Daphne Initiative Final Report

Transcription

1 Daphne Initiative 1999 Final Report Project N. : 1999/DAP/163/W Title : Training health sector professionals to deal with domestic violence Start date : 01/11/1999 End date : 30/11/2000 Name of coordinating body : Institut de l Humanitaire (Humanitarian Institute) Contact : Cécile Morvant Institut de l Humanitaire 33 Boulevard de Picpus Paris France Tel. : Fax : Name and country of partner organisations : Fédération Nationale Solidarité Femmes (National Federation for Women s Solidarity) (France) Instituto de Medicina Preventiva, faculdade de Medicina de Lisboa (Institute of Preventive Medicine, Lisbon Faculty of Medicine) (Portugal) Associaçaõ de Mulheres contra a violencia (Association of Women against Violence) (Portugal) Direccion General de la Mujer de la Communidad de Madrid (The Madrid Community s Women s Department, (Spain) Casa delle Donne per non subire violenza (Women against violence) (Italy) 1

2 Final Report Training health sector professionals to deal with domestic violence France, Italy, Portugal, Spain and Belgium Daphne project 1999/DAP/163/W 2

3 Project aims Domestic violence has a major impact on the health of women and their children, whether it be the injuries caused or the resulting chronic illnesses. Those constantly subjected to violence suffer from stress, fear, anxiety, guilt feelings and shame, which tends to isolate them. Medically speaking, injuries, pathological pregnancies, sexually transmissible diseases, psychosomatic disorders, anxiety, depression, post-traumatic syndrome and suicidal tendencies are all medical conditions caused by violence. Finally, death may be the final outcome. Battered women find it difficult to seek medical attention or to accept medical care. However, more and more frequently they are presenting signs of physical and psychological disorders and increasing numbers are receiving medical treatment. Domestic violence also affects children. They suffer from somatic and behavioural disorders as well as psychological problems. Children of violent couples are themselves victims of psychological or even physical violence. The children of battered mothers are 6 to 15 times more likely to suffer physical or psychological violence than other children. Consequently, domestic violence must be considered a public health problem. WHO found that battered women lose between one and four years of good health and that out-patient care for a woman victim of domestic violence costs two and a half times that for other women. At its 33 rd special session of the General Assembly in 2000, the UN stressed the important role of the health system in helping women victims of domestic violence. Those in the health sector are often the first, and perhaps the only, contact victims have. They can identify the problem and, with this knowledge, treat, provide support for and, if necessary, direct the patients to other professionals (reception centres or shelters, lawyers, the police, social workers, psychologists, etc.). However, health sector professionals within the European Union are not yet sufficiently aware of the problem. Training on the subject of domestic violence is practically non-existent at university or post-university level. Few studies have shown these institutions making any tangible investment in this area. Our project s main aim, therefore, was to provide all health sector professionals with a working tool and training to enable them to deal with cases of domestic violence. We have chosen Internet support because its flexibility and accessibility at any time have made it a means of training that is increasingly used by health sector professionals. The secondary aims of our project are three-fold : to provide training for health sector professionals throughout Europe, to provide a training tool that is common to all specialised fields and to enable health sector professionals and members of 3

4 battered women s support organisations to work together in implementing the project. The aim of the Internet site is : to provide health sector professionals with general information on domestic violence in order to help them understand the process, its causes and its effects ; to put forward practical recommendations for identifying and treating women victims and their children ; to put forward action protocols for each specialised medical field ; to describe the various effects of violence on the health of the women and children concerned ; to recall the key factors to be shown on a medical certificate or in a medical file and to provide standard models ; to set up a system to enable website users to communicate and exchange information and experiences with the site coordinators. The website, which is common to the five project partners is aimed at health sector professionals in all specialised fields (general medicine, emergency services, occupational medicine, gynaecology and obstetrics, psychiatry, paediatrics, surgery, paramedical professions and forensic medicine). The site is also intended for use by health sector professionals in all five partner countries. This is why it has been translated in the four languages of the five partners - French, Spanish, Portuguese and Italian. (The Belgian version is in French). It has also been translated into English in order to ensure that is has the widest possible impact. 4

5 Project implementation The health sector professionals and the members of battered women s support associations worked together throughout the year. Each partner country relied on an extended group of experts (assocations, health sector professionals and researchers). The year was marked by three meetings in France, organised by the coordination team. 1) December 1999 Appraisal of the situation Definition of website aims An initial meeting of the various partners in Paris allowed them to appraise the situation in each country. The associations reviewed the action they were taking, especially their collaboration with the health sector professionals. They gave the reasons why they wished to be involved in a health project. The health professionals presented their own work and that being done by their country in the area of domestic violence. They also reviewed the health authorities involvement in that area, especially institutional and government efforts. Generally speaking, very little medical work is being done in each country. Overall, domestic violence is increasing, but institutional efforts are not keeping pace with that increase. The associations stressed the need to provide health sector professionals with information and training on domestic violence. Indeed, they have found that the medical help given to women was often inadequate, with doctors often failing to spot women victims of domestic abuse. Mindful of this need to raise the awareness of and provide training for health sector professionals, we defined our aims and the basic principles which we considered important. It was decided to produce a working tool which would provide accurate, practical information which the professionals could put to everyday use. Our Italian and Spanish partners had already drawn up documents and protocols for doctors confronted with cases of domestic violence. These handbooks have been translated and have been used as working documents. 2) January March 2000 Preparation of the site : topics to be covered ; site plan During the first quarter, we decided on the topics to be covered on the website. With this in mind, we read papers, articles, reports and training protocols on 5

6 domestic violence published in various European countries, the United States and Canada. We also consulted a number of experts who had worked in this area (doctors and researchers) in an effort to jointly determine what information would be essential for the professionals. The coordination team assembled all these data and drew up a website organisation plan. At the second meeting in April 2000, we examined all the topics proposed for inclusion on the website. We studied the organisation of the proposed site with the help of an IT expert chosen to set up the site. It was decided to divide the site up as follows : A general part on domestic violence : definition and description of the process of violence, the laws in force in each country, the role of other professionals (police, social workers and associations). A medical part aimed at all health sector professionals : recommendations on how to identify and treat patients who have suffered violence. This part would be divided into four : suspect, identify, assess and take action ; Αction protocols for each specialised medical field : key messages for each specialised field, the medical consequences of violence for each specialised field, explaining their link to violence and giving a brief medical bibliography to help professonals expand their knowledge. The specialised fields covered were : 1. primary care medicine (general practice, emergency services, occupational medicine) 2. psychiatry 3. gynaecology/obstetrics 4. paediatrics 5. surgery (orthopaedics, ENT, ophthalmology and dental surgery) 6. para-medical professions 7. forensic medecine 8. specialised medical fields (cardiology, pneumology, rhumatology, endocrinology, internal medicine, dermatology) Provision of standard medical documents : to be consulted or downloaded for use during consultations (medical files, medical certificates, protocol of examination following sexual attacks). Clinical situations with analysis and review A bibliography : a list of bibliographical references on medical work in the field of domestic violence. This selection is subjective, but consists of papers which seem interesting and useful. 6

7 A bulletin board : to allow users of the site to contact the working team or submit ideas or knowhow. Presentation of the working team : This part presents the partners and draws attention to the fact that the site was created under the Daphne Initiative. Because it was felt that certain stereotypes of battered women or other prejudices concerning domestic violence still persisted in our society, we chose to draw attention to some of them. An animated format with true/false questions was used to present these prejudices. 3) April October 2000 Production of the text Αpproval of text content and completion of text Translation of text into 5 languages During the second quarter, we prepared the various texts to be included in the site. Our group comprised a general practitioner, a gynaecologist/obstetrician, a psychiatrist and a surgeon. Each brought specific knowledge from his/her field of work. We also called upon other doctors outwith the project to check and approve other specialist fields. Association members were responsible for the general parts on domestic violence. After the project coordinator had written up and completed the texts in autumn 2000, each partner reread and corrected them, drawing on the work of experts and non-experts alike. The purpose of this rereading was to verify the information provided and to ensure that our documents were comprehensible and met the expectations of the health sector professionals. This latter aspect is always difficult to assess, but it would appear that those professionals not specialised in domestic violence to whom we turned were satisfied with the information received from the text. A third meeting was held in Paris in October 2000 at which the entire text prepared for the site was reread so that it could be finalised and definitively approved. The IT expert presented the site in terms of structure and graphic design. The team approved the chosen site name: SIVIC, SIte sur la VIolence Conjugale pour les professionnels de santé (Site on domestic violence for health sector professionals). This meeting also looked at ways of organising project follow-up, in particular, the resources to be used to keep the site alive and to finance regular up-dating. These questions will be dealt with in Chapter 4 of this report. 7

8 The approved text, written in French, was translated into Spanish, Italian, Portuguese and English. Each partner reread the translation in his/her own language and, where necessary, corrected it. 4) November 2000 Creation of the website and the placing of the text on the Internet by the IT expert. Design and printing of a site presentation card. We have created a unique site with 6 possible language versions (French, Spanish, Italian, Portuguese, Belgian and English). Users may choose the language in which they wish to consult the site. With the exception of the address book for battered women s reception centres, the list of relevant laws and, for some countries, a short bibliography of papers and books on domestic violence published in the country concerned, all the papers are the same in each language version. We designed and had printed a card measuring 8 x 5 cm presenting the Sivic site in each of the languages concerned. It is to be distributed to health sector professionals as a means of introducing the site, but it can also be kept to ensure that the site address is easily accessible. There had been no plans to produce such a card at the start of the project. The idea came to us as we were trying to find ways to publicise it. We were able to to do this as the part of our budget allocated to miscellaneous expenses had not been used. To conclude on the subject of project implementation, it is worth noting that all originally planned activities were carried out. However, we wish to stress that the rereading work, the approval of the text and the finalisation of the Internet tool were the most difficult parts of the project. The distance separating the persons involved and the availability of the various partners are factors to be taken into account when there are deadlines to be met. Project results and effects Results The end result of our project was the Internet site. The final site plan was as follows: Domestic violence: definition, the process of violence, laws, the role of social workers, the police and the associations, a brief history of the steps taken to combat domestic violence; 8

9 During a consultation with the doctor: practical recommendations for suspecting and identifying cases of domestic violence, assessing the situation and taking action; Domestic violence by specialised field: action protocols for each specialised field (primary care medicine, psychiatry, gynaecology/obstetrics, paediatrics, forensic medicine, surgery, paramedical professions, specialised medical care) Clinical cases: Presentation of 7 cases, with an analysis of the situation and the treatment given. Bibliography: about one hundred international medical references. Medical documents: medical certificates for cases of physical and sexual attacks, examination to be carried out for sexual attacks, medical file (possible to download). Links and contacts: an address book containing the addresses of reception centres and shelters for women victims of domestic violence and links with other Internet sites on domestic violence or medical sites. Bulletin board: a bulletin board for each language version (French, Portuguese, Italian, Spanish, Belgian and English). An enumeration of existing stereotypes and prejudices using an animated format. We would like you to visit the site and read the attached document which is a hard copy of the text on the site. We have chosen the French version, but there is little difference between versions (bibliography, address book and laws). As regards the booklet which was part of our initial plans, we decided that each site user could prepare his/her own booklet made up of the site pages that he/she wishes to keep. The medical papers are downloadable. This system gives users the freedom to keep paper copies of the information they find most useful. Project assessment This was done in two parts. First of all, at the start of the project we consulted several experts on domestic violence (health sector professionals, association leaders and researchers) in order to get their opinion of the project and their comments and ideas about its implementation. Later, we asked the same persons to read and approve our work. These experts were chosen from each partner country in an attempt to retain the project s European image and to ensure that each country s requirements and special features would be taken into account. This assessment was basically for our own benefit, to ensure that our work was as accurate as possible and met the expectations of the various professionals. For, although our project partners were closely involved and competent in this area, it is always useful, and perhaps more objective, to have an outside opinion. Finally, the persons contacted in their capacity as experts were even more closely involved with raising doctors awareness of domestic violence; they have sometimes undertaken 9

10 their own information and awareness-raising initiatives, and some have even conducted studies on domestic violence. To conclude, it is our opinion that one should always think of involving the largest possible number of persons in this type of project so that it will have the widest possible impact. Project impacts The project was presented to government institutions, including the Ministry for Women s Rights and the Ministry of Health in Spain, France and Portugal. Discussions have begun on the role of health sector professionals and their involvement in combating domestic violence. These ministries, particularly those in Spain, are currently drawing up financing plans. Project beneficiaries, i.e., the health sector professionals, have been involved throughout the course of the project. This helped to ensure that the project met their expectations and will, subsequently, help to keep the site alive. The needs of the women, the long-term beneficiaries of the work done, were taken into consideration through the members of the associations specialising in domestic violence. Our partners passed on their knowledge of the medical treatment of battered women, based on what they had learned from the victims. Therefore, not only were we able to take into account the needs of the health sector professionals but of the women as well. Collaboration between women s associations and health sector professionals is essential, as the knowledge and experience acquired by these associations over the years are wide-ranging and meaningful. 10

11 Dissemination and follow-up At the last meeting of the project partners in Paris, we together examined ways of promoting the site and keeping it alive. We decided to retain a common site and to seek funding from a government institution. The Humanitarian Institute is willing to continue to coordinate our work. During the past year, contacts were made with the Ministry of Health in France, Spain and Portugal with the aim of presenting on-going work, the group s thoughts and the completed website. We decided at the start of the project that the Humanitarian Institute would work on a voluntary basis, thus co-funding the European Union s grant. Since then, we have obtained co-funding from France s Ministry of Health and Health Department, which has meant that this Daphne project was fully funded. The site was presented to the networks set up during the course of the year for this project, i.e. the expert groups (doctors, nurses and representatives of medical institutions) and to the members of battered women s support organisations who worked with us. During a conference in Geneva on domestic violence: the role of health sector professionals, the project coordinator met health sector professionals and medical services working with battered women, and institutions such as WHO, and was able to present the Daphne project and the content of the website to them. In order to promote the site, the Spanish team invited all the other project partners to a final meeting in Madrid in mid-december 2000 to put the final touches to the site maintenance work programme which is to come into effect after the completion of the Daphne project, and to take part in the official site launch. The launch was organised by the Ministry of Social Affairs in Madrid, in the presence of the Minister of Social Affairs, the Minister of Health, the Department for Women and the Health Department. Members of the medical and non-medical press and TV journalists were also present. The launch was a great success with the ministries and the media alike. The site will be presented in France at a domestic violence awareness-raising day for health sector professionals on 28 February 2001 in Paris. This presentation will take place at the Ministry of Health in the presence of the Minister of Health and the press. The entire team of project partners will also be present. We have prepared a press file specially for the medical and general press on this occasion. Some 6000 copies of a site presentation card, translated into each language, has been produced. It will be distributed to health sector professionals by the medical networks. A model of the card will be made available to each partner country for reprinting if necessary. The graphic shown on the card is the same as that on the 11

12 site. The card was not originally planned, but was funded using a part of the budget allocated initially to miscellaneous expenses. The European Union s contribution was mentioned on the Internet site, on the presentation card and at press conferences and official presentations. Conclusion The Daphne project Training health sector professionals to deal with domestic violence was implemented by health sector professionals and members of battered women s associations in five partner countries : France Spain, Portugal, Italy and Belgium. Its aim was to create an Internet site as a training tool for health sector professionals in all specialised fields of medicine. The site can be reached at the following address : It deals with the following topics : General information on domestic violence to help in the understanding of the process, its causes and effects. Practical recommendations for identifying, following up and treating patients who have suffered this form of violence and directing them to other nonmedical structures (associations, the police, the justice system and social workers). Action protocols for each specialised medical field concerned (general medicine, emergency services, psychiatry, gynaecology and obstetrics, paediatry, forensic medicine, surgery, other specialised fields of medicine and para-medical professions). Analysis of clinical cases Samples of medical certificates and medical files Medical bibliography on domestic violence An address book of battered women s reception centres and shelters. A bulletin board is also available to users who can also reach other medical sites or sites on domestic violence. The site, which is common to five countries is translated into French, Italian, Spanish, Portuguese and, for greater impact, English. The site is the outcome of a joint effort by health sector professionals and associations, and expert groups in each partner country. The experts (health professionals, associations and researchers) helped to prepare and assess the site. The two sets of project beneficiaries, health sector professionals and battered women were able to be involved in the project through these partners. 12

13 The Humanitarian Institute in Paris coordinated the project. The partners were: France: Institut de l Humanitaire (Humanitarian Institute) (Cécile Morvant, doctor and project coordinator and Jacques Lebas, doctor) Fédération Nationale Solidarité Femmes (Women s Solidarity National Federation) (Viviane Monnier, national delegate and Véra Albaret, co-chairperson) Spain: Direccion General de la Mujer de la Communidad de Madrid (the Madrid Community s Women s Department): Asuncion Miura and Francisco Orengo (psychiatrist) Italy: Casa Delle Donne per nonsubire violenza (the Association of Women against Violence): Ana Maria Vega and Lucia Gonzo (psychiatrist) Belgium: Collectif et Refuge pour femmes battues (League for Battered Women): Emmanuelle Graver et Christiane Rigomond Portugal: Associaçaõ de mulheres contra a violencia (Association of Women against Violence): Maria Shearman de Macedo and Miguel Oliveira e Silva (gynaecologist and obstetrician) The site was presented to the Minister of Health and the Minister of Social Affairs in Madrid in December 2000, and will be presented at the Ministry of Health in France on 28 February 2001 on the occasion of a conference on the theme Women victims of domestic violence: the role of health sector professionals, organised by the Humanitarian Institute. A site presentation card was designed and printed in each language and will be distributed to health sector professionals from each participating country as a means of promoting the site and its Internet address. Bearing in mind that domestic violence knows no bounds and concerns all five countries, and aware of the need to step up the involvement of health sector professionals in helping its women victims, we hope to play a part in raising the awareness of players in the health sector and in providing them with information. 13