ABC of Domestic and Sexual Violence

Domestic and sexual violence is becoming a more openly discussed and disclosed subject, however, not all health professionals are equipped with the knowledge to support and signpost the person(s) affected. Indeed, many may not feel confident in being able to identify individuals subjected to abuse.

The information should be clear and practical and this is where this book fits in. The ABC of domestic and sexual violence presents a practical guide suitable for all health care professionals, with contributors from a wide range of professions adding to the multidisciplinary remit of the publication. It is one in a series of ABC books all
aiming to provide knowledge and information on a variety of topics in a practical and easily understood format.

This book is of particular relevance to midwives and others working with women and with men being the perpetrator. However, this is not exclusive to women and can affect the whole age spectrum and as midwives we come in contact with a range of people, from newborns through to grandparents and even great grandparents. It is therefore our duty to be vigilant for signs of abuse and to be able to act upon such information.

The chapters within the book discuss the different ways people are affected, including same sex situations and female genital mutilation. It also gives guidance on how to identify domestic abuse and violence, varying types of abuse and the impact it has on the abused.

I particularly like the layout of the book with the inclusion of boxes with guidance of what to do, ask and consider in certain situations and the case studies give insight into real situations that the reader may come across in practice. Some of the case study scenarios may resonate with experiences already encountered by the reader – these are good to reflect upon and consider if the action taken was appropriate or whether situations could have been handled differently.

The final chapters discuss how we can move forward and develop care pathways within the health service and how to build these services into future careers. It is acknowledged that, although teaching on the subject of domestic abuse is not always integral to all undergraduate training, there are various ways of gaining this information at a later stage. The appendix contains some useful resources including a risk-identification checklist.

I would highly recommend this book to students and qualified professionals that are inexperienced in the knowledge of domestic abuse and sexual violence. It contains valuable
information in every chapter and once read should be kept as a useful resource to turn to when working in the field of health care. (Cathy Ashwin, Principal Editor, MIDIRS Midwifery Digest 26:1, 2016)

This excellent text skilfully addresses the topic of domestic and sexual violence, thoroughly yet concisely, within a slim A4 volume of 26 short chapters.

Domestic and sexual violence is a daunting area for most clinicians. It is ubiquitous yet concealed, requiring knowledge, skill, commitment and sensitivity to tackle it, based on awareness that it may underpin the patient’s presenting complaints. Written in an authoritative yet user-friendly style, this book deftly leads the reader through all aspects of the subject, anticipating and addressing the concerns faced by all clinicians, notably in the field of legal practice. Reference to the ‘burden of disease’ sheds new light on the topic, pointing out analogies to physical illness and injury, supported by scholarly references.

One particular strength of this book is its breadth of vision, including in its remit safeguarding, child protection and mental health, as well as topics less commonly-addressed, such as elder abuse and the role of the dental practitioner in recognising the significance of facial injuries.

Yet despite this, the book does not neglect its core areas, namely General Practice, Accident & Emergency, Sexual Health and Obstetrics & Gynaecology. It reminds us that abuse often starts or escalates in pregnancy, and that it is a major cause of maternal and fetal death, as well as premature labour, antepartum haemorrhage and fetal growth restriction. Likewise, chronic pelvic pain can be a manifestation of abuse.

I have found this volume to be a valuable and refreshing source of information and advice, and I would thoroughly recommend it to all clinicians, including trainees and medical students. (Brigid Hayden FRCOG, Consultant O&G, Bolton Hospital, Lancashire, UK, in The Obstetrician & Gynaecologist, Issue 2, Vol 17, 2015)

The ABC of Domestic and Sexual Violence complements the existing series of ABC books. Both the editors are passionate about this subject and with this book aim to improve health services to support families suffering domestic and sexual violence.

This book is targeted at all teams providing health care and aims to increase knowledge and confidence to enable the team to identify, question and act appropriately within this realm. It highlights when, where and how to achieve this most effectively within conventional health care settings.

The twenty-six chapters are conveniently titled and penned by various authors. The authors provide a valuable picture of each topic and go on to identify noteworthy points and give very practical ideas of how to cope when faced with a domestic and sexual violence issue. Case examples are described in many chapters, including ‘The Dental Team’. These case scenarios provide real insight into what ‘survivors’ (classically termed ‘victims’) may be thinking and feeling. Signposts to online resources and descriptions of available services that patients may be referred to are included. To understand the evidence base of each topic further reading is recommended. A ‘Risk Identification Checklist’ provided as an appendix gives front line practitioners the basic tools to identify high risk cases.

However, ‘The Dental Team’ chapter is rather disappointing as it provides no additional information beyond what is learnt and understood by a recent graduate. Alone this chapter is a poor as a clinical tool but it identifies further chapters and this is where the real information can be found.

The book goes on to consider documentation and how clinicians may be involved in court proceedings. The points made and lessons learnt listed here can clearly be applied to many situations dental teams commonly find themselves in.

The book very effectively challenges traditions and viewpoints, including the very topical Female Genital Mutilation as well as questioning male circumcision. It also does not forget the less obvious groups involved in domestic and sexual violence: males, children, the vulnerable or elderly and the perpetrators themselves.

As a sometimes uncomfortable subject to research the book is thoughtful and non-apologetic throughout and, allows the reader to see the true value in its pages and not be put off by taboos. Overall the book achieves its aim of empowering health-care workers to ask searching questions at appropriate points whilst providing clear structured guidance and excellent signposts. (Charlotte Molyneaux BDS (Hons.))

A quick online search for ‘domestic violence statistics’ yields a glut of disturbing responses. Womens Aid lead with ‘one episode of domestic violence is reported to the police every minute’, the Crime Survey for England and Wales reports a lifetime prevalence of partner abuse of 31% for women, and two women a week in the UK are murdered by their partners. Domestic and sexual violence is common. It affects all genders and all ages, all ethnic backgrounds and those of all faiths and none. It affects the patients whom we see every day and its’ repercussions echo through their physical and psychological health.

Domestic and sexual violence are more prevalent than diabetes, inflammatory bowel disease and stroke, and yet teaching on domestic violence features little on undergraduate and postgraduate medical curriculae. How many of us can claim to feel comfortable asking about a history of sexual violence, would know where to refer a women in crisis, or how to advise her about basic safety precautions?  If you, like me, find your knowledge base wanting, then the ABC of Domestic and Sexual Violence may be the book for you.

Edited by Susan Bewley, Professor of complex obstetrics at Kings College London and Jan Welch, Consultant in HIV Medicine and Sexual Health, the ABC of Domestic and Sexual Violence is a one stop shop for information on this complex topic. With contributors ranging from GUM consultants to psychiatrists and from GPs to those working in the third sector the book is both wide ranging in its scope and practical in its approach.

Early chapters focus on the epidemiology and impact of abuse. The range of abusive behaviors is made clear, and the role of the health care professional is set out in the three R’s; recognise, respond and offer to refer. An important chapter from Michael King discusses the sexual assault of men and boys, busting common myths held by the public and health professionals alike that men cannot be forced to have sex against their will, that men can defend themselves when threatened and that a man experiencing an erection or who ejaculates during an assault must have been in some way complicit. Case studies throughout these chapters work through examples with the reader, reminding you of what you need to consider and of key learning points.

Despite being armed with the worrying knowledge of the prevalence of domestic violence and abuse within the communities we work in, many of us struggle to know how to identify patients who are affected. We may feel unsure of when to ask, how to do so sensitively and what to do with the information. Here the ABC really comes in to it’s own. A chapter is dedicated specifically to identifying domestic violence and abuse, and to the average registrar like me, it was invaluable. The do’s and don’ts of asking about abuse are made clear with helpful text boxes giving examples of questions to use, from the open ‘how are things at home’, to the more direct ‘are you afraid of anyone at home?’ The validated HARK questions were new to me, but are a take home point that I am incorporating in to my consultations (Humiliation; ‘have you ever been humiliated or emotionally abused by your partner/ex partner, Afraid; ‘have you ever been afraid of your partner/ex partner’? Rape; ‘Have you ever been raped or forced to have any kind of sexual activity by your partner/ ex partner’ Kick: ‘Have you ever been kicked, hit, slapped or otherwise physically hurt by your partner/ex partner’).

Aimed across the spectrum of health care professionals, the ABC of Domestic and Sexual Violence is both a practical guide and a springboard for further learning (chapters are well referenced, and useful websites and phone numbers are made available). A whole chapter is dedicated to how to manage a primary care consultation on domestic violence and, crucially, another chapter details how to document those consultations. A brief chapter on Female Genital Mutilation may well be expanded in future editions, but its’ presence is important and timely. Sections on the law in relation to sexual assault and domestic violence, and on the ethics of professional boundaries help to provide a thorough overview of a large topic.

The ABC of Domestic and Sexual Violence is both an eye opening read, and a practical handbook. It is brief, concise and always relevant. With the police receiving one domestic violence call a minute in the UK, and almost one in three teenagers already having experienced domestic or sexual violence, the real question is whether this a book you can afford not to read? (Dr R Fisher, GP ACF ST3, Oxford)

On the face of it, the ABC series seems an unlikely place for a book about domestic and sexual violence. Wiley’s ABC guides comprise a collection of some 80 titles, all highly illustrated, packed with diagrams, case histories, colour photographs and easily-digested text, written by specialists for non-specialists in primary care and covering subjects such as dermatology, kidney disease and resuscitation. But domestic violence, a complex, psychosocial issue that is often not even included in the training of health care professionals? Well, it seems to me that the publishers are to be congratulated for taking the bold step of putting some new and potentially life-saving skills into the hands of primary care-givers.

The scale of the problem and its impact on health services alone justifies this subject being included in the series. According to the Crime Survey for England and Wales, the most reliable source of estimates of prevalence within the community, 31% of women and 18% of men will experience abuse from a partner in their lifetime. Intimate partner violence is not a private matter. A burden-of-disease
analysis (in Australia) reported that interpersonal violence contributed 8% of the total disease burden in women aged between 15-44, making it the main cause of death, disability and illness in this age group, way ahead of harms resulting from drug-taking, smoking or obesity [1].

But most importantly, this book’s intended audience of primary caregivers—GP’s, nurses, health visitors, midwives, social workers, paramedics, even dentists—have unique and privileged opportunities
to be able to identify abuse and so have a chance to begin to help this vulnerable group of patients, if only they could know how and, crucially, have the confidence to ask the difficult questions. This slim volume applies the ABC series’ approachable and userfriendly format to a series of essays by a multidisciplinary range of contributors which take an evidence-based and practical look at a wide range of aspects of gender-based violence, including that within intimate relationships but also covering forms of violence linked to particular ethnic or social groups, for example, female genital mutilation, prostitution and sex-trafficking. The focus is not exclusively on women—there is a chapter on the sexual assault of men and boys; violence in same-sex relationships is also considered.
However the greater emphasis on women reflects evidence showing that the most consistent risk factor for domestic and sexual violence is being a woman; most severe domestic violence and most sexual
violence is perpetrated by men.

Each essay is broken into digestible sections, with diagrams, checklists, myth-busters, and case histories with “what would you do?” exercises. The section on identifying abuse, for example, includes sample questions, suggestions for