1 . Most healthcare professionals will encounter patients in their practice who are victims of domestic violence.
Domestic violence continues to be a prevalent problem in the
United States today. Because of the number of individuals affected, it is likely that most
healthcare professionals will encounter patients in their practice who are victims.
Accordingly, it is essential that healthcare professionals are taught to recognize and
accurately interpret behaviors associated with domestic violence. It is incumbent upon the
healthcare professional to establish and implement protocols for early identification of
domestic violence victims and their abusers. In order to prevent domestic violence and promote
the well-being of their patients, healthcare professionals in all settings should take the
initiative to properly assess all women for abuse during each visit and, for those women who
are or may be victims, to offer education, counseling, and referral information.
2 . The Florida Department of Children and Families' definition of domestic violence may include pet abuse, physical abuse, and/or emotional abuse.
DEFINING DOMESTIC VIOLENCE
Domestic violence, which is sometimes also referred to as
spousal abuse, battering, or intimate partner violence (IPV), refers to the victimization of
an individual with whom the abuser has or has had an intimate or romantic relationship.
Researchers in the field of domestic violence have not agreed on a uniform definition of what
constitutes violence or an abusive relationship. The Centers for Disease Control and
Prevention (CDC) defines IPV as, "violence or aggression that occurs in a romantic
relationship" [1]. According to the Florida
Department of Children and Families, domestic violence is "a pattern of abusive behaviors that
adults use to maintain power and control over their intimate partners or former partners.
People who abuse their partners use a variety of tactics to coerce, intimidate, threaten, and
frighten their victims" [2]. Domestic violence
may include physical violence, sexual violence, emotional abuse, economic abuse, isolation,
pet abuse, threats relating to children, and a variety of other behaviors meant to increase
fear, intimidation, and power over the victim [2]. Florida law defines domestic violence as "any assault, aggravated
assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated
stalking, kidnapping, false imprisonment, or any criminal offense resulting in physical injury
or death of one family or household member by another family or household member" [3]. Family or household members, according to
Florida definition, must "be currently residing or have in the past resided together in the
same single dwelling unit" [3]. Domestic
violence knows no boundaries. It occurs in intimate relationships regardless of race,
religion, culture, or socioeconomic status [2].
3 . Florida law defines domestic violence exclusively as spouse abuse or battering.
DEFINING DOMESTIC VIOLENCE
Domestic violence, which is sometimes also referred to as
spousal abuse, battering, or intimate partner violence (IPV), refers to the victimization of
an individual with whom the abuser has or has had an intimate or romantic relationship.
Researchers in the field of domestic violence have not agreed on a uniform definition of what
constitutes violence or an abusive relationship. The Centers for Disease Control and
Prevention (CDC) defines IPV as, "violence or aggression that occurs in a romantic
relationship" [1]. According to the Florida
Department of Children and Families, domestic violence is "a pattern of abusive behaviors that
adults use to maintain power and control over their intimate partners or former partners.
People who abuse their partners use a variety of tactics to coerce, intimidate, threaten, and
frighten their victims" [2]. Domestic violence
may include physical violence, sexual violence, emotional abuse, economic abuse, isolation,
pet abuse, threats relating to children, and a variety of other behaviors meant to increase
fear, intimidation, and power over the victim [2]. Florida law defines domestic violence as "any assault, aggravated
assault, battery, aggravated battery, sexual assault, sexual battery, stalking, aggravated
stalking, kidnapping, false imprisonment, or any criminal offense resulting in physical injury
or death of one family or household member by another family or household member" [3]. Family or household members, according to
Florida definition, must "be currently residing or have in the past resided together in the
same single dwelling unit" [3]. Domestic
violence knows no boundaries. It occurs in intimate relationships regardless of race,
religion, culture, or socioeconomic status [2].
4 . House Bill 1099 strengthened domestic violence services by streamlining the process of allocating funds.
NATIONAL AND STATE STATISTICS AND LEGISLATION
In 2003, Governor Bush signed House Bill 1099, which
transferred funding authority of the Florida Domestic Violence Trust Fund from the
Department of Children and Families to the Florida Coalition Against Domestic Violence.
According to the Domestic Violence in Florida 2010–2011 Annual Report to the Legislature,
this has strengthened domestic violence services provided by streamlining the process of
allocating funds [23].
5 . Domestic violence resulted in 217 deaths in Florida in 2020.
NATIONAL AND STATE STATISTICS AND LEGISLATION
In 2020, the FDLE reported 106,736 domestic violence offenses
[8]. In general, domestic violence rates
have been declining since 1998. An estimated 19.5% of domestic violence incidents involved
spouses and 27.8% involved cohabitants; 11.6% of the victims were parents of the offenders.
Domestic violence offenses resulted in the death of 217 victims in Florida in 2020, a number
that has been decreasing since 2014 [8].
Domestic violence accounted for 16.9% of the state's murders in 2020 [8].
6 . The majority of children exposed to intimate partner violence are direct eyewitnesses.
IDENTIFYING GROUPS AT RISK FOR DOMESTIC VIOLENCE
Children exposed to family violence are at high risk for
abuse and for emotional damage that may affect them as they grow older. The Department of
Justice estimates that of the 76 million children in the United States, 46 million will be
exposed to some type of violence during their childhood [52]. Results of the National Survey of Children's Exposure to Violence
indicated that 11% of children were exposed to IPV at home within the last year, and as many
as 26% of children were exposed to at least one form of family violence during their
lifetimes [31]. Of those children exposed to
IPV, 90% were direct eyewitnesses of the violence; the remaining children were exposed by
either hearing the violence or seeing or being told about injuries [31]. Of note, according to Florida criminal
law, witnessing domestic violence is defined as "violence in the presence of a child if an
offender is convicted of a primary offense of domestic violence, and that offense was
committed in the presence of a child under age 16 who is a family or household member with
the victim or perpetrator" [32].
7 . Domestic violence injury patterns are more likely than accidental injuries to involve the extremities of the body.
SCREENING FOR DOMESTIC VIOLENCE AND ABUSE
Several barriers to screening for domestic violence have been
noted, including a lack of knowledge and training, time constraints, lack of privacy for
asking appropriate questions, and the sensitive nature of the subject [35]. Although awareness and assessment for IPV
has increased among healthcare providers, many are still hesitant to inquire about abuse [46]. At a minimum, those exhibiting signs of
domestic violence should be screened. Although victims of IPV may not display typical signs
and symptoms when they present to healthcare providers, there are certain cues that may be
attributed to abuse. The obvious cues are physical. Injuries range from bruises, cuts, black
eyes, concussions, broken bones, and miscarriages to permanent injuries such as damage to
joints, partial loss of hearing or vision, and scars from burns, bites, or knife wounds.
Typical injury patterns include contusions or minor lacerations to the head, face, neck,
breast, or abdomen and musculoskeletal injuries. These are often distinguishable from
accidental injuries, which are more likely to involve the extremities of the body. Abuse
victims are also more likely to have multiple injuries than accident victims. When this
pattern of injuries is seen, particularly in combination with evidence of old injury, physical
abuse should be suspected [44].
8 . In addition to physical signs and symptoms, domestic violence victims may also exhibit psychologic cues that resemble an agitated depression.
SCREENING FOR DOMESTIC VIOLENCE AND ABUSE
In addition to physical signs and symptoms, domestic violence
victims also exhibit psychologic cues that resemble an agitated depression. As a result of
prolonged stress, various psychosomatic symptoms that generally lack an organic basis often
manifest. For example, complaints of backaches, headaches, and digestive problems are common.
Often, there are reports of fatigue, restlessness, insomnia, or loss of appetite. Great
amounts of anxiety, guilt, and depression or dysphoria are also typical. Women who experienced
IPV are also more likely to report asthma, irritable bowel syndrome, and diabetes [4]. Healthcare professionals should look beyond
the typical symptoms of a domestic violence victim and work within their respective practice
settings to develop appropriate assessment mechanisms to detect victims who exhibit less
obvious symptoms.
9 . Assessment of domestic violence victims should occur immediately after disclosure of abuse and at any follow-up appointments.
ASSESSING DOMESTIC VIOLENCE AND ABUSE
Assessment of domestic violence victims should occur
immediately after disclosure of abuse and at any follow-up appointments. Assessing immediate
safety is priority. Having a list of questions readily available and well-practiced can help
alleviate the uncertainty of how to begin the assessment (Table
1). If the patient is in immediate danger, referral to an
advocate, support system, hotline, or shelter is indicated [35].
10 . Florida does not presently have a toll-free domestic violence hotline, although this was a recommendation of the Governor's Task Force on Domestic Violence.
INTERVENTIONS FOR DOMESTIC VIOLENCE AND ABUSE
In Florida, a 24-hour domestic violence hotline is available
for toll-free counseling and information. The number is 800-500-1119. The counselors answering
the toll-free line may refer the victim to her or his local domestic violence center. A list
of Florida certified domestic violence centers organized by county may also be found on the
Florida Department of Children and Families website at https://www.myflfamilies.com/service-programs/domestic-violence. Florida's domestic
violence centers provide information and referral services, counseling and case management
services, a 24-hour hotline, temporary emergency shelter for more than 24 hours, educational
services for community awareness relative to domestic violence, assessment and appropriate
referral of resident children, and training for law enforcement personnel.
