10/15/2018 INTIMATE PARTNER I have no disclosers to report. VIOLENCE IN ASIAN AMERICANS OCTOBER 12 TH , 2018 NICOLE APPELLE, MD MPH PREVALENCE OF IPV WORLDWIDE OUTLINE • Prevalence • Screening for IPV • Support • Documentation • Reporting • Resources WHO (2015). Global and Regional Estimates of violence against women. Retrieved from http://apps.who.int/iris/bitstream/handle/10665/85239/9789241564625_eng.pdf?sequence=1 on September 20,2018 1
10/15/2018 PREVALENCE OF IPV PREVALENCE OF IPV BY ETHNICITY • National Violence Against Women finds 20% of woman and 7% of men report lifetime prevalence of intimate partner violence. • National Latino and Asian American ‐1400 Asian partiticpants assessed with inperson interviews in English, Mandarin, Tagalog, Vietnamese, showed lower rates than those reported in other ethnicities • Higher rates of aggressor report than victim reports. Chang, D. F., Shen, B.‐J., & Takeuchi, D. T. (2009). Prevalence and demographic correlates of intimate partner violence in Asian Americans. International Journal of Law and Psychiatry , 32 (3), 167–175. Leung C & Cheung C. 2008. A prevalence study on partner abuse in six Asian American ethnic groups in the USA. International Social Work . 51(5): 635 – Tjanes, J. ThoennesN. ( 2015)>. Prevalence and Consequences of Male‐to‐female and Female‐to‐male Intimate Partner Violence as Measured by the National Violence Against 649. Women Survey Violence Against Women. Vol 6, Issue 2, pp. 142 ‐ 161 UNDERREPORTING OF IPV ATTITUDES TOWARD IPV • Cultural taboos in seeking help for IPV • Stigma for mental health issues • Value of family over self • Barriers finding culturally appropriate services. Yoshioka MR, DiNoia J, & Ullah K. 2001. Attitudes toward marital violence: An examination of four Asian communities. Violence Against Women . 7(8): 900 – 926 Wang, S. Change, D. (2014). Intimate Partner Violence Among Asian American and Pacific Islander Women. Retrieved from https://aapaonline.org/wp‐content/uploads/2014/06/AA_IPV‐final‐web.pdf on September 20,2018 2
10/15/2018 SCREENING FOR IPV SCREENING FOR IPV • • Interview patient alone ( for this part of the interview) IPV survivors 20% more likely chronic health issue • • Use professional interpreters 80% IPV survivor back pain, chronic headaches, arthritis • • Ask direct questions: has your partner every hit/ kicked/ threatened you? Mental health • Ask indirect question: what happens when you and your partner argue? • Validated screening tools • HITS Hurt, Insult, Threaten, Scream • HARK Humiliation, Afraid, Rape, Kick • WAST Woman Abuse Screening Tool ASSESSMENT DANGER ASSESSMENT DA‐5 • Assess current safety risk • Danger assessment 3
10/15/2018 INTERVENTION/ SUPPORT • SUPPORT • Safety plan • Connection to resources • Counseling • Shelter • Police • Legal • Social work • Advocate • Community LEAP SF https://www.leapsf.org/html/safety_plan.shtml Image from http://drugfreeva.org/signs‐drug‐alcohol‐abuse/ retrieved on Octover 1, 2018 available in Chinese, Korean, Mongolian, Thai, Tagalog, Vietnamese LEAP SF https://www.leapsf.org/html/safety_plan.shtml Developed by the Domestic Violence Project, Kenosha WI. Adopted from the original wheel by the Domestic Violence Intervention Project. 4
10/15/2018 TRAUMA INFORMED CARE GUIDELINES • Realizes the widespread impact of trauma and understands potential pathways for recovery • Recognizes the signs and symptoms of trauma in clients, families, staff and others in the system • Responds by fully integrating knowledge about trauma into policies , procedures and practices • Seeks to actively resist re‐traumatization The Missouri Coalition Against Domestic Violence. ( Retrieved from https://www.womenscollegehospital.ca/assets/legacy/wch/pdfs/4084_AdvocacyEmpowermentwheel.pdf on October 1 2018 PROVIDER DOCUMENTATION REPORTING • • Document details: who, what, where, when, If visible injury, mandatory reporting regardless of patient request. • Use quotations • If >65 or dependent adult, report to APS • • Physical: photograph any visible injury, describe in detail. If child witnesses violence or is harmed, report to CPS • SAFETY – consider any possibility of aggressor finding evidence of report. • Diagnostic codes • EHR portal • After visit summary 5
10/15/2018 REPORTING: SAN FRANCISCO SUPPLEMENT FORM REPORTING: SUSPICIOUS INJURY REPORT REPORTING: SAN FRANCISCO SUPPLEMENT FORM REPORTING: APS 6
10/15/2018 RESOURCES • Hotline: • National Domestic violence hotline 1 800 799 7233 • Asian Women’s Shelter 1 877 751 0880 • COUNSELING • APA Family services 415 617 0061 • LEGAL • Asian Pacific Islander Legal Outreach 415 567 6255 • SEARCH ASIAN PACIFIC INSTITUTE http://apigbv.force.com 7
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