DOCUMENT RESUME CG 030 130 ED 443 053 Cook, Paddy; Gartner, Constance Grant; Markl, Lise; AUTHOR Henderson, Randi; Brooks, Margaret K.; Wesson, Donald; Dogoloff, Mary Lou; Vitzthum, Virginia; Hayes, Elizabeth Substance Abuse Treatment and Domestic Violence. Treatment TITLE Improvement Protocol (TIP) Series 25. Substance Abuse and Mental Health Services Administration INSTITUTION (DHHS/PHS), Rockville, MD. Center for Substance Abuse Treatment. REPORT NO SMA-00-3406 PUB DATE 1997-00-00 168p.; For other documents in the TIP Series, see CG 030 NOTE 098-103 and CG 030 131-134. CONTRACT 270-95-0013 AVAILABLE FROM National Clearinghouse for Alcohol and Drug Information, P.O. Box 2345, Rockville, MD 20847-2345. Tel: 800-729-6686 (Toll Free). -- Tests/Questionnaires (160) Non-Classroom (055) PUB TYPE Guides EDRS PRICE MF01/PC07 Plus Postage. *Battered Women; Behavior Modification; Counseling; DESCRIPTORS Counselor Training; Decision Making Skills; *Drug Rehabilitation; Family Counseling; *Family Violence; Interpersonal Relationship; *Intervention; Males; Mental Health; *Sex Role; *Substance Abuse ABSTRACT The major goal of this TIP, on the best practice guidelines to improve the treatment of substance abuse, is to provide clinicians, educators, and paraprofessionals with the latest findings concerning domestic violence. The information is intended to educate providers about the needs and behaviors of batterers and survivors, and how to tailor treatment plans accordingly. The focus is on men who abuse their female partners and women who are battered by their male partners. It reports that up to one half of the men who commit acts of domestic violence also have substance abuse problems. Failure to address domestic violence issues among substance abusers can interfere with treatment effectiveness and contribute to relapse. Chapters include information on the survivors of domestic violence, screening and referral of survivors and batterers for additional services, legal issues, coordinated community linkages, and a summary of recommendations. It states that teaching decision-making skills to both the men and women involved in domestic violence is a key aspect of treatment. Appendixes include: "Bibliography," "Federal Confidentiality Regulations," "Instruments," "Sample Personalized Safety Plan for Domestic Violence Survivors," "Hotlines and Other Resources for Domestic Violence and Related Issues," "Resource Panel," and "Field Reviewers." (Contains approximately 200 resources.) (JDM) Reproductions supplied by EDRS are the best that can be made from the original document. Substance Abuse and Mental Health Services Administration U.S. DEPARTMENT. OF HEALTH AND HUMAN SERVICES Public Health Service Center for Substance Abuse Treatment Substance Abuse and Mental Health Services Administration Substance Abuse Treatment and Domestic Violence Treatment Improvement Protocol (TIP) Series 25 =i1 =111:1=antm =at =iii/OME=7.09 IZZIESOMNIO 6111111111111=131511 GZSZ:=1==f CZME=1 z- t 1 1 :::r";::..;77 U.S. DEPARTMENT OF EDUCATION Office of Educational Research and Improvement CD en EDUCATIONAL RESOURCES INFORMATION CENTER (ERIC) I'M This document has been reproduced as received from the person or organization =1 M originating it. Minor changes have been made to CD improve reproduction quality. Points of view or opinions stated in this document do not necessarily represent Cool) official OERI position or policy. AVAILABLE BEST COPY HOTLINES National Domestic Violence Hotline Suite 101-297 3616 Far West Blvd. Austin, TX 78731-3074 (800) 799-SAFE (800) 787-3224 (TDD) Provides crisis intervention. information about sources of assistance, and referrals to battered women's shelters. Rape, Abuse, and Incest National Network (RA INN) (800) 656-4673 Sexual assault survivors who call will be automatically connected to a trained counselor at the closest center in their area. Childhelp USA/Forrester National Child Abuse Hotline (800) 4A-CHILD With a focus on children and the prevention of child abuse, this hotline provides crisis counseling, referrals, and reporting guidance to callers in crisis. Statistical and other informative materials can be ordered through this number. Access to information on partner violence is limited. 0 007 0= Cn F mm Cl) M -74 73 Zrn OM 3 0 > 73 0 r r- cr. ST COPY AMIABLE 3 1111111111 = ' n r . . . - Z . - , > z a t Q 7 O 0 , o v , . D o C , n E - F 0 - e t V v F c . 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I . i o f e P T e u r d n i o e n v l s s I b e i s T o l s i s l s : a u . l i o d i - u d e h e t n n s a d o n f l f f t v e e i r e i o n y u e h / t i n i h l t s s f r a o h a t a d p i e i u r a t g r t m u e m l s r g u e t m n p o e s r b r o r r e y l m o b u o o l o o w s e d e F f r : o i P l u w n n h u l n f t i s c a o w I t u i o o d ) T c c s l s y n i y e i i i s t a i ' d p i a i 1 s n l i m P - d n P l o P i z ( 1 s i i ' h i a i w l I t i s I d ' : l I V : e n e 1 t ' e T t T e e I t b s s a ' a ' ' e n w w m r a a O e e e e e d g o h t o o e a e a h h h h h d h r W l l O H H R N A T T P T T T P P e Z i t Substance Abuse Treatment and Domestic Violence Treatment Improvement Protocol (TIP) Series 25 Patricia Anne Fazzone, R.N., D.N.Sc., M.P.H., C.S. John Kingsley Holton, Ph.D. Beth Glover Reed, Ph.D. Consensus Panel Co-Chairs U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Rockwall II, 5600 Fishers Lane Rockville, MD 20857 cJ C.R.N.P., Ed.D., MaryLou Leonard, Pamela This publication is part of the Substance Nicholson, Annie Thornton, Jack Rhode, Abuse Prevention and Treatment Block Cecil Gross, Niyati Pandya, and Wendy Grant technical assistance program. All Carter for their considerable contributions to material appearing in this volume except that taken directly from copyrighted sources this document. is in the public domain and may be The opinions expressed herein are the views reproduced or copied without permission of the Consensus Panel members and do not from the Substance Abuse and Mental reflect U.S. Department of Health and Health Services Administration's Human Services (DHHS). No official (SAMHSA) Center for Substance Abuse support or endorsement of CSAT, Treatment (CSAT) or the authors. Citation SAMHSA, or DHHS for these opinions or of the source is appreciated. for particular instruments or software that may be described in this document is This publication was written under contract intended or should be inferred. The number ADM 270-95-0013. Sandra guidelines in this document should not be Clunies, M.S., I.C.A.D.C., served as the considered substitutes for individualized CSAT Government project officer. Writers patient care and treatment decisions. were Paddy Cook, Constance Grant Gartner, M.S.W., Lise Markl, Randi Henderson, Margaret K. Brooks, Esq., Donald Wesson, M.D., Mary Lou Dogoloff, Virginia DHHS Publication No. (SMA) 00-3406 Vitzthum, and Elizabeth Hayes. Special Printed 1997 thanks go to Daniel Vinson, M.D., Reprinted 2000 M.S.H.P., Mim J. Landry, Mary Smolenski, Contents What Is a TIP? Editorial Advisory Board vii Consensus Panel ix Foreword xi Executive Summary and Recommendations xiii Scope of the TIP xiii Summary of Recommendations xiv Supplemental Materials xviii Chapter 1Effects of Domestic Violence on Substance Abuse Treatment 1 Defining the Problem 2 Identifying the Connections 3 A New Way of Thinking 7 Chapter 2Survivors of Domestic Violence: An Overview 9 Entering the Treatment System 9 Treatment Planning for the Survivor Client 11 Issues for Children of Survivors 17 Summary 19 Case Scenario: Profile of a Survivor 20 Chapter 3Batterers: An Overview 25 Perspectives on Substance Abuse and the Batterer Client 25 Profiling Batterers 26 Treatment Issues for the Substance-Abusing Batterer 32 Chapter 4Screening and Referral of Survivors and Batterers in Substance Abuse Treatment Programs 37 Screening 37 Methods of Screening for Domestic Violence: Survivors 38 Screening for Domestic Violence: Batterers 42 Screening for Presence of Child Abuse 44 Referral 45 7 iii Contents Treatment Concerns for Survivors and Batterers 48 Chapter 5Legal Issues 51 Federal Law 51 Local Laws: Civil Protection and Restraining Orders 53 Other Legal Issues 54 Communicating With the Legal System 59 Dealing With the Police 60 Conclusion 61 Chapter 6Linkages: A Coordinated Community Response 63 Systemic Reform 64 Community-Based Linkages 65 Identifying Critical Linkages, Barriers, and Opportunities 68 Establishing a Linkage Relationship 68 Other Linkage Strategies 76 Examples of Effective Community-Based Linkages 77 Coordination of Care 79 Appendix ABibliography 81 Appendix BFederal Confidentiality Regulations 95 Types of Programs Covered by the Regulations 95 Federal Confidentiality Laws 96 Rules Governing Communication of Information 99 Five Other Exceptions to the General Confidentiality Rule 107 Other Requirements 111 Conclusion 111 Endnotes 111 Appendix CInstruments 115 Abuse Assessment Screen (English Version) 116 Encuesta Sobre El Maltrato (Spanish Version) 117 Danger Assessment 119 The Psychological Maltreatment of Women Inventory (PMWI) 121 The Revised Conflict Tactics Scale (CTS2) (for Couples) 123 Appendix DSample Personalized Safety Plan for Domestic Violence Survivors 127 Personalized Safety Plan 128 Telephone Numbers I Need to Know: 133 Appendix EHotlines and Other Resources for Domestic Violence and Related Issues 135 Hotlines 135 General Resources 136 Other Services 139 Appendix FResource Panel 147 Appendix GField Reviewers 149 iv What Is a TIP? Treatment Improvement Protocols (TIPs) of discussions; the information and are best practice guidelines for the recommendations on which they reach treatment of substance abuse, provided consensus form the foundation of the TIP. The as a service of the Substance Abuse and Mental members of each Consensus Panel represent Health Service Administration's Center for substance abuse treatment programs, hospitals, Substance Abuse Treatment (CSAT). CSAT's community health centers, counseling Office of Evaluation, Scientific Analysis, and programs, criminal justice and child welfare Synthesis draws on the experience and agencies, and private practitioners. A Panel knowledge of clinical, research, and Chair (or Co-Chairs) ensures that the guidelines administrative experts to produce the TIPs, mirror the results of the group's collaboration. which are distributed to a growing number of A large and diverse group of experts closely facilities and individuals across the country. reviews the draft document. Once the changes The audience for the TIPs is expanding beyond recommended by these field reviewers have public and private substance abuse treatment been incorporated, the TIP is prepared for facilities as alcohol and other drug disorders are publication, in print and online. The TIPs can be increasingly recognized as a major problem. accessed via the Internet on the National Library The TIPs Editorial Advisory Board, a of Medicine's home page at the URL: distinguished group of substance abuse experts http: / /text.nlm.nih.gov. The move to electronic and professionals in such related fields as media also means that the TIPs can be updated primary care, mental health, and social services, more easily so they continue to provide the field works with the State Alcohol and Other Drug with state-of-the-art information. Abuse Directors to generate topics for the TIPs While each TIP strives to include an evidence based on the field's current needs for base for the practices it recommends, CSAT information and guidance. recognizes that the field of substance abuse After selecting a topic, CSAT invites staff treatment is evolving, and research frequently from pertinent Federal agencies and national lags behind the innovations pioneered in the organizations to a Resource Panel that field. A major goal of each TIP is to convey recommends specific areas of focus as well as "front-line" information quickly but resources that should be considered in responsibly. For this reason, recommendations developing the content for the TIP. Then proffered in the TIP are attributed to either recommendations are communicated to a Panelists' clinical experience or the literature. If Consensus Panel composed of non-Federal there is research to support a particular experts on the topic who have been nominated approach, citations are provided. by their peers. This Panel participates in a series What Is a TIP? blueprint for a more integrated system of care This TIP, Substance Abuse Treatment and that would enhance treatment for both Domestic Violence, presents treatment providers with an introduction to the field of domestic problems. This section includes practical violence. It gives providers useful information suggestions for establishing linkages both on the role of substance abuse in domestic between substance abuse treatment providers violenceboth among the men who batter and and domestic violence support workers and the women who are battered. Useful techniques with legal, health care, criminal justice, and for detecting and eliciting such information are other relevant service agencies. supplied, along with ways to modify treatment Other TIPs may be ordered by contacting The to ensure victims' safety and to stop the cycle of National Clearinghouse for Alcohol and Drug violence in both parties' lives. Legal issues, Information (NCADI), (800) 729-6686 or (301) 468- including duty to warn and confidentiality, are 2600; TDD (for hearing impaired), (800) 487-4889. discussed. Finally, the Panel provides a 10 vi