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A prospective twelve-year follow-up of alcoholic women: A prognostic scale for long-term outcome. In: Harris, L.S., ed. Problems of Drug Dependence, 1984: Proceedings of the 46th Annual Scientific Meeting, The Committee on Problems of Drug Dependence, Inc. NIDA Research Monograph Series, Number 55. DHHS Pub. No. ADM 85-1393. Rockville, MD: National Institute on Drug Abuse, 1985. pp. 245-251.
Snow, M.G.; Prochaska, J.O.; and Rossi, J.S.
Processes of change in Alcoholics
Anonymous: Maintenance factors in long-term sobriety. Journal of Studies on
Alcohol 55:362-371, 1994.
Sonkin, D.J.; Martin, D.; and Walker, L.
The Male Batterer. New York: Springer, 1985.
Violence among intimates: An epidemiological review. In: Van Hasselt, V.D.; Morrison, R.L.; Bellack, A.S.; and Herson, M., eds. Handbook of Family Violence. New York: Plenum, 1988a. pp. 159-199.
Women at risk: A feminist perspective
on child abuse. International Journal of Health Services 18(1):97-118,
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Wife abuse in the Medical Setting: An Introduction for Health Personnel. Monograph Series, Number 7. Washington, DC: Office of Domestic Violence, 1981.
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Alcohol myopia: Its prized and
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Treating Attachment Abuse. New York: Springer, 1995.
Straus, M.A., and Gelles, R.J.
How violent are American families: Estimates from the National Family Violence Resurvey and other studies. In: Straus, M.A., and Gelles, R.J., eds. Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families. New Brunswick, NJ: Transaction Publishers, 1990. pp. 95-112.
Straus, M.A.; Hamby, S.L.; Boney-McCoy, S.; and Sugarman, D.B.
The Revised Conflict Tactics Scale
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Straus, M.A., and Kantor, G.K.
Corporal punishment of adolescents
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Systems of Care for Children and Adolescents With Severe Emotional Disturbances: What Are the Results? Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center, 1993.
Integrated treatment for the
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Tolman, R.M., and Bennett, L.W.
A review of the quantitative research on men who batter. Journal of Interpersonal Violence 5(1):87-118, 1990.
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The case for the cautious use of anger control with men who batter. Response to the Victimization of Women and Children 11(2):15-20, 1988.
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Relapse prevention and self-efficacy: An integrative model. Addictive Behaviors 15:271-283, 1990.
The Battered Woman. New York: Harper & Row, 1979.
Psychological impact of the criminalization of domestic violence on victims. Victimology: An International Journal 10:281-300, 1987.
Posttraumatic stress disorder in women: Diagnosis and treatment of battered woman syndrome. Psychotherapy 28:21-29, 1991.
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Appendix B -- Federal Confidentiality Regulations
by Margaret K. Brooks, Esq.1
Federal law (United States Code, Title 42, §§290dd-2 [1992]) and the Federal regulations that implement it -- Title 42, Part 2, of the Code of Federal Regulations (42 C.F.R. Part 2) -- guarantee the strict confidentiality of information about all persons receiving substance abuse prevention and treatment services.2 They are designed to protect privacy rights and thereby attract individuals into treatment. The regulations are more restrictive of communications than are those governing the doctor-client relationship or the attorney-client privilege. Violating the regulations is punishable by a fine of up to $500 for a first offense or up to $5,000 for each subsequent offense (§2.4).
While some persons may view the restrictions that Federal regulations place on communications as a hindrance, if not a barrier, to program goals, due foresight can eliminate most of the problems that arise from the regulations. Familiarity with the regulations will facilitate communication and minimize the incidence of confidentiality-related conflicts among program, client, and outside agencies.
Types of Programs Covered by the Regulations
Any program that specializes, in whole or in part, in providing treatment, counseling and assessment, and referral services, or a combination thereof, for clients with alcohol or other drug problems must comply with the Federal confidentiality regulations (§2.12(e)). It is the kind of services provided, not the label, that determines whether a program must comply with the Federal law. Calling itself a "prevention program" does not insulate a program that also offers treatment services from the need to comply with confidentiality regulations. Although the Federal regulations apply only to programs that receive Federal assistance, the word assistance is broadly interpreted and includes indirect forms of Federal aid such as tax-exempt status or State or local funding that is derived, in whole or in part, from the Federal government.
Federal Confidentiality Laws
The Federal confidentiality law and regulations protect any information about a client if the client has applied for or received any alcohol- or drug abuse-related services -- including assessment, diagnosis, detoxification, counseling, group counseling, treatment, and referral for treatment -- from a covered program.3 The restrictions on disclosure apply to any information that would identify the client as a substance abuser, either directly or by implication. The rule applies from the moment the client makes an appointment. It applies to clients who are civilly or involuntarily committed, minors, clients who are mandated into treatment by the criminal justice system, and former clients. Finally, the rule applies whether or not the person making the inquiry already has the information, has other ways of getting it, enjoys official status, is authorized by State law, or comes armed with a subpoena or search warrant.4
Conditions Under Which Confidential Information May Be Shared
Information that is protected by the Federal confidentiality regulations may always be disclosed after the client has signed a proper consent form. If the client is a minor, parental consent must also be obtained in some States. The regulations also permit disclosure without the client's consent in several situations, including communicating information to medical personnel during a medical emergency or reporting child abuse to the authorities.
The most commonly used exception to the general rule prohibiting disclosures is for a program to obtain the client's consent. The regulations' requirements regarding consent are somewhat unusual and strict and must be carefully followed.
Items required for disclosure of information
Disclosures are permissible if a client has signed a valid consent form that has not expired or been revoked (§2.31). A proper consent form must be in writing and must contain each of the items that appear in Figure B-1.
A general medical release form, or any consent form that does not contain all of the elements listed in Figure B-1, is not acceptable. A sample consent form may be found in Figure B-2. Two of the required items in Figure B-1 merit further explanation: the purpose of the disclosure and how much and what kind of information will be disclosed. These two items are closely related. All disclosures, especially those made pursuant to a consent form, must be limited to information that is necessary to accomplish the need for or purpose of the disclosure (§2.13(a)). It would be improper to disclose everything in a client's file if the person making the request needed only one specific piece of information.
In completing a consent form, one must determine the purpose of or need for the communication of information. Once this has been identified, it is easier to determine how much and what kind of information will be disclosed and to restrict the disclosure to what is essential to accomplish the identified need or purpose. As an illustration, if a client needs to have the fact that he or she has entered a treatment program verified in order to be eligible for a benefit program, the purpose of the disclosure would be "to verify treatment status," and the amount and kind of information to be disclosed would be "enrollment in treatment." The disclosure would then be limited to a statement that "Jane Doe (the client) is receiving counseling at XYZ Program."
The client's right to revoke consent
The client may revoke consent at any time, and the consent form must include a statement to this effect. Revocation need not be in writing. If a program has made a disclosure prior to the revocation, the program has "acted in reliance" on the consent and is not required to try to retrieve the information it has already disclosed.
The regulations state that acting in reliance includes providing services in reliance on a consent form permitting disclosures to a third party payer. Thus, a program may bill the third party payer for past services to the client even after consent has been revoked. A program may not, however, make any disclosure to the third party payer in order to receive reimbursement for services provided after the client has revoked consent (§2.31(a)(8)).
Expiration of the consent form
The form must also contain a date, an event, or a condition on which it will expire, if not previously revoked. A consent must last "no longer than reasonably necessary to serve the purpose for which it is given" (§2.31(a)(9)). If the purpose of the disclosure is expected to be accomplished in 5 or 10 days, it is better to stipulate that amount of time rather than to request a longer period or have a uniform 60- or 90-day expiration date for all forms.
The consent form may specify an event or a condition for expiration, rather than a date. For example, if a client has been placed on probation on the condition that he or she attend the treatment program, the consent form should not expire until the expected time of completion of the probationary period. Alternatively, if a client is being referred by the program to a specialist for a single appointment, the consent form should say that consent will expire after he or she has seen "Dr. X," unless the client is expected to need ongoing consultation with the specialist.
Signatures of minors and parental consent
In order for a program to release information about a minor, even to his or her parent or guardian, the minor must have signed a consent form. The program must obtain the parent's signature to make a disclosure to anyone else only if it was required by State law to obtain parental permission before providing treatment to the minor (§2.14). (Parent includes parent, guardian, or other person legally responsible for the minor.) In other words, if State law does not require the program to get parental consent in order to provide services to a minor, parental consent is not required to make disclosures (§2.14(b)). If, by contrast, State law requires parental consent to provide services to minors, parental consent also is required to make any disclosures.
Required notice against redisclosing information
Once the consent form has been properly completed, one formal requirement remains. Any disclosure made with written client consent must be accompanied by a written statement that the information disclosed is protected by Federal law and that the recipient may not make any further disclosure unless permitted by the regulations (§2.32). This statement, not the consent form itself, should be delivered and explained to the recipient at the time of disclosure or earlier.
The prohibition on redisclosure is clear and strict. Those who receive the notice are prohibited from rereleasing information except as permitted by the regulations. A client may, of course, sign a consent form authorizing such a redisclosure. A sample Notice of Prohibition appears in Figure B-3.
Decisions Concerning Disclosure
The fact that a client has signed a proper consent form authorizing the release of information does not force a program to make the proposed disclosure, unless the program has also received a subpoena or court order (§§2.3(b); 2.61(a)(b)).
The only obligation the program has is to refuse to honor a consent that is expired, deficient, or otherwise known to be revoked, false, or invalid (§2.31(c)).
In most cases, the decision whether or not to make a disclosure pursuant to a consent form is within the discretion of the program, unless State law requires or prohibits disclosure once consent is given. In general, it is best to follow this rule: Disclose only what is necessary, for only as long as is necessary, in light of the purpose of the communication.
Rules Governing Communication of Information
Seeking Information From Collateral and Referral Sources
Making inquiries of parents, other relatives, health care providers, employers, schools, or criminal justice agencies might seem at first glance to pose no risk to a client's right to confidentiality, particularly if the person or entity approached for information referred the client to treatment. Nonetheless, it does.
When a program that screens, assesses, or treats a client asks a relative or parent, a doctor, an employer, or a school to verify information it has obtained from the client, it is making a "client-identifying disclosure." Client-identifying information is information that identifies someone as a substance abuser. In other words, when program staff seek information from other sources, they are letting these sources know that the client has asked for treatment services. The Federal regulations generally prohibit this kind of disclosure, unless the client consents.
How should a program go about making such requests? The easiest way is to get the client's consent to contact the relative, doctor, employer, school, or health care facility. When filling out the consent form, staff should give thought to the "purpose of the disclosure" and "how much and what kind of information is to be disclosed." For example, if a program is assessing a client for treatment and seeks records from a mental health provider, the purpose of the disclosure would be "to obtain mental health treatment records to complete the assessment." The "kind of information disclosed" would be limited to a statement that "Robert Roe (the client) is being assessed by the XYZ Program." No other information about Robert Roe would be released. If the program not only seeks records but also wishes to discuss with the mental health provider the treatment he or she provided the client, the purpose of the disclosure would be "to discuss mental health treatment provided to Robert Roe by the mental health program." If the program merely seeks information, the kind of information disclosed would, as in the example above, be limited to a statement that "Robert Roe is being assessed by the XYZ Program"; however, if the program needs to disclose information it has gained in its assessment of Robert Roe to the mental health provider in order to further the discussion or coordinate care, the kind of information disclosed would be "assessment information about Robert Roe."
A program that routinely seeks collateral information from many sources could consider asking the client to sign a consent form that permits it to make a disclosure for purposes of seeking information from collateral sources to any one of a number of entities or persons listed on the consent form. Such a form must still include "the name or title of the individual or the name of the organization" for each collateral source the program may contact.
Even when information is disclosed over the telephone, program staff are required to notify the recipient of the information of the prohibition on redisclosure. Mention should be made of this restriction during the conversation; for example, the staff member could say, "I'll be sending you a written statement that the information I gave you about Mr. Roe may not be redisclosed."
Communications with employers may warrant special consideration. When a client enters treatment voluntarily, program staff should maintain an open mind about whether communications with an employer would be beneficial to the client. A client who tells program staff that his or her employer will not be sympathetic about the decision to enter treatment may well have an accurate picture of the employer's attitude. Should staff insist on communicating with the employer, the client may lose his or her job. If such communication takes place without the client's consent, the program may be faced with a lawsuit.5
Communications With Insurance Carriers
Programs must obtain a client's written consent on the form required by the Federal regulations in order to communicate with any third party payer who may be responsible for funding the client's treatment. Some clients do not want their treatment reported to the insurer. Clients whose employers are self-insured may fear they will be fired, demoted, or disciplined, should their employer learn they have a substance abuse problem. Clients whose treatment is covered by health insurance may fear they will lose their benefits and be unable to obtain other coverage once their current insurer discovers they have been treated for a substance abuse problem. What should programs do in these circumstances?
The program clearly cannot make a disclosure to a third party payer without the client's consent. If the third party payer is the client's employer, the program would not only be violating the Federal regulations but also would be risking a lawsuit, should the client be fired or disciplined. If the third party payer is an insurance company, the program is taking similar risks: If the client's insurance is canceled or he or she cannot obtain coverage elsewhere, the program may face a lawsuit.6
If a client does not want the insurance carrier to be notified and is unable to pay for treatment, the program may refer the client to a publicly funded program, if one is available.7 Programs should consult State law to learn whether they may refuse to admit a client who is unable to pay and who will not consent to the necessary disclosures to his or her insurance carrier.
Insurance carriers, particularly managed care entities, are demanding more and more information about the clients covered by their policies and the treatment provided to those clients. Programs need to be sensitive about the amount and kind of information they disclose, because the insurer may use this information to deny benefits to the client. For example, if, in response to a request from the insurer, the program releases the client's entire chart, the insurer may learn from the intake notes that the client's substance abuse problem included both alcohol and illegal drugs. The insurer may then deny benefits, arguing that since its policy does not cover treatment for abuse of drugs other than alcohol, it will not reimburse for treatment when abuse of both alcohol and drugs is involved. As a second example, the insurer may learn that the client began drinking at age 11 and deny benefits for a "preexisting condition." Treatment notes may contain personal information about the client's family life that is extraneous for insurance company review, the sole purpose of which is to determine whether treatment should be covered and, if so, what kind.
Communication Among Agencies
Communication with other care providers
Treatment programs sometimes need to maintain ongoing communication with the referral source or with other professionals providing services to clients. The best way to proceed is to get the client's consent.
In wording the consent form, one should take care to permit the kinds of communications necessary. For example, if the program will need ongoing communication with a mental health provider, the "purpose of the disclosure" would be "coordination of care for Mildred Moe"; "how much and what kind of information to be disclosed" might be "treatment status, treatment issues, progress in treatment." If the program is treating a client who is on probation at work and whose continued employment is contingent on treatment, the "purpose of disclosure" might be "to assist the client to comply with employer's mandates" or "supply periodic reports about treatment"; "how much and what kind of information will be disclosed" might be "progress in treatment." The kinds of information that would be disclosed in the two examples are quite different. The program might well share detailed clinical information about a client with a mental health provider, if it would assist in coordinating care. Disclosure to an employer, by contrast, would generally be limited to a brief statement about the client's progress in treatment. Disclosure of clinical information to an employer generally would be inappropriate.
The program should also be careful in setting the expiration date or event on which expiration of the consent form is based. A consent form with a mental health provider might expire when treatment ends, while a form permitting disclosures to an employer might expire when the client's probationary period at work ends.
Referral for additional services
When a staff member of a treatment program refers a client to another program for services (e.g., domestic violence support or vocational rehabilitation) and makes an appointment for the client, he or she is making a disclosure covered by the Federal regulations -- a disclosure that the client has sought or received substance abuse treatment services. A consent form is, therefore, required. If the substance abuse treatment program is part of a larger program to which the client is being referred, a consent form may not be necessary under the Federal rules, since there is an exception for information disclosed to staff within the same program.
Transferring clients to the hospital
Substance abuse treatment programs, particularly those with limited medical resources, may transfer clients to a hospital for intensive medical management and care. How should programs handle such transfers, since they involve a disclosure of client-identifying information?
Programs may deal with this issue in two ways. First, they may ask all clients admitted to treatment to sign a consent form permitting disclosure to the cooperating hospital, should hospitalization be required. Second, they may take advantage of a provision in the Federal regulations that permits a program to make disclosures in a "medical emergency" to medical personnel "who have a need for information about a client for the purpose of treating a condition which poses an immediate threat to the health of any individual." The regulations define "medical emergency" as "a condition which poses an immediate threat to the health of any individual and which requires immediate medical intervention" (§2.51). If a client's condition requires emergency treatment, the program may use this exception to communicate with medical personnel at a hospital. Whenever a disclosure is made to cope with a medical emergency, the program must document in the client's records the name and affiliation of the recipient of the information, the name of the individual making the disclosure, the date and time of the disclosure, and the nature of the emergency.
Mandatory reporting to public health authorities
All States require that new cases of acquired immunodeficiency syndrome (AIDS) be reported to public health authorities, which submit this information to the Federal Centers for Disease Control and Prevention. In some cases, they also use it for other purposes. Some States also require the reporting of new cases of human immunodeficiency virus (HIV) infection. States also require reporting of certain infectious diseases, such as tuberculosis and sexually transmitted diseases. The public health authority often uses reports of infectious diseases to engage in "contact tracing," that is, finding others to whom an infected person may have spread the disease.
The types of information that must be reported and for which diseases, who must report, and the purposes to which the information is put vary from State to State. Therefore, program directors must examine their State laws to discover (1) whether they or any member of their staff is a mandated reporter, (2) when reporting is required, (3) what information must be reported and whether it includes client-identifying information, and (4) what will be done with the information reported.8
If State law permits the use of a code rather than a client's name, the program may make the report without the client's consent since no client-identifying information is being revealed.
If client-identifying information must be reported, there are a number of ways programs can comply with State mandatory reporting laws without violating the Federal confidentiality regulations. They include the following:
- Obtaining consent. The easiest way to comply with a State law that mandates reporting of client-identifying information to a public health authority is to obtain the client's consent. The information reported by the program may not be redisclosed by the public health authority unless the consent form is drafted to permit redisclosure.
- Reporting without making a client-identifying disclosure. If the program is part of another health care facility (for example, a general hospital or mental health program), it can include the client's name in reports if it does so under the name of the parent agency, as long as no information is released that would link the client with substance abuse treatment.
- Using a Qualified Service Organization Agreement (QSOA). A treatment program that is required to report clients' names to a public health department also may enter into a QSOA with a general medical care facility or a laboratory that conducts testing or other services for the program. The QSOA, which is explained in detail later in this appendix, permits the program to report the names of clients to the medical care facility or laboratory, which may then report the information, including client names, to the public heath department. However, no information is provided that would link those names with substance abuse treatment.
- Reporting under the audit and evaluation exception. One of the exceptions to the general rule prohibiting disclosure without client consent is found in §2.53, which permits programs, under certain conditions, to disclose information to auditors and evaluators. The U.S. Department of Health and Human Services (DHHS) has written two opinion letters that approve the use of the audit and evaluation exception to report HIV-related information to public health authorities.9 Read together, these two letters suggest that substance abuse programs may report client-identifying information even if that information will be used by the public health department to conduct contact tracing, as long as the health department does not disclose the name of the client to the "contacts" it approaches. The letters also suggest that the public health authorities could use the information to contact the infected client directly. Section 2.53 is intended to permit an outside entity, such as a peer review organization or an accounting firm, to examine or copy a program's records in order to determine whether it is operating in accordance with regulations. It was not intended to permit an outside entity to gain information to perform other tasks or accomplish other social ends. The legal validity of these two letters may, therefore, be considered debatable.
Telephone Calls to Clients
If someone telephones a client at a program, the staff may not reveal that the client is at the program unless the program has a written consent form signed by the client to make a disclosure to that particular caller. Given this restriction, how should a program handle telephone calls to clients? There are at least four options:
- The program can obtain the client's written consent to accept telephone calls from particular people and consult a list of these individuals' names when the client receives a phone call.
- If the client has not consented to receive calls from a particular person, the staff member can put the caller on hold and ask the client if he or she wants to speak to the caller. If the client wants to accept the call, the client, not the staff member, is making the disclosure that he or she is at the treatment program. If the client does not want to speak to the caller, the staff member must tell the caller, "I'm sorry, but I can't tell you whether Tommy Toe is here." At no time may the program reveal, even indirectly, that the person being inquired after is a client at the program.
- The program can uniformly take messages for clients, telling all callers, "I'm sorry, but I cannot tell you if Tommy is here, but if he is I will give him this message." Again, this leaves it up to the client whether to make a disclosure about being in treatment.
- The program can set up a "client phone" that is answered only by clients. Since only clients would answer the telephone and give the phone number to others if the number were unlisted, the program would be making no disclosures. The program should caution clients to act discreetly and thoughtfully when handling calls for others.
Clients Mandated Into Treatment By the Criminal Justice System
Programs treating clients who are required to enter and participate in treatment as part of a criminal justice sanction must follow the Federal confidentiality rules. In addition, some special rules apply when a client is in treatment as an official condition of probation, sentence, dismissal of charges, release from detention, or other disposition of any criminal proceeding, and information is being disclosed to the mandating agency.
A consent form or court order is still required before any disclosure may be made about an offender who is mandated into assessment or treatment. However, the rules concerning the length of time that a consent remains valid are different, and a "criminal justice system consent" may not be revoked before its expiration event or date.
The regulations require that the following factors be considered in determining how long a criminal justice system consent will remain in effect:
- The anticipated duration of treatment
- The type of criminal proceeding in which the offender is involved
- The need for treatment information in dealing with the proceeding
- When the final disposition will occur
- Anything else the client, program, or criminal justice agency believes is relevant.
These rules allow programs to continue to use a traditional expiration condition for a consent form that once was the only one allowed, namely, "when there is a substantial change in the client's criminal justice system status." A substantial change in status occurs whenever the client moves from one phase of the criminal justice system to the next. For example, if a client is on probation or parole, a change in criminal justice status would occur when the probation or parole ended, either by successful completion or revocation. Thus, the program could provide treatment or periodic reports to the probation or parole officer monitoring the client and could even testify at a revocation hearing if it so desired, since no change in criminal justice status would occur until after that hearing. This formula appears to work well.
Concerning revocability of the consent (that is, the conditions under which the offender can take back his or her consent), the regulations provide that the form may state that consent may not be revoked until a specified date arrives or condition occurs. The regulations permit the criminal justice system consent form to be irrevocable, so that a client who has agreed to enter treatment in lieu of prosecution or punishment cannot later prevent the court, probation department, or other agency from monitoring his or her progress. Although a criminal justice system consent may be made irrevocable for a specified period of time, its irrevocability must end no later than the final disposition of the criminal proceeding. Thereafter, the client may freely revoke consent.
Several other considerations relating to criminal justice system referrals are important. First, any information received by one of the eligible criminal justice agencies from a treatment program may be used by that justice agency only in connection with its official duties with respect to that particular criminal proceeding. The information may not be used in other proceedings, for other purposes, or with respect to other individuals (§2.34(d)). Second, whenever possible, the judge or referring agency should require that a proper criminal justice system consent form be signed by the client at the time he or she is referred to the treatment program. If this is not possible, the treatment program should have the client sign a criminal justice system consent form at his or her first appointment. With a properly signed criminal justice consent form, the treatment program can communicate with the referring criminal justice agency, even if the client appears for assessment or treatment only once. This avoids the problems that may arise if a client mandated into treatment does not sign a proper consent form and leaves before the assessment or treatment has been completed.
If a program fails to have the client sign a criminal justice system form and the client fails to complete the assessment or treatment, the program has few options when faced with a request for information from the referring criminal justice agency. The program could attempt to locate the client and ask him or her to sign a consent form. The client is, however, unlikely to do so. It is uncertain whether a court can issue an order to authorize the program to release information about a referred client who has left the program in this type of case, because the regulations allow a court to order disclosure of treatment information for the purpose of investigating or prosecuting a client for a crime only when the crime was "extremely serious." A parole or probation violation generally will not meet that criterion.
Therefore, unless the judge, criminal justice agency, or program obtains consent at the beginning of the assessment or treatment process, the program may be prevented from providing any information to the referring criminal justice agency.
If a client referred by a criminal justice agency never applies for or receives services from the program, that fact may be communicated to the referring agency without client consent (§2.13(c)(2)). As soon as a client has made an appointment to visit the program, a signed consent form or a court order is needed for any disclosures.
Driving While Impaired
Suppose that an intoxicated client arrives at a treatment program but decides not to enter treatment. If the client is not in condition to drive home, what should the program do? First, it can offer the client a ride home or taxi fare for a ride home. Second, it can maintain a room where such a person can "sleep it off." (The program would be wise to obtain the person's consent to alert his or her family.) This strategy can also be used by programs that do not admit clients who are inebriated.
What if the client refuses both offers and leaves the premises, intending to drive home? Does the program have a duty to call the police to prevent an accident? Does it risk a lawsuit if it fails to do so? This is a question of State law.
In most States, it is unlikely that the program would be liable, particularly if it had made an effort to stop the client from driving. As noted in Chapter 5, in States that follow the Tarasoff doctrine, liability has generally been limited to those situations where a client threatens to harm a specific person. Liability has generally not been imposed in situations where a client poses a threat to the community in general.
Liability concerns aside, the program may nonetheless believe it is obligated to call the police if its attempts to prevent the client from driving fail. In doing so, it must take care not to violate the client's confidentiality. For example, the program can call the police and tell them that the driver of a 1991 tan Nissan with a license number "XYZ 123," who is heading downtown from the intersection of Maple and Third streets, is not in a condition to operate a vehicle. The program should ask the police to respond immediately. The program may not tell the police that the client has a substance abuse problem. This means it may not tell the police that the client is impaired by alcohol or drugs and cannot reveal the program's name, since to do so would tell the police that the client has a substance abuse problem.
In order to get the client's license number and a description of his or her car, it may be necessary to detain the client. If it does so, the program should avoid using force, since the client could sue the program for battery or false imprisonment.
Conducting Research
Research about and evaluation of the efficacy of different methods of treatment are essential to advances in the field. But can programs share client-identifying information with researchers and program evaluators? The confidentiality regulations do permit programs to disclose client-identifying information to researchers, auditors, and evaluators without client consent, provided certain safeguards are met (§§2.52, 2.53).
Research
Treatment programs may disclose client-identifying information to persons conducting "scientific research" if the program director determines that the researcher (1) is qualified to conduct the research, (2) has a protocol under which client-identifying information will be kept in accordance with the regulations' security provisions (see §2.16, as described below), and (3) has provided a written statement from a group of three or more independent individuals who have reviewed the protocol and determined that it protects clients' rights. Researchers are prohibited from identifying an individual client in any report or from otherwise disclosing any client identities, except back to the program.10
Audit and evaluation
Federal, State, and local government agencies that fund or are authorized to regulate a program, private entities that fund or provide third party payments to a program, and peer review entities performing a utilization or quality control review may review client records on the program premises in order to conduct an audit or evaluation.11 Any person or entity that reviews client records to perform an audit or conduct an evaluation must agree in writing that it will use the information only to carry out the audit or evaluation and that it will redisclose client information only (1) back to the program, (2) in accordance with a court order to investigate or prosecute the program (§2.66), or (3) to a government agency overseeing a Medicare or Medicaid audit or evaluation (§2.53(a), (c), (d)). Any other person or entity that is determined by the program director to be qualified to conduct an audit or evaluation and that agrees in writing to abide by the restrictions on redisclosure also may review client records.
Followup research
Research that follows clients for any period of time after they leave treatment presents a special challenge under the Federal regulations. The treatment program, researcher, or evaluator who seeks to contact former clients to gain information about how they are faring after leaving treatment must do so without disclosing to others any information about their connection to the treatment program. If followup contact is attempted by telephone, the caller must make sure he or she is talking to the client before identifying himself or herself or mentioning a connection to the treatment program. For example, asking for "William Woe," when his wife or child has answered the phone, and announcing that one is calling from the "ABC Treatment Program" (or the "Drug Research Corporation") violates the regulations. The program or research agency may form another entity, without a hint of drug or alcohol treatment in its name (for example, Health Research, Inc.) that can contact former clients without worrying about disclosing information simply by giving its name. When a representative of such an entity calls former clients, however, care must be taken that the client is actually on the line before revealing any connection with the treatment program.
If followup is done by mail, the return address should not disclose any information that could lead someone seeing the envelope to conclude that the addressee had been in treatment.
Five Other Exceptions To the General Confidentiality Rule
Reference has been made to other exceptions the Federal confidentiality rules make to the general rule prohibiting disclosure. Presented below are five additional categories of exceptions to the general rule.
Communications That Do Not Disclose Client-Identifying Information
The Federal regulations permit programs to disclose information about a client if the program reveals no client-identifying information. Thus, a program may disclose information about a client if that information does not identify the client as a substance abuser or does not verify anyone else's identification of the client as a substance abuser.
A program may make a disclosure that does not identify a client in two ways. First, it may report aggregate data that give an overview of the clients served in the program or some portion of its population. For example, a program could tell the newspaper that in the last 6 months it had 43 clients, 10 female and 33 male. Second, a program may communicate information about a client in a way that does not reveal the client's status as a drug or alcohol abuse client (§2.12(a)(i)). For example, a program that provides services to clients with other problems or illnesses as well as alcohol or drug addiction may disclose information about a particular client as long as the fact that the client has a substance abuse problem is not revealed. To cite a more specific example, a counselor from a program that is part of a general hospital could call the police about a threat a client made, as long as he or she does not disclose that the client has an alcohol or drug abuse problem or is a client of the treatment program.
Programs that provide only alcohol or drug services or that provide a full range of services but are identified by the general public as drug or alcohol programs cannot disclose information that identifies a client under this exception, since letting someone know a counselor is calling from the "XYZ Program" will automatically identify the client as someone who got services from the program. However, a freestanding program may sometimes make "anonymous" disclosures, that is, disclosures that do not mention the name of the program or otherwise reveal the client's status as an alcohol or drug abuser.
Court-Ordered Disclosures
A State or Federal court may issue an authorizing order that will permit a program to make a disclosure about a client that would otherwise be forbidden. A court may issue one of these orders, however, only after it follows certain special procedures and makes particular determinations required by the regulations. A subpoena, search warrant, or arrest warrant, even when signed by a judge, is not sufficient standing alone to require, or even to permit, a program to disclose information (§2.61).12
Before a court can issue an authorizing order, the program and any client whose records are sought must be given notice of the application for the order and some opportunity to make an oral or a written statement to the court.13 Generally, the application and any court order must use fictitious names for any known client. All court proceedings in connection with the application must remain confidential, unless the client requests otherwise (§§2.64(a), (b), 2.65, 2.66).
Before issuing an authorizing order, the court must find that there is "good cause" for the disclosure. A court may find "good cause" only if it determines that the public interest and the need for disclosure outweigh any adverse effect that the disclosure will have on the client, the doctor-client or counselor-client relationship, and the effectiveness of the program's treatment services. Before it may issue an order, the court also must find that other ways of obtaining the information are unavailable or would be ineffective (§2.64(d)).14 The judge may examine the records before making a decision (§2.64(c)).
There are also limits on the scope of disclosure that a court may authorize, even when it finds good cause. The disclosure must be limited to information essential to fulfill the purpose of the order and restricted to those persons who need the information for that purpose. The court also should take any other steps that are necessary to protect the client's confidentiality, including sealing court records from public scrutiny (§2.64(e)).
The court may order disclosure of "confidential communications" by a client to the program only if the disclosure is necessary to protect against a threat to life or of serious bodily injury or to investigate or prosecute an extremely serious crime (including child abuse), or is in connection with a proceeding at which the client has already presented evidence concerning confidential communications (§2.63).
Medical Emergencies
A program may make disclosures to public or private medical personnel "who have a need for information about a client for the purpose of treating a condition which poses an immediate threat to the health of any individual." The regulations define medical emergency as a situation that poses an immediate threat to health and requires immediate medical intervention (§2.51).
The medical emergency exception permits disclosure only to medical personnel. It cannot be used as the basis for a disclosure to the police or other nonmedical personnel, including parents. Under this exception, however, a program could notify a private physician about a suicidal client so that medical intervention could be arranged. The physician, in turn, could notify a client's parents or other relatives, as long as no mention were made of the client's substance abuse problem. Whenever a disclosure is made to cope with a medical emergency, the program must document in the client's records the name and affiliation of the recipient of the information, the name of the individual making the disclosure, the date and time of the disclosure, and the nature of the emergency.
Qualified Service Organization Agreements
If a program routinely needs to share certain information with an outside agency that provides services to the program, it can enter into a QSOA. A QSOA (Figure B-4) is a written agreement between a program and a person providing services to the program in which that person (1) acknowledges that in receiving, storing, processing, or otherwise dealing with any client records from the program, he or she is fully bound by [the Federal confidentiality] regulations; and (2) promises that, if necessary, he or she will resist in judicial proceedings any efforts to obtain access to client records except as permitted by these regulations (§§2.11, 2.12(c)(4)).
A QSOA should be used only when an agency or official outside of the program, for example, a clinical laboratory or data-processing agency, is providing a service to the program itself. An example is when laboratory analysis or data processing is performed for the program by an outside agency. A QSOA is not a substitute for individual consent in other situations. Disclosures under a QSOA must be limited to information that is needed by others so that the program can function effectively. QSOAs may not be used between programs providing alcohol and drug services.
Internal Program Communications
The Federal regulations permit some information to be disclosed to individuals within the same program:
The restrictions on disclosure in these regulations do not apply to communications of information between or among personnel having a need for the information in connection with their duties that arise out of the provision of diagnosis, treatment, or referral for treatment of alcohol or drug abuse if the communications are (i) within a program or (ii) between a program and an entity that has direct administrative control over that program. (§2.12(c)(3))
In other words, staff (including full- or part-time employees and unpaid volunteers) who have access to client records because they work for or administratively direct the program may consult among themselves or otherwise share information if their substance abuse work so requires.
Does this exception allow a treatment program that is part of a larger entity, such as a hospital, to share confidential information with others that are not part of the treatment unit? The answer to this question is quite complicated. In brief, there are circumstances under which the treatment unit may share information with other units that are part of the greater entity to which it belongs. Before such an internal communication system is set up within a large institution, however, it is essential that an expert in the area be consulted.
Other Requirements
Client Notice and Access to Records
The Federal confidentiality regulations require programs to notify clients of their right to confidentiality and to give them a written summary of the regulations' requirements. The notice and summary should be handed to clients when they enter the program or shortly thereafter (§2.22(a)). The regulations contain a sample notice that may be used for this purpose.
Unless State law grants the right of client access to records, programs have the right to decide when to permit clients to view or obtain copies of their records. The Federal regulations do not require programs to obtain written consent from clients before permitting them to see their own records.
Security of Records
The Federal regulations require programs to keep written records in a secure room, locked file cabinet, safe, or other similar container. The program should establish written procedures that regulate access to and use of client records. The program director or a single staff person should be designated to process inquiries and requests for information (§2.16).
Conclusion
Administrators and staff members of substance abuse treatment programs should become thoroughly familiar with the many legal issues affecting their work. Such knowledge can prevent costly mistakes. Because legal requirements often vary by State and change over time, it is also essential that programs find a reliable source to whom they may turn for up-to-date information, advice, and training.
Endnotes
1.Margaret K. Brooks is an independent consultant in Montclair, New
Jersey.
2. Citations throughout this appendix in the form "§2..."
refer to specific sections of 42 C.F.R., Part 2, Implementing the Substance
Abuse and Mental Health Services Administration (42 U.S.C. §290dd-2).
3. Only clients who have "applied for or received"
services from a program are protected. If a client has not personally sought
help from the program or has not yet been evaluated or counseled by a program,
the program is free to discuss the client's drug or alcohol problems with
others. The Federal regulations govern from the moment the client applies for
services or the program first conducts an evaluation or begins counseling.
4. Subpoenas and search and arrest warrants are discussed in Chapter 5.
5. Although Federal and, in some cases, State laws may prohibit the
employer from firing employees or taking other action simply because they have
entered treatment, discriminatory practices against recovering people continue.
6. Some States prohibit insurance companies from discriminating
against individuals who have received substance abuse treatment; however,
discriminatory practices continue. Insurance companies routinely share
information about policy holders. Although the Federal regulations prohibit
insurance companies from sharing information from a treatment program with
other carriers, that prohibition is no guarantee that such redisclosure will
not take place.
7. If a client who has signed a consent form permitting the program
to make disclosures to a third party payer later revokes his or her consent,
the program can bill the third party payer for services provided before consent
was revoked. A program cannot, however, make any disclosures to the third party
payer in order to receive reimbursement for services rendered after the client
revoked consent (§2.31(a)(8)).
8. If the State's reporting law is intended only to gather
information for research purposes, treatment programs can include clients'
names in their reports, if the public health department complies with §2.52 of
the Federal regulations. That section permits release of client-identifying
information to researchers when (1) they are qualified to conduct the research;
(2) they have a research protocol to protect client-identifying information,
and a group of three or more individuals independent of the research project
have reviewed the protocol and found it adequate; and (3) they agree not to
redisclose clients' names or identifying information except back to the program
and not to identify any client in a report. In most cases, a department of
public health will easily satisfy the first requirement. The U.S. Department of
Health and Human Services (DHSS) has suggested in opinion letters that the
second requirement may not apply when the research is intended to track the
incidence and causation of diseases. Thus, if the State is gathering
information only for research purposes, the program can probably make reports
including clients' names, if the department agrees not to redisclose clients'
names or identifying information except back to the program and not to identify
any client in a report.
9. See Letter to Oklahoma State Department of Health from the Legal
Adviser to the U.S. Alcohol, Drug Abuse, and Mental Health Administration,
dated September 2, 1988, and Letter to the New York State Department of Health
from the Acting General Counsel to the U.S. DHHS, dated May 17, 1989.
10. Two statutes (42 U.S.C. §241[d] and 21 U.S.C. §872[c]), both of
which cover research into drug use, permit the Secretary of DHHS and the U.S.
Attorney General, respectively, to authorize researchers to withhold the names
and identities of research subjects. The statutes both state that the
researcher "may not be compelled in any Federal, State, or local civil,
criminal, administrative, legislative, or other proceeding" to identify
the subjects of research for which such authorization was obtained. Such
authorization is commonly called a "certificate of confidentiality."
Whether or not research investigators have obtained an authorization from the Attorney
General or the Secretary of DHHS, however, they must comply with the
prohibitions on redisclosure discussed in this section of the chapter if they
have been given access to clients' records in a federally assisted treatment
program.
11. These particular entities also may copy or remove records, but
only if they agree in writing to maintain client-identifying information in
accordance with the regulations' security requirements (see §2.16), to destroy
all client-identifying information when the audit or evaluation is completed,
and to redisclose client information only (1) back to the program, (2) in
accordance with a court order to investigate or prosecute the program (§2.66),
or (3) to a government agency overseeing a Medicare or Medicaid audit or
evaluation (§2.53(b)).
12. For information on how to deal with subpoenas, see Chapter 5
and Confidentiality: A Guide to the Federal Law and Regulations, New
York: Legal Action Center, 1995.
13. If the information is being sought to investigate or prosecute a
client, only the program need be notified (§2.65). If the information is sought
to investigate or prosecute the program, no prior notice is required (§2.66).
14. If the purpose of seeking the court order is to obtain
authorization to disclose information in order to investigate or prosecute a
client for a crime, the court also must find that (1) the crime involved was
extremely serious, such as an act causing or threatening to cause death or
serious injury; (2) the records sought are likely to contain information of
significance to the investigation or prosecution; (3) there is no other
practical way to obtain the information; and (4) the public interest in
disclosure outweighs any actual or potential harm to the client, the
doctor-client relationship, and the ability of the program to provide services
to other clients. When law enforcement personnel seek the order, the court also
must find that the program had an opportunity to be represented by independent
counsel. If the program is a government entity, it must be represented by
independent counsel, §2.65(d).
Appendix C -- Instruments
This appendix reproduces the following tools:
- Abuse Assessment Screen (in English and Spanish)
- Danger Assessment
- Psychological Maltreatment of Women Inventory (PMWI)
- Revised Conflict Tactics Scale (CTS2)
Although these instruments have been used extensively in research settings, they have not been validated as clinical tools; nor do they have instructions for scoring. The PMWI and the CTS2, in particular, were designed as research tools, not clinical tools, and do not have cutting scores (the score beyond which a person has a problem). All the instruments in this appendix can, however, serve to open dialogue with a client, elicit information, promote discussion, and help evaluate a program.
Abuse Assessment Screen (English Version)
|
1. |
WITHIN THE LAST YEAR, have you been hit, slapped, kicked, or otherwise physically hurt by someone? |
YES |
NO |
|
|
If YES, by whom?____________________________________ |
|
|
|
|
Total number of times ________________________________ |
|
|
|
2. |
SINCE YOU'VE BEEN PREGNANT, have you been hit, slapped, kicked, or otherwise physically hurt by someone? |
YES |
NO |
|
|
If YES, by whom? ____________________________________ |
|
|
|
|
Total number of times ________________________________ |
|
|
|
|
MARK THE AREA OF INJURY ON THE BODY MAP, SCORE EACH
INCIDENT ACCORDING TO THE FOLLOWING SCALE: |
|
SCORE |
|
|
1 = Threats of abuse including use of a weapon |
|
_______ |
|
|
2 = Slapping, pushing; no injuries and/or lasting pain |
|
_______ |
|
|
3 = Punching, kicking, bruises, cuts and/or continuing pain |
|
_______ |
|
|
4 = Beating up, severe contusions, burns, broken bones |
|
_______ |
|
|
5 = Head injury, internal injury, permanent injury |
|
_______ |
|
|
6 = Use of weapon; wound from weapon |
|
_______ |
|
|
If any of the descriptions for the higher number apply, use the higher number. |
|
|
|
3. |
WITHIN THE LAST YEAR, has anyone forced you to have sexual activities? |
YES |
NO |
|
|
If YES, by whom? ___________________________________ |
|
|
|
Developed by the Nursing Research Consortium on Violence and Abuse. |
|||
|
Reproduced with permission from J. McFarlane & B. Parker (1994). Abuse During Pregnancy: A Protocol for Prevention and Intervention. White Plains, NY: The March of Dimes Birth Defects Foundation, pp. 22-23. |
|||
Encuesta Sobre El Maltrato (Spanish
Version)
|
|
DURANTE EL ÚLTIMO AÑO, fuÉ golpeada, bofeteada, pateada, o lastimada fisicamente de alguna otra manera por alguien? |
SI |
NO |
|
|
Si la respuesta es "SI" por quien(es)?___________________ |
|
|
|
|
Cuantas veces?______________________________________ |
|
|
|
2. |
DESDE QUE SALIO EMBARAZADA, ha sido golpeada, bofeteada, pateada, o lastimada fisicamente de alguna otra manera por alguien?__________________________________ |
SI |
NO |
|
|
Si la respuesta es "SI" por quien(es)? ___________________ |
|
|
|
|
Cuantas veces?______________________________________ |
|
|
|
|
EN EL DIAGRAMA ANATÓMICO, MARQUE LAS PARTES DE SU
CUERPO QUE HAN SIDO LASTIMADAS. VALORE CADA INCIDENTE USANDO LAS SIGUIENTE
ESCALA: |
|
GRADO |
|
|
1 = Amenazas de maltrato que incluyen el uso de un arma |
|
_______ |
|
|
2 = Bofeteadas, permanentel ompujones sin lesiones fisicas o dolor permanente |
|
_______ |
|
|
3 = Moquestos, patadas, moretones, heridas y/o dolor continuo |
|
_______ |
|
|
4 = Molida a palos, contusiones severas, quemaduras, fracturas de huesos |
|
_______ |
|
|
5 = Heridas en la cabeza, lesiones internas, lesiones permanentes |
|
_______ |
|
|
6 = Uso de armas, herida por arma |
|
_______ |
|
|
Si cualquiera de las situaciones valora un numero alto en la escala, Úselo. |
|
|
|
3. |
DURANTE EL ÚLTIMO AÑO, fuÉ forzada a tener relaciones sexuales? |
SI |
NO |
|
|
Si la respuesta es "SI" por quien(es)_____________________ |
|
|
|
|
Cuantas veces?______________________________________ |
|
|
Danger Assessment
Several risk factors have been associated with homicides (murders) of both batterers and battered women in research conducted after the murders have taken place. We cannot predict what will happen in your case, but we would like you to be aware of the danger of homicide in situations of severe battering and for you to see how many of the risk factors apply to your situation.
Using the calendar, please mark the approximate dates during the past year when you were beaten by your husband or partner. Write on that date how bad the incident was according to the following scale (if any of the descriptions for the higher number apply, use the higher number):
- Slapping, pushing; no injuries and/or lasting pain
- Punching, kicking; bruises, cuts, and/or continuing pain
- "Beating up"; severe contusions, burns, broken bones
- Threat to use weapon; head injury, internal injury, permanent injury
- Use of weapon; wounds from weapon
Mark YES or NO for each of the following. ("He" refers to your husband, partner, ex-husband, ex-partner, or whoever is currently physically hurting you.)
Thank you. Please talk to your nurse, advocate, or counselor about what the
Danger Assessment means in terms of your situation.
|
|
|
|
|
_______ |
1. |
Has the physical violence increased in frequency over the past year? |
|
_______ |
2. |
Has the physical violence increased in severity over the past year and/or has a weapon or threat from a weapon ever been used? |
|
_______ |
3. |
Does he ever try to choke you? |
|
_______ |
4. |
Is there a gun in the house? |
|
_______ |
5. |
Has he ever forced you to have sex when you did not wish to do so? |
|
_______ |
6. |
Does he use drugs? By drugs, I mean "uppers" or amphetamines, speed, angel dust, cocaine, "crack," street drugs, or mixtures. |
|
_______ |
7. |
Does he threaten to kill you and/or do you believe he is capable of killing you? |
|
_______ |
8. |
Is he drunk every day or almost every day? (In terms of quantity of alcohol.) |
|
_______ |
9. |
Does he control most or all of your daily activities? For instance: Does he tell you who you can be friends with, how much money you can take with you shopping, or when you can take the car? (If he tries, but you do not let him, check here: . ) |
|
_______ |
10. |
Have you ever been beaten by him while you were pregnant? (If you have never been pregnant by him, check here: . ) |
|
_______ |
11. |
Is he violently and constantly jealous of you? (For instance, does he say, "If I can't have you, no one can.") |
|
_______ |
12. |
Have you ever threatened or tried to commit suicide? |
|
_______ |
13. |
Has he ever threatened or tried to commit suicide? |
|
_______ |
14. |
Is he violent toward your children? |
|
_______ |
15. |
Is he violent outside of the home? |
|
_______ |
|
Total "Yes" Answers |
Reproduced with permission. Copyright Jacquelyn C. Campbell, Ph.D., R.N., 1985, 1988.
Please share with the author the results of any research (raw or coded data)
that is done with the instrument and/or an approximate number of women with
whom the instrument was used, a description of their demographics, their mean
score, and the setting in which data were collected. Please send this
information within the next year. Also please send comments (positive and
negative) and suggestions for improvement from battered women themselves,
advocates, and professionals who are involved in its use.
Sources:
Campbell, J. Nursing assessment for risk of homicide in battered women. Advances in Nursing Science 8:36-51, 1986.
Campbell, J.C. Prediction of homicide of and by battered women. In:
Campbell, J.C., ed. Assessing Dangerousness. Violence by Sexual Offenders,
Batterers, and Child Abusers. Thousand Oaks, CA: Sage Publications, Inc.,
1995.
The Psychological Maltreatment Of Women
Inventory (PMWI)
The PMWI is a 58-item test designed to measure the extent and nature of
abuse toward women in a relationship. The questionnaire below is given to women
survivors of abuse. The version for male perpetrators includes identical
behaviors but reverses the pronouns and direction of abuse.
|
|
|
|
How often, if at all, did the behavior described in each item occur in the past six months (never, rarely, sometimes, frequently, or very frequently)? |
|
|
1. |
My partner put down my physical appearance. |
|
2. |
My partner insulted me or shamed me in front of others. |
|
3. |
My partner treated me like I was stupid. |
|
4. |
My partner was insensitive to my feelings. |
|
5. |
My partner told me I couldn't manage or take care of myself without him. |
|
6. |
My partner put down my care of the children. |
|
7. |
My partner criticized the way I took care of the house. |
|
8. |
My partner said something to spite me. |
|
9. |
My partner brought up something from the past to hurt me. |
|
10. |
My partner called me names. |
|
11. |
My partner swore at me. |
|
12. |
My partner yelled and screamed at me. |
|
13. |
My partner treated me like an inferior. |
|
14. |
My partner sulked or refused to talk about a problem. |
|
15. |
My partner stomped out of the house or yard during a disagreement. |
|
16. |
My partner gave me the silent treatment, or acted as if I wasn't there. |
|
17. |
My partner withheld affection from me. |
|
18. |
My partner did not let me talk about my feelings. |
|
19. |
My partner was insensitive to my sexual needs and desires. |
|
20. |
My partner demanded obedience to his whims. |
|
21. |
My partner became upset if dinner, housework, or laundry was not done when he thought it should be. |
|
22. |
My partner acted like I was his personal servant. |
|
23. |
My partner did not do a fair share of household tasks. |
|
24. |
My partner did not do a fair share of child care. |
|
25. |
My partner ordered me around. |
|
26. |
My partner monitored my time and made me account for where I was. |
|
27. |
My partner was stingy in giving me money to run our home. |
|
28. |
My partner acted irresponsibly with our financial resources. |
|
29. |
My partner did not contribute enough to supporting our family. |
|
30. |
My partner used our money or made important financial decisions without talking to me about it. |
|
31. |
My partner kept me from getting medical care that I needed. |
|
32. |
My partner was jealous or suspicious of my friends. |
|
33. |
My partner was jealous of other men. |
|
34. |
My partner did not want me to go to school or other self-improvement activities. |
|
35. |
My partner did not want me to socialize with my female friends. |
|
36. |
My partner accused me of having an affair with another man. |
|
37. |
My partner demanded that I stay home and take care of the children. |
|
38. |
My partner tried to keep me from seeing or talking to my family. |
|
39. |
My partner interfered in my relationships with other family members. |
|
40. |
My partner tried to keep me from doing things to help myself. |
|
41. |
My partner restricted my use of the car. |
|
42. |
My partner restricted my use of the telephone. |
|
43. |
My partner did not allow me to go out of the house when I wanted to go. |
|
44. |
My partner refused to let me work outside of the home. |
|
45. |
My partner told me my feelings were irrational or crazy. |
|
46. |
My partner blamed me for his problems. |
|
47. |
My partner tried to turn our family, friends, and children against me. |
|
48. |
My partner blamed me for causing his violent behavior. |
|
49. |
My partner tried to make me feel like I was crazy. |
|
50. |
My partner's moods changed radically, from calm to angry, or vice versa. |
|
51. |
My partner blamed me when he was upset about something, even when it had nothing to do with me. |
|
52. |
My partner tried to convince my friends, family, or children that I was crazy. |
|
53. |
My partner threatened to hurt himself if I left him. |
|
54. |
My partner threatened to hurt himself if I didn't do what he wanted me to do. |
|
55. |
My partner threatened to have an affair with someone else. |
|
56. |
My partner threatened to leave the relationship. |
|
57. |
My partner threatened to take the children away from me. |
|
58. |
My partner threatened to have me committed to a mental institution. |
Source: Tolman, R.M. The development of a measure of
psychological maltreatment of women by their male partners. Violence and
Victims 4(3):159B177, 1989.
Reproduced with permission of the author.
The Revised Conflict Tactics Scale (CTS2) (for Couples)
Copyrights
The Revised Conflict Tactics Scale (CTS2) is copyrighted by the test authors
and may be reproduced only with their express permission. Permission will be
granted on the basis of completing a one-page permission form and signing a
user agreement. The agreement commits the user to either (1) carry out and
publish, or make available to the test authors, psychometric analyses,
including frequency distribution, mean, standard deviation, and alpha
coefficient of reliability for each scale; or (2) provide the test authors with
the raw data for each subject tested in a form that will enable the test
authors to compute these statistics, together with as much demographic
information as possible for each subject. The test authors agree to only use
this information for psychometric analyses and to acknowledge the source of the
data. The user providing the information retains the sole right to use the data
for substantive purposes. Copies of the permission form and user agreement are
available from Murray A. Straus, Family Research Laboratory, University of New
Hampshire, Durham, NH 03824; e-mail: mailto:mas2@christic.unh.edu
telephone: (603) 862-2594; fax: (603) 862-1122.
|
|
|||
|
No matter how well a couple gets along, there are times when they disagree, get annoyed with the other person, want different things from each other, or just have spats or fights because they are in a bad mood, are tired, or for some other reason. Couples also have many different ways of trying to settle their differences. This is a list of things that might happen when you have differences. Please circle how many times you did each of these things in the past year, and how many times your partner did them in the past year. If you or your partner did not do one of these things in the past year, but it happened before that, circle "7." |
|||
|
How often did this happen? |
|
|
|
|
1 = Once in the past year |
5 = 11-20 times in the past year |
||
|
2 = Twice in the past year |
6 = More than 20 times in the past year |
||
|
3 = 3-5 times in the past year |
7 = Not in the past year, but it did happen before |
||
|
4 = 6-10 times in the past year |
0 = This has never happened |
||
|
1. |
I showed my partner I cared even though we disagreed. |
1 2 3 4 5 6 |
7 0 |
|
2. |
My partner showed care for me even though we disagreed. |
1 2 3 4 5 6 |
7 0 |
|
3. |
I explained my side of a disagreement to my partner. |
1 2 3 4 5 6 |
7 0 |
|
4. |
My partner explained his or her side of a disagreement to me. |
1 2 3 4 5 6 |
7 0 |
|
5. |
I insulted or swore at my partner. |
1 2 3 4 5 6 |
7 0 |
|
6. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
7. |
I threw something at my partner that could hurt. |
1 2 3 4 5 6 |
7 0 |
|
8. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
9. |
I twisted my partner's arm or hair. |
1 2 3 4 5 6 |
7 0 |
|
10. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
11. |
I had a sprain, bruise, or small cut because of a fight with my partner. |
1 2 3 4 5 6 |
7 0 |
|
12. |
My partner had a sprain, bruise, or small cut because of a fight with me. |
1 2 3 4 5 6 |
7 0 |
|
13. |
I showed respect for my partner's feelings about an issue. |
1 2 3 4 5 6 |
7 0 |
|
14. |
My partner showed respect for my feelings about an issue. |
1 2 3 4 5 6 |
7 0 |
|
15. |
I made my partner have sex without a condom. |
1 2 3 4 5 6 |
7 0 |
|
16. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
17. |
I pushed or shoved my partner. |
1 2 3 4 5 6 |
7 0 |
|
18. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
19. |
I used force (like hitting, holding down, or using a weapon) to make my partner have oral or anal sex. |
1 2 3 4 5 6 |
7 0 |
|
20. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
21. |
I used a knife or gun on my partner. |
1 2 3 4 5 6 |
7 0 |
|
22. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
23. |
I passed out from being hit on the head by my partner in a fight. |
1 2 3 4 5 6 |
7 0 |
|
24. |
My partner passed out from being hit on the head in a fight with me. |
1 2 3 4 5 6 |
7 0 |
|
25. |
I called my partner fat or ugly. |
1 2 3 4 5 6 |
7 0 |
|
26. |
My partner called me fat or ugly. |
1 2 3 4 5 6 |
7 0 |
|
27. |
I punched or hit my partner with something that could hurt. |
1 2 3 4 5 6 |
7 0 |
|
28. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
29. |
I destroyed something belonging to my partner. |
1 2 3 4 5 6 |
7 0 |
|
30. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
31. |
I went to a doctor because of a fight with my partner. |
1 2 3 4 5 6 |
7 0 |
|
32. |
My partner went to a doctor because of a fight with me. |
1 2 3 4 5 6 |
7 0 |
|
33. |
I choked my partner. |
1 2 3 4 5 6 |
7 0 |
|
34. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
35. |
I shouted or yelled at my partner. |
1 2 3 4 5 6 |
7 0 |
|
36. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
37. |
I slammed my partner against a wall. |
1 2 3 4 5 6 |
7 0 |
|
38. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
39. |
I said I was sure we could work out a problem. |
1 2 3 4 5 6 |
7 0 |
|
40. |
My partner was sure we could work it out. |
1 2 3 4 5 6 |
7 0 |
|
41. |
I needed to see a doctor because of a fight with my partner, but I didn't. |
1 2 3 4 5 6 |
7 0 |
|
42. |
My partner needed to see a doctor because of a fight with me, but didn't. |
1 2 3 4 5 6 |
7 0 |
|
43. |
I beat up my partner. |
1 2 3 4 5 6 |
7 0 |
|
44. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
45. |
I grabbed my partner. |
1 2 3 4 5 6 |
7 0 |
|
46. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
47. |
I used force (like hitting, holding down, or using a weapon) to make my partner have sex. |
1 2 3 4 5 6 |
7 0 |
|
48. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
49. |
I stomped out of the room or house or yard during a disagreement. |
1 2 3 4 5 6 |
7 0 |
|
50. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
51. |
I insisted on sex when my partner did not want to (but did not use physical force). |
1 2 3 4 5 6 |
7 0 |
|
52. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
53. |
I slapped my partner. |
1 2 3 4 5 6 |
7 0 |
|
54. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
55. |
I had a broken bone from a fight with my partner. |
1 2 3 4 5 6 |
7 0 |
|
56. |
My partner had a broken bone from a fight with me. |
1 2 3 4 5 6 |
7 0 |
|
57. |
I used threats to make my partner have oral or anal sex. |
1 2 3 4 5 6 |
7 0 |
|
58. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
59. |
I suggested a compromise to a disagreement. |
1 2 3 4 5 6 |
7 0 |
|
60. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
61. |
I burned or scalded my partner on purpose. |
1 2 3 4 5 6 |
7 0 |
|
62. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
63. |
I insisted my partner have oral or anal sex (but did not use physical force). |
1 2 3 4 5 6 |
7 0 |
|
64. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
65. |
I accused my partner of being a lousy lover. |
1 2 3 4 5 6 |
7 0 |
|
66. |
My partner accused me of this. |
1 2 3 4 5 6 |
7 0 |
|
67. |
I did something to spite my partner. |
1 2 3 4 5 6 |
7 0 |
|
68. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
69. |
I threatened to hit or throw something at my partner. |
1 2 3 4 5 6 |
7 0 |
|
70. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
71. |
I felt physical pain that still hurt the next day because of a fight with my partner. |
1 2 3 4 5 6 |
7 0 |
|
72. |
My partner still felt physical pain the next day because of a fight we had. |
1 2 3 4 5 6 |
7 0 |
|
73. |
I kicked my partner. |
1 2 3 4 5 6 |
7 0 |
|
74. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
75. |
I used threats to make my partner have sex. |
1 2 3 4 5 6 |
7 0 |
|
76. |
My partner did this to me. |
1 2 3 4 5 6 |
7 0 |
|
77. |
I agreed to try a solution to a disagreement my partner suggested. |
1 2 3 4 5 6 |
7 0 |
|
78. |
My partner agreed to try a solution I suggested. |
1 2 3 4 5 6 |
7 0 |
Scoring
The principles for scoring the CTS2 have been previously described in the CTS1 manual (Straus, 1995) and in Straus and Gelles (1990). Therefore, only the most basic aspects of scoring are presented here. The reader is referred to these other sources for further information.
The CTS2 is scored by adding the response number (i.e., the number of times something happened) midpoint for each category chosen by the participant. Categories 0, 1, and 2 do not have midpoints, and responses for these categories are scored 0, 1, and 2, respectively. For Category 3 (3-5 times), the midpoint is 4; for Category 4 (6-10 times), the midpoint is 8; and for Category 5 (11-20 times), it is 15. The assigned scores for responses to Categories 3, 4, and 5 are, respectively, 4, 8 , and 15. For Category 6 responses (20 times in the past year), the authors recommend assigning a score of 25.
Responses for Category 7 ("Not in the past year, but it did happen before") may be used in two ways: (1) When scores for the previous year are desired (the usual use of the CTS2), Category 7 is assigned a score of 0; and (2) to obtain a relationship prevalence measure of physical assault (i.e., Did an assault ever occur?), respondents who answer 1-7 are assigned a score of 1 ("yes").
When the CTS2 is used for research with any type of sample except cases
known to be violent (e.g., men in a batterer treatment program), the test
authors recommend that two variables be created for the physical assault,
sexual coercion, and physical injury scales: a prevalence variable and a
chronicity variable. The prevalence variable is a 0-or-1 dichotomy, with a
score of 1 assigned if one or more of the acts in the scale occurred. The
chronicity variable is the number of times the act(s) in the scale occurred
among those who engaged in at least one of the acts in the scale. If the CTS2
is used with a person (or group member) who is known to be violent, separate
prevalence and chronicity variables are not required because prevalence is
already known.
Source
Straus, M.A.; Hamby, S.L.; Boney-McCoy, S.; and Sugarman, D.B. The Revised
Conflict Tactics Scale (CTS2): Development and preliminary psychometric data. Journal
of Family Issues 17(3):283-316, 1996.
References
Straus, M.A. Manual for the Conflict Tactics Scales. Durham, NH: Family Research Laboratory, University of New Hampshire, 1995.
Straus, M.A., and Gelles, R.J. Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families. New Brunswick, NJ: Transaction Publishing, 1990.
NOTE: Copyright 1995 Straus, Hamby, Boney-McCoy, and Sugarman.
Reprinted with permission.
Appendix D -- Sample
Personalized Safety Plan For Domestic Violence Survivors
Name: _________________________
Date: __________________________
Review dates: ___________________
________________________________________________________________
Personalized Safety Plan
|
|
|
|
Step 1: Safety during a violent incident. Women cannot always avoid violent incidents. In order to increase safety, battered women may use a variety of strategies. |
|
|
I can use some or all of the following strategies: |
|
|
A. |
If I decide to leave, I will ______________________. (Practice how to get out safely. What doors, windows, elevators, stairwells, or fire escapes would you use?) |
|
B. |
I can keep my purse and car keys ready and put them (place) ____________________ in order to leave quickly. |
|
C. |
I can tell ____________________ about the violence and
request they call the police if they hear suspicious noises coming from my
house. |
|
D. |
I can teach my children how to use the telephone to contact the police and the fire department. |
|
E. |
I will use __________________________ as my code word with my children or my friends so they can call for help. |
|
F. |
If I have to leave my home, I will go
___________________________. (Decide this even if you don't think there will
be a next time.) |
|
G. |
I can also teach some of these strategies to some/all of my children. |
|
H. |
When I expect we are going to have an argument, I will try to move to a space that is lowest risk, such as _______________________________________________. (Try to avoid arguments in the bathroom, garage, kitchens, near weapons or in rooms without access to an outside door.) |
|
I. |
I will use my judgment and intuition. If the situation is very serious, I can give my partner what he/she wants to calm him/her down. I have to protect myself until I/we are out of danger. |
|
Step 2: Safety when preparing to leave. Battered women frequently leave the residence they share with the battering partner. Leaving must be done with a careful plan in order to increase safety. Batterers often strike back when they believe that a battered woman is leaving a relationship. |
|
|
I can use some or all of the following safety strategies: |
|
|
A. |
I will leave money and an extra set of keys with ____________________ so I can leave quickly. |
|
B. |
I will keep copies of important documents or keys at ___________________________. |
|
C. |
I will open a savings account by ______________________ (date), to increase my independence. |
|
D. |
Other things I can do to increase my independence include: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ |
|
E. |
The domestic violence program's hotline number is ________________________. I can seek shelter by calling this hotline. |
|
F. |
I can keep change for phone calls on me at all times. I understand that if I use my telephone credit card, the following month the telephone bill will tell my batterer those numbers that I called after I left. To keep my telephone communications confidential, I must either use coins or I might get a friend to permit me to use their telephone credit card for a limited time when I first leave. |
|
G. |
I will check with ___________________ and ___________________ to see who would be able to let me stay with them or lend me some money. |
|
H. |
I can leave extra clothes with _____________________________________________. |
|
I. |
I will sit down and review my safety plan every ____________________________ in order to plan the safest way to leave the residence. ____________________________ (domestic violence advocate or friend) has agreed to help me review this plan. |
|
J. |
I will rehearse my escape plan and, as appropriate, practice it with my children. |
|
Step 3: Safety in my own residence. There are many things that a woman can do to increase her safety in her own residence. It may impossible to do everything at once, but safety measures can be added step by step. |
|
|
Safety measures I can use include: |
|
|
A. |
I can change the locks on my doors and windows as soon as possible. |
|
B. |
I can replace wooden doors with steel/metal doors. |
|
C. |
I can install security systems including additional locks, window bars, poles to wedge against doors, an electronic system, etc. |
|
D. |
I can purchase rope ladders to be used for escape from second floor windows. |
|
E. |
I can install smoke detectors and purchase fire extinguishers for each floor in my house/apartment. |
|
F. |
I can install an outside lighting system that lights up when a person is coming close to my house. |
|
G. |
I will teach my children how to use the telephone to make a collect call to me and to (friend/minister/other) in the event that my partner takes the children. |
|
H. |
I will tell people who take care of my children which
people have permission to pick up my children and that my partner is not
permitted to do so. The people I will inform about pick-up permission include |
|
I. |
I can inform ________________________________________________ (neighbor), ________________________________ (pastor), and _________________________ (friend) that my partner no longer resides with me and they should call the police if he is observed near my residence. |
|
Step 4: Safety with a protection order. Many batterers obey protection orders, but one can never be sure which violent partner will obey and which will violate protection orders. I recognize that I may need to ask the police and the courts to enforce my protection order. |
|
|
The following are some steps that I can take to help the enforcement of my protection order: |
|
|
A. |
I will keep my protection order _________________________ (location). (Always keep it on or near your person. If you change purses, that's the first thing that should go in.) |
|
B. |
I will give my protection order to police departments in the community where I work, in those communities where I usually visit family or friends, and in the community where I live. |
|
C. |
There should be a county registry of protection orders that all police departments can call to confirm a protection order. I can check to make sure that my order is in the registry. The telephone number for the county registry of protection orders is __________________. |
|
D. |
For further safety, if I often visit other counties in my state, I might file my protection order with the court in those counties. I will register my protection order in the following counties: __________________, __________________________, and _________________________. |
|
E. |
I can call the local domestic violence program if I am not sure about B, C, or D above or if I have some problem with my protection order. |
|
F. |
I will inform my employer, my minister, my closest friend and ___________________ and _____________________ that I have a protection order in effect. |
|
G. |
If my partner destroys my protection order, I can get another copy from the courthouse by going to [the office] located at __________________________ |
|
H. |
If my partner violates the protection order, I can call the police and report a violation, contact my attorney, call my advocate, and/or advise the court of the violation. |
|
I. |
If the police do not help, I can contact my advocate or attorney and will file a complaint with the chief of the police department. |
|
J. |
I can also file a private criminal complaint with the district justice in the jurisdiction where the violation occurred or with the district attorney. I can charge my battering partner with a violation of the protection order and all the crimes that he commits in violating the order. I can call the domestic violence advocate to help me with this. |
|
Step 5: Safety on the job and in public. Each battered woman must decide if and when she will tell others that her partner has battered her and that she may be at continued risk. Friends, family and coworkers can help to protect women. Each woman should consider carefully which people to invite to help secure her safety. |
|
|
I might do any or all of the following: |
|
|
A. |
I can inform my boss, the security supervisor and _____________________________ at work of my situation. |
|
B. |
I can ask ________________________________________ to help screen my telephone calls at work. |
|
C. |
When leaving work, I can _______________________________________________. |
|
D. |
When driving home if problems occur, I can _________________________________. |
|
E. |
If I use public transit, I can ______________________________________________. |
|
F. |
I can use different grocery stores and shopping malls to conduct my business and shop at hours that are different than those when residing with my battering partner. |
|
G. |
I can use a different bank and take care of my banking at hours different from those I used when residing with my battering partner. |
|
H. |
I can also __________________________________________________________. |
|
Step 6: Safety and drug or alcohol use. Most people in this culture use alcohol. Many use mood-altering drugs. Much of this use is legal and some is not. The legal outcomes of using illegal drugs can be very hard on a battered woman, may hurt her relationship with her children and put her at a disadvantage in other legal actions with her battering partner. Therefore, women should carefully consider the potential cost of the use of illegal drugs. But beyond this, the use of any alcohol or other drugs can reduce a woman's awareness and ability to act quickly to protect herself from her battering partner. Furthermore, the use of alcohol or other drugs by the batterer may give him/her an excuse to use violence. Therefore, in the context of drug or alcohol use, a woman needs to make specific safety plans. |
|
|
If drug or alcohol use has occurred in my relationship with the battering partner, I can enhance my safety by some or all of the following: |
|
|
A. |
If I am going to use, I can do so in a safe place and with people who understand the risk of violence and are committed to my safety. |
|
B. |
I can also _______________________________________________________. |
|
C. |
If my partner is using, I can _______________________________________. |
|
D. |
I might also _____________________________________________________. |
|
E. |
To safeguard my children, I might _________________________________ and _________________________. |
|
Step 7: Safety and my emotional health. The experience of being battered and verbally degraded by partners is usually exhausting and emotionally draining. The process of building a new life for myself takes much courage and incredible energy. |
|
|
To conserve my emotional energy and resources and to avoid hard emotional times, I can do some of the following: |
|
|
A. |
If I feel down and ready to return to a potentially abusive situation, I can ______________________________. |
|
B. |
When I have to communicate with my partner in person or by telephone, I can _________________________________________________________. |
|
C. |
I can try to use "I can . . ." statements with myself and to be assertive with others. |
|
D. |
I can tell myself, "____________________________________________" whenever I feel others are trying to control or abuse me. |
|
E. |
I can read ___________________________ to help me feel stronger. |
|
F. |
I can call ______________________________, ______________________________ and _______________________________ as other resources to be of support to me. |
|
G. |
Other things I can do to help me feel stronger are _______________________, ____________________, and __________________________________. |
|
H. |
I can attend workshops and support groups at the domestic violence program or __________________________________, __________________________ , or _________________________________ to gain support and strengthen my relationships with other people. |
|
Step 8: Items to take when leaving. When women leave partners, it is important to take certain items with them. Beyond this, women sometimes give an extra copy of papers and an extra set of clothing to a friend just in case they have to leave quickly. |
|
|
Items with asterisks on the following list are the most important to take. If there is time, the other items might be taken, or stored outside the home. |
|
|
These items might best be placed in one location, so that if we have to leave in a hurry, I can grab them quickly. |
|
|
When I leave, I should take: |
|
|
* |
Identification for myself |
|
* |
Children's birth certificates |
|
* |
My birth certificate |
|
* |
Social Security cards |
|
* |
School and vaccination records |
|
* |
Money |
|
* |
Checkbook, ATM (Automatic Teller Machine) card |
|
* |
Credit cards |
|
* |
Keys-house/car/office |
|
* |
Driver's license and registration |
|
* |
Medications |
|
|
Welfare identification |
|
|
Work permits |
|
|
Green card |
|
|
Passport(s) |
|
|
Divorce papers |
|
|
Medical records-for all family members |
|
|
Lease/rental agreement, house deed, mortgage payment book |
|
|
Bank books |
|
|
Insurance papers |
|
|
Small saleable objects |
|
|
Address book |
|
|
Pictures |
|
|
Jewelry |
|
|
Children's favorite toys and/or blankets |
|
|
Items of special sentimental value |
Telephone Numbers I Need to
Know:
|
|
________________________ |
|
Police department-school |
________________________ |
|
Police department-work |
________________________ |
|
Battered women's program |
________________________ |
|
County registry of protection orders |
________________________ |
|
Work number |
________________________ |
|
Supervisor's home number |
________________________ |
|
Minister |
________________________ |
|
Other |
________________________ |
Reproduced with permission from Barbara Hart and Jane Stuehling, Pennsylvania
Coalition Against Domestic Violence, Harrisburg, Pennsylvania, 1992.
Adapted from "Personalized Safety Plan," Office of the City Attorney,
City of San Diego, California, April 1990.
Appendix E -- Hotlines and Other Resources For Domestic Violence and Related Issues
This appendix provides addresses, phone numbers, and information on three
types of domestic violence organizations and groups in related fields such as
rape, child abuse and neglect, and victimization. Hotlines provide
crisis counseling and referrals to victims and those in crisis and usually
supply general information either by mail or over the phone. General
resources send bulletins, pamphlets, manuals, and other publications by
mail (sometimes at cost); sometimes they give information over the phone. They
also may provide additional services, such as referrals. Most of them serve the
general public, although some target professionals in specific fields. The other
services category includes research and policy groups and those that
provide technical assistance, training, and advocacy. Unlike those in the previous
category, other services tend to target professionals in specific
fields, as indicated, and are not resources for the general public. Many
of the programs and organizations listed below provide more than one type of
service, so they are categorized by their primary purpose.
Hotlines
National Domestic Violence Hotline
(800) 799-SAFE
(800) 787-3224 (TDD)
Suite 101-297
3616 Far West Boulevard
Austin, TX 78731-3074
The National Domestic Violence Hotline links individuals and
services using a nationwide database of domestic violence and other emergency
shelters, legal advocacy and assistance programs, and social services programs.
The hotline provides crisis intervention, information about sources of
assistance, and referrals to battered women's shelters.
Rape, Abuse, and Incest National Network (RAINN)
(800) 656-4673
RAINN links 628 rape crisis centers nationwide. Sexual
assault survivors who call will be automatically connected to a trained
counselor at the closest center in their area.
Childhelp USA/National Child Abuse Hotline
(800) 4A-CHILD
15757 North 78th Street
Scottsdale, AZ 85260
(602) 922-8212
With a focus on children and the prevention of child abuse, this hotline provides crisis counseling, referrals, and reporting guidance to callers in crisis, including children, troubled parents, and adult survivors of abuse. All calls are answered by a staff of professional counselors. In addition, statistical and other informative materials can be ordered through this number. Access to information on partner violence is limited.
Childhelp, one of the largest national, nonprofit child abuse treatment
and prevention agencies in the country, also runs the nation's first
residential treatment facility for abused children, provides prevention
services and training, and participates in advocacy and education efforts.
General Resources
American College of Obstetricians and Gynecologists
(ACOG)
ACOG Resource Center
409 12th Street, S.W.
Washington, DC 20024-2188
(202) 638-5577
ACOG has patient education pamphlets and bulletins for
medical professionals on both domestic violence and substance abuse.
American Medical Association (AMA)
Department of Mental Health
515 State Street
Chicago, IL 60610
Contact: Jean Owens
(312) 464-5000
(312) 464-5066 (to order resources)
(312) 464-4184 (fax)
The AMA educates physicians through publications,
conferences, and by serving as a resource center for physicians and other
concerned professionals. Among its publications are six diagnostic and
treatment guidelines on child physical abuse and neglect, child sexual abuse,
domestic violence, elder abuse and neglect, mental health effects of domestic
violence, treatment and prevention of sexual assault, and media violence.
March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
Attn: Resource Center
(914) 428-7100
The March of Dimes provides general information on prenatal care and on the first few years of life through its resource center and its fulfillment center. The March of Dimes does not have a hotline.
March of Dimes Resource Center
(888) 663-4637
(914) 997-4763 (fax)
Contact: Beverly Robertson, Director
Callers to this number can speak to someone about pregnancy, prepregnancy, drug use during pregnancy, birth defects, genetics, and other issues related to prenatal care.
March of Dimes Fulfillment Center
(800) 367-6630
Callers to this number can only place an order for
materials. Two domestic violence materials are available at cost: Abuse
During Pregnancy Nursing Module, which provides continuing education units
to nurses, and a video titled Crime Against the Future.
National Center for Missing or Exploited Children
(NCMEC)
Suite 550
2101 Wilson Boulevard
Arlington, VA 22201-3052
Hotline: (800) THE LOST, (800) 843-5678, (800) 826-7653 (TDD)
Business office: (703) 235-3900, (703) 235-4067 (fax)
NCMEC leads national efforts to locate and recover missing
children and raises public awareness about ways to prevent child abduction,
molestation, and sexual exploitation. The hotline is available to report
information on missing or exploited children or to request information or
assistance. NCMEC publishes materials, including handbooks, pamphlets
containing parental and professional guidelines on runaways and missing or
exploited children, and publication packages aimed toward families, child care
and social service practitioners, and law enforcement, legal, and criminal
justice professionals.
National Clearinghouse on Child Abuse and Neglect
P.O. Box 1182
Washington, DC 20013-1182
(800) FYI-3366
(703) 385-7565
(703) 385-3206 (fax)
This clearinghouse offers child abuse and neglect information
in the form of manuals, research reports, studies, directories, grant
compendia, literature reviews, annotated bibliographies, fact sheets, database
searches, CD ROM databases, and on-line services. It is sponsored by the
National Center on Child Abuse and Neglect.
National Coalition Against Domestic Violence
P.O. Box 18749
Denver, CO 80218
(303) 839-1852
(303) 831-9251 (fax)
The National Coalition Against Domestic Violence serves as
an information and referral center for the general public, the media, battered
women and their children, and agencies and organizations. Among its purposes
are to enhance coalition-building at the local, State, and national levels;
support the provision of community-based, nonviolent alternatives such as safe
homes and shelters for battered women and their children; provide information
and referral services, public education, and technical assistance; and develop
public policy and innovative legislation. The coalition maintains a public
policy office in Washington, DC, and maintains a National Directory of Domestic
Violence Programs.
National Sheriffs 'Association
1450 Duke Street
Alexandria, VA 22314
(800) 424-7827
(703) 836-7827
The National Sheriffs' Association has developed a handbook
on victim's assistance for law enforcement officers who deal with all types of
victims, including those of domestic violence. It provides training in dealing
with victims sensitively, finding resources in one's community to help them,
and setting up a victim assistance program.
National Victim Center (NVC)/INFOLINK
(800) FYI-CALL
(703) 276-2880
NVC operates an information and referral program called
INFOLINK, which provides a toll-free source of comprehensive crime and victim-related
information as well as referrals to over 8,000 victim assistance programs
across the nation. Each caller can receive up to 5 of the 70 information
bulletins free of charge. In addition, all INFOLINK bulletins, as well as other
important information, are available on NVC's website.
Other Services
Center for the Prevention of Sexual and Domestic
Violence
Suite 200
936 North 34th Street
Seattle, WA 98103
(206) 634-1903
(206) 634-0115 (fax)
The Center for the Prevention of Sexual and Domestic
Violence is the only national organization working with and within religious
communities on issues of sexual and domestic violence. Although the center's
constituency includes those in the fields of law, health care, social services,
counseling, and other fields, the center primarily targets religious
professionals and teaches them how to effectively respond to and prevent sexual
abuse and domestic violence. Services and products include trainings,
workshops, and seminars; consultations; videos; specialized curriculum
materials; and publications.
Colorado Coalition Against Domestic Violence
P.O. Box 18902
Denver, CO 80218
(303) 831-9632
This group does public policy work and provides community
education and training, information in the form of statistics and brochures,
and technical assistance to domestic violence programs.
Domestic Violence Project/Face-to-Face
(800) 842-4546
This project, sponsored by the American Academy of Facial
Plastic and Reconstructive Surgery, offers free facial reconstructive surgery
to anyone who has been physically disfigured due to domestic violence.
Domestic Violence Training Project (DVTP)
900 State Street
New Haven, CT 06511
(203) 865-3699
DVTP, a project for health professionals, runs enhanced
education, early intervention, and advocacy programs to end domestic violence.
Ongoing programs and services include seminars, conferences, consultation
services, and case reviews. Project SAFE (Safety Assessment for Everyone) is an
education campaign to raise health care professionals' awareness of domestic
violence as a significant health problem and increase their collaboration with
community-based domestic violence advocates.
Family Violence and Sexual Assault Institute
Suite 130
1121 ESE Loop 323
Tyler, TX 75701
(903) 534-5100
(903) 534-5454 (fax)
To improve networking among researchers, practitioners, and agencies, the Family Violence and Sexual Assault Institute maintains an international clearinghouse, reviews its materials, and disseminates the information through its Family Violence and Sexual Assault Bulletin. This independent, nonprofit corporation helps crisis centers, agencies, universities, and counseling clinics develop treatment programs for partner and sexual abuse and has published several books and bibliographies as a result of this research. The institute also provides training and consultation in the form of program evaluation, research, and technical assistance.
National Center on Elder Abuse (NCEA)
Suite 500
810 First Street, N.E.
Washington, DC 20002-4267
(202) 682-2470
(202) 289-6555 (fax)
NCEA performs clearinghouse functions, develops and
disseminates information, provides training and technical assistance, and
conducts research and demonstration projects of national significance. In
addition, NCEA runs the country's only automated, elder abuse literature search
and retrieval system. Four organizations comprise the NCEA: the American Public
Welfare Association, the National Association of State Units on Aging, the
University of Delaware College of Human Resources, and the National Committee
for Prevention of Elder Abuse.
National Clearinghouse on Marital and Date Rape
http://members.aol.com/ncmdr/index.html
The National Clearinghouse on Marital and Date Rape provides
fee-based phone consultations for information, referrals, strategies, and
advocacy. The website contains fee and membership information.
National Criminal Justice Reference Service
(NCJRS)
P.O. Box 6000
Rockville, MD 20847-6000
(800) 851-3420
(301) 251-5500
NCJRS, one of the most extensive sources of information on
criminal and juvenile justice in the world, provides services to an
international community of policymakers and professionals. NCJRS is a
collection of clearinghouses supporting all bureaus of the U.S. Department of
Justice, Office of Justice Programs. It also supports the Office of National
Drug Control Policy. Information is available through information specialists,
on-line services, or its CD ROM database. NCJRS does not provide counseling
or legal advice.
National Network to End Domestic Violence
Suite 900
701 Pennsylvania Avenue, N.W.
Washington, DC 20004
(202) 347-9520
A member organization of State domestic violence coalitions,
the National Network to End Domestic Violence supports 2,000 programs and
services, provides training, and focuses on public policy issues.
The Domestic Violence Resource Network
The Domestic Violence Resource Network comprises four entities: the Resource
Center on Domestic Violence: Child Protection and Custody; the National
Resource Center on Domestic Violence; the Health Resource Center on Domestic
Violence; and the Battered Women's Justice Project (a collaboration of three
organizations).
Resource Center on Domestic Violence: Child Protection
and Custody
Project of the National Council of Juvenile and Family Court Judges (NCJFCJ) Violence Project
P.O. Box 8970
Reno, NV 89507
(800) 527-3223
(702) 784-6160 (fax)
NCJFCJ, a national judicial membership organization, runs the Family Violence Project with the goal of developing, testing, and promoting criminal, civil, and family court procedures that better respond to domestic violence. The Resource Center, a component of the Family Violence Project, provides immediate access to information and training for judges, court workers, advocates, lawyers, child protective workers, law enforcement personnel, and other professionals dealing with child protection/custody issues in the context of domestic violence. Callers can receive accurate, up-to-date information and technical assistance over the phone or can request information packets, program materials, and other resources.
The Family Violence Project developed -- through a committee of domestic
violence experts including judges, attorneys, battered women's advocates,
health care professionals, and law enforcement personnel -- the Model State
Code on Domestic and Family Violence. The project provides technical
assistance to implement the model code.
National Resource Center on Domestic Violence
Project of the Pennsylvania Coalition Against Domestic Violence
Suite 1300
6400 Flank Drive
Harrisburg, PA 17112
(800) 537-2238
(717) 545-9456 (fax)
The National Resource Center on Domestic Violence (NRC),
operated by the Pennsylvania Coalition Against Domestic Violence, is a source
of comprehensive information, training, and technical assistance on domestic
violence prevention and intervention. NRC serves as a central resource for the
collection, preparation, analysis, and dissemination of information on domestic
violence; identifies and supports the development of innovative and exemplary
intervention and prevention resources; and maintains a comprehensive database
of information to coordinate resource development and technical assistance
throughout the nation. Although its target groups are domestic violence
programs and State coalitions, NRC also serves government agencies, policy
leaders, media, and other professionals and organizations involved in the
prevention or response to domestic violence.
Health Resource Center on Domestic Violence
Project of the Family Violence Prevention Fund
Suite 304
383 Rhode Island Street
San Francisco, CA 94103-5133
toll free (888) Rx ABUSE, weekdays 9 a.m. to 5 p.m., P.S.T.
(415) 252-8991 (fax)
The Health Resource Center, which focuses on strengthening
the health care response to domestic violence, provides resources and training
materials, technical assistance, and information and referrals to health care
professionals and others who help victims of domestic violence. Its products
and services include comprehensive resource manuals providing the tools for an
effective multidisciplinary response; multidisciplinary protocols emphasizing
routine screening and identification of domestic violence; assistance with
health care training programs and protocol development; models for local,
State, and national health policymaking; a national network of experts for
public speaking, training, and consultation; and educational materials
specifically developed for health care providers.
Battered Women's Justice Project (BWJP)
4032 Chicago Avenue, South
Minneapolis, MN 55407
903-0111
(612) 824-8965 (fax)
The BWJP serves as a resource center and national toll-free
information line regarding domestic violence issues in the criminal and civil
justice systems. A collaboration of three organizations, the BWJP responds to
specific requests for information or technical assistance from people who work
with battered women. Each component specializes in certain areas of law and
responds to questions about training, practices, and policies in those areas.
BWJP develops resources such as bibliographies, various resource packets, and
information about model programs, protocols, curricula, experts in the field,
and training materials. The project is funded by a grant from the U.S.
Department of Health and Human Services. The three organizations can be reached
through the same toll-free number listed above; each has its own extension.
Extension 1:
The Criminal Justice Center -- Domestic Abuse Intervention Project: for information about criminal justice responses to domestic violence.
The Criminal Justice Center responds to questions on the criminal justice system, including law enforcement, prosecution, sentencing, probation, batterer's counseling programs, coordinated community/court responses, and victim advocacy. This office also handles information requests about domestic violence and the military and intervention strategies within Native American communities.
4032 Chicago Avenue, South
Minneapolis, MN 55407
(612) 824-8768
(612) 824-8965 (fax)
Extension 2:
Civil Access and Representation Center -- Pennsylvania Coalition Against Domestic Violence: For information about civil court access and legal representation issues of battered women.
The Civil Access and Legal Center aims to enhance justice for battered women and their children by increasing their access to civil court options and legal representation. With special expertise in state-of-the-art legal approaches and model protocols, legal staff provide assistance to advocates, attorneys, court personnel, and policymakers.
Suite 1300
6400 Flank Drive
Harrisburg, PA 17112
(717) 545-6400
(717) 545-9456 (fax)
Extension 3:
The Self-Defense Center -- National Clearinghouse for the Defense of Battered Women: For information about issues that arise when battered women are charged with crimes.
The Self-Defense Center provides technical assistance to battered women charged with crimes and to their defense teams: attorneys, battered women's advocates, and expert witnesses; works with incarcerated battered women filing appeals or applying for parole or clemency; coordinates a national network of advocates and other professionals assisting battered women defendants; maintains a resource library of relevant articles and case law; and conducts community and professional training seminars.
Suite 302
125 South 9th Street
Philadelphia, PA 19107
(215) 351-0010
(215) 351-0779 (fax)
American Academy of Child and Adolescent Psychiatry
Washington, D.C.
Health Manpower Specialist
Bureau of Health Professionals
Division of Medicine
Health Resources and Services Administration
Rockville, Maryland
Chief
Alcoholism and Substance Abuse Program Branch
Indian Health Service
Rockville, Maryland
Senior Advisor to the Director
Medications Development Division
National Institute on Drug Abuse
Rockville, Maryland
Associate Administrator
Office for Women's Services
Substance Abuse and Mental Health Services Administration
Rockville, Maryland
Acting Director
Program Policy and Planning Division
National Center on Child Abuse and Neglect
Children's Bureau
Department of Health and Human Services
Washington, D.C.
Deputy Director
Office of Planning, Research, and Evaluation
Administration for Children and Families
Department of Health and Human Services
Washington, D.C.
Director
Office of Substance Abuse
American Psychological Association
Washington, D.C.
Team Leader
Family and Intimate Violence Prevention Team
Division of Violence Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention
Atlanta, Georgia
Senior Technical Advisor
Special Projects Section
American College of Nurse-Midwives
Washington, D.C.
Program Manager
National Institute of Justice
Washington, D.C.
Deputy Director of National Policy
Legal Action Center
Washington, D.C.
Program Specialist
Quality Assurance Programs
National Association of State Alcohol and Drug Abuse Directors, Inc.
Washington, D.C.
Nurse Consultant
Division of Nursing
Health Resources and Services Administration
Department of Health and Human Services
Rockville, Maryland
Director
Clinical Issues
The National Association of Alcoholism and Drug Abuse Counselors
Arlington, Virginia
Associate Director
Addictive Disorders
Mental Health and Behavioral Sciences Services
Department of Veterans Affairs
Washington, D.C.
Public Relations Specialist
American Academy of Child and Adolescent Psychiatry
Washington, D.C.
Research Assistant
School of Social Welfare
Twente Hall
University of Kansas
Lawrence, Kansas
High Risk Coordinator
Providence Prenatal Center
Holyoke, Massachusetts
Alcohol Therapist II
Adult Medicine/Ambulatory Care
Harborview Medical Center
Seattle, Washington
Associate Research Scientist
Health Services Reseach and Development Field Program
Ann Arbor, Michigan
Vice President
Drug Strategies
Washington, D.C.
Senior Research Associate
National Perinatal Information Center
Providence, Rhode Island
Graduate Academic Programs
School of Nursing
Johns Hopkins University
Baltimore, Maryland
Special Expert
Medications Development Division
National Institute on Drug Abuse
Rockville, Maryland
Director
Older Adult Services
Hanley-Hazelden
Hazelden Foundation
West Palm Beach, Florida
Senior Program Director
Health and Social Policy Division
Research Triangle Institute
Research Triangle Park, North
Carolina
Chief
Division of Addiction Medicine
Addiction Medicine/ Family Practice
Lutheran General Hospital Advocate
Park Ridge, Illinois
Senior Advisor to the Director
Medications Development Division
National Institute on Drug Abuse
Rockville, Maryland
Director
Recovery and Family Treatment, Inc.
Alexandria, Virginia
Acting Director
Program Policy and Planning Division
National Center on Child Abuse and Neglect
Children's Bureau
Department of Health and Human Services
Washington, D.C.
Consultant
Addiction Training Center
University of Missouri-Kansas City
Kansas City, Missouri
Assessment Supervisor
Southwest Migrant Farm Workers and Native American (TIGUA) Assistance Program
West Texas Council on Alcoholism and Drug Abuse
El Paso, Texas
Community Outreach Specialist
Rural South Central Wisconsin Perinatal
Substance Abuse Project
Health and Human Issues
University of Wisconsin
Madison, Wisconsin
Director, Center for Addiction Medicine
Center for Training and Education in Addiction Medicine (C-Team)
Department of Preventive Medicine/Biometrics
Uniformed Services University of the Health Sciences
Bethesda, Maryland
Licensing Specialist
Division of Children and Family Services
Wisconsin Department of Health and Family Services
Madison, Wisconsin
Judge
County of Alameda
Municipal Court of California
Hayward, California
Manager of Outpatient Psychiatry
Department of Psychiatry
Allegheny General Hospital
Pittsburgh, Pennsylvania
Team Leader
Family and Intimate Violence Prevention Team
Division of Violence Prevention
National Center for Injury Prevention and Control
Centers for Disease Control and Prevention
Atlanta, Georgia
Assistant Professor
Department of Counseling and Educational Development
University of North Carolina at Greensboro
Greensboro, North Carolina
PAVE
Denver, Colorado
Assistant Professor
School of Nursing
Johns Hopkins University
Baltimore, Maryland
Drug Court Administrator
22nd Judicial District
Municipal Court of Saint Louis
Saint Louis, Missouri
Executive Director
Alcohol and Other Drug Council of Kenosha County Inc.
Kenosha, Wisconsin
Director
Substance Abuse Research Programs
Lovelace Institutes
Institute for Health and Population Research
Albuquerque, New Mexico
Senior Research Scientist
Research Institute on Addictions
Buffalo, New York
Associate Professor
School of Public Health
University of Illinois
Chicago, Illinois
Clinical Instructor of Medicine
Section of General Internal Medicine
Boston City Hospital
Boston University School of Medicine
Boston, Massachusetts
Statewide Coordinator for Women's Services
Alcohol and Drug Abuse Administration
Baltimore, Maryland
Deputy Commissioner
Victim Services
Oklahoma Department of Mental Health and Substance Abuse Services
Oklahoma City, Oklahoma
Research Analyst
Substance Abuse Unit
Virginia Department of Juvenile Justice
Richmond, Virginia
Deputy Commissioner of Offender Services
Department of Corrections
Atlanta, Georgia
Executive Director
Amethyst, Inc.
Columbus, Ohio
Director
Services for Families, Women, and Children
Colorado Alcohol and Drug Abuse Division
Denver, Colorado
Social Services Coordinator
Ben Archer Health Center
Hatch, New Mexico
Director
Division of Drug Dependence
Kings County Addictive Disease Hospital
Brooklyn, New York
Senior Technical Advisor
Special Projects Section
American College of Nurse-Midwives
Washington, D.C.
Program Manager
National Institute of Justice
Washington, D.C.
Executive Director
Matrix Center
Los Angeles, California
Executive Director
National Community Mental Healthcare Council
Rockville, Maryland
Executive Director
Educational Center on Family Violence
St. Louis, Missouri
Deputy Director
Medical Research and Practice Policy
National Center on Addiction and Substance Abuse
Columbia University
New York, New York
Executive Director
Hispanic Institute for Family Development
San Jose, California
Deputy Director of National Policy
Legal Action Center
Washington, D.C.
Director
Clinical Issues
The National Association of Alcoholism and Drug Abuse Counselors
Arlington, Virginia
Senior Policy Analyst
U.S. Department of Health and Human Services
Office of the Assistant Secretary for Planning and Evaluation
Washington, D.C.
Associate Director
Addictive Disorders
Mental Health and Behavioral Sciences Services
Department of Veterans Affairs
Washington, D.C.
Community Anti-Drug Coalitions of America (CADCA)
Washington, D.C.
Project Manager
St. Louis Target Cities Project
Missouri Division of Alcohol and Drug Abuse
Missouri Department of Mental Health
Saint Louis, Missouri
Director
Preventive Services Development
Administration of Children Services
New York, New York
Director
Human Services Policy and Planning
New York State Office for the Prevention of Domestic Violence
Rensselaer, New York
Figure 1-1: Manifestations of Domestic Violence
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Figure 3-1: Models for Batterers'
Intervention Programs
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The "Duluth model," as it is commonly called,
was developed at the Domestic Abuse Intervention Project in Duluth,
Minnesota, (Pence, 1989; Pence and Paymar, 1993) and is probably the most
widely used model for batterers' intervention programs in the United States.
There are many variations on the Duluth model, but all feature victim safety
and community coordination as cornerstones and require batterers' programs to
be accountable to victims and to victim advocates. The Duluth model is based
on confronting the denial of violent behavior, exposing the manifestations of
power and control, offering alternatives to dominance, and promoting behavioral
changes. It calls for communitywide intervention that employs the resources
of law enforcement, courts, domestic violence shelters and advocates, health
providers, and batterers' programs. A batterers' program cannot, in this
model, exist without the other components in the network. Although some
experts feel that the Duluth model tends to encourage shame and guilt rather
than real change, it sees domestic violence not as a form of personal
pathology, anger and hostility, or substance-induced behavior, but as an
outcropping of men's socially sanctioned domination of women. Batterers'
programs developed under this model are designed to educate men about power
and control, not merely to assist them in managing anger or personal
problems. Communitywide coordination ensures that batterers are arrested and
prosecuted and that victims are protected. |
Figure 3-2: Positive and Negative
Aspects of Bonding Among Batterers
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Positive
Negative
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Figure 4-1: Safeguarding Important
Documents
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As part of the survivor's safety plan, it may be helpful to advise the survivor client to keep important documents in a safe deposit box or in a place where her partner cannot gain access to them. These materials may include some or all of the following:
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Figure 4-2: Gathering
Documentation
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All States have mandatory reporting laws for child abuse,
but only some have or are developing such laws for reporting domestic
violence. Some battered women's advocates support such laws because they
"take the pressure off" the victims to report their batterers. Some
domestic violence service providers also believe that it is the community's
responsibility -- not the victim's -- to stop the batterer's behavior. Some
States mandate the arrest of batterers whether or not their victims press
charges, and some are proposing mandatory physician reporting of battering.
Concerns have been raised, however, about preserving victims' ability to
decide whether they want to become involved in the criminal justice system or
in domestic violence programs. For this reason, such laws are opposed by some
battered-women's groups, who believe they put women at greater risk.
Complete criminal justice and medical records may be difficult to obtain. In the case of medical records, for example, survivors may have made visits to numerous institutions (e.g., clinics and emergency rooms) in order to avoid raising the suspicion of domestic violence. Issues of confidentiality also may be an impediment to obtaining these records. (See Appendix B for more information on confidentiality.) When clients are unsuccessful in compiling information from standard sources, their self-reports to substance abuse treatment providers, documented in their program records, can be used to fill in the gaps and to help support their claims. When entering notes into the client's record, however, it is important to include the facts as presented or observed. Records can be subpoenaed and "gratuitous comments or opinions" may be used against survivors in custody cases (Minnesota Coalition for Battered Women, 1992, p. 41). |
Figure 6-1: Key Linkages
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Health Care
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Justice System
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Education/Schools
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Adult Education
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Employers
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Social Welfare
|
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Domestic Violence
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Mental Health
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Substance Abuse
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Other Community Resources
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Figure 6-2: Facets of
Collaboration Between Substance Abuse Treatment and Domestic Violence Programs
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Perceptions and Attitudes of Those Working in the Field |
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Stereotypes, generalizations, and myths about the other field |
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Special joint conferences to explore common ground and bridge gaps |
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Develop cross-training courses for providers in network
through community college or other sources |
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Funding and Reimbursement |
|
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Limitations on reimbursable services, particularly under
managed care |
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Work with State Director to incorporate language in
managed care contracts to support needed services |
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Learn about blended funding strategies |
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Welfare Reform |
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Increased limits on shelter stays |
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Increased funding of collaborative and innovative programming |
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For example, in Wisconsin, the Milwaukee Women's Center has developed a collaboration between employment maintenance organizations, health maintenance organizations, and community-based organizations to establish specialized services for survivors who are substance abusers |
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Fundraising |
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Limited availability of funds from any source |
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Identify appropriate partners for funding opportunities
and lay groundwork for response to funding opportunities |
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Partner with a proven "fundraiser" to supply a
needed specialized service (e.g., via subcontract) |
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Sociopolitical Issues |
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Prevailing political climate, which does not readily offer
support for treatment programs |
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Grassroots-level recognition of the overlap of the
problems of substance abuse and domestic violence |
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Form political action coalitions |
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Programmatic, Staffing, and Logistical Concerns |
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Wide variety of different agencies and agendas with which
programs must work |
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Expanded roles of counselors and other professionals in each field; increased respectability and acceptance of these fields |
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Work with the National Association of Alcohol and Drug
Abuse Counselors to explore this issue fully and investigate credentialing
implications |
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Recordkeeping and Data Management |
|
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Increasing need for employees to have computer skills and for organizations to have access to on-line and other technological resources |
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Increased information available for staff to use |
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Joint training, leadership programs, staff and materials exchange, information and evaluation exchange |
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Relationship With the Criminal Justice System |
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Competing need for information |
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Develop boundaries and administrative/therapeutic splits to protect information being used for treatment from information related to behaviors and actions |
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Relationship Between Workplace and Treatment |
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Identification of domestic violence problems can have adverse impact on career no matter what the resolution of the case |
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Develop a problem-based definition of abuse that is linked to behavioral goals |
Figure B-1: Client Consent Form:
Required Items
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*As set forth in §2.31(a). |
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Figure B-2: Consent for the Release
of Confidential Information
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Figure B-3: Prohibition on
Redisclosing Information Concerning Substance Abuse Treatment Clients
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This notice accompanies a disclosure of information concerning a client in alcohol/drug abuse treatment, made to you with the consent of such client. This information has been disclosed to you from records protected by Federal confidentiality rules (42 C.F.R. Part 2). The Federal rules prohibit you from making any further disclosure of this information unless further disclosure is expressly permitted by the written consent of the person to whom it pertains or as otherwise permitted by 42 C.F.R. Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The Federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse client. |
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Figure B-4: Qualified Service
Organization Agreement
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