An idealized system of coordinated community response to domestic violence contains many more components than are present in any real-world system that we visited (or probably in any real-world system). But many of the communities included in this study are making efforts to expand their network in a number of interesting directions that other communities might wish to follow. This section examines some of the issues that our six communities have encountered as they began to work toward greater inclusion.
-
Health Care Providers
-
It is now commonly accepted that health care providers encounter many women who experience battering, since women who otherwise do not seek assistance for the battering itself do seek health and mental health care for the physical and psychological damage caused by the battering, or they seek it for their children. It is also commonly accepted that health care providers have often been unaware of or ignored the existence of the battering and its relation to illness or injury and possibly to the course of recovery and healing. Some health care providers, usually hospital emergency rooms and community health centers, are now beginning to consider their role in addressing domestic violence among battered women who come to them for treatment. Clearly, these providers have the potential to identify vastly more women experiencing domestic violence than currently come to the formal attention of the justice systems and traditional domestic violence services.
In Chapter 5 we presented many of the issues raised by extensions of domestic violence networks to include health care providers. Here we want to raise several additional issues, including: (1) whether, in addition to screening and identifying domestic violence, hospitals community health centers, and other providers should try to develop some internal capacity to counsel or otherwise help victims, or whether they should rely on referral networks; (2) what types of training might be appropriate for health care system personnel and who should provide it; and (3) the implications for types of services and approaches of the fact that many of the women identified through case screening in health care settings will not be ready to accept referrals to traditional domestic violence programs.
One of the key factors discouraging health care workers from implementing screening procedures for domestic violence is uncertainty about what they should do if they find it. If a community lacks resources to assist the newly discovered cases, or if the health care workers do not know of available resources and potential actions, they cannot refer new cases to appropriate sources of help outside their own settings. If the resources exist in the community, some of the difficulty can be overcome with training and education for health care workers. But, if the resources do not exist, or are in some ways inappropriate for the women whose situation is being discovered by screening in health care settings, health care workers may find themselves caught in a bind. One option is for health care workers to cooperate with current domestic violence service providers to help them expand their services in ways that would meet the needs of the women identified in health settings. As these services develop, referral could take place as usual.
An option other than referral is for health care settings to develop some level of internal capacity to address the needs of battered women. In hospitals this is likely to be limited to counseling in the immediate circumstance of having someone who screens in for battering. However, in community health center settings more extensive options are possible including running on-going counseling groups for women, as well as making individual counseling available and discussing options for legal and other types of action with the woman. Having health care agencies begin to set up their own services for battered women raises all kinds of questions and concerns, but also may offer women a greater range of options that may fit the circumstances and wants of some women better than the currently available array of services in agencies devoted exclusively to domestic violence issues. One important issue is the training and knowledge base of the health-based staff who would provide the additional services. It is important that they know a good deal about domestic violence patterns and issues, and also know a good deal about the life circumstances of the people they are likely to be working with. Who should provide the training, of what it should consist, how often it should be repeated, are all issues to be resolved.
A second important issue is what services should be offered. This issue includes the extremely touchy subject of what guiding philosophy or analysis of domestic violence should be used to structure the services and guide the information and advice given to women. In our site visits we found health care providers that were beginning to offer individual and group counseling for women who had been battered, some of whom, at least, were not interested in leaving their batterers. Nevertheless, they were interested in attending these sessions, and found it safer to do in the context of a health setting, where they could not be identified as seeking services for the battering (and they could tell their partner that they were going to the doctor, which was a destination acceptable to the batterer and therefore safe for the woman). To add further complications, community-based health care providers often serve ethnic minority populations who may feel more comfortable going to an ethnically compatible neighborhood service than going to an unknown battered women's service. The goals of these services include increasing the safety of the women participants, but not necessarily through the route of leaving the batterer, which is the implicit or explicit goal of most services specializing in helping battered women. It is easy to see that there are many issues to be resolved, but also many opportunities to expand services to reach potentially large proportions of the population of women who experience battering but are probably unlikely, at least in their present situation and consciousness, to seek help from the formal battered women's network or from the justice systems.
-
-
Child Protective Services
-
Several communities around the United States are beginning to focus on the overlap between child abuse and domestic violence, as reported in Aron and Olson (1996).(2) In Oregon, analyses of child welfare case records reveals that the presence of battering of the mother is the best predictor of severe child abuse, and also of very long stays in out-of-home placement. Clearly child safety is compromised in households where there is battering toward the mother, and some child protection agencies are starting to contact domestic violence services to work on some of the issues involved. Of the communities in the present study, only San Diego has focused on this issue. San Diego has a special unit combining probation officers and child protective workers that seeks to reduce the risk to children in households where the man is on probation for felony battering.
In this report we can only touch on a few of the most critical issues that have arisen in these efforts, and have selected those that appear to have the greatest likelihood of also being issues for other expansions of the domestic violence network. These include: (1) the conflicting goals and requirements of child protection agencies and traditional domestic violence programs and how each can learn to appreciate the role of the other; (2) understanding of the characteristics of the typical woman involved with child protective services who also experiences domestic violence, and how these might differ from the characteristics of the women most frequently seen by traditional domestic violence programs; and (3) understanding of the ways in which the batterers in child protection cases may differ from the average batterer seen in batterer intervention programs.
There are many critical ways that the requirements under which child protection agencies operate differ from the procedures and assumptions of traditional domestic violence programs. Each needs to appreciate the pressures on the other if there is to be successful collaboration. Traditional domestic violence programs do not have to deal with the fathers of the children in families where battering occurs; child protection agencies do. Many traditional domestic violence programs turn away women with active chemical dependency or chronic mental illness problems; child protection agencies cannot do this. Traditional domestic violence agencies deal almost entirely with women who have voluntarily sought their services; child protection agencies usually deal with women who are being forced to confront neglect and abuse issues related to their children, and who may have no desire to leave their own batterers even for the sake of their children. Child protection agencies have a primary mission to assure the safety of the child; traditional domestic violence programs have a primary mission to empower the woman/mother and secure her safety from her abuser. Child protective services' determination that the mother "failed to protect" her children is seen by domestic violence workers as further blaming the victim, when the mother cannot protect herself either. In addition to all of these problems and issues, some evidence from batterer intervention program staff indicates that the men doing the battering in these complex partner-and-child abuse cases, when compared to the men typically seen by these programs, are significantly more dangerous, more violent in non-familial as well as familial contexts, less amenable to available intervention techniques, and more likely to show complete unconcern about the welfare of others.
Despite all of these initial differences and grounds for misperception and hostility, child protection and domestic violence workers in a growing number of communities are starting to develop ways to work together to address the issues of battering in child welfare caseloads. Domestic violence workers who have come to appreciate these differences sometimes reflect that close to the entire child protective services caseload consists of cases that look like "the hardest 1 percent of the women we have to deal with."
Child protection workers need to learn about the legal remedies that have been developed over the years to protect women from battering, so they have something to use in controlling the batterer other than the threat to remove the children from the home (which may not be an effective threat). They need to learn how to deal with batterers and not become victims of threats and intimidation themselves. They need to learn how to deal with battered women in ways that do not put them in the same controlling and intimidating relationship to the woman that the batterer maintains, while still working toward assuring the safety of the children. They can get help with all of these from traditional domestic violence providers.
At the same time, the traditional providers must learn to appreciate the very different job demands that face child protection workers, the fact that there are many, many women experiencing battering, sometimes very severe battering, who need help but are not ready or willing to accept the particular form of help that they themselves currently offer, and that they can make an important contribution if they help the child protection agencies work out policies and protocols that try to respect everyone's rights and interests. The opportunity in this area is having both child protection agencies and traditional domestic violence services working together in an on-going collaborative relationship that has already produced more help for more women in the communities where these efforts have begun. In the long run, such a relationship will be much more effective than having both sides perceiving each other as the enemy and blocking attempts to improve the ability of child protection agencies to recognize battering and take it into account as they try to develop safety plans for children.
-
-
Clergy and Community-Based Providers
-
Within the domestic violence movement, religion has typically been seen as a vehicle for keeping women in battering relationships. Many workers in battered women's shelters have heard stories from women who first went to their clergy about the battering only to be reminded about the importance of marriage and of their duty to uphold it under all circumstances. In light of these experiences, it takes some bravery and determination for battered women's service providers to consider the role of the clergy in changing the climate of public acceptance for battering and in becoming known as a source of supportive pastoral counseling. Recognizing that clergy have a large potential audience for these messages and knowing that they had several sympathetic clergy to work with, Range Women's Advocates in Northern St. Louis County has begun to explore avenues to reach clergy and bring them into the struggle on the side of ending violence against women.
RWA worked with three pastors to develop a day-long training session that began with an interpretation of Biblical scriptures that support respect for women and reject battering, and went on to detail the harm done by battering and ways that clergy could help end violence against women. These ways focused primarily on trying to change attitudes toward and acceptance of battering within their congregations by preaching on the subject, but also included ways to make themselves more approachable by battered women and more knowledgeable about services and supports that women could use in the community. Invitations went out to the more than 200 clergy in the entire community to attend one of three sessions held around the county. Nineteen accepted, attended, and emerged with considerably changed attitudes and a new determination to take the message further. One fundamentalist minister left saying he was determined to work with the other ministers of his acquaintance to convince them that even a literal interpretation of the Bible could and did support an anti-violence position, and he would try to get them to change their message to their own congregations.
At the same time, the three clergy originally involved in planning the workshops are continuing to develop ideas for how to work further with the religious community. Were other communities to experience equal or even greater success in recruiting clergy and religious communities to the cause of making the world safer for battered women, it could only contribute to changing the public's attitudes toward the acceptability of battering.
-
-
Drunk Driving and Other Chemical Dependency Programs
-
It stands to reason that if abuse of alcohol and drugs is heavily involved in many battering situations, the obverse is also true—many batterers will be found in large groups of alcohol and drug abusers. This overlap suggests a role for chemical dependency providers in a community's response to domestic violence.
The sites in the study provide a couple of examples of the involvement of substance abuse providers in addressing domestic violence. In Baltimore, for example, a nonprofit substance abuse provider has operated an intervention program since 1992 for batterers who are chemically dependent. While this program focuses mainly on battering issues, the provider is aware of and sensitive to substance abuse issues among this population, and provides an intervention for chemically-dependent batterers who may be unable to participate in traditional intervention programs. The program also operates a women's therapy group for chemically-dependent women that includes discussion of domestic violence issues, which are prevalent among the participants. Despite this agency's interaction with battered women and batterers and its role in addressing domestic violence among its clients, it has limited interaction with other community agencies or organizations around domestic violence, except for the Probation Department. As one respondent characterized it, this agency is "not in the loop."
In Northern St. Louis County, judges hearing drunk driving cases automatically sentence offenders to chemical dependency treatment in addition to any fines or jail time they may receive. The same judges automatically include chemical dependency treatment when it is relevant in any protection orders or conditions of probation in domestic violence cases. The director of the chemical dependency treatment center in this community says her agency only knows whether people are court-ordered to treatment, not the primary reason they are there (drunk driving or battering). She also says she finds if very difficult to tell the difference; she knows that those in for drunk driving do a lot of battering, and vice versa. When questioned about whether her staff ever raise issues of battering in their groups rather than staying strictly to issues related to drinking, she said they do not, but began to wonder how this might be done and whether it could be done effectively or would backfire. The conversation raised the issue for us of whether there might be additional opportunities to intervene with batterers through these chemical dependency treatment programs.
-
-
The Business Community
-
The business community offers another avenue to help reduce violence against women, both in their role as community opinion leaders and, for large companies, in their capacity as service providers through employee assistance programs, health insurance, and other benefits. In Northern St. Louis County, both Range Women's Advocates and the chief judge's Anti-Violence Council are beginning to work with business leaders to stimulate their involvement in both of these ways. Baltimore's DVCC is funding a manual for employers on violence against women in the workplace to raise awareness about the issue in their community. In San Francisco, the Domestic Violence Consortium established Partners Ending Domestic Abuse, a group of professional women, to raise private donations for domestic violence. This collaboration resulted in $40,000 in grants to Consortium member agencies in 1994.
Although not a part of this study, the director of the employee assistance program at a major corporation in New England has done several things to involve the business community in fighting domestic violence. He has developed and implemented model policies and procedures for his own company to help its employees affected by domestic violence; he has used his own company as a model to stimulate other major corporations in the state to develop similar programs; and he has challenged chief executive officers of major corporations to become publicly involved in the issue. One result is that each of the battered women's shelters in the state now has at least one major corporate sponsor.
-
-
Batterer Intervention Programs
-
There are many batterer intervention programs in this country, but, at present, there is widespread uncertainty about their effectiveness in changing batterers in any significant way. Most of the research done to date bears out this lack of conviction at the grass-roots level. Many programs are based on principles derived from theories of battering, principally that battering is a manifestation of male power and control. Others are based on simple "anger management" or behavior control principles that treat battering in the same way they would treat fear of heights or smoking cessation. One promising program that has not been adequately evaluated bases its approach on object relations and attachment theories (Stosny, 1995). Some states have minimum requirements for the number of sessions in approved programs (California's is the longest, at 52 weeks); in other states judges order offenders into programs that are as short as one Saturday afternoon. One of our sites insisted that they knew of no "treatment" for batterers, since they had doubts that anything could really successfully change them. Therefore the best they could do was offer an educational component based on the Duluth model, but that still required batterers to examine and discuss their own behavior.
We include batterer intervention here as a huge gap, or opportunity, not because we have anything successful to suggest but because no community response can be truly comprehensive unless it includes the ability to change batterer behavior once the batterers are apprehended. Every community we visited expressed their frustration with this gap, whether they had ample intervention resources or not.
-
