This 15 unit course
addresses the
'red flags'
assessment,
detection, and
intervention strategies including
community resources,
cultural factors,
substance abuse,
same gender abuse dynamics, and
treatment regarding
spousal or partner abuse
and may be taken in fulfillment of the CA BBS and BOP mandated continuing abuse requirement

Increasingly, gender-based violence is recognized as a major public health concern and a violation of human rights. The effects of violence can be devastating to a woman's reproductive health as well as to other aspects of her physical and mental well-being. In addition to causing injury, violence increases women's long-term risk of a number of other health problems, including chronic pain, physical disability, drug and alcohol abuse, and depression. Women with a history of physical or sexual abuse are also at increased risk for unintended pregnancy, sexually transmitted infections, and adverse pregnancy outcomes. Yet victims of violence who seek care from health professionals often have needs that providers do not recognize, do not ask about, and do not know how to address."(Ending violence against women, a report from the Center for Communications Programs, Johns Hopkins University at http://www.infoforhealth.org/pr/l11edsum.shtml)Volume XXVII, Number 4
December, 1999
Series L, Number 11
Issues in World Health

RED FLAGS

The best way to uncover a history of abuse in female clients is to ask about it. Nonetheless, several types of physical injuries, health conditions, and client behavior should raise health care providers' suspicion of domestic violence or sexual abuse. When these signs, or 'red flags,' are present, providers should be sure to ask their clients about possible abuse, remembering to be empathic and respectful of the client's privacy.

Domestic Violence		Sexual Abuse
	Chronic, vague complaints that have no obvious physical cause,		Pregnancy of unmarried girls under age 14,
	Injuries that do not match the explanation of how they occurred,		Sexually transmitted infections in children or young girls,
	A male partner who is overly attentive, controlling, or unwilling to leave the woman's side,		Vaginal itching or bleeding,
	Physical injury during pregnancy,		Painful defecation or painful urination,
	Late entry into prenatal care,		Abdominal or pelvic pain,
	A history of attempted suicide or suicidal thoughts,		Sexual problems, lack of pleasure,
	Delays between injuries and seeking treatment,		Vaginismus (spasms of the muscles around the opening of the vagina),
	Urinary tract infection,		Sleeping problems,
	Chronic irritable bowel syndrome,		A history of chronic, unexplained physical symptoms,
	Chronic pelvic pain.		Having difficulty with or avoiding pelvic exams,
			Problems with alcohol and drugs,
			Sexual 'acting out,'
			Extreme obesity.
Fuente: Center for Health and Gender Equity y Family Violence Prevention Fund (460).

source: http://www.infoforhealth.org/pr/l11/l11pullout.shtml#top

What are the warning signs of an abusive spouse or partner?
According to the National Coalition Against Domestic Violence, the following signs are common predictors of abuse:

http://www.mentalhealth.org/highlights/october2003/domestic/

Professional, Ethical, and Legal Issues Concerning Partner and Spousal Abuse, Interpersonal Violence, Maltreatment, and Related Trauma

Please go to: Potential Problems for Psychologists Working with the Area of Interpersonal Violence

While this article is written specifically  for psychologists, it has important information about the dangers of working with spousal and partner abuse for all mental health professionals.

For Psychologists

"Interpersonal violence cases have the potential for the most dangerous outcomes. It is important for psychologists in their various roles to ensure safety, prevent harm whenever possible (General Principle E, F, and ES 1.14), and to warn clients or others in danger. In all interpersonal violence cases or alleged cases, it is crucial that some type of assessment of the abuse or violence be conducted, and the risk of harm be ascertained. It is also important that all clinical cases be evaluated or screened to determine the likelihood of present or past abuse or violence....

Psychologists should have an up-to-date awareness of the ethical and legal standards that affect their practice. Knowledge of confidentiality and exceptions to confidentiality is particularly important when working with clients who may be involved with violence." Please go to APAonline for the complete article at http://www.apa.org/pi/pii/professional.html?CFID=2636885&CFTOKEN=52026085

California psychologists please go to: http://www.psychceu.com/ca-bop_law_summary.pdf
for State Of California Department Of Consumer Affairs Board Of Psychology Summary Of California Laws Relating To The Practice Of Psychology.

You may need to get Adobe Acrobat to view this and other pdfs; please go to http://www.adobe.com/products/acrobat/readstep2_allversions.html
.

Who is vulnerable to being abused?

Physical violence in intimate relationships almost always is accompanied by psychological abuse and, in one-third to over one-half of cases, by sexual abuse (59, 75, 131, 258, 272). For example, among 613 abused women in Japan, 57% had suffered all three types of abuse—physical, psychological, and sexual. Only 8% had experienced physical abuse alone (485). In Monterrey, Mexico, 52% of physically abused women had also been sexually abused by their partners (191). In Le'n, Nicaragua, among 188 women who were physically abused by their partners, only 5 were not also abused sexually, psychologically, or both (131).
Most women who suffer any physical aggression generally experience multiple acts over time. In the Le'n study, for example, 60% of women abused in the previous year were abused more than once, and 20% experienced severe violence more than six times. Among women reporting any physical aggression, 70% reported severe abuse (130). The average number of physical assaults in the previous year among currently abused women surveyed in London was seven (308); in the US in 1997, three (436).
In surveys of partner violence, women usually are asked whether or not they have experienced any of a list of specific actions, such as being slapped, pushed, punched, beaten, or threatened with a weapon. Asking behavioral questions—for example, “Has your partner ever physically forced you to have sex against your will?”—yields more accurate responses than asking women whether they have been “abused” or “raped” (127). Surveys generally define physical acts more severe than slapping, pushing, shoving, or throwing objects as “severe violence.”
Measuring “acts” of violence does not describe the atmosphere of terror that often permeates abusive relationships. For example, in Canada's 1993 national violence survey one-third of women who had been physically assaulted by a partner said that they had feared for their lives at some point in the relationship (378). Women often say that the psychological abuse and degradation are even more difficult to bear than the physical abuse (57, 58, 96).
http://www.infoforhealth.org/pr/l11/l11chap2_1.shtml

From the Center for Disease Control

Intimate Partner Violence On This Page Overview Occurrence Consequences Groups at Risk Risk Factors References Overview Intimate partner violence—or IPV—is actual or threatened physical or sexual violence or psychological and emotional abuse directed toward a spouse, ex-spouse, current or former boyfriend or girlfriend, or current or former dating partner. Intimate partners may be heterosexual or of the same sex. Some of the common terms used to describe intimate partner violence are domestic abuse, spouse abuse, domestic violence, courtship violence, battering, marital rape, and date rape (Saltzman, et al. 1999). CDC uses the term intimate partner violence because it describes violence that occurs within all intimate relationships. Some of the other terms are overlapping and may be used to mean other forms of violence including abuse of elders, children, and siblings. Back to Top Occurrence Approximately 1.5 million women and 834,700 men are raped and/or physicallyassaulted by an intimate partner each year (Tjaden and Thoennes 2000a). Nearly two-thirds of women who reported being raped, physically assaulted, or stalked since age 18 were victimized by a current or former husband, cohabiting partner, boyfriend, or date (Tjaden and Thoennes 2000a). Among women who are physically assaulted or raped by an intimate partner, one in three is injured. Each year, more than 500,000 women injured as a result of IPV require medical treatment (Tjaden and Thoennes 2000a). As many as 324,000 women each year experience IPV during their pregnancy (Gazmararian, et al. 2000). Firearms were the major weapon type used in intimate partner homicides from 1981 to 1998 (Paulozzi, et al. 2001). Back to Top Consequences Intimate partner violence is associated with both short- and long-term problems, including physical injury and illness, psychological symptoms, economic costs, and death (National Research Council 1996). As a consequence of severe intimate partner violence, female victims are more likely than male victims to need medical attention and take time off from work; they also spend more days in bed and suffer more from stress and depression (National Research Council 1996). Each year, thousands of American children witness IPV within their families. Witnessing violence is a risk factor for long-term physical and mental health problems, including alcohol and substance abuse, being a victim of abuse, and perpetrating IPV (Felitti, et al. 1998). The health care costs of intimate partner rape, physical assault, and stalking exceed $5.8 billion each year, nearly $4.1 billion of which is for direct medical and mental health care services (CDC 2003). Back to Top Groups at Risk More women than men experience intimate partner violence. According to the National Violence Against Women Survey, 1 out of 4 U.S. women has been physically assaulted or raped by an intimate partner; 1 out of every 14 U.S. men reported such an experience (Tjaden and Thoennes 2000a). Women are more likely than men to be murdered in the context of intimate partner violence.Women ages 20 to 29 years are at greatest risk of being killed by an intimate partner (Paulozzi, et al. 2001). Nearly one-third of African American women experience IPV in their lifetimes compared with one-fourth of white women (Tjaden and Thoennes 2000b). According to the National Violence Against Women Survey, American Indian/Alaska Native women and men were most likely to report IPV, and Asian/Pacific Islander women and men were least likely to report IPV. It is unclear whether this difference is due to variations in willingness to report information about violence or to variations in incidence of IPV (Tjaden and Thoennes 2000b). Back to Top Risk Factors Alcohol use is frequently associated with violence between intimate partners. It is estimated that in 45% of cases of IPV, men had been drinking, and in about 20% of cases, women had been drinking (Roizen 1993). One study recently found that male partners’ unemployment and drug or alcohol use were associated with increased risk for physical, sexual, and/or emotional abuse (Coker, et al. 2000). Witnessing IPV as a child or adolescent, or experiencing violence from caregivers as a child, increases one’s risk of both perpetrating IPV and becoming a victim of IPV (Straus and Gelles 1990). Men who are physically violent towards their partners are also likely to be sexually violent towards their partners and are likely to use violence towards children (Straus and Gelles 1990). Perpetrators of IPV may lack some social skills, such as lack of communication skills, particularly in the context of problematic situations with their intimate partners (Holtzworth-Monroe, et al. 1997). Research has determined that violent husbands report more anger and hostility toward women when compared with nonviolent husbands (Holtzworth-Monroe, et al. 1997). A high proportion of IPV perpetrators report more depression, lower self-esteem, and more aggression than non-violent intimate partners. Evidence indicates that violent intimate partners may be more likely to have personality disorders such as schizoidal/borderline personality, antisocial or narcissistic behaviors, and dependency and attachment problems (Holtzworth-Monroe, et al. 1997). Back to Top Prevention Tips and Resources Back to Top References Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Costs of Intimate Partner Violence Against Women in the United States. Atlanta (GA): Centers for Disease Control and Prevention; 2003. Available on-line at http://www.cdc.gov/ncipc/pub-res/ipv_cost/ipv.htm. Coker AL, Smith PH, McKeown RE, Melissa KJ. Frequency and correlates of intimate partner violence by type: physical, sexual, and psychological battering. American Journal of Public Health 2000;90(4):553–9. Felitti V, Anda R, Nordenberg D, Williamson D, Spitz A, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine 1998;14(4):245–58. Gazmararian JA, Petersen R, Spitz AM, Goodwin MM, Saltzman LE, Marks JS. Violence and reproductive health; current knowledge and future research directions. Maternal and Child Health Journal 2000;4(2):79–84. Holtzworth-Monroe A, Bates L, Smutzler N, Sandin E. A brief review of the research on husband violence: part I: maritally violent versus nonviolent men. Aggression and Violent Behavior 1997;2(1):65–99. National Research Council. Understanding Violence Against Women. Washington (DC): National Academy Press; 1996. p. 74–80. Paulozzi LJ, Saltzman LA, Thompson MJ, Holmgreen P. Surveillance for homicide among intimate partners—United States, 1981–1998. CDC Surveillance Summaries 2001;50(SS-3):1–16. Roizen J. Issues in the epidemiology of alcohol and violence. In: Martin SE, editor. Alcohol and Interpersonal Violence: Fostering multidisciplinary perspectives. Bethesda (MD): National Institute on Alcohol Abuse and Alcoholism; 1993. p. 3–36. NIAAA Research Monograph No. 24. Saltzman LE, Fanslow JL, McMahon PM, Shelley GA. Intimate Partner Violence Surveillance: Uniform definitions and recommended data elements. Atlanta: National Center for Injury Prevention and Control; 1999. Straus MA, Gelles, RJ, editors. Physical Violence in American Families: Risk factors and adaptations to violence in 8,145 families. New Brunswick (NJ): Transaction Books; 1990. Tjaden P, Thoennes N. Full Report of the Prevalence, Incidence, and Consequences of Intimate Partner Violence Against Women: Findings from the National Violence Against Women Survey. Report for grant 93-IJ-CX-0012, funded by the National Institute of Justice and the Centers for Disease Control and Prevention. Washington (DC): NIJ; 2000. Tjaden P, Thoennes N. Extent, Nature, and Consequences of Intimate Partner Violence: Findings from the National Violence Against Women Survey. Report for grant 93-IJ-CX-0012, funded by the National Institute of Justice and the Centers for Disease Control. Washington (DC): NIJ; 2000. Wisner CL, Gilmer TP, Saltzman LE, Zink TM. Intimate partner violence against women: do victims cost health plans more? Journal of Family Practice 1999;48(6):439–43. Back to Top http://www.cdc.gov/

Abuse Questionnaire

http://www.infoforhealth.org/pr/l11/l11chap3.shtml

Women, Law and Development Centre Nigeria

As this poster from Nigeria illustrates, violence against women takes many forms. Often, social and cultural norms condone gender-based violence.

You may be becoming or already are a victim of abuse if you:

• Feel like you have to "walk on eggshells" to keep him from getting angry and are frightened by his temper.
• Feel you can't live without him.
• Stop seeing other friends or family, or give up activities you enjoy because he doesn't like them.
• Are afraid to tell him your worries and feelings about the relationship.
• Are often compliant because you are afraid to hurt his feelings; and have the urge to "rescue" him when he is troubled.
• Feel that you are the only one who can help him and that you should try to "reform" him.
• Find yourself apologizing to yourself or others for your partner's behaviour when you are treated badly.
• Stop expressing opinions if he doesn't agree with them.
• Stay because you feel he will kill himself if you leave.
• Believe that his jealousy is a sign of love.
• Have been kicked, hit, shoved, or had things thrown at you by him when he was jealous or angry.
• Believe the critical things he says to make you feel bad about yourself.
• Believe that there is something wrong with you if you don't enjoy the sexual things he makes you do.
• Believe in the traditional ideas of what a man and a woman should be and do -- that the man makes the decisions and the woman pleases him.
• (some people) Have been abused as a child or seen your mother abused.

If you are abused:

Look out for men who:

http://www.womanabuseprevention.com/html/abuse_signs.html

For children whose parents are in an abusive relationship

Things You Can Do To Stay Safe

Are you a child or teenager living in a home where violence occurs, either between your parents or your brothers and sisters?
If you answered yes, you should know that as a child living in an abusive household there are things that you can do to be safe.
You should not get in the middle of a fight between your parents or brothers and sisters, even if they ask you for help. This will not make the fighting stop, and you may get hurt.
If you want to help the abused person ask how or simply dial 911, learn important numbers including family and local emergency agencies, and go over a safety or escape plan with the abused person.
Tips on calling 911:
When dialing 911 there are ways to make the response quicker, and to ensure your safety. First tell the operator your name and address, tell them what is going on and where this is happening, and you should tell them if this has happened before.
Before an emergency situation occurs you should know:
*Your full name
*Your complete address including city, state and zip code
*Your entire phone number with area code
*What situations will lead you to call 911. If domestic violence is occurring in your house, you might want to make up a code word with the abused parent or sibling. If he/she uses that word then you will call 911
During an emergency situation you should know:
*Dialing 911 can reach police, the fire department or ambulance
*Try to remain calm
*When the 911 operator answers, state the problem briefly and give your full name and address
*Do not hang up the phone until the operator says to

Asking For Help
Asking for help does not mean you are going to get in trouble, but if you do get into trouble call the police again or speak to a trusted adult. Trusted adults can include your teachers, ministers, coaches or family members. If your parents are separated, divorced or never married, the school should know who can and cannot pick you up from school. If the person who is abusive visits your school or tries to remove you, please notify a teacher or the principal. They can help you decide what to do next.
If you need someone to talk to, there is help for you at school or somewhere in your community.

Don't Blame Yourself
As a child living in an abusive home, it’s easy to blame yourself and think that what is going on is your fault. You think "If I would be quieter, better at school, neater, more respectful and so on and so on." Living there, you must know that no matter how hard you try, it does not stop. You are not the problem.
If the abused person or the abuser at some time needs to leave the home for safety reasons, remember again this is not your fault. The abuser in your home has a problem. This person chooses to be violent or controlling. There is help for abusers. This help can come after you call the police or through counseling. The abuser needs to learn that he/she does not have the right to use violence, threats or intimidation to get what he/she wants. Staying may seem dangerous or even stupid to you, but there are reasons and some of them include your safety. Talk to the abused person, talk to a teacher, or call a hotline and make a safety plan. For more help, or someone to talk to please check the links section or call the National Domestic Violence Hotline at 1-800-799-SAFE.

-------------

Department of Health and Human Services:
HELPING CHILDREN  WHO WITNESS DOMESTIC VIOLENCE

HHS Secretary Tommy G. Thompson today announced a new initiative to help children who witness domestic violence to develop into healthy, well-adjusted adults and prevent the cycle of violence from continuing from one generation to the next.
The initiative, called "Safe and Bright Futures for Children," will incorporate evidence-based practices such as treatment for child and adolescent trauma, mentoring and mental health services while also addressing risk and protective factors to negate the cyclical effects of violence. It will encourage the integration of these services at the local and regional level by building collaborations of community, faith-based or other programs that identify, assess, treat and provide long-term services.
"Each year, there are nearly 700,000 documented incidents of domestic violence that threaten the well-being of children and families across our nation," Secretary Thompson said. "This new effort will provide preventive services and support to help children affected by this violence to enjoy a safe and bright future and to break the cycle of violence. We want to provide our youth with the skills and tools they need to make healthy choices in their lives."
Research has found that activities that involve and empower youth in their families, schools and communities can help protect them from harm. Under the new effort, HHS expects to provide funding for demonstration projects nationwide to serve children and adolescents who witness or are exposed to domestic violence.
A significant percentage of children who witness domestic violence eventually become abusers or victims of abuse. In addition, children who witness domestic violence are more likely to exhibit behavioral and physical health problems including depression, anxiety and violence towards peers. Adolescents are also more likely to attempt suicide, abuse drugs and alcohol, run away from home, engage in teenage prostitution and commit sexual assault crimes.

U.S. Department of Health & Human Services • 200 Independence Avenue, S.W. • Washington, D.C. 20201
http://www.hhs.gov/news/press/2003pres/20031008.html

Please go to the:

WORKSHOP ON CHILDREN EXPOSED TO VIOLENCE:
CURRENT STATUS, GAPS, AND RESEARCH PRIORITIES

WORKSHOP SPONSORS:
National Institute of Child Health and Human Development (NICHD)
National Institute on Drug Abuse (NIDA)
National Institute of Mental Health (NIMH)
Fogarty International Center (FIC)
Office of Behavioral and Social Sciences Research (OBSSR)
Office of the Assistant Secretary for Planning and Evaluation (ASPE)
Centers for Disease Control and Prevention (CDC)
Substance Abuse and Mental Health Services Administration (SAMHSA)
Department of Health and Human Services (DHHS)
National Institute of Justice (NIJ)
Department of Justice
Office of Special Education Programs (OSEP)
Department of Education

Same Gender Abuse Dynamics

Abuse in Same-Sex Relationships [reprinted with permission from the authors] Nature of Abuse: Abuse in relationships is any behavior or pattern of behavior used to coerce, dominate or isolate the other partner. It is the use of any form of power that is imposed by one partner over the other to maintain control within the relationship. Abuse includes but is not limited to: Physical Abuse - hitting; choking; slapping; burning; shoving; using a weapon; physically restraining; intentional interference with basic needs (e.g. food, medicine, sleep) Isolation: Restricting Freedom - controlling contacts with friends and family, access to information and participation in groups or organizations; locking up in a room / restricting mobility; monitoring telephone calls Psychological & Emotional Abuse - constantly criticizing, ridiculing (self, family, friends, past); trying to humiliate or degrade; lying; undermining self-esteem; misleading someone about the norms and values of the gay/lesbian communities in order to control or exploit them Stalking / Harassing Behavior - following; turning up at workplace or house; parking outside; repeated phone calls or mail to victim and/or family, friends, colleagues Threats & Intimidation - threatening to harm partner, self or others (children, family, friends, pets); threatening to make reports to authorities that jeopardize child custody, immigration or legal status; threatening to disclose HIV status, threatening to reveal sexual orientation to family, friends, neighbors, and/or employers Economic Abuse - controlling or stealing money; fostering dependency; making financial decisions without asking or telling partner Sexual Abuse/Harassment - forcing sex or specific acts, pressuring into unwanted sexual behavior, criticizing performance Property Destruction - destroying mementos, breaking furniture or windows, throwing or smashing objects, trashing clothes or other possessions Common Myths About Abuse in Lesbian Relationships: "Women are not abusive - only men are." Anyone can choose to be abusive or not. "Lesbians are always equal in relationships. It is not abuse, it is a relationship struggle." Two women in a relationship do not automatically guarantee equality. Relationship struggles are never equal if abuse is involved. "Abusive lesbians are more "butch," larger, apolitical or have social lives that revolve around the bar culture." Abuse occurs regardless of race, class, religion, age, political affiliation, lifestyle, or physical attributes. "Lesbian violence is caused by drugs, alcohol, stress, childhood abuse." While these factors can be important, they do not excuse the abuse. "Lesbian abusers have been abused/oppressed by men are therefore not as responsible for what they do." This is an excuse; abuse will only stop when responsibility is taken for the abuse. "It is easier for a lesbian to leave her abusive partner that it is for a heterosexual woman to leave her abusive partner." It is never easy to leave an abusive relationship. Common Myths About Abuse in Gay Male Relationships: "Gay men are rarely victims of abuse by their partners." Men can be and are abused. This myth makes it particularly hard for men to come forward for help. "When violence occurs between gay men in a relationship, it's a fight, it's normal, it's 'boys will be boys.'" Using violence or 'taking it' is not normal; it is an unhealthy way to relate to others. "Abuse in gay male relationships primarily involves apolitical gay men, or gay men who are part of the bar culture." Abuse occurs regardless of race, class, religion, age, political affiliation or life style. "Abuse in gay male relationships is sexual behavior: it's a version of sadomasochism and the victims actually like it." In s/m there are mutually agreed upon verbal contracts between the involved parties. No such contract exists between an abuser and his victim.* "It is easier for a gay man to leave his abusive partner that it is for a heterosexual woman to leave her abusive partner." It is never easy to leave an abusive relationship. *This applies to lesbian relationships as well. Abuse in Same-Sex Relationships Versus Abuse in Opposite-Sex Relationships: What is the Same: Abuse is always the responsibility of the abuser and is always a choice. Victims are often blamed for the abuse by partners, and sometimes even family, friends and professionals can excuse or minimize the abusive behavior. It is difficult for victims to leave abusive relationships. Abuse is not an acceptable or healthy way to solve difficulties in relationships, regardless of orientation. Victims feels responsible for their partner's violence and their partner's emotional state, hoping to prevent further violence. Abuse usually worsens over time. The abuser is often apologetic after abusing, giving false hope that the abuse will stop. Some or all of the following effects of abuse may be present: shame, self-blame, physical injuries, short and long-term health problems, sleep disturbances, constantly on guard, social withdrawal, lack of confidence, low self-esteem, anxiety, depression, feelings of hopelessness, shock, and dissociative states. What is Different: Very limited services exist specifically for abused and abusive lesbians and gay men. Lesbians and gay men often experience a lack of understanding of the seriousness of the abuse when reporting incidences of violence to a therapist, police officer or medical personnel. Homophobia in society denies the reality of lesbian and gay men's lives, including the existence of lesbian and gay male relationships, let alone abusive ones. When abuse exists, attitudes often range from 'who cares' to 'these relationships are generally unstable or unhealthy.' Shelters for abused women may not be sensitive to same-sex abuse (theoretically, shelters are open to all women and therefore, a same-sex victim may not feel safe as her abuser may also have access to the shelter). Abused gay men have even fewer places to turn for help in that there are no agency-sponsored safe places to stay. In lesbian and gay male relationships, there may be additional fears of losing the relationship which confirms one's sexual orientation; fears of not being believed about the abuse and fears of losing friends and support within the lesbian/gay communities. What To Do If You're Being Abused: Recognize that you are not responsible for the abuse. Recognize that violence/abuse is not likely to stop on its own - episodes of violence usually become more frequent and more severe. It is important to break the silence. Try to tell someone who will believe you. Seek professional help from a qualified counselor who is knowledgeable about partner abuse and is lesbian/gay positive. A lesbian or gay male counselor with the above qualities may help you address the pertinent issues of abuse with more comfort and focus. Only you can decide what to do about your relationship - whether to stay or leave is your decision. However, it is important to develop a safety plan in case your safety and/or your children's safety is in jeopardy such as: a safe place to stay; emergency phone numbers; some money; your own bank account; post office box; and bag of essentials.   What To Do If You're Being Abusive: Stop being abusive. Stop using abuse of any form (physical, sexual, verbal or emotional), including threats and intimidation. Accept responsibility for your behavior. Remember that the use of violence in any form is always a choice that you make. Do not make excuses for your violence or blame your partner for your abusive behavior. Recognize that assaultive behavior is unacceptable and is a criminal act. Seek professional help from a qualified counselor who is knowledgeable about partner abuse and is lesbian/gay positive. A lesbian or gay male counselor may help you address the pertinent issues of abuse with more comfort and focus. Alcohol, drug use or mental health problems are not excuses for abusive behavior. Seek appropriate help for these problems. How Can Friends/Relatives Help? If someone discloses or you suspect that he/she is being abused, don't be afraid to privately express your concern and offer to help. Possible ways to help include locating resources, encouraging safety planning, respecting confidentiality and being there to listen. Believe their experience - don't minimize it. Don't give up or criticize them. If a friend doesn't leave an abusive partner, understand it is not easy. Let your friend know that you will be there regardless. If someone you know is being abusive, tell them that violence and abuse are unacceptable. Encourage and support them in getting help to stop the violent behavior. Hold them accountable for their actions and the need to change. What Lesbian and Gay Male Communities Can Do: The lesbian and gay male communities must begin to break down the silences and defensiveness around the issue of abuse in same-sex relationships. The more it is talked about the easier it will be for individuals to identify and change their own behavior and to expect relationships that are mutually respectful and free from fear and any form of abuse. Get educated and help educate; work to include this issue in community papers and public forums. Advocate for treatment and services on the part of medical, legal, police and social services that is equal, accessible and sensitive to the needs of people who are in abusive same-sex relationships. How Professionals Can Help: All professionals need to examine their own attitudes and feelings and how these have been influenced by homophobia and heterosexism. Become aware of the silence and prevailing myths about partner abuse in lesbian and gay male relationships. Do not assume with either males or females that their partner is of the opposite sex. Respect your client's anxieties about disclosure of sexual orientation, which may be based on real fears of discrimination and its effects on child custody, family support, job security, and/or deportation. Choices about disclosure of orientation and same-sex relationships are those of your clients and theirs alone. It is important to impart acceptance of your client's sexual orientation. Clients who have been abused by a same-sex partner may initially have issues of trust with a professional of the same sex. Learn about and encourage the use of supportive social networks within and outside the lesbian and gay male communities. Further Reading: Chesley, Laurie C et al. Abuse in Lesbian Relationships: A Handbook of Information and Resources. Republished as a chapter in "Lesbian Health Guide," edited by Regan McClure and Annie Vespry. Toronto: Queer Press, 1994 Island, D and Letellier, P. Men Who Beat the Men Who Love Them: Battered Gay Men and Domestic Violence. New York: Haworth Press Inc., 1991 Pharr, S. Homophobia: A Weapon of Sexism. Little Rock: Chardon Press, 1988 Lobel, K. Naming the Violence. Seattle: Seal Press, 1986. Sonkin, D.J. and Durphy, M. Learning to Live Without Violence: A Handbook for Men. California: Volcano Press, 1989. Web Resources: The Northwest Network Acknowledgments: This handbook was authored and produced by the Violence in Same-Sex Relationship Information Project, which consists of: Bernie Finnigan, MSW, CSW, Donna MacAulay, MSW, CSW, Nick Mule, MSW, CSW This project was funded by a grant from the Lesbian and Gay Community Appeal of Toronto and a grant from the City of Toronto "Breaking the Cycle of Violence" Grants Program 1996. To Contact CASSPA: Write To: Coalition Against Same-Sex Partner Abuse c/o David Kelley Lesbian/Gay and HIV/AIDS Services 355 Church St. Toronto, Ontario M5B 1Z8 Or Phone:(416) 925-XTRA, ext. 2141 Copyright 1997 Contact info@womanabuseprevention.com with questions or comments © Copyright 1997-2000, Education Wife Assault Site updated Sunday, November 25, 2001. Used with permission

Why do people stay in abusive relationships?

Women consistently cite similar reasons that they remain in abusive relationships: fear of retribution, lack of other means of economic support, concern for the children, emotional dependence, lack of support from family and friends, and an abiding hope that “he will change” (10, 131, 330, 413, 488). In developing countries women cite the unacceptability of being single or unmarried as an additional barrier that keeps them in destructive marriages (169, 368, 488).
At the same time, denial and fear of social stigma often prevent women from reaching out for help. In surveys, for example, from 22% to almost 70% of abused women say that they have never told anyone about their abuse before being asked in the interview (see Table 3). Those who reach out do so primarily to family members and friends. Few have ever contacted the police.
http://www.infoforhealth.org/pr/l11/l11chap2_3.shtml

• At the individual level these include being abused as a child or witnessing marital violence in the home (218, 310), having an absent or rejecting father (118), and frequent use of alcohol (30, 263, 291, 310, 339, 352).
• At the level of the family and relationship, cross-cultural studies have cited male control of wealth and decision-making within the family (275, 339) and marital conflict as strong predictors of abuse (215, 219).
• At the community level women's isolation and lack of social support, together with male peer groups that condone and legitimize men's violence, predict higher rates of violence (159, 255, 339).
• At the societal level studies around the world have found that violence against women is most common where gender roles are rigidly defined and enforced (210) and where the concept of masculinity is linked to toughness, male honor, or dominance (95, 393). Other cultural norms associated with abuse include tolerance of physical punishment of women and children, acceptance of violence as a means to settle interpersonal disputes, and the perception that men have 'ownership' of women (210, 275, 310, 340).
  http://www.infoforhealth.org/pr/l11/l11boxes.shtml#culture
  

The Abuser

Questionnaire:
ARE YOU BEING ABUSIVE?

Below are a series of questions that may assist you in understanding if your behavior is abusive or violent. Domestic violence includes not only the more visible physical manifestations but also includes verbal, emotional and sexual forms of behavior. If you answer yes to any of these questions you may wish to seek assistance through the Gay Partner Abuse Project or another source of professional assistance. Recognizing your behavior is the first step towards making change.

• Do you attempt to control the decisions, thoughts, activities, circle of friends, spending patterns, clothing choices or eating patterns of your partner?
• If your partner is unwilling to follow your advice or instruction do you get angry, criticize, insult, name call, intimidate, make accusations or become violent?
• Do you think you have a much better sense of what is right than your partner?
• Do you have difficulty being patient with and supportive of your partner?
• Do you have difficulty controlling your own frustration, anger or urges?
• Are you uncomfortable with your partner's freedom and independence, particularly in regard to those activities and friendships in which you are not included?
• Have others described your behavior toward your partner as cruel, demeaning, aggressive, intimidating or degrading?
• Have you ever destroyed or damaged his or her property?
• Have you ever hit him or her or continued to touch him or her in any way after he or she asked you to stop?
• Do you avoid discussing your behavior?
• Do you justify your behavior including blaming it on drinking or drug use or your partner's actions?
• Do you have a lot of expectations regarding your partner and become very critical when they are not met?

http://www.gaypartnerabuseproject.org/html/abusive.html

Understanding the cycle of violence

What is the difference between S/M and Abuse?

	ABUSE IS NOT S/M AND S/M IS NOT ABUSE Whether you are topping, or bottoming, or both, these are some questions to ask yourself: Is your partner turned on by violating your limits or terms? Does your partner not use a safeword, and then later say you violated his/her limits? Does she claim to know more about your s/m "energy" than you do? Does your partner try to extend a dynamic outside of a scene without your consent? Does your partner expect you to read her mind about what she/he wants? Does your partner refuse to talk about what felt wrong or confusing to you about a scene? Does your partner negotiate while in role when you haven't agreed to that? Do you feel guilty after playing, like you've done something wrong? Do you feel like you're playing because you have to? Does your partner involve others in your scenes without asking? Does your partner say you pushed her/him too far even though you stayed within the limits you negotiated? Does your partner humiliate you by talking about your play in public without your consent? Does your partner use arousal or orgasm as evidence of consent? Do you feel fear or dread about ending a scene or setting a limit? Does she say you're not "real" for wanting to switch or pressure you into switching? Are you confused about when a scene begins and ends? Do you feel that if you could just play better, be hotter or give/take more, everything could be okay? Does you partner use scenes to suppress or cover up anger and frustration? S/M play is consensual Abuse is not consensual S/M play is negotiated and agreed upon ahead of time Abuse is not negotiated S/M has responsible limits and safety rules Abuse has no rules or limits and there are no safewords S/M is fun, erotic and loving Abuse is manipulative, selfish and hurtful S/M play is enjoyed by both Victims do not enjoy abuse S/M play can be stopped by either partner at any time Abuse cannot be stopped by the victim/survivor Players exchange power in agreed upon roles with negotiated boundaries Abusers force control using non-consensual manipulation and violence S/M creates a bond of trust Abuse destroys trust
Copyright © 2003 Northwest Network.All Rights Reserved.

Cultural Competency

"Many cultures hold that men have the right to control their wives' behavior and that women who challenge that right—even by asking for household money or by expressing the needs of the children—may be punished. In countries as different as Bangladesh, Cambodia, India, Mexico, Nigeria, Pakistan, Papua New Guinea, Tanzania, and Zimbabwe, studies find that violence is frequently viewed as physical chastisement—the husband's right to “correct” an erring wife (10, 39, 94, 189, 204, 233, 303, 341, 407, 488). As one husband said in a focus-group discussion in Tamil Nadu, India, “If it is a great mistake, then the husband is justified in beating his wife. Why not? A cow will not be obedient without beatings” (233)." (Ending violence against women, a report from the Center for Communications Programs, Johns Hopkins University at http://www.infoforhealth.org/pr/l11/l11chap2_2.shtml#top)

From the University of Michigan Health System Tools & Resources:  Culture and Domestic Violence

Help Minority Battered Women Seek Assistance!

Cultural Barriers for African American Victims of Domestic Violence

Internal Barriers:

External Barriers:

Sources:
Campbell, DW. "Nursing Care of African-American Battered Women: Afrocentric Perspectives." AWHONN's Clinical Issues in Nursing. 4(3): 407-415. 1993.
Robinson, MS. "Battered Women: An African American Perspective." The ABNF Journal. pp. 81-84. 1991.

Cultural Barriers for Asian Victims of Domestic Violence

Internal Barriers:

External Barriers:

Source: Asian Task Force Against Domestic Violence

Cultural Barriers for Latino Victims of Domestic Violence

Internal Barriers:

External Barriers:

Source: "Bauer HM, et.al. "Barriers to health care for abused Latina and Asian Immigrant Women." Journal of Health Care for the Poor and Underserved. Vol (1) 11. pp. 33-44. 2000.
AYUDA Family Violence and Prevention Fund

Culture and Domestic Violence: A Select Bibliography

Adams, DL. (Ed.) Health Issues for Women of Color: A Cultural Diversity Perspective. Thousand Oaks, CA: Sage Publications, 1995.

Berenson AB, Stiglich NJ, et al. "Drug Abuse and other Risk Factors for Physical Abuse in Pregnancy among White non-Hispanic, Black, and Hispanic Women." American Journal of Obstetrics and Gynecology. 164: pp. 1491-1499. 1991.

Burns, MC (ed) The Speaking Profits US: Violence in the Lives of Women of Color. Seattle, WA: Center for the Prevention of Sexual and Domestic Violence.1986.

Campbell JC, Campbell DW. "Cultural Competence in the Care of Abused Women." Journal of Nurse Midwifery. 41(6): pp. 457-462.1996.

Campbell, DW. "Nursing Care of African-American Battered Women: Afrocentric Perspectives." AWHONN's Clinical Issues. 4 (3): pp. 407-415. 1993.

Denis RE, Key LJ, et al. "Addressing Domestic Violence in the African American Community." Journal of Health Care for the Poor and Underserved. 6(2): pp. 284-293.1995.

Galanti, GA. Caring for Patients of Different Cultures. Philadelphia, PA: University of Pennsylvania Press, 1991.

Huisman, KA. "Wife Battering in Asian American Communities: Identifying the Service Needs of an Overlooked Segment of the US Population." Violence Against Women. 2(3) pp. 260-283. 1996.

Panigua, F. Assessing and Treating Culturally Diverse Clients. Thousand Oaks, CA: Sage Publications Inc. 1994.

Richie, BE. Understanding Family Violence Within US Refugee Communities: A Training Manual. Washington, DC: Refugee Women In Development, Inc, 1988.

Thompson MP, Kaslow NJ. "Partner Violence, Social Support, and Distress Among Inner-City African American Women." American Journal of Community Psychology. 28(1) pp. 127-143. 2000.

Sorenson SB. "Violence Against Women: Examining ethnic differences and commonalties." Evaluation Review. 20(3) p. 123. 1996.

Volpp L, Main L. Working with Battered Immigrant Women: A Handbook to Make Services Accessible. San Francisco, CA: Family Violence Prevention Fund, 1995.

White, EC. Chain Chain Change: For Black Women in Abusive Relationships. Seattle. WA: Seal Press. 1994.

http://www.med.umich.edu/multicultural/ccp/cdv.htm

Leaving an abusive relationship

Despite the obstacles, many women eventually do leave violent partners—even if after many years, once the children are grown (129, 227). In Le'n, Nicaragua, for example, the likelihood that an abused woman will eventually leave her abuser is 70%. The median time that women spend in a violent relationship is five years. Younger women are more likely to leave sooner (131).
Studies suggest a consistent set of factors that propel women to leave an abusive relationship: The violence gets more severe and triggers a realization that “he” is not going to change, or the violence begins to take a toll on the children. Women also cite emotional and logistical support from family or friends as pivotal in their decisions to leave (52, 62, 65, 69, 202, 413).
Leaving an abusive relationship is a process. The process often includes periods of denial, self-blame, and endurance before women come to recognize the abuse as a pattern and to identify with other women in the same situation. This is the beginning of disengagement and recovery. Most women leave and return several times before they finally leave once and for all (264).
Regrettably, leaving does not necessarily guarantee a woman's safety. Violence sometimes continues and may even escalate after a woman leaves her partner (227). In fact, a woman's risk of being murdered is greatest immediately after separation (60).http://www.infoforhealth.org/pr/l11/l11chap2_3.shtml

Prevention

Since Congress enacted the Violence Against Women Act as part of the Violent Crime Control and Law Enforcement Act of 1994, HHS has significantly expanded its efforts. HHS quadrupled resources for battered women's programs and shelters, created a national toll-free domestic violence hotline (1-800-799-SAFE), and expanded efforts to raise awareness of domestic violence in the workplace and among health care providers. In fiscal year 2001, Congress appropriated $244.5 million for HHS programs to prevent violence against women, including $2.2 million for the National Domestic Violence Hotline. President Bush's fiscal year 2002 budget increases that commitment to $251 million.

BACKGROUND

The landmark Violence Against Women Act (VAWA), administered by HHS and the Department of Justice (DOJ), provided funding to hire more prosecutors and improve domestic violence training among prosecutors, police officers, and health and social services professionals. It also provided for more shelters, counseling services and research into causes of violence and effective community campaigns to reduce violence against women.

The VAWA set new federal penalties for those who cross state lines to continue abuse of a spouse or partner, making interstate domestic abuse and harassment a federal offense. It also requires states to honor protective orders issued in other states and gives victims the right to mandatory restitution and the right to address the court at the time of sentencing.

In 1995, HHS and DOJ created the National Advisory Council on Violence Against Women, consisting of experts from law enforcement, media, business, sports, health and social services, and victim advocacy. The council works with both the public and private sectors to promote greater awareness about the problem of violence against women and its victims, to help devise solutions, and to advise the federal government on these issues. In October 2000, the council released an "Agenda for the Nation on Violence Against Women," which outlines recommendations for future efforts to build on the early successes of the VAWA.

In October 2000, Congress reauthorized the Violence Against Women Act programs as part of the Victims of Trafficking and Violence Protection Act of 2000.

HHS PROGRAMS UNDER VAWA

Grants for battered women's shelters. The VAWA significantly expanded HHS funding for battered women's shelters. Since the law was passed, HHS' grants for these programs more than quadrupled from $27.6 million in fiscal year 1994 to $116.9 million in fiscal year 2001. The reauthorization legislation enacted in 2000 increased the minimum grant amount for each state from $400,000 to $600,000. These resources also support related services, such as community outreach and prevention, children's counseling, and linkage to child protection services.

The National Domestic Violence Hotline. In 1996, HHS launched the National Domestic Violence Hotline, a 24-hour, toll-free service that provides crisis assistance and local shelter referrals for callers across the country. Since then, the hotline has responded to more than 500,000 calls, mostly from individuals who have never before reached out for assistance. HHS funds the hotline through a grant to the Texas Council on Family Violence. The hotline number is 1-800-799-SAFE, and the TDD line for the hearing impaired is 1-800-787-3224.

Grants to reduce sexual assault. HHS provides grants to states for rape prevention and education programs conducted by rape crisis centers or similar nongovernmental, nonprofit entities. The funds support educational seminars, the operation of hotlines, training programs and other activities to increase awareness of and help prevent sexual assault, including programs targeted to students. HHS funding for the program in fiscal year 2001 is $44.1 million. In addition, $7 million from the Preventive Health and Health Services Block Grant is earmarked for rape prevention programs.

Coordinated community responses. The Centers for Disease Control and Prevention (CDC) works to build new community programs aimed at preventing intimate partner violence and strengthening existing community intervention and prevention programs. The CDC is currently funding a total of 10 projects and received $5.9 million to fund these efforts in fiscal year 2001. CDC has also conducted the National Violence Against Women survey and completed a study on the cost of violence against women. CDC funds numerous cooperative agreements with state health departments to improve understanding of the issue.

Outreach to runaway, homeless youth. HHS funds a program to provide street-based outreach and education, including treatment, counseling and provision of information and referrals to runaways, homeless and street youth who have been subjected to or are at risk of sexual abuse. The program was appropriated at $15 million for fiscal year 2001.

OTHER HHS INITIATIVES

National resource centers. The Administration for Children and Families (ACF) funds a network of five national resource centers that provide information, technical assistance and research findings related to domestic violence. The network includes the National Resource Center on Domestic Violence (800-537-2238), the Battered Women's Justice Project (800-903-0111), the Resource Center on Child Custody and Protection (800-527-3223), the Health Resource Center on Domestic Violence (888-792-2873), and the Sacred Circle Center on Violence Against Native Women (605-341-2050). The CDC funds the National Electronic Violence Against Women Resource Network (VAWnet) and the National Sexual Assault Resource Center (http://www.nsvrc.org). The VAWnet is an online resource for advocates working to end domestic violence, sexual assault and other violence in the lives of women and their children. The electronic library is available at http://www.VAWnet.org.

Child welfare grants. HHS has funded 26 grants over three years to local programs to stimulate collaboration between child welfare agencies and domestic violence providers. These projects train child welfare staff to identify and respond appropriately to instances of domestic violence in their caseloads. In addition, HHS has awarded 13 training stipends to schools of social work to develop curricula and train social workers in family violence.

Welfare Reform and Family Violence. In 1996, Congress enacted the Personal Responsibility and Work Opportunities Reconciliation Act, which included provisions to help welfare recipients who are victims of domestic violence move successfully into work. Specifically, the provisions give states the option to screen welfare recipients for domestic abuse; refer them to counseling and supportive services; and temporarily waive any program requirements that would prevent recipients from escaping violence or would unfairly penalize them.

Guidelines on effective intervention. Supported by HHS and DOJ funding, the National Council of Juvenile and Family Court Judges developed a best practice guidelines for handling child protection cases involving domestic violence. The group published "Effective Intervention in Domestic Violence and Child Maltreatment Cases: Guidelines for Policy and Practice" in 1999. In 2000, following a competitive process, six sites were selected to demonstrate the effectiveness of community collaborations in implementing the report's recommendations.

Mental health, substance abuse and violence. The Substance Abuse and Mental Health Services Administration (SAMHSA) supports several programs addressing substance abuse and mental health issues among victims of violence. These efforts include a five-year study designed to develop effective integrated service programs for women and their children affected by violence and co-occurring mental and addictive disorders. The program has yielded several comprehensive curricula to train substance abuse, mental health and other health and human services professionals on working with women victims of violence. Another multi-year SAMHSA grant program focuses on the connection among domestic violence, mental illness, substance abuse and homelessness among women and their children by assessing the effectiveness of time-limited intensive treatment, housing, support and family preservation services to homeless mothers and their dependent children.

Research initiatives. In 2000, the Agency for Healthcare Research and Quality (AHRQ) awarded $5.5 million to fund four comparative studies examining the effectiveness of intervention programs offered in health care settings. AHRQ and the nonprofit Family Violence Prevention Fund also jointly sponsor a Scholar in Residence, who is developing better ways to assess health system interventions. In addition, the National Institute of Mental Health (NIMH) funds a number of research studies focusing on the mental health consequences of violence, treatments for the traumatic consequences of violence, and factors that influence the initiation of physically aggressive behavior in intimate relationships. These studies have significant implications for preventing and reducing the mental health consequences of domestic violence.

Related programs. HHS agencies run and support a wide range of programs that provide services, information and other resources to address violence against women as part of broader program goals. For example, the Administration on Aging (AoA) funds elder abuse prevention programs in all 50 states that focus on the prevention of elder abuse, neglect and exploitation - including domestic violence. In addition, many HHS programs aim to strengthen families, prevent the abuse of women and children, and help families provide a healthy and safe environment for children. These programs include the Promoting Safe and Stable Families program and Child Abuse Prevention and Treatment Act grants.

Getting Help

If you are in danger call 911 or
National Domestic Violence Hotline: 800 799 SAFE or
National Sexual Assault Hotline: 800 656 HOPE

Where can I get help if I am being abused?
The National Domestic Violence Hotline, available 24 hours a day, 7 days a week, provides services in English and Spanish. If you or someone you know is being abused, contact the Hotline at (800) 799-7233. The Rape, Abuse and Incest National Network also operates a 24-hour, 7-day-a-week hotline for victims of sexual assault. The Network automatically connects callers to a rape crisis center in their community where they can find counseling and support. You can reach the Network at (800) 656-4673.
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Intimate Partner Violence

Like all violence, intimate partner violence perpetration is a learned behavior that can be changed or prevented.


Safety Tips for You and Your Family

• If you are the victim of intimate partner violence, do not blame yourself. Talk with people you trust and seek services. Contact your local battered women’s shelter or the National Domestic Violence Hotline at 800-799-SAFE (7233), 800-787-3224 TDD, or www.ndvh.org/. They can provide you with helpful information and advice.
  

• If you are or think you may become a perpetrator of intimate partner violence contact the National Domestic Violence Hotline at 800-799-SAFE (7233), 800-787-3224 (TDD), or www.ndvh.org/. They can provide you with helpful contact information.
  

• Recognize early warning signs for physical violence such as a partner's extreme jealousy, controlling behavior, verbal threats, history of violent tendencies or abusing others, and verbal or emotional abuse.
  

• Know what services are available for victims and perpetrators of intimate partner violence and their children in case you or a friend should need help.
  

• Learn more about intimate partner violence. Information is available in libraries, from local and national domestic violence organizations, and through the Internet. The more you know about intimate partner violence, the easier it will be to recognize it and help friends who may be victims or perpetrators.

In Your Community

• Support increased access to services for victims and perpetrators of intimate partner violence as well as for their children.

• Coordinate community initiatives to strengthen safety networks for women who experience violence.

• Increase public awareness to help decrease and prevent intimate partner violence.

CDC Resources

Preventing intimate partner violence requires the support and contribution of a variety of partners.

National Sexual Violence Resource Center
www.nsvrc.org
877-739-3895
A clearinghouse of information, resources, and research, related to all aspects of sexual violence. Activities include collecting, reviewing, cataloging, and disseminating information related to sexual violence; coordinating efforts with other organizations and projects; providing technical assistance and customized information packets on specific topics; and maintaining a website with current information including upcoming conferences, funding opportunities, job announcements, research, special events, links to state and territory coalitions, and other resources. The NSVRC also produces a biannual newsletter, The Resource; recommends speakers for conferences; coordinates national sexual assault awareness activities; and identifies emerging policy issues and research needs. The NSVRC serves coalitions, local rape crisis centers, government and tribal entities, colleges and universities, service providers, researchers, allied organizations, policy-makers, and the general public.

National Violence Against Women Prevention Research Center
www.vawprevention.org
843-792-2945
Helps prevent violence against women by advancing knowledge about prevention research and fostering collaboration among advocates, practitioners, policy makers, and researchers. Over the next five years, the NVAWPRC and its partners at CDC will be involved in a number of activities to accomplish this mission. The NVAWPRC serves as a clearinghouse for prevention strategies and keeps researchers and practitioners aware of training opportunities, policy decisions, and recent research findings. The NVAWPRC website also offers the latest research on violence against women as a resource to everyone involved in the field of violence prevention so they can better do their work.

Violence Against Women Electronic Network (VAWnet)
www.vawnet.org
Provides support for the development, implementation, and maintenance of effective violence against women intervention and prevention efforts at the national, state, and local levels through electronic communication and information dissemination. VAWnet participants, including state domestic violence and sexual assault coalitions, allied organizations, and individuals, have access to online database resources. Network members are able to engage in information sharing, problem-solving, and issue analysis via electronic mail and a series of issue-specific forums facilitated by nationally recognized experts in the field of violence against women. VAWnet also operates an extensive searchable electronic library available to the general public, providing links to external sources; an “In the News” section; and access to articles and audio and video resources focused on intimate partner and sexual violence and related issues.


Other Resources

The materials presented herein are for information purposes only. We have not screened each individual or organization that appears on this site or that is electronically linked to this site. The appearance of an individual or organization on this site is not intended as an endorsement. We urge all users of this site to conduct their own investigations of the products or services identified herein.

This list is not comprehensive but presents some of the major national violence against women resources and national organizations addressing violence against women.

If you are experiencing an emergency, call 911 or your local emergency number immediately.

American Bar Association
Commission on Domestic Violence
phone: 202.662.1737/1744
fax: 202.662.1594
www.abanet.org/domviol/home.html
The members of the Commission help resolve problems in family law, criminal law, victims' and individuals' rights, judicial administration, tort and civil rights litigation, and immigration law. Representatives of other professional organizations serve on the Commission to help develop a national domestic violence agenda as well as to enhance existing policies and solutions in the constantly changing fields of state and federal domestic violence law.

American College of Obstetricians and Gynecologists (ACOG)
409 12th Street SW
Washington, DC 20024-2188
phone: 202.638.5577
www.acog.org
ACOG is the nation's leading group of professional providing health care for women. ACOG is dedicated to the advancement of women's health through education, advocacy, practice, and research.

American Institute on Domestic Violence
2116 Rover Drive
Lake Havasu City, AZ 86403
phone: 928.453.9015
fax: 775.522.9120
www.aidv-usa.com
The American Institute on Domestic Violence offers on-site workshops and conference presentations addressing the corporate cost of domestic violence in the workplace.

Asian and Pacific Islander Institute on Domestic Violence
942 Market Street, 2nd Floor
San Francisco, CA 94102
phone: 425.954.9964
fax: 415.954.9999
www.apiafh.org/
The Asian and Pacific Islander Institute on Domestic Violence is a national network that works to raise awareness in Asian & Pacific Islander communities about domestic violence; expand leadership and expertise within Asian & Pacific Islander communities about prevention, intervention, advocacy and research; and promote culturally relevant programming, research, and advocacy by identifying promising practices.

Battered Women's Justice Project
phone: 800-903-0111
fax: 218-722-0779
http://www.bwjp.org/
The Battered Women’s Justice Project consists of three sections, criminal justice, civil justice and the defense of battered women charged with crimes.

Communities Against Violence Network
www.cavnet2.org
Communities Against Violence Network (CAVNET) provides an interactive online database of information; an international network of professionals; and real-time voice conferencing with professionals and survivors, from all over the world, using the Internet. CAVNET seeks to address violence against women, youth violence, and crimes against people with disabilities

Corporate Alliance to End Partner Violence
2416 E. Washington Street, Suite E Bloomington, IL 61704-4472
phone: 309.664.0667
fax: 309.664.0747
www.caepv.org
The Corporate Alliance to End Partner Violence (CAEPV) is a national non-profit alliance of corporations and businesses throughout the U.S. and Canada, united to educate and aid in the prevention of partner violence. CAEPV provides technical assistance and materials to help corporations and businesses address domestic violence in their workplaces.

The Family Violence Prevention Fund
383 Rhode Island Street, Suite 304
San Francisco, CA 94103-5133
phone: 415.252.8900
fax: 415.252.8991
www.endabuse.org
The Family Violence Prevention Fund is a national non-profit organization most noted for it’s national public education campaign “There’s No Excuse for Domestic Violence.” The Fund also has a National Health Initiative on Domestic Violence that works to train health care providers throughout the nation to recognize signs of abuse and to intervene effectively to help battered women. Hallmarks of this initiative include: the Ten-State Pilot Health Care Response to Domestic Violence program working to develop and implement state wide plans for a comprehensive health care system response to domestic violence; and the FVPF's Health Resource Center on Domestic Violence, which acts as the nation's clearinghouse for information on the health care response to domestic violence. Other projects include the Judicial Education Project, the Child Welfare Project, the National Workplace Resource Center on Domestic Violence, and the Battered Immigrant Women's Rights Project. Their Health Resource Center on Domestic Violence Provides resource and training material, technical assistance, information and referrals, and models for local, state and national health policymakers to support those interested in developing a comprehensive health care response.

The Institute on Domestic Violence in the African American Community
University of Minnesota/School of Social Work
290 Peters Hall
1404 Gortner Ave.
St. Paul, MN 55108-6142
phone: 877.643.8222
fax: 612.624.9201
www.dvinstitute.org
The Institute on Domestic Violence in the African American Community seeks to create a community of African American scholars and practitioners working in the area of violence in the African American community, further scholarship in the area of African American violence, raise community consciousness of the impact of violence in the African American community, inform public policy, organize and facilitate local and national conferences and training forums, and to identify community needs and recommend best practices.

Minnesota Center Against Violence and Abuse
School of Social Work, University of Minnesota 105 Peters Hall, 1404 Gortner Avenue St. Paul, Minnesota 55108-6142
phone: 612.624.0721
fax: 612.625.4288
www.mincava.umn.edu
The Minnesota Center Against Violence and Abuse (MINCAVA) is an electronic clearinghouse located in the School of Social Work of the University of Minnesota with educational resources about all types of violence, including higher education syllabi, published research, funding sources, upcoming training events, individuals or organizations which serve as resources, and searchable databases with over 700 training manuals, videos and other education resources. MINCAVA is also part of a is a cooperative project - the Violence Against Women Online Resources - between the Center and the United States Department of Justice, Office of Justice Programs, Violence Against Women Office. This website provides law, criminal justice, and social service professionals with current information on interventions to stop violence against women.

National Coalition Against Domestic Violence
P.O. Box 18749 Denver, CO 80218 phone: 303.839.1852 fax: 303.831.9251
www.ncadv.org
The National Coalition Against Domestic Violence (NCADV) is a membership organization of domestic violence coalitions and service programs. NCADV provides training, technical assistance, legislative and policy advocacy, promotional and educational materials and products on domestic violence; coordinates a national collaborative effort to assist battered women in removing the physical scars of abuse; and works to raise awareness about domestic violence.

National Domestic Violence Hotline
PO Box 161810
Austin, TX 78716
phone hotline: 1.800.779.SAFE (7233)
tty:1.800.787.3224
administrative: 512.453.8117
fax: 512.453.8541
www.ndvh.org
The National Domestic Violence Hotline connects individuals to help in their area using a nationwide database that includes detailed information on domestic violence shelters, other emergency shelters, legal advocacy and assistance programs, and social service programs. Help is available in English or Spanish, 24 hours a day, seven days each week. Interpreters are available to translate an additional 139 languages.

National Latino Alliance for the Elimination of Domestic Violence
P.O. Box 322086 Ft. Washington Station New York, NY 10032
phone: 646-672-1404 or 1-800-342-9908 fax: 1-800-216-2404
www.DVAlianza.org
The National Latino Alliance for the Elimination of Domestic Violence (the Alianza) is a group of nationally recognized Latina and Latino advocates, community activists, practitioners, researchers, and survivors of domestic violence working together to promote understanding, sustain dialogue, and generate solutions to move toward the elimination of domestic violence affecting Latino communities, with an understanding of the sacredness of all relations and communities. Support from ACF/DHHS has allowed the Alianza to establish El Centro: National Latino Research Center on Domestic Violence and the Alianza Training and Technical Assistance (T/TA) Division.

National Network on Behalf of Battered Immigrant Women
http://www.endabuse.org/programs/immigrant/
The National Network on Behalf of Battered Immigrant Women was co-founded in 1994 by the Family Violence Prevention Fund, AYUDA, NOW Legal Defense and Education Fund and the National Immigration Project of the National Lawyers Guild to nationally coordinate advocacy efforts aimed at removing the barriers battered immigrant and children face when they attempt to leave abusive relationships. Each organization provides leadership in their area of expertise.

National Network to End Domestic Violence
660 Pennsylvania Ave. SE, Suite 303
Washington, DC 20003
phone: 202.543.5566
www.nnedv.org
The National Network to End Domestic Violence (NNEDV) is a membership and advocacy organization of state domestic violence coalitions. NNEDV provides legislative and policy advocacy on behalf of the state domestic violence coalitions and, through the National Network to End Domestic Violence Fund, provides training, technical assistance and funds to domestic violence advocates.

National Resource Center on Domestic Violence
6400 Flank Drive, Suite 1300
Harrisburg, PA 17112-2778
phone: 800-537-2238
tty: 800-553-2508
fax: 717-545-9456
www.vawnet.org
The National Resource Center on Domestic Violence (NRC) provides comprehensive information and resources, policy development and technical assistance designed to enhance community response to and prevention of domestic violence. There are 40 NRC publications, as well as NRC project descriptions and project publication lists available via VAWnet. These NRC projects include the Building Comprehensive Solutions to Domestic Violence Initiative, the Public Education Technical Assistance Project, and VAWnet.

National Training Center on Domestic and Sexual Violence
2300 Pasadena Drive
Austin, TX 78757
phone: 512.407.9020
fax: 512.407.9022
www.ntcdsv.org
The National Training Center on Domestic and Sexual Violence develops and provides innovative training and consultation, influences policy and promotes collaboration and diversity in working to end domestic and sexual violence. NTCDV has a staff of nationally known trainers and sponsor national and regional conferences.

Rape, Abuse & Incest National Network (RAINN)
www.rainn.org
hotline: 800.656.HOPE
RAINN is the country’s only national rape hotline. RAINN works as a call-routing system. When an individual calls RAINN a computer reads the area code and first three digits of their phone number and routes the call to the nearest member rape crisis center.

Sacred Circle: Native Resource Center to End Violence Against Native Women PO Box 638
Kyle, SD 57752
phone: 877.733.7623 (red-road)
fax: 605.341.2472
www.sacred-circle.com
Provides technical assistance, policy development, training institutes, and resource information regarding domestic violence and sexual assault to develop coordinated agency responses in American Indian/ Alaska Native tribal communities.

The Stalking Resource Center
c/o National Center for Victims of Crime
2000 M Street NW, Suite 480
Washington, DC 20036
phone: 202.467.8700 fax: 202.467.8701
www.ncvc.org
The Stalking Resource Center is a project of the National Center for Victims of Crime, funded through the Violence Against Women Office, U.S. Department of Justice. The Stalking Resource Center has established a clearinghouse of information and resources to inform and support local, multi disciplinary stalking response programs nationwide; developed a national peer-to-peer exchange program to provide targeted, on-site problem-solving assistance to VAWO Arrest grantee jurisdictions; and organized a nationwide network of local practitioners representing VAWO grantee jurisdictions to support their multi disciplinary approaches to stalking.

Federal Agencies

Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Injury Prevention and Control
Division of Violence Prevention
4770 Buford Highway, NE MS K-60
Atlanta, GA 30341
Fax: 770-488-4349
www.cdc.gov/injury
The National Center for Injury Prevention and Control (NCIPC) guides national efforts to reduce the incidence, severity, and adverse outcomes of intentional and unintentional injuries in the United States. As the lead federal agency for injury prevention, NCIPC works closely with other federal agencies and national, state, and local organizations to reduce injury, disability, and premature death. NCIPC’s priority areas for violence prevention are: child maltreatment, intimate partner violence, sexual violence, suicide and youth violence. Project and activities focus on primary prevention of violence through a public health approach.

Department of Health and Human Services,
The Office on Women’s Health,
National Women’s Health Information Center (NWHIC)
Office on Women's Health
Department of Health and Human Services
200 Independence Avenue, SW
Room 730B Washington, DC 20201
Phone: 202-690-7650
Fax: 202-205-2631
www.4woman.gov/
The National Women's Health Information Center (NWHIC) is the Office on Women's Health's clearinghouse for women's health information. The NWHIC provides a gateway to the vast array of Federal and other women's health information resources. This site provides links to a wide variety of women's health-related material developed by the Department of Health and Human Services, other Federal agencies, and private sector resources.

U. S. Department of Justice, Office for Victims of Crime
Office for Victims of Crime Resource Center
National Criminal Justice Reference Service
P.O. Box 6000
Rockville, MD 20849––6000
1–800–627–6872
(TTY 1–877–712-9279)
www.ojp.usdoj.gov/ovc/
The Office for Victims of Crime (OVC) was established by the 1984 Victims of Crime Act (VOCA) to oversee diverse programs that benefit victims of crime. OVC provides substantial funding to state victim assistance and compensation programs——the lifeline services that help victims to heal. The agency supports trainings designed to educate criminal justice and allied professionals regarding the rights and needs of crime victims. OVC also sponsors an annual event in April to commemorate National Crime Victims Rights Week (NCVRW).

U.S. Department of Justice
Violence Against Women Office
810 7th Street, NW
Washington, DC 20531
Phone (202) 307-6026
Fax (202) 307-3911
TTY (202) 307-2277
www.ojp.usdoj.gov
The Violence Against Women Office works with victim advocates and law enforcement in developing grant programs that support a wide range of services for victims of domestic violence, sexual assault, and stalking, including: advocacy, emergency shelter, law enforcement protection, and legal aid. Additionally the Violence Against Women Office is leading efforts nationally and abroad to intervene in and prosecute crimes of trafficking in women and children and is addressing domestic violence issues in international fora.

Diagnosis and Treatment

Trauma is the German word for "nightmare," but in English, it is used for any kind of injury, physical or psychological. As a survivor of abusive relationships, you have suffered trauma which probably seems like a "nightmare."

Stress is a force that changes the shape of things (including people). This traumatic relationship has changed you—you will never be the same again. You are recovering from a great deal of stress on your body and mind as a result of this trauma.

Because of this stressful, traumatic relationship you may exhibit the signs of post-traumatic stress. It will take time and hard work to completely heal.

1. Continuing psychological "re-runs" of the events, including:
• frequent thoughts and memories about what happened, even when trying to avoid them.
• recurring nightmares about the trauma.
• suddenly feeling or acting as if the events were happening again (flashbacks).
• strong, painful feelings set off by things which are in some way related to what happened.
2. Ongoing attempts to avoid memories and feelings by:
• becoming generally numb to everything, by cutting off most feelings, both good and bad.
• avoiding activities or situations which may bring back memories and feelings.
• loss of large areas of memory about past life.
• loss of interest in things most other people care about; feeling different and cut off from other people.
• lack of any sense of having a future.
3. Continuous extreme physical alertness, including:
• constantly watching for signs of danger, with "startle responses," and trouble sleeping.
• trouble concentrating on business in the present world.
• irritability; outbursts of anger.
• physical reactions similar to what happened during past trauma (tremors, sweating, nausea, etc.)

1. Put together a written herstory of your life, understanding the effect the traumatic parts had. You can lay out a "life line," beginning with your birth and put in any markers that will keep track of time. Talk to family, friends, teachers, ministers, neighbors and anyone else who may have information about your life. Pay special attention to periods of time you cannot remember, or that others will not discuss with you. Sometimes it is possible to work backward from things that are known. Put your notes in a safe place. You may wish to add to them from time to time, as you find new information. Sometimes reviewing them will help you understand some new problem in your life.
2. Map out your usual triggers, where they are likely to be encountered, and what your usual reactions are. Some triggers can be avoided almost completely, and should be. Others may be harder to avoid, or you may have good reason to take the chances involved in running into them.
3. Learn to recognize and avoid hurtful people.
4. Avoid the use of drugs which temporarily improve symptoms, but make them worse on the "rebound."
5. Reduce your exposure to new injury (stay out of places that serve alcohol, for example.)
6. Stop current patterns of behavior which may be replays or reenactments of your own previous trauma, such as child abuse, fighting, etc.
7. Actions to make the real world safer are much more helpful than just trying to cope with your feelings about what might happen. Good locks and a dog are more helpful than lying in bed trying not to be afraid.

Finding someone to talk to about the abuse is not quick or simple. Some people will listen because they have had to live with abuse too. They may or may not be able to tolerate terrible stories at a given time. Listening to your story may bring up feelings they find too painful to deal with.

Others will listen because they are unusually committed to helping other people--or care a lot about you personally. Finding people who can listen is a key part of surviving. It involves several specific steps:

Abuse survivors often are pressed to "forgive" the abuser. The pressure may come from others, especially family members, or from your own beliefs about what should be done.

Forgiveness is a word for something that does not exist in the real world. There is no way to go back and act as if nothing ever happened, which is what most people want and most people think forgiveness means. People other than you made bad choices, with terrible outcomes, and became worse people as a result.

You may choose not to seek revenge, you may choose to continue with some contact with the abuser, and you may try to support any positive change that the abuser may attempt, but there is no way you can control what the abuser chose to do. If you had been able to control other people's decisions, there would have been no abuse. You have nothing to be forgiven for, because you did not make the choices.

http://www.nwnetwork.org/articles/5.html

Please go to the

Treatment Improvement Protocols
for Domestic Violence Intervention by
Multnomah County Alcohol and Drug Treatment Providers

based upon the SAMHSA Substance Abuse Treatment
and Domestic Violence, Treatment Improvement Protocol (TIP) Series, Number 25.

Excerpted here:

: If a client believes that she is in immediate danger from a batterer, the treatment
provider should respond to this situation before addressing any other issues. If
necessary, they should suspend the screening interview for this purpose, and assist
the client in developing a safety plan (Appendix B). The provider should refer the
client to a domestic violence program, and allow the client to use the telephone to
contact identified resources, if appropriate (Appendix C).
: The provider can identify and ask about several indicators of abuse. The most
obvious indicators are physical injuries, especially patterns of untreated injuries to
the face, neck, throat, and breasts. Other indicators may include a history of
relapse or noncompliance with substance abuse treatment plans; inconsistent
explanations for injuries and evasive answers when questioned about them; complications in pregnancy (including miscarriage, premature birth, and infant illness or birth defects); stress-related
illnesses and conditions (such as headache, backache, chronic pain, gastrointestinal
distress, sleep disorders, eating disorders, and fatigue); anxiety-related conditions
(such as heart palpitations, hyperventilation, and panic attacks); sad, depressed
affect; or talk of suicide. In addition, the client may mention being afraid of the
partner or his "anger" problem or controlling behaviors. Agency medical protocols
may need to be reviewed in order to respond most appropriately to survivors.
: Always interview clients about domestic violence in private, and do not reveal any
information about disclosure of domestic violence to other family members.
• : Ask about violence using concrete examples and hypothetical situations rather
than vague, conceptual questions.
: In framing screening questions, it is extremely important to convey to the survivor
that there is no justification for the battering and that substance abuse is no
excuse. Questions such as, "Does he blame his violence on his alcohol or drug use?"
or, "Does he use alcohol (or other drugs) as an excuse for his violence?" serve the
dual purpose of determining whether the client's partner may be a substance
abuser while reinforcing to her that substance abuse is not the real reason for his
violence.
: Addictions counselors should be trained to screen clients for domestic violence, to
assist in safety planning and to provide information about resources. The
counselors should also know when domestic violence experts should be contacted.
Violence assessment requires in-depth knowledge and skill and should be conducted
by a domestic violence expert.
• : Providers should be aware that the overlap between child abuse and domestic
violence is 60-70%, thus they should be alert to the possibility that the mother of a
child who has been or is being abused by her partner is also being abused herself,
and vice versa.
• : The provider should refer the client to or encourage the client to use other
resources, such as medical care, if injured, police or the criminal justice system,
shelters or other victim programs.
: Once the client has entered substance abuse treatment, a treatment plan that
includes a safety plan (see Appendix B) should be developed. In addition, the
provider should support the client in avoiding contact with the perpetrator, if the client goal is to avoid contact. A subsequent relapse prevention plan should address domestic violence issues, including safety planning and avoiding contact with the perpetrator, if appropriate.
: Survivors appear to benefit by participating in same-sex treatment groups that do
not use confrontational techniques. Providers should keep in mind that victims of
domestic violence have been systematically deprived of their self-determination as
part of the abuse. Thus, program models that emphasize powerlessness as a
treatment strategy should be aware that this might be counter to recovery needs
related to domestic violence. When external limits are necessary, they should also
take into account that she may be placing her safety above success in the
treatment program.
• Staff training in the areas of crisis intervention and co-occurring mental health
problems such as PTSD is important so that treatment providers can respond
effectively. Referrals should also be made whenever appropriate for specialized
counseling.

Batterers

Part 11: Screening, Referral, and Treatment of Batterer Clients
A discussion of family relationships is an element of all substance abuse screening
interviews. This component of the interview should be used to address the issue of
domestic violence and controlling behaviors with male clients.
. To initially gauge the possibility that a client is being abusive toward his family
members, the interviewer can ask whether he/she thinks violence and controlling
behaviors against a partner is justified in some situations, using a third person
example.
•Ask specific, concrete questions (e.g., "What happens when you lose your
temper?"). Be direct and candid; avoid euphemisms such as, "Is your relationship
with your partner troubled?" Instead, talk about "his violence and controlling
behaviors" and keep the focus on "his behavior." Ask about specific violent and
controlling behaviors (e.g., "When you hit her, was it a slap or a punch?", "Do you
take her car keys away?", "Damage her property?", "Threaten to hurt or kill
her?").
• In asking screening questions, substance abuse treatment providers must be
careful not to enable a batterer to place the blame for the battering on the victim
or the drug.
•Become familiar with batterers' rationalizations for their behavior, and with ways
to counter them. Examples are:
• Minimizing "I only pushed her," "She bruises easily," "She exaggerates." To counter
minimizing, say, "Any violence is unacceptable and harmful to the victim."
• Citing good intentions "She gets hysterical so I have to slap her to calm her down.
To counter a claim of good intentions, say, "Any violence is unacceptable and
harmful to the victim. You are the only person responsible for your violent
behavior."
• Blaming the use of alcohol and drugs "I'm not myself when I drink." To counter a
blaming use of alcohol and drugs, say, "Any violence is unacceptable and harmful
to the victim. You are the only person responsible for your violent behavior;
abuse/use of alcohol and drugs does not make it okay."
• Claiming loss of control: "Something snapped," "I can only take so much," "I was
so angry, I didn't know what I was doing." To counter claiming loss of control, say
"Any violence is unacceptable and harmful to the victim. Being angry or 'out of control'
does not make it okay."
• Blaming the partner "She drove me to it," "She really knows how to get to me." To
counter blaming the victim, say, "Any violence is unacceptable and harmful to the
victim. You are the only person responsible for your violent behavior; her behavior
does not make your violent acts okay."
• Blaming someone or something else: "I was raised that way," "My probation
officer is putting a lot of pressure on me," "I've been out of work." To counter a
blaming someone else, say, "Any violence is unacceptable and harmful to the victim.
You are the only person responsible for your violent behavior. Being out of work is
no excuse for being violent."
: Perpetrators' often attempt to maintain contact with their partner in order to
control her time or access to support. When establishing rules, providers should be
careful to assure that contact with the victim is for a legitimate reason, and does
not give the perpetrator an opportunity for on-going control or violence.
• : Once there is an indication that a client has assaulted or been controlling of a
partner, the provider should contact a domestic violence expert, either for
consultation or referral.
• : Treatment providers should try to ensure the safety of those who have been or
may become victims of the client, in particular his partner and children, during any
crisis during treatment, including to be aware of the providers duty to warn.
Appendix D.
• : Treatment providers, in some cases, may require that batterers sign a "no
contact contract" or a "no offensive contact contract." (Appendix E). that states
that the client will refrain from using violence and controlling behaviors both inside
and outside the program. If the provider requires signing contracts, they should
have in place a way to verify whether or not the batterer has complied with the
contract, and have specific consequences if they have not.
• : Domestic violence staff sometimes interviews the batterer's partner in order to
obtain salient information about his dangerousness to himself, his partner, and
others. This type of collateral interviewing is quite different from that practiced in
the substance abuse treatment setting and should only be performed by someone with specialized skills and expertise in domestic violence.

Any information obtained in that interview should never to revealed to the
perpetrator, without the explicit request by the victim. If the victim does request that
information be shared with the perpetrator, the provider must address safety
concerns with the victim.
The relationship between substance abuse and violent and controlling behavior should
be addressed in relapse prevention planning. The following information may be useful in
developing the plan:
• Exactly when in relation to substance abuse do the violence and controlling
behaviors occurs
• How much of the violent behavior occurs while the batterer is drinking or on other
drugs.
• What substances are used before the violent act.
• What feelings and thoughts precede and accompany the use of alcohol or other
drugs or precede the violence or controlling behaviors.
• Whether alcohol or other drugs are used to "recover" from the violent incident.
After identifying the chain of events that precede or trigger violent episodes, provider
and client should together formulate strategies for modifying those behaviors and
recognizing emotions and thoughts that contribute to violent and controlling behavior.
Providers should be alert to signs that batterer clients are misinterpreting the 12-Step philosophy to justify or excuse continued violence and controlling behaviors.
Another danger is that they will call their victims "codependent" in order to shift
blame for the battering onto the woman.
Referrals to batterers intervention programs should be a routine part of the
treatment, and referrals to family or couples counseling should only be made after the
client has completed a batterers' intervention program and has remained nonviolent
for a specified period of time.
If a provider is asked or subpoenaed to testify in a custody or visitation hearing on
behalf of the batterer, it is standard practice for the information provided to be
limited to information contained in the file, such as treatment status and progress in
treatment. Providers should refrain from offering opinions relating to the client's
potential future threat for violence or controlling behavior and his parental fitness.

Part III: Specific Recommendations for Family-Based Treatment
: Family-based treatment or couples counseling is generally contraindicated in
situations where one partner is violent or controlling toward the other. In part this
is because asking or expecting the victim to disclose battering in front of the
perpetrator may further endanger her. Such programs should only be utilized after
the perpetrator has completed a batterers' intervention program and has
remained nonviolent and non-controlling for a specified period of time. Providers
should have defined criteria and a method to determine whether the victim safety
is assured before recommending family-based treatment or couples counseling.
: If the victim (whether the victim is the client or the spouse or mother of the
perpetrator's children) has separated or is attempting to separate from the
perpetrator, the provider should not attempt to facilitate or encourage
reconciliation or reunification with the perpetrator. These attempts are
inappropriate and are likely to endanger the victim.
: If the victim is choosing to stay with the perpetrator, any family work must assure
that the victim is safe and must protect her confidentiality. The provider must be
willing to give her information that will increase her safety. This may mean getting
the perpetrator (if he is the client) to sign a release of information. Until safety can
be assured, it may mean working separately with the perpetrator and with the
victim.
• : Treatment providers should support other family members in taking steps to be
safe, including restricted visitation by children, limited contact with the
victim/partner, or other steps.
• : Discussions of co-dependency in cases of battering are inappropriate, because it
too easily can be used to blame the victim for the violence.
• : See Appendix F, Domestic Abuse Project, Training and Research UPDATE, "Why
Couples Counseling May be Inappropriate for Violent Relationships."
Part IV:Legal Issues
There are many Federal, State, and local regulations that bear upon domestic
violence, particularly ORS Family Abuse Prevention Act and Mandatory Arrest law, and
the 1994 Violence Against Women Act (VAWA). Providers need to
be aware of such issues as restraining orders, duty to warn, the legal obligation to
report threats and past crimes, and confidentiality.
: Substance abuse treatment providers should be familiar with relevant Federal,
State, and local regulations as well as with the legal resources available to victims
of domestic abuse. (Appendix C)
: Providers should have information available to victims ONLY about restraining
orders and how to get them, mandatory arrest laws, law enforcement and district
attorney services available, including child support enforcement, victim advocates
and Crime Victim Compensation programs.
• : Providers should provide identified batterers with information about the criminal
nature of domestic violence, and possible negative consequences to criminal justice
system involvement, as part of a message that domestic violence is not
acceptable behavior (as opposed to suggestions for how to "beat the system.")
Part V: Establishing Linkages
This Protocol recommends linkages between substance abuse treatment programs
and domestic violence programs and among other agencies as well.
• : Treatment providers and domestic violence support workers should foster a new
way of thinking about linkages on the systems level. Both fields would benefit from
a coordinated system that could addresses the multiple supportive interventions
needed by victims who are abusing substances and multiple means to stop
perpetrators who are abusing substances from continuing to be violent.
: In the absence of systemic reform, substance abuse treatment providers, domestic
violence experts, and legal or other relevant professionals should plan treatment
collaboratively.
: Initial meetings between organizations trying to establish linkages should include
discussion of the origins of both communities in order to help each understand the
other's beliefs and attitudes.
• : Linkages should address needs for housing, child care, emotional and physical
safety, health and mental health care, economic stability, legal
protection, vocational and educational services, parenting training, and support and
peer counseling, among others.
• : A legal professional or legal service is the best resource for resolving problems
that pertain to individual clients' involvement in the civil and criminal justice
systems. Providers should be aware of the resources available and have
established relationships, as appropriate.
: Substance abuse treatment providers should assess their ability to screen for
violence and create a safety plan, as well as their knowledge of legal issues related
to domestic violence, and develop a plan to assure staff competency.
• : Providers should work collaboratively with domestic violence specific programs to
assure adequate staff training. Cross-training for both disciplines is important, and
providers should participate in training domestic violence programs on alcohol and
drug treatment abuse.
• : Providers should participate, as appropriate, in a coordinated community response
to domestic violence.

Appendix E—No Offensive Contact Contract
MULTNOMAH COUNTY OREGON
DEPARTMENT OF ADULT COMMUNITY JUSTICE
DOMESTIC VIOLENCE UNIT
407 NE 12TH AVE. PORTLAND, OR 97232
(503) 248-5056
FAX (503) 306-5517
Review date: ______________________
Offender's name/SID # (please print): ______________________________________
THIS DOCUMENT REFERS TO: ___________________________________
(Name of victim partner/designated party) Please print
DEFINITION OF OFFENSIVE CONTACT
Domestic Violence is a pattern of behaviors in which one partner attempts to establish or
maintain power and control over the other through physical, sexual, and/or psychological
abuse. There are many ways you may control a person through threat and intimidation without
actually using physical violence, particularly if you have used physical violence against that
person in the past. As a result of your violence against your partner, you are directed to refrain
from behaviors that constitute domestic violence. These behaviors are called offensive contact.
Offensive contact is defined as engaging in physical, sexual or psychological abuse of another
person.
Physical abuse
Physical abuse is defined as any forceful or violent action directed at someone
else.
Some examples of physical abuse are: Slapping, choking or strangling, maiming, stabbing,
punching, scratching, wrestling, kicking, spanking, grabbing, pinching, biting, burning,
pushing, poking, restraining, pulling hair, picking a person up, carrying them, throwing them
bodily, forcing them to eat or drink something, stopping them from getting medical attention,
stealing or hiding their medication, throwing things at or near a person, using any object or
weapon against them, physically making a person do something against their will (i.e.: forcing
them to sit down, hang up the phone, get into the car, put something down, stay at home, etc.).
These are only some examples of physical abuse. There are many other types of physical abuse
that are not listed here, but they are stir/ offensive contact.
Please initial here if you understand what is meant by physical abuse.
Sexual Abuse
Sexual abuse is defined as any non-consenting (not freely agreed to) sexual act or
behavior.
Some examples of sexual abuse are: Forcing or demanding sexual activity when a person says no, when
they are asleep, when they are drunk or high, when a person is afraid of being hurt (or that the
children will be hurt or sexually abused) if they say no, when you have not asked first, asking for or
demanding sexual activity after you have physically or psychologically abused a person (for example
hitting, pushing or threatening them).
Physically attacking the sexual parts of a persons" body, pulling or ripping their clothes off, demanding
or forcing a person to engage in sexual behaviors that they do not like or that embarrasses, humiliates,
scares or hurts them.
These are only some examples of sexual abuse. There are many more types of sexual abuse that are
not listed here, but they are still offensive contact.
________ Please initial here if you understand what is meant by sexual abuse.
Psychological Abuse
Psychological abuse is defined as behaviors (words or actions) that are used to
intimidate, create fear, or threaten another person, and can be determined to be a
pattern of harassment.
Some examples of psychological abuse are:
*Acting like you are going to physically or sexually abuse them or the children.
*Holding your hand up like you are going to slap, hit or punch, throw things, making them
think that you are going to throw or punch something, hurt the children, use a weapon o r
break something, etc.
*Using your physical size to intimidate a person (standing over them, backing them against a
wall, blocking them from leaving a room or the house), getting in a person's face, using a
commanding/intimidating tone of voice, yelling at them, the children or pets, etc.
*Using threatening behaviors like: driving recklessly with a person (and/or the children) in
the car, throwing things, hurting a pet, punching walls, threatening a person with an object
or weapon, slamming doors, smashing or breaking things, following a person around to watch
what they are doing, pulling the phone out of the wall, etc.
*Specifically doing things you were told not to do by a person (including contacting them at
work, calling them late at night, etc).
*Stalking a person by driving or walking past their residence, place of work or their friends
and family members residences or places of work. Or having a person known to the victim drive
or walk past the residences, places of work, etc.
*Telling him/her you are going to physically or sexually abuse him/her.
*Saying that if they do something you are going to slap, smack, shoot, stab, hit, etc. them, the
children or the pet(s), making vague threats (i.e.: "You're going to get it" or "You better not
piss me off" or "Now you're in trouble", etc), or referring to abuse you have subjected them or
someone else to in the past like, "Do you want me to have to hit you again," or "You're acting like
you did the last time I hit you," or " When you do that you remind me of my ex-partner and you
know what happened to them."
*Making threats to do things to a person (and/or the children), such as saying you will take
away the children (or have them taken away), that you will have them arrested, will not pay
child support, have an affair, hurt a pet, commit suicide, start drinking or using drugs
(especially when you have been violent to them while under the influence), etc.
*White psychological abuse may not cause immediate physical damage, it is very powerful
because you have hurt a person (and/or the children) in the past. All threats and threatening
behaviors are abusive because you have shown that you may back up your threats with violence.
These are only some examples of psychological abuse. There are many more types of
psychological abuse that are not listed here, but they are still offensive contact.
_______Please initial here if you understand what is meant by psychological abuse.
If authorized to have non-offensive contact with the victim in my case(s), I agree to abide by
the definition of offensive contact listed herein. I further understand that any violation of this
definition may result in my arrest, and revocation of the contact directive established.
Offender's signature:________________________________________
Parole/Probation Officer's name (please print):________________________________
Parole/Probation Officer's
signature:_________________________________________
Original: File
Copies: Offender
Victim/partner/designated party
Document created by Lane County Parole and Probation, Eugene, OR. Used and modified by Muitnomah County with permission.
Revised 8/05/99 (Microsoft Word: Hafowler: Offensive contact)

Batterer intervention Programs

Batterer intervention Programs -Evaluation of Effectiveness

Batterer intervention programs (BIPs) are designed for men arrested for domestic violence and for men who would be arrested if their actions were public. These programs usually consist of educational classes or treatment groups, but may include other intervention elements such as extensive evaluation, individual counseling, or case management. Because 80% of batterers are referred by the criminal justice system, one set of implicit goals for BIPs includes justice and accountability (Healey, Smith & O'Sullivan, 1998 ), goals that have not been adequately recognized in evaluations of BIPs. Another goal of BIPs is victim safety. Most standards for BIPs specify that service providers consider victim safety implications when implementing interventions such as contacting victims for information about the batterer ( Austin & Dankwort, 1997 ; 1999 ). A final goal for BIPs is rehabilitation and behavioral changes such as skill building, attitude change, and emotional development.
The details of conducting batterer intervention programs are readily available (e.g. Edleson & Tolman, 1992 ; Pence & Paymar, 1993 ; Russell & Frohberg, 1995 ; Sonkin & Durphy, 1997 ; Stordeur & Stille, 1989 ). The purpose of this paper is to look not at what batterer programs do, but rather at the effectiveness of these programs. Knowledge about batterer program effectiveness is important for several reasons. Increasingly, courts are referring men convicted of domestic abuse to batterers intervention programs, suggesting a certain level of public confidence in the effectiveness of these programs. Is that confidence justified? Second, victims of domestic violence often want to remain in a relationship with their partner, and are looking for help in changing his violent and controlling behavior. Since a batterer seeking counseling is one of the strongest predictors that a woman will return to her batterer ( Gondolf, 1988 ), advocates are justifiably concerned that batterer programs not hold out a promise of hope which may become a vehicle for injury. Third, people who work with batterers are interested in outcomes so they can improve the level of program effectiveness; for these people, the concern is less whether batterer programs work, but how they work, for whom do they work best, and which elements of the program are most important.
Controversies and Recent Studies of Batterer Intervention Program Effectiveness by Larry Bennett, Ph.D and Oliver Williams, Ph.D. http://new.vawnet.org/category/Main_Doc.php?docid=373

Treatment of both batterers and abuse victims must include an understanding of Posttraumatic Stress Disorder

A National Center for PTSD Fact Sheet

Posttraumatic Stress Disorder, or PTSD, is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life.

PTSD is marked by clear biological changes as well as psychological symptoms. PTSD is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person's ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting.

Understanding PTSD

PTSD is not a new disorder. There are written accounts of similar symptoms that go back to ancient times, and there is clear documentation in the historical medical literature starting with the Civil War, when a PTSD-like disorder was known as "Da Costa's Syndrome." There are particularly good descriptions of posttraumatic stress symptoms in the medical literature on combat veterans of World War II and on Holocaust survivors.

Careful research and documentation of PTSD began in earnest after the Vietnam War. The National Vietnam Veterans Readjustment Study estimated in 1988 that the prevalence of PTSD in that group was 15.2% at that time and that 30% had experienced the disorder at some point since returning from Vietnam.

PTSD has subsequently been observed in all veteran populations that have been studied, including World War II, Korean conflict, and Persian Gulf populations, and in United Nations peacekeeping forces deployed to other war zones around the world. There are remarkably similar findings of PTSD in military veterans in other countries. For example, Australian Vietnam veterans experience many of the same symptoms that American Vietnam veterans experience.

PTSD is not only a problem for veterans, however. Although there are unique cultural- and gender-based aspects of the disorder, it occurs in men and women, adults and children, Western and non-Western cultural groups, and all socioeconomic strata. A national study of American civilians conducted in 1995 estimated that the lifetime prevalence of PTSD was 5% in men and 10% in women.

How does PTSD develop?

Most people who are exposed to a traumatic, stressful event experience some of the symptoms of PTSD in the days and weeks following exposure. Available data suggest that about 8% of men and 20% of women go on to develop PTSD, and roughly 30% of these individuals develop a chronic form that persists throughout their lifetimes.

The course of chronic PTSD usually involves periods of symptom increase followed by remission or decrease, although some individuals may experience symptoms that are unremitting and severe. Some older veterans, who report a lifetime of only mild symptoms, experience significant increases in symptoms following retirement, severe medical illness in themselves or their spouses, or reminders of their military service (such as reunions or media broadcasts of the anniversaries of war events).

How is PTSD assessed?

In recent years, a great deal of research has been aimed at developing and testing reliable assessment tools. It is generally thought that the best way to diagnose PTSD-or any psychiatric disorder, for that matter-is to combine findings from structured interviews and questionnaires with physiological assessments. A multi-method approach especially helps address concerns that some patients might be either denying or exaggerating their symptoms.

How common is PTSD?

An estimated 7.8 percent of Americans will experience PTSD at some point in their lives, with women (10.4%) twice as likely as men (5%) to develop PTSD. About 3.6 percent of U.S. adults aged 18 to 54 (5.2 million people) have PTSD during the course of a given year. This represents a small portion of those who have experienced at least one traumatic event; 60.7% of men and 51.2% of women reported at least one traumatic event. The traumatic events most often associated with PTSD for men are rape, combat exposure, childhood neglect, and childhood physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.

About 30 percent of the men and women who have spent time in war zones experience PTSD. An additional 20 to 25 percent have had partial PTSD at some point in their lives. More than half of all male Vietnam veterans and almost half of all female Vietnam veterans have experienced "clinically serious stress reaction symptoms." PTSD has also been detected among veterans of the Gulf War, with some estimates running as high as 8 percent.

Who is most likely to develop PTSD?

1. Those who experience greater stressor magnitude and intensity, unpredictability, uncontrollability, sexual (as opposed to nonsexual) victimization, real or perceived responsibility, and betrayal

2. Those with prior vulnerability factors such as genetics, early age of onset and longer-lasting childhood trauma, lack of functional social support, and concurrent stressful life events

3. Those who report greater perceived threat or danger, suffering, upset, terror, and horror or fear

4. Those with a social environment that produces shame, guilt, stigmatization, or self-hatred

What are the consequences associated with PTSD?

PTSD is associated with a number of distinctive neurobiological and physiological changes. PTSD may be associated with stable neurobiological alterations in both the central and autonomic nervous systems, such as altered brainwave activity, decreased volume of the hippocampus, and abnormal activation of the amygdala. Both the hippocampus and the amygdala are involved in the processing and integration of memory. The amygdala has also been found to be involved in coordinating the body's fear response.

Psychophysiological alterations associated with PTSD include hyper-arousal of the sympathetic nervous system, increased sensitivity of the startle reflex, and sleep abnormalities.

People with PTSD tend to have abnormal levels of key hormones involved in the body's response to stress. Thyroid function also seems to be enhanced in people with PTSD. Some studies have shown that cortisol levels in those with PTSD are lower than normal and epinephrine and norepinephrine levels are higher than normal. People with PTSD also continue to produce higher than normal levels of natural opiates after the trauma has passed. An important finding is that the neurohormonal changes seen in PTSD are distinct from, and actually opposite to, those seen in major depression. The distinctive profile associated with PTSD is also seen in individuals who have both PTSD and depression.

PTSD is associated with the increased likelihood of co-occurring psychiatric disorders. In a large-scale study, 88 percent of men and 79 percent of women with PTSD met criteria for another psychiatric disorder. The co-occurring disorders most prevalent for men with PTSD were alcohol abuse or dependence (51.9 percent), major depressive episodes (47.9 percent), conduct disorders (43.3 percent), and drug abuse and dependence (34.5 percent). The disorders most frequently comorbid with PTSD among women were major depressive disorders (48.5 percent), simple phobias (29 percent), social phobias (28.4 percent), and alcohol abuse/dependence (27.9 percent).

PTSD also significantly impacts psychosocial functioning, independent of comorbid conditions. For instance, Vietnam veterans with PTSD were found to have profound and pervasive problems in their daily lives. These included problems in family and other interpersonal relationships, problems with employment, and involvement with the criminal justice system.

Headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain, and discomfort in other parts of the body are common in people with PTSD. Often, medical doctors treat the symptoms without being aware that they stem from PTSD.

How is PTSD treated?

PTSD is treated by a variety of forms of psychotherapy and drug therapy. There is no definitive treatment, and no cure, but some treatments appear to be quite promising, especially cognitive-behavioral therapy, group therapy, and exposure therapy. Exposure therapy involves having the patient repeatedly relive the frightening experience under controlled conditions to help him or her work through the trauma. Studies have also shown that medications help ease associated symptoms of depression and anxiety and help with sleep. The most widely used drug treatments for PTSD are the selective serotonin reuptake inhibitors, such as Prozac and Zoloft. At present, cognitive-behavioral therapy appears to be somewhat more effective than drug therapy. However, it would be premature to conclude that drug therapy is less effective overall since drug trials for PTSD are at a very early stage. Drug therapy appears to be highly effective for some individuals and is helpful for many more. In addition, the recent findings on the biological changes associated with PTSD have spurred new research into drugs that target these biological changes, which may lead to much increased efficacy.

http://www.ncptsd.org/

http://www.ncptsd.org/

International Resources

There is increasing consensus, as reflected in this declaration, that abuse of women and girls, regardless of where and how it occurs, is best understood within a “gender” framework because it stems in part from women's and girls' subordinate status in society.
Article 2 of the UN Declaration clarifies that the definition of violence against women should encompass, but not be limited to, acts of physical, sexual, and psychological violence in the family and the community. These acts include spousal battering, sexual abuse of female children, dowry-related violence, rape including marital rape, and traditional practices harmful to women, such as female genital mutilation (FGM). They also include nonspousal violence, sexual harassment and intimidation at work and in school, trafficking in women, forced prostitution, and violence perpetrated or condoned by the state, such as rape in war.

http://www.infoforhealth.org/pr/l11/l11chap1_1.shtml#top

--Hot Peach Pages, a list of abuse organizations and help lines worldwide. The site includes abuse information in 55 languages, including Hindi, Punjabi and Tamil at http://www.hotpeachpages.net/

Sawnet (South Asian Women's NETwork)
is a forum for those interested in South Asian women's issues, including domestic violence at http://www.sawnet.org/orgns/violence.php

Legal Issues for South Asian Women

Internet Resources

Domestic Violence Hotline Numbers by State

Continue to Part II of the course