Transcript Slide 1

Reducing Intimate Partner Abuse:
A Look at National, State, and Local
Strategies for Prevention of
Domestic Violence
Barbara Johnson
CH530: Seminar in
Health Promotion Strategies
Dr. Kathleen Zavela
April 15, 2002
Introduction
• Domestic violence has a radiating impact
with first, second, and third-order effects
– First-order effects:
Direct impact on the victim with acute and
chronic physical, mental, and behavioral
health problems
i.e. concussion, sensorimotor impairment,
post-traumatic stress disorder,
addictive behaviors
Introduction
– Second-order effects:
Victim experiences compromised ability to
function as an employee/student, parent,
friend, & community member.
i.e. absenteeism, infirmary, poverty
– Third-order effects:
Outcomes incurred upon children, family,
co-workers and the community.
i.e. vicarious trauma
Introduction
Third-order effects – Data:
• Even mild spousal abuse is associated
with a 150% increase in physical child
abuse
• Men who abuse their wives are three
times as likely to be violent toward their
children
• Battered women show a 50% greater
likelihood of child abuse
Introduction
Domestic violence (DV) includes:
– Physical battering
– Sexual abuse
– Psychological abuse
– Economic & resource deprivation
Abuse is progressive and relies heavily on rigid
gender stereotypes in order to justify
domination & control
Scope of the Problem
National Issues
• No universal definition or
tool for detection of DV
• 92% of all DV incidents are
committed by men against
women
• DV is the most common cause
of non-fatal injury to American
women
Scope of the Problem
National Issues
• Family violence costs up
to 10 billion dollars each
year in medical expenses,
legal costs, shelters, foster care,
absenteeism, and nonproductivity
• U.S. women experience an
estimated 960,000 incidents of
partner abuse each year
Scope of the Problem
National Issues
• Of women who enter ER’s
due to violence-related
injuries, 84% of those injuries
were caused by her partner
• 1/3 of all American women will
experience physical or sexual DV
• 1/3 of all female murder victims
were killed by an intimate partner
Scope of the Problem
State Issues
• Colorado is one of only seven states with
mandatory DV reporting for health care workers
• In 1999, there were 7,302 reported DV incidents:
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26 murders
144 forced sex offenses
26 non-forced sex offenses
106 kidnapping
319 intimidation
755 aggravated assault
5,899 simple assault
Scope of the Problem
State Issues
The most dangerous place for a battered woman
to be is in her own home. For example:
Of the 5,899 simple assaults occurring in 1999, the
following locations were cited:
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28 school/college
57 bar/nightclub
153 hotel/motel
216 parking lot/garage
375 street/highway
4,876 home/residence
Scope of the Problem
Local Issues
• Domestic violence services
oriented to child health issues
• Victims most likely to be
identified by health care
workers
• Increased number of barriers
when couples must travel out
of the city to seek treatment
Healthy People 2010
Focus Area 15:
Injury and Violence Prevention
• Objective 15-34.
Reduce the rate of physical assault by current
or former intimate partners.
• Target: 3.3 physical assaults per 1,000
persons aged 12 and older.
• Baseline: 4.4 assaults per 1,000 persons
aged 12 and older.
Healthy People 2010
Injury-Related Deaths
United States, 1997
Source:CDC, NCHS, National Vital Statistics System
3%
Unintentional
Deaths
34%
Intentional
Deaths
Undetermined
63%
Theories and Models
Ecological Model
Bronfenbrenner, 1977
An interplay of factors shape behavior,
including:
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Microsystems (family)
Mesosystems (neighborhood, workplace)
Exosystems (broad influences/media)
Macrosystems (ideologies, government)
Theories and Models
Ecological Model
Bronfenbrenner, 1977
Change in one strata trickles down to
others. Thus, mandatory reporting
laws create changes in institutions
such as hospitals, which changes the
attitude orientation of staff, which then
changes neighborhoods and families.
Theories and Models
Social Cognitive Theory
Bandura, 1986
There is a triadic reciprocity between behavior,
cognition and other personal factors, and
environmental events.
In order to perform a target
behavior, one must learn
from observation, symbolize
behavior, anticipate outcome
and possess confidence
Theories and Models
Social Cognitive Theory
Bandura, 1986
An application of Social Cognitive Theory could be:
Public service announcements which role-model
target behavior of speaking
out against violence in
families.
This would employ behavior
symbolization, outcome
anticipation & learning via
observation.
Theories and Models
Locus of Control
Rotter, 1966
Individuals acquire internal or external
orientations:
Internal: One has the ability to effect
present and future events through
initiating change, using coping
mechanisms, and demonstrating
vigilance
External: One believes that life events
are a result of chance, fate and other
outside influences
Theories and Models
Locus of Control
Rotter, 1966
Battered women are more likely to have an
external locus of control.
Assisting victims to transition from
external to internal locus of control
is essential in order for the abusive
relationship and the cycle of violence
to terminate.
Theories and Models
Cognitive Dissonance
Festinger, 1970
Cognitive dissonance is an uncomfortable
psychological state in which the individual
experiences two incompatible beliefs.
The individual is motivated to reduce this
discomfort through either action, or avoidance
Theories and Models
Cognitive Dissonance
Festinger, 1970
Warshaw (1986) found that because of lack of DV
training, health care workers approach social
issues from the perspective of their own gender
socialization. Many will use avoidance when
confronted with DV patients and minimize or
dismiss the issue
Zaitman (1999) states that battered women avoid
DV information and other intervention stimuli to
avoid feeling conflicted about staying in the
relationship
National Strategies
Outline recommended community action plans
– Provide free materials and checklists
– Offer federal grants and other funds
Establish guidelines for military DV prevention
– Position victim advocate on base
– Asses incidents of DV
– Offer multidisciplinary services
Monitor US image to other countries
– Use non-violent imagery
– Speak out against DV worldwide
National Strategies
Work with Justice System
– Protection for immigrant women escaping
abuse
– Guarantee confidentiality
– Federal law prohibiting gun ownership for
those convicted of DV
Provide website information
and linkage
State Strategies
Abusive Men Exploring New Directions
(AMEND)
Community Strategies:
• Sponsor/produce plays on DV in high
schools and middle schools
• Support legislation, such as the
Battered Women’s Employment
Protection Act
• Provide DV risk assessment training for
law enforcement, court personnel, &
others who work with DV populations
State Strategies
Abusive Men Exploring New Directions
(AMEND)
Community Strategies:
• Develop state-wide treatment standards
• Provide literature to schools
• Use posters in health care clinics
• Run radio ads on the scope of the
problem and available treatment
Local Strategies
Alternatives to Family Violence
Group Strategies:
• Use client vernacular
• Separate voluntary from courtordered clients
• Allow clients to request group
topic
• Therapist shares from personal
DV experience
• Therapist dresses casually
Local Strategies
Alternatives to Family Violence
Individual Strategies:
• Bi-lingual materials & services
• Allow children to participate in treatment
• Music, art, and play therapy
• Adolescent program
• 24-hour crisis line
• Victim advocacy to accompany
client to court, link to resources
• Celebrate progress with rewards
Conclusion
Intimate partner abuse is a crisis of
– Human rights
– Child protection
– Law enforcement
– Community endangerment
A public health approach employs
– Persistency
– Creativity
– Vision
Recommendations
National strategies will effect change to
macrosystems, but until the benefits of social
change are felt in local programs, those smaller
organizations need greater support.
Local efforts are often unstable due to lack of
funding and guidance from state and national
entities.
Increase grant funding to local programs and offer
more specific treatment guidelines, making the
funding contingent upon a more consistent
clinical structure.
Special Thanks
Linda Loflin Pettit
Executive Director
AMEND
Carol Hollomon
Executive Director
Alternatives to Family Violence