535-5400

(x384)

Carroll Family and Children’s Services of Central MD 410-876-1233

Caroline Mid-Shore Council on Family Violence 410-479-1149

Cecil Cecil Co. Domestic Violence/Rape Crisis Center 410-996-0333

Charles Center for Abused Persons 301-645-8994

Dorchester Mid-Shore Council on Family Violence 410-479-1149

Frederick Heartly House 301-418-6610

Garrett The Dove Center 301-334-6255

Harford Sexual Assault/Spouse Abuse Resource Center 410-836-8431

Howard Domestic Violence Center 410-997-0304

Kent Mid-Shore Council on Family Violence 410-479-1149

Montgomery Abused Persons Program 240-777-4210

Prince

George’s

Family Crisis Center, Inc. 301-779-2100

House of Ruth MD (legal, counseling services) 240-450-3270

Queen Anne’s Mid-Shore Council on Family Violence 410-479-1149

St. Mary’s Walden/Sierra, Inc. 301-863-6677

Somerset Life Crisis Center 410-749-0771

Talbot Mid-Shore Council on Family Violence 410-479-0771

Washington CASA (Citizens Assisting and Sheltering the Abused) 301-739-4990

Wicomico Life Crisis Center 410-749-0771

Worcester Life Crisis Center 410-749-0771

Asian/Spanish resources:

Asian/Pacific Islander Domestic Violence Resource Project 202-464-4477

Adelante Familia 410-732-2176



The Maryland Network Against Domestic Violence (www.mnadv.org/) has

information on Maryland resources by jurisdiction, population (immigrant, military,

disabled) and service type (legal, faith-based).

MarylandDomesticViolence/intimatePartnerViolence(IPV)ServicePrograms

National Domestic Violence Hotline

(Has interpreters for 170 languages and links to local DV hotlines)

1-800-799-SAFE (7233), or 1-800-787-3224 TTY

Maryland Helpline 1-800-MD-HELPS (800-634-3577)

National Teen Dating Abuse

1-866-331-9474

On-line chat www.loveisrespect.org

Rape, Abuse & Incest National Network (RAINN) Hotline

1-800-656-HOPE (4673)

ACOG Committee Opinion, Intimate Partner Violence 2012

http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committ

ee_on_Health_Care_for_Underserved_Women/Intimate_Partner_Violence

ACOG Committee Opinion, Reproductive and Sexual Coercion 2013

http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Health%20C

are%20for%20Underserved%20Women/co554.pdf?dmc=1&ts=20130126T1003210611

AMA Violence Prevention

http://www.ama-assn.org/ama/pub/physician-resources/public-health/promoting-

healthy-lifestyles/violence-prevention.shtml

Break the Cycle, Empowering Youth to End Dating Violence

www.breakthecycle.org

CDC Injury Center: Violence Prevention

http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/index.html

Futures Without Violence (excellent resource for providers, brochures)

www.FuturesWithoutViolence.org

House of Ruth (Maryland)

www.hruth.org

Maryland Coalition Against Sexual Assault (MCASA)

www.mcasa.org

410-974-4507

Hotlines/Helpline

Resources

Maryland Health Care Coalition Against Domestic Violence (brochures available)

www.healthymaryland.org/public-health/domestic-violence/

Maryland Network Against Domestic Violence

1-800-MD-HELPS (1-800-634-3577)

www.mnadv.org

Maryland Pregnancy Risk Assessment Monitoring System (PRAMS)

Focus Brief, Intimate Partner Violence (IPV), February 2011

www.MarylandPRAMS.org

National Coalition Against Domestic Violence

www.ncadv.org

National Intimate Partner and Sexual Assault Survey

http://www.cdc.gov/ViolencePrevention/pdf/NISVS_Report2010-a.pdf

National Network to End Domestic Violence

www.nnedv.org

National Resource Center on Domestic Violence

www.nrcdv.org

National Sexual Violence Resource Center

www.nsvrc.org

National Violence Against Women Prevention Research Center

http://www.musc.edu/vawprevention/

Office on Violence Against Women, U.S. Department of Justice

www.usdoj.gov/ovw

Rape, Abuse and Incest National Network (RAINN)

www.rainn.org

Safe for All (includes information for male victims)

http://safe4all.org

U.S. Preventive Services Task Force Statement on IPV Assessment

http://annals.org/article.aspx?articleid=1558517

Women’s Law Center of Maryland, Inc.