AddressingAddressingDomestic ViolenceDomestic Violence

Elizabeth W Bierer, MDElizabeth W Bierer, MD

Domestic ViolenceDomestic Violence

DeliberateDeliberate

Pattern of controlling and assaultive Pattern of controlling and assaultive behaviorbehavior

Effort to gain power and maintain controlEffort to gain power and maintain control

Types of AbuseTypes of Abuse

PhysicalPhysical PsychologicalPsychological SexualSexual Verbal/emotionalVerbal/emotional EconomicEconomic FinancialFinancial LegalLegal

Risk FactorsRisk Factors

PovertyPoverty UnemploymentUnemployment Substance abuseSubstance abuse HomelessnessHomelessness Exposure to other violence in the Exposure to other violence in the

communitycommunity

IMPORTANT: knows NO boundariesIMPORTANT: knows NO boundaries

National StatisticsNational Statistics On average, more than three women are murdered by their husbands or boyfriends in On average, more than three women are murdered by their husbands or boyfriends in

this country every day. this country every day. (Bureau of Justice Statistics Data Brief, Intimate Partner Violence, 1993-2001, February 2003).(Bureau of Justice Statistics Data Brief, Intimate Partner Violence, 1993-2001, February 2003).

Thirty seven percent of women who sought treatment in an emergency room for Thirty seven percent of women who sought treatment in an emergency room for violence-related injuries were injured by a current or former intimate partner. violence-related injuries were injured by a current or former intimate partner. (U.S. (U.S. Department of Justice, Violence by Intimates: Analysis of Data on Crimes by Current or Former Spouses, Boyfriends, and Girlfriends, Department of Justice, Violence by Intimates: Analysis of Data on Crimes by Current or Former Spouses, Boyfriends, and Girlfriends, March 1998).March 1998).

Abuse in relationships exists among all classes, races and cultural groups, although Abuse in relationships exists among all classes, races and cultural groups, although women between ages 16 and 24 are nearly three times more vulnerable to intimate women between ages 16 and 24 are nearly three times more vulnerable to intimate partner violence partner violence (Intimate Partner Violence & Age of Victim, U.S. Department of Justice, Bureau of Justice Statistics, 1999).(Intimate Partner Violence & Age of Victim, U.S. Department of Justice, Bureau of Justice Statistics, 1999).

A recent National Crime Victimization survey found that women were 6 times more A recent National Crime Victimization survey found that women were 6 times more than men to experience violence at the hands of an intimate partner. than men to experience violence at the hands of an intimate partner.

http://www.cpedv.org/stats.htmlhttp://www.cpedv.org/stats.html

California StatisticsCalifornia Statistics

Every year, almost 6% of California ’s women suffer physical injuries from domestic violence. Every year, almost 6% of California ’s women suffer physical injuries from domestic violence. (California Women’s Health Survey, 1998-99).(California Women’s Health Survey, 1998-99).

In 2002, 153 murders were the result of intimate partner violence in California . In 2002, 153 murders were the result of intimate partner violence in California . (California Department of (California Department of Justice [DOJ], Criminal Justice Statistics)Justice [DOJ], Criminal Justice Statistics)

In 2002, 128 women in California were killed by their husbands, ex-husbands or boyfriends, and In 2002, 128 women in California were killed by their husbands, ex-husbands or boyfriends, and 25 men were killed by their wives, ex-wives or girlfriends. 25 men were killed by their wives, ex-wives or girlfriends. (DOJ, Criminal Justice Statistics Center )(DOJ, Criminal Justice Statistics Center )

California law enforcement received 196,569 domestic violence calls in 2002 --- 119,850 involved California law enforcement received 196,569 domestic violence calls in 2002 --- 119,850 involved weapons, including firearms and knives. weapons, including firearms and knives. (DOJ, Criminal Justice Statistics Center )(DOJ, Criminal Justice Statistics Center )

About 916,000 children were exposed to intimate partner violence at home in 1998. About 916,000 children were exposed to intimate partner violence at home in 1998. (Department of (Department of Health Services, California Women’s Health Survey, 1998-99).Health Services, California Women’s Health Survey, 1998-99).

Nearly 1 in 5 women who went hungry because they did not have enough money to buy food was Nearly 1 in 5 women who went hungry because they did not have enough money to buy food was also a victim of intimate partner violence also a victim of intimate partner violence (Department of Health Services, California Women’s Health Survey, 1998-99).(Department of Health Services, California Women’s Health Survey, 1998-99).

http://www.cpedv.org/stats.htmlhttp://www.cpedv.org/stats.html

Contra Costa CountyContra Costa County

Most at risk cities in the three regions Most at risk cities in the three regions (east,west,central):(east,west,central): RichmondRichmond

AntiochAntioch

ConcordConcord

Tracking systemTracking system

Office of the Sheriff maintains:Office of the Sheriff maintains: Automated Regional Information Exchange System Automated Regional Information Exchange System

““ARIESARIES” database and the ” database and the Domestic Violence Relational DatabaseDomestic Violence Relational Database

• Linked to vital criminal justice recordsLinked to vital criminal justice records Can be accessed by multiple agenciesCan be accessed by multiple agencies Increasing investigative capacityIncreasing investigative capacity

• Tracks active warrants, restraining orders, case disposition, Tracks active warrants, restraining orders, case disposition, terms of parole, injury specificsterms of parole, injury specifics

Access more info at: www.cocosheriff.orgAccess more info at: www.cocosheriff.org

Zero ToleranceZero Tolerance Program created in 2000 to address domestic, family Program created in 2000 to address domestic, family

and elder abuse/violence in Contra Costa Countyand elder abuse/violence in Contra Costa County FIRST Zero Tolerance county in California!FIRST Zero Tolerance county in California!

Develops and delivers direct services to people through Develops and delivers direct services to people through partnershipspartnerships

Advances policy changeAdvances policy change

Collaborate with, amongst many, STAND! against Collaborate with, amongst many, STAND! against domestic violencedomestic violence

Zero Tolerance ProjectsZero Tolerance Projects Supervised VisitationSupervised Visitation

The DELTA ProjectThe DELTA Project Prevent first time Prevent first time

domestic violencedomestic violence

Grants to encourage Grants to encourage arrestarrest

Safe and Bright FuturesSafe and Bright Futures

http://contracostazt.org/documents/posters.pdfhttp://contracostazt.org/documents/posters.pdf

Originated as a volunteer crisis line in 1977 (CALL)Originated as a volunteer crisis line in 1977 (CALL)

Became Battered Women’s alternatives with addition of Became Battered Women’s alternatives with addition of resources/shelters.resources/shelters.

Started opening shelter centers (emergency and transitional)Started opening shelter centers (emergency and transitional) Margaret Lesher Housing and Employment CenterMargaret Lesher Housing and Employment Center Rollie Mullen CenterRollie Mullen Center

Now has offices in all regions of the county Now has offices in all regions of the county Antioch, Richmond, Pittsburg being the newest in 2002/2003Antioch, Richmond, Pittsburg being the newest in 2002/2003

60 Staff and 150+ volunteers60 Staff and 150+ volunteers

More on STAND!More on STAND!

Provide Provide Support Support ShelterShelter Training to people who are abused, Training to people who are abused, Treatment programs to people who abuse, Treatment programs to people who abuse, Preventive education programs to youth, Preventive education programs to youth,

children and adults who might experience children and adults who might experience abuse in the future. abuse in the future.

My ProjectMy Project

Acquired Domestic violence posters and Acquired Domestic violence posters and referral cards from STAND!referral cards from STAND!

Distributed them to residents with clinics Distributed them to residents with clinics outside of Martinezoutside of Martinez

In Martinez, placed them in the Family In Martinez, placed them in the Family Medicine clinic bathrooms Medicine clinic bathrooms

Distributed referral cards to several Distributed referral cards to several residents (I have more, and will be getting residents (I have more, and will be getting more!!)more!!)

Continuing my projectContinuing my project

Getting STAND! to give a presentation to Getting STAND! to give a presentation to our staff – Physicians, Nurses, Social our staff – Physicians, Nurses, Social workersworkers

Become more cognizant Become more cognizant screen my screen my patients, and recognize features patients, and recognize features suggestive of violencesuggestive of violence

Familiarize myself with Healthy People Familiarize myself with Healthy People 2010 initiatives2010 initiatives

Healthy People 2010Healthy People 2010

Studies have demonstrated a link between Studies have demonstrated a link between intimate partner violence (IPV) and 8 out intimate partner violence (IPV) and 8 out of 10 the Leading Health Indicators (LHIs)of 10 the Leading Health Indicators (LHIs)

IPV significant risk factor forIPV significant risk factor for Chronic health problemsChronic health problems

• Headaches, GI problems, depression, anxiety, Headaches, GI problems, depression, anxiety, sleep problems, PTSDsleep problems, PTSD

Health risk behaviorsHealth risk behaviors• Substance abuse, irresponsible sexual behaviorSubstance abuse, irresponsible sexual behavior

Leading Health Indicators and Leading Health Indicators and Intimate Partner ViolenceIntimate Partner Violence

IncludeInclude Overweight and obesityOverweight and obesity Tobacco useTobacco use Substance abuseSubstance abuse Sexual behaviorSexual behavior Mental healthMental health Injury and violenceInjury and violence Immunization Immunization Access to health careAccess to health care

Clues to violenceClues to violence Questions you may consider asking?Questions you may consider asking?

Does your partner act extremely jealous of others who pay attention to you, or Does your partner act extremely jealous of others who pay attention to you, or use jealousy to justify his/her actions? use jealousy to justify his/her actions?

Control your finances, behavior and even whom you socialize with? Control your finances, behavior and even whom you socialize with? Threaten to kill you or commit suicide? Threaten to kill you or commit suicide? Make you afraid by using looks, actions, and gestures like smashing things, Make you afraid by using looks, actions, and gestures like smashing things,

destroying your property or displaying weapons? destroying your property or displaying weapons? Make all the decisions? Make all the decisions? Stop you from seeing or talking to friends, family or limits your outside Stop you from seeing or talking to friends, family or limits your outside

involvement? involvement? Act like the abuse is no big deal; it's your fault or even denies doing it? Act like the abuse is no big deal; it's your fault or even denies doing it? Threatens to kill your pets? Threatens to kill your pets? Puts you down in front of other people, humiliates you, plays mind games and Puts you down in front of other people, humiliates you, plays mind games and

makes you feel as if you are crazy? makes you feel as if you are crazy? Prevents you from getting or keeping a job? Prevents you from getting or keeping a job? Takes your money or does not let you know about or have access to the family Takes your money or does not let you know about or have access to the family

income? income? Blame drugs or alcohol for his violent behavior? Blame drugs or alcohol for his violent behavior? Threatens to take the children away? Threatens to take the children away?

Somewhere we can all startSomewhere we can all start

Prenatal care!Prenatal care! Those who are victims of IPV are less likely to Those who are victims of IPV are less likely to

access healthcare, but this is a time they do access healthcare, but this is a time they do access itaccess it

Violence in PregnancyViolence in Pregnancy Homicide is the second leading cause of traumatic death for pregnant and recently

pregnant women in the U.S., accounting for 31 percent of maternal injury deaths.

Women experiencing abuse in the year prior to and/or during a recent pregnancy are 40 to 60 percent more likely than non-abused women to report high-blood pressure, vaginal bleeding, severe nausea, kidney or urinary tract infections and hospitalization during pregnancy and are 37 percent more likely to deliver preterm.

Children born to abused mothers are 17 percent more likely to be born underweight and more than 30 percent more likely than other children to require intensive care upon birth.

Few doctors screen their patients for abuse, even though up to one in 12 pregnant women are battered.

Women who were screened for abuse and given a wallet sized referral reported fewer threats of violence, assaults or even harassment at work.

GoalGoal

Personal:Personal: Screening all my prenatal patients at least Screening all my prenatal patients at least

once while following them during their once while following them during their pregnancypregnancy

For the residency:For the residency: Get an area on the prenatal record that Get an area on the prenatal record that

indicates we (not Healthy Start) have indicates we (not Healthy Start) have addressed it in prenatal care at least once.addressed it in prenatal care at least once.

Family Medicine PracticeFamily Medicine Practice

These are our patients!!These are our patients!! I urge everyone to remind yourself to:I urge everyone to remind yourself to:

screen patients, screen patients, talk with them, talk with them, give them the information they need to give them the information they need to

prevent, treat and escape a harmful situationprevent, treat and escape a harmful situation

ResourcesResources Treatment:Treatment:

Anger Management for Families - Center for Human Dev. Anger Management for Families - Center for Human Dev. 391 Taylor Boulevard, Suite 120 391 Taylor Boulevard, Suite 120 Pleasant Hill, CA  94523 Pleasant Hill, CA  94523 (925) 687-8844 Ext. 224 (925) 687-8844 Ext. 224

Asian Pacific Psychological Services - Richmond Asian Pacific Psychological Services - Richmond 3905 MacDonald Street 3905 MacDonald Street Richmond, CA  94805 Richmond, CA  94805 (510) 233-7555  (510) 233-7555 

Domestic Violence Support Group Domestic Violence Support Group 3919 Roosevelt Ave. 3919 Roosevelt Ave. Richmond, CA  94805 Richmond, CA  94805 (510) 233-8595 Information  (510) 233-8595 Information  

Domestic Violence Treatment Program - Alpha Family Services Domestic Violence Treatment Program - Alpha Family Services 31 Raye Avenue 31 Raye Avenue Oakley, CA  94561 Oakley, CA  94561 (925) 625-9318 Confidential Line (925) 625-9318 Confidential Line

Familias Seguras - ECMHP Familias Seguras - ECMHP 4101 Macdonald Avenue 4101 Macdonald Avenue Richmond, CA  94805 Richmond, CA  94805 (510) 412-9200  (510) 412-9200 

Korean Community Center of the East Bay Korean Community Center of the East Bay 4390 Telegraph Avenue, Suite A 4390 Telegraph Avenue, Suite A Oakland, CA  94609 Oakland, CA  94609 (510) 547-2662  (510) 547-2662 

Peace Creations Peace Creations 2960 Camino Diablo, Suite 200 2960 Camino Diablo, Suite 200 Walnut Creek, CA  94597 Walnut Creek, CA  94597 (925) 988-9505  (925) 988-9505 

POCOVI - Centro de Educacion Familiar POCOVI - Centro de Educacion Familiar 474 Valencia Street, Suite 150 474 Valencia Street, Suite 150 San Francisco, CA  94103 San Francisco, CA  94103 (415) 552-1361  (415) 552-1361 

Riley Center - Community Office - St. Vincent De Paul Riley Center - Community Office - St. Vincent De Paul 3543-18th Street, # 4 3543-18th Street, # 4 San Francisco, CA  94110 San Francisco, CA  94110 (415) 255-0165 Crisis line (415) 255-0165 Crisis line

Saving Our Sons and Daughters - Concord Saving Our Sons and Daughters - Concord 3039 Willow Pass Road 3039 Willow Pass Road Concord, CA  94519 Concord, CA  94519 (925) 432-4200   (925) 432-4200   

Saving Our Sons and Daughters - Pittsburg Saving Our Sons and Daughters - Pittsburg 3330 Loveridge Road 3330 Loveridge Road Pittsburg, CA  94565 Pittsburg, CA  94565 (925) 432-4200   (925) 432-4200   

Saving Our Sons and Daughters - Richmond Saving Our Sons and Daughters - Richmond 598 Nevin Avenue 598 Nevin Avenue Richmond, CA  94801 Richmond, CA  94801 (510) 215-0130  (510) 215-0130 

ResourcesResources Legal:Legal:

Bay Area Legal Aid - East/Central County Bay Area Legal Aid - East/Central County 1901 Railroad Avenue, Suite D 1901 Railroad Avenue, Suite D Pittsburg, CA  94565 Pittsburg, CA  94565 (800) 551-5554 Toll free Advice Line  (800) 551-5554 Toll free Advice Line  

Bay Area Legal Aid - West County Bay Area Legal Aid - West County 1025 Macdonald Avenue 1025 Macdonald Avenue Richmond, CA  94801 Richmond, CA  94801 (510) 233-9954 Office (510) 233-9954 Office

Domestic Violence Restraining Order Clinic - Pittsburg - STAND! Domestic Violence Restraining Order Clinic - Pittsburg - STAND! ***CONFIDENTIAL*** ***CONFIDENTIAL*** Pittsburg, CA  94563 Pittsburg, CA  94563 (888) 215-5555 Crisis hotline  (888) 215-5555 Crisis hotline  

Domestic Violence Restraining Order Petitioners Clinic Domestic Violence Restraining Order Petitioners Clinic Richmond Superior Court Richmond Superior Court 100-37th Street 100-37th Street Richmond, CA  94805 Richmond, CA  94805 (510) 965-4048 Clinic  (510) 965-4048 Clinic  

Domestic Violence Restraining Order Respondents Clinic Domestic Violence Restraining Order Respondents Clinic Richmond Superior Court Richmond Superior Court 100-37th Street 100-37th Street Richmond, CA  94805 Richmond, CA  94805 (510) 965-4048 Clinic (510) 965-4048 Clinic

Legal Advocacy Program - STAND! Legal Advocacy Program - STAND! ***CONFIDENTIAL*** ***CONFIDENTIAL*** Concord, CA  94524 Concord, CA  94524 (888) 215-5555 Crisis hotline (888) 215-5555 Crisis hotline

ResourcesResources Shelter:Shelter:

Asian Women's Shelter (AWS) Asian Women's Shelter (AWS) 3543-18th Street, Suite 19 3543-18th Street, Suite 19 San Francisco, CA  94110 San Francisco, CA  94110 (877) 751-0880 Crisis (877) 751-0880 Crisis

Emergency Shelter - STAND! Emergency Shelter - STAND! ***CONFIDENTIAL*** ***CONFIDENTIAL*** Concord, CA   Concord, CA   (888) 215-5555 Crisis hotline (888) 215-5555 Crisis hotline

Homeless Assistance Program - CCCEHSD Homeless Assistance Program - CCCEHSD 400 Ellinwood Way 400 Ellinwood Way Pleasant Hill, CA  94523 Pleasant Hill, CA  94523 (925) 602-9379 Pleasant Hill (925) 602-9379 Pleasant Hill

Korean Community Center of the East Bay Korean Community Center of the East Bay 4390 Telegraph Avenue, Suite A 4390 Telegraph Avenue, Suite A Oakland, CA  94609 Oakland, CA  94609 (510) 547-2662  (510) 547-2662 

La Casa de Las Madres La Casa de Las Madres 1663 Mission Street, Suite 225 1663 Mission Street, Suite 225 San Francisco, CA  94103 San Francisco, CA  94103 (415) 503-0500  (415) 503-0500 

Riley Center - Brennan House - St. Vincent De Paul Riley Center - Brennan House - St. Vincent De Paul ***CONFIDENTIAL*** ***CONFIDENTIAL*** San Francisco, CA  94110 San Francisco, CA  94110 (415) 255-2894  (415) 255-2894 

Riley Center - Rosalie House - St Vincent De Paul Riley Center - Rosalie House - St Vincent De Paul ***CONFIDENTIAL*** ***CONFIDENTIAL*** San Francisco, CA  94110 San Francisco, CA  94110 (415) 255-0165 Crisis line (415) 255-0165 Crisis line

Safe At Home Confidential Address Program Safe At Home Confidential Address Program 1500 11th Street 1500 11th Street Sacramento, CA  95814 Sacramento, CA  95814 (877) 322-5227  (877) 322-5227 

Shelter Against Violent Environments, Inc. (SAVE) Shelter Against Violent Environments, Inc. (SAVE) 39155 Liberty Street, Suite C310 39155 Liberty Street, Suite C310 Fremont, CA  94538 Fremont, CA  94538 (510) 794-6055 24 hour Crisis Hotline  (510) 794-6055 24 hour Crisis Hotline  

Sister Me Home Safe House - Building Futures for Women & Children Sister Me Home Safe House - Building Futures for Women & Children 1385 Bancroft, Suite 13 1385 Bancroft, Suite 13 San Leandro, CA  94577 San Leandro, CA  94577 (866) 292-9688 866-A-WAY-OUT  (866) 292-9688 866-A-WAY-OUT  

Tri-Valley Haven Tri-Valley Haven 3663 Pacific Avenue 3663 Pacific Avenue Livermore, CA  94550 Livermore, CA  94550 (800) 884-8119 Toll-Free (800) 884-8119 Toll-Free

ResourcesResources Multiple Services:Multiple Services:

Maitri Maitri 234 East Gish Road, Suite 200 234 East Gish Road, Suite 200 Sunnyvale, CA  95112 Sunnyvale, CA  95112 (888) 862-4874 (888) 8 MAITRI  (888) 862-4874 (888) 8 MAITRI  

Narika Narika P.O. Box 14014 P.O. Box 14014 Berkeley, CA  94712 Berkeley, CA  94712 (800) 215-7308 Helpline (800) 215-7308 Helpline

Korean Community Center of the East Bay Korean Community Center of the East Bay 4390 Telegraph Avenue, Suite A 4390 Telegraph Avenue, Suite A Oakland, CA  94609 Oakland, CA  94609 (510) 547-2662  (510) 547-2662 

La Casa de Las Madres La Casa de Las Madres 1663 Mission Street, Suite 225 1663 Mission Street, Suite 225 San Francisco, CA  94103 San Francisco, CA  94103 (415) 503-0500  (415) 503-0500 

STAND! Against Domestic Violence - Central County STAND! Against Domestic Violence - Central County 1410 Danzig Plaza, 2nd Floor 1410 Danzig Plaza, 2nd Floor Concord, CA  94520 Concord, CA  94520 (888) 215-5555 Crisis Hotline  (888) 215-5555 Crisis Hotline  

STAND! Against Domestic Violence - East County STAND! Against Domestic Violence - East County 2400 Sycamore Street, #6 2400 Sycamore Street, #6 Antioch, CA  94509 Antioch, CA  94509 (888) 215-5555 Crisis Hotline (888) 215-5555 Crisis Hotline

STAND! Against Domestic Violence - West County STAND! Against Domestic Violence - West County 12230 San Pablo Ave 12230 San Pablo Ave Richmond, CA  94805 Richmond, CA  94805 (888) 215-5555 Crisis Hotline (888) 215-5555 Crisis Hotline

ReferencesReferences Zero Tolerance for Domestic Violence Zero Tolerance for Domestic Violence

http://contracostazt.org/background.phphttp://contracostazt.org/background.php California Partnership to end domestic violence (CPEDV) California Partnership to end domestic violence (CPEDV)

http://www.cpedv.org/stats.htmlhttp://www.cpedv.org/stats.html Family Violence Prevention Fund Family Violence Prevention Fund

http://www.endabuse.org/content/action_center/detail/754http://www.endabuse.org/content/action_center/detail/754 Family Violence Prevention Fund Facts on Reproductive Health and Family Violence Prevention Fund Facts on Reproductive Health and

Violence against women Violence against women http://www.endabuse.org/userfiles/file/Children_and_Families/Reprodhttp://www.endabuse.org/userfiles/file/Children_and_Families/Reproductive.pdfuctive.pdf

STAND! Against Domestic Violence STAND! Against Domestic Violence http://www.standagainstdv.org/aboutdomviolence.phphttp://www.standagainstdv.org/aboutdomviolence.php

Safe Network http://www.safenetwork.net/Safe Network http://www.safenetwork.net/ 211 Database http://www.irissoft.com/cccc/search.asp211 Database http://www.irissoft.com/cccc/search.asp