Unit 3: Working with People Affected by Domestic Violence and Sexual Violence

DPH Training Unit 3: Working with People Affected by Domestic Violence and Sexual Violence

Working with DV/SV Survivors

Guiding Principles

Regardless of your role and the context of your work, there are essential principles that should guide your work with DV/SV survivors. The principles apply not only to how you interact with survivors, but also how you internally manage your thoughts, feelings, and biases about DV/SV and survivors.

1. Avoid trying to get survivors to disclose or "admit" their experiences. Why?

• • Essentially, disclosure is complicated. People might not want to talk about their experiences due to feelings of embarrassment, shame, or fear of consequences (e.g., police involvement). Alternatively, people may not identify the dynamics of their relationships as domestic violence, or think that what happened to them constituted sexual violence. It is important to build your understanding of the reasons why survivors might not disclose and/or hide signs of DV/SV.

  • In addition, it might not be necessary to know; consider your professional role, what information you absolutely need in order to do your job, and go from there. Although it is often the case that knowing about someone’s current or past experiences of victimization can help providers assist survivors more effectively, forcing or cajoling them into disclosing is a surefire way to ensure that you don’t help them at all – because they most likely will not return.

2. Mimic survivors' terminology regarding DV/SV. Why?

• • As professionals, it is very easy to get caught up in lingo and terminology. It is important, however, to avoid doing so when working with survivors, because it can be alienating if they do not know what the terms mean, define those terms differently from you, or feel labeled. Thus, avoid throwing around terms such as "intimate partner violence" or "domestic violence" and do not refer to the person who has abused them as their "perpetrator" and "abuser." The latter point is especially important because survivors often have conflicted feelings about the person who has abused them, and often do not see them as “all bad” or unidimensional. When possible, ask the person you're talking to what they're most comfortable with and use that terminology.

3. Listening is just as important, if not more important, than the questions you ask. Why?

• • Paying attention to all aspects of people's lives can help you gain a fuller picture of the person you're working with, beyond just the violence they've experienced. This means that you will be better able to support them in minimizing the tradeoffs that hinder positive change (e.g., the person you're working with might decline a domestic violence shelter if it means her children will have to move to a new school).

  • Listen for:

    • What the person says is the most important to them and what they are holding onto or unwilling to give up. You may not always agree or understand their motivations, but this information gives you critical clues into the person's priorities and the resources that they won't or can't give up because the tradeoff is not worth it.

    • The sophisticated strategies that survivors have already been using, and recognize the value of these strategies, even if they're not the strategies you would use or encourage. You don't need to agree, but you do need to listen non-judgmentally.

4. Use a tone and demeanor that reflects support and interest. Why?

• • Survivors may be traumatized and feel mistrustful of providers and systems due to previous experiences such as feeling judged. Supportive communication that reflects curiosity - combined with a non-judgmental attitude - might help lower defenses and lead people to be more open to questions and conversation.

  • This approach also includes paying attention to your body language (e.g., try to avoid crossing your arms in front of your chest) and letting the interaction "breathe" (i.e., giving time for people to feel their emotions, recover composure, take breaks). See more on the importance of letting the interaction “breathe” in the spotlight on memory consolidation below.

5. Build rapport through focusing on assets and strengths. Why?

• • Good rapport is essential to positive and productive interactions with the people you serve. The better the rapport, the more likely people will be to share their needs and concerns and the more likely you can be of help. Thus, establishing good rapport should be the primary purpose of any first encounter. Part of building rapport is demonstrating that you see the person as a whole person, meaning someone with multiple identities and strengths - not only as someone who has experienced trauma.

6. Be prepared for when survivors disclose. Why?

• • It is essential that you respond to disclosure sensitively and prepared to share information about potential resources and referrals. It might be that this is the first time that the survivor has chosen to share their story, and they might not disclose again if they feel that the interaction was upsetting or unhelpful. Being prepared is especially important when you are specifically asking about victimization history. If you’re feeling tongue tied about what to say when someone discloses, a simple “I’m so sorry; can you tell me more about that?” will go a long way. Do not treat the question just like another yes/no item to check off your list and keep moving.

7. Pay attention to your attitudes and feelings about DV/SV and how they are driving your actions. Why?

• • Domestic and sexual violence are emotion-laden and controversial issues. It is common for people to have strong attitudes and feelings about why DV/SV happens, how survivors should act, and how society should respond to survivors and people who use violence. It is important to pay attention to the source of your own feelings, especially if they are rooted in fear, personal experiences, biases, misinformation, or a lack of information. Otherwise, you risk harming your patient or client with your tone, body language, and actions.

8. Practice self-care. Why?

• • As we described in the introduction unit, you cannot provide adequate care for others if you are exhausted, burnt out, or stressed to the max. Developing self-care practices, however small, can help prevent these from happening.

Screening and Assessment

The terms screening and assessment often are used interchangeably; however, they often reflect different processes. Whereas screening provides a “snapshot of a person at a point in time” collected with one or two questions verbally or in writing (e.g., via intake), assessment is a more in depth process that occurs over a period of time and results in more nuanced information.¹ Although there are merits to both, assessment is superior because it allows providers to gather a more holistic picture of people’s victimization experiences, other life stressors, and protective factors.²

Whether you engage in screening, assessment, or both will depend upon your role and work setting. For example, if you work as a health care provider in a medical setting, it is highly likely that you are required to engage in routine screening for domestic violence starting with the patient’s first visit; doing so is recommended as best practice by a variety of stakeholder groups including, but not limited to, the American College of Obstetricians and Gynecologists, Institute of Medicine, and U.S. Preventive Services Task Force.³ If you are a clinical social worker in private practice, however, you might not ask specifically about domestic violence at first visit. Instead, depending on the presenting problem and other indicators, you might ask questions about the person’s relationship and feelings of safety as part of an ongoing assessment. Also, it is important to remember that routine screening should focus on DV, not SV. Generally speaking, screening for sexual violence (outside the context of DV) should occur only if there are indicators that the person has been assaulted.

Screening challenges and considerations:

• • The primary goals of screening are case identification and intervention. Unfortunately, most providers stop at case identification, providing little to no intervention, which is hugely problematic. Although it is understandable to feel stymied by logistical barriers to intervention (e.g., lack of time, not knowing what to say or do when someone discloses), the reality is that you do not actually need loads of time, nor do you need to have all the answers!

  • Research with survivors indicates that what they really want is for providers to use active listening, be sensitive and nonjudgmental, validate their feelings and experiences, avoid pressuring them to make a decision about the relationship, and provide information and support regarding relevant resources.⁴ In practice, what this typically looks like is showing care, concern, and belief (i.e., trauma informed care), asking a few follow-up questions (e.g., “can you tell me more about that?”), and then offering information or connecting the person to appropriate resources within and outside your organization. (See Unit 4 for information on resources). Remember, good screening is not just about what you ask, but also how you ask and how you respond. In the spotlight below, we describe the strategy of “Universal Education,” an alternative to universal screening that has emerged in recent years.

How to Assess for Risk and Protective Factors

Below you will find two carefully thought out tables with examples of potential questions to assess for protective factors and risk factors. The left hand column lists the questions you might ask the person you are working with; the right hand column lists the reasons why you might ask these particular questions and things to consider when doing so. We have included both columns because it is essential to be intentional and informed in your assessment. For example, some of the questions get at factors that are associated with lethality risk. Although formal lethality risk assessment requires specific tools and training (see here), it is important to be aware of the factors that increase risk so you can help survivors plan accordingly.

It is also important that you don’t treat these questions like a checklist or come across as judgmental. This is especially true when asking about sensitive areas such as substance use, safety strategies, and employment. Be sure to explain that the intention is merely to understand the full picture of risk in order to tailor your work together.

Assessing Protective Factors

Assessing Risk Factors*

*The following references on lethality risk factors and health effects of strangulation inform this table.

• Campbell, J. C., Glass, N., Sharps, P. W., Laughon, K., & Bloom, T. (2007). Intimate partner homicide: Review and implications of research and policy. Trauma, Violence, & Abuse, ^{8, 246–269}.

• Campbell, J., Webster, D., & Glass, N. (2009). The Danger Assessment: Validation of a lethality risk assessment instrument for intimate partner femicide. Journal of Interpersonal Violence, ^{24, 653–674}.

• Glass, N., Perrin, N., Hanson, G., Bloom, T., Gardner, E., & Campbell, J. C. (2008). Risk for reassault in abusive female same-sex relationships. American Journal of Public Health, ^{98, 1021–1027}.

What to do when you suspect DV but the person can't disclose or chooses not to:

As we discussed, it is common – and sometimes necessary – for DV survivors to avoid talking about their experiences of abuse, or even say that they are not being abused. In those cases, be sure to use a universal education approach with the person and be on the lookout for the following indicators:

• • Unexplainable injuries and accidents, especially during pregnancy.

  • Expressed fear of their partner or other significant person in their life. This can range from a general sense of unease or anxiety to terror.

  • Difficulty or inability talking to you alone because a partner or other significant person insists on being present.

  • Partner-initiated constraints on the person's freedom to act and make choices (e.g., not being allowed to see friends or buy necessities for themselves and their children).

  • Intense anxiety about things that typically do not cause anxiety (e.g., getting a call from a wrong number).

  • An unusually high number of visits to health care providers.

  • High number of sexually transmitted infections, vaginal and urinary tract infections, miscarriages, and/or abortions.

  • Provide a range of referrals to relevant services (e.g., domestic violence counseling) with the explanation that it is standard practice with all clients (see Unit 4 for resources).

Response and Ongoing Work

As discussed, your role and work setting matter will dictate how much contact you will have with survivors and the extent to which you can engage in ongoing work with them. It is beyond the scope of this training to cover the universe of interventions that healthcare providers, social workers, and therapists might use with survivors. Instead, we present several basic steps that you should consider taking with survivors.

Support and Validate

One of the most important things you can do is validate DV/SV survivors by believing them, listening and responding in a nonjudgmental way, and normalizing what they’ve endured. As you have learned through this training, DV/SV is common experience that can manifest in many forms. Letting survivors know that they are not alone in their experiences can be very helpful for them.

Safety Plan

Safety planning is an essential part of working with DV/SV survivors. This involves working with them to develop a plan to help minimize risks to their emotional and physical safety. It is important to remember that safety planning is an ongoing process to continuously assesses someone’s situation. It’s only a one-time event when your interaction with a survivor is a one-time event. Otherwise, continuous safety planning is necessary because the level and source of risk can change and fluctuate. For example, if the person you’re working with moves to a new residence, that will require developing a new safety plan to ensure that new risks are considered. Also remember that each safety plan is unique, in that it is based on each person’s individual needs, circumstances, and choices. Because safety planning can be complicated, we recommend that you consult with a trained DV/SV staff member or connect the survivor with a DV/SV agency through a warm referral.

There are several resources that can assist with safety planning. One is this resource from the MA Office for Victim Assistance (MOVA): http://www.mass.gov/mova/docs/safety-plan/safety-plan-english.pdf

Another is myPlan, an evidence-based, online safety decision aid that is available for download on Apple and Android devices.5 myPlan can assist clients and patients with making safe decisions for themselves, or someone they care about if they are experiencing abuse in their relationship. Please see www.myplanapp.org/home for more detail (also available in Spanish).

Refer

Finally, provide survivors with the information and confidence they need to access other relevant resources. In some cases, it might make sense for you to make the first contact on behalf of the survivor as a way to facilitate the connection (with their permission, of course). Unit 4 of this training provides a plethora of options, and we encourage you to get to know them.

Working with Children Exposed to Domestic Violence

When Children Disclose

It is not uncommon for children to disclose that there is domestic violence in the home. You might not be sure how to handle the situation, so it is important to be as prepared as you can for the possibility. Inevitably, your professional role, the child's age, the level of danger, and other factors will shape your response; however, here are some things to consider.

• Respond to the child in a calm, supportive, and affirming way. Be sure to validate whatever feelings the child expresses and thank them for sharing with you. Depending on the age of the child, listen to what he or she wants from you and be honest about the steps that you need to take next.

• Seek consultation. Contact your supervisor, and, if needed, consult with a domestic violence program or child welfare agency to help you think through safety issues and assess risk. You can call a domestic violence hotline, the NASW ethics hotline, or someone at the MA Department of Children and Families (DCF) without revealing the identity of the family.

  • Know whether you are a mandated reporter. If the child is currently in a dangerous situation, talk with the non-abusive parent or guardian (and it is safe to do so) and explain your role as a mandated reporter before making the appropriate report.

    • Please note that in Massachusetts, domestic violence in and of itself does not warrant child welfare intervention; in some cases, a report may actually create additional risks for the survivor and the children. DCF has identified a series of factors that increase the likelihood that a report is necessary (e.g., threats to kill survivor, child hurt in DV incident). For more detail, please contact DCF.

Working with Children Means Working with Families

Children are part of a larger family system with its own dynamics and challenges. To best support children, we must also support the survivors who parent them.⁶ As discussed in this training, domestic violence can affect survivors’ physical, mental, social, and financial health, which subsequently can hinder their parenting capacity.⁷

In some cases, supporting children involves supporting survivors and their family members and friends.6 And, finally, in some cases, it means supporting the entire family unit, which includes the parent who is or has been using abusive behaviors. This last situation is complicated, and must be handled delicately and safely. However, it is important to remember that many survivors and their children are in contact with abusive partners and might want and need help for that person.

Ways to support children by supporting families:

• Work to strengthen the parent-child relationship through activities such as playing together, encouraging the survivor to help with homework, or facilitating discussions that focus on tough or sensitive topics.

• Discuss parenting techniques with survivors and other family members to strengthen the family bond and support the child.

• Provide information about the effects of trauma on children to help survivors and other family members make sense of the child's behavior.

• Brainstorm strategies to keep children safe when the abusive partner is present.

• Make an effort to ensure that tasks (e.g., intakes) and environments (e.g., offices, shelter spaces) are child-friendly.

• Support survivors and the people in their network to access tangible resources that, when absent, can impede healthy parenting skills and safer environments.

• Understand that interventions aimed at improving children's internal processes will be ineffective if the negative environment surrounding the child remains unchanged.

• Collaborate with and learn from the other systems that are involved in families' lives. In their report to the Attorney General, The National Task Force on Children Exposed to Domestic Violence offered recommendations to protect children including the need for "collaborative responses by police, mental health providers, domestic violence advocates, child protective service workers, and court personnel".⁶

Working with People Who Use Violence

As mentioned, it is beyond the scope of this training to fully prepare you for working with people who use violence against their current or former intimate partners. Here we review some of the most essential information you need to know, which focuses on managing your feelings, expectations, stereotypes, and personal safety. We highly encourage you to receive additional training on working with this population, including strategies for risk assessment.

Feelings

You may find that you have very strong and automatic gut-level responses to people who are abusive to their partners: rage, anger, disgust, fear, sympathy, and/or compassion.

Feelings of anger and a desire to punish might be particularly acute when the person denies or minimizes their abusive behavior. However, it is important to understand that minimization and denial are normal responses when asked to admit to engaging in violent and cruel behavior toward others, especially an intimate partner. It is important to remember that such revelations occur over time and after building trust.

You might also be tempted to dismiss or marginalize the person directly (e.g., refuse to work with them, believe they can't change).

Sometimes this tendency is sound clinical practice (e.g., if you are feeling threatened or at risk). Sometimes it's because you or someone you love is a survivor of domestic violence. And finally, sometimes it's a result of not knowing how to proceed in a way that feels safe for yourself or others. It is important to reflect on what is driving your actions in order to proceed accordingly.

You might be tempted to excuse someone’s behavior because you think it is part of their cultural “values,” or because they have a history of trauma or oppression.

Although cultures differ in their values and beliefs about gender roles and roles in intimate relationships, domestic violence does not correspond with the ideals of any culture as a whole; but rather, reflects segments of people within. If the person you're working with argues that their behavior is normal in their culture, most likely they are simply hoping that you don't know it's not true or won't try to find out. Also remember that in mainstream American culture, there are many justifications for domestic violence (e.g., "she made me do it"); they just happen to be more covert than in some other countries due to increased societal and legal sanctions against domestic violence. Essentially, justifications exist in every culture, but they do not excuse domestic violence.

Similarly, experiences of trauma and oppression are not excuses for domestic and sexual violence. They are, however, important factors to explore when helping people work toward healing and transformation. For example, it might take longer for people who have endured violence to adopt nonviolence or for people victimized by systems to trust that there are providers who want to help them.

You might experience feelings of confusion regarding who is at fault, especially when the work is ongoing.

In cases of people who are particularly coercive and manipulative, you might find yourself pulled into – and start believing – the person's rationales for using violence, which often include blaming the survivor. In fact, abdication of blame is a primary red flag that someone is using violence and coercive control in their relationships. Or, you might find it difficult to imagine that the person you're working with is capable of being violent because of how they act when they are with you. Falling into these situations can be dangerous. For example, you might end treatment prematurely or make recommendations that could harm the survivor and others.

For all of these reasons, it is essential to seek consultation, attend to your own feelings and biases, and consider your own physical and emotional needs so that you can effectively engage with people who use violence and coercive behaviors.

Expectations and Stereotypes

It is important to be aware of your expectations and stereotypes regarding people who use violence. Two common expectations are described below.

Expectation: A clear dichotomy between "victim" and "perpetrator"

One expectation you might have is that survivors never use violence and that people who use violence are never victimized. This dichotomy is true in some cases, but not always.

First, research and practice wisdom indicates that female survivors use a variety of strategies to protect themselves and their loved ones, and that some of these strategies involve violent behaviors - as is often the case with anyone protecting themselves from an assault.⁸ As described in Unit 1 of this training, these behaviors typically constitute "violent resistance," one of several types of domestic violence distinguished by who is using coercive controlling tactics.⁹

Second, there are also situations in which survivors use violence toward their abusive partners as an act of retaliation^8,10,11 and sometimes toward their children.¹² Although these behaviors warrant attention, they do not negate the person's status as a victim.

Finally, many people who use violence and coercive behaviors against partners have been victims themselves at some point, be it by a family member (e.g., child abuse, exposure to domestic violence),¹³ peer (e.g., bullying;),¹⁴ neighbor (e.g., community violence),¹⁵ or society (e.g., racism, homophobia).^16-18 As mentioned, these experiences do not excuse the perpetration of domestic violence; however, they do make it difficult to maintain that "victims" are totally distinct from "perpetrators."

Expectation: A "typical" presentation

You might expect that you can identify the primary aggressor just by certain visible indicators such as their physical size, how they act in front of you, or their level of success and status in other domains (e.g., school, workplace, friend circles).

This, however, is an erroneous assumption. For example, size can be particularly tricky when assessing domestic violence in gay and lesbian relationships. There is a tendency to assume that the larger, more “manly” partner is the one being abusive; however, there is no evidence to support that assumption.¹⁹

Similarly, some people are very skilled at targeting their abusive behaviors toward their partners only; and, thus, keep the abuse a secret from friends and colleagues.²⁰ They often present in public as charming, successful, and – in some cases – more “together” than their partners (whose physical, mental, and economic heath has been eroded by the violence they’ve endured). Such a charming presentation can be particularly effective when the person also has multiple layers of privilege at their disposal (e.g., male, white, educated).

Essentially, avoid jumping to conclusions based solely on initial observations.

Personal Safety

It is also important to think about your own safety when engaging with people who use violence and coercive behaviors. Be sure to take all threats, intimidation, and manipulating behaviors seriously. In some circumstances, people who use abusive behaviors extend their violence beyond partners to anyone they see as a threat to their power and control. It is important to think about this and put in place some measures for your own personal safety. Speaking with the survivor about safety planning can be helpful in understanding the capability and behaviors of the abusive partner.

As is good practice for anyone in a helping profession, be aware of how accessible your personal information is. For example, is your home address listed? Are your social media accounts publicly available? Also, depending on agency policy, you might be allowed to use your personal cell phone to call or text with clients. Before doing so, consider whether that will allow you to maintain appropriate and safe boundaries – advice that applies to working with survivors too.

Finally, educate yourself about the protections that are in place at your workplace. Discuss concerns with your supervisor and co-workers to develop additional safety strategies that can be implemented.

Reporting Requirements for Survivors, Children, and People who use Violence

If you are taking this training as part of your licensing requirement, you are a mandated reporter. Thus, this section provides a very broad overview of mandated reporting as it relates to DV/SV situations that involve a child, an adult with a disability, or an elderly individual in MA. Because it is beyond the scope of this training to cover all there is to know about mandated reporting, you will need to seek out additional information to be sure you understand exact filing requirements, specific procedures, and ways to support the people involved in the report.

Please remember that filing a mandated report is often a difficult decision. It always requires thought and care before action, and this is particularly true for domestic violence cases, as it can increase danger to survivors and their children. It is important not to make that decision alone, but to seek the consultation and support of your supervisor or another consultant.

Overview of Mandated Reporting Requirements

• • Mandated reporters are required by law to report abuse of a child by a caretaking adult (Mass General Law Chapter 119A, Section 51A), abuse of an elder (Mass General Law Chapter 19A), and abuse of a person with a disability (Mass General Law Chapter 19C). Mandated reporters who fail to report such incidents are subject to fines and possible loss of licensure.

  • In Massachusetts, there is no requirement to report incidents of domestic violence toward non-elderly, non-disabled adults. However, in Massachusetts, mandated reporters must warn a victim and the police if any of the following applies:

    • The patient/client has communicated to the licensed mental health professional an explicit threat to kill or inflict serious bodily injury upon a reasonably identified victim or victims and the patient has the apparent intent and ability to carry out the threat.

    • The patient has a history of physical violence which is known to the licensed mental health professional and the licensed mental health professional has a reasonable basis to believe that there is a clear and present danger that the patient will attempt to kill or inflict serious bodily injury against a reasonably identified victim or victims.

    • For more information, see here.

Reporting child abuse/neglect, including in domestic violence situations (known as "51A")

• If you are a mandated reporter who suspects a child is being abused or neglected, a report must be filed verbally within 24 hours of learning of the harm or neglect being done to the child to the DCF office that covers the town or city in which the family lives. In addition, a written report must be filed within 48 hours of learning of the abuse.

• If you see that the child is in imminent danger of being harmed without immediate intervention on a night, weekend, or holiday, there is a 24 hour DCF hotline number (1-800-792-5200).

• Please note that not every situation involving domestic violence merits intervention by the Department of Children and Families (DCF). There is no requirement to report incidents of a child witnessing domestic violence to DCF, and witnessing domestic violence is NOT considered, in itself, a reportable condition.

• Instead, mandated reporters are encouraged to

  • Carefully review each family's situation and to identify any specific impact on the child/children when considering whether or not to file a 51A child abuse/neglect report with DCF.

  • Consult with the DCF Domestic Violence Unit (617-748-2000), which works in consultation with Area and Regional DCF offices on cases involving domestic violence and child welfare.

Adult with disability abuse reporting

• Mandated reporters are required to file a report with the Disabled Persons Protection Commission (DPPC) if a person between the ages of 17 and 59 (inclusive) with a disability is being physically, sexually, emotionally, or financially abused by a caretaker. The 24-hour hotline number for the DPPC is 1-800-426-9009 V/TTY.

Elder abuse reporting

• Mandated reporters are mandated to report situations where an elder, defined as anyone 60 years of age or older, is abused physically, emotionally or financially by a care-taker or through self-neglect.

  • Reports are telephoned in to the nearest Aging Service Access Point or to the elder abuse hot-line at 800-922-2275.

  • Elders in nursing homes are covered by a different law. Such reports should go to the local Long-Term Care Ombudsman.

  • Telephone numbers for Access Points and Ombudsman offices can be found through the massresources.org page at: http://www.mass.gov/elders/homecare/.

As a reminder, mandated reporters in MA include, but are not limited to:

• Social workers

• Physicians and physician assistants

• Medical interns

• Hospital personnel engaged in the examination, care or treatment of persons

• Medical examiners and coroners

• Dentists

• Psychologists

• Nurses

• Chiropractors

• Podiatrists

• Osteopath

• Occupational therapists

• Licensed human service professionals

• Public or private school teachers

• Educational administrators

• Probation officers

• Foster parents

• Police officers

• Person employed by a state agency within the EOHHS

• Person employed by a private agency providing services to persons with disabilities

• Early education, preschool, child care, daycare, or after school program staff

• Any person paid to care for, or work with, a child in any public or private facility, home, or program funded or licensed by the commonwealth of Massachusetts to provide child care or residential services

• Child care resources and referral agencies (CCR&RS)

• Voucher management agencies

• Family child care programs

• Child care food programs

• Child care licensors

• EMTs

• Firefighters

• Director of a home health aide agency

• Homemaker agency

• Assisted living residence

• Case managers

• Health Aides

• Homemakers

• Council on aging directors

• Outreach workers

Unit 3 References

1. DeCandia CJ. Assessment of Families Experiencing Homelessness: a Guide for Practitioners and Policy Makers. Boston, MA: Homes for Families; 2015.

2. Alpert EJ. Intimate Partner Violence: the Clinician’s Guide to Identification, Assessment, Intervention, and Prevention. 6 ed. Waltham, MA: Massachusetts Medical Society; 2015:1-88. www.massmed.org/partnerviolence.

3. Miller E, Decker MR, Glass N. Innovative health care responses to violence against women. In: Renzetti CM, Edleson JL, Bergen RK, eds. Sourcebook on Violence Against Women. 3rd ed. Los Angeles; 2018:305-319.

4. Chisholm CA, Bullock L, Ferguson JE. Intimate partner violence and pregnancy: screening and intervention. The American Journal of Obstetrics & Gynecology. 2017;217(2):145-149. doi:10.1016/j.ajog.2017.05.043.

5. Glass NE, Perrin NA, Hanson GC, et al. The longitudinal impact of an internet safety decision aid for abused women. American Journal of Preventative Medicine. 2017;52(5):606-615. doi:10.1016/j.amepre.2016.12.014.

6. Listenbee RL, Torre J, Boyle G, et al. Report of the Attorney General's National Task Force on Children Exposed to Violence. Washington, D.C.: Office of the Attorney General. U.S. Department of Justice; 2012.

7. Davies J, & Lyon E. Domestic violence advocacy: Complex lives/Difficult choices. 2014. Thousand Oaks, CA: Sage.

8. Hamby SL. Battered Women's Protective Strategies: Stronger Than You Know. New York: Oxford University Press; 2014.

9. Johnson MP. A Typology of Domestic Violence: Intimate Terrorism, Violent Resistance, and Situational Couple Violence. Boston, MA: Northeastern University Press; 2008.

10. Larance LY, Goodmark L, Miller SL, & Dasgupta, SD. Understanding and addressing women’s use of force in intimate relationships: A retrospective. Violence Against Women. 2019:25:56–80.

11. Larance LY, Miller SL. In Her Own Words: Women Describe Their Use of Force Resulting in Court-Ordered Intervention. Violence Against Women. September 2016:1-24. doi:10.1177/1077801216662340.

12. Peled E. Abused women who abuse their children: A critical review of the literature. Aggression and Violent Behavior. 2011;16(4):325-330. doi:10.1016/j.avb.2011.04.007.

13. Anda RF, Felitti VJ, Bremner JD, et al. The enduring effects of abuse and related adverse experiences in childhood. European archives of psychiatry and clinical neuroscience. 2006;256:174-186. doi:10.1007/s00406-005-0624-4.

14. Miller S, Williams J, Cutbush S, Gibbs D, Clinton-Sherrod M, Jones S. Dating violence, bullying, and sexual harassment: longitudinal profiles and transitions over time. J Youth Adolescence. 2013;42(4):607-618. doi:10.1007/s10964-013-9914-8.

15. Powell JA. The impact of societal systems on black male violence. Journal of Aggression, Maltreatment & Trauma. 2008;16(3):311-329. doi:10.1080/10926770801925742.

16. Al’Uqdah SN, Maxwell C, Hill N. Intimate partner violence in the African American community: Risk, theory, and interventions. J Fam Viol. 2016;31:877-884. doi:10.1007/s10896-016-9819-x.

17. Burnette C. Historical oppression and intimate partner violence experienced by Indigenous Women in the United States: Understanding connections. Social Service Review. 2015;89(3):531-563. doi:10.1086/683336.

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