Background

The Need

  • 75% of Alaskans have experienced or know someone who has experienced domestic violence or sexual assault.
  • Alaska Women have a 59% likelihood of experiencing interpersonal violence.
  • 84% of Alaska Native/Native American women experience violence during their lifetimes. 
  • Men have a 30.2 % likelihood of being victims of interpersonal violence.
  • Alaska’s rate of child mistreatment is 69.3% higher than the national average.
  • The Alaska rate for elder physical abuse is 2.4 times the national rate.
  • Elder psychological abuse is 1.6 times higher than the national rate.
  • An assault occurs in Alaska every hour.
  • Alaska has the highest homicide rate for female victims killed by male perpetrators. 3.4 women per 1000 are victims of homicide.
  • Alaska showed a 14.7% increase in interpersonal violence against women from 2015 to 2020.
  • One out of 9 of Alaska's women over the age of 60 experiences elder abuse in the form of psychological or physical abuse, in the past year. 

Despite the state’s high level of violence, many areas of the state lack the ability to document and collect medical evidence to help protect victims of crime.

The National Network to End Domestic Violence reports that on an average day, there are 19,159 calls for domestic violence services, equating to thirteen calls per minute. However, these services are primarily concentrated in urban areas such as Anchorage, Fairbanks, Juneau, and hub communities like Bethel, Dillingham, Nome, Kotzebue, Sitka, Ketchikan, and Utqiaġvik. Many smaller communities lack domestic violence shelters, law enforcement services, or Village Public Safety Officers, relying on intermittent State Trooper assistance for investigations. In remote villages, access to medical providers is limited, often relying on the CHAPS (community health aides) program.

A Vital Role for First Responders and Providers

Working with victims of domestic violence is a profound responsibility, as it may be their only opportunity to share their stories. Some victims may feel the shame of interpersonal violence, choosing not to engage with providers, while others fear potential repercussions if they disclose the truth. Providers play a crucial role in assisting and protecting victims, addressing complex issues that arise when seeking help. Understanding and addressing victims' needs with empathy and compassion is essential, given the intricate dynamics involved. Providers must skillfully navigate the challenges, recognizing signs of shock, ensuring proper documentation, and asking the right questions during medical examinations. Neglecting these details can lead to discounted testimonies and jeopardize the chain of custody, risking the validity of evidence in legal proceedings. First responders, including healthcare professionals, legal professionals, social workers, and law enforcement officers, make a significant impact. In instances like those reported in the Aleutian Islands, Village Public Safety Officers (VPSOs) were often the initial responders, demonstrating a correlation between their involvement, access to sexual assault kits, and increased criminal prosecution rates, as highlighted by the UAA Justice Center's findings in 2018.

The Complex Intersection of Mental Health and Interpersonal Violence

Within the realm of domestic violence, some victims concurrently grapple with mental illness, posing a challenge for practitioners to discern whether the mental health condition or an underlying domestic violence component is influencing the patient. Similarly, victims of interpersonal violence may resort to substance abuse as a coping mechanism, rationalizing that intoxication numbs the pain or allows them to deny traumatic events. Cognitive deficits, often stemming from traumatic brain injuries inflicted by perpetrators, can further complicate the situation, affecting executive thinking. Practitioners are urged to attune themselves to subtle cues when working with patients. Understanding the rules of interpersonal violence is crucial; it typically takes victims 6-8 attempts to extricate themselves from the situation. Although practitioners may find it repetitive to engage with the same patient, it's essential to recognize that the patient is navigating a process of assimilating information and strategizing a safe exit. Examining the victim's response is key, as retaliation often occurs after repeated incidents, with the victim's actions perceived as more forceful than the perpetrator's acts.

Recognizing Diverse Challenges in Patient Care

ACFTA aims to broaden provider awareness of the multifaceted nature of domestic violence, emphasizing its diverse manifestations and impact on the interview process. Factors such as cultural influences, religious beliefs, and multi-generational trauma play crucial roles in shaping victims' perspectives and presenting challenges for providers. Cultures endorsing early marriages or justifying violence within marriage pose unique hurdles, while shame and familial expectations may hinder victims from seeking help. Additionally, individuals with Fetal Alcohol Spectrum Disorder (FASD) or prenatal drug exposure face heightened vulnerability, grappling with cognitive disabilities that complicate their ability to articulate experiences. Practitioners must navigate these complexities, recognizing hidden disabilities and making informed referrals to aid victims in extricating themselves from interpersonal violence situations. These conversations are inherent in medical care, requiring practitioners to understand the nuanced narratives, appreciate the patient's complexity, and acknowledge the potential for provider burnout.

Designing a Solution

The ACFTA was developed as a collaborative effort spearheaded by Angelia Trujillo, UAA professor of nursing, in 2019 in partnership with the Alaska Council on Domestic Violence & Sexual Assault, the UAA College of Health, and the Alaska Nurses Association. Founded with a mission to extend beyond the conventional boundaries of forensic health care and to enact community-level change, the academy focuses on educating health care professionals, from nurses and doctors to nurse practitioners and physician's assistants, while broadening the scope of victimization for the wider community by using hard data.

"The challenge is we're finding lots of crossover in victimization - elder abuse, child abuse, domestic violence and sexual assault. There's a huge overlap between all of those and it does our patients a disservice when we only recognize the response for sexual assault. That's really the focus of the project,  to promote forensically-related health care for anyone of any age, gender and lifestyle," says Trujillo.

Since the creation of ACFTA, over 60 providers to date have fully completed the academy and 300 people have completed the online portion.