Abstract
ABSTRACT
Animal abuse and domestic violence are linked issues, and pet ownership is reported to play a crucial role in the choice to leave an abusive situation. Although veterinarians witness the effects of abuse and violence over the course of their careers, they have limited training regarding these issues. One mechanism for educating veterinary students while providing a service for victims of domestic violence is the creation of partnerships between domestic violence shelters and veterinary schools. These extracurricular programs can provide both care for pets belonging to victims of domestic violence and an educational platform for student participants. The goals of this study were to determine the prevalence and characteristics of domestic violence shelter partnerships (DVSPs) at North American veterinary teaching hospitals and to determine whether the presence of a DVSP was associated with increased awareness among veterinary students regarding animal abuse and domestic violence. Nine of 33 veterinary schools surveyed described a DVSP program. Students at schools with DVSPs associated with their veterinary teaching hospitals were significantly more likely to indicate that their awareness of the link between animal abuse and domestic violence had increased during veterinary school. Most veterinary students reported that they felt poorly prepared to handle domestic violence and animal abuse issues in the workplace. This study indicates that extracurricular DVSPs are a viable means of educating veterinary students regarding domestic violence and animal abuse. A need for improved education on these topics in veterinary schools across North America is identified.
The link between animal abuse and domestic violence has been well documented; in many cases, perpetrators who abuse women and children also abuse animals.1,2 From 40% to 82% of women entering domestic violence shelters report current or recent pet ownership,3–6 and among pet-owning women, 25%–71% report that their pets have been threatened or harmed by the abuser.3–7 Compared with batterers who do not abuse pets, those who do are more likely to demonstrate controlling behaviors and are more prone to sexual violence, emotional violence, marital rape, and stalking, suggesting that pet abuse may be linked to increased violence or higher risk abusive situations.6
The specific use of threats of harm or actual harm to pets as a means of exerting control over victims has also been described. Loring et al.8 reported a study of women at a family violence center who had themselves each committed an illegal act. Of the 62% of women in this group who owned pets, 75% reported threats or actual animal harm by their abusers, and 44% reported committing illegal acts such as theft, fraud, and drug trafficking specifically to prevent harm to their pets.8 This coercive and controlling behavior on the part of the abuser is related to the pivotal role that companion animals play in victims' decisions to leave an abusive situation. A study of 107 women at a domestic violence shelter found that 55% of women whose pets had been abused described their pets as very important sources of emotional support and that 40% of those whose pets had been abused delayed entry into the domestic violence shelter out of concern for their animals; 65% of women with pets who had been abused continued to worry about them after entering the shelter.5 Similarly, in another study of 41 battered women with pets, 49% reported that their partners had threatened their pets, 46% reported actual harm to a pet from the batterer, and 27% reported that their pets had affected their decision to stay or leave their abusers. Women who had pets that were threatened or abused were 7.1 and 7.9 times more likely, respectively, to be influenced by consideration of their pets in the decision to stay or leave.4
Veterinarians have an ethical, professional, and, in some states, legal responsibility to address the abuse of living creatures, but they have limited training regarding appropriate assessment and handling of these cases. In a survey of veterinary schools reported in the Journal of the American Veterinary Medical Association by Landau,9 respondents from 97% of schools agreed that veterinarians would encounter animal abuse during their careers, but only 75% addressed this topic in the curriculum, and veterinary students received an average of only 76 minutes of training regarding animal abuse during their education. Further complicating this educational deficit is the fact that current legislation for veterinary professionals regarding animal abuse is erratic, complex, and not currently compiled in a single accessible location. An extensive search of hundreds of Web sites that publish the statutes of the 50 US states and 13 Canadian provinces and territories showed that veterinarians are required to report cases of animal cruelty in 14 US states—Alabama, Arizona, California, Colorado, Illinois, Kansas, Maine, Maryland, Minnesota, Nebraska, Oklahoma, Oregon, West Virginia, and Wisconsin—and three Canadian provinces—British Columbia, Manitoba, and Ontario; however, the specific requirements of when to report (direct evidence vs. suspicion) and the type of cruelty that should be reported (several states have legislation specific to dog fighting) vary considerably.10–12 Other states do not require reporting of animal abuse but do provide immunity for veterinarians who report abuse in good faith. Despite patchy legislation and education, the American Veterinary Medical Association (AVMA) position statement on animal abuse and neglect recommends that veterinarians report these cases regardless of whether reporting is mandated by law and goes on to specify that “disclosure of abuse is necessary to protect the health and welfare of animals and people.”13
If expectations for handling animal abuse and cruelty are poorly delineated, then any responsibility on the part of veterinary professionals to address the linked problem of interpersonal violence is even less clear. In the study by Landau,9 63% of respondents believed that veterinarians would encounter human abuse, yet only 21% of schools addressed this topic, with an average of eight minutes during a student's four years of veterinary education devoted to the subject. Laws regarding veterinary reporting of domestic violence and child abuse are contentious and vary even more widely by state than laws regarding reporting of animal abuse. Veterinarians are mandated reporters of child abuse, adult abuse, or both in a few scattered states,14 despite almost nonexistent training on identification or reporting.
Educational and community service partnerships between domestic violence shelters and veterinary schools have arisen across the country.15 These programs both provide needed safe haven and medical care for pets that are seldom able to enter shelters with their owners and create an educational platform for veterinary students on the issues of animal abuse and domestic violence. In a study of human medical curricula, didactic training improved knowledge, and community service involvement improved medical student confidence and action regarding issues specific to domestic violence;16 however, no similar information exists for the veterinary medical community. The purpose of this study was to describe the prevalence and characteristics of domestic violence shelter partnerships (DVSPs) with North American veterinary teaching hospitals (VTHs) and to determine whether such programs are associated with increased awareness of these issues among veterinary students. We hypothesized that students whose schools had a DVSP would self-assess a higher level of familiarity and comfort with issues of domestic violence and animal abuse.
Two distinct surveys were distributed electronically to faculty and staff (Survey 1) and students (Survey 2) at the 33 AVMA-accredited veterinary schools in North America. Survey 1 was designed to document the existence or absence of DVSPs at the veterinary schools and to describe the characteristics of each DVSP in existence. At each school, the dean, hospital director, dean of academic affairs, and head of clinical sciences were targeted to receive a survey. As a result of varying organizational structures among the colleges and schools of veterinary medicine, not all named positions exist at all schools, and in those instances personnel with approximately equivalent job titles were contacted. Additional potential contacts identified by searching the term domestic violence on the veterinary schools' Web sites were also sent surveys. E-mailed requests to complete the electronic survey were distributed to the aforementioned contacts. Respondents were first asked to note whether their schools were affiliated with DVSPs and whether they were personally involved with the programs. If they responded affirmatively and indicated personal involvement, they were prompted to proceed to more specific survey questions regarding the organization, duration of existence, missions, and funding sources of the programs. If the respondents were aware of programs but uninvolved or if they were unsure of the existence of such programs, they were asked to suggest alternate contacts who might be able to provide further information. These secondary contacts were then invited to complete the same survey. If all contacts at a school indicated that there was no DVSP, then Survey 1 was concluded for that school. The initial survey invitation was distributed on May 1, 2011, with follow-up requests on May 19 and June 12, 2011, to personnel at schools from which no response had been received.
The second survey (Survey 2) was distributed to students at each North American veterinary college via the dean of academic affairs, president of the AVMA student chapter, or both. These individuals were contacted and asked to e-mail the electronic survey link to the student body at each school. Survey items for all respondents addressed awareness of domestic violence and animal abuse and veterinarians' responsibilities regarding these issues. If students indicated that they were aware of a link between animal abuse and domestic violence, they were prompted to respond to additional survey items addressing when this awareness developed and whether it had changed throughout veterinary school. Responses to Survey 2 were anonymous, although students were asked to identify their veterinary schools and year of the curriculum in which they were currently enrolled. The initial survey invitation was distributed to deans of academic affairs on May 1, 2011, with a follow-up request on May 19, 2011, to those at schools from which no response had been received. If deans indicated that they did not want their students to be contacted, they were removed from future mailings; otherwise, AVMA student chapter presidents were asked to distribute the survey on June 22, 2011, at schools from which students had not yet responded.
Approval from the University of Georgia Human Subjects Institutional Review Board was obtained for Survey 1 and Survey 2 (Project Number 2011–10740–0). American Association of Veterinary Medical Colleges Survey Committee approval was additionally obtained for Survey 2, because it targeted veterinary students. (The surveys are available as a supplement at http://dx.doi.org/10.3138/jvme.0912-084R.)
To identify the prevailing laws in each administrative region (i.e., US state or Canadian province or territory) for comparison with student responses about legal obligations, an Internet search was used. Initially, summary legal information from the AVMA and the Humane Society Veterinary Medical Association was used; however, these summary statements were each more than a year old at the time of access, and they only provided information regarding animal cruelty. Using the Google search engine, each administrative region was individually searched, coupled with the words “law,” “legal,” “statute,” or “government” until that region's official legislative Web site was found. The design of each region's Web site varied, and search parameters compatible with each Web site were used to find statutes pertaining to mandated reporting of animal abuse, child abuse, and domestic partner abuse.
Simple descriptive statistics were generated for data from both surveys. Program descriptions from the administrative survey were not analyzed statistically. To evaluate student responses to questions regarding legal obligations to report animal abuse, child abuse, and domestic partner abuse, legal statutes for each state or province were reviewed. A positive obligation to report was recorded if veterinarians were specifically named as mandated reporters or if health professionals in general or all people were named as mandated reporters. Differences among student responses within DVSP groups were tested using Fisher's exact test for binary comparisons and χ2 for comparison among more than two categorical variables. Significance was set at p<.05.
Administrators from 22 of 33 veterinary schools responded to Survey 1. Of these 22 schools, DVSP programs were identified at nine (27% of all schools surveyed) (Figure 1). An additional DVSP program terminated in 2009 was reported; details of this program were not included in the descriptive analysis, and the school was recorded as having no DVSP. Because this DVSP was no longer operational, it was unlikely to have influenced currently enrolled veterinary students. Identified DVSPs were further subdivided into two groups: those organized and run by personnel within the VTH (VTH DVSP; N=5) and those primarily controlled externally (Other DVSP; N=4). Within the veterinary colleges, the program coordinators or liaisons were primarily faculty or staff (N=8). One DVSP was coordinated jointly by faculty and a student group. One of the DVSPs controlled externally had only faculty or staff liaisons within the veterinary college, and no further information was available beyond its existence and basic organizational structure; thus, all subsequent program descriptions refer only to those eight programs for which detailed information could be obtained.
Figure 1 Identification of domestic violence shelter partnerships (DVSPs) at North American veterinary schools and colleges. The sidebar shows subcategories of programs primarily organized and managed within the veterinary teaching hospital (VTH) and those primarily organized and managed elsewhere (Other).
Programs were quite diverse with respect to organization, duration of existence, missions, and funding (Table 1). Two programs had existed for less than three years, one program for three to five years, and the most programs (N=5) for more than five years. Six programs obtained funding through private donors, four through industry donations (three programs received financial support, one received donations of goods), one received support from the VTH, and one received support from a domestic violence shelter. Services offered by DVSP programs included medical care (N=7), boarding or foster care (N=5), organizational help such as coordinating foster care (N=2), and adoption of animals surrendered by victims of domestic violence (N=1). Programs tended to serve a small number of animals; four programs cared for 10 or fewer animals annually, two programs cared for between 11 and 25 animals, and one program each cared for between 26 and 50 and more than 50 animals. All programs provided care for cats and dogs, and most programs provided care for small mammals and birds (Ns=7 and 6, respectively). Four programs provided care for horses and small ruminants or camelids, and two programs offered care for an even wider variety of species. Programs that provided boarding or foster care housed animals at the VTH (N=4), in private homes (N=4), in a kennel facility (N=2), and at animal control (N=1); in one case, the location of animal housing was kept confidential.
|
| Descriptive feature | N |
|---|---|
| Duration of existence | |
| 1–3 years | 2 |
| 3–5 years | 1 |
| >5 years | 5 |
| Funding sources* | |
| Private donors | 6 |
| Industry support, financial | 3 |
| Industry support, products | 1 |
| VTH | 1 |
| DV shelter | 1 |
| Services provided* | |
| Medical care | 7 |
| Boarding or foster care | 5 |
| Organizational assistance | 2 |
| Adoption of surrendered animals | 1 |
| No. of animals cared for annually | |
| ≤10 | 4 |
| 11–25 | 2 |
| 25–50 | 1 |
| >50 | 1 |
| Species welcomed* | |
| Dogs | 8 |
| Cats | 8 |
| Small mammals | 7 |
| Birds | 6 |
| Horses | 4 |
| Camelids or small ruminants | 4 |
| Other | 2 (spiders, no species limitations) |
| Location of pet housing, if offered* | |
| VTH | 4 |
| Private homes | 4 |
| Kennel | 2 |
| Animal control | 1 |
| Confidential | 1 |
| Means of outreach to public* | |
| Printed materials in VTH | 2 |
| Web site | 4 |
| Outreach to vet clinics | 2 |
| Public speaking | 2 |
| Through DV shelter | 5 |
| No active outreach to community (not shared to maintain confidentiality) | 1 |
| Other (police, attorneys, clergy, social workers) | 4 |
| Means of outreach to veterinary students* | |
| Classroom lectures | 3 |
| Extracurricular events | 2 |
| Clinical rotations | 7 |
| No active outreach to vet students (not shared to maintain confidentiality) | 1 |
| Other (service project opportunity) | 1 |
DV=domestic violence; DVSP=domestic violence shelter partnership; VTH=veterinary teaching hospitals
*Categories are nonexclusive.
Outreach and public education were accomplished through the local domestic violence shelter (N=5), Web sites (N=4), printed materials available at the VTH (N=2), public speaking events (N=2), and communication with local veterinary clinics (N=2). Other individuals, such as clergymen, police, attorneys, and social workers were also targets for disseminating information (N=1), and one program was kept completely confidential. Outreach to veterinary students was accomplished through clinical rotations (N=7), classroom lectures (N=3), extracurricular events (N=2), and a service project opportunity (N=1); again, the confidential program was not shared with veterinary students. All descriptive data are shown in Table 1.
Five hundred eighty students from 14 different North American veterinary schools and colleges responded to the survey. Of the respondents, 41% (N=240) were from veterinary schools that had a VTH DVSP, 15% (N=87) were from veterinary schools that had an Other DVSP, and 44% (N=253) were from veterinary schools without a DVSP (Figure 2). Students were asked to identify whether their schools were affiliated with a DVSP; 65% of students at schools with a VTH DVSP were aware of the DVSP, whereas only 25% of students at Other DVSP schools were aware of these programs (Figure 3). Because student respondents from schools in these two groups demonstrated significantly different awareness of the existence of the DVSP (p<.0001), these categories were maintained for subsequent analysis.
Figure 2 Distribution of Survey 2 respondents on the basis of the domestic violence shelter partnership (DVSP) categories of their veterinary schools and colleges. VTH DVSP=DVSP primarily organized and managed within the veterinary teaching hospital; Other DVSP=DVSP primarily organized and managed elsewhere; no DVSP=veterinary school or college with no reported DVSP.
Figure 3 Student respondents' awareness of the domestic violence shelter partnership (DVSP) differed for programs primarily organized and managed within the veterinary teaching hospital (VTH DVSP) vs. elsewhere (Other DVSP) (p<.001). * Significant difference
When asked about their awareness of cases of animal abuse or domestic violence during their time in the veterinary field, 72% of students reported awareness of animal abuse cases and 34% of students reported awareness of domestic violence cases. Students from the Other DVSP group reported the highest awareness of animal abuse and domestic violence cases (85% and 42%, respectively). However, this higher level of awareness did not quite achieve significant difference from other student groups (p=.05) for animal abuse cases. Awareness of domestic violence cases by students in the Other DVSP group was significantly greater than that in other groups (p=.009) (data not shown). Most students (93% VTH DVSP, 99% Other DVSP, 93% no DVSP) were aware of the link between animal abuse and domestic violence, with no significant differences among the groups (p=.11). When asked how their knowledge regarding the link between animal abuse and domestic violence had changed during veterinary school, students at VTH DVSP programs were more likely to report a significant increase than students in other groups, and this difference was significant (p<.001) (Figure 4).
Figure 4 Student respondents from schools with a domestic violence shelter partnership (DVSP) primarily organized and managed within the veterinary teaching hospital (VTH DVSP) were more likely to describe a significant increase in their awareness of the link between domestic violence and animal abuse during the span of their veterinary education than student respondents in other groups. Other DVSP=DVSP primarily organized and managed elsewhere; no DVSP=veterinary school or college with no reported DVSP) (p<.001). * Significant difference from VTH DVSP
Respondents documented that information regarding animal abuse and domestic violence was disseminated in myriad ways, with classroom lecture and extracurricular activities predominating at all schools. Significantly more (32%) VTH DVSP students responded that information was shared via the DVSP than Other DVSP students (10%) (p<.001). A minority of students at all schools (45% of VTH DVSP students, 43% of Other DVSP students, and 32% of no-DVSP students) indicated they felt “somewhat” or “extremely” well prepared to handle issues related to domestic violence or animal abuse in their careers; no significant difference was detected among groups (p=.08).
When questioned about the legal imperative to report animal, child, and domestic partner abuse, students in states with mandated reporting laws had poor to moderate awareness of their obligations. Overall, only 43% of student respondents accurately identified whether they had a legal obligation to report animal abuse, based on their state or province of residence. Similarly, only 47% of respondents accurately identified their legal obligation with respect to reporting child abuse. Few states or provinces mandate reporting of domestic partner abuse; 72% of respondents accurately identified their legal obligation in this category. In an attempt to identify factors that increased students' accuracy in identifying their legal obligations, responses were separately analyzed by DVSP category and by presence or absence of mandated reporting requirements in specific states or provinces. No association was found between presence of a DVSP in the respondents' schools, or between residence in states or provinces with mandated reporting requirements, and accuracy of respondents' identification of their legal obligations. Only Colorado has legislation that explicitly names veterinarians as mandated reporters of child abuse, and more students at Colorado's veterinary school knew they were legally compelled to report child abuse than at any other; however, only 55% of respondents from this school were aware of this responsibility.
Despite confusion regarding mandatory reporting laws, most student respondents believed they had an ethical responsibility to report all kinds of abuse. An ethical obligation to report animal abuse was cited by 92% of student respondents; 86% and 82% of students identified an ethical obligation to report child abuse and domestic partner abuse, respectively. This self-reported ethical obligation did not differ by presence or absence of a DVSP at the students' schools or by state or province of residence.
DVSP programs were identified at 27% of veterinary schools and colleges across North America (9 of the 22 schools and colleges that responded); additional programs may be associated with schools and colleges from which we received no response to our survey. The DVSPs had diverse organizational structures; notably, some programs were managed by personnel at the VTH, and others were primarily based elsewhere, such as the local humane society or shelter for victims of domestic violence. The location from which the DVSP was primarily run was significantly associated with student awareness of the existence of the program. This rough organizational distinction between VTH DVSP and Other DVSP programs was used for data analysis in the hope of more accurately assessing the impact of a DVSP program on students; our theory was that a DVSP housed in the VTH might be more visible to students and might therefore have greater impact on their knowledge and attitudes. However, given the extremely variable nature of these programs in organization, duration of existence, mission, personnel, and student involvement, the variable impact each DVSP has on student attitudes is likely to have more than one cause. Furthermore, only 65% of students at VTH DVSP schools (155 of the 238 VTH DVSP student respondents) were aware of the existence of the DVSP program, which may be the result of programs that had limited educational missions or of students who were not involved in extracurricular educational or service events.
Most programs were well established, having been in place for more than 5 years; however, most of these programs still cared for relatively small numbers of animals annually. These low numbers suggest that direct pet care is only one part of the mission of DVSP programs and that, as evidenced by the numerous ways in which most DVSP programs solicited student engagement, student education was an important simultaneous objective of DVSPs. Although most programs appeared to have the dual aims of teaching and service, some programs had very different philosophies about student involvement, citing safety concerns as a reason for confidentiality and limited or absent teaching and outreach.
In determining students' baseline level of experience with animal abuse and domestic violence in the veterinary field, 72% of 580 student respondents indicated they had encountered animal abuse, and more than one third of students had encountered domestic violence, verifying that these issues are both prevalent and relevant within the veterinary community. Students from schools in all DVSP categories were very aware of the link between animal abuse and domestic violence. The plurality of Other DVSP students acknowledged a slight increase in their knowledge of this link during veterinary school; in contrast, the plurality of VTH DVSP students reported a significant increase in their knowledge of this link during veterinary school, confirming that DVSP programs are a viable means of student education and suggesting that VTH DVSP programs may be more visible.
The difference in students' self-assessed preparation to manage issues surrounding abuse was not related to the presence or absence of a DVSP and, overall, veterinary students reported feeling unsure or underprepared regarding animal abuse and domestic violence. Students also had limited awareness of their legal responsibilities regarding all kinds of abuse reporting; however, the substantial majority identified an ethical obligation to report abuse regardless of their legal duties. A study by Miller and colleagues17 documented that physicians are similarly underprepared through medical school curricula to identify and report interpersonal violence. Examination of the training of physicians to recognize and report domestic violence found that residents in a variety of specialties reported having received only six to seven hours of dedicated domestic violence education. In this study, residents in training in 2001 reported an increased emphasis on domestic violence during their medical school years than residents in training in 1995. Despite this reported increased emphasis, however, the actual hours of training provided showed no identifiable increase. The residents who reported the increase in emphasis were not more likely to ask patients about domestic violence, nor did they report greater self-confidence in handling issues specific to domestic violence.17
In a separate study of medical students, although increased didactic training was shown to improve knowledge regarding domestic violence, involving students in community service programs related to interpersonal violence was shown to improve student confidence regarding identifying and acting when encountering interpersonal violence.16 The effectiveness of education that is transmitted outside the classroom—the informal and hidden curricula—has been reported for human medicine and is increasingly being recognized in veterinary medicine.18–21 All DVSPs identified in our study were extracurricular programs; the documented impact on student awareness and attitudes parallels that described in human medical education and confirms that service-learning projects are a viable means of education on this topic. However, given that veterinary student respondents to this survey overwhelmingly indicated both exposure to instances of abuse and a lack of confidence in handling animal abuse and domestic violence situations, increased formal curricular education as well as expansion of service-learning opportunities in this arena are justified. The fact that the human medical community has demonstrated interest in the education of its students on matters of domestic violence, as evidenced by research on the impact of such training, suggests an opportunity to partner with our colleagues in human medical education on the creation of service-learning opportunities. Furthermore, we hope that the data gathered and presented in this study will serve as a resource for leaders at schools or colleges that are contemplating creation of DVSPs; we would be pleased to provide additional information on request.
Limitations of this work include the lack of stratification of student responses by personal interactions with DVSP programs. Because these programs are non-curricular, student participation is likely to be highly variable, which may in turn affect knowledge and confidence in handling abuse situations. Furthermore, the students' progress through the curriculum would have influenced their opportunities for involvement, in that students with more years of veterinary school would have had more chances to interact with a DVSP, and we were unable to stratify responses for this variable. We also did not obtain student responses from all schools and colleges of veterinary medicine, resulting in data that are not representative of students at all institutions. Obtaining responses from every North American veterinary school would have allowed for more thorough conclusions to be drawn regarding the impact of unique DVSP programs in all locations. Finally, given that responses to Survey 1 were not obtained from all veterinary schools and colleges in North America, we acknowledge that additional DVSPs not described in this study may exist.
The link between interpersonal violence and animal abuse is clear, and as community sentinels, veterinarians are likely to encounter both. The goals of this study were to identify the presence of DSVPs and delineate the effects of DVSPs on veterinary students' awareness of, and ability to handle, domestic violence and animal abuse issues. Numerous, highly diverse DVSP programs associated with North American veterinary schools were identified. DVSP programs coordinated through the VTH were associated with a greater increase in awareness regarding the link between animal abuse and domestic violence throughout veterinary schools; however, a minority of all students expressed confidence in their ability to handle these issues as veterinarians. DVSPs are identified as a viable means of providing educational outreach to veterinary students on a vital professional issue and of providing a service to victims of abuse and violence. A need for greater educational outreach on these issues in veterinary medical curricula is identified.
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