Journal of Global Social Work Practice, Volume 4, Number 2, November/December 2011
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International Problems of Intimate Partner Violence and Its Impact upon Immigrant Groups in the United States
This article explores definitions of domestic violence around the globe, even to the extent that some cultures do not even have a word to describe it. Reporting trends are discussed and examples are presented regarding how intimate partner violence (IPV) is accepted in many parts of the world. Three factors-patriarchy, immigration, and religion-are noted that continue to allow IPV to occur in many households and family systems. The cultural contexts of its prevalence among ethnic minorities are also reported. Both the issues about the impact and the limited amount of services for IPV victims are discussed and include in-depth discussions about the universal screening for IPV and how to respond to disclosure. Keywords: international domestic violence, intimate partner violence, interventions, techniques Contents Intimate Partner Violence Concerns Cross-culturally Intimate Partner Violence as a Global Concern Intimate Partner Violence in Ethnic Minorities East and Southeast Asian Americans Survivor Help-seeking and Professional Responses Domestic violence, also called intimate partner violence (IPV), is defined by James and Gilliland (2005) as any form of physical violence perpetrated by one person against another in a romantic relationship. In addition to physical violence, McLeod, Muldoon, and Hays (2009) note that the abuse may also be emotional, sexual or a combination of them all. The abuser may use physical violence, threats, and/or verbally degrade the victim to resolve conflict as well as establish power and control over the vulnerable partner. For the purposes of this article, the authors choose to use the term intimate partner violence. IPV occurs across race and socioeconomic barriers. According to Meyersfield (2003), "Every day, throughout the world, women are subjected to extreme acts of physical violence, which take place within the beguiling safety of domesticity. The violence is severe, painful, humiliating, and debilitating. And it is common. It is a phenomenon that stretches across borders, nationalities, cultures, and race. A binding characteristic of communities throughout the world, almost without exception, is the battering of women by men" (p. 371). IPV is a major concern for the American people, as documented by the National Coalition Against Domestic Violence. However, it is also important to acknowledge and understand the prevalence among vulnerable groups such as cultural and ethnic minorities: Eastern European, First Nations, East and Southeast Asians, Pacific Islanders, Latinos, Arabs, and West Indians. This article presents findings on traditional perspectives and values, cultural adjustment, available services, religious values and distinctions between class and poverty that contribute to the perpetuation of IPV. In an attempt to remain impartial, contributors to fighting IPV are also presented. To present the relevancy of the findings, the authors also discuss the social worker's role in screening, cultural competency, and providing recommendations of how to best serve these vulnerable communities in fighting against IPV. The National Coalition Against Domestic Violence (NCADV) reported that 1 in every 4 women, approximately 1.3 million women per year, in the United States will be the victim of IPV at some point during her life (2007). The statistics do not take into account the drastic underreporting associated with IPV. While reporting has improved in the last decade, the Department of Justice estimates that only 60% of victimizations were reported to police between 1998 and 2002 (Bureau of Justice Statistics, 2007). A fear of retaliation from the perpetrator was cited as the rationale behind the lack of reporting for 19% of female victims surveyed, while less than 10% did not want to get the offender into legal trouble (Bureau of Justice Statistics, 2007). Intimate Partner Violence Concerns Cross-culturally The above data is a starting point for the main focus of this article. The importance of considering domestic violence on a larger international scope is imperative. Ultimately, understanding the data and multicultural considerations are important steps to becoming knowledgeable about how to support and counsel individuals. Several factors should be considered as we examine cultural variations in IPV. Differences in reporting trends and help- seeking behaviors among racial/ethnic groups may occur for several reasons. Perspectives. IPV may be defined differently across people groups, and thus be tolerated differently. For many cultures, the concept of IPV is unknown, partly due to a lack of terminology. For example, there is no term for domestic violence in many Asian languages (Lemberg, 2002) though it is possible to recognize or understand IPV by its consequences. Victims of IPV have a higher rate of eating disorders, substance abuse, depression, anxiety, and suicidal thoughts and attempts (Amar & Gennero, 2005; Holt & Espelage, 2005) as well as acute stress disorder (ASD) or post-traumatic stress disorder (PTSD) (James & Gilliland, 2005). Domestic violence was known in Japan as children's violence toward their parents (Kozu, 1999). There are no terms synonymous with batterer or rape in Russia (Horne, 1999) and in Chile, IPV is called private violence (McWhirter, 1999). Even with increased attention to IPV, considering it a crime increases the difficulty for many racial/ethnic minority women to report the abuse, often leading them to report only severe cases of abuse. Cultural factors. Cultural issues may influence the timing, presentation, and sequencing of reporting. These issues include cultural solidarity, family structure, gender role socialization, socioeconomic status, and religiosity, to name a few. Cultural concerns such as social isolation, language barriers, economic barriers, dedication to family, shame, and cultural stigma against divorce also influence IPV reporting. Immigrants may also experience fear of deportation or may be familiar only with their home country's cultural mores surrounding IPV (McLeod, et al. 2009) Barriers to help-seeking. Finally, IPV-related resources may be unavailable in certain lower socio-economic communities which impacts reporting and help-seeking trends (Lee, Thompson, & Mechanic, 2002). Various forms of oppression such as racism, heterosexism, classism, and ableism (disability issues) may intersect to further prohibit a sense of safety to report IPV. Alternatively, the degree of cultural solidarity may perpetuate IPV. Strong cultural ties, particularly in small communities, may isolate women from outside resources, promote greater acceptance of gender inequities, and result in a stronger tradition of family secrecy. For example, cultural norms, particularly those in non-Western cultures, may restrict survivors from seeking legal or medical attention for IPV. (McLeod, et al., 2009). Intimate Partner Violence as a Global Concern In order to address the issue of IPV among ethnic minority populations in the United States, it is important to acknowledge each culture's understanding of this concept. The worldviews of many cultures acknowledge IPV as harmful to individuals and societies. However, there are also other cultures that may not be aware of it or may consider it to be a part of family life. This article attempts to shed some light on the perspectives of Jordan, Russia, Japan, Chile, Philippines, Vatican City, and the African American community. Examples of IPV from around the world are evident. In Jordan, 89 criminal records for homicides were reviewed in 1995. Thirty-eight homicides involved women, of which 23 were reported as honor crimes (i.e., violence against a female by her male relative for alleged sexual misconduct that 'violated the honor of the family'). This may be supported by the Jordanian Penal Code Article 340, which states:
In Russia, some common proverbs that seem to support IPV include: "If he beats you, he loves you" and "Beat the wife for better cabbage soup." Additionally, a common joke stated by males is, "If I could think of a reason, I would kill you." (Horne, 1999, p. 58). In Japan, it is commonly understood that internal family life is free from legal intervention. Further, one Japanese proverb illustrates the tradition of family secrecy and honor, which contributes to IPV: "A nail that sticks out will get struck down" (Kozu, 1999, p. 52). Finally, until 1989, Chile's Civil Code called for wives to obey their husbands and for husbands to have authority over their wives' possessions and persons. Unfortunately, much resistance to the dissolution of the Code still remains today. The Philippines and the Vatican City are the only two places in the world that have banned divorce (Conde, 2011). Regardless of prevalence rates by race and ethnicity, there seem to be similar reasons for remaining in violent relationships. However, there are cultural subtleties in how IPV is recognized and addressed that impact reporting trends across racial and ethnic groups. The interrelated factors include patriarchal family structure, immigrant status, and religiosity. Patriarchy denotes clear gender role assignments based on patrilineal descent. Feminists view patriarchy as the most important cause of IPV because there is a power imbalance between males and females; abuse is used as a source of control. In patrilineal societies where male honor is measured by female chastity and fidelity, IPV could be higher since any male member of the patriline may be violent towards any female member of the patriline. Patriarchal societies often contribute to violent environments for women and tolerate IPV (McLeod, et al., 2009). Gender roles. Traditional gender roles are characteristics of patriarchal family structure, creating cultural pressure to remain in violent relationships (McLeod, et al., 2009). For example, marianismo in Latin cultures is the value of females depending economically on males, maintaining the family unit above their personal needs, and respecting males as decision-makers (Mattson & Rodriguez, 1999). Further, African American women are often socialized to be strong and may avoid the impression of victim (Sleutel, 1998). Japanese women may view sexual acts with shame and embarrassment, thus underreporting sexual abuse (Kozu, 1999). Family honor versus shame. A final example illustrates practices in Arab cultures. The concepts of family honor (sharaf) and shame (ird, and ayb) promote manliness of male members, sexual purity of females, and fidelity of a wife or mother. These values contribute to norms and practices shaping social and sexual behaviors among males and females, and in some instances, promote IPV without criminal prosecution (Kulwicki, 2002). In Arab cultures, violence from husbands is often regarded as occupational or domestic stress, with women tolerating some forms of IPV. For example, between 14-69% of Palestinian women support wife-beating on certain occasions (e.g., refusing to have sex, disobeying husband, challenging his manhood) (Haj- Yahia, 1998). In addition, 86% of Egyptian women, previously or currently married, agreed that wife-beating is appropriate under certain circumstances (e.g., when a wife burns food, neglects children, disobeys her husband, wastes money, refuses to have sex, or talk to other men) (El-Zanaty, Hussein, Shawky, Way, & Kishor, 1996). Some Jordanian women justified wife-beating in cases of sexual infidelity, challenging a husband's manhood, and insulting a husband in front of others (Haj-Yahia, 2002). According to the United Nations (1995), 17-38% of the world's women have been physically assaulted by a partner, with as many as 60% of women in developing countries experiencing IPV. Stress in the relationship or family system is a primary risk factor for violent behavior in any culture. Normalized life-transitions, such as children changing schools or a loss of income can be a stressor. However, immigrants also face stressful and even traumatic events such as terrorist attacks or sudden death (United Nations, 1995). Cultural adjustment. Immigration of any type elicits psychological, physiological, and emotional responses, such as distress. Immigrants must cope with the loss of previously established symbolic and actual resources as well as their immediate need to adjust and establish new connections to needed resources. The greater the gap of norms, values, and familial/social communication patterns, the greater the psychological adjustment that is required. (Yeh, Anora, Inose, Okubo, Li, & Greene, 2003). Therefore, interpersonal violence may be salient for immigrants because relocating from one country to another often induces isolation that facilitates IPV. Access to services. For female immigrants not highly acculturated to United States culture, there is an overall decrease in the use of social and health care services (Lipsky, Caetano, Field, & Larkin, 2006; Mattson & Rodriguez, 1999). Language barriers often prevent women in abusive relationships from seeking assistance. In addition, dissonance with gender roles may perpetuate IPV. Women often become the primary breadwinner in the family due to restricted employment opportunities for male immigrants (Mattson & Ruiz, 2005). External motivating and personal factors such as being employed and being in a committed relationship constitute an index of "marginality" or the assets that are at stake for a man to lose (or maintain). Therefore, a man who is unemployed and/or not in a committed relationship is less likely to participate in/complete treatment/intervention, thereby increasing/maintaining the risk of future IPV (Cadsky, Hanson, Crawford & Lalonde, 1996). With many immigrant women entering the United States each year, it is imperative that social workers acknowledge the prevalence and consequences of IPV to these populations as well as the factors that increase the possibility of IPV. Throughout history, religious beliefs, cultural and faith traditions, and religious teachings have been used to both justify as well as denounce the use of IPV (National Resources Center on Domestic Violence, 2007). On the other hand, religion may also serve as a protective factor against IPV and a coping mechanism in recovering from its consequences. Religion as a contributing factor. Although religion may contribute to the perpetuation of IPV, the prevalence of violence across religious groups is not known. Religious values may lead to male domination, superior male morality, the value of suffering, biblical references of submission, and the importance of marital reconciliation in Christianity (Foss & Warnke, 2003; Sleutel, 1998). Additionally, references to husbands as shujin (meaning master) and the Confucian value of putting aside one's career aspirations to care for the husband's elderly parents contribute to patriarchal values that can lead to IPV (Kozu, 1999). Passages in the Koran highlight obedience and respect for a husband as a wife's duty (Haj-Yahia, 2002). Thus, religious texts have been used (and misused) to promote violence in intimate partnerships. The use of religious teachings that promote IPV and place emphasis on the imbalance of relationships often results in feelings of guilt, self-blame, and powerlessness on the part of the abused partner and empowerment on the part of the abuser (National Resource Center on Domestic Violence, 2007). Religion in support of women. Increased religiosity may be associated with decreased IPV (Elliott, 1994) or decreased severity of violence (Bowker, 1998), which is noted in some religious beliefs. For example, in Judaism and Christianity, marriage is lived as an expression of holiness and mutual love necessary in fulfilling a covenant relationship before God (Elits, 1995). In Islam, marriage portrays both the husband as a responsible caregiver for his wife and the wife as devoted to the husband (Alkhateeb, 2003). Khan (2007) eloquently describes Islam's view of IPV: "In essence, the Qur'an does not discriminate between the two sexes in any way that undermines their full worth as equal human beings, nor does it give either of them; men or women, priority or superiority over the other in any manner whatsoever, neither does it endorse spouse abuse nor does it encourage spouse battering" (National Resource Center on Domestic Violence, 2007, p. 3). Spirituality. Faith is another essential component of belief systems that are significant aspects in the experiences of IPV victims and survivors. In the African American community, prayer is used significantly for coping with IPV consequences (El-Khoury, Dutton, Goodman, Engel, Belamaric, & Murphy, 2004). Supportive faith communities afford opportunities of spiritual and personal power, as well as social services, for IPV victims. Research has shown that participation in non-religious organized and individual spiritual activities (prayer, meditation, private readings) produces comparable positive health benefits to that of people who define their beliefs in a more traditional light (Nygren, Alex, Jonsen, Gustafson, Norberg, & Lundman, 2005; Gelderloos, Hermans, Ahlscröm & Jacoby, 1990). Faith empowers the survivor and provides strength, courage, and hope in facing situations beyond human control. Faith provides purpose and meaning, allowing people to view life experiences relative to a larger picture, or purpose, that is consistent with a sense of transcendence. Faith is transformative and universal in the manifest expressions, which are private or public actions that enable focus and restore sense to one's existence (Durkheim, 1965). Therefore, religious teachings can be used to promote both mutual respect and submission and condone violence in intimate partnerships. Certain socioeconomic dynamics have been identified as risk factors for IPV. Unemployed male partners with lower levels of education were correlated with a greater risk of IPV (Kyriacou, Anglin, Taliaferro, Stone, Tubb, Linden, et al., 1999). American studies have reported that two-thirds of poor and homeless women are victims of IPV (Bassuk, Dawson, & Huntington, 2006; Bureau of Justice Statistics, 2007; Eby, 2004). Research from the Former Soviet Union has shown that IPV is two times higher in low-income populations than higher income groups (Hadas, Markovitzky, & Sarid, 2008). Global research studies also highlight the impact of economic factors on domestic violence against women. A lack of economic resources often stifles a woman's ability to leave an abusive relationship. There is also evidence that a women's increasing economic independence is perceived as a threat to the patriarchal structure of many societies, placing them at risk for violence. Increases in poverty levels, widening income gaps, and unemployment led to IPV in the Former Soviet Union and Eastern Europe (UNICEF, 2000). Macro-economic policies, globalization and inequality led to violence against women in the regions of Latin America, Africa, and Asia (UNICEF, 2000). Intimate Partner Violence in Ethnic Minorities Ethnic minority populations are among the most vulnerable to victimization. Therefore, it is important to acknowledge the prevalence and concerns of each ethnic group residing in the United States. This article addresses the First Nations/Native American people, Latino Americans, East & Southeast Asian Americans, South Asian Americans, West Indian Americans, and Arab Americans. An overview of prevalence rates and cultural perspectives of community members are provided as a starting point. Native Americans/First Nations People Perhaps the most important consideration about IPV in Native American/First Nations People (NA/FNP) is that IPV is a serious problem in Native American communities (Jones, 2008). Duran, Oetzel, Parer, Malcoe, Lucero, and Jiang (2009) note that estimates of IPV among American Indians/Alaskan Natives are based on limited research. Thus, it is important for future research to provide more basic information on the prevalence of different categories of IPV, such as different levels of severity and emotional abuse (Oetzel & Duran, 2004). A final consideration about prevalence rates of IPV is that it is underreported in primary care settings. A dramatic illustration of the difficulty of identifying IPV is evident at the Albuquerque Indian Hospital. In the entire history of hospital ambulatory outpatient records, only 123 American Indian women (1.6%) have been identified as victims of domestic violence, and 58 of those women were identified as late as 1996 (Clark, 2001). These statistics strongly suggest that episodes of IPV experience American Indian/Alaskan Native women are seriously underdetected and underreported in primary care settings. General statistics. Actual incidence rates of IPV follow from several research sources. One study that utilized a large national probability sample (n=8000) found that American Indian/Alaskan Native American women were the racial group most likely to report a physical assault by a family member or an intimate partner (Tjaden & Thoennes, 2000). A second study that used a non-probability sample of 347 Navajo women, who were users of a general medical clinic, found that 52% of the sample reported at least one IPV episode in their lives. Additionally, 16% reported victimization in the past 12 months (Fairchild, Fairchild, & Stoner, 1998). Another non-probability study of Southwestern Indians (n-329) found that 91% of the women reported they were victims of IPV, 1/3 of whom reported that the violence occurred in the past 12 months (Robin, Chester, & Rasmussen, 1998). This data suggest that IPV is more likely to occur among the Native Americans than among the general population. The Navajo Nation Council recognized the widespread occurrence of IPV among Navajos when it passed a resolution in 1993 that described it as an epidemic and enacted the Domestic Violence Prevention Act (McEachern, Van Winkle, & Steiner, 1998). History of the problem Historically, IPV was rare among First Nations people. When it did occur, it was handled swiftly and succinctly by the male members of the woman's family (in the case of wife battering). The woman's uncles took her home and the family ostracized her husband until he changed his ways (Kluckhohn, Leighton, Wales, & Kluckhohn, 1974; Zion & Zion, 1993). However, research on American Indians has emphasized the importance of alcohol and drugs in the development of problems (Lujan, DeBruyn, May, & Bird, 1989; Mitka, 2002). Robin, Chester and Rasmussen (1998) reported that 62% of men and 74% of women said they were using alcohol during IPV episodes. Thirty-percent of the women in Norton and Manson's (1995) sample said the victimization made it more likely that they would use substances. The use of alcohol was associated with the most severe abuse. Berrios & Grady (1991) indicated that 48% of spousal perpetrators had an alcohol or drug problem and that alcohol was directly associated with abuse 43% of the time. Culture of oppression Additional reasons for the disproportionate occurrence of IPV in the First Nations community are both historical (the legacy of colonialism, subjugation, oppression, and subsequent trauma) and current (high poverty rates, encounters with racism, high rates of abuse of alcohol and drugs, and isolation, particularly in rural areas) (McEachern et al., 1998; Mitka, 2002). Genocide, racism, forcible expulsion from ancestral lands, and removal of children from their homes were all part of this legacy. This history left most First Nations people clustered in economically marginal rural areas of the country. The end result is transgenerational trauma as a consequence of the historic mistreatment and oppression of First Nations people by the dominant culture (McEachern et al., 1998; Chester, Robin, Koss, Lopez, & Goldman, 1994). Practice implications. Due to their history, First Nations people perceive mental health care to be inaccessible and culturally insensitive (van Uchelen, Davidson, Quressette, Brasfield, & Demerais, 1997). McCormick and Honori (1995) found that First Nations clients were twice as likely as their Caucasian counterparts to not return after a first counseling session. Nuttgens and Campbell (2010) state that one of the first things social workers can do is to learn about the history of First Nations people, thus having an understanding before a client even walks into the office. Morrissette (2008) suggests that social workers assess the degree of acculturation (traditional, marginal, bi-cultural, assimilated, pantraditional) of a First Nations client. In addition, Nuttgens and Campbell (2010) state that inquiring about acculturation can lead to thoughtful introspection regarding traditional beliefs without having cultural heritage forced on them. Wyrostok and Paulson (2000) found that exploring a client's acculturation allows the social worker to discuss the use of traditional practices, such as healing circles, sweetgrass ceremonies, and sweat lodge ceremonies through the guidance and leadership of a community elder. From a social justice perspective, part of the process needs to be directed towards the social conditions that led to mental health issues in the first place. Ignoring these issues implies that First Nations clients adjust to their oppression (Nuttgens & Campbell, 2010). Statistical data regarding IPV for Latino Americans is difficult to obtain due to the generality of the term "Latino," since many identify their ethnicity as their country of immigration or heritage. However, the population of Latino Americans expanded from 15 million to 39.9 million between 1980 and 2003. Statistics indicate that many Latinos are likely to live below the poverty line, suffer from a high level of unemployment, and maintain large households (U.S. Census Bureau, 2001). Latino females suffer from IPV at a rate slightly below that of all non-Latino females combined. However, results from one study by Straus & Smith (1990) found domestic violence prevalence rates of 23% for Latino families and 15% for Caucasian families. Cultural perspectives. Latino cultures are generally patriarchal, placing males in authoritarian positions within the family, although Puerto-Rican and Mexican-American men were at highest risk to perpetrate IPV (Kantor, Jasinski, & Aldarondo, 1994). The term machismo refers to male dominance, and often permits the acceptance of aggression, promiscuity, excessive alcohol use, and emotional withdrawal. On the contrary, Latino females are characterized by marianismo; their self-sacrifice, submissiveness, and unassertiveness (Saez-Betacourt, Lam, & Nguyen, 2008; McAuliffe, 2007). Research has indicated that violence is a common way of dealing with conflict for Latino families (Mattson & Ruiz, 2005). When working with Latino perpetrators or survivors, it is important to understand that the extended family is the first resources in times of crisis (Sue & Sue, 2003). East and Southeast Asian Americans General statistics. Statistics gathered in 2000 indicate that roughly 3.5% (10 million) of the United States population is made up of East and Southeast Asian Americans (U.S. Census Bureau, 2002). At least 25 specific ethnic groups make up this category, including: Cambodians, Chinese, Filipinos, Japanese, Vietnamese, and Koreans. Studies of Korean and Chinese American women have shown 14-18% prevalence of physical violence (Yick, 2007). Finally, Asian and Pacific Islander women have reported lower rates of physical assault and rape (12.8% and 3.8%, respectively), although other studies show lifetime rates for physical and/or sexual abuse being as high as 41-61% depending on the amount of time subgroups have resided in the United States (Yoshihama & Dabby, 2009). Cultural perspectives. While each East and Southeast Asian culture has its own values, there are seven common values among them. These values are avoiding family shame, conforming to familial and social norms and expectations, deferring decisions to authority figures, respecting the family unit and ancestors, placing the needs of others first, quietly resolving emotional problems, and demonstrating self-control (McAuliffe, 2007). In addition to their patriarchal orientation, East and Southeast Asian Americans are collectivistic. Disruptions in family life that could potentially bring shame to the family and ancestry are often blamed on the woman of the home (Yick, 2007; Atkinson & Hackett, 2003). General statistics. Coming from Pakistan, Sri Lanka, Bangladesh, Bhutan, India, and Nepal, South Asian Americans are one of the fastest growing populations in the United States, consisting of approximately 20% of the total Asian population (U.S. Census Bureau, 2001). Little statistical data regarding IPV has been gathered specifically on South Asians. Two studies revealed prevalence rates of 71% and 40.8%, respectively, for South Asians surveyed (Adam & Schewe, 2007; Raj & Silverman, 2002). Cultural perspectives. Similar to East and Southeast Asian cultures, South Asians traditionally maintain patriarchal family structures and a collectivist ethnic identity. Additionally, South Asians emphasize reticence and self-restraint from strong emotional expression and religion (McAuliffe, 2007). The greatest number of immigrants came from the Dominican Republic, Haiti, Jamaica, and Cuba (U. S. Census Bureau, 2000). West Indians are another immigrant group with little research on IPV prevalence. In 2000, those born in the Caribbean accounted for roughly 10% of the total United States population. General statistics. In one study, 31% of 200 Trinidadians surveyed reported being victims of IPV (Rawlins, 2000). Of 187 Jamaican women obtaining services at a crisis center, 89% reported being physically injured, while 59% reported suffering sexual assault by their husbands or partners (Arscott-Mills, 2001). Cultural perspective. The legacy of slavery has been identified as a source of the tolerance IPV receives in the Caribbean. Many Caribbean cultures support household privacy and avoid bringing shame to the family (Griffith, Negy, & Chadee, 2006). The 2000 United States census measured 1.2 million Americans reporting Arab descent, an increase from the 860, 000 reported in 1990. (U.S. Census Bureau, 2003a). The Lebanese Americans was the largest specific group reported (37%) however people reported they were both Lebanase only and Lebanase and another ancestry. Syrians and Egyptians reported equal growth at 12% (U.S. Census Bureau, 2003a). General statistics. According to UNICEF (2000), 35% of the Egyptian women in a nationally representative study reported being beaten by their husbands, while 32% of Israeli women surveyed reported at least one episode of physical violence. Cultural perspectives. Collectivism and paternalism remain core values in Arab cultures. Many of these cultures approve of corporal punishment as well as gender segregation UNICEF (2000). When victimization occurs, the survivor experiences a host of consequences as a result of the perpetrator's criminal actions: emotional and psychological distress, or trauma. However, it is also a social problem that negatively affects society, resulting in increased financial cost to the government each year. Financial consequences The costs of violence against women are long-term and considerable. Financial losses related to battering were estimated at approximately $150 million per year, with property loss, medical expenses, and lost wages accounting for approximately 44%, 40%, and 16% respectively (Arias, Dankwort, Douglas, Dutton, & Stein, 2002; Greenfield, Rand, & Craven, 1998). In recent years, the figure has grown to more than $5.8 billion spent each year as a result of domestic violence, with $4.1 billion going to medical and mental health services (NCADV, 2007). Emotional/psychological impact The emotional consequences of IPV are equally as devastating as the physical consequences. According to Bostock, Plumpton, and Pratt (2009), female victims suffer from depression, anxiety, shame, fear, and stress, putting them at higher risk of completing a suicide attempt. IPV can lead to an internalized sense of responsibility and diminished self- worth on the part of the victim (Bostock et al., 2009). Psychological distress. High rates of depression and low self-esteem are common among survivors (Holtzworth- Munroe, Bates, Smultzer, & Sandin, 1997), and IPV is a major predictor of female drug and alcohol abuse (Clark & Foy, 2000). Many survivors experience posttraumatic stress symptoms, including: re-experiencing the trauma (e.g., intrusive recollections, nightmares, flashbacks), avoidance/numbing (e.g., restricted range of affect, anhedonia, social withdrawal, inability to recall aspects of the trauma), and increased arousal (e.g., hypervigilance, exaggerated startle response, difficulty falling or stay asleep) (Riger, Raja, & Camacho, 2002; Walker, 2006). In addition to the symptoms traditionally associated with posttraumatic stress, Walker (2006) argues that IPV survivors often experience a cluster of symptoms referred to as the battered woman syndrome, which includes disrupted interpersonal relationships, difficulties with body image/somatic concerns, and sexual or intimacy problems. Survivor Help-seeking and Professional Responses An under-utilization of mental health and support services of female victims coincides with the underreporting of IPV. A common practice of medical professionals responding to victims is the prescription of medications to treat anxiety and depression, with referrals to community resources insufficiently equipped to help women remove themselves form the abusive situation (Hanmer & Saunders, 1984). Screening for Intimate Partner Violence Due to the prevalence of IPV, it is generally agreed that screening should be universal, Social workers should also be culturally sensitive when directly asking clients, particularly female clients, about IPV. Most research focuses on screening assessments in doctors' offices and emergency rooms, since many survivors require medical treatment for physical injury inflicted by an intimate partner. Survivors may not necessarily seek counseling to address the effects of IPV. (McLeod, et al., 2009). Healthcare workers' barriers. There are several barriers to overcome before discussing screening. Although the majority of health care providers acknowledge the need for intervention with IPV survivors, most healthcare providers fail to routinely screen for it (Tower, 2006, 2007). The personal barriers include lack of knowledge and personal attitudes. A primary barrier to universal IPV screening is the lack of knowledge and training regarding the history of the client as they experience the abuse within his or her cultural context. The important consideration is how to respond if IPV is either suspected or disclosed by the individual as they describe the cultural context of family relationships and connectedness (Gerbert, Capsers, Milliken, Berlin, Bronstone, & Moe, 2000; Tower, 2006, 2007). Personal variables may also prevent healthcare professionals and social workers from asking about IPV. From example, some social workers may have negative attitudes towards survivors that stem from personal experiences with IPV or from prejudicial attitudes, such as racism, classism ageism, religiosity, and homophobia (Tower, 2006, 2007).. A third barrier is that healthcare workers may also avoid screening for IPV due to fear for their own safety, a fear of offending their patient or the perception that they do not have time to address IPV issues (Tower, 2007; Gerbert et al., 2000). Institutional barriers. There are also institutional and professional barriers to IPV screening avoidance, such as perceptions of powerlessness to help survivors due to insufficient community resources and the fear of marginalization by colleagues (Tower, 2006). The multitude of reasons for not asking about IPV does not outweigh the argument for IPV screening. Screening can help prevent injury and can literally help save the lives of individuals who suffer from partner abuse. Recommendations for healthcare workers and social workers. The first step in screening for IPV is to create a safe environment. Disclosing IPV can be a very difficult and painful process for survivors due to shame, embarrassment, and fear of being judged (McLeod, et al., 2009). Survivors may also fear losing their children or further abuse form the partner as a result of IPV disclosure (Kramer, Lorenzon, & Mueller, 2004; Lutenbacher, Cohen, & Mitzel, 2003). Social workers need to be aware of the cultural relevance of clients disclosing IPV and the effect of disclosure on the family, community, and cultural systems. Placing multicultural and bilingual posters and other IPV awareness materials in their offices and waiting rooms are ways for social workers to indicate that it is safe to talk about IPV (Chang, Decker, Moracco, Martin, Petersen, & Frasier, 2005). The social worker's interpersonal style can also help create a safe atmosphere. For example, IPV survivors report that social workers who smile, demonstrate caring through empowering statements, reduce the power differential by using personal self-disclosure, don't appear to be rushed, and are easily accessible are easier to trust and talk to about IPV (Battaglia, Finley, & Liebschutz, 2003; Chang et al., 2005, Kramer et al., 2004). The single most important factor to remember about IPV screening is that social workers should never ask about abuse in the presence of the client's partner; doing so may greatly increase the risk of harm to the client (Chang et al., 2005; Keller, 1996; Kramer et al., 2004; McCloskey & Grigsby, 2005). Initial screening Once a safe atmosphere is established and a rapport is developed with the client, a social worker should compassionately ask about IPV, gathering as many concrete and specific details of the client's experience as possible. Initial screening questions may include asking the survivor if anyone is hurting them, who it is, how arguments usually begin, details of the most recent incident of violence, how long the most recent incident lasted, and what happened when the incident was over (Keller, 1996; McCloskey & Grigsby, 2005). The client's personal, familial, and cultural history is important as well, including the first and worst incidents of violence, past attempts at intervention by others (e.g., family, friends, neighbors, police, legal system), and the role of mental health and substance abuse (McCloskey & Grigsby, 2005). Lethality assessment Social workers are also advised to complete a lethality assessment whenever IPV is disclosed in order to determine the degree of urgency for responding to the crisis. The continuum of options may range from developing a safety plan with the survivor to immediate police intervention and hospitalization. A lethality assessment includes questions 28 about the severity of violence, other criminal behaviors of the abuser (e.g., assaults or harassments of others, previous criminal charges), failed past interventions (e.g., multiple calls to 911, abuser ignoring court orders, and violence continuing despite family, friends, and neighbors trying to intervene), obsessive or stalking behaviors, psychological risk factors (e.g., previous homicidal or suicidal threats or attempts, substance abuse issues, external life stressors, severe depression), perceived threats to the relationship (e.g. survivor planning to leave, separation or divorce, infidelity), access to weapons, and behaviors that prevent the survivor from accessing emergency resources. Throughout the process of IPV assessment, a social worker should be mindful in phrasing screening questions and be careful not to inadvertently convey judgment or blame. Also, a social worker should remember that survivors may initially deny that they are experiencing abuse. If this occurs, one should make sure to revisit questions about IPV in later sessions.
An important aspect of the social worker's role in working with survivors of IPV is their initial response to disclosure. The social worker should validate the survivor's feelings and document evidence, provide resources or referrals, and assist the client to develop a safety plan. Validate and document Most social workers will work with a survivor at some point and they must be prepared to respond when a client reports being abused by a partner. Immediately following an IPV disclosure, it is critical for social workers to validate the survivor's experience and communicate that the survivor is not to blame for the abuse (Dienemann, Glass, & Hyman, 2005; Gerbert et al., 2000; Keller, 1996). Documenting that the client is experiencing IPV is also important. Survivors indicate that it is helpful for social workers to make notes about the disclosure of IPV and to take pictures of physical injuries (Dienemann et al., 2005) that could later be used in court if the survivor chooses to take legal action. Resources and referrals Providing the survivor with resources and protection is another essential component of responding to an IPV disclosure. Social workers should have an extensive list of IPV resources available, including options for emergency shelter, transportation, food, childcare, medical needs, mental health care, and legal aid. Social workers may also consider providing a list of resources to clients regardless of whether or not IPV is disclosed. Some agencies place small cards printed with IPV resources in the restroom so that survivors may anonymously take the information and hide it if necessary (Chang et al., 2005). Social workers should also strive to empower survivors by giving them as much control over their situations as possible (Dienemann et al., 2005). Survivors indicate that it is helpful to be informed despite not choosing to access IPV resources, that they can return to the agency and receive assistance if they ever decide to do so. Safety Planning Safety planning involves working with a survivor to create a strategy for establishing physical and emotional safety that incorporates available resources and existing barriers. Safety plans are tailored to the unique situations of each survivor. Therefore, gaining concrete and specific information about the survivor's experiences is essential. It is also important to emphasize that a safety plan is a precautionary measure that in no way guarantees the survivor's safety (McCloskey & Grigsby, 2005). Why a safety plan? Safety plans can be completed with clients whether they intend to leave the abusive partner/relationship or not. Social workers should be careful not to recommend ending the relationship as the only way to establish safety. In fact, the risk of harm to a survivor may increase following separation from an abusive partner (Humphreys & Thiara, 2003). Post-separation violence involves the batter's attempts to regain control over the abused partner and may include physical assault, rape, stalking, harassment, and even homicide (Humphreys & Thiara, 2003). Research on non-lethal post-separation violence among heterosexual married couples indicates that the prevalence of IPV is 9 times greater among women who are separated from their abusive husbands than among women who are still married. IPV is 4 times more prevalent among divorced women than among women who are still married (Brownridge, Chan, Hiebert-Murphy, Ristock, Tiwari, Leung, & Santos, 2008). Other research indicates that an estimated 76% of women experience some form of post- separation violence (Humphreys & Thiara, 2003) and that women are at the greatest risk of being killed by an abusive partner at the point of separation, or after leaving an abusive partner (Wilson & Daly, 1988). Safety networks. In order to leave the abusive partner as safely as possible, the social worker and survivor should work together to ensure that adequate personal, familial, and communal networking resources are available to provide protection and safety for the survivor. Whether the client is ready to leave the abusive relationship or not, the goal of safety planning is harm reduction. For example, the survivor may strategize to avoid rooms with no outside doors that contain weapons (e.g., bathrooms and kitchens) when they anticipate violence (McCloskey & Grigsby, 2005). Other ideas for safety planning include developing a code word, or signal, with friends and neighbors when they need to call for help, creating a signal for children when they to stay in their bedrooms or flee to a neighbor's house for safety, or hiding a bag filled with essential items (e.g., clothes, cash, driver's licenses or visas, extra sets of keys) in case the survivor needs to leave the house quickly (McLeod, et al., 2009). Self-care. Safety plans may also include self-care techniques that can help relieve some of the emotional pain caused by the abuse (McLeod, Hays, & Chang, 2010). For example, survivors report that taking a quiet walk, listening to music, reading the Bible and/or self- care books, meditating, practicing guided imagery, praying, and journaling helped in coping with IPV. The key to safety planning is creativity in both mobilizing communal and personal resources. Cultural competency. Social workers need to be aware of the cultural relevance of clients disclosing about IPV and the effect of disclosure on the family and cultural system. According to Suarez-Balcazar (2007), "Cultural competence is demonstrated when the social worker understands and appreciates differences in cultural beliefs and respects the differences that occur within the cultural groups but can adjust and implement effective interventions for the individuals within the context of his/her culture." (p.4). When working with a survivor to construct a treatment plan or make a diagnosis, it is essential to consider his/her trauma history in a cultural context. Unfortunately, many survivors are misdiagnosed and prescribed inappropriate medications by mental health care providers who fail to account for the effects of IPV. Intervention models used with IPV survivors are often related to dealing with trauma. Survivors may be empowered by learning that the symptoms they are experiencing are a normal response to a traumatic event (McLeod et al., 2010). Empowerment as an intervention for women enhances their self-esteem, and decreases self-blame and feelings of helplessness (Carlson, 1997). Social worker's worldview. Cultural competence does not imply developing new practices or theories, but requires the social worker to implement and integrate practices within the context of the IPV survivor's cultural frame of reference (Zastrow, 2010). Cultural competence, according to Arredondo, Toporek, Brown, Jones, Lock, Sanchez, & Stadler (1996), means that social workers have: a) an awareness of their own cultural values and biases; b) an awareness of client's worldview; and c) knowledge of culturally-appropriate intervention strategies. Cultural identity. A culturally competent practitioner begins, includes, and builds upon the survivor's sense of self-identity, including his/her individual and collective cultural definition in relation to family and community resources. Culturally competent empowerment includes identifying, utilizing, and building upon the strengths of the IVP survivor's sense of self/identity in relation to family and support systems and resources (Barker, 2003). It is imperative to know and understand whether or not the cultural background of the survivor promotes IPV and how to address it in a culturally-sensitive manner. Given that, the most essential intervention in treating women who experience IPV is to focus on safety through education about domestic violence dynamics and available resources within the context of their cultural background. More research on effective methods and interventions for specific populations within a culture/ethnic group, such as Mexican-Americans within the Latino culture, needs to be conducted. This article began by exploring definitions of interpersonal violence around the globe, to the extent that some cultures do not even have a word to describe it. Historical trends were then discussed and were followed with examples of how IPV is accepted in many parts of the world. The prevalence of IPV for ethnic minorities was also reported. Three factors- patriarchy, immigration, and religion-were noted as contributors to IPV that continue to occur in many households and family systems. The article also examined the impact and the limited amount of services for survivors. The paper concluded with in-depth discussions about universal screening and how to respond to disclosure about IPV. In summary, this is an extremely important global issue. 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Previously, he worked as a counselor in community mental health and substance abuse programs and directed a batterer intervention program. His research interests include batterer intervention; substance abuse prevention and treatment; children of alcoholics, and group process. He is a licensed professional counselor and certified addictions professional. Correspondence may be sent to jmuldoon@kean.edu. Maureen V. Himchak, Ph.D, LCSW is an Assistant Professor at Kean University teaching Graduate Research, Human Behavior, and Social Work Practice. Dr. Himchak has obtained her degrees from Fordham University. She has her Ph.D in Social Work, specializing in Gerontology (1995), an MSW in Individual and Family Counseling (1988), and a Masters of Science in Religious Studies (1976). In practice Dr. Himchak is a Licensed Clinical Social Worker and a Certified School Social Worker in the State of New Jersey. She presented at the Audem International Conference and numerous CSWE Conferences. Dr. Himchak has just recently published an article in the Journal Social Work Values and Ethics entitled "A Social Justice Value Approach towards Physician Assisted Suicide and Euthanasia among the Elderly" Daniel John Lemond works as a Psychotherapist in the Child and Adolescent Psychiatric Service at East Orange General Hospital, East Orange, New Jersey. He is a licensed associate counselor with prior community mental health experience working in adolescent residential treatment, psychiatric inpatient crisis management, and jail diversion. His research interests include psychotherapy techniques; self-injurious behavior; family dynamics; and socially deviant behaviors. Correspondence may be sent to lemondd@evh.org. |