Impact of Domestic Violence on Human Services Agencies - Research Proposal Example

IMPACT OF DOMESTIC VIOLENCE ON HUMAN SERVICES AGENCIES Introduction Any incident of threatening behavior, violence or abuse, of any form, between individuals who are, or have been, intimate partners or family members, or share a relationship, is known as domestic violence. The victims are usually women, children, elderly people, physically or mentally challenged persons and partners in gay or lesbian relationship. Domestic violence can be either physical - where there is danger of harm to any part of the victims body; psychological and emotional - where the offender abuses the victim verbally or criticizes her in front of others or causes embarrassment, despair, sadness or terror; sexual- where in the victim suffers rape or any other derogatory treatment; economical- the offender tortures the victim by causing financial tensions, not allowing her to spend or asking her penny-to-penny accounts of what is being spent; or social- where the victim is not given freedom to meet her friends and relatives or attend social gatherings. Other methods of harassment include blackmailing, following, unwanted mails and phone calls, etc. Children, elderly and the disabled may also suffer by sheer negligence like not giving food, shelter and clothes properly or not giving medical aid in time. Also, children may suffer by just looking at their mother being beaten up. Effects of domestic violence 1. Physical- bruising, fractures, burns, disability, loss of hair or tooth, choking and death. 2. Psychological effects- depression, anxiety, sleep disorders, eating disorders, post trauma stress disorder, suicidal tendencies, self harm, shame, insecure ness ,fear, terror, confusion, guilt, lost sense of self, isolation, despair, sadness, social phobia, etc. 3. Drug/alcohol misuse- the victim may resort to substance abuse as a means of solace. Incidence and prevalence According to the 1998 Commonwealth fund survey, nearly 31% of American women report being abused by their partners at some point in their lives (Common wealth fund, 1999). According to the ‘National Violence Against Women’ survey (1995-96), about 25% of women reported sexual domestic violence at some time in their lives. In the year 2001, 85% of the victims of intimate partner violence were women (Bureau of Justice Statistics, 2003). There was no difference in rates as far as social, racial, geographical or ethnic differences are concerned. Also, 50% of men who assaulted their wives also assaulted their children. Underlying causes of Domestic Violence There are various theories for causes of domestic violence: 1. Biological theory: According to this theory, violent behavior is organic and biological with predisposing factors being genetics, biochemistry and head trauma. 2. Individual Psychopathology theory: This perspective suggests that drastic childhood experiences like being abused or watching domestic violence lead to dysfunctional personality structures. 3. Couple and Family Interactions Theory: According to this view, family dynamics and relations play important role in violence. 4. Social Learning and Development theory: This theory suggests that domestic violence is a learned behavior that is modeled, rewarded and supported by the family during early developmental stages. 5. Societal Structure theory: According to this theory, the perpetual male domination in the society over women and children, in many aspects like physical, economic and political causes superiority attitude in men. 6. Genetic theory: Abnormal levels of serotonin, dopamine and nor-epinephrine in the brain, as a result of mutation in the gene that codes for an enzyme, monoamine oxidase A have been implicated in aggression and criminal behavior (Brunner, 1993). 7. Brain damage theory: Repeated stress during childhood, on trauma to the brain can cause aggressive behavior in adulthood. Assessment of Domestic Violence 1. First assess the immediate safety needs of the victim - is there any immediate danger to the victim medically or by the perpetrator and is there any need for personal security? 2. Assess the duration, the pattern, the form and the history of abuse 3. Assess the impact of the violence on the victim- physically, mentally, financially and spiritually. 4. Assess the victim’s resources of help like advocates, police, doctors, public health personnel and human services agencies. 5. Assess long-term safety like any suicidal tendencies or intense harm by the perpetrator like death. Intervention Strategies for Domestic Violence 1. Listen to the victim and show that you are concerned and that the victim does not deserve this harassment and there is no need to put up with this. 2. Respond to safety issues immediately- encourage the victim to make her own safety plans. 3. Provide information about domestic violence and clarify about myths. Give information about the consequences that can occur and clearly mention that the responsibility of stopping the violence is that of the perpetrator. 4. Give information about the local resources and make referrals to them. 5. Record and document the information in the medical records in the victims own words and inform the victim about this. Document all the injuries by mapping and if possible by photographs. Also document about the resources offered (Steiner, 1996). 6. Follow-up: Schedule a follow-up appointment and encourage the victim to come. Review medical records and enquire about what happened in between. Also refer to a primary care provider. Models Used for intervention and prevention of Domestic Violence The Medical Model This model is based on the fact that physicians are the first point of contact to the victim and when suspected, should be enquired about it and dealt with promptly. In cases of partner abuse, the role of the physician must be that of facilitator rather than rescuer, the aim must be to assist the victim in regaining a sense of both control and self direction. He must suggest resources for obtaining assistance and encourage the victim to formulate a plan of exit. The physician should also identify the psychological effects of violence on the victim and the threat of any suicide attempt and take necessary steps. Also, victims whose partners have threatened to commit suicide also must be taken care because they can turn homicidal. He must encourage follow-up visits and develop a good patient-to-doctor relationship. Local laws must be consulted and the abuse must be reported to appropriate adult protective services. In case of abuse of an elder person, the patients functional ability assessment is important. The goal of intervention is to enable older people to maintain as much independence in safety as possible. Programs such as respite care, adult day programs, or religious activities allow patient and caregiver to spend time away from each other and should be strongly encouraged. The American Medical Association does recommend screening for domestic violence across all population sectors, and it highlights screening for abuse among women and adolescents seeking medical care (Steiner, 1996). In children, any suspicion of child abuse must be reported immediately to the child protection organizations. All the findings must be documented. Limitations of Medical Model 1. The physician may be busy (Sugg, 1999) and may not open the Pandoras Box even if he suspects domestic violence. 2. Affected women may hesitate to complain about abuse and discuss about it. 3. Physician can be easily frustrated when the victim does not take immediate action to remove herself from a dangerous situation (Steiner, 1996) 4. Physicians are often reluctant to make the diagnosis (Sugg, 1999) 5. Incorrect diagnoses can occur. Public Health model While the Medical model stresses on the treatment of the individual with the problem, the Public Health model emphasizes interventions in target populations. There are 3 types of interventions according to this model. 1. Primary prevention: efforts to reduce the incidence of the problem before it occurs in the population. The nurse or any other public health personnel shall visit the families at home for intervention. 2. Secondary prevention: The public health personnel start interfering during the early stages of domestic violence or at just the suspicion of it. 3. Tertiary prevention: The public health personnel get involved once there is definite evidence of domestic violence. Limitations of Public health Model 1. Guessing target population is difficult and it is not practical to intervene at primary prevention. 2. Lack of resources hampers activities. 3. Progress will depend on the level of public interest and commitment from the Government side. 4. Adopting preventive strategies is difficult, because of lack of awareness about the causes of abuse and the existing myths. 5. This also requires fundamental changes in attitudes and behavior; hence there will be resistance from the individuals and society. Various programs to support Public Health Model 1. Hawaiis Healthy Start Program- Started in 1984, it assesses the strengths and needs of families at the time of birth and works to build trust relationships. The program deals with teaching of problem-solving skills, and promotion of healthy child development. 2. My Family and Me- Violence Free Program was started in the year 1987 by the Minnesota Coalition for Battered Women. It concentrates mainly on education of school children about domestic violence, safety strategies, how to escape from it and how to have a high self-regard despite family problems. Creating public awareness is also a part of this program. 3. The Youth Relationships Project. This project mainly concentrates on awareness of dating partner violence. Other Models: Advocacy model: involves power and control, safety and empowerment, advocacy and support and access to resources. Clinical model: involves individual or system pathology, control of symptoms, treatment and medication. Domestic Violence and Human Services Agencies Human Services Agencies are professional social workers who work for the cause of human rights and social justice. Their approach is to consider the individual within the social environment. They have access to various other resources like health and mental care, police, advocates, security personnel, etc. As far as domestic violence is concerned, dealing with the victims is a highly demanding job. The major issues of concern of these agencies are: 1. Identifying the target population: Not many women are open enough to express about intimate partner violence. They and their children are silent sufferers of the abuse. Children are abused directly or they may suffer by observing their mother being beaten up (Wolfe, 1999). Elders may not be able to complain about their care-takers. 2. There are many myths about domestic violence, like the victim triggering the incident or consumption of alcohol causing violence or poverty causing it. So women actually take up the responsibility of preventing the episodes. 3. In rural areas, the environmental characteristics, cultural practices and informal social controls make the victims resistant to outside help. There are low levels of anonymity and reporting. Also in these places, there are difficulties related to transport, housing, employment and safety (Eastman, 2007). 4. In many situations, there is need to assume multiple roles while working, which is strenuous. The burden of arranging safety, getting medical service, consulting lawyer and informing police lies on the service providers. 5. Multiple appointments or visits are necessary to solve the problem. And the victim may drop the case in between. 6. Recidivism rates in domestic violence cases are high. Financial Cost of Domestic Violence According to the American Institute on Domestic Violence, the cost of domestic violence exceeds 5.8 billion dollar each year of which nearly 80% goes to direct medical and health care services. Added to this, the victims also suffer financially by not being able to attend to work. This amounts to almost 1.8 billion dollars per year (Domestic Violence Statistics, 2001). What is new in Direct Violence research? Researchers believe the discovery of genetic influences on aggression will open the door to effective treatments. Though in 1993, Brunner and others indicated the abnormal MAO-A metabolism could lead to aggression, Shih and others injected ginkgo biloba, a common herbal remedy that appears to have complex effects on neurotransmitters, into aggressive mice (those with deficient MAO) and proved decrease in aggressive behavior in them (Shih, 2000). In 2004, a study by Skondras and others again implicated low levels of MAO activity in those with aggressive behaviors (Skondas, 2004). Conclusion: Domestic Violence is an emerging national problem world wide. Despite Government’s policies and interventions by human agencies, the weaker still suffer. The only solution for this problem, especially for women, seems to be to get out of the relationship and start a new life again. Let’s hope the ginkgo biloba works in men too! References List American Institute on Domestic Violence. “Domestic Violence Statistic, 2001.” Retrieved from 5/31/2007 from http://www.aidv-usa.com/Statistics. Brunner, H.G., Nelen, M., Breakefield, X. O., Ropers, H. H., & Van Oost, B.A. (Oct. 22, 1993 ). “Abnormal behavior associated with a point mutation in the structural gene for monoamine oxidase A.” Science, Vol. 262, No. 5133, 578-580. Eastman, J.B & Bunch, G.S. (April 2007 ). “Providing Services to Survivors of Domestic Violence- A Comparison of Rural and Urban Service Provider Perceptions.” Journal of Interpersonal Violence, Volume 22, Number 4, 465-473. “Health Concerns across a Woman’s Lifespan: 1998 Survey of Women’s Health” The Commonwealth Fund, May 1999, retrieved on 5/31/2007 from http://www.endabuse.org/resources/facts/DomesticViolence. Intimate Partner Violence, 1993-2001, Bureau of Justice Statistics Crime Data Brief, February 2003. Retrieved on 5/31/2007 from http://www.endabuse.org/resources/facts/DomesticViolence. Shih, C.J., Chen, K., Ridd, J.M. & Seif, I.(2000). "Ginkgo biloba abolishes aggression in mice lacking MAOA.” Antioxidants and Redox Signaling, Vol. 2 (3), 467-71. Skondras, M., Markianos, A.M., Bistolaki, E.B. & Christodoulou, G. (Dec.2004). "Platelet monoamine oxidase activity and psychometric correlates in male violent offenders imprisoned for homicide or other violent acts." European Archives of Psychiatry and Clinical Neuroscience, Vol. 254, No. 6, 380-6. Steiner, P.R., Vansickle K, Lippmann BS. (July 1996). "Domestic violence- Do you know when and how to intervene?" Postgraduate Medicine, Vol. 100(1). Retrieved on 5/31/2007 from http://www.postgradmed.com/issues/1996/07_96/steiner.htm. Sugg, K.N., Thompson, S. R., Thompson, C.D., Maiuro, R & Rivara, P.F.(1999). “Domestic Violence and Primary Care Attitudes, Practices, and Beliefs.” Archives of Family Medicine, 8,301-306. Violence against Women: Findings from the National Violence Against Women Survey, November 1998. Retrieved on 5/31/2007 from http://www.endabuse.org/resources/facts/DomesticViolence Wolfe, A.D & Jaffe, G.P.(1999). “Emerging Strategies in the prevention of Domestic Violence.” The Future of Children. Retrieved on 30/5/2007 from http://www.thefutureofchildren.com. Read More