8/13/2018 L GBT T r auma and Dome stic Viole nc e : Wha t c - - PDF document

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8/13/2018 L GBT T r auma and Dome stic Viole nc e : Wha t c - - PDF document

8/13/2018 L GBT T r auma and Dome stic Viole nc e : Wha t c linic ia ns ne e d to know JOHN M. O BRI E N, PH.D. ME NT AL HE AL T H ASSOCI AT E S OF MAI NE 251 WOODF ORD ST . PORT L AND, ME 04103 AUGUST 17, 2018 L


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8/13/2018 1

L GBT T r auma and Dome stic Viole nc e :

Wha t c linic ia ns ne e d to know JOHN M. O’ BRI E N, PH.D. ME NT AL HE AL T H ASSOCI AT E S OF MAI NE 251 WOODF ORD ST . PORT L AND, ME 04103 AUGUST 17, 2018

L GBT T ra uma a nd Dome stic Viole nc e

By the e nd of this wor kshop, pa rtic ipa nts will be a ble to:  ide ntify a nd disc uss issue s o f re le va nc e to se xua l o rie nta tio n

a nd/ o r g e nde r ide ntity

 disc uss the e xpe rie nc e s o f tra uma in L

GBT c lie nts, inc luding mic ro - a g g re ssio ns.

 unde rsta nd the e xpe rie nc e s o f do me stic vio le nc e fa c e d b y

me mb e rs o f the L GBT c o mmunity a nd wa ys to e ffe c tive ly inte rve ne

 imple me nt pra c tic a l skills fo r sc re e ning , a sse ssing a nd suppo rting

L GBT c lie nts who a re e xpe rie nc ing tra uma a nd do me stic vio le nc e .

L GBT T ra uma a nd Dome stic Viole nc e

OVE RVIE W OF PRE SE NT AT ION

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L GBT T ra uma a nd Dome stic Viole nc e

Ke y T e rms

 Se x ve rsus Ge nde r  Ge nde r ide ntity/ Ge nde r e xpre ssio n  Se xua l o rie nta tio n  T

ra nsg e nde r

 Cisg e nde r  Co ming o ut  He te ro se xua l privile g e  Ho mo pho b ia  Inte rna lize d Oppre ssio n (Ho mo pho b ia / Bipho b ia / T

ra nspho b ia )

L GBT T ra uma a nd Dome stic Viole nc e

 Ke y T e rms: L

GBT QQIP2SAA

 L

e sb ia n

 Ga y  Bise xua l  T

ra nsg e nde r

 Que e r  Que stio ning  Inte rse x  Pa nse xua l  2 spirit  Ase xua l  Ally

L GBT T ra uma a nd Dome stic Viole nc e

History of L GBT Community  Anc ie nt histo ry  E uro pe a n histo ry  Unite d Sta te s histo ry  So do my la ws  1950’ s: Ma tta c hine So c ie ty/ Da ug hte rs o f Bilitis  1960’ s : Civil Rig hts a nd June 28, 1969 Stone wall Inn  1970’ s: Unite d Churc h o f Christ/ PF L AG/ Na tio na l L e sb ia n/ Ga y T a sk F

  • rc e / Huma n Rig hts

Ca mpa ig n

 1980’ s thro ug h to da y: ACT

UP/ Que e r Na tio n/ Do n’ t Ask Do n’ t T e ll

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L GBT T ra uma a nd Dome stic Viole nc e

Adole sc e nts  Suic ida lity  L

GBT Yo uth

De pre ssio n (SAMHSA, 2014) 4 to 5 time s mo re like ly to a tte mpt suic ide (Ahuja , 2016);

inc re a se d risk o f suic ide risk o utc o me s (Sto ne , e t a l, 2014)

I

mpo rta nc e o f fa mily re spo nse (L e vy, Russo n & Dia mo nd, 2016)

Culture a nd ne ig hb o rho o d (Dunc a n & Ha tze nb ue hle r, 2014)

L GBT T ra uma a nd Dome stic Viole nc e

Adole sc e nts

 Bullying  De finitio n  L

GBT Yo uth a t inc re a se d risk b ut a lso re silie nc e (Ma rsto n, 2015; Pizmo ny-L e vy & K

  • sc iw, 2016))

 L

e g a l o ptio ns (K imme l, 2016)

 Sc ho o ls (Ma rsto n, 2015)  Suppo rt  Sa fe e nviro nme nt  Ga y-Stra ig ht a llia nc e  Pro te c t priva c y

L GBT T ra uma a nd Dome stic Viole nc e

Adole sc e nts

Cybe rbullying : Ke y F inding s on Bullying / Ha ra ssme nt a nd Sa fe ty  L

GBT yo uth we re ne a rly thre e time s a s like ly a s no n-L GBT yo uth to sa y the y ha d b e e n b ullie d o r ha ra sse d o nline (42% vs. 15%) a nd twic e a s like ly to sa y the y ha d b e e n b ullie d via te xt me ssa g e (27% vs 13%).

 1 in 4 L

GBT yo uth (26%) sa id the y ha d b e e n b ullie d o nline spe c ific a lly b e c a use o f the ir se xua l o rie nta tio n o r g e nde r e xpre ssio n in the pa st ye a r, a nd 1 in 5 (18%) sa id the y ha d e xpe rie nc e d b ullying a nd ha ra ssme nt fo r the se re a so ns via te xt me ssa g e . (GL SE N, 2013).

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L GBT T ra uma a nd Dome stic Viole nc e

Adole sc e nts Cybe rbullying : Ke y F inding s on Bullying / Ha ra ssme nt a nd Sa fe ty  1 in 3 (32%) L

GBT re spo nde nts sa id the y ha d b e e n se xua lly ha ra sse d

  • nline in the pa st ye a r. 1 in 4 L

GBT yo uth (25%) sa id the y ha d b e e n se xua lly ha ra sse d via te xt me ssa g e .

 L

GBT yo uth we re fo ur time s a s like ly a s no n-L GBT yo uth to sa y the y ha d b e e n se xua lly ha ra sse d o nline (32% vs. 8%) a nd thre e time s a s like ly to sa y the y ha d b e e n se xua lly ha ra sse d via te xt me ssa g e (25%

  • vs. 8%).

(GL SE N, 2013).

L GBT T ra uma a nd Dome stic Viole nc e

Adole sc e nts

 Vio le nc e  De finitio n a nd inc re a se d risk (CDC, 2017)  Yo uth Risk Be havio r Sur ve y (CDC, 2015): L GB stude nts  10% we re thre a te ne d o r injure d with a we a po n o n sc ho o l pro pe rty  34% we re b ullie d o n sc ho o l pro pe rty  28% we re b ullie d e le c tro nic a lly  23% who ha d da te d o r we nt o ut with so me o ne during the 12 mo nths b e fo re the

surve y ha d e xpe rie nc e d se xua l da ting vio le nc e in the prio r ye a r

 18% ha d e xpe rie nc e d physic a l da ting vio le nc e  18% ha d b e e n fo rc e d to ha ve se xua l inte rc o urse a t so me po int in the ir live s.

L GBT T ra uma a nd Dome stic Viole nc e

Adole sc e nts

Cybe r se lf-har m o r Digital se lf-har m

 Digital se lf-harm, a s it ha s b e e n te rme d, o c c urs whe n a n individua l

c re a te s a n a no nymo us o nline a c c o unt a nd use s it to pub lic ly se nd hurtful me ssa g e s o r thre a ts to o ne ’ s se lf.

 the “ano nymo us o nline po sting, se nding, o r o the rwise sharing o f

hurtful c o nte nt abo ut o ne se lf.” Mo st c o mmo nly, it ma nife sts a s thre a ts o r ta rg e te d me ssa g e s o f ha te – the mo re e xtre me a nd ra re fo rms o f c yb e rb ullying .

Hinduja & Pa tc hin, 2017

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L GBT T ra uma a nd Dome stic Viole nc e

Adole sc e nts Cybe r se lf-har m or Digital se lf-har m

 6% o f tho se who re spo nde d sa id the y ha d a no nymo usly po ste d so me thing

  • nline a b o ut the mse lve s tha t wa s me a n. Mo re b o ys a dmitte d to do ing it

tha n g irls

 Co rre la te s o f dig ita l se lf-ha rm,  b e ing no n-he te ro se xua l,  e xpe rie nc ing b ullying a t sc ho o l o r b ullying o nline ,  using drug s o r pa rtic ipa ting in de via nt b e ha vio r, a nd  ha ving de pre ssive tho ug hts a nd pa rtic ipa ting in o ff-line se lf-ha rm

b e ha vio rs. Hinduju & Pa tc hin 2017; Pa tc hin & Hinduju, 2017

L GBT T ra uma a nd Dome stic Viole nc e

Oppr e ssion  Strug g le fo r Civil Rig hts  I

nc re a se d a c c e pta nc e o f L GBT pe o ple in the Unite d Sta te s o ve r the la st fo ur de c a de s

Pro te c tio n fro m disc rimina tio n Ma rria g e I

nc re a se d visib ility in pub lic o ffic ia ls, me dia

 I

nc re a se d visib ility le a ds to inc re a se in ta rg e ting o f L GBT pe o ple O’ Brie n, 2017

L GBT T ra uma a nd Dome stic Viole nc e

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L GBT T ra uma a nd Dome stic Viole nc e

Oppre ssion  He a lth dispa ritie s  Why impo rta nt? Histo ry o f a nti-L

GBT b ia s in he a lthc a re

No L

GBT dise a se s b ut spe c ific he a lth dispa ritie s

Mo re diffic ulty with a c c e ss to he a lthc a re a nd mo re like ly with

unme t he a lth ne e ds

Inc re a se d risk o f de pre ssio n, a nxie ty, suic ida l ide a tio n, sub sta nc e

a b use

Inc re a se d ra te s o f HIV a nd ST

I’ s in g a y me n a nd MtFtra nsg e nde r individua ls

L

e sb ia ns a nd b ise xua l wo me n inc re a se d risk o f o b e sity, a sthma , smo king , drinking a s c o mpa re d to he te ro se xua l wo me n (F re dric kse n-Go ldse n, e t a l, 2013)

L GBT T ra uma a nd Dome stic Viole nc e

Oppr e ssion  He a lth dispa ritie s  L

e ss pre va le nt in a re a s whe re the re is g re a te r suppo rt fo r sa me -se x ma rria g e (Ha tze nb ue hle r, F lo re x & Ga te s, 2017)

 L

GB a dults (F re drikse n-Go lso n, e t a l., 2017)

 I

nc re a se d risk o f we a ke ne d immune syste m, lo w b a c k/ ne c k pa in

 I

nc re a se d risk o f disa b ility a nd me nta l distre ss.

 L

e sb ia ns/ b ise xua l wo me n inc re a se d risk o f a rthritis, a sthma , he a rt a tta c k, stro ke , hig he r numb e r o f c hro nic c o nditio ns, a nd po o r g e ne ra l he a lth.

 Ga y/ b ise xua l me n inc re a se d risk o f c a nc e r a nd a ng ina , mo re like ly

to b e c urre nt smo ke rs a nd e xc e ssive drinke rs.

L GBT T ra uma a nd Dome stic Viole nc e

Oppr e ssion  Anti-L

GBT vio le nc e

 Ha te c rime de finitio n  Histo ry in the Unite d Sta te s Cha rlie Ho wa rd 1984 Re b e c c a Wig ht a nd Cla udia Bre nne r 1988 Sc o tt Ame dure 1995 Ma tthe w She pa rd 1998 Se a ttle 2013

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L GBT T ra uma a nd Dome stic Viole nc e

Oppre ssion

 Anti-L

GBT vio le nc e

 Re c e nt e ve nts Orla ndo , PUL

SE nig htc lub June 2016

Che c hnya , April 2017  2017 sta tistic s 36 L

GBT a nd HI V-a ffe c te d pe o ple murde re d so fa r this ye a r a s

  • f Aug ust 23, mo st e ve r

 2015 Ma ine ha te c rime s

L GBT T ra uma a nd Dome stic Viole nc e

Ha te Crime s

L GBT T ra uma a nd Dome stic Viole nc e

Ha te Crime s: Ma ine 2016

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L GBT T ra uma a nd Dome stic Viole nc e

Oppr e ssion  Mic ro -a g g re ssio ns  De fine d  T

hre e type s

Mic ro a ssa ults Mic ro insults Mic ro inva lida tio ns  Outside a nd within L

GBT c o mmunity (O’ Brie n, 2017; Sue , 2010)

L GBT T ra uma a nd Dome stic Viole nc e

Oppr e ssion  F

a mily o f o rig in

 I

mpo rta nc e o f fa mily

Co ming o ut to fa mily Ove r 50% ne g a tive a t first, so me re ma in tha t wa y I

nc re a se d risk o f inte rna lize d ho mo pho b ia , de pre ssio n, suic ida l ide a tio n, use o f sub sta nc e s a nd e xpe c ta tio n tha t

  • the rs will re spo nd ne g a tive ly

Ma y le a d L

GBT pe rso n to de ny this pa rt o f the mse lve s o r b e c o me e stra ng e d fro m fa mily o f o rig in O’ Brie n, 2017

L GBT T ra uma a nd Dome stic Viole nc e

 F

a mily o f Cho ic e

 L

GBT pe o ple c re a te "re pla c e me nt" fa mily ne two rks tha t a re ma de up o f individua ls who a re sig nific a nt to the m, inc luding :

 frie nds  pa rtne rs  fa milie s o f pa rtne rs  e x-lo ve rs  b lo o d re la tive s  individua ls who ha ve die d o r a re no lo ng e r a n imme dia te pa rt o f the

c lie nt’ s life b e c a use o f a ddic tio n, HIV/ AIDS, a re la tio nship b re a k-up, o r

  • the r life e ve nts.

(Ore l, 2017)

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L GBT T ra uma a nd Dome stic Viole nc e

Oppr e ssion

 Dia g no stic issue s  Ho o ke r (1957)  DSM  DSM-I

I : 1968: Ho mo se xua lity is a me nta l diso rde r

 1973: Ame ric a n Psyc hia tric Asso c ia tio n; 1975, Ame ric a n Psyc ho lo g ic a l Asso c ia tio n  DSM-I

I Se xua l Orie nta tio n Disturb a nc e

 DSM-I

I I E g o -dysto nic ho mo se xua lity 1980;

 DSM-I

I I R, 1987: re mo ve d fro m DSM;

 E

g o -dysto nic ho mo se xua lity still in ICD-10, unc le a r wha t will ha ppe n in re visio n

L GBT T ra uma a nd Dome stic Viole nc e

Oppre ssion

 Dia g no stic issue s  Ge nde r: a ppe a re d a s a n issue o f “po ssib le disturb a nc e ” a s

ho mo se xua lity wa s b e ing re mo ve d fro m DSM

 Ge nde r ide ntity diso rde r (DSM-3-1980; DSM 3R-1987; DSM 4-1994)  Ge nde r dyspho ria (DSM 5- 2014)  Co ntro ve rsy re ma ins

L GBT T ra uma a nd Dome stic Viole nc e

Oppr e ssion

 Ho using / e mplo yme nt disc rimina tio n  Ho using : F

a ir Ho using Ac t- 1968 do e s no t c o ve r L GBT pe rso ns- unle ss the re is po ssib ility o f a c la im unde r no n-c o nfo rmity to g e nde r ste re o type s

 E

mplo yme nt: April 2017: F e de ra l a ppe a ls c o urt rule d in fa vo r o f a le sb ia n who wa s de nie d a full time jo b b e c a use she is a le sb ia n. Disc rimina tio n b a se d o n se xua l

  • rie nta tio n is a fo rm o f se x disc rimina tio n

 Re c e nt c o ntro ve rsy with c urre nt pre side ntia l a dministra tio n re mo ving e xe c utive

  • rde r tha t re q uire s fe de ra l c o ntra c to rs to re fra in fro m disc rimina ting b a se d o n

se xua l o rie nta tio n

 Ma ine Huma n Rig hts Ac t: e mplo yme nt  Ma ine 2016: Ca mpa ig n fo r E

q ua l Rig hts No t Spe c ia l Rig hts

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L GBT T ra uma a nd Dome stic Viole nc e

T r a uma :  De finitio n  a n e xpe rie nc e tha t pro duc e s psyc ho lo g ic a l injury o r pa in; the

psyc ho lo g ic a l injury so c a use d

 a n e mo tio na l wo und o r sho c k tha t c re a te s sub sta ntia l, la sting

da ma g e to the psyc ho lo g ic a l de ve lo pme nt o f pe rso n. (Sha piro , 2010).

L GBT T ra uma a nd Dome stic Viole nc e

Pote ntia lly tra uma tic e ve nts

 I

nte rpe rso na l vio le nc e

Ma ss vio le nc e I

ndividua l a ssa ult

 Na tura l disa ste rs  Do me stic vio le nc e  Child Ab use / Ne g le c t Adve rse Childho o d E

xpe rie nc e (ACE) Brie re & Sc o tt, 2015

L GBT T ra uma a nd Dome stic Viole nc e

Pote ntially tr aumatic e ve nts  T

ra nspo rta tio n a c c ide nts

L

a rg e sc a le

Mo to r ve hic le a c c ide nts Wa r Co mb a t Re fug e e s T

  • rture

F

irst re spo nde rs

He a rt a tta c k Stro ke

Brie re & Sc o tt, 2015

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L GBT T ra uma a nd Dome stic Viole nc e

L GBT c lie nts a nd T ra uma  E

xpe rie nc e o f L GBT c lie nts ha s b e e n la rg e ly a b se nt fro m re se a rc h o n tra uma .

 L

GBT individua ls e xpe rie nc e hig he r le ve ls o f c hildho o d a b use , inte rpe rso na l vio le nc e , se xua l a ssa ult a nd do me stic vio le nc e a s c o mpa re d to he te ro se xua ls (Ba lsa m, Ro thb lum a nd Be a uc ha ine , 2005)

 Co ming o ut c a n b e me t with a tra uma tic re spo nse .  L

GBT pe o ple o f c o lo r fa c e e ve n hig he r ra te s o f a b use c o mpa re d to Ca uc a sia ns (Ba lsa m, e t a l, 2010).

 L

GBT c lie nts a nd he te ro se xua l individua ls who e ve r ha d a sa me se x e xpe rie nc e ha ve hig he r ra te s o f de ve lo ping PT SD a s c o mpa re d to he te ro se xua ls (Ro b e rts e t a l., 2010)

L GBT T ra uma a nd Dome stic Viole nc e

HIV/ AIDS  Ga y-re la te d immune de fic ie nc y (GRI

D): “g a y c a nc e r”, “g a y pla g ue ” c a use d g a y me n to b e se e n a s so le ly re spo nsib le fo r the dise a se

 Ca use d ne e d to ”c o me o ut” a s g a y a nd a s HI

V-po sitive : this c a n still b e true

 HI

V-po sitive individua ls c a n b e vie we d a s “dirty” o r “dise a se d ”.

 Pe rso na l a ds c a n indic a te tha t so me o ne is “c le a n”; this c a n le a d a n

HI V-po sitive pe rso n to e xpe rie nc e sig nific a nt se lf-ha tre d

L GBT T ra uma a nd Dome stic Viole nc e

Clinic al issue s for le sbian/ gay c lie nts Conve rsion the rapy  “Psyc ho the ra pe utic mo da litie s to c o nve rt o r ‘ re pa ir’ ho mo se xua lity a re b a se d

  • n de ve lo pme nta l the o rie s who se sc ie ntific va lidity is q ue stio na b le .

F urthe rmo re , a ne c do ta l re po rts o f ‘ c ure s’ a re c o unte rb a la nc e d b y a ne c do ta l c la ims o f psyc ho lo g ic a l ha rm. In the la st fo ur de c a de s, ‘ re pa ra tive ’ the ra pists ha ve no t pro duc e d a ny rig o ro us sc ie ntific re se a rc h to sub sta ntia te the ir c la ims

  • f c ure . Until the re is suc h re se a rc h a va ila b le , [the Ame ric a n Psyc hia tric

Asso c ia tio n] re c o mme nds tha t e thic a l pra c titio ne rs re fra in fro m a tte mpts to c ha ng e individua ls’ se xua l o rie nta tio n, ke e ping in mind the me dic a l dic tum to first, do no ha rm.”

Ame ric an Psyc hiatric Assoc iation, 2000 Br

  • the r

s on the Road http:/ / www.b ro the rsro a d.o rg

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L GBT T ra uma a nd Dome stic Viole nc e

T r a nsg e nde r Disc rimina tion/ Viole nc e

 T

ra nsg e nde r individua ls re po rt pe rva sive disc rimina tio n, mic ro -a g g re ssio ns, a nd vic timiza tio n a c ro ss the life spa n.

 One in te n (10%) o f tho se who we re o ut to the ir imme dia te fa mily re po rte d tha t a

fa mily me mb e r wa s vio le nt to wa rds the m b e c a use the y we re tra nsg e nde r, a nd 8% we re kic ke d o ut o f the ho use b e c a use the y we re tra nsg e nde r.

 T

he ma jo rity o f re spo nde nts who we re o ut o r pe rc e ive d a s tra nsg e nde r while in sc ho o l (K –12) e xpe rie nc e d so me fo rm o f mistre a tme nt, inc luding b e ing ve rb a lly ha ra sse d (54%), physic a lly a tta c ke d (24%), a nd se xua lly a ssa ulte d (13%) b e c a use the y we re tra nsg e nde r.

 F

urthe r, 17% e xpe rie nc e d suc h se ve re mistre a tme nt tha t the y le ft a sc ho o l a s a re sult. Na tio na l Ce nte r fo r T ra nsg e nde r E q ua lity (2015)

L GBT T ra uma a nd Dome stic Viole nc e

T ransge nde r Disc rimination/ Viole nc e  39% o f re spo nde nts e xpe rie nc e d se rio us psyc ho lo g ic a l distre ss in the mo nth

prio r to c o mple ting the surve y, c o mpa re d with o nly 5% o f the U.S. po pula tio n.

 40% o f re spo nde nts ha ve a tte mpte d suic ide in the ir life time —ne a rly nine

time s the a tte mpte d suic ide ra te in the U.S. po pula tio n (4.6%).

 One -third (33%) o f tho se who sa w a he a lth c a re pro vide r ha d a t le a st o ne

ne g a tive e xpe rie nc e re la te d to b e ing tra nsg e nde r, suc h a s b e ing ve rb a lly ha ra sse d o r re fuse d tre a tme nt b e c a use o f the ir g e nde r ide ntity.

 One -q ua rte r (23%) o f re spo nde nts re po rte d tha t the y did no t se e k the

he a lth c a re the y ne e de d in the ye a r prio r to c o mple ting the surve y due to fe a r o f b e ing mistre a te d a s a tra nsg e nde r pe rso n, Na tio na l Ce nte r fo r T ra nsg e nde r E q ua lity (2015)

L GBT T ra uma a nd Dome stic Viole nc e

T ransg e nde r Disc r imina tion/ Viole nc e : Re stroom ac c e ss  Ne a rly o ne in te n (9%) re spo nde nts re po rte d tha t so me o ne de nie d the m

a c c e ss to a re stro o m in the pa st ye a r. In the pa st ye a r, re spo nde nts re po rte d b e ing ve rb a lly ha ra sse d (12%), physic a lly a tta c ke d (1%), o r se xua lly a ssa ulte d (1%) whe n a c c e ssing a re stro o m.

 Mo re tha n ha lf (59%) o f re spo nde nts a vo ide d using a pub lic re stro o m in

the pa st ye a r b e c a use the y we re a fra id o f c o nfro nta tio ns o r o the r pro b le ms the y mig ht e xpe rie nc e .

 Ne a rly o ne -third (32%) o f re spo nde nts limite d the a mo unt tha t the y a te

a nd dra nk to a vo id using the re stro o m in the pa st ye a r. Na tio na l Ce nte r fo r T ra nsg e nde r E q ua lity (2015)

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8/13/2018 13

L GBT T ra uma a nd Dome stic Viole nc e Biolog y of Addic tion a nd T ra uma L GBT T ra uma a nd Dome stic Viole nc e

 T

he Re wa rd Pa thwa y of the Bra in (Both ple a sure a nd sa tia tion):

 VT

A (ve ntra l te g me nta l a re a -midb ra in) to Nuc le us Ac c umb e ns (fo re b ra in, a re a in the b a sa l g a ng lia ) to Pre fro nta l Co rte x. (c o rte x- c o nsc io usne ss a nd pla nning ) a nd to the limb ic syste m (e mo tio ns).

L GBT T ra uma a nd Dome stic Viole nc e

 nuc le us a c c umbe ns: c re a te s a sig na l in the b ra in

(initia lly) o f g o o d re sults fro m use . T his is the ple a sure c e nte r.

 L

  • c us c e r

ule us- a re a o f the b ra in tha t c o o rdina te s the

b o dy’ s re spo nse to no ve l e xte rna l stimuli a nd inte rna l stimuli tha t mig ht sig na l da ng e r (re sp o nds to b lo o d lo ss, hypo xia a nd pa in).

slide-14
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8/13/2018 14

L GBT T ra uma a nd Dome stic Viole nc e

Bio lo g y a nd Addic tio n F a c e s o f me tha mphe ta mine use www.fac e sofme th.us

L GBT T ra uma a nd Dome stic Viole nc e

Bio lo g y a nd Addic tio n F a c e s o f me tha mphe ta mine use www.fac e sofme th.us

L GBT T ra uma a nd Dome stic Viole nc e

Biolog y a nd tra uma / PT SD

 Ne uro na l Re spo nse  L

imb ic Syste m:

Amyg da la - e mo tio n a nd surviva l

Hippo c a mpus- sto ra g e o f me mo rie s

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8/13/2018 15

L GBT T ra uma a nd Dome stic Viole nc e

Biolog y a nd tra uma / PT SD

 Ho rmo na l Re spo nse  Adre na line a nd No ra dre na line (e pine p hrine a nd

no re phine p hrine : ho rmo ne s a nd ne uro tra nsmitte rs).

 Co rtiso l (g luc o rtic o id , a ho rmo ne tha t a ffe c ts the

b urning o f sug a r o r g luc o se ).

L GBT T ra uma a nd Dome stic Viole nc e

Biolog y a nd tra uma / PT SD

 Ho rmo na l Re spo nse

 Stre ss re spo nse : fig ht/ flig ht/ fe a r(fre e ze )/ sub mit  Sto ma c h: during time s o f da ng e r, the sto ma c h pro duc e s e xtra

se ro to nin

 Gluc o rtic o ids a nd ne uro pe ptide s a ffe c t the hypo tha la mus a nd

hippo c a mpus. T he hippo c a mpus inte ra c ts with the a myg da la , the fe a r c e nte r.

L GBT T ra uma a nd Dome stic Viole nc e

Disc ussion:  How c a n you use this infor

ma tion with a c lie nt?

 How would you e xpla in biolog ic a l fa c tors to a

c lie nt?

slide-16
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8/13/2018 16

L GBT T ra uma a nd Dome stic Viole nc e

DSM- V a nd PT SD

Ne w Cate gory: T rauma and Stre ssor- re late d disorde rs  a . PT SD Sympto ms  1. Re living (1)  2. Avo ida nc e (2)*  3. Ne g a tive a lte ra tio ns in c o g nitio ns/ mo o d (2)*  4. Aro usa l (2)  b . PT SD ve rsus Ac ute Stre ss Diso rde r (ASD)  c . Co mb ine d/ c umula tive tra uma

L GBT T ra uma a nd Dome stic Viole nc e

DSM- V a nd PT SD  d. Othe r sympto ms a sso c ia te d with tra uma Co g nitive disturb a nc e Diffic ultie s with a ffe c t re g ula tio n/ a ng e r I

de ntity disturb a nc e

Chro nic inte rpe rso na l diffic ultie s T

e nsio n-re d uc tio n a c tivitie s.

L GBT T ra uma a nd Dome stic Viole nc e

Post- T r aumatic Gr

  • wth (PT

G):

*c o nno te s po sitive c ha ng e s tha t o c c ur in so me o ne ’ s psyc ho lo g ic a l ma ke -up a s a re sult o f a tra uma tic e ve nt (Mo ra n, Sc hmidt & Burke r, 2013; Re ndo n, 2015).

PT G c ha ng e s:

g re a te r a ppre c ia tio n fo r life

a n o pe nne ss to ne w po ssib ilitie s

a n inc re a se in spiritua lity

a g re a te r se nse o f pe rso na l stre ng th

slide-17
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8/13/2018 17

L GBT T ra uma a nd Dome stic Viole nc e

Post- T r aumatic Gr

  • wth (PT

G):

Pe o ple who e xpe rie nc e PT G ha ve b e e n fo und to po sse ss the fo llo wing five c ha ra c te r tra its (Pe te rso n, e t a l., 2008, Re ndo n, 2015):

  • I

nte rpe rso na l skills (suc h a s humo r, kindne ss, a nd so c ia l inte llig e nc e )

  • Co g nitive skills (c re a tivity, c urio sity a nd willing ne ss to le a rn)
  • F
  • rtitude (b ra ve ry, ho ne sty a nd the a b ility to ha ve pe rspe c tive )
  • T

e mpe ra nc e (fa irne ss, fo rg ive ne ss, a nd prude nc e )

  • T

ra nsc e nde nc e (g ra titude , ho pe a nd re lig io usne ss)

L GBT T ra uma a nd Dome stic Viole nc e

Asse ssme nt: Window of T

  • le ra nc e

L GBT T ra uma a nd Dome stic Viole nc e

Asse ssme nt: Window of T

  • le ra nc e

 Windo w o f to le ra nc e : the o ptima l a ro usa l zo ne fro m

whic h pe o ple e xpe rie nc e va rio us inte nsitie s o f e mo tio na l a nd physio lo g ic a l a ro usa l witho ut disrupting the func tio ning o f the syste m.” (Sha piro , 2010).

 Disso c ia tio n ve rsus b la c ko uts ve rsus de nia l

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8/13/2018 18

L GBT T ra uma a nd Dome stic Viole nc e

Asse ssme nt: Affe c t tole r a nc e

  • de fine d a s a pe rso n’ s a b ility to ma na g e stro ng e mo tio n witho ut

b e c o ming o ve rwhe lme d a nd/ o r una b le to func tio n.

Inte r na l/ e xte rna l r e sour c e s

  • I

nte rna l: Wha t do e s so me o ne to do to c o pe ?

  • E

xte rna l: Who a re yo ur so urc e o f so c ia l suppo rt? T

  • who m wo uld

yo u turn if yo u we re ha ving a diffic ult time ? Brie re & Sc o tt, 2015

L GBT T ra uma a nd Dome stic Viole nc e

Asse ssme nt:  E

ffe c tive a sse ssme nt: Pro c e ss a wa re ne ss

T e mpe ra me nt

Atta c hme nt

Affe c t to le ra nc e

Bo dy a wa re ne ss

Disso c ia tio n Sha piro , 2010

L GBT T ra uma a nd Dome stic Viole nc e

Asse ssme nt:  E

ffe c tive a sse ssme nt: Se lf-re po rt

T e mpe ra me nt

Atta c hme nt

Affe c t to le ra nc e

Bo dy a wa re ne ss

Disso c ia tio n Sha piro , 2010

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8/13/2018 19

L GBT T ra uma a nd Dome stic Viole nc e

Asse ssme nt:  E

ffe c tive a sse ssme nt: Sc re e ning to o ls

L ife -E ve nts Che c klist (We a the rs e t a l, 2001)

Clinic ia n Administe re d PT SD Sc a le (CAPS) (We a the rs e t a l, 2001)

Disso c ia tive E xpe rie nc e s Sc a le (Ca rlso n & Putna m, 1992)

L GBT T ra uma a nd Dome stic Viole nc e

T r e a tme nt Pha se s for T r a uma  Judith He rma n (1997) T

ra uma a nd Re c o ve ry

 Pha se One / Sa fe ty:  Pha se T

wo / Re me mb ra nc e a nd Mo urning

 Pha se T

hre e / Re c o nne c tio n

 Ne w q ue stio ns o f va lidity o f this mo de l?

L GBT T ra uma a nd Dome stic Viole nc e

Dive rsity issue s  E

ffe c ts o f dive rse va ria b le s: so c ia l sta tus

 Ge nde r (T

  • lin & F
  • a , 2008)

Gre a te r inc ide nc e o f tra uma / PT

SD

T

ype s o f tra uma

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8/13/2018 20

L GBT T ra uma a nd Dome stic Viole nc e

Dive rsity issue s

  • Spe c ific po pula tio ns
  • Ve te ra ns (Ba ke r e t a l., 2009; E

va ns, 2010)

  • Culture (Dia s, 2008)
  • Se xua l o rie nta tio n (Ro b e rts, A., Auste n, S., Co rliss, H. Va nde rmo rris,

A.& K

  • e ne n, K

., 2009).

  • Ado le sc e nts (Pe re ple tc hiko va , F

. e t a l., 2008).

L GBT T ra uma a nd Dome stic Viole nc e

Dome stic Viole nc e

De finition:

 A patte r n o f abusive be havio r in an intimate r e latio nship that is use d by o ne par tne r to gain o r maintain po we r and c o ntr

  • l o ve r

ano the r intimate par tne r . Maine Co alitio n to E nd Do me stic Vio le nc e

L GBT T ra uma a nd Dome stic Viole nc e

Dome stic Viole nc e  F

a mily Vio le nc e

 Do me stic Vio le nc e  I

ntima te Pa rtne r Vio le nc e Ho lt, 2014

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8/13/2018 21

L GBT T ra uma a nd Dome stic Viole nc e

Dome stic Viole nc e

Dyna mic s o f Do me stic / Intima te Pa rtne r Vio le nc e

  • Ve r

bal abuse

  • Physic al abuse
  • Se xual abuse
  • Psyc hologic al/ e motional abuse
  • E

nvir

  • nme ntal abuse
  • E

c onomic abuse

  • Isolation
  • Intimidation
  • Use of Pr

ivile ge NCAVP, 2010

L GBT T ra uma a nd Dome stic Viole nc e

Dome stic Viole nc e Sta tistic s: Na tiona l

  • On a ve ra g e , 24 pe o ple pe r minute a re vic tims o f ra pe , physic a l

vio le nc e o r sta lking b y a n intima te pa rtne r in the Unite d Sta te s — mo re tha n 12 millio n wo me n a nd me n o ve r the c o urse o f a ye a r.

  • Ne a rly 3 in 10 wo me n (29%) a nd 1 in 10 me n (10%) in the US ha ve

e xpe rie nc e d ra pe , physic a l vio le nc e a nd/ o r sta lking b y a pa rtne r a nd re po rt a re la te d impa c t o n the ir func tio ning .

NCADV, 2018

L GBT T ra uma a nd Dome stic Viole nc e

Dome stic Viole nc e Sta tistic s: Na tiona l

  • Ne a rly, 15% o f wo me n (14.8%) a nd 4% o f me n ha ve b e e n injure d a s

a re sult o f I PV tha t inc lude d ra pe , physic a l vio le nc e a nd/ o r sta lking b y a n intima te pa rtne r in the ir life time .

  • 1 in 4 wo me n (24.3%) a nd 1 in 7 me n (13.8%) a g e d 18 a nd o lde r in

the Unite d Sta te s ha ve b e e n the vic tim o f se ve re physic a l vio le nc e b y a n intima te pa rtne r in the ir life time .

  • F

e ma le s a g e s 18 to 24 a nd 25 to 34 g e ne ra lly e xpe rie nc e d the hig he st ra te s o f intima te pa rtne r vio le nc e .

NCADV, 2018

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8/13/2018 22

L GBT T ra uma a nd Dome stic Viole nc e

Dome stic Viole nc e Sta tistic s: Ma ine  Ove r the pa st de c a de , do me stic vio le nc e ho mic ide s ha ve

a c c o unte d fo r ne a rly ha lf o f a ll murde rs in o ur sta te , c o mpa re d with a b o ut 16 pe rc e nt na tio na lly.

 I

n 2013, 5,487 do me stic vio le nc e inc ide nts we re re po rte d to Ma ine la w e nfo rc e me nt, c o mprising a lmo st ha lf o f a ssa ult re po rts. Ma ny

  • the r do me stic vio le nc e inc ide nts we nt unre po rte d.

 Arre sts we re ma de in o nly 17.4% o f re po rte d inc ide nts. NCADV, 2014

L GBT T ra uma a nd Dome stic Viole nc e

Dome stic Viole nc e Sta tistic s: Ma ine  I

n 2013, the re we re 12 do me stic vio le nc e ho mic ide s in Ma ine , c o mprising a lmo st ha lf o f a ll ho mic ide s.

 46% o f do me stic vio le nc e ho mic ide s in Ma ine fro m 2012 to 2013

we re c o mmitte d using fire a rms.

 On o ne da y in 2014, Ma ine ’ s e ig ht do me stic vio le nc e pro g ra ms

se rve d 439 vic tims/ survivo rs o f do me stic vio le nc e ; 55 re q ue sts fo r se rvic e s we re de nie d due to la c k o f re so urc e s.

NCADV, 2018

L GBT T ra uma a nd Dome stic Viole nc e

Dome stic Viole nc e Cyc le of a buse T e nsion building Abuse / Ac ute viole nc e R e c onc ilia tion/ Hone ymoon Ca lm

Wa lke r (1984)

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8/13/2018 23

L GBT T ra uma a nd Dome stic Viole nc e L GBT T ra uma a nd Dome stic Viole nc e L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT

 Pa rtne r Ab use do e s no t ne c e ssa rily invo lve physic a l vio le nc e  “Pa rtne r,” re fe rs to a ra ng e o f intima te re la tio nships inc luding :  Spo use  Girlfrie nd/ Bo yfrie nd/ Bo o  Pla y Pa rtne r  Da te  Ho o k-up  L

  • ve r

 Se x pa rtne r  L

ife Pa rtne r

Pre sle y, 2017

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8/13/2018 24

L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT What IPV is not:  A c o mmunic a tio n issue o r style .  A re la tio nship pro b le m.  T

he re sult o f stre ss.

 T

he re sult o f a ng e r ma na g e me nt diffic ultie s.

 An impulse c o ntro l pro b le m.  Co de pe nde nc e .  T

he re sult o f sub sta nc e a b use . Ho lt, 2014

L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT : Cha lle ng e s  Ho mo pho b ia  L

a c k o f a wa re ne ss a nd de nia l within the L GBT c o mmunity

 Se rvic e s a re o rie nte d prima rily to he te ro se xua l wo me n  L

a c k o f a wa re ne ss in the “ma instre a m” a nti-DV mo ve me nt.

 Unde rre p o rting  F

e a r o f disc lo sure o f o ne ’ s se xua l o rie nta tio n o r g e nde r e xpre ssio n o r

  • f “b e ing o ute d.”

L GBT Intima te Pa r tne r Viole nc e

L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT : Pr e va le nc e Se xua l Minor ity Wome n

  • hig he r pre va le nc e o f life time e xpe rie nc e s o f I

PV a mo ng b ise xua l wo me n tha n he te ro se xua l wo me n (Wa lte rs e t a l, 2013). Bise xua l wo me n a re 1.8 time s mo re like ly to re po rt e ve r ha ving e xpe rie nc e d I PV tha n he te ro se xua l wo me n

  • re po rte d life time pre va le nc e o f I

PV a mo ng le sb ia ns is hig he r tha n he te ro se xua l wo me n, b ut this is no t a sta tistic a lly sig nific a nt diffe re nc e .

Brown & He rman, 2015

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8/13/2018 25

L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT : Pr e va le nc e Se xua l Minor ity Wome n  Bise xua l wo me n a re 2.6 time s mo re like ly to re po rt e ve r ha ving

e xpe rie nc e d intima te pa rtne r se xua l vio le nc e c o mpa re d to he te ro se xua l wo me n.

 3.6% o f le sb ia n wo me n ha d e xpe rie nc e d I

PSA in the ir life time s

Br

  • wn & He r

ma n, 2015

L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT : Pr e va le nc e Se xua l Minor ity Me n  Bise xua l me n mo re like ly to re po rt e ve r ha ving e xpe rie nc e d I

PV tha n he te ro se xua l me n, a nd g a y me n se e m le ss like ly tha n he te ro se xua l me n to re po rt e ve r ha ving e xpe rie nc e d I PV, a ltho ug h diffe re nc e s we re no t sta tistic a lly sig nific a nt.

 26.9% o f g a y me n ha d e xpe rie nc e d I

PV in the ir life time s a nd 12.1% ha d e xpe rie nc e d I PV in the pa st ye a r

Brown & He rman, 2015

L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT T r a nsg e nde r  F

inding s o f life time I PV a mo ng tra nsg e nde r pe o ple fro m purpo sive studie s ra ng e fro m 31.1% to 50.0%

 L

ife time pre va le nc e o f I PV a mo ng tra nsg e nde r a nd c isg e nde r pe o ple : 31.1% o f tra nsg e nde r pe o ple a nd 20.4% o f c isg e nde r pe o ple ha d e ve r e xpe rie nc e d I PV o r da ting vio le nc e (L a ng e nde rfe r- Ma g rude r, 2014).

Br

  • wn & He r

ma n, 2015

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8/13/2018 26

L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT : R isk F a c tor s: Vic timiza tion

  • R

a c ia l minority sta tus

  • L
  • we r

soc ioe c onomic sta tus

  • Young e r

a g e

  • De a f/ ha r

d of he a r ing

  • Substa nc e use / a buse / de pe nde nc e
  • L
  • w se lf- e ste e m
  • Risky se xua l be ha vior
  • Vic tim Bla ming a ttitude s

E dwa r ds, Syla ska & Ne a l (2015)

L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT : R isk F a c tor s: Vic timiza tion

  • L

a c k of powe r in r e la tionships

  • Atta c hme nt a nxie ty
  • Child a buse / witne ssing IPV a s a c hild
  • HIV+ sta tus
  • Psyc holog ic a l/ physic a l he a lth pr
  • ble ms
  • Histor

y of se x wor k

  • Histor

y of inc a r c e r a tion

E dwards, Sylaska & Ne al (2015)

L GBT T ra uma a nd Dome stic Viole nc e

Intimate Partne r Viole nc e (IPV) and L GBT : Risk F ac tors: Pe rpe tration

  • Inte rpe rsonal proble ms
  • Gre ate r c onformity to masc uline norms
  • L

e ss se c ure attac hme nts

  • Gre ate r psyc hologic al distre ss
  • More substanc e use / abuse de pe nde nc y
  • Ge ne ral aggre ssive ne ss
  • Suppr

e ssion of e motional vulne r ability

  • High ne e d for c ontrol
  • L
  • we r soc ioe c onomic status

E dwards, Sylaska & Ne al (2015)

slide-27
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8/13/2018 27

L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT : R isk F a c tor s: Pe r pe tr a tion

  • L

e ss e duc a tion

  • R

a c ia l minority sta tus

  • L
  • w se lf e ste e m
  • HIV+ sta tus
  • Unpr
  • te c te d se xua l inte r

c our se

  • Child a buse / e xposur

e to IPV a s a c hild

  • Pe r

sona lity disor de r e d

  • Poor

r e la tionship Quality E dwa r ds, Syla ska & Ne a l (2015)

L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT : Sig ns of IPV

 Bruise s o r injurie s tha t lo o k like the y c a me fro m c ho king , punc hing , o r b e ing thro wn

do wn. Bla c k e ye s, re d o r purple ma rks a t the ne c k, a nd spra ine d wrists a re c o mmo n injurie s in vio le nt re la tio nships.

 Atte mpting to hide b ruise s with ma ke up o r c lo thing  Ma king e xc use s like tripping o r b e ing a c c ide nt-pro ne o r c lumsy. Ofte n the

se rio usne ss o f the injury do e s no t ma tc h up with the e xpla na tio n.

 Ha ving fe w c lo se frie nds a nd b e ing iso la te d fro m re la tive s a nd c o wo rke rs a nd ke pt

fro m ma king frie nds

 Ha ving to a sk pe rmissio n to me e t, ta lk with, o r do thing s with o the r pe o ple  Ha ving little mo ne y a va ila b le ; ma y no t ha ve c re dit c a rds o r e ve n a c a r We bMD 2018

L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT Othe r be ha vior s in c ouple :

  • Ove r

ly pr

  • te c tive pa r

tne r s

  • Ove r

ly timid pa r tne r s

  • Une xpla ine d injur

ie s Wa lla c e , 2015

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L GBT T ra uma a nd Dome stic Viole nc e

Intima te Pa r tne r Viole nc e (IPV) a nd L GBT Why do pe ople sta y?

  • L

a c k o f re so urc e s a nd suppo rt.

  • L

a c k o f se lf-e ste e m / se lf-wo rth

  • Be lie f tha t the y a re no t a c tua lly vic tims.

Why don’t pe ople le a ve ?

  • L
  • ve s the a b use r
  • I

s a sha me d to a dmit she ’ s b e ing a b use d

  • Be lie ve s the a b use r whe n he sa ys it wo n’ t ha ppe n a g a in
  • Do e s no t kno w whe re to g o to g e t he lp

Holt, 2014

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Intima te Pa r tne r Viole nc e : Myths  Wo me n a re g e ne ra lly no t vio le nt.  Whe n wo me n a re vio le nt, the vio le nc e the y pe rpe tra te is no t a s se ve re

a s the vio le nc e pe rpe tra te d b y me n.

 Me n a re no t c o mmo nly vic tims o f intima te pa rtne r vio le nc e .  Physic a l size a nd stre ng th de te rmine whic h pa rtne r is mo st a pt to b e

vio le nt.

 Ge nde r o r g e nde r ro le s de te rmine whic h pa rtne r is mo st a pt to b e

vio le nt.

 I

t is e a sie r fo r L GBT vic tims to le a ve a b usive re la tio nship s tha n it is fo r he te ro se xua l vic tims to do so .

Holt, 2014

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Intima te Pa r tne r Viole nc e : Myths  L

GBT intima te pa rtne r vio le nc e is mutua l.

 L

GBT intima te pa rtne r vio le nc e usua lly ma nife sts a s c o mmo n c o uple vio le nc e .

 Disc ussio n o f L

GBT intima te pa rtne r vio le nc e te nds to inc re a se so c ie ta l pre judic e & disc rimina tio n a g a inst L GBT pe o ple .

 Ma le vic tims c a n g e ne ra lly a c c e ss b a tte re d wo me n’ s re so urc e s &

se rvic e s.

 T

ra nsg e nde r do me stic vio le nc e is mo re simila r to he te ro se xua l do me stic vio le nc e tha n to sa me -g e nde r do me stic vio le nc e .

Holt, 2014

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L GBT T ra uma a nd Dome stic Viole nc e

L GBT Intima te Pa r tne r Viole nc e : R e a litie s

  • Wo me n who e xpe rie nc e do me stic vio le nc e a re 80% mo re like ly to

ha ve a stro ke , 70% mo re like ly to ha ve he a rt dise a se , 60% mo re like ly to ha ve a sthma , a nd 70% mo re like ly to drink he a vily tha n wo me n who ha ve no t e xpe rie nc e d it (CDC, 2008).

  • Do me stic vio le nc e c a n inc re a se the risk o f HI

V infe c tio n a nd re - infe c tio n, o the r ST D’ s, a nd e a ting diso rde rs, inte rna l b le e ding , b ro ke n b o ne s, he a d tra uma , se ve re la sting disa b ilitie s, c hro nic g yne c o lo g ic a l a nd c e ntra l ne rvo us syste m pro b le ms a nd de a th (Willia ms, 2008).

Cite d in Holt, 2014

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Intima te Pa r tne r Viole nc e : R e a litie s  Ga y a nd b ise xua l me n who a re vic tims o f I

PV a re mo re like ly to re po rt suffe ring fro m se rio us he a lth pro b le ms inc luding he a rt dise a se , hype rte nsio n, de pre ssio n, a nxie ty, a nd a re mo re like ly to e ng a g e in unhe a lthy b e ha vio rs suc h a s sub sta nc e a b use a nd unpro te c te d se x (Jo urna l o f Urb a n He a lth, 2007).

 Me n infe c te d with HI

V a re a t hig he r risk fo r psyc ho lo g ic a l a nd physic a l a b use fro m ma le pa rtne rs tha n the ir HI V ne g a tive pe e rs (Gre e nwo o d e t a l, 2002).

Cite d in Holt, 2014

L GBT T ra uma a nd Dome stic Viole nc e

L GBT IPV: Similar itie s to He te r

  • se xual

 No o ne de se rve s to b e a b use d.  Ab use c a n b e physic a l, se xua l, a nd ve rb a l b e ha vio r to c o e rc e o r humilia te ;

e mo tio na l; o r psyc ho lo g ic a l.

 Ab use o fte n o c c urs in a c yc lic fa shio n.  Ab use c a n b e le tha l.  Purpo se o f the a b use is to ma inta in c o ntro l a nd po we r o ve r o ne ’ s pa rtne r. Ro utine

intimida tio n is use d to g a in tha t po we r.

 T

he a b use d pe rso n fe e ls iso la te d, a fra id, a nd usua lly c o nvinc e d tha t the y a re a t fa ult.

 T

he inc ide nc e ra te in vic tims o f fe ma le sa me se x b a tte ring is a ppro xima te ly the sa me a s the inc ide nc e ra te in vic tims o f fe ma le he te ro se xua l vic tims R

  • ge rs, e t al. 2016
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8/13/2018 30

L GBT T ra uma a nd Dome stic Viole nc e

L GBT IPV: F

  • r

ms o f Batte r ing Spe c ific to L GBT pe o ple  Unlike he te ro se xua l b a tte ring , AL

WAYS o c c urs within the c o nte xt o f so c ie ta l a nti-L GBT b ia s (ho mo / b i/ tra ns pho b ia ), a nd c o mmo nly HI V- re la te d b ia s, b o th o f whic h a re ve ry po we rful c o ntro l ta c tic s a nd c o mplic a te the ide ntific a tio n o f a b use , he lp se e king b e ha vio rs, a nd ultima te ra mific a tio ns / o utc o me s.

Rog e r s, e t a l. 2016

L GBT T ra uma a nd Dome stic Viole nc e

L GBT IPV: F

  • r

ms o f Batte r ing Spe c ific to L GBT pe o ple  Outing a nd thre a ts o f o uting to fa mily, frie nds, e mplo ye r, po lic e ,

c o mmunity, o r in c hild c usto dy dispute s.

 Re info rc ing fe a rs tha t no o ne will he lp the vic tim o r tha t the y

“de se rve ” the a b use

 Justifying a b use with the no tio n tha t pa rtne r is no t “re a lly” L

GBT .

 T

e lling the pa rtne r tha t a b usive b e ha vio r is a no rma l pa rt o f L GBT re la tio nships o r tha t it c a n’ t b e DV b e c a use it is o c c urring b e twe e n L GBT individ ua ls.

 De nying vic tim a c c e ss to L

GBT re so urc e s o r e ve nts

Rog e rs, e t a l. 2016

L GBT T ra uma a nd Dome stic Viole nc e

L GBT IPV: F

  • r

ms o f Batte r ing Spe c ific to L GBT pe o ple

 Po rtra ying the vio le nc e a s mutua l o r e ve n c o nse nsua l.  De pic ting the a b use a s pa rt o f S/ M  So me L

GBT survivo rs kno w fe w o r no o the r L GBT fo lks a nd le a ving the a b use r c o uld me a n iso la tio n fro m L GBT c o mmunity.

 L

GBT c o mmunity ma y b e sma ll a nd e ve ryo ne the survivo r kno ws ma y so o n kno w

  • f the a b use .

 Ab use r c a n use c hildre n in re la tio nship b e c a use if survivo r le a ve s, she ha s no

pa re nta l rig hts to kids

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L GBT T ra uma a nd Dome stic Viole nc e

L GBT IPV: F

  • r

ms o f Batte r ing Spe c ific to L GBT pe o ple

 If the kids a re the survivo rs, the c o unty ma y ta ke the kids a wa y fro m the “vio le nt,

ho mo se xua l de via nt”

 Mo re diffic ulty finding a ppro pria te suppo rt  Myth o f mutua l b a tte ring pre va ils  Utilizing se rvic e s suc h a s le g a l syste m is like “c o ming o ut”  Ha rd to find L

GBT sympa the tic frie nds sinc e c o mmunity ma y no t b e e a g e r to “a ir dirty la undry”

L GBT T ra uma a nd Dome stic Viole nc e

L GBT IPV: Unique e le me nts fo r T r ansge nde r c lie nts

  • Co mpa re d to pe o ple who did no t ide ntify a s tra nsg e nde r, tra nsg e nde r

survivo rs we re two time s mo re like ly to fa c e thre a ts/ intimida tio n, ne a rly two time s mo re like ly to e xpe rie nc e ha ra ssme nt, a nd o ve r fo ur time s mo re like ly to fa c e po lic e vio le nc e in re spo nse to re po rting IPV.

  • Ge ne ra lly hig h ra te s o f vio le nc e , tra uma , a nd disc rimina tio n in the live s o f

tra nsg e nde r individua ls ma y ha ve a c o mpo unding e ffe c t, influe nc ing tra nsg e nde r IPV survivo rs’ willing ne ss to ide ntify a b use o r se e k he lp

  • luc ky to e ve r find lo ve , e ve n if tha t lo ve turns vio le nt
  • c a n’ t c o nc e ptua lize the ir tra ns pa rtne r’ s b e ha vio r a s a b usive b e c a use

the y vie we d the se pa rtne rs a s b e ing so o ppre sse d the mse lve s

NCAVP, 2015

L GBT T ra uma a nd Dome stic Viole nc e

L GBT IPV: Spe c ific Sub- popula tions T wo- Spirit L GBT Na tive pe ople s

  • 78% o f T

wo -Spirit wo me n re po rte d e xpe rie nc ing physic a l a ssa ult a nd 85% re po rte d e xpe rie nc ing se xua l a ssa ult (L e ha vo t e t a l. 2009).

Immig r a nts a nd r e fug e e s

  • histo ry o f b ia s a g a inst immig ra nts, e spe c ia lly L

GBT

  • thre a ts a g a inst immig ra tio n sta tus

Re ligious and Spir itual L GBT

  • re lig io us c o mmunitie s c a n b e he lpful/ so urc e o f o ppre ssio n

R

  • g e rs e t a l., 2016
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L GBT T ra uma a nd Dome stic Viole nc e

L GBT IPV: Unique e le me nts fo r HIV-po sitive c lie nts  Dire c t tra nsmissio n thro ug h se xua l vio le nc e .  I

ndire c t tra nsmissio n thro ug h se xua l risk ta king .

 I

ndire c t tra nsmissio n thro ug h ina b ility to ne g o tia te sa fe r se x pra c tic e s / c o ndo m use .

 Vio le nc e a s a c o nse q ue nc e o f b e ing HI

V +.

 Vic tims o f I

PV a re 1.5 time s mo re like ly to c o ntra c t HI V tha n tho se who ha ve no t e xpe rie nc e d I PV (Wo rld He a lth Org a niza tio n, 2013).

World He alth Organization, 2014

L GBT T ra uma a nd Dome stic Viole nc e

L GBT IPV: Unique e le me nts fo r HIV-po sitive c lie nts  Disc ussing sa fe r se x within a vio le nt re la tio nship o fte n e sc a la te s a b use

(Pa jo uhi, 2000; Co b b , 2008; Go re -F e lto n e t a l, 2007).

 HI

V sta tus ma y impa c t the de c isio n to sta y o r le a ve a n a b usive pa rtne r (L e te llie r, 1996).

 69% o f b a tte re d g a y a nd b ise xua l me n who we re HI

V + indic a te d tha t the fe a r o f b e c o ming sic k a nd dying a lo ne pla ye d a ma jo r pa rt in the de c isio n to re ma in in a n a b usive re la tio nship (Me rrill & Wo lfe , 2000).

Cite d in Holt, 2014

L GBT T ra uma a nd Dome stic Viole nc e

L GBT IPV: HIV-status use d as a we apo n  T

hre a ts to re ve a l HI V + sta tus to o the rs to c a use ha rm.

 Se xua lly humilia ting o r de g ra ding the vic tim fo r ha ving HI

  • V. T

e lling the vic tim he is “dirty” o r unde sira b le .

 I

so la ting the vic tim o n the b a sis tha t he po se s a thre a t o f infe c tio n to o the rs.

 T

hre a te ning o r re fusing to a ssist the vic tim whe n he is sic k.

 Use the vic tim’ s HI

V + sta tus to justify o r e xc use the a b use r’ s vio le nc e . Ho lt, 2014

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L GBT T ra uma a nd Dome stic Viole nc e

L GBT IPV: HIV-status use d as a we apo n

  • Ab use rs ma y ra pe o r se xua lly a ssa ult the ir vic tims witho ut

c o ndo ms o r inte ntio na lly infe c t the ir pa rtne rs with HI V to ke e p the m fro m le a ving o r a s punishme nt.

  • Ab use rs ma y fo rc e the ir vic tims to e ng a g e in se x with o the rs.
  • Ab use rs ma y use the vic tim’ s HI

V sta tus a s a n e xc use fo r g o ing

  • utside the re la tio nship fo r se x

L GBT T ra uma a nd Dome stic Viole nc e

L GBT IPV: HIV-status use d as a we apo n

  • Ab use rs ma y pre ve nt vic tims fro m se e king o r o b ta ining me dic a l

c a re a nd so c ia l se rvic e s.

  • Ab use rs ma y fo rb id vic tims fro m a pplying fo r disa b ility o r fo rc e the

vic tim to use disa b ility b e ne fits to suppo rt him o r pa y fo r a lc o ho l, drug s, a nd o the r e xpe nditure s.

  • Ab use rs ma y de stro y me dic a l re c o rds, me dic a tio n, immig ra tio n

do c ume nts, fo rms o f ide ntific a tio n, a nd/ o r a ny pro pe rty o r e q uipme nt ne e de d b y the vic tim (c a ne s, whe e lc ha irs, e tc .)

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Sc re e ning a nd Asse ssme nt Who is pe r c e ive d a s he lpful?

  • Individua l c ounse lor

s

  • She lte r

s

  • He a lth c a r

e pr

  • vide r

s

  • L

a w e nfor c e me nt Br

  • wn a nd He r

ma n, 2015

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L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Sc re e ning and Asse ssme nt: Dynamic s to Conside r Age nc y/ Se rvic e Provide rs

  • ma y no t trust a ssura nc e s tha t se rvic e s a re fo r a ll.

Batte re rs

  • le ss like ly to inc rimina te b a tte re r sinc e it me a ns “a iring dirty la undry” a nd

furthe r ma rg ina lizing a n o ppre sse d c o mmunity me mb e r. Wa nt the m to g e t he lp inste a d.

Polic e

  • L

GBT vic tim ma y no t wa nt to invo lve po lic e

Sa fe ty

  • Wha t do e s this me a n to L

GBT ?

Holt, 2014

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Sc re e ning a nd Asse ssme nt Br

  • wn a nd Gr
  • sc up (2008)
  • pre se nte d sc e na rio s o f do me stic vio le nc e to 120 c risis c e nte r wo rke rs with

sa me fa c ts, just g e nde rs o f pa rtic ipa nts c ha ng e d.

  • pa rtic ipa nts ra nke d sa me -se x DV a s le ss se ve re a nd le ss like ly to g e t

wor se tha n the sa me sc e na rio a mo ng he te ro se xua l pa irs.

  • the se kinds o f b ia se s ma y a ffe c t a b ility o f c risis sta ff to e ve n ide ntify I

PV in the L GBT c o mmunity

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Sc re e ning a nd Asse ssme nt

  • Be twe e n 2010 a nd 2011, L

GBQT survivo rs re po rte d a n inc r

e a se of inc ide nc e s in whic h the polic e a r r e ste d both the a buse r a nd vic tim

whe n c a lle d (28.4% up fro m 21.9%), a n inc r

e a se in the pe r c e nta g e of L GBQT * sur vivor s se e king she lte r who we r e de nie d (61.6% up fro m

44.6%), a nd a de c r

e a se in the pe r c e nta g e of L GBQT * sur vivor s who r e c e ive d r e que ste d or de r s of pr

  • te c tion (78.1% do wn fro m 83.7%)
  • T

ra nsg e nde r I PV survivo rs we r

e ove r six time s mor e like ly to e xpe r ie nc e physic a l viole nc e while inte r a c ting with the polic e tha n o the r survivo rs,

a nd mor

e like ly to e xpe r ie nc e ha te viole nc e in she lte r s tha n o the r

survivo rs

NCAVP, 2015

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L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Sc r e e ning - E nsur e pr iva c y Ope ning the disc ussion

  • “Be c a use a b use a ffe c ts so ma ny pe o ple , I like to a sk a ll o f my pa tie nts a b o ut

a b use .” Ask a bout a buse a nd the n r e spond If abuse is disc lose d

  • E

duc a te a b o ut IPV.

  • Asse ss sa fe ty a nd le tha lity risk.
  • De ve lo p imme dia te sa fe ty pla n in c o lla b o ra tio n with the pa tie nt.

If abuse is not disc lose d, but you suspe c t

  • L

e t he r/ him kno w tha t yo u a re a va ila b le F lorida State Unive rsity, 2014

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Asse ssme nt  De te rmine fre q ue nc y a nd se ve rity o f a b use .  T

ype o f a b use (Situa tio na l, Co mmo n Co uple s, I ntima te T e rro rism).

 Diffe re ntia te b e twe e n Vic tim a nd Ab use r.  De te rmine le ve l o f po te ntia l le tha lity. Holt, 2014

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Asse ssme nt  Intimate par tne r vio le nc e is always a tr e atme nt pr io r ity – r e gar dle ss

  • f o the r

issue s o r c o nditio ns.  I f the c lie nt ha s a sub sta nc e a b use pro b le m, it sho uld b e tre a te d c o nc urre ntly with the do me stic vio le nc e .  Gro up is the mo da lity o f c ho ic e fo r survivo rs a nd b a tte re rs.  Co uple s a nd fa mily c o unse ling is da ng e ro us, c a n inc re a se vio le nc e , a nd is c o ntra indic a te d . Holt, 2014

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L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Asse ssme nt a nd Inte rve ntion

  • Ne ve r sug g e st tha t a vic tim le a ve a n a busive re la tionship

without a re a listic a nd solid sa fe ty pla n, support, a nd informa tion. T his is da ng e rous a nd c a n put the vic tim’s life a t risk.

  • Be re a listic a b o ut re fe rra ls a nd pre pa re the c lie nt fo r the m.

F

  • r e xa mple , if yo u re fe r a c lie nt into she lte r, b e ho ne st with

he r/ him a b o ut the c ha lle ng e s she ma y e nc o unte r.

Holt, 2014

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Asse ssme nt a nd Inte rve ntion

Ma nda te d re porting ?

 He a lth c a re pro vide rs?  Me nta l he a lth pra c titio ne rs a re NOT

ma nda te d re po rte rs fo r intima te pa rtne r vio le nc e b ut a re re q uire d to re po rt c hild a b use tha t o c c urs a s a re sult o f I PV o r thre a ts unde r T a ra so ff.

 Me nta l he a lth pra c titio ne rs a re re q uire d to re po rt whe n the y le a rn

tha t a mino r ha s b e e n in the pre se nc e o f o r ha s witne sse d I PV

Holt, 2014

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Asse ssme nt a nd Inte rve ntion Re fe rra l options in Ma ine

24-hour he lpline : 1.866.834.HE L P

F amily Crisis Se rvic e s (Cumbe r la nd County)

www.fa milyc risis.o rg

Ca r ing Unlimite d (Yor k County)

www.c a ring -unlimite d .o rg

F a mily Viole nc e Pr

  • je c t (Ke nne be c & Some r

se t Countie s)

www.fa milyvio le nc e p ro je c t.o rg

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L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Asse ssme nt a nd Inte rve ntion Re fe rra l options in Ma ine L GBT Q+ Advisory T a sk F

  • rc e

Co- Chairs: Sa mma Abdur r a g ib: sa ma a @ mc e dv.o rg Ka tie Kondr a t: ka tie @ me c a sa .o rg

L GBT T ra uma a nd Dome stic Viole nc e

  • L

GBT Dome stic Viole nc e : Asse ssme nt a nd Inte rve ntion

  • How to ma na g e a busive r

e la tionships

  • I

de ntify wa rning sig ns o f a b use :

  • T

a ke a c tio ns b e fo re a vio le nt inc ide nt to insure yo ur pro te c tio n:

  • Pa c k a b a g with impo rta nt thing s yo u’ d ne e d (mo ne y, ke ys,

c lo thing , me dic a tio n, re c o rds/ d o c ume nts, e tc .) if yo u ha d to le a ve yo ur ho me q uic kly

  • Asse ss yo ur risks if sta y in o r le a ve re la tio nship

Cor ne r stone F

  • unda tion, 2003

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Asse ssme nt and Inte rve ntion How to manage abusive re lationships  During a n a b usive inc ide nt:  Sta y a wa y fro m the kitc he n (the a b use r c a n find we a po ns, like knive s,

the re )

 Sta y a wa y fro m the b a thro o m o r a ny o the r sma ll spa c e whe re the

a b use r c o uld tra p yo u

 Go to a ro o m with a do o r o r a windo w so tha t yo u c a n e sc a pe  Go to a ro o m with a pho ne so tha t yo u c a n c a ll fo r he lp, lo c king the

a b use r o utside if po ssib le

 Ca ll the po lic e rig ht a wa y b e fo re the situa tio n e sc a la te s Corne rstone F

  • undation, 2003
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L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Asse ssme nt a nd Inte rve ntion How to ma na g e a busive r e la tionships  Afte r a n a b usive inc ide nt  I

f a po lic e o ffic e r c o me s, te ll him o r he r wha t ha ppe ne d a nd g e t his o r he r na me fo r yo ur o wn re c o rds

 Do c ume nt a nd ta ke pic ture s o f a ny injurie s a nd se e k me dic a l

a tte ntio n

Cor ne r stone F

  • unda tion, 2003

L GBT T ra uma a nd Dome stic Viole nc e CASE DISCUSSIONS L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic : Ca se disc ussions: Sha ron

1.

Wha t e le me nts of a buse do you se e on the L GBT Powe r a nd Contr

  • l Whe e l?

2.

Do you a dvise Sha r

  • n to e nd this r

e la tionship? How do you he lp he r e xplor e this r e la tionship?

3.

Wha t do you te ll he r to do if she is de c iding to sta y in this r e lationship?

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L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic : Ca se disc ussions: Ga ry

1.

Wha t e le me nts of a buse do you se e on the L GBT Powe r a nd Contr

  • l Whe e l?

2.

Do you a dvise Ga r y to e nd this re lationship? How do you he lp him e xplor e this r e la tionship?

3.

Wha t do you te ll him to do if he is de c iding to sta y in this r e lationship?

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Ca se disc ussions: Ka re n

1.

Wha t e le me nts of a buse do you se e on the L GBT Powe r a nd Contr

  • l Whe e l?

2.

Do you a dvise Ka r e n to e nd this re lationship? How do you he lp him e xplor e this r e la tionship?

3.

Wha t do you te ll he r to do if she is de c iding to sta y in this r e lationship?

L GBT T ra uma a nd Dome stic Viole nc e

L GBT Dome stic Viole nc e : Ca se disc ussions: Pa t

  • 1. Wha t do you do to he lp Pa t most imme dia te ly?
  • 2. Whe r

e do you r e fe r Pa t to?

  • 3. Wha t r

e sour c e s a r e in your a r e a to he lp Pa t?

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L GBT T ra uma a nd Dome stic Viole nc e Que stions? L GBT T ra uma a nd Dome stic Viole nc e

T hank you for c oming! John M. O’Br ie n, Ph.D 251 Woodfor d St. Por tla nd, ME 04103 (207) 773-2828 x105

  • br

ie n@me ntalhe a ltha ssoc ia te s.me www.me nta lhe a ltha ssoc ia te s.me