Domestic Violence, Sexual Violence, Intimate Partner Violence Course | CEUfast Nursing Continuing Education
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Domestic Violence, Sexual Violence, Intimate Partner Violence

3.00 Contact Hours
FPTA Approval: CE17-27946. Accreditation of this course does not necessarily imply the FPTA supports the views of the presenter or the sponsors.
A score of 80% correct answers on a test is required to successfully complete any course and attain a certificate of completion.
Author:    Melissa DeCapua (DNP, PMHNP-BC)

Purpose/Goals

This course assists the healthcare worker in understanding domestic violence and the mandates about domestic violence that involve healthcare workers. It concludes with strategies for healthcare workers to use in identifying and managing victims of domestic violence.

Objectives

After completing this course, the learner will be able to:

  1. Define domestic abuse;
  2. Recognize murder and workplace violence trends seen across the United States and various racial monitories;
  3. Identify 5 risk factors for violence against a spouse or significant other;
  4. Discuss 3 reasons why victims stay with the  abusive partners;
  5. Explain 3 reasons why victims of domestic violence are not identified in the healthcare system; and
  6. Create a treatment plan for a victim of domestic violence using the treatment protocol discussed in this activity.

Definition

Domestic violence amongst family members can take many forms. It may include emotional abuse, economic abuse, sexual abuse, threats, using the threat of removing children, using male privilege, intimidation, isolation, and other behaviors used to maintain fear, intimidation, and power. Acts of domestic violence are categorized into psychological battering, physical battering, or sexual abuse (CDC, 2010). The term domestic violence is still used, but more recently physical, psychological, or sexual violence in the context of a relationship is called intimate partner violence. The World Health Organization (WHO) defines intimate partner violence as “any behavior within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship” (Rhodes, 2012)

Psychological Battering causes trauma to the victim by acts, or threats of acts, or coercive behavior. Typical behaviors classified as psychological battering include controlling/dominating behavior, deprivation of economic, healthcare and physical resources, destruction of personal property, embarrassment, excessive possessiveness, harassment, humiliation, isolation from family and friends,  stalking, and verbal abuse, (CDC, 2010).

Physical Battering involves intentional physical attacks and aggressive behaviors that have the potential to cause harm, harm that ranges from bruising and pain to murder. It often begins with what is excused as trivial contact and escalates into more frequent and serious attacks (CDC, 2010).  

Sexual Abuse is typically divided into three categories: 1) sexual activity that is compelled, forced; 2) sexual activity with someone who cannot, or is incapable of giving consent or understanding the sexual situation, and; 3) sexual activity that is abusive, degrading, or humiliating (CDC 2010). Sexual abuse can take place in many types of relationships. Sexual abuse and sexual violence and violence against women commonly occur together in the context of a relationship of an intimate partner relationship.

Battering is a pattern of behavior that uses fear and intimidation to establish power and control over another person. It is an escalating process. It often begins with threats, name-calling[G2] , and damage to objects or pets. It may escalate into restraining, pushing, slapping, or pinching. Next, the behavior may include punching, kicking, biting, sexual assault, tripping, or throwing. Finally, battering may become life-threatening with serious behaviors like choking, breaking bones, or using weapons (CDC, 2010). Abuse tends to happen in cycles; does not just go away; and tends to get worse over time (CDC, 2010).

Prevalence and Trends

According to the Bureau of Justice Statistics, domestic violence accounts for approximately 17% of all violent crime in the United States (Planty, 2016). Most victims of domestic violence are spouses, but children and other family members are often victimized as well. The incidence of child physical abuse and child neglect associated with intimate partner violence has been estimated to be between 30%-60% (Lamers-Winkleman et al., 2012).

Although males are victims, females are the victim in 85% of abuse by a spouse or significant other (Planty, 2016). The lifetime risk for U.S. women of suffering from intimate partner violence has been estimated to be between 22% - 39% (Nelson et al., 2012). Elder abuse, child abuse, and same-sex abuse are also significant problems.

Fifty percent of domestic violence occurs at or near the victim’s home (US Census Bureau, 2013). Simple assault is the most common domestic violence offense, but domestic violence/intimate partner violence can be lethal: approximately 22% of homicides are domestic murders (Wozniak et al., 2010).

There is a strong association between substance abuse and domestic violence/intimate partner violence (Smith et al., 2012). Smith et al., 2012, found that almost 22% of all perpetrators of intimate partner violence had an alcohol abuse problem. About 31% of all the perpetrators had a substance abuse problem (alcohol, illicit drugs), and the use of alcohol in conjunction with incidents of intimate partner violence has been estimated to be between 22-60% (Smith et al., 2012; Taft et al., 2010).

The traditional image of domestic violence/intimate partner violence has been a man abusing a woman. However, women can be the perpetrators of violence in a relationship. There is controversy about how common women-initiated violence is. The reported incidence of abused men varies widely, but in 2010, Black et al. stated in the WHO reports that 1 in 4 men have been abused by their female partner, and this appears to be confirmed by other studies (Walter et al., 2016).

Research demonstrates that violence by women in the context of an intimate relationship is relatively common. But the consequences to the victims and the motives of the female perpetrator do appear to be different. The violence perpetrated by women seems to be less frequent, but any particular incident is likely to be more severe. Violence is also common in lesbian, gay, bi-sexual, and transgender relationships (Goldberg et al., 2012).

Murder Trends

About 22% of murder victims in 2007 were family members. Family members were most likely to kill a young child, while a friend or acquaintance was most likely to murder an older child age 15 to 17. Forty-three percent of murder victims were related to or acquainted with their assailants (Durose et al., 2005). Intimate partners committed 14% of all homicides in the US in 2007, and 64% of all women killed in 2007 were murdered by a family member or an intimate partner (Catalano et al., 2009).

Workplace Violence Trends

Intimate partner violence is relatively common. Approximately 15% of employees in the workplace suffer the effects of intimate partner violence (Katula, 2012). Women lose roughly 8 million days of work a year due to intimate partner violence (Magnusson et al., 2011), and their emotional and psychological issues and their work absence affect co-workers and the places they work, as well. Intimates (current and former spouses, boyfriends and girlfriends) were identified by the victims as the perpetrators of 1.7% of all workplace violent crime against females and 0.8% of males (US Department of Justice, 2011). About 59% of the female victims of violence in the workplace reported that they knew their offender (US Department of Justice, 2011).

Race/Ethnicity

Approximately four out of 10 African American women, American Indian women, and Alaska Native women have experienced physical violence, rape, or stalking in their lifetime by an intimate partner (Black et al., 2010). Mixed race non-Hispanic women experience these crimes at an incidence of 53.8%. The rate for white women is 34.6%, for Hispanic women 37.1%, and 19.6% for Asian and Pacific Islander women (Black et al., 2010).

Cycle of Violence

Abuse tends to occur in cycles. It does not just go away and tends to get worse over time. Domestic violence and intimate partner violence typically, but not always, follows a pattern. There is a period of tension building; there is an episode of violence; and there is a time calm, or a "honeymoon" (Hancock, 2012). Research suggests the more severe the violence, the more chronic it is and the more likely it is to worsen over time (Lipsky et al., 2012).
Cycle of Domestic Violence

The cycle of violence is as follows:

  1. Tension Building
    1. Tension mounts in the relationship.
    2. The batterer is irritable, frustrated, and unable to cope with everyday stresses.
    3. The victim attempts to appease the batterer by becoming compliant, nurturing, or staying out of the way
    4. The victim often assumes responsibility for controlling the abuser’s anger
    5. The victim denies the inevitability of the beating and the terror.
    6. The batterer fears that the victim will leave and their fears are reinforced by the victim’s coping strategy of withdrawing and avoiding.
  2. The Battering Incident 
    1. The batterer's intent is to teach a lesson, not to inflict injury. In the process, they lose control of their rage
    2. Only the batterer can end this phase
    3. The victim needs a safe place during this phase
    4. Once over, the victim will deny the incident, injuries, and terror
  3. The Calm Respite of "the Honeymoon."
    1. The batterer is kind and charming, afraid that the victim will leave
    2. The victim believes the suffering is over
    3. Then the cycle continues and returns to stage one

 

Abuser

There are many theories as to why some people are abusers. However, the reason abusers use this behavior is that violence is an effective method for gaining and keeping control over another person. In a domestic situation, the abuser traditionally has not suffered adverse consequences as a result of violent behavior.

Historically, domestic violence in many cultures and societies has not been treated as a "real" crime. This lack of regard to violence is evident in the absence of severe consequences, like incarceration or financial penalties (WHO, 2016). Some cultures support the man’s right and just cause to punish their spouse by beating, in some circumstances (Waltermaurer, 2012; Uthman et al., 2011; WHO, 2016).

Abusers often display immaturity and are dependent and non-assertive (Saddock, 2015). They tend to suffer from strong feelings of inadequacy, and they use their bullying behavior to humiliate their partner in order to support their own low self-esteem. They sometimes displace aggression provoked by others onto their partner. The psychological dynamics of male abusers include identification with an aggressor (father, boss, brother, etc.), testing behaviors (i.e., “Will she stay with me no matter what I do to her?”), distorted desires to express manhood, and dehumanization of women (Saddock, 2015).

Risk factors for violence against their spouse or significant other are (Farrell, 2011; Theobald et al., 2012; WHO, 2016):

  • Family history of violence
  • Alcohol and drug use
  • Emotional dependency, insecure and low self-esteem
  • Lack of impulse control
  • Antisocial, aggressive, and borderline personality disorders
  • Poverty
  • Marital discord or conflict

Research from both developed and undeveloped countries has consistently identified the following triggers for domestic violence (Dobash et al., 2011):

  • Not obeying the man;
  • Arguing back;
  • Not having food ready on time;
  • Not caring adequately for the children or home;
  • Questioning the man about money or girlfriends;
  • Going somewhere without the man’s permission;
  • Refusing the man sex;
  • The man is suspecting the woman of infidelity.

Batterers come from all social classes, races, cultures, religions, backgrounds, and countries (WHO, 2016). The following behaviors may be warning signs (Farrell, 2011; Theobald et al., 2012):

  • Extreme jealousy;
  • Blames others for their faults and circumstances for their problems;
  • Unpredictable behavior;
  • Verbally abusive;
  • Unable to control their anger;
  • Always asking for a second chance, saying they’ll change and won’t do it again;
  • Their family resolves problems with violence;
  • Plays on your guilt;
  • Their way is the only way;
  • Behavior often worsens when using alcohol or drugs; and
  • Cruelty to animals.

There have been assessment tools developed that can help identify someone who has the potential for domestic violence/intimate partner violence. The Spousal Abuse Risk Assessment (SARA) is a validated tool that looks for the presence of 20 behaviors such as a history of assault and/or sexual violence, personality disorder, history of the use of weapons, and emotional denial or minimization of violence (Theobald et al., 2012).

Victims

Why do victims stay? All too often that question is answered with a victim-blaming attitude. Victims of abuse often hear that they must like or need abusive treatment, or else they would leave. Sometimes, victims are told that they “love too much" or have low self-esteem. The truth is that no one likes being beaten, regardless of his or her emotional state or self-image. The reasons that a victim stays are many and complex (Kelly, 2011; Panchanadeswaran et al., 2011; Employee Assistance, 2004).

  1. Lack of resources
    1. Responsibility for dependent children.
    2. Not employed outside of the home.
    3. The victim does not solely own any property.
    4. Lack of access to cash or bank accounts.
    5. Fear of being charged with desertion; therefore, losing children or joint assets.
    6. Fear of a decline in living standards for herself and her children.
  2. Institutional responses
    1. Clergy and secular counselors are often trained to see only the goal of saving the marriage at all costs.
    2. Police officers treat domestic violence as a dispute instead of a crime.
    3. Police may try to dissuade women from filing charges.
    4. Prosecutors are reluctant to prosecute cases and judges are lenient with the sentencing.
    5. Even with a restraining order, there is little to prevent a released abuser from returning and repeating the assault.
    6. There are not enough shelters to keep victims safe.
  3. Traditional ideology
    1. The belief that divorce is not a viable alternative.
    2. The belief that a single parent family is unacceptable, and that even a violent father is better than no father at all.
    3. Many women are socialized to believe that they are responsible for making their marriage work.
    4. The isolation of a victim contributes to a sense that there is nowhere to turn.
    5. Rationalization of their abuser’s behavior by blaming stress, alcohol, problems at work unemployment, or other factors.
    6. Many women feel that their identity and worth are contingent upon getting and keeping a man.
    7. During the non-violent phases, the abuser may fulfill the woman’s dream of romantic love. She believes that he is basically good.

Millions of children witness intimate partner violence at home (Harding et al., 2013). The effect of this exposure has been compared to direct physical abuse of the child (Harding et al., 2013), and these children suffer from a wide range of emotional, physical, and psychological problems listed below (Lamers-Winkleman et al., 2012; Bauer et al., 2013; Nicklas et al., 2013).

  • Attention deficit/hyperactivity disorder
  • Anxiety
  • Behavioral problems, e.g., aggression
  • Depression
  • Eating disorders
  • Poor academic performance
  • Low self-esteem
  • Need for psychotropic medications
  • Nightmares
  • Physical health complaints
  • Self-harming behaviors

Domestic violence/intimate partner violence is also strongly associated with a high incidence of child neglect and maltreatment (Nicklas et al., 2013). Evidence suggests that domestic violence increases the risk of child morbidity and mortality (WHO, 2016).

Mandates against Domestic Violence

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines standards for healthcare organizations and monitors compliance with those standards. JCAHO mandates that hospitals must develop criteria to identify possible victims of abuse. The criteria must focus on observable evidence and not just on allegations. It must at least address physical assault; rape or other sexual molestation; domestic abuse; and abuse or neglect of elders and children. The criteria should be developed in a way to prevent any action or question that could create false memories of abuse in an individual (Burnett, 2011).

Staff must be trained to apply the criteria. They should question whether abuse might have occurred if a patient's story for his or her injury does not match the actual injury. A hospital must maintain a list of private and public community agencies that provide help for abuse victims. Staff must be able to make appropriate referrals for victims (Burnett, 2011).

For example, a child’s x-rays may show an unexplained broken bone. Staff should observe the behavior of the people who brought the child to the emergency room. Does the child cling to one parent and avoid the other? Staff members should question the child in a non-threatening manner, look for bruises on the body, and listen to explanations to see if there is a balance between the physical evidence and the story.

New York was the first state that requires hospitals to establish protocols to identify and treat domestic violence victims and make referrals to community services. California passed the first state law mandating protocols for hospitals and clinics to detect the presence of violence in the lives of patients.

California further required domestic violence training a part of the licensing and re-certification process for healthcare providers. Connecticut, Florida, Iowa, and Kentucky also require domestic violence training for re-licensure of physicians (Medscape Education, 2012).

WHO (2010) recommends the following actions:

  • Governments and other donors should be encouraged to invest much more in research on violence by intimate partners over the next decade.
  • Programs should place greater emphasis on enabling families, circles of friends and community groups, including religious communities, to deal with the problem of partner violence.
  • Programs on partner violence should be integrated with other programs, such as those tackling youth violence, teenage pregnancies, substance abuse and other forms of family violence.
  • Programs should focus more on the primary prevention of intimate partner violence.

Role of Healthcare Professionals

Early identification and intervention with victims of domestic violence can help prevent injuries and save lives (Nelson et al., 2012; Decker et al., 2012). Many victims of domestic violence seek assistance in healthcare settings, often repeatedly, but are only treated for symptoms and injuries. Unfortunately, healthcare professionals often fail to identify victims. Missed cases of intimate partner violence may be due to the screening method: depending on the screening tool that is being used, the rate of detection has been reported to range from 9.2% to 30.5% (Sprague, Madden, Dosanjh, et al., 2012).

Missed cases may also be due to healthcare professionals simply not screening (Sprague, Madden, Simonuvic, et al., 2012), and many nurses are not prepared to provide care to a woman who is a victim of violence from her partner (Sundborg et al., 2012). There are many reasons nurses, physicians, and other healthcare professionals may not screen for intimate partner violence (Beynon et al., 2012).

  • Lack of time
  • Lack of training
  • Lack of resources
  • Language barriers
  • Cultural barriers
  • Emotional discomfort
  • Behavior of the victim, e.g., uncooperative, unwilling to accept help

Mental health providers see victims of domestic violence for suicide attempts, anxiety, and depression. Practitioners who specialize in chronic pain, such as headaches or stomach disorders, also treat victims of abuse. Pediatricians who see abused children may also see abused women because child abuse and spousal abuse frequently co-exist (Harding et al., 2013).

Pregnancy may be a risk factor for battering. Approximately 1 in 12 women in North America who are pregnant experience some form of intimate partner violence (Kramer et al., 2012). Violence during pregnancy increases the incidence of morbidity and mortality. Specifically, victims of violence are more likely to deliver a pre-term or low-birth-weight infant (Kramer et al., 2012), it affects breastfeeding, and these victimized women are more prone to miscarriage, depression, alcohol and drug abuse, and forgoing prenatal care (Hellmuth et al., 2013).

Healthcare providers can help by screening for domestic violence, documenting abuse in the medical record, safeguarding evidence, providing medical advice, referrals, and safety planning, and showing empathy and compassion. Victims of domestic violence/intimate partner violence may not discuss the violence unless they are asked directly (Beynon et al., 2012; Morse et al., 2012). However, many victims of domestic violence/intimate partner violence will talk about the abuse if they are asked in a direct, caring, and non-judgmental manner (Decker et al., 2012).

Abuse victims need referrals to legal and social services. They may need help with finding temporary shelter, advice on how to keep safe should they return home, and affirmation that the abuse is not their fault (Burnett, 2011).

Screening questions should always be asked in a private room, away from the batterer and preceded by assurances of strict confidentiality. The spouse or partner should be separated from the patient if they demand to accompany the patient into the examining room (Hancock, 2011).

It is not the role of the healthcare provider to invoke or foster criminal justice intervention. Calling the police is not always in the best interest of a victim of domestic abuse. Some victims of domestic violence have learned to distrust the police or believe that law enforcement intervention will further endanger them. Immigrant victims may fear that calling the police will lead to deportation. Others are unwilling to use law enforcement intervention until a safety plan is in place.

Each victim should be informed of their legal options and encouraged to make their own choices (Burnett, 2011; Hancock, 2011). The requirements for reporting incidents of domestic violence/intimate partner violence - what must be reported, how it must be reported and to whom, and who is responsible for the reporting – vary from state to state (Family Violence Prevention Fund, 2010).

Treating Victims of Domestic Violence

Treatment should follow these steps (Saddock, 2015):

  • Identify patients who may be suffering from domestic violence
  • Encourage him or her to talk about it
  • Listen nonjudgmentally
  • Validate their fears and concerns
  • Document their complaints, symptoms, and injuries
  • Assess the danger they are currently in
  • Provide appropriate referral and support

The first step in treatment is identification of the victim. Many women who are victims of abuse will not voluntarily share this information; however, they will discuss if the provider asks the right question in a compassionate, non-judgmental manner. The healthcare provider might start by asking, “Because violence is common in many people’s lives, I ask every patient the same question. At any point, has your partner harmed or threatened you?” These conversations should always take place in a private setting when the patient is alone.

If the patient answers yes to this question, the healthcare provider should encourage her to talk about it. The healthcare provider should listen nonjudgmentally; this helps begin the healing process and provides information that will help with treatment planning. It is also very important for the healthcare worker to validate the victim's fears because they often think that others won’t believe them or will downplay their experiences. The healthcare provider might say, “You don’t deserve to be treated this way,” and “You are not to blame.”

The healthcare provider must document the patient’s complaints and symptoms. The complaint should be written using the patient’s own words when possible. Also, be sure to detail and describe injuries including their type, size, location, and number. If possible take color photographs and include those in the chart as well.

Next, assess the danger to your patient. Determine whether he or she is safe to leave the healthcare setting. Indicators of escalating danger include an increase in the frequency, duration, or severity of assaults, new threats of homicide or suicide by the partner, threats to children or other loved ones, and the presence or availability of a gun.

Finally, healthcare providers should offer the appropriate referral and support. Start by treating the victim’s injuries. If the victim is determined to be in imminent danger, refer him or her to stay with friends, family, or at a domestic violence shelter. If he or she is not in imminent danger, provide written information about community shelters and resources. Also, be sure to provide him or her with a toll-free domestic violence hotline number.

Case Studies

Case 1

Chelsea is a 43-year-old Caucasian female living with her second husband. She arrives at the clinic appearing shaky and nervous. During the initial physical assessment, she begins to cry explaining that her husband is aggressive towards her. She describes his various behaviors, which could be classified as emotional, physical, and financial abuse. She has two children, ages three and six who both at the clinic with her.

She denies any current suicidal thoughts and any current drug or alcohol misuse. Assessment of the children does not reveal any evidence of abuse towards them, and Chelsea denies witnessing any aggression towards them in the past. The healthcare worker completes an assessment and explains to Chelsea her legal options. Chelsea agrees to go with her children to a local shelter where she can begin more specialized treatment and receive adequate community resources.

Case 2

Nitya, a 28-year-old immigrant from India living in the Midwest, left her husband and moved into her friend’s house after three instances of physical abuse. Nitya has obtained a restraining order, but her husband is attempting to retaliate by filing for a modification of custody for their children, citing frivolous allegations and inappropriate parenting. Her lawyer continues to represent her, and she has recently begun seeing a social worker for cognitive-behavioral therapy. This counseling has helped her emotionally process her situation and previous trauma.

Case 3

Stephanie, a 21-year-old college student, broke up with her violent boyfriend about a month ago; however, he continues to stalk her. He continues to show up on campus and will appear outside her classes, the cafeteria, and the library. He calls and text messages her daily saying threatening and hurtful things. Stephanie is scared and has been considering dropping out of school. She decides to seek help through a legal aid, who documents his stalking behavior and facilitates a meeting with the college dean. Her attorney represents her in a court hearing, and she is able to obtain a protective order so she can continue her education.

Conclusion

Domestic violence is a crime that causes severe health consequences. Healthcare professionals are mandated and obligated to identify and offer assistance to victims of domestic violence. Legal and societal changes in the United States have reduced the occurrence of Domestic Violence, but the problem is still epidemic. Your efforts can make a difference.

Resources

National Hotlines

National Domestic Violence Hotline
Staffed 24 hours a day by trained counselors who can provide crisis assistance and information about shelters, legal advocacy, health care centers, and counseling.
1-800-799-SAFE (7233)
1-800-787-3224 (TDD)

Rape, Abuse & Incest National Network
The Rape, Abuse & Incest National Network (RAINN) is the nation's largest anti-sexual assault organization. Among its programs, RAINN created and operates the National Sexual Assault Hotline at 1.800.656.HOPE and the National Sexual Assault Online Hotline at rainn.org . This nationwide partnership of more than 1,100 local rape crisis centers provides victims of sexual assault with free, confidential services, 24 hours per day, 7 days per week. These hotlines have helped over 1.3 million people since RAINN's founding in 1994.
1-800-656-HOPE

State Coalitions on Domestic Violence

Alabama
Alabama Coalition Against Domestic Violence
P.O. Box 4762
Montgomery, AL 36101
Phone: 1-800-650-6522 (in state)
Fax: 334-832-4803
TTY: 1-800-787-3224
Another State: 1-800-799-SAFE (7233)
Email: info@acadv.org
Crisis help lines are open 24 hours

Alaska
Alaska Network on Domestic Violence and Sexual Assault
130 Seward Street, Room 214
Juneau, AK 99801
Phone: 907-586-3650
FAX: 907-463-4493
Hotline: 1-800-799-SAFE (7233)
Email: info@acadv.org

Arizona
Arizona Coalition Against Domestic Violence
301 E. Bethany Home Rd.
Suite C194
Phoenix, AZ 85012
Phone: 602-279-2900
FAX: 602-279-2980
TTY: 602-279-7270
Toll-Free: 1-800-782-6400
E-mail: acadv@azcadv.org
Hours: 8:30am-5-00pm Monday - Friday

Arkansas
Arkansas Coalition Against Domestic Violence
1401 West Capitol Ave, Suite 170
Little Rock AR 72201
Phone: (501) 907-5612
FAX: (501)907-5618
Toll-Free: (800)269-4668
E-mail: info@domesticpeace.com

California
Coalition to End Family Violence
1030 N. Ventra Rd
Oxnard, CA 93030
Phone: 805-983-6014
FAX: 805-983-6240
24-Hour Hotline: 805-656-1111
Spanish Hotline: 800-300-2181
TDD: 805-656-4439
E-mail: admin@thecoalition.org

Colorado
Alternative Horizons
P.O. Box 503
Durango, CO 81302
Phone: 970-247-9619 (24-hour hotline)
E-mail: info@alternativehorizons.org

Colorado Coalition Against Domestic Violence
1120 Lincoln Street, Suite 900
Denver, CO 80203
TOLL-FREE: 888-778-7091
Phone: 303-831-9632
FAX: 303-832-7067
E-mail: ccadv@ccadv.org

Washington, DC
D.C. Coalition Against Domestic Violence
5 Thomas Circle, NW
Washington, DC 20005
Phone: 202-299-1181
FAX: 202-299-1193
E-mail: info@ccadv.org
Hours: 8:30am-5-00pm Monday - Friday

SOS Program (A part of DC Coalition)
Domestic Violence Intake Center Satellite Office
Greater Southeast Community Hospital
1328 Southern Ave SE
Room 311
Washington, DC 20032
Phone: 202-561-3095 x12
Fax: 202-561-3093
Hours: 9:00am-5:00pm

My Sister's Place
P.O. Box 29596
Washington, DC 20017
Phone: 202-529-5991 (24-hour hotline)
Administrative Office: 202-529-5261
Fax: 202-529-5984
E-mail: info@mysistersplacedc.org

Delaware
Delaware Coalition Against Domestic Violence
100 W. 10th Street Suite 703
Wilmington, DE 19801
Phone: 302-658-2958
FAX: 302-658-5049
Hotline: 1-800-799-7233
E-mail: dcadv@dcadv.org

Florida
Florida Coalition Against Domestic Violence
425 Office Plaza Dr.
Tallahassee, FL 32301
TOLL-FREE: 800-500-1119
Phone: 850-425-2749
FAX: 850-425-3091
FL Domestic Violence Hotline: 1-800-500-1119
FL Domestic Violence Hotline TTY: 1-800-621-4202
E-mail: prevention@fcadv.org

Georgia 
Georgia Advocates for Battered Women and Children
250 Georgia Avenue, S.E., Suite 308
Atlanta, GA 30312
TOLL-FREE: 800-334-2836
Phone: 404-524-3847
FAX: 404-524-5959

Hawaii
Hawaii State Coalition Against Domestic Violence
1164 Bishop Street, Ste 1609
Honolulu, HI 96813
Phone: 808-832-9316
Fax: 808-841-6028
Email: info@hscadv.org

 

24 Hr Hawaii Shelters by Island:

  • Hilo: 959-8864
  • Kauai: 245-8404
  • Kona: 322-SAFE (7233)
  • Maui/Lanai: 579-9581
  • Molokai: 567-6888
  • Oahu: 841-0822

 

Iowa
Iowa Coalition Against Domestic Violence
6200 Aurora Avenue, Ste 405E
Urbandale, IA 50322
TOLL-FREE: 800-942-0333
Phone: 515-244-8028
FAX: 515-244-7417
E-mail: icadv@icadv.org

Idaho
Idaho Coalition Against Sexual and Domestic Violence
300 E. Mallard Dr., Suite 130
Boise, ID 83706
TOLL-FREE: 888-293-6118
Phone: 208-384-0419
FAX: 208-331-0687
E-mail: info@engagingvoices.org

Illinois 
Illinois Coalition Against Domestic Violence
801 South 11th Street
Springfield, Illinois 62703
Phone: 217-789-2830
FAX: 217-789-1939
TTY: 217-241-0376
E-mail: ilcadv@ilcadv.org

Between Friends
(Formerly The Friends of Battered Women and Their Children)
P. O. Box 608548
Chicago, IL 60660
Phone: 773-274-5232
FAX: 773-262-2543
HOTLINE: 1-800-603-HELP
E-mail:info@betweenfriendschicago.org

Life Span
701 Lee Street, #700
Des Plaines, IL 60016
24-Hour Crisis Line: 847-824-4454
Phone: 847-824-0382
Fax: 847-824-5311
E-mail: life-span@life-span.org

Indiana 
Indiana Coalition Against Domestic Violence
1915 W. 18th Street, Suite B
Indianapolis, IN 46202
TOLL-FREE: 800-538-3393
Phone: 317-917-3685
Fax 317-917-3695
Crisis Line: 1-800-332-7385
E-mail: icadv@icadvinc.org

Kansas
Kansas Coalition Against Sexual and Domestic Violence
634 SW Harrison
Topeka, KS 66603
TOLL-FREE: 888-END-ABUSE (Kansas state-wide hotline)
Phone: 785-232-9784
FAX: 785-266-1874
E-mail: coalition@kcsdv.org

YWCA Northeast Kansas
225 SW 12th St.
Topeka, KS 66612
Phone: 785-233-1750
Fax: 785-233-4867
24 Hour HOTLINE: 1-888-822-2983
E-mail: volunteer@ywcaneks.org

Kentucky
Kentucky Domestic Violence Association
111 Darby Shire Circle
Frankfort, KY 40601
Phone: 502-209-5382
FAX: 502-226-5382
E-mail:info@kcadv.org

Louisiana
Louisiana Coalition Against Domestic Violence
P.O. Box 77308
Baton Rouge, LA 70879-7308
Phone: 225-752-1296
FAX: 225-751-8927
HOTLINE: 1-888-411-1333
E-mail: info@lcadv.org

Maine
Maine Coalition to End Domestic Violence
One Weston Court, Box #2
Augusta, ME 04330
Phone: 207-430-8334
FAX: 207-430-8348
HOTLINE: 866-83-4HELP
Email: info@mcedv.org

Maryland
Maryland Network Against Domestic Violence
4601 Presidents Drive, Ste 370
Lanham, MD 20706
TOLL-FREE: 800-MD-HELPS
Phone: 301-429-3601
Email: info@mnadv.org

Massachusetts
Jane Doe Inc./Massachusetts Coalition Against Sexual Assault and Domestic Violence
14 Beacon Street, Suite 507
Boston, MA 02108
Phone: 617-248-0922
Crisis / Information: 989-686-4551
FAX: 617-248-0902
TTY/TDD: 617-263-2200
Email: info@janedoe.org

Michigan
Bay Area Women's Center
P.O. Box 1458
3411 E. Midland Rd.
Bay City, MI 48706
TOLL-FREE: 800-834-2098
Phone: 989-686-4551
E-mail: info@bawc-mi.org

Michigan 24-Hour Crisis Line: 517-265-6776

Minnesota
Minnesota Coalition for Battered Women
60 East Plato Blvd, Ste 130
St. Paul, MN 55107
TOLL-FREE: 800-289-6177
Phone: 651-646-6177
FAX: 651-646-1527
E-mail: lfloyd@mcbw.org

 

Missouri
Missouri Coalition Against Domestic and Sexual Violence
217 Oscar Dr., Suite A
Jefferson City, MO 65101
Phone: 573-634-4161
FAX: 573-636-6613
E-mail: mocadsv@mocadsv.org

Safe Connections
2165 Hampton Ave
St. Louis, MO 63139
HOTLINE: 314-531-2003
Office: 314-646-7500
E-Mail: susan@safeconnections.org
Hours: Monday-Thursday 8:00am-7:00pm; Friday 8:00am-1:00pm

Mississippi
Mississippi State Coalition Against Domestic Violence
P.O. Box 4703
Jackson, MS 39296-4703
HOTLINE: 800-898-3234
After Hours HOTLINE: 1-800-799-7233
Phone: 601-981-9196
FAX: 601-981-2501
E-mail: support@mcadv.org
Hours: Monday-Friday 8:00am-5:00pm

Montana
Montana Coalition Against Domestic and Sexual Violence
Montana Coalition Against Domestic & Sexual Violence
PO Box 818
Helena MT 59624
Phone: 406.443.7794
TOLL-FREE: 888-404-7794
E-mail: mtcoalition@mcadsv.com

Nebraska
Nebraska Coalition To End Sexual and Domestic Violence
245 S. 84th Street, Ste 200
Lincoln, NE 68510
Phone: 402-476-6256
Nebraska Spanish Helpline: 1-877-215-0167
E-mail: info@nebraskacoalition.org

Nevada
Nevada Coalition to end Domestic and Sexual Violence
Northern Nevada
250 South Rock Blvd, Ste 116
Reno, NV 89502
Southern Nevada
3275 E. Warm Springs Road
Las Vegas, NV 89120
Phone: 775-828-1115
FAX: 775-828-9911
E-mail: info@ncedsv.org

Safe House
921 American Pacific Dr. Suite 300,
Henderson, NV 89014
Phone: 702-451-4203
FAX: 702-451-4302
HOTLINE: 702-564-3227
E-mail: juliep@safehousenv.org

New Hampshire
New Hampshire Coalition Against Domestic and Sexual Violence
P.O. Box 353
Concord, NH 03302-0353
TOLL-FREE For Domestic Violence: 866-644-3574
TOLL-FREE For Sexual Assault: 1-800-277-5570
Phone: 603-224-8893
E-mail: info@nhcadsv.org

New Jersey
New Jersey Coalition to End Domestic Violence
1670 Whitehorse/Hamilton Square Road
Trenton, NJ 08690
TOLL-FREE: for Battered Lesbians: 800-224-0211 (in NJ only)
Phone: 609-584-8107
FAX: 609-584-9750
HOTLINE: 1-800-572-7233
TTY: 609-584-0027 (9am-5pm, then into message service)
E-mail: info@njcedv.org

Strengthen Our Sisters
P.O. Box 359
Wanaque, N.J. 07465
Emergency Line: 973-831-6156
Office: 973-506-4577
E-mail: info@strengthenoursisters.org

New Mexico
New Mexico State Coalition Against Domestic Violence
1210 Luisa Street, Ste 7
Santa Fe, NM 87505
TOLL-FREE: 800-773-3645 (in New Mexico Only)
Legal Helpline: 800-209-DVLH
Phone: 505-246-9240
E-mail: info@nmcadv.org

New York
New York State Coalition Against Domestic Violence
119 Washington Avenue, 
Albany, NY 12210
Phone: 518-482-5465
HOTLINE: 1-800-942-6906
Fax: 518-482-3807
Email us at nyscadv@nyscadv.org

North Carolina
North Carolina Coalition Against Domestic Violence
3710 University Drive, Ste 140
Durham, NC 27707
Phone: 919-956-9124
Fax: 919-682-1449
E-mail: info@nccadv.org

North Dakota
North Dakota Council on Abused Women's Services
521 E. Main Avenue, Ste 250
Bismarck, ND 58501
TOLL-FREE: 888-255-6240 (In ND Only)
Phone: 701-255-6240
FAX: 701-255-1904
E-mail: contact@cawsnorthdakota.org

Ohio
Ohio Domestic Violence Network
1855 E. Dublin-Granville
Columbus, Ohio 43229
Phone: 614-781-9651
TTY: 614 781-9654
HOTLINE: 800-934-9840
Fax: 614 781-9652
E-mail: info@odvn.org

Oklahoma
Oklahoma Coalition Against Domestic Violence and Sexual Assault
3815 N. Santa Fe 
Oklahoma City, OK 73118
Telephone: 405-524-0700
Fax: 405-524-0711
Oklahoma Safeline: 1-800-522-7233
E-mail: info@ocadvsa.org
 

Oregon
Oregon Coalition Against Domestic Violence and Sexual Assault
State Office:
9570 SW Barbur Blvd, Ste 214
Portland, OR 97219
Telephone: 503-230-1951
Fax: 503-230-1973
Statewide Crisis Number: 1-888-235-5333

Pennsylvania
Pennsylvania Coalition Against Domestic Violence
3605 Vartan Way, Ste 101
Harrisburg, PA 17110
Phone: 717-545-6400
Toll-Free: 800-932-4632
TTY: 800-553-2508
FAX: 717-671-8149
 

Women's Center of Montgomery County
Main Administrative Office:
8080 Old York Road, Ste 200
Elkins Park, PA 19027
Toll-free hotline: 1-800-773-2424
Phone: 215-635-7340
E-mail: wcwebmail@womenscentermc.org

Norristown Office:
Women's Advocacy Project
107 East Main Street, Ste 307
Norristown PA 19404
610-279-1548

Pottstown Office:
Women's Advocacy Project
1800 East High Street, Ste 350
Pottstown PA 19464
610-970-7363

Bryn Mawr Office:
14 S. Bryn Mawr Avenue, Ste 207
Bryn Mawr, PA 19010
Phone: 610-525-1427

Lansdale Office:
100 Medical Campus Drive
Lansdale, PA 19446
Pone: 215-853-8060

Laurel House
P.O. Box 764
Norristown, PA 19404
Phone: 610-277-1860
HOTLINE: 1-800-642-3150
Fax: 610-277-64025
E-Mail: info@laurel-house.org

Rhode Island
Rhode Island Coalition Against Domestic Violence
422 Post Road, Suite 102
Warwick, RI 02888
HOTLINE: 800-494-8100
Phone: 401-467-9940
FAX: 401-467-9943
Email: ricadv@ricadv.org

South Carolina
South Carolina Coalition Against Domestic Violence & Sexual Assault
P.O. Box 7776
Columbia, SC 29202-7776
TOLL-FREE: 800-260-9293
Phone: 803-256-2900
FAX: 803-256-1030
E-mail: info@sccadvasa.org

South Dakota 
South Dakota Coalition Ending Domestic & Sexual Violence
122 E. Sioux Ave, Ste B
Pierre, SD 57501
Phone: 605-945-0869
FAX: 605-945-0870
NATIONAL HOTLINE: 800-430-7233
INFO/REFERRAL Only: 1-800-572-9196
Email: info@sdcedsv.org

Safe Harbor
PO Box 41
Aberdeen, SD 57402
Phone: 605 226-1212
Toll-Free: 888-290-2935
E-mail safeharbor@safeharbor.org

Tennessee
Tennessee Coalition to End Domestic & Sexual Violence
2 International Plaza Dr., Suite 425
Nashville, TN 37217
TOLL-FREE: 800-289-9018
Phone: 615-386-9406
FAX: 615-383-2967
Email: mservice@tncoalition.org

Texas
Texas Council on Family Violence
P.O. Box 163865
Austin, TX 78716
TOLL-FREE: 800-525-1978
Phone: 512-794-1133
FAX: 512-685-6397
E-mail:rrios@tcfv.org

Families In Crisis, Inc.
P.O. Box 25
Killeen, Texas 76540
Phone: 254-773-7765
Fax: 254-526-6111
HOTLINE: 888-799-SAFE

Utah
Utah Domestic Violence Coalition
124 South 400 East, Ste 300
Salt Lake City, UT 84111
Phone: 801-521-5544
FAX: 801-521-5548
E-mail: admin@udvc.org

Vermont
Steps to End Domestic Violence
PO BOX 1535
Burlington, VT
Phone: 802-658-3131
Fax: 802-658-3832
HOTLINE: 802-658-1996
TTY: 802-658-1996
Toll-free: 1-800-228-7395
E-mail: steps@stepsvt.org

Hope Works
PO Box 92
Burlington, VT 05402
24 Hour HOTLINE: 802-863-1236
Statewide HOTLINE: 800-489-7273
E-mail: lucy@hopeworksvt.org

Vermont Network Against Domestic and Sexual Violence
P.O. Box 405
Montpelier, VT 05601
Phone: 802-223-1302
TTY: 800-223-1115
24 Hour HOTLINE: 1 800 228 7395
FAX: 802-223-6943
E-mail: info@vtnetwork.org

Virginia
Virginia Sexual & Domestic Violence Action Alliance
1118 W. Main Street
Richmond, VA 23220
Phone: 804-377-0335
HOTLINE: 1-800-356-6998
Text: 804-793-9999
LGBTQ Hotline: 1-866-356-6998
E-mail: mailto:info@vsdvalliance.org

Washington
Washington State Coalition Against Domestic Violence
WSCADV- Olympia Office
711 Capitol Way, Suite 702
Olympia, WA 98501
Phone: 360-586-1022
Fax: 360-586-1024
TTY: 360-586-1029
WSCADV - Seattle Office
1511 Third Avenue, Ste 433
Seattle WA 98101
206-389-2515
206-389-2520 FAX
206- 389-2900 TTY
E-mail: wscadv@wscadv.org


Washington State Domestic Violence Hotline
Phone: 800-562-6025
 

West Virginia
West Virginia Coalition Against Domestic Violence
Elk Office Center
5004 Elk River Road, South
Elkview, WV 25071
Phone: 304-965-3552
FAX:  877-335-2306
E-mail: website@wvcadv.org

Wisconsin
Manitowoc County Domestic Violence Center/In-Courage
300 E. Reed Avenue
Manitowoc, WI 54220
24/7 Crisis Line: 920-684-5770
Fax: 920-684-6344
E-mail: incourage@incouragewi.org

Wisconsin Coalition Against Domestic Violence
1245 East Washington Avenue, Ste 150
Madison, WI 53703
Phone: 608-255-0539
Fax: 608-255-3560
E-mail: sarak@endabusewi.org

Wyoming
Wyoming Coalition Against Domestic Violence and Sexual Assault
P.O. Box 236
Laramie, WY 82073
TOLL-FREE:1-844-264-8080
Phone: 307-755-5481
Legal Staff: 307-755-0992
Fax: 307-755-5482
E-mail: info@wyomingdvsa.org

 

National Organizations

Future Without Violence
100 Montgomery Street, The Presidio
San Francisco, CA 94129
Phone: 415-678-5500
TTY: 800-595-4889
FAX: 415-529-2930
E-mail: info@futureswithoutviolence.org

Washington, DC Office
1320 19th St NW, Ste 401
Washington DC 20036
Phone: 202-595-7382
Fax: 202-499-6757

Boston Office
50 Milk Street, 16th Floor
Boston, MA 02109
Phone: 617-702-2004
Fax: 857-415-3293

National Coalition Against Domestic Violence
One Broadway, Ste B210
Denver, CO 80203
Phone: 303 839 1852
TTY: (303) 839-8459
Fax: (303) 831-9251
E-mail: mainoffice@ncadv.org

Public Policy Office
1633 Q Street NW, Suite 210
Washington, DC 20009
Phone: (202) 745-1211
TTY: (202) 745-2042
Fax: (202) 745-0088
E-mail: publicpolicy@ncadv.org

National Battered Women's Law Project
275 7th Avenue, Suite 1206
New York, NY 10001
Phone: 212-741-9480
FAX: 212-741-6438

Safe Horizons
2 Lafayette Street, 3rd Floor
New York, NY 10007
Domestic Violence Victims: 800-621-4673
Rape and Sexual Assult & Incest HOTLINE: 212-227-3000
For Victims of Crime and their Families: 1-866-689-4357
Phone: 212-577-7700
Domestic Violence Shelters Information
E-mail: help@safehorizons.org

National Resource Center on Domestic Violence
Pennsylvania:
6041 Linglestown Road
Harrisburg, PA 17112
Washington DC:
1101 Vermont Avenue, Ste 400
Washington, DC 20005
Phone: 1-800-537-2238
E-mail: nrcdvTA@nrcdv.org

Legal Office:
3605 Vartan Way, Ste 101
Harrisburg, PA 17110
Phone: 1-800-235-3425
Fax: 717-671-5542

National Recourse Center on Domestic Violence
Phone: 800-537-2238
TTY: 1-800-553-2508
Fax: 717-545-9456

Battered Women's Justice Project
Minnesota Program Development, Inc
1801 Nicollet Ave, Suite 102
Minneapolis, MN 55403
Phone: 800-903-0111, ext.1
E-mail: ncffc@bwjp.org

National Council of Juvenile and Family Court Judges
NCJFCJ
P.O. Box 8970
Reno, NV 89507
Office: 775-784-6012
Fax: 775-507-4848
Email: contactus@ncjfcj.org
They are only a resource center for professionals and agencies.

Battered Women's Justice Project
c/o National Clearinghouse for the Defense of Battered Women
125 South 9th Street, Suite 302
Philadelphia, PA 19107
TOLL-FREE: 800-903-0111 ext. 3
Phone: 215-351-0010
E-mail: ncdbw@ncdbw.org
National Clearinghouse is a national resource and advocacy center providing assistance to women defendants, their defense attorneys, and other members of their defense teams in an effort to insure justice for battered women charged with crimes.

Faith Trust Institute
(Formerly Center for the Prevention of Sexual and Domestic Violence)
2414 SW Andover Street, Ste D208
Seattle, WA 98106
Phone: 206-634-1903, ext. 10
Fax: 206-634-0115
Email: info@faithtrustinstitute.org

National Network to End Domestic Violence
1325 Massachusetts Avenue NW, 7th Floor
Washington, DC 20005
Phone: 202-543-5566
HOTLINE: 800-799-SAFE (7233)
TTY: 800-787-3224
FAX: 202-543-5626

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This course is applicable for the following professions:

Advanced Registered Nurse Practitioner (ARNP), Athletic Trainer (AT/AL), Certified Nursing Assistant (CNA), Certified Registered Nurse Anesthetist (CRNA), Clinical Nurse Specialist (CNS), Dietetic Technicians, Registered (DTR), Dietitian/Nutritionalist (RDN), Home Health Aid (HHA), Licensed Practical Nurse (LPN), Licensed Vocational Nurses (LVN), Midwife (MW), Physical Therapist (PT/PTA), Registered Nurse (RN), Respiratory Therapist (RT)

Topics:

CPD: Practice Effectively, CPD: Preserve Safety, Domestic Violence, Florida Requirements, Kentucky Requirements, Massachusetts Requirements


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