Recognizing and Responding Safely to Family Violence - SOGC
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Recognizing and Responding Safely to Family Violence
Harriet MacMillan, CM, MD, MSc, FRCPC
Professor, Departments of Psychiatry & Behavioural Neurosciences,
and of Pediatrics, McMaster University
Funding provided by the
© 2020 VEGA Project, McMaster University Public Health Agency of Canada 2014-2020
No relevant financial Disclosures relationships to disclose
Medical Expert
Scholar
To describe two types of
family violence – child To discuss the role of the
maltreatment & intimate VEGA Project in educating
partner violence – and professional about family
their impact violence
Communicator, Professional
To apply evidence-based
approaches to recognizing
and responding to family
violence
WHO definition of IPV Intimate partner violence refers to behaviour by an intimate partner or ex-partner that causes physical, sexual or psychological harm, including physical aggression, sexual coercion, psychological abuse and controlling behaviours.
IPV Definitions
Situational - less violent, usually
episodic conflict between
couple partners; often bilateral
violence
Intimate - a pattern of physical, sexual
and/or emotional abuse
partner almost always directed
terrorism toward women => coercive
control
(Johnson et al., 2006)
IPV/SV Prevalence – WHO Regions
IPV Impairment
Child Maltreatment
• Refers to inflicting harm on a child and
also failing to protect them from harm.
• Children may be abused by someone
they know in a family or in an
institutional or community setting or,
more rarely, by someone they don’t know
(e.g., through the internet).
• Commonly refers to:
• Physical • Neglect
• Sexual • Exposure
to intimate
• Emotional partner
violence
Prevalence of child abuse including IPV exposure
Physical
Abuse
26%
Any
Child
Abuse
32%
Sexual Exposure
Abuse to IPV
10% 8%
Canadian Community Health Survey 2012
(Afifi et al., 2014)
Impairment Across
Lifespan
Injury Anxiety disorders Conduct disorder Personality
and PTSD disorders
Affect regulation Alcohol abuse
Mood disorders Relationship
Attachment Drug abuse problems
problems Disruptive behaviour
disorders including Other risk-taking Maltreatment of
Growth problems ADHD behaviours one’s own offspring
Developmental Academic failure Recurrent Chronic disease
delay victimization including heart
Poor peer relations disease, cancer
Infancy Childhood Adolescence AdulthoodExposure to IPV
in the Home
• Similar psychological and
emotional problems as other
forms of child maltreatment
(Krug et al., 2002)
• Associated with trauma
symptoms, and other symptoms
like anxiety and aggression
(Kitzmann et al., 2003; Evans et al., 2008)
• Review of 35 studies found 30%
to 60% overlap with other types
of child maltreatment
(Edleson, 1999)Need for evidence-based health & social service response
No one taught us in
Nursing School how to
We work in a busy ER. These help people who were
issues take way too long to getting beat up every
address, especially when there’s day.
no privacy! Also, we will never
see the patient again so how can
we develop the kind of
relationship you need to help
someone through this kind of
issue.National Guidance and Implementation Committee
Association of Faculties of Medicine of Canada Canadian Paediatrics Society
Canadian Association of Community Health Centres Canadian Psychiatric Association
Canadian Association of Midwives Canadian Psychological Association
Canadian Association of Schools of Nursing Canadian Public Health Association
Canadian Association of Social Workers Child Welfare League of Canada
Canadian Centre on Substance Abuse College of Family Physicians Canada
Canadian Dental Association Mental Health Commission of Canada
Canadian Dental Hygienists Association National Aboriginal Council of Midwives
Canadian Indigenous Nurses Association Royal College of Physicians & Surgeons of Canada
Canadian Medical Association Society of Obstetricians & Gynaecologists of Canada
Canadian Nurses Association Women's Shelters Canada
Invited to participate at project inception by the Federal Health MinisterKnowledge & Resources
What do How/when
providers do we
need to know engage with
about How do people patients?
violence? develop “real
world” practice
competencies?
Trauma & violence informed care
(TVIC) How do we prepare providers to
understand the impact of historical and
ongoing trauma, including cultural safety,
equity considerations, and the harm that
systems and structures can cause and
perpetuate?A foundation of evidenced- Consideration of the lifespan approach
based information that is
applicable to a wide range
of health and social service
providers, including
students
Emphasis on recognizing and responding safely with
integration of the three types of family violence
© 2020 VEGA Project McMaster UniversityVEGA’s LEARNING PATHWAY AND CONTENT © 2020 VEGA Project McMaster University
Examples of learning module content HOW-TO GAME SCRIPTS KNOWLEDGE REFLECTIONS VIDEOS SCENARIOS CHECKS
Child
Maltreatment
Care
Pathway
© 2020 VEGA Project, McMaster UniversityIntimate
Partner
Violence
Care Pathway
© 2020 VEGA Project, McMaster UniversityIPV Guidance Example
Ask questions about IPV when
potential indicators are present:
1) Signs and symptoms related to IPV exposure
2) Behavioural indicators or cues
3) Specific risk indicators
Universal screening for IPV is not recommended
© 2020 VEGA Project, McMaster UniversityWhat to say: “How to” videos: Knowledge checks:
“Everybody deserves to feel safe.”
“No one deserves to be abused.”
“I’m taking what you have told me
seriously. I’m here to help.”
“I’m concerned that this may be
affecting your health.”
Intimate Partner Violence:
Content examples
© 2020 VEGA Project, McMaster UniversityVEGA Collaborations
To register for VEGA’s Family Violence Education Resources:
https://vegaproject.mcmaster.ca/
For more information:
vega@mcmaster.ca
@VEGA_CanadaYou can also read
