Domestic Violence in Jacksonville

Vincent H. Ober, M.D., Shands Jacksonville Family Practice Center,
Hubbard House Board, Secretary


This issue of Jacksonville Medicine dedicated to domestic violence covers a wide variety of topics. This article concentrates on screening for domestic violence by physicians, confidentiality in the evaluation and treatment of victims of domestic violence and an overview of Hubbard House programs.

Screening

Screening all patients for domestic violence may seem unnecessary to some physicians. But all physicians see victims, and patient care is compromised when the diagnosis is not made and treatment is not started.

Domestic violence is common: one in six women has been abused and one in four pregnant women are abused (statistics may vary depending on the source). In Duval County the reported domestic violent crime rate (including murder, rape and assault) declined in 2001 but still remained at 913 per 100,000 (including 11 deaths)1, and many crimes go unreported5. Women are more likely to suffer abuse during pregnancy and postpartum. The most common cause of pregnancy related death (during pregnancy and the year following delivery) is murder. Women who are not diagnosed tend to have higher levels of health care use and have more sexually transmitted diseases, somatic and stress-related illnesses, chronic pain syndromes, depression, posttraumatic stress disorder and substance abuse disorders3. Women referred to a domestic violence shelter program can decrease their chances of injury, disability and death. They are more functional, and the long-term outlook for the victim and her children are much improved. Children who participate in domestic violence programs are less likely themselves to become victims or perpetrators of abuse.

Physicians miss many opportunities for screening. Less than 15% of female patients are asked about abuse by their doctors or disclose abuse to them. Patient related barriers to screening include fear of patient retaliation and police involvement, lack of patient disclosure and follow-up and cultural differences3. Physician related barriers include a lack of knowledge about screening techniques (what questions to ask and how to ask them), lack of time in a busy office schedule and lack of knowledge about treatment. Physicians who attend domestic violence training are more likely to ask about abuse. Many educational programs and other resources exist across the country2, and in Florida domestic violence education is required for medical licensure.

Three simple questions can identify the majority of abused women:

  1. Have you been hit, slapped, kicked or otherwise physically hurt in the past year?
  2. When you were pregnant were you ever hit, slapped, kicked or otherwise physically hurt?
  3. Have you been forced to have sexual intercourse in the past year?

These questions should be a part of every history form and physical exam and should take only seconds. Less specific questions such as "Have you been abused?" are not as helpful. Individuals who answer positively should be referred to a domestic violence program such as Hubbard House. Patients who want additional information can learn about Hubbard at www.hubbardhouse.org or call the Hubbard House hotline at (800) 500-1119 or (904) 354-3114.

Other domestic violence programs in the area include:

  • Quigley House
  • St. Johns House

Confidentiality

Confidentiality is important in the identification, referral and treatment of domestic violence victims. Victims are at highest risk of further and escalated abuse and death when an abuser finds the victim is trying to end the relationship. Mandatory reporting programs have not been established in most states because of concerns for victims4. Domestic violence treatment programs do not reveal information about victims. In fact the address of Hubbard House is not public so that victims can remain in a safe location. Physicians may feel that their referred patients are not being treated. If the patient will sign a release, information can be given to their physician.

Hubbard House Programs

Hubbard House is a premier domestic violence program located in Jacksonville. The basic programs available for a victim of domestic violence are outlined below.

A domestic violence victim can contact Hubbard House by calling the hotline at any time (800) 500-1119 or (904) 354-3114. Many victims are referred from law enforcement organizations, other support agencies and outreach programs. The victim is brought to Hubbard House and is given safe shelter, food, lodging, counseling and other services for herself and her children.

A treatment program (safety and service plan) is designed to address victim safety, medical conditions, psychological problems and social issues. Hubbard House works closely with the police and court systems to assure safety when a victim comes into the shelter, when she acquires an Injunction for Protection, when they leave the shelter, when the abuser is released from prison, during court proceedings and at other times. A counseling program helps the victim understand her abusive relationship and learn ways to live on her own and develop healthy relationships in the future. Education includes job skill training. Housing is arranged for the family when they leave Hubbard House at the completion of the program.

Children are also interviewed and a treatment program arranged. In addition to shelter2, food and lodging, children attend a fully accredited school within the shelter. Counseling for children helps them understand domestic violence and prevents them from becoming a victim or abuser in the future.

The usual maximum stay for families is six weeks. The longer a family is able to take advantage of the educational and counseling resources, the greater the benefit. However, families have different needs and may stay for variable periods. Transitional housing is available from other agencies but the supply does not fill the needs in the Jacksonville area. Hubbard House is working with other governmental and charity organizations to expand opportunities for transitional housing.

Conclusion

Domestic violence remains a huge problem in Jacksonville but progress is being made. Increased awareness and screening by physicians and prompt referral for assistance can improve the outlook for victims and their families. Domestic violence programs such as Hubbard House are the major treatment organizations and they are helping to make every relationship violence free.

References

  1. www.fdle.state.fl.us/FSAC/Crime_trends/domestic_violence/index.asp accessed 4/29/02.
  2. Goodman, Domestic violence resources on the internet, JAMA, 1998; 280:477-480.
  3. Rodriguez, Screening and intervention for intimate partner abuse. JAMA, 1999; 282:468-469.
  4. Rodriguez, Mandatory reporting of domestic violence injuries to the police. JAMA, 2001; 286:580-583.
  5. Watts, Violence against women: global scope and magnitude. Lancet, 2002;39:1172.
May, 2002/ Jacksonville Medicine

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