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‘MAKING THE LINK’
TRAINING VETERINARY
PROFESSIONALS TO RECOGNIZE AND
RESPOND TO HUMAN AND ANIMAL
VICTIMS OF DOMESTIC ABUSE
DR CHRISTINE GOODALL
PROF PETER DONNELLY, DR PAULA BOYDEN, LIBBY ANDERSON,
DR FREDA SCOTT-PARK
christine.goodall@glasgow.ac.uk
@MAVScotland
PRESENTER DISCLOSURES
(1) The following personal financial relationships with
commercial interests relevant to this presentation existed
during the past 12 months:
Dr Christine Goodall
No relationships to disclose
MEDICS AGAINST
VIOLENCE
A Scottish charity organization set up in 2008
We are healthcare professionals who have seen the results of
violence in our daily jobs
We have Scottish Government funding
We work in partnership with the police and other organizations
such as the WHO
We are about one thing-preventing violence, serious injury and
death
We do this in the main via education and training and awareness
raising through campaigns
We take a public health approach to violence
www.medicsagainstvioelnce.co.uk
DOMESTIC ABUSE
TRAINING
We have developed and provide
domestic abuse training to various
professional groups
Our training is delivered in
partnership with the Scottish
Violence Reduction Unit, a branch
of Police Scotland
Our programme was adapted from
one developed by Dr Barbera
Gerbert and colleagues for use
with dentists
AVDR
OUR AIM
By providing domestic abuse identification training to
professional groups we hope to
• Increase awareness
• Increase knowledge
• Increase confidence
• Increase the likelihood that professionals will take action
• Expose more victims to opportunities to access help
A DEFINITION OF
DOMESTIC ABUSE
Domestic abuse (as gender-based abuse) can be
perpetrated by partners or ex-partners and can
include physical abuse (assault and physical attack
involving a range of behavior), sexual abuse (acts
which degrade and humiliate women and are
perpetrated against their will, including rape) and
mental and emotional abuse (such as threats,
verbal abuse, racial abuse, withholding money and
other types of controlling behavior such as
isolation from family and friends).
Domestic abuse can affect any relationship but is most
often perpetrated by men against women
DOMESTIC ABUSE
RANGE OF ABUSE
Emotional abuse
Psychological abuse
Physical abuse
Sexual abuse
Financial abuse
DOMESTIC ABUSE
WHAT WE KNOW
In Scotland 1 in 4 women experience domestic abuse during
their lifetime
58,976 reported cases in 2013-14
The level of repeat victimization is high
It will take up to 35 incidents before victims report abuse to
anyone
Can involve rape and sexual assault
The cost of dealing with it amounts to 3% of the entire NHS
budget
Everyone working in health has seen victims-we just don’t
always know what to do
DOMESTIC ABUSE
WHAT WE KNOW
It takes 6-7 attempts before a victim will finally leave an
abusive relationship
There may be resistance or denial to intervention but
evidence shows that the act of someone they consider to be
in authority asking about abuse will make the victim start to
realize the seriousness of their situation
This may encourage them to take action.
MORBIDITY AND
MORTALITY
Worldwide domestic abuse is the leading cause of
morbidity for women aged 19-44 - greater than
cancer, war and motor vehicle accidents .
In England and Wales, two women a week die at the
hands of their domestic abuser.
Home Office figures published in February 2008 reveal
that thirty three children were murdered by their
parents in the previous year.
Amongst a group of pregnant women attending
primary care in East London, 5% reported that
domestic abuse had at sometime in the past caused
them to miscarry.
HEALTH CONSEQUENCES
FOR WOMEN
Chronic stress/depression/PTSD/suicide
Miscarriage/low birth weight/unwanted pregnancy
Female cancers-over half report history of domestic
violence
• advanced stage at diagnosis
• not related to lack of screening
Serious knock on effect for children
IT CAN BE EASY TO
IDENTIFY HUMAN
VICTIMS
Most human victims suffer
injuries to the head or neck
Facial trauma in women is
more likely to be due to
domestic abuse than any
other cause
Health professionals often
form long term relationships
with patients/clients so can
spot changes in appearance
or behavior
DOMESTIC ABUSE
Facial injuries in 50-90% of
victims
(Crandall et al, 2004)
A facial bruise in a female patient
is 32x more likely to be a result
of domestic violence than any
other cause
(Hutchinson et al, 1998)
DENTISTS’ ATTITUDES TO
DOMESTIC VIOLENCE (LOVE ET AL 2001)
47% had suspected a patient to be a victim
87% never screened for domestic violence
18% never screened even when patients had visible signs of
trauma
Dentists only offered minimal intervention such as recording the
findings in their notes
Dentists with training were more likely to record domestic
violence or express concern
They want to be asked
70% of patients presenting to
their dentist with signs of abuse
wished they had been asked
88% were not asked
Nelms et al (2009)
If a patient present with obvious
injuries and nobody asks they
will go away wondering why not
and this will possibly reinforce
their belief that somehow they
are in the wrong and that nobody
believes them
WHAT DO VICTIMS
WANT?
We started training in domestic abuse in 2010 with dentists, we now
train vets, doctors and the fire service
We will soon be training hairdressers
and pharmacists
WHY VETS?
Animals are often abused as part
of a domestic abuse situation.
13% of intentional injury to animals
involves domestic abuse
It may be clear that injuries are
non-accidental
Threats or abuse to the animal are
used to prevent the victim from
leaving
25-40% of victims will not leave an
abusive situation because they
what will happen to their pet if they
do (American Humane
Association)
Shelters often do not take pets
Are you and your pet
sharing a secret?
Domestic abuse affects all members of the family
Ask your Vet for information
If you know
who is responsible
for VIOLENCE
Contact
Crimestoppers
0800 555 111
www.medicsagainstviolence.org www.crimestoppers-uk.org www.thelinksgroup.org.uk www.actiononviolence.co.uk www.onekind.org
Vets are part of the national campaign against domestic abuse
SPECTRUM OF
ANIMAL ABUSE
Physical abuse: includes kicking, punching, throwing,
burning, microwaving, drowning, asphyxiation, and the
administration of drugs or poisons. (Non-accidental injury)
Sexual: any use of an animal for sexual gratification.
Neglect: a failure to provide adequate food, water, shelter,
companionship or veterinary attention.
Emotional abuse: persistent threatening behaviour or failure
to provide basic behavioural needs
MORE VETS ARE
BECOMING AWARE OF
‘THE LINK’
RECOGNIZING HUMAN
AND ANIMAL VICTIMS IN
THE SURGERY
• Repeated injuries
• Bruises at different stages of healing
• Dental/maxillofacial injuries
• Unlikely explanations for injury
• This is true for domestic abuse, child abuse and also abuse
of animals
SO WHAT DO I DO IF I ASK
AND SHE SAYS YES?
Introduction
Domestic abuse is our greatest national shame. Every 10 minutes the police in Scotland deal with an
incident of domestic abuse but it will have taken on average 35 previous incidents of abuse before the
victim feels able to makes the call.
To encourage those suffering domestic abuse to divulge or report, we need a range of strategies and
support systems endorsed and practised by all the professionals who the victim may come into contact
with, including doctors, dentists, and veterinary surgeons. Sometimes the most everyday scenarios can
be the most successful in encouraging this reporting and we must never miss the “golden moment”
when a client confides in a professional who they can trust.
Our colleagues working with adults vulnerable to abuse have welcomed the active participation of
veterinary practices as part of the team required to break the cycle of abuse. For instance, dentists are
frequently the first health professional a victim of domestic abuse sees when seeking care for violence
related injuries. Patients often develop long lasting relationships with their dentists that may
encourage the disclosure of sensitive information, such as violence in a relationship thus the dentist is
perfectly placed to encourage reporting. Veterinary surgeons are similarly trusted.
Therefore the Domestic Abuse Veterinary Initiative (DAVI) has been developed in conjunction with the
Violence Reduction Unit and Medics against Violence (MAV). Most of the current dental studies are
from the USA but are relevant to the UK and the initiative is being extended to other healthcare
professionals. This note provides a brief guide to the initiative and how it works.
Further information relating to this initiative can be
obtained via the MAV website,
www.medicsagainstviolence.org
or by contacting the
Violence Reduction Unit,
First Floor, Pegasus House,
375 West George Street,
Glasgow G2 4LW
abuse
initiative
MAV Practice Note 2
Further reading
1. Musculoskeletal Manifestations of
Physical Abuse After Intimate Partner
Violence, Mohit Bhandari MD, MSc, Sonia Dosanjh
MSW, Paul Tornetta III, MD, and David Matthews,
PsyD, on behalf of the Violence Against Women
Health Research Collaborative, The Journal of
Trauma Injury, Infection, and Critical Care Volume 61,
Number 6
2. Trauma, Violence & Abuse: Acute Injury
Patterns of Intimate Partner Violence Victims,
Daniel J. Sheridan and Katherine R. Nash, Sage
Publications. Available online at
http://tva.sagepub.com/cgi/content/abstract/8/3/281
3.Maxillofacial Injuries and Violence
Against Women, Oneida A. Arosarena, MD; Travis
A. Fritsch, MS; Yichung Hsueh, MD; Behrad
Aynehchi, MD; Richard Haug, DDS, Arch Facial Plast
Surg/Vol 11 (No 1) Jan / Feb, www.archfacial.com
4. Changing dentists’ knowledge,
attitudes and behavior regarding domestic
violence through an interactive multimedia
tutorial, Nancy Kwon Hsieh, Karen Herzig, Stuart A.
Gansky, Dale Danley and Barbara Gerbert, The
Journal of the American Dental Association
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ASK
! Ask about abuse in a confidential setting
‘sometimes when I see injuries like this it means an animal is being hurt
by someone-is that what happened to your dog?’
VALIDATE
! Provide validating messages that take the blame away from the victim.
Heping the owner will help the animal
‘Your animal/you do not deserve to be hurt or hit no matter what
happened’
‘I am concerned about your safety’
DOCUMENT
Specific and detailed documentation of injuries as notes may end up in court
some time later
REFER
! Refer the owner and pet to appropriate services
! Scottish Domestic Abuse Helpline/Women’s Aid/ SSPCA
WHAT IS NOT
EXPECTED
It is not the role of the healthcare professional to
provide specific advice to victims about eg
leaving the home
Leaving home is the most dangerous time for the
victim and their pets
This is best left to the professional organizations
who deal with domestic violence
The victim should also be advised to contact the
police
RECOGNIZING HUMAN
AND ANIMAL VICTIMS
Behavior
• missed appointments
• frequent appointments
• accompanied by an over-bearing partner who may be very
charming
• partner insists on being present
• partner may insist on female practitioner
• suspected human victim does not speak when partner is
present
• animal may seem afraid
• change in behavior of owner or pet
DOES TRAINING
HELP?-VETS
Training increased knowledge, confidence and the ability to
provide practical help to victims and their pets
Vets were empowered to help victims and could see a clear
role
Several put this into practice soon after the course-in one
case the next day
RECOGNIZING ABUSE
HUMANS
0
10
20
30
40
50
60
70
80
90
100
SD D NSF A SA
Before
After
ANIMALS
0
10
20
30
40
50
60
70
80
90
100
SD D NSF A SA
Before
After
I KNOW HOW TO ASK
ABOUT ABUSE
0
10
20
30
40
50
60
70
80
90
100
SD D NSF A SA
Percentage of vets
Before
After
I KNOW HOW TO
DOCUMENT INCIDENTS
ABUSE IN MY NOTES
0
10
20
30
40
50
60
70
80
90
100
SD D NSF A SA
Percentage of vets
Before
After
I KNOW HOW TO ACCESS HELP
FOR HUMAN VICTIMS OF
DOMESTIC ABUSE
0
10
20
30
40
50
60
70
80
90
100
SD D NSF A SA
Percentage of vets
Before
After
I KNOW MY PROFESSIONAL AND
LEGAL RESPONSIBILITIES WITH
REGARD TO ANIMAL VICTIMS OF
ABUSE
0
10
20
30
40
50
60
70
80
90
100
SD D NSF A SA
Percentage of vets
Before
After
I AM COMMITTED TO
HELPING VICTIMS OF
DOMESTIC ABUSE
0
10
20
30
40
50
60
70
80
90
100
SD D NSF A SA
Percentage of vets
Before
After
I KNOW WHAT MY ROLE IS WITH
REGARD TO HUMAN VICTIMS OF
ABUSE
0
10
20
30
40
50
60
70
80
90
100
SD D NSF A SA
Percentage of vets
Before
After
AVDR
The AVDR intervention is quick and easy
Limits the enquirers involvement to very simple tasks, devolving
them of the responsibility to get too involved in the often
complex circumstances surrounding the abuse
Allows professionals to work within their comfort zone
If people know that their involvement is limited they are more
likely to undertake the intervention
It does seem to increase the confidence of veterinary
professionals in dealing with this subject
The main thing is to play to the
strengths that professionals already
have
Communication
Empathy
Concern
Knowledge-we can give them this
We all worry about asking and
getting it wrong, but better that than
not giving someone the chance to
get get help
!
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thelinksgroup
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vulnerabl e children, animals, adults
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