Domestic Violence

Objectives:
• Identify populations at risk of being victims or perpetrators of
domestic violence based on current State of Florida and national
statistics.
• Discuss cycle of violence
• Discuss evidence related to consequences of being a domestic
violence victim
• Describe how to screen and assess individuals, across the
lifespan, who may be victims or perpetrators of domestic violence.
• Apply knowledge of Florida regulations when domestic violence is
suspected in protected populations.
• Identify local resources available for domestic violence victims
and perpetrators to assist with legal aid, shelter, victim and
batterer counseling and child protection services.

What is domestic violence ?
• Two terms are commonly used to talk about violence committed
by one partner against another, intimate partner violence and
domestic violence.
• The Florida Department of Children and Families defines
Domestic Violence as “a pattern of behaviors that adults or
adolescents use against their intimate partners to establish power
and control. It may include physical abuse, sexual abuse,
emotional abuse, and economic abuse. It may also include
threats, isolation, pet abuse, using children, and a variety of other
behaviors.”
• Abuse can range in intensity and consequence. For example, the
abuse may consist of one slap, or two derogatory comments that
have little impact on the victim to life threatening injuries or death.
Even after healing from their injuries, victims of repeated abuse
may experience life long psychological distress as a result of the
trauma they experienced.

Intimate Partner Violence (IPV)
• Intimate partner violence ( IPV) occurs when an abuser
victimizes a person with whom he or she has had an
intimate or romantic relationship.
• The Centers for Disease Control and Prevention (CDC)
defines IPV as “physical,, sexual, or psychological harm
by a current or former partner or spouse. The CDC
further notes “this type of violence can occur among
heterosexual or same sax couples and does not require
sexual intimacy.

National abuse statistics
• 1 in 4 women and 1 in 9 men experience severe intimate partner
physical violence, intimate partner sexual violence, and/or
intimate partner stalking
• The presence of a gun in a domestic violence situation increases
the risk of homicide by 500%.
• Women between the ages of 18-24 are most commonly abused
by an intimate partner.
• Only 34% of people who are injured by intimate partners receive
medical care for their injuries.
• 1 in 5 women and 1 in 71 men in the United States has been
raped in their lifetime

State abuse statistics
• 37.9% of Florida women and 29.3% of Florida men experience
intimate partner dating violence, intimate partner sexual violence
and/or intimate partner stalking in their lifetimes
• In 2019, 221 Floridians were killed in domestic violence incidents. 3
42% of these murders were committed with firearms
• While some measures are in place to limit domestic violence
perpetrators access to firearms, in many situations these actions
depend on the decision of a judge. See link.

• Although rates of domestic abuse are declining studies continue to
report high numbers of women with a history of abuse.
• According to one study, 49.6% of women seen in the emergency
department had a history of abuse
• Police identified 993 women with a history of IPV. Only 28% of
these women were identified as victims of IPV in the Emergency
department.

State statistics
• According to the Florida Department of Law Enforcement (FDLE)
there was a slight increase in the number of reported incidents of
domestic/ interpersonal violence (DV/IPV)from 2018 to 2019.
• Go to the following website answer these questions to better
understand the rates of DV /IPV in our state. Current State of
Florida Crime Rates
• Look at the 2 tables pertaining to Domestic Violence:
• What were the 3 most common domestic violence incidents
reported?
• How often did crimes occur within different relationships; which 2-3
surprised or disturbed you the most?

Trend in number and rate of DV
offenses

• It is important to look at not only the number, but the rate of
deaths. The number of total deaths attributed to domestic
violence, as of 2016, had decreased from 245 to 170. According
to 2019 data, 219 people died due to DV. Domestic violence rates
are calculated based on number of events per 100,000 persons in
the population. In 2016, the rate of DV decreased by 1.9%. The
rate of DV cases decreased by 3.8% in 2018.
• Prior to the pandemic domestic violence resource centers and
hotlines, conscientious law enforcement and healthcare
professionals contributed to decreasing the numbers of domestic
violence victims.
• On the next slide we will discuss what we know about the impact
of the pandemic.

How has the Pandemic affected
cases of Domestic Violence?
• State reports for the years during the pandemic are not yet
available.
• One Florida media source, WESH 2 news, interviewed local
Domestic Violence shelters and law enforcement officers in in
2020.
• One shelter reported that:
• The number of individuals who screened positive for lethality risk increased
from 26 in May of 2019 to 81 in May of 2020
• The lethality risk increased from 39 in June of 2019 to 94 in June of 2020.
• Law enforcement in the central Florida Area investigated 2000
domestic violence cases and 3 homicides related to domestic
violence.

• According to the 2017, Annual Report Fatality Review Team in which
deaths related to domestic violence were assessed:
• 80% of Perpetrators were male and had female victims
• 66% had prior criminal histories
• 55% of these criminal histories included domestic violence
• 31% of the perpetrators had a “do not contact” filed against them
• 55% had a Substance abuse history
• 28% had a mental health disorder
• IN MOST CASES: neither the victim nor the abuser sought help

Florida state initiatives and legislation
• 1993 Lawton Chile appointed a Task Force on Domestic Violence
• 1995: One hour CE: Domestic violence required for nurses and other
healthcare providers every renewal cycle
• 1997: Florida Department of Law Enforcement researched ability to track
Domestic violence incidents
• 2000: Florida Statute 741.316 required annual report be published by fatality
review team
• 2001: Family Protection Act: Domestic violence perpetrators go to jail 5 days
when someone is injured for first offense; second offense is a felony
• 2006: 2 hours Domestic Violence every 3rd renewal cycle required
• 2007: Domestic Violence Leave Act stated organizations with 50 or more
employees needed to guarantee leave for domestic violence

First:
Recognize domestic
violence victims and
perpetrators (abusers.)

Healthcare staff may encounter
possible victims of domestic
violence:
• In any healthcare setting
• Victims may request care after an accident
• In the clinic
• In the Emergency room
• On the floor after surgery
• Some specialists such as Obstetricians and Gynecologists are
trained to assess for physical evidence of abuse.
• Mental Health professionals are also trained to detect behaviors
that indicate possible abuse in a relationship.

Victims may include:
• Female or male intimate/ domestic partners
• Pregnant women
• Children
• Elderly
• Same sex couples

Characteristics of Victims
• May fear their partner’s temper
• May try to avoid conflicts and disagreements at any cost
• May have poor self-esteem and a poor self-image
• May experience physical problems such as headaches, nausea, and
other stress-related symptoms
• May spend all free time with the dating partner
• May avoid friends or end relationships to avoid anyone finding out
about the abuse
• May have physical injuries such as bruises, black eyes, etc.
• May take the blame for the abuse
Charactericts of abusers and victims
Safe harbors of Finger Lakes

According to the CDC characteristics
of abusers include:
• Low self-esteem
• Low income
• Low academic achievement
• Young age
• Aggressive or delinquent behavior as a
youth
• Heavy alcohol and drug use
• Depression
• Anger and hostility
• Antisocial personality traits
• Borderline personality traits
• Prior history of being physically abusive
• Having few friends and being isolated from
other people
• Unemployment
• Emotional dependence and insecurity
• Belief in strict gender roles (e.g., male
dominance and aggression in relationships)
• Desire for power and control in relationships
• Perpetrating psychological aggression
• Being a victim of physical or psychological
abuse (consistently one of the strongest
predictors of perpetration)
• History of experiencing poor parenting as a
child
• History of experiencing physical discipline as
a child

What makes the relationship vulnerable
to domestic violence?
• Conflict and fights between the marital partners
• Instability of the marriage -divorces or separations
• One partner exerting dominance and control in the relationship
over the other partner.
• Economic stress
• Unhealthy family relationships and interactions

Communication between partners
• Communication patterns of couples who resort to interpersonal
violence contribute to the friction in these relationships. Both
partners may have failed to learn effective problem-solving skills.
Abusers may not have learned anger-management strategies in
childhood.
• Studies show that couples who have engaged in interpersonal
violence tend to communicate more negatively than nonviolent
couples.
• They may not focus on a way to end the argument, but instead
communicate with anger or hostility.
• Similarly, they tend to not notice positive actions exhibited by their
partners.

Societal Factors which
influence Domestic Violence:
• Couples do not need to be married for Domestic Violence to occur.
• Victims who were living with their partner, had a greater chance of
being abused than did those who were married, in studies
conducted in both the United States and Latin America.

Community influences
• The following community factors are also associated with
increased rates of abuse:
• Poverty and crowded living situations.
• Lack of access to social groups where different values might be learned
and practiced.
• Little community response when domestic violence witnessed.

What psychosocial factors
contribute to domestic
violence?
• Shifting socio-economic status may influence rates of abuse. More
women are working outside the home, making them less financially
dependent on their partners.
• However, not all women have learned the skills needed to support
themselves outside the home.
• Some cultures tolerate male violence against women
• Victims and abusers may have been exposed to parental violence. They
may not question these behaviors. In addition, these individuals may
have failed to learn effective problem-solving and/ or anger-
management strategies in childhood.

Domestic Abuse models
• Different models have been developed to demonstrate what happens
within an abusive relationship. During a clinical assessment, a potential
victim may not feel safe enough to share that she/ he is at risk. As a
healthcare team member, you might observe some of the behaviors
described in these models.
• In a later section we will discuss how to create a safe space in which you
can ask the victim some questions.
• Two different models are often used to portray the patterns of behavior
seen between domestic abuse perpetrators and their victims:
• The Cycle of Violence
• The Duluth Model

Cycle of violence: Tension building
phase
• Tension building stage: Problems may start when the
perpetrator blames the victim for a problem. The perpetrator may
slap the victim. The victim may offer to “fix” the situation or accept
blame, even though she had nothing to do with what happened,
just to keep the perpetrator from blowing up. Tension may
continue to build with intermittent episodes of the perpetrator
making accusations, engaging in verbal abuse, or using other
intimidating behaviors. The victim may respond by “ walking on
eggshells,” so as not to further agitate the perpetrator.
• Tension and anger mount leading to an “ explosion” or act of
aggression.

Cycle of Violence: Explosion or
Battering phase
• Once the perpetrator’s anger reaches a peak the victim may be
exposed to any or all of the following:
• Physical abuse, including slapping, punching, or repeated beatings or
forced sexual activity.
• Emotional abuse
• Financial abuse
• Research indicates the battering incidents increase in severity and frequency over time.
• During this phase the victim often blames herself.

Honeymoon phase
• In the honeymoon phase the abuser is apologetic and may promise
to “never do it again”. The victim is often blamed at this point, for
example, “If you could keep this house cleaned up, this (abuse)
wouldn’t happen—it’s your fault.” The perpetrator may even deny
the event, saying something like “it wasn’t really that bad” or “no, I
didn’t do that”. At this point the victim sees abuser as loving partner.
The cycle then begins again with a period of calmness before the
next incident. (Walker, 1979)

What keeps the cycle going?
• There are three dynamics that serve to maintain the cycle: love, hope
and fear.
• Love: The feelings of love for her partner may be important to the victim.
The victim learns to focus on the good parts of the relationship, thinking
such things as, “He’s a good provider, he’s not always like this”, or she
may have concerns about children , “They need to grow up with a
father.”
• Hope: She remembers that the relationship didn’t start out this way and
holds out hope that things may change.
• Fear: At some point the victim begins to fear that threats of worsening
violence or death may turn out to be a reality. The fear associated with
leaving and being found by the abuser then suffering severe
consequences helps to keep the victim locked into the cycle of violence.

The Duluth Model
The Duluth model, developed by the Domestic Abuse Intervention Project ,
provides more examples of behaviors abusers use to exert power and control
over victims.
• Using isolation (limiting her movement, controlling who she talks to, etc.)
• Using emotional abuse (humiliating her, making her feel guilty, etc.)
• Using intimidation (displaying weapons, smashing things, etc.)
• Using coercion and threats (making threats of physical harm, etc.)
• Using economic abuse (denying access to family income, giving her an
allowance, etc.)
• Minimizing, denying and blaming (making light of the abuse, saying she
caused it, etc.)
• Using children (threatening to take them away, instilling guilt about the
children, etc.)
• Using male privilege (treating her like a servant, autocratic, etc.

Why do women stay
• Most women do not stay in abusive relationships
• Those who stay:
• May fear for their safety
• May have limited knowledge of available resources such as shelters or
legal assistance
• They may have strong religious or moral beliefs regarding marriage or
divorce.
• May fear that by leaving, the children will suffer.
• Many, if not most victims of domestic violence have been cut off from
family and/or friends and have inadequate emotional support for making
such a decision.
• In addition to lack of finances when they do leave, they are often lacking in
employable skills and work experience necessary to sustain them and their
children once they leave.

Consequences of intimate partner
violence:
• Intimate partner violence can lead to short term and long-term
consequences
• Long term exposure to the stress of IPV violence has been
associated with:
• Physical problems such as back pain, headaches, seizures and
gastrointestinal problems
• Mental Health problems such as depression, increased substance use
and /or dependence, deliberate self-harm and suicide.

According to guidelines for health
care setting:
• The National Consensus Guidelines on Identifying and
Responding to Domestic Violence Victimization in Healthcare
Settings provides several strategies health care staff can use to
intervene with potential domestic abuse victims.
• The United States Preventive Services Task Force (USPSTF), in
2013, found evidence to support a recommendation that clinicians
screen all women of childbearing age for intimate partner violence
(IPV) and refer those who screen positive for intervention and / or
counseling.

ASSESSMENT SHOULD BE:
• Conducted routinely, regardless of the presence or absence of indicators
of abuse
• Conducted orally as part of a face-to-face health care encounter
• Included in written or computer-based health questionnaires
• Direct and nonjudgmental using language that is culturally/linguistically
appropriate
• Conducted in private: no friends, relatives (except children under 3) or
caregivers should be present
• Confidential: prior to inquiry, patients should be informed of any
reporting requirements or other limits to provider/patient confidentiality
• Assisted, if needed, by interpreters who have been trained to ask about
abuse and who do not know the patient or the patient’s partner,
caregiver, friends or family socially

How often should healthcare
staff check for history of DV/
IPV?
• During each new admission assessment
• When patient returns for a follow up visit with a new health
concern
• When patient reports a new intimate partner as part of the
routine health history
• When signs and symptoms raise concerns or at other times at
the healthcare team member’s discretion

When do you NOT want to ask
about DV/ IPV?
• If staff can not secure a private space in which to ask questions
• If there are concerns that assessing the patient is unsafe for
either patient or staff
• If staff member is unable to secure an appropriate interpreter
• If staff member is NOT able to ask about DV/ IPV:
• The provider will place a note in the chart stating the screening was not
completed and a follow up appointment may be made.
• Posters, safety cards and patient education materials about DV/IPV may
be made available in exam or waiting rooms, bathrooms or on discharge
instructions.

If the patient shares that abuse
is or has occurred:
• ASSESS PATIENT’S IMMEDIATE
SAFETY
• “Are you in immediate danger?”
• “Is your partner at the health facility
now?”
• “Do you want to (or have to) go home
with your partner?”
• “Do you have somewhere safe to
go?”
• “Have there been threats or direct
abuse of the children (if s/he has
children)?”
• “Are you afraid your life may be in
danger?”
• “Has the violence gotten worse or is
it getting scarier?
• “ Is it happening more often?”
• “Has your partner used
weapons, alcohol or drugs?”
• “Has your partner ever held you
or your children against your
will?”
• “Does your partner ever watch
you closely, follow you or stalk
you?”
• “Has your partner ever
threatened to kill you,
him/herself or your children?”

If you are caring for the person in a
healthcare setting:
• The primary goal is to remove the victim from the situation.
• Treat any injuries, making sure to document carefully.
• Help the victim identify herself as a battered woman. Statements such
as, “You are the victim of domestic violence” are important since the
interaction is occurring shortly after the violent episode and the victim is
more likely to assess his/her situation more accurately and realistically.
S/he is most ready for intervention at this time.
• Assist him/her in identifying support systems. Inform him/her of referral
sources: shelters, counseling/therapy resources, and legal resources.
Help him/her assess the extent of danger with questions such as: “Are
there guns in the house?”; “Has s/he ever threatened to kill you or your
children?”; “Is there any history of homicide or suicide attempts, or
fantasies?”

If victim chooses to return home:
• Make sure s/he creates a personal safety plan which includes:
• Keeping copies of important legal documents ready at a friend’s
house or in a safe place at home which can be easily accessed
• Having a plan to stay safe in the home, including an escape
route
• Detailed plans are available at the Domestic Violence Hotline.
Personal Safety Plan
Click on the link above and note other important planning steps
that will help potential victims exit safely.

Determine present and past history of
abuse
• Interview the patient privately
• Direct or indirect questions may be used to determine if abuse
present.
• Indirect questions:
• How are things going at home?
• How does your partner treat you?
• Direct questions:
• Every couple fights at times.. What are your fights like at home? Do the
fights ever become physical?
• More interview tips from Stanford University School of Medicine

The Department of Health and Human Services
reviewed current domestic violence screening and found
that:
• Screening remains low across health care settings, although
recommendations are in place
• Clinical staff were found to be more likely to provide regular
screening if:
• They had received training in how to screen patients
• They were female
• They were younger
• They were nurses rather than physicians

Additional considerations:
• To help individuals who have identified an alternative sexual
orientation:
• Provide a private location for assessment, away from partners
• Ask about Intimate Partner Violence
• Confirm if they want other individuals to be told about their sexual
orientation status before sharing this information with others
• Refer individuals to another caretaker if you are unable to interact with
them respectfully. (Not being assigned to the patient may not be an option
in most nursing facilities. We care for diverse patients and practice
treating them non-judgmentally. )

National statistics
• According to data available December 2021, based on 2019
reports:
• Child abuse reports involved 7.9 million children.
• Only 3.4 million children received prevention or other services.
• 91,710 victims (74.9%) were neglected.; 115,100 victims (17.5%)
were physically abused; 60,927 victims (9.3%) were sexually abused; ;and
39,824 victims (6.1%) are psychologically maltreated.
• 1,840 children died from abuse and neglect in 2019.
• 2018 was the first year for which states are reporting the new maltreatment type
of sex trafficking. For 2019, 29 states report 877 unique victims of sex
trafficking.
• For victims of the sex trafficking maltreatment type, the majority (89.1%)
are female and 10.4 percent are male.
• It is estimated that between 50-60% of maltreatment fatalities are not recorded
on death certificates.

As you look at this
graph, look at the number
of children less than 1
year of age who were
victims of abuse.
What situations might
do lead to their being
abused?

Florida Statistics:
• In 2019 about 34,700 cases of child abuse or neglect were confirmed.
• 5,126 victims were less than one year old
• 2,493 were one year of age; 1,602 were 9 years of age.
• 1,066 suffered from medical neglect, 19,362, were victims of neglect,
2,807 were victims of physical abuse, 430 experienced psychological
abuse and 2,888 were victims of sexual abuse.
• No sexual trafficking victims were reported for Florida.
• Number of victim cases per 1,000 based on youth ethnicity and or
race were: 10.7 African American, 0.9 Asian, 4.5 Hispanic, 10.7 Multiple
Race and 8.3 white. 74% of the victims were maltreated by their
parents; and
• 114 children died as a result of child abuse and neglect.

Who abuses children?
• 94% of abused children knew their abuser
• Female parents or caretakers more frequently committed acts of
neglect, whereas males were most often responsible for
physical and sexual abuse. (Herendeen, 2003.)
• Researchers note that children are more at risk of fatal
maltreatment if their parents are young, have difficulty adapting
to the parenting role, and provide a home environment in which
one or more unrelated persons are living in the home.

According to Sheldon-Sherman,
Wilson and Smith (2013)
• Parents under 30 years of age are most likely to fatally maltreat their children
• Within this age group those in their late teens and early twenties are most likely to abuse their
children.
• Women are more likely to neglect infants. Men more commonly shake, scald or batter
children.
• As the stress of parenting increases, the risk of abuse also increases. Parents who
have difficulty coping with an infant crying, especially if the crying is inconsolable, are
more at risk of fatally injuring that infant.
• Premature infants are at high risk for child abuse as are those with other physical or
mental disabilities. The added stress and cost of providing care to children with special
needs greatly increases the risk of abuse.
• An increased risk of fatal maltreatment also exists if a parent is emotionally
disconnected.
• When a child lives in a home with unrelated persons, the risk of fatal injury increases
also. Having a non-related male in the home increases the risk of fatal injury 6 to 8
times.

Why are teenage mothers
considered to be at high risk for
being abusive?
• Dyanandhan, Bohr and Connolly (2014) note that teenage moms have not yet
completed developmental tasks related to adolescence. In adolescence teens
learn to be emotionally independent of their parents, find their own identity and
gather skills to be used in an occupation. Once teenagers have children, child
-care responsibilities may limit how much time these adolescents devote to
their own development. Mothers who don’t meet developmental tasks may not
develop as much resilience and may unintentionally resort to abuse to cope
with stressors.
• Other factors which increase the risk of the mother’s use of abusive behavior
include social isolation, the need to support herself and child and lack of
knowledge about how to handle the child’s behavior.
• Lee and Guterman (2010), in a study of 1597 families , compared the
behaviors of adolescent mothers to older mothers. Younger mothers were
noted to be more likely to have used harsher discipline than older mothers
over the past year.

We may not know about the
child’s abuse
• Child Abuse is the most underreported form of abuse as
children are often too traumatized and afraid to talk about it and
there is rarely anyone in the household to advocate for them.
• Children may tell another child what is happening, but they do
not share their experiences with another adult ( Child
Advocacy Center, 2015.)

Child Abuse definition
• Any act , by a parent, guardian, or other person
responsible for the child's well being, which is physically
or mentally injurious to the child.
• Turner, et,al (2012) expand this list to include sexual
abuse, sibling victimization, child neglect and witnessing
family violence.
• Sibling victimization can range from emotional ( constant
teasing or name calling)to physical abuse (hitting,
slapping, etc.), perpetrated by one sibling against
another.

Physical signs of abuse:
• Investigate when the child has any unexplained injury or injury inconsistent
with the history.
• On the skin:
• Take special note of burns, old or recent scars, bruises, soft tissue swelling, human
bites.
• Trauma from objects such as hot irons or belt buckles may leave recognizable shapes
(burns or bruises) on the skin.
• Other telltale signs such as cigarette burns may be an early clue.
• Recent or healing fractures, particularly of the posterior ribs should be
viewed with suspicion. Subdural hematomas and complex skull fractures
rarely result from short falls and should be carefully investigated. Bilateral
eye injuries are suspicious as most children sustain injuries to one eye or
the other but rarely both at the same time.
• Particularly suspicious is trauma to genitals, as are sexually transmitted
diseases.

Also observe for:
• Other signs of abuse such as dehydration or malnourishment
without obvious cause.
• Evidence of overall poor care such as unkempt, dirty appearance,
poor dentition, or clothing that is inadequate or inappropriate to the
circumstances (e.g., short sleeves and no shoes on a very cold
day).
• Be aware of how the child interacts with others. Behavior such as
fearfulness of nurses and other care givers may be an indication of
abuse.
• Notice if the parent(s) refer to the child as a “bad kid,” or if the child
seems to take care of the parent as both behaviors may be a clue
that something is wrong.

Abuse reporting:
• In Florida, EVERYONE is mandated to report child
abuse.
• Physicians, Nurses and “personnel who provide care to
the patient” must provide their name when reporting
abuse

Consequences of exposure to
violence
• Turner, et. al. (2012) noted that children who witnessed violence
were most likely to demonstrate these trauma symptoms of
depression anxiety and dissociation.
• Children exposed to hostile and inconsistent parenting, had high
levels of trauma symptoms and were more likely to engage in
sibling victimization.

Consequences of exposure to
violence
• In 2002, The National Resource Center on Domestic Violence, (NRCDV,)
studied the effects of childhood exposure to intimate partner violence, or what
happened to children who observed violence between their parents and a
parent and partner, but were not themselves abused.
• Through the review of 29 studies, NRCDV authors noted that children
exposed to intimate partner violence risked potentially significant future
emotional, behavioral, cognitive and physical harm.
• “Youth who witness domestic violence are more likely to attempt suicide,
abuse drugs and alcohol, run away from home, commit other delinquent
behavior, engage in teenage prostitution, and commit sexual assault crimes
(NRCDV, 2002.)”
• The Adverse Childhood Experience Study( ACES) has demonstrated a
relationship between exposure to violent events in the home and negative
outcomes in later life. Personal resilience and professional intervention can
minimize these effects.

Mandatory reporting of
abuse:
Who needs to report what types of abuse?

Abuse of children:
• According to the state of Florida:
• Link to Florida statutes for reporting
• Any person who knows, or has reasonable cause to suspect, that a
child is abused, abandoned, or neglected by a parent, legal
custodian, caregiver, or other person responsible for the child’s
welfare, as defined in this chapter, or that a child is in need of
supervision and care and has no parent, legal custodian, or
responsible adult relative immediately known and available to
provide supervision and care shall report such knowledge or
suspicion to the department ( see next slide for how to report)
• If the child was abused by another individual not listed above, or is
suspected to be a victim of sexual abuse, abuse reporting is also
mandatory

• Physicians, Nurses and hospital personnel involved in the care
of the child are mandated to report abuse and must provide
their name when asked.
• The abuse can be reported either online or by phone
• report online at https://reportabuse.dcf.state.fl.us/
• call 1-800-962-2873
• Don’t forget to call 911 if the child is in immediate danger!

A 2010, report from the Department of Health
and Human Services (DHHS) on elder abuse
noted:
• One of every 10 persons 60 or older, who lives at home, suffers abuse,
neglect or exploitation.
• One-half of persons living with dementia experience neglect or abuse
from caretakers.
• Cognitive impairment, or problems with thinking decrease an elder’s
ability to handle finances, which increases their dependence on others
and may place them at risk of financial exploitation.
• High rates of neglect and poor care continue to occur in nursing homes.
• African American, Latino, poor and isolated adults experience higher
rates of abuse.
(Connelly, Brandl and Breckman ,2012)

ABUSE, NEGLECT, OR EXPLOITATION OF
VULNERABLE ADULTS
• Nurses and other staff who work with vulnerable adults are now
also considered to be mandatory reporters of abuse, exploitation
or neglect
• "Vulnerable adult" means a person 18 years of age or older whose
ability to
perform the normal activities of daily living or to provide for his or h
er own care or protection is impaired due to a mental, emotional, l
ong‐term physical, or developmental disability
• To report Abuse of vulnerable adult call 1-800-96-abuse

What is exploitation?
• “Exploitation” means basically not using the elder’s finances to
care for them.
• It may include, but is not limited to:
• Caretaker misuse of power of attorney or abuse of guardianship
duties, resulting in:
• Unauthorized taking of personal assets;
• Intentional or negligent failure to effectively use a vulnerable
adult’s income and assets for the necessities required for that
person’s support and maintenance.

Who abuses elders?
• Elders may be abused by their spouses, family members or
caretakers (Connelly, Brandl and Breckman ,2012).

What factors contribute to abuse of
elders?
• Spouses may begin to experience cognitive difficulties and a decline in
their ability to cope. They may respond to each situation with
aggression.
• Children or other caretakers may have become financially dependent on
the elder and manipulate confused victims to obtain more money.
• Elders, who were previously independent, may refuse assistance yet fail
to attend to their own needs for health and safety.
• Long term care staff may find it difficult to know how to respond to
agitated patients with dementia. These long-term care staff might also
struggle with challenging patient care assignments.
(Connelly, Brandl and Breckman , 2012).

What steps can be taken to decrease
elder abuse?
• The DHHS Task force, Executive Roadmap provided 5 goals for all
individuals who work with the elderly (Connelly, Brandl and Breckman ,
2012):
• Awareness: Increase public awareness of elder abuse
• Brain Health: Investigate how cognitive capacity and mental health
issues affect both victim and perpetrators.
• Caregiving: Improve support and training for paid and unpaid caregivers
• Economics: Assess what elder abuse costs victims and perpetrators
and identify financial factors which contribute to abuse.
• Resources: Invest more resources in service, education and research.

Assess for and investigate if
evidence of abuse present
• Cook, Dinnen, and O’Donnell (2011) note that only 3% of older
women were asked about violence when they were assessed.
• Listen for reports of physical symptoms and be suspicious of
unexplained or repeated injuries.
• Observe for untreated sores or other skin injuries such as decubiti,
burns etc., or failure to seek appropriate medical care.
• Carefully examine contractures that may have resulted from
immobility or restraint.

• Observe for withdrawal, passivity or fear of the caregiver as signs of
possible physical or psychological abuse.
• Older female victims are less likely to report psychological symptoms,
such as depression and anxiety, and more likely to report physical
symptoms.
• Further assess any identified situation that suggests overall poor care.
• Environmental conditions such as improper home repair or other unsafe
home conditions require further evaluation—a neglected home may
mean there is a neglected elder living in that home.
(Connelly, Brandl and Breckman ,
2012).

Domestic Violence
Resources:
Where Can you get help for Victims and Perpetrators?

Seek patient’s permission
• Use nonjudgmental approach to discuss situation with patient ask their permission to help
them seek safer situation
• If victim is in acute danger be sure to involve law enforcement.

To report abuse:
• call the
Florida Domestic Violence Hotline at 1-800-500-1119
• you will be given information about:
• Domestic violence
• Safety planning
• Resources and referrals
• And receive emotional support.

To report other age specific Abuse
ELDER ABUSE
o Call 1- 800 96A-buse
CHILD ABUSE:
o Call 1-800-962-2873

Peaceful Paths, a local shelter, is
one of 42 certified domestic
violence centers in Florida
• Peaceful Paths (Serves Alachua, Bradford and Union counties)
• Hotline numbers: (352)377-TALK (8255)
PO Box 5099
Gainesville, FL 32627-5099
• Staff at the center provide personal advocacy, shelter, safety
planning, legal advocacy, children’s programs and information
and referrals. All services are confidential.
• Additional Florida Domestic Violence shelters

Domestic Violence Hotline
• Available online and by phone
• Personal Safety Plans available
• Tips available for perpetrators of abuse

The Child Advocacy Center
• Staff listen to and provide counseling for children who are victims
of abuse
• Staff also provide coordinate services of law enforcement, child
protective services, prosecution, medical and mental health care
provided to individual children.
• Staff additionally provide advocacy for victims and educate the
community about current child abuse trends.
• The Child Advocacy Center

Batterer intervention:
• A batterer may be referred to treatment in two different ways
• Voluntary treatment may be pursued, if no criminal charges are
pending. An individual who is motivated to change has the
potential to learn different strategies for handling stress and may
learn relationship skills that do not rely on power and control. The
batterer may be referred to local mental health service providers,
based on individual treatment needs.
• Once a batterer has been convicted of a crime, treatment will be
ordered by the court, and by state law must be provided by a
local state approved program.

References
American Society for the Positive Care of Children. (n.d.) Child maltreatment statistics.
mericanspcc.org/child-abuse-statistics/
Ard KL, Makadon HJ. (2011) Addressing intimate partner violence in lesbian, gay, bisexual, and
transgender patients. Journal General Internal Medicine. 26(8):930-933.
Calton JM, Cattaneo LB, Gebhard KT. (2016) Barriers to help seeking for lesbian, gay, bisexual,
transgender, and queer survivors of intimate partner violence. Trauma Violence Abuse. 17(5):585-600.
Centers for Disease Control and Prevention (2015). Intimate partner violence: Risk and protective factors.
Retrieved from http://www.cdc.gov/ViolencePrevention/intimatepartnerviolence/riskprotectivefactors.html.
Connolly, M. , Brandl,B., & Breckman, R. (2012). Elder Justice Roadmap: A stakeholder initiative to
respond to an emerging health, justics, financial and social crisis. Retrieved from
http://www.ncea.aoa.gov/Library/Gov_Report/docs/EJRP_Roadmap.pdf.
Cook, J., Dinnen, S. & O’Donnell (2011). Older women survivors of physical and sexual violence: A
systematic review of the literature. Journal of Women’s Health. (Vol 20), 7,

References
Department of Health and Human Services (2013). Screening for domestic violence in Healthcare settings. Retrieved from
http://aspe.hhs.gov/report/screening-domestic-violence-health-care-settings.
Domestic Abuse Intervention Project. (n.d.) Diagram of power and control. Author. Duluth, MN
Dhayanandhan, B., Bohr, Y & Connolly (2015). Developmental task attainment and child abuse potential in at-risk adolescent mothers. Journal of Child
and Family Studies; 24: 1997-1998.
Florida Department of Elder Affairs (2011). Programs and Services. Retrieved from http://elderaffairs.state.fl.us/doea/report_abuse.php.
Florida Department of Law Enforcement (2021) Crime in Florida abstract. https://www.fdle.state.fl.us/FSAC/UCR/UCR-Annual-Archives/Crime-in-Florida-
Report-Abstract/UCR-Crime-in-Florida-Abstract-Statewide-2019A
Florida Department of Law Enforcement (n.d.). Domestic violence offenses in Florida 1998-2018. http://www.fdle.state.fl.us/FSAC/Crime-
Trends/Domestic-Violence.aspx
Florida Domestic Violence Fatality Review Team. (2017) Faces of Fatality, 2017. http://fcadv.org/sites/default/files/face_fatality_vii.pdf. Accessed
December 4th, 2018.

References
Florida Department of Children and Families (2021). The Florida 2021 Statutes.
http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0000-0099/0039/Sections/0039.201.html
Florida Department of Children and Families (n.d.) Local Domestic Violence Shelters. https://www.myflfamilies.com/service-programs/domestic-
violence/map.shtml
Herendeen, P.M. (2003). Physical abuse in children. Advance for Nurses. 4 (8), 13-16.
James L, Brody D, Hamilton Z. (2013). Risk factors for domestic violence during pregnancy: a meta-analytic review. Violence Victims. 28(3):359-380.
Lee, Y & Guterman, N. ( 2010) Young mother-father dyads and maternal harsh parenting behavior. Child abuse & Neglect. (34) 874-885.
National Coalition Against Domestic Violence (2020a).Domestic Violence. https://assets.speakcdn.com/assets/2497/domestic_violence-
2020080709350855.pdf?1596828650457

National Coalition Against Domestic Violence( 2020b). Domestic Violence in Florida.
https://assets.speakcdn.com/assets/2497/ncadv_florida_fact_sheet_2020.pdf
National Resource Center on Domestic Violence. (2002). Children exposed to intimate partner violence. Retrieved Sept. 15, 2004 from:
http://www.vawnet.org/NRCDVPublications/TAPE/Packets/NRC_Children.pdf
Portland Community College.(n.d.) Safety Plan for Victims of Domestic Violence. https://www.pcc.edu/illumination/wp-
content/uploads/sites/54/2018/05/safety-plan-for-victims.pdf
Safe harbors of Finger Lakes. (n.d) Characteristics of abusers and victims of intimate partner violence. http://safeharborsfl.org/domestic-violence/teen-
dating-violence/characteristics-of-abusers-and-victims.
Sheldon-Sherman, J., Wilson, D., & Smith, S. (2013). Extent and Nature of Child Maltreatment-Related Fatalities: Implications for Policy and Practice.
Child Welfare, 92(2), 41-58.
The Florida Statistical Analysis Center, FDLE. (2010). Total domestic violence for Florida, 1994-2010.
http://www.fdle.state.fl.us/FSAC/Crime_Trends/domestic_violence/index.asp

References
The Florida Network of Children’s Advocacy Centers (n.d.). Child Abuse Statistics. https://www.fncac.org/child-abuse-and-neglect-statistics
The Florida Senate (2021). Florida Statutes. Mandatory reporting of abuse, neglect, or exploitation of vulnerable adults; mandatory reports of death.
https://www.flsenate.gov/Laws/Statutes/2021/0415.1034
Turner, H. A., Finkelhor, D., Ormrod, R., Hamby, S., Leeb, R., Mercy, J., Holt, M. (2012). Family context, victimization and child trauma symptoms:
Variations in safe, stable and nurturing relationships during early and middle childhood. American Journal of Orthopsychiatry. Wiley-Blackwell. Vol. 82
Issue 2, p209-219. DOI: 10.1111/j.1939-0025.2012.01147.x.
U.S. Census Bureau. (2010). Prepared by Center for Economic Development Research, College of Business Administration, University of South
Florida. Retrieved Sept. 16, 2004 from: http://cedr.coba.usf.edu/projects/FLpopWFemp_6.2000.pdf

References
US Department of Health and Human Services Children’s Bureau (2019) Child Maltreatment 2019. Child Maltreatment 2019 | The Administration for
Children and Families (hhs.gov)
WESH 2 News(2021)Meredith McDonough: “Isolation is an abusers best friend”: Domestic abuse cases in Central Florida up amid Covid-19 pandemic.
https://www.wesh.com/article/domestic-violence-covid-19/35598993#
Walker, L. (1979). The battered woman syndrome, 2nd ed. New York: Springer.

thank you12-2021
Ethel Leon
Ethel.leon@sfcollege.edu

Domestic Violence

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