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The following is a summary of Connecting the Dots: An Overview of the Links of Multiple Forms of Violence (Center for Disease Control, 2014). The aim of the report is, firstly, to highlight the often overlooked connections between various forms of violence including child abuse, intimate partner violence, bullying, and community violence. The report goes on to urge service providers to break down the walls that currently exist between specialized fields in order to more adequately address the harms created by violent behavior and to prevent continued perpetuation.
“Professionally we have silos, and we operate in these silos we’ve got to break down. Across the country, people working to prevent child abuse are right across the hall from people working on violence against women, and they don’t work together. As we go into communities to bring everybody to the table, don’t let people say, ‘I work on child abuse, but this is about gang violence.’ Don’t let people say, ‘I work on violence against women, and this is about child abuse.’ This thing, all this violence, is connected.” -Deborah Prothrow-Stith, MD, Adjunct Professor, Harvard School of Public Health
Risk Factors and Protective Factors
Violent behavior is incredibly complex and is influenced by a myriad of risk factors–the things that put an individual at greater risk for experiencing and perpetrating violence–and protective factors–things that increase resiliency and decrease the likelihood that someone will engage in or be victim to violence. The CDC has identified the following risk and protective factors with regards to violent behavior:
Examples of risk factors are: rigid social beliefs about what is “masculine” and “feminine,” lack of job opportunities, and family conflict
Examples of protective factors are: connection to a caring adult or access to mental health services
The Impact of Violence on Development
-Children who grow up in safe and nurturing environments “learn empathy, impulse control, anger management and problem-solving—all skills that protect against violence”
-Children who grow up in persistently violent, unstable, and/or unsafe environments often interpret situations to be threatening and are more likely to respond violently (fight) or to avoid the situation together (flee)
-These responses, termed fight-or-flight, “are survival skills that people are born with and often override other skills that enable non-violent conflict resolution, such as impulse control, empathy, anger management, and problem-solving skills”
Community Context and the Co-Occurrence of Multiple Forms of Violence
-Low social cohesion within communities and lack of economic opportunities are associated with higher rates of intimate partner violence, child abuse and maltreatment, and youth violence
-Individuals who lack adequate support from friends, family members, or neighbors, have been found to perpetrate partner abuse, child maltreatment, and/or elder abuse at rates higher than their more socially integrated counterparts
-Witnessing community violence is a risk factor for being bullied and for perpetrating sexual violence
-Access to mental health and substance abuse services in addition to coordination of resources and services across community agencies increases communities’ resiliency to violence
DrugScope have been working with London services, commissioners, and academics to examine how the needs of individuals who have experienced intimate partner violence can be better addressed within substance misuse services. Lauren Garland writes about the new briefing published by DrugScope on behalf of the Recovery partnership.
Intimate partner violence (IPV) is an issue which disproportionately affects people accessing drug and alcohol services. Research suggests that women who have experienced gender based violence are 5.5 times more likely to be diagnosed with a substance misuse problem over the course of their lifetime, while another study suggests that 21% of people who had experienced IPV believed that the perpetrator was under the influence of alcohol and 8% thought the perpetrator had used illicit drugs.
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Pediatrician Nadine Burke Harris discusses the detrimental impact of traumatic childhood experiences on physical and mental health outcomes across the lifespan. Harris ardently calls on healthcare professionals to take seriously the treatment of prevention of trauma:
“The science is clear: Early adversity dramatically affects health across a lifetime. Today, we are beginning to understand how to interrupt the progression from early adversity to disease and early death, and 30 years from now, the child who has a high ACE score and whose behavioral symptoms go unrecognized, whose asthma management is not connected, and who goes on to develop high blood pressure and early heart disease or cancer will be just as anomalous as a six-month mortality from HIV/AIDS”
Below is a summary of a January 2013 report entitled, What works to reduce recidivism by domestic violence offenders? This report was published by Washington State Institute for Public Policy. All statistics, research findings, and information related to Washington state’s domestic violence laws presented below, were drawn from the Institute’s report which can be accessed here..
Following a 2012 legislative mandate, Washington State Institute for Public Policy (WSIPP) set out to update it’s review of the literature on the efficacy of domestic violence (DV) treatment programs. In particular, WSIPP focused on treatment outcomes for offenders mandated to Duluth-style programs. According to the institute, Washington State law requires that DV treatment programs adhere to Duluth Model guidelines which conceptualize domestic violence as the following: “…a gender-specific behavior which is socially and historically constructed. Men are socialized to take control and to use physical force when necessary to maintain dominance”. Substance abuse, mental illness, dysfunctional relationship dynamics, and other potentially relevant etiological issues are not seen as related within this model. In Washington State–as well as in states with similar laws–the use of non-Duluth treatment programs such as cognitive behavioral therapy, substance abuse treatment, or anger management is prohibited.
In January 2013, WSIPP released a report outlining the results of their systematic review of group-based treatment for domestic violence offenders. Below are some of the most pertinent findings.
Summary conclusions: “Based on six rigorous outcome evaluations of group-based DV treatment for male offenders, we conclude that the Duluth model, the most common treatment approach, appears to have no effect on recidivism. This updated finding is consistent with our (and others’) previous work on this topic. There may be other reasons for courts to order offenders to participate in these Duluth-like programs, but the evidence suggests that DV recidivism will not decrease as a result” (pg. 12)
Impact on recidivism for “Duluth-like” programs: “We also considered programs to be similar to Duluth if the study authors said the curriculum included “power and control” dynamics, “sex role stereotyping,” or gender-based values. Six of the 11 effect sizes assessed Duluth-like programs. We analyzed separately the results of these six effect sizes and found that, on average, programs using Duluth-like models had no effect on recidivism (see the upper panel in Exhibit 3); therefore, this approach cannot be considered “evidence-based” (or research-based or promising)” (pg. 6)
Impact on recidivism for non-Duluth Model programs: “…when these other non-Duluth models are analyzed as a whole, the combined effects indicate a statistically significant reduction in DV recidivism (the lower “average effect size” in Exhibit 3). The average effect was a 33% reduction in domestic violence recidivism” (pg. 6)
The models that indicate efficacy with regards to reducing repeat incidents of DV offending in Exhibit 3 include:
Cognitive behavioral therapy (Palmer, 1992, and Dunford, 2000b)
Relationship enhancement (Waldo, 1988)
Substance abuse treatment (Easton, 2007)
Group couples counseling (Dunford, 2000a)
Based on their research, WSIPP also suggest that addressing offender psychopathology through therapy aimed at treating Borderline Personality Disorder (BPD) and Post-Traumatic Stress Disorder (PTSD) could be efficacious. This is particularly promising they note, given that both BPD and PTSD are highly prevalent among DV offenders and both disorders are associated with impulsive and aggressive behavior (pg. 7)
Rethinking our Dependence on the Duluth Model Paradigm
Research such as this is hugely important for the domestic violence field. Data on rates of DV incidents and on rates of DV incidents which end in homicide continues to show that domestic violence remains a major social problem. The development and utilization of evidence-based treatment models which can be shown to reduce recidivism has never been more pressing. In their January 2013 report, WSIPP highlights that 44 of 50 states in the U.S have legal guidelines that stipulate the kind of treatment professionals can legally administer. Furthermore, “In 28 states, standards for DV treatment specify the Duluth model by name, or require that power and control dynamics—central to the Duluth model—must be included in the treatment curriculum”.
This mandate is highly troubling. When put to the test via rigorous research standards the Duluth Model fails time and again to reduce rates of re-offending and yet it remains the treatment of choice for professionals engaged in this difficult work. In light of this failure, a paradigm shift regarding our conceptualization of domestic violence, including how we view and work with both victim and offender, is needed. A suggestion such as this which challenges the core assumptions of the feminist-rooted Duluth Model is viewed by many as an anti-woman, victim-blaming stance. We cannot however continue to allow criticisms and challenges such as this to prevent us from developing innovative work in the area of violence intervention and treatment.
The Milwaukee Domestic Violence Experiment
In 1992, results from the Milwaukee Domestic Violence Experiment were published, revealing that the implementation of mandatory arrest laws had failed to decrease rates of re-assault in domestic violence (DV) cases. The experiment compared the impact of arrest and detention, with the offender eligible for release on $250 bail; arrest and detention, with the offender quickly released on personal recognizance; and finally, no arrest, with the suspect read a standardized warning by responding officers.
After comparing results from 1,200 DV cases, researchers found that the arrest of offenders had variable deterrence effects depending on specific offender characteristics. For example, when the offender was white, employed, and/or married to the victim, arrest was found to have a strong deterrence effect. While for offenders who were Black, unemployed, and/or cohabitating with an unmarried partner, arrest increased both the prevalence and the severity of future violent incidents. The study calculated, “….that 10,000 arrested whites produce 2,504 fewer acts of domestic violence a year than warned whites, while 10,000 arrested blacks produce 1,803 more acts of violence per year than warned blacks…” (Sherman et al., pp. 160, 1992). Looking at employment status as a variable, researchers found that “With 958 fewer acts of violence committed against victims of 10,000 employed suspects who had been arrested than those who had been warned, the price equals 2,274 more acts of violence per 10,000 unemployed suspects who had been arrested than if they had only been warned” (Sherman et al., pp. 160, 1992).
Follow-up Study: Increased Premature Death of Domestic Violence Victims from Arrest
Twenty-three years later researchers Lawrence W. Sherman and Heather M. Harris followed up on the landmark Milwaukee Domestic Violence Experiment and found shocking results. After analyzing state and national death data on 1,125 victims enrolled in the Milwaukee Experiment, researchers found that victims whose partners had been arrested and jailed, rather than warned, were 64% more likely to have died prematurely. Heart disease, cancer, and other “internal illnesses” caused the overwhelming majority of deaths. Such illnesses are associated with chronic stress, leading researchers to postulate that the stress of having their partner arrested contributed greatly to these detrimental health outcomes.
As in the original study, race was found to be a significant variable in predicting premature death among victims. White victims whose partners were arrested rather than warned had a 9% higher death rate. Black victims on the other hand, had a 98% higher death rate when their partners were arrested. Employment was, again, an important variable. For white and Black victims alike, victim employment at the time of their partner’s arrest was correlated with higher victim mortality (Sherman & Harris, 2014). However, victim mortality among employed Black victims was the greatest. Out of the 125 employed Black victims whose partners were arrested following a DV offense, 14 (11%) died prematurely while none (0%) of the 67 employed Black victims whose partners were warned died at the 23-year follow-up (Sherman & Harris, 2014).
The results of both studies call into question the efficacy of mandatory arrest policies for addressing the problem of partner violence. Although certain offenders in the Milwaukee Domestic Violence Experiment were deterred by arrest, others were not. This means that while some victims can in fact benefit from the involvement of law enforcement officials, other victims not only experience little reprieve from partner violence, the violence perpetrated against them increases in frequency and severity following their partners arrest.
Sherman and Harris’s follow up study reveals even more troubling findings. Namely, that in addition to more frequent experiences of partner violence over their lifetime, premature death due to stress-related illnesses increased significantly among Black victims whose partners were arrested.
Findings such as these might reveal a reality that is hard to accept, Sherman concedes. However, Sherman continues, “the moral burden of proof now lies with those who wish to continue this mass arrest policy”.
Pacific Standard contributor Lauren Kirchner recently reviewed a 2013 Journal of Family Violence study examining Veterans Health Administration (VHA) perspectives on screening patients for intimate partner violence (IPV). The study reveals that female veterans experience IPV at rates much higher than the general public. The study also highlights that while women comprise a growing number of active duty personnel and veterans, their unique health care needs often go unaddressed. VHA doctors lamented the lack the training they receive when it comes to identifying and intervening in cases of IPV.
One doctor interviewed for the study had the following to say about screening for domestic violence among female veterans: “It’s just really not on my radar. It is so overshadowed by other mental health issues and substance abuse issues that, relative to those topics, IPV isn’t really up there.”
This failure to recognize the role that IPV plays in exacerbating such issues speaks to the need for increased training among VHA practitioners around identifying IPV in patients. For IPV survivors and advocates, it comes as no surprise that women experiencing abuse would present with a myriad of mental health concerns and substance abuse issues—particularly if this abuse is compounded by combat related trauma.
While millions gather today to pay tribute to the men and women who have served in the nation’s military, let us also acknowledge the problem of IPV for female veterans and their families. Improving the healthcare that America’s veterans receive is no doubt the best way to honor their service.
The Division of Criminal Justice Services reported 54,848 domestic violence victims outside New York City in 2012, up more than 1,700, or 3 percent, from the year before. The New York Police Department, using data that excludes some lower level crimes, said there were 30,428 domestic violence victims last year, an increase of about 1,500. State criminal justice officials said Wednesday that the increase in police reports about domestic assaults, sex offenses and violations of protection orders may reflect an ongoing push for victims to contact authorities.
Recently released data on incidents of domestic violence throughout New York reveal an increase in rates for the year 2012. Read the full article here for a summary of 2012’s findings
As we’ve mentioned elsewhere on this blog, serious concerns exist with regards to use of restorative justice to address violent criminal offenses. Of the few restorative justice programs in existence across the U.S, the majority target juvenile offenders who have committed low-level, non-violent property crimes. The National Council on Crime and Delinquency which has implemented a restorative juvenile diversion program throughout Almeda County in Oakland, CA is one notable example.
In New Zealand however, where the use of RJ throughout the criminal justice system is widespread, new research has challenged the notion that RJ would be ineffective in addressing the harms caused by more serious crimes. In fact, the study claims that RJ may actually be more effective in helping victims heal and in reducing rates of reoffending in cases where the criminal offense is more serious in nature.
Highlights of this new research includes the following as reported by New Zealand’s Scoop Independent News:
Restorative Justice conferencing is more effective in cases of serious crime, particularly cases of violence, than in cases of property theft, or minor incidents. Overall, restorative justice conferencing, reduces reoffending by about 20%, with around 90% of victims registering satisfaction with the process, and indicating that it has helped them in the healing process.
A 2007 UK Ministry of Justice research concluded that there was a 27% drop in reoffending by those who experienced restorative justice across a wide range of offences from less serious juvenile crime through to adult robbery and serious assault, compared with those who took part in the usual criminal justice process.
A 2011 New Zealand research showed a 20% reduction in reoffending, and long term fiscal benefits arising out of 1,500 conferences of $7.6m for the public sector, and $9.9m for the private sector.
Read the full story here
A recently published article in the Scientific American has revealed that increased training for doctors and other healthcare professionals is key to identifying victims of intimate partner violence. Unfortunately however, professionals often lack the tools needed to help such victims and their families end or escape the violence they are experiencing.
“More than one in three women and more than one in four men fall prey to stalking, rape or other physical or psychological violence by a partner at some time in their lives. Despite these grim statistics and evidence that victims can end up suffering mental and physical health problems such as post-traumatic stress disorder, health professionals have yet to nail down the best way to stop the abuse—which they call “intimate partner violence”—and to care for those affected by it.”
Read the full article here