TASK FORCE on the Health Effects of WOMAN ABUSE The Task Force on the Health Effects of Woman Abuse London, Ontario 519-663-5317 ext. 2444 www.healthunit.com MIDDLESEX-LONDON HEALTH UNIT – Task Force on the Health Effects of Woman Abuse - Final Report Task Force on the Health Effects of Woman Abuse Final Report September, 2000 For information please contact: Office of the Medical Officer of Health Middlesex-London Health Unit 50 King St. London, Ontario N6A 5L7 phone: 519-663-5317, ext. 2444 fax: 519-663-9581 e-mail: [email protected] MIDDLESEX-LONDON HEALTH UNIT – Task Force on the Health Effects of Woman Abuse - Final Report © Copyright information Middlesex-London Health Unit 50 King Street London, Ontario N6A 5L7 Cite reference as: Task Force on the Health Effects of Woman Abuse, Middlesex-London Health Unit (2000). Task Force on the Health Effects of Woman Abuse - Final Report. London, Ontario: Author. Author: Marion Boyd Crosshealth Consultant Services All rights reserved. Funding for this project was made available through the Public Health Research, Education and Development (PHRED) Program of the Middlesex-London Health Unit. MIDDLESEX-LONDON HEALTH UNIT – Task Force on the Health Effects of Woman Abuse - Final Report Table of Contents Executive Summary and Recommendations ........................................................................................................i Chapter I: Task Force on the Health Effects of Woman Abuse, Middlesex-London Health Unit, London, Ontario ....1 a) A Public Health Initiative .............................................................................................................1 b) Membership of the Task Force .....................................................................................................4 c) Mandate of the Task Force ...........................................................................................................6 d) Why the Mandate Excludes Consideration of Abuse of Men ............................................................6 e) The Task Force Process ................................................................................................................7 Chapter II: Woman Abuse as an Urgent Public Health Issue ...............................................................................9 a) The Definition of Woman Abuse ...................................................................................................9 b) Putting the Definition of Woman Abuse in Context ........................................................................9 c) The Prevalence of Woman Abuse ..................................................................................................9 d) The Cost of Woman Abuse ......................................................................................................... 10 e) The Public Health Approach to Woman Abuse ............................................................................. 11 Chapter III: The Health Effects of Woman Abuse .............................................................................................. 15 a) General Comments .................................................................................................................... 15 b) Fatal Health Effects ................................................................................................................... 15 c) Physical Health Effects .............................................................................................................. 15 d) Sexual Health Effects ................................................................................................................ 16 e) Psychological Health Effects ....................................................................................................... 16 f) Psychiatric Health Effects ........................................................................................................... 16 Chapter IV: The Indicators of Woman Abuse .................................................................................................... 17 a) General Comments .................................................................................................................... 17 b) Incidental Indicators of Abuse .................................................................................................... 17 c) Physical Indicators of Abuse ....................................................................................................... 17 d) Sexual Indicators of Abuse ........................................................................................................ 17 e) Indicators of Isolation Associated with Abuse .............................................................................. 17 f) Behavioural Indicators of Abuse .................................................................................................. 18 g) Social Indicators of Abuse .......................................................................................................... 18 h) Financial Indicators of Abuse ..................................................................................................... 18 Chapter V: Developing a Screening Protocol for Woman Abuse .......................................................................... 19 a) Terminology .............................................................................................................................. 19 b) Identification of Woman Abuse ................................................................................................... 20 c) Meeting the WHO Principles for Screening ................................................................................... 20 d) What Screening Protocols Currently Exist? ................................................................................. 21 e) Four Approaches to Screening .................................................................................................... 22 f) Indicator-Based Diagnosis vs Universal Screening ........................................................................ 22 g) Routine Universal Screening ...................................................................................................... 23 h) The Routine Universal Comprehensive Screening (RUCS) Protocol ................................................ 25 i) Task Force Response .................................................................................................................. 27 Chapter VI: Guidelines for the Screening Protocol ............................................................................................ 28 a) The Purpose of Screening ........................................................................................................... 28 b) The Elements of a Successful Screening Protocol ........................................................................ 28 c) The Guiding Principles for Applying the Screening Protocol .......................................................... 28 d) Who Should Routinely be Screened for Woman Abuse? ................................................................ 30 e) Who Should Screen for Woman Abuse? ....................................................................................... 30 MIDDLESEX-LONDON HEALTH UNIT – Task Force on the Health Effects of Woman Abuse - Final Report f) Basic Requirements for Successful Screening .............................................................................. 31 g) How Should Screening Occur? .................................................................................................... 32 h) When to Screen Routinely for Woman Abuse ............................................................................... 33 i) Developing a Personal Style ........................................................................................................ 33 Chapter VII: A Step by Step Guide to the Screening Protocol ............................................................................. 35 a) The Routine Universal Comprehensive Screening (RUCS) Protocol: The Flow Chart ....................... 35 b) Introductory Question ............................................................................................................... 35 c) When She Says "No Abuse" ........................................................................................................ 36 d) When She Discloses Abuse ........................................................................................................ 36 e) Health Assessment and Documentation ...................................................................................... 38 f) Safety Check/Safety Planning ..................................................................................................... 39 g) Referral and Follow-up ............................................................................................................... 42 Chapter VIII: The Referral Network as an Essential Ingredient .......................................................................... 45 a) Achieving an Effective Integrated Network ................................................................................... 45 b) Future Considerations ............................................................................................................... 46 Chapter IX: The Challenges of Implementation ................................................................................................. 47