Tuesday, 22 December 2015

Happy 40th JANniversary!

Roger Watson, Editor-in-Chief

JAN is 40 years old in 2016 and I have written this editorial to reflect and look forward: 40 year on (listen as podcast).


And we have a special cover:


Thursday, 10 December 2015

Human Rights Day 2015 (10 December 2016)

Parveen Ali

10 December 2015, which is celebrated as Human Rights Day, is also the last day of United Nation’s ‘16 days of activism’. Today is also the end of the JAN interactive entries on violence against women (VAW) and we launch a JAN special virtual issue on violence against women containing 13 articles published in the past 6 years.

It was an honour for me to run these activities as a guest editor. I am extremely thankful to all my colleagues who contributed to the JAN interactive series, all those who helped make this possible and all our readers who have been following the series. I am very grateful to Roger Watson, Editor-in Chief of JAN who made highlighting the issue of VAW possible.

I thought, it would be useful to reflect on the past 16 days to consolidate points explored. We explored: the scope of VAW; intimate partner violence and its impact; sexual and street harassment; acid violence; female genital mutilation; forced marriages, health care professionals response to forced marriage, honour based violence, impact of domestic violoence and abuse (DVA) on children; prevention of DVA in adolescents , old age and sexual assault; older women’s experiences of DVA; DVA and suicide; the usefulness of DVA perpetrator programme; DVA in the context of migration; DVA and women from minority ethnic backgrounds; role of men; priorities for nursing research focusing on VAW; DVA statistics; and how health care professionals (HCPs) should respond to DVA.

It has been an amazing experience to see the breadth of perspectives presented in these entries. However, a common and very clear message in all of these entries was that health care professionals, especially nurses and midwives, can play a vital role in prevention of DVA. They can do this by contributing to early identification of intimate partner violence victims. They can do this by providing appropriate opportunities and supportive environment (privacy, confidentiality) to DVA victims, so they feel able to disclose their experience. HCPs can help prevent DVA by ensuring appropriate referrals are made to appropriate services. In addition, active listening, an empathetic and non-judgmental attitude and an awareness of one’s own values and beliefs related to DVA/VAW, prejudice and biases is necessary to provide appropriate care. HCPs, including doctors, nurses, midwives, can also play their role by contributing to the development and implementation of appropriate policies, guidelines, and legislations at all levels. They need to ensure that every DVA victim is provided with person-centred and individualised care. Other points raised in these entries include recognising the importance of engaging men in prevention of VAW, the importance of increasing awareness of issues such as sexual and street harassment and the usefulness of perpetrator programmes. It is also important to explore perpetrator's perspective as it can help identify motives and characteristics of perpetrators, which can help develop appropriate programme.

VAW is a complex and multifactorial issue, therefore, it requires a multi-sectoral and ecological approach to deal with it. HCPs including doctors, nurses and midwives are integral part of health care system of any society, and by virtue of their position, they can help prevent VAW.

I hope that those who have engaged with JAN interactive series on VAW have found it useful. I also hope that we can continue to engage in such debate in future.


Domestic violence and abuse: how should doctors and nurses respond? (10 December 2015)

Gene Feder

Domestic violence and abuse (DVA) is a violation of human rights with long-term health consequences, from chronic pain to mental ill-health. It is a global public health challenge, requiring political and educational intervention to drive prevention, as well as a robust criminal justice response. But what is required from front line doctors and nurses, beyond the requirement to respond with clinical competence and compassion to survivors of DVA presenting with, for example, acute injuries, pelvic pain or PTSD? What are the arguments and the evidence for an extended role for clinicians, as articulated in the NICE guidelines on DVA and the WHO guidelines on intimate partner and sexual violence, requiring specific training on DVA and the resources for referral of patients experiencing DVA to specialist DVA services?

A crucial argument and evidence source, as we move towards more patient-centred care, are that women survivors of DVA want their health care professionals to ask them about abuse and respond appropriately. In a systematic review (now almost ten years old) of 25 qualitative studies, a consistent message emerged about expectations that patients who had experienced DVA have of their doctors, which we can also extrapolate to nurses.
  • Before disclosure/questioning: try to ensure continuity of care and follow up (difficult for doctors and nurses in emergency settings) 
  • Make it possible for women to disclose: ask about current and past abuse 
  • When issue of partner violence is raised: don’t pressurise women to fully disclose 
  • Immediate response to disclosure: ensure that the women feel that they have control over the situation and address safety concerns 
  • Response in later consultations: understand the chronicity of the problem and provide follow up and continued support 

A second argument is that training of doctors and multi-disciplinary teams improves identification of patients experiencing DVA and safe, appropriate management after disclosure. A systematic review of studies testing the effectiveness of DVA training found that training was effective, particularly if it included a referral pathway to specialist DVA or other supportive services. The crucial contribution of access to DVA services is central to the UK-wide IRIS programme of training and support for general practice teams. Based on a randomised controlled trial of that intervention, the IRIS model is now being implemented in over 30 localities in England and Wales, with a similar programme in the Scottish Lothian region.

A third argument for an extended role for clinicians with regards to DVA is based on growing evidence of effectiveness for interventions after disclosure. As discussed in our overview of health system responses to intimate partner violence, beyond first-line support that doctors and nurses can give to patients who disclose abuse, specialist DVA advocacy, cognitive behavioural and other trauma-informed psychological methods can improve women’s safety and mental health outcomes. It is tragic that, in the UK and internationally, just as the case for linkage of health services to specialist DVA services is finally being heard, the charitable sector, in which most of the specialist services are located, is being squeezed financially as part of a wider attack on the public sector.

Health care settings should be safe places where women are asked (but not screened) about DVA by doctors and nurses, can be confident of a validating response from the clinician and an offer of referral for specialist DVA support.


Author profile

Professor Gene Feder is a Professor of Primary Healthcare at the University of Bristol. His research interests are in cardiovascular medicine and domestic violence. Gene held the chair of primary care research and development at Barts and the London (QMUL) until 2008. He chaired 4 NICE clinical guidelines (Lipid management in type II diabetes, Falls in older people, Secondary prevention of MI, Domestic violence and abuse) and the WHO intimate partner violence guideline development group.
















Wednesday, 9 December 2015

Culturally biased misconception of triage nurse role in the emergency department

Amir Mirhaghi


Commentary on: Innes K. (2015) Care of patients in emergency department waiting rooms – an integrative review. Journal of Advanced Nursing 71, 2702–2714.

With reference to the recent JAN article from Innes et al. (2015). Triage in the emergency department (ED) is defined as the priority allocation in the provision of care and cure for the patients in the ED (Mirhaghi et al. 2015), so most EDs have developed triage practice in response to overcrowding to ensure critically-ill patients receive required services in a timely manner. However the role appears to be challenging for emergency nurses in the ED, the triage nurse role needs to be extended as overcrowding grows too (Oredsson et al. 2011). Therefore, triage-related interventions have been developed to reduce the negative effects of overcrowding and advance triage practice. Consequently, I would like to bring your attention to the culturally biased misconception of triage nurse role in the ED. It is globally accepted that the triage nurse role is to mitigate the effect of ED overcrowding through prioritizing patient care and carrying out interventions to lessen waiting time (Oredsson et al. 2011, Rowe et al. 2011). In fact, the triage nurse is responsible for ensuring patient safety as well as early recognition of patient deterioration by means of reassessment and re-triage prior to being seen by a physician in the ED, so any study in this regard must address triage nurse role dimensions to examine healthcare roles in the waiting room.

Overall, it is not reasonable to limit health care roles to a specific label called 'clinical initiative nurse role' (CIN) and exclude triage from search strategy, resulting in a significant bias in the review. However, the authors declared that CIN has been viewed as an adjunct to the triage role as well as indicating the same definition as triage nurse role that has been well known to practitioners for CIN, They did not use the search strategy to uncover ultimate aspects of care of patients in emergency department waiting rooms (Whittemore & Knafl 2005).

We highly recommend further studies on the role of triage nurse address culturally sensitive investigation on diverse variations of triage nurse role worldwide to reveal transforming nature of triage practice in EDs.



Amir Mirhaghi
Evidence-Based Caring Research Center,
Department of Medical-Surgical Nursing, School of Nursing and Midwifery,
Mashhad University of Medical Sciences, Mashhad, Iran
mirhaghia@mums.ac.ir



References

Innes K., Jackson D., Plummer V. & Elliott D. (2015) Care of patients in emergency department waiting rooms - an integrative review. Journal of Advanced Nursing 71, 2702–2714.

Oredsson S., Jonsson H., Rognes J., Lind L., Göransson KE., Ehrenberg A., Asplund K., Castrén M. & Farrohknia N. (2011) A systematic review of triage-related interventions to improve patient flow in emergency departments. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 19, 43.

Rowe BH., Villa-Roel C., Guo X., Bullard MJ., Ospina M., Vandermeer B., Innes G., Schull MJ. & Holroyd BR. (2011) The role of triage nurse ordering on mitigating overcrowding in emergency departments: a systematic review. Academic Emergency Medicine 18, 1349-57.

Mirhaghi A., Kooshiar H., Esmaeili H. & Ebrahimi M. (2015) Outcomes for emergency severity index triage implementation in the emergency department. Journal of Clinical and Diagnostic Research 9, OC04-7.

Whittemore R. & Knafl K. (2005) The integrative review: updated methodology. Journal of Advanced Nursing 52, 546-53.






“One in three women” (9 December 2015)

Henriette Jansen


Results from surveys on violence against women from around the world done in the last 15 years helped enormously with getting violence against women on the global agenda which recently culminated in violence against women now also being included in the 2030 Sustainable development agenda.

Most of you have probably heard that one in every three women will experience physical or sexual violence in her lifetime. We have seen this on TV adverts, on the posters in the waiting room of the doctor, and indeed in important reports and campaigns by the UN and others.

One in every three women. Where does this number come from? And is it actually true?

Fifteen years ago, when the Beijing Platform for Action pointed out the scarcity of the evidence and called for collection of data on violence against women, almost no data was available from the global South and only very little from the global North. At that time some activists and researchers working on violence already used the ‘one in three’ statistic, actually a guesstimate at best.

Now, 15 years further, we have come a long way and we do have national survey data on violence against women from about half of all countries in the world. A recent WHO report looked at many of these surveys and concludes with ‘one in three’ women aged 15-49 reporting experience of physical or sexual violence at one point in their life. Most of this violence is caused by an intimate partner or ex-partner, husband, boyfriend; someone who is supposed to care for her.

‘One in three’ is now officially the global statistic supported by the combined evidence. Lucky for those activists who have been using this all along and long before we had the evidence! True, it differs within and between countries and between regions. For example, in Viet Nam three out of 10 women reported physical or sexual violence by a husband while in Fiji even twice as many women, two out of three report ever having experience physical or sexual violence by a male partner.

One in three. It is an important statistic even if it is not the whole story. This statistic does not tell us how often it happened, how severe, when it happed, how long it lasted or whether it is still ongoing. All that is also extremely important, but the ‘one in three’ is simply reflecting the proportion of women in the total population that had had such an experience at least once in her life. It speaks of very large numbers. It is particularly useful to raise awareness.

How do these surveys get these numbers? In violence prevalence surveys, the methods we use to measure how common violence against women is, involve using especially trained female interviewers who know how to build rapport, keep a woman safe and her story confidential. In a national survey, thousands of women in the general population are interviewed; any woman can be chosen, the interviewer does not know in advance anything on the woman’s life. The questions do not use the word ‘violence’ but ask about the experience of very concrete behavioural acts, such as slapping, kicking, strangling, forcing to have sex, etc.

One in three. I have often been asked if some women could be exaggerating or lying. I am sure this is extremely unlikely. We know from the surveys that many of the women who tell their stories to interviewers have never told anyone before about their experience with violence… Women usually do not share their problems with others because if her husband or partner finds out that she has been talking about him, he’ll beat her up again. Or she is afraid that she will not be taken serious, she will be blamed. The silence, the stigma and the prejudices cause that it is extremely hard for most women to talk about the violence that is happening to them; and this keeps the problem hidden. So we are much more likely that some women remain silent and we thus underestimate the proportion of women with violence rather than overestimate.

No matter how high the quality of this data, you should realize we will always underestimate the proportion of women with violent experiences…, even if all women that we interview will talk openly about their experience. This is because we will always miss the most severe cases. A murdered woman will never appear in statistics that are based on surveys. She cannot be interviewed in a survey! There are many more who will not enter in our statistics: all those who are hard to reach, for example those who are hospitalized because of the injuries inflicted to them by violent partners, those who are institutionalized, because of their mental problems after many years of psychological abuse and manipulation, those who are locked up by husband or relatives, those who are not given permission to leave the house or even to open the door and be interviewed by strangers, or those who are too afraid to do so. And we have no idea how many they are.

From now one, when you hear ‘one in three’ or any other prevalence rate from a violence survey, just think for a moment about the many women that we could not count. The reality is always worse.


References


Fiji Women’s Crisis Center (2014) Somebody’s life, everybody’s business! National Research on Women's Health and Life Experiences in Fiji (2010/2011): A survey exploring the prevalence, incidence and attitudes to intimate partner violence in Fiji.

Garcia-Moreno C., Jansen H.A.F.M., Heise L., Watts C. (2005) WHO multi-country study on women’s health and domestic violence against women. Initial results on prevalence, health outcomes and women’s response. World Health Organization, Geneva

General Statistics Office (2010) 'Keeping silence is dying': Results from the National Study on Domestic Violence against Women in Viet Nam. Hanoi, Viet Nam: GSO.

Jansen H.A.F.M. (2012) Prevalence surveys on violence against women - Challenges around indicators, data collection and use. Expert paper prepared for Expert Group Meeting Prevention of Violence against Women and Girls, Bangkok, Thailand

Jansen H., Watts C., Ellsberg M., Heise L., Garcia-Moreno C. (2004) Interviewer training in the WHO multi- country study on women's health and domestic violence. Violence Against Women 10:831-849

United Nations (2015) Transforming our World: The 2030 Agenda for Sustainable Development

World Health Organization, London School of Hygiene and Tropical Medicine, South African Medical Research Council (2013) Global and regional estimates of violence against women. Prevalence and health effects of intimate partner violence and non-partner sexual violence.


Author Profile

Dr Henrica A.F.M. (Henriette) Jansen is an internationally renowned expert on violence against women (VAW) research, with special interest in measurement, ethical and safety issues. She has 35 years world wide experience with the UN, governments and NGOs, working in public health and epidemiology in Africa, Asia, Caribbean, Middle East, Pacific and South America, of which the last 15 years exclusively in the area of VAW. Currently she is involved with UNFPA Asia and the Pacific Regional Office supporting national VAW studies and strengthening regional research capacity. She led VAW studies in the Pacific Region (2009-2013, UNFPA and NGOs), Viet Nam (2009-2010, WHO/GSO) and Turkey (2008-2009, HUIPS/KSGM/EU) and was Core Research Team member on the WHO Multi-country Study on Women’s Health and Domestic Violence (1999-2007). She (co-) authored on multiple journal article articles and reports, including an expert paper in preparation of the 57th CSW, where she spoke on two high level panels on VAW data. Email: Henriette.jansen@gmail.com.





Tuesday, 8 December 2015

Listening to Women’s Voices and Focusing on Prevention: Priorities for Nursing Research on Violence against Women (8 December 2015)

Caroline Bradbury-Jones


Over the past few years there has been a surge of political and research interest in violence against women. This has brought the issue into the spotlight and a very recent editorial in The Lancet (2015) has pointed out that as the problem of violence against women and girls is elevated in global policy circles, the activists who put the issue on the map in the first place are being left out of important discussions. The editorial argues that women’s voices are critical because they know the emerging issues and they can ensure that policy and service developments remain responsive to the needs of women and girls.

There is now indubitable evidence for the economic, social, health and personal costs of all forms of violence against women - such as trafficking, female genital mutilation and early and forced marriage and domestic violence and abuse. Nurses have a key role in recognising and responding to women who have experienced violence, and in my own area of research (domestic violence and abuse) their crucial role has been highlighted (Taylor et al. 2013, Bradbury-Jones et al. 2014). As testimony to the relevance of violence against women for nursing, JAN has created this blog. It is no coincidence that the blog coincides with the 16 Days of Activism against Gender-Based Violence 2015 campaign, which for the first time ever, has prevention as its theme.

The aim of the 16 Days of Activism campaign is to eradicate violence against women; violence is not inevitable, most is preventable (The Lancet 2015). Over the recent days of the activism campaign, there are two issues that come to the fore: listening to women’s voices and focusing on prevention. The accompanying image for this blog is a collage created by women who had experienced domestic violence and abuse. The wings of empowerment and feeling free from within, are strong representations of women’s fight for freedom. Translated into priorities for nursing research, listening to women’s voices and focusing on prevention can form the bedrock of good quality research. No studies regarding violence against women should be done in the absence of women themselves; it is inherently empowering to be heard. Additionally, most violence is preventable and knowing this should strengthen our efforts to eradicate it. Women can be free of violence, and focusing on prevention gives nursing research purpose and direction.


References

Bradbury-Jones, C., Taylor, J., Kroll, T. & Duncan, F. (2014) Domestic Abuse Awareness and Recognition among Primary Healthcare Professionals and Abused Women: a qualitative investigation. Journal of Clinical Nursing, 23, 3057-68.

Taylor, J., Bradbury-Jones, C., Kroll, T. & Duncan, F. (2013) Health Professionals’ Beliefs about Domestic Abuse and the issue of Disclosure: A Critical Incident Technique Study. Health & Social Care in the Community, 21(5), 489-499.

The Lancet (2015) Violence against women and girls: how far have we come? [Editorial]. The Lancet, 386, 2029.


Author profile

Caroline Bradbury-Jones is Reader in Nursing at the University of Birmingham, England. She has a clinical background in nursing, midwifery and health visiting. Her primary research interest is in domestic violence and abuse and more specifically, public health interventions and responses to the issue. Caroline is an Associate Editor for the international journal Child Abuse Review and sits on the Board of Trustees for the British Association for the Study and Prevention of Child Abuse & Neglect (BASPCAN).



Monday, 7 December 2015

Triple Jeopardy: Being an abused woman from minority ethnic background (7 December 2016)

Parveen Ali


Domestic violence and abuse (DVA) is a widespread problem intersecting age, social class, ethnicity, religion, nationality and culture. DVA is associated with severe physical and psychological consequence, and victims/survivors need help and support from appropriate professionals and services. However, experiences of women from minority ethnic communities, in any country, could be different. Immigrant women are at higher risk of DVA related morbidity, mortality, and experience additional barriers, than the majority of native women in any country (Briones-Vozmediano,2014) due to a combination of factors including gender, ethnicities and marginalisation (Briones-Vozmediano 2014, Anitha 2010). There are service user (victim/survivor) and service provider (practitioners/health care professionals) related factors affecting provision of appropriate services to women victims of violence who are already marginalised.

Many of these women may also be experiencing violence from other family members such as in-laws. Factors such as lack of social networks and appropriate family support system, lack of personal income adds to their vulnerability to experience further abuse and coercive control by intimate partners and other family members. Not knowing who to ask for help, lack of knowledge of available services, limited ability to access health care and other services independently and language barriers mean that they have to endure such abusive relationship longer.

One of the biggest factors contributing to social isolation and inability to access appropriate support for women from minority ethnic communities is their inability to communicate in mainstream language of the country for example English. Language barriers limit their ability to develop contacts and social relationships. Such barriers make it difficult for women to disclose their experiences of abuse, as in most situations women are accompanied by their family members who may function as interpreters making disclosure impossible. Use of interpreters and translators is one way of minimizing the impact of language barriers (Flores 2005), though, risk of communication errors and difficulties in establishing rapport limit the effectiveness of these services. Preparedness of interpreters to work with DVA victims is another important issue that remains under investigated. Other issues, such as not having travel document, fear of children being taken away, fear of being sent back to family and country of origin may add to additional pressure for women victims of DVA.


In addition to language barriers, there are many other issues associated with practitioner’s ability to explore DVA and provide appropriate services to DVA victims from minority ethnic communities. For instance, practitioners may fear appearing ‘racist’ or offending when asking DVA related questions (Khelaifat et al. 2014). They may assume that DVA is part of the victim’s culture or religion and, therefore, they may not explore DVA. Findings of my own research reveal that practitioners do not feel comfortable in challenging cultural and religious justification of DVA and, therefore, do not explore DVA (Burman et al. 2004, Puri 2005). Practitioners often ‘otherise’ minority ethnic women’s experiences of abuse or may impose their own perceptions, values and belief about DVA and what abuse is. While it is important to understand how DVA is conceptualised in different groups to ensure development of appropriate preventive approaches, it is also necessary to be mindful of accepting culture and/or religion as an excuse for DVA. This may contribute to ‘otherisation’ which further marginalise already marginalised groups.


Practitioners needs to be aware of such challenges when providing care to victims of DVA from minority ethnic communities. Spending appropriate time with the victim to develop rapport and trust, active listening, provision of privacy, ensuring confidentiality is necessary.


References

Anitha, S. (2010). No recourse, no support: State policy and practice towards South Asian women facing domestic violence in the UK. British Journal of Social Work, 40(2), 462-479.

Belknap, R. A., & Sayeed, P. (2003). Te contaria mi vida: I would tell you my life, if only you would ask. Health Care for Women International, 24, 723-737.

Briones-Vozmediano, E., Goicolea, I., Ortiz-Barreda, G. M., Gil-González, D., & Vives-Cases, C. (2014). Professionals’ Perceptions of Support Resources for Battered Immigrant Women Chronicle of an Anticipated Failure. Journal of Interpersonal Violence, 29(6), 1006-1027.

Burman, E., Smailes, S. L., & Chantler, K. (2004). ‘Culture’as a barrier to service provision and delivery: domestic violence services for minoritized women. Critical Social Policy, 24(3), 332-357.

Khelaifat, N., Shaw, A., & Feder, G. (2014). Why are Clear Migrant Definitions and Classifications Important for Research on Violence Against (Im-) Migrant Women. Arts Social Sci J S, 1, 2.

Puri, S. (2005). Rhetoric v. reality: the effect of ‘multiculturalism’on doctors’ responses to battered South Asian women in the United States and Britain. Patterns of Prejudice, 39, 416-430.




Where men stand: the role of men in preventing violence against women (7 December 2016)

Parveen Ali


Since 25 November 2015, in JAN interactive, we have explored various forms of violence against women (VAW). Diverse perspectives from people from various disciplines are presented. A common theme among all these perspective was that VAW is a significant social and public health problem and that it is often perpetrated by men against women, though not all men are violent (United Nations Division for the Advancement of Women 2003). The question is why some men use VAW? How can we stop VAW? What is the role of men in preventing VAW?

Well, over the centuries, various explanations have been proposed to explain why some perpetrate violence and other don’t. The ideology of patriarchy, culture and society, religion and the role of media have been explored. Biological (structural and chemical changes in the brain due, for example, to trauma or head injury) and psychopathological (psychopathology, mental illness, attachment problems, inability to manage anger and hostility, deficiency in various skills and abilities, such as management of anger and hostility, lack of assertiveness, low self-esteem and communication skills) explanation have been proposed (Ali & Naylor 2013). Power and control issues, violence in the family of origin, differences in the possession of tangible and intangible resources of men and women in the intimate relationship (Ali & Naylor 2013) have been discussed. Available evidence suggests that men who use violence against other men are more likely to perpetrate VAW. There is also an association between experiencing abuse and perpetrating abuse against women (Jewkes et al. 2013). All in all, it appears that no single factor can fully explain the phenomenon of VAW, though every perspective contributes to the explanation of VAW. Thus, an ecological approach considering various relationship, family, community and society related factors deems appropriate to address VAW (Jewkes et al. 2015). Such exploratory efforts, however, have helped unearth the need to involve men, as ‘ally’, is vital (Jewkes et al. 2015).

Since the 1990s, there has been an increasing acknowledgement that men and boys can play a very positive role in promoting gender equality and preventing VAW. Therefore, many interventions aiming to help men understand and change their behaviour were developed and promoted. Domestic violence perpetrators programme are one such important example. However, there is a need to involve men generally and to challenge forms of masculinities condoning violence, prevalent in cultures and societies (Lorentzen 2005). The first step in engagement of men is to understand why VAW should concern men and why should the get engaged? Campaigns, such as White Ribbons, have been instrumental in developing such understating; however, much more needs to be done. There are some important reasons for VAW should concern men. VAW should concern men as it impacts the lives of important women (mother, sisters, wife/partner, daughters and/or friends) in their life. VAW should concern men as violence perpetrated by a minority creates a negative image of all men. VAW is a men’s issue as, by virtue of their social position, men can speak out and step up against VAW (Flood 2010) in societies and cultures. There are various ways through which men can contribute to the development of a culture and environment that condones VAW. For instance, by not engaging in VAW, intervening against VAW perpetrated by other men, refusing to be bystanders to other’s violent behaviour, and contributing to VAW preventive programmes such as awareness sessions, exploring gender identities and attitudes about VAW (Berkowitz 2004).


As engagement of men is an important aspect of VAW prevention, much needs to be done to explore strategies fostering engagement opportunities. Appropriate opportunities need to be created for men to discuss their feelings. Men’s perspective about VAW men’s contribution to VAW preventive efforts need to investigated. Space and opportunities need to be created for both men and women to share their views and concerns with each other in an open, honest, structured and non-confrontational way. More programmes, strategies involving men, women, boys and girls need to be done to limit gender stereotyping and promote gender transformation.


References

Ali, P. A., & Naylor, P. B. (2013). Intimate partner violence: A narrative review of the biological and psychological explanations for its causation. Aggression and Violent Behavior, 18(3), 373-382.

Ali, P. A., & Naylor, P. B. (2013a). Intimate partner violence: A narrative review of the feminist, social and ecological explanations for its causation. Aggression and Violent Behavior, 18(6), 611-619.

Berkowitz, A. (2004, October). Working With Men to Prevent Violence: An Overview (Part One). Harrisburg, PA: VAWnet, a project of the National Resource Centre on Domestic Violence/Pennsylvania Coalition Against Domestic Violence Accessed 4 December 2015.

Flood (2010). Where Men Stand: Men’s roles in ending violence against women. Accessed 4 December 2015

Jewkes, R., Fulu, E., Roselli, T., & Garcia-Moreno, C. (2013). Prevalence of and factors associated with non-partner rape perpetration: findings from the UN Multi-country Cross-sectional Study on Men and Violence in Asia and the Pacific. The Lancet Global Health, 1(4), e208-e218.

Jewkes, R., Flood, M., & Lang, J. (2015). From work with men and boys to changes of social norms and reduction of inequities in gender relations: a conceptual shift in prevention of violence against women and girls. The Lancet, 385, 1580-1589.

Lorentzen, J. (2005). The role of men in combating violence against women. UNDAW background paper in print. Accessed 4 December 2015.

United Nations Division for the Advancement of Women (2003). The Role of Men and Boys in Achieving Gender Equality. Division for the Advancement of Women. Accessed 4 December 2015



Sunday, 6 December 2015

Domestic violence against women in the context of migration and minoritization (6 December 2015)

Punita Chowbey

‘The day I got here it was evening, but the second day he showed me around his house, where everything was, the kitchen, and bathroom. The first thing he said to me you don't need to worry about me, you don't need to know my whereabouts, when I come and when I go. I only got married because of my parents - so you can just look after them. I use to enjoy wearing nail polish and he said to me, my parents don’t like it so take it off.' (Fatima (a fictitious name), research participant, South Asian Women's experience of domestic abuse, Minhas et al. 2002)

Fatima had left behind everything familiar her family, friends and surroundings and followed her husband to the UK, whom her parents trusted to look after their daughter. However, the trust was soon broken. When violence became unbearable, Fatima ended up in a refuge in the North of England. Many women like Fatima who are first generation migrants are vulnerable and isolated in an unfamiliar and hostile environment. Though domestic violence is pervasive globally and in all ethnicities, it differs in its form, content and severity depending on women's location in the socioeconomic, racial, and sometimes legal hierarchies.  Thus, experience of domestic violence is not homogenous and need to be seen against various intersecting axes of inequalities such as race, class, and migration; these need diligent theoretical and empirical investigation (Burman et al. 2004, Reavey et al. 2006, Chantler 2006).

While the incidence of domestic violence is not higher among migrant populations as compared to the white majority, minority ethnic women's experiences of domestic violence are often exacerbated due to poverty and social isolation (Anitha et al. 2008, Minhas et al. 2002). They are more likely to experience higher rates of unemployment and have lower levels of individual income (for a UK scenario on ethnic minority women's poverty, see Nandi and Platt 2010).  Lack of access to and control over resources, lead to financial dependence on the very perpetrators they seek to escape from (Minhas et al. 2002; Hague et al. 2006). Seeking support from the woman's natal family is usually avoided due to shame, fear of disapproval and distance (Haguet et al. 2006).

The above situation is further aggravated by systemic barriers to accessing support (Hague et al. 2006, Anitha et al. 2008).  Many migrant women lack English language skills and the ability to navigate services, rendering them invisible and isolated.  Fear of racism in mainstream services or anxieties about confidentiality in culturally specific services can further prevent them from seeking support (Burman et al. 2004, Hague et al. 2006).  In some cases, for example where identification documents are in the control of husband or in-laws or where the woman is subject to a 'No Recourse to Public Funds' (NRPF) stamp (in case of UK),   women feel unable to seek formal support (Anitha et al. 2008).  Although UK immigration law offers a 'domestic violence exemption', many women are not aware of their rights and the uptake of these services is very low (Hague et al. 2006).

Work around domestic violence has either disregarded minoritized women's experiences of violence on 'cultural' grounds, 'a homogenised absence'  or has put a spotlight on them and brought them and their community under scrutiny,  'a pathologised presence' (Burman et al. 2004, Chantler 2006 ). Those women who seek to engage with services against the above-mentioned odds report mixed experiences (Anitha et al. 2008).  A  UK study found positive experiences with specialist domestic violence services, Law centres and Citizen's Advice Bureau but dissatisfaction with health professionals, police and social services (Anitha et al. 2008). Another study revealed health professionals' failure to pick up on signs of violence due to assumptions related to culture and clothing (Minhas et al. 2002). Such 'cultural framing of violence' can pathologise and obscure the real issues of intersecting gender, class and racial inequalities in which domestic violence is embedded (Menjívar 2002, Burman et al. 2004).

Health professionals need to understand and engage with both specific and common forms of violence in context of migration and minoritizaion and respond appropriately rather than making assumptions about 'culture' (Burman 2004).   A multi-sectoral approach to bring out sustainable changes in wider social, political and legal structures including immigration policies is  needed to address migrant and minoritized women's needs (Michau et al. 2015, Anitha et al. 2008, WHO 2013).


References
Burman, E., Smailes, S. L., & Chantler, K. (2004). ‘Culture’as a barrier to service provision and delivery: domestic violence services for minoritized women. Critical social policy, 24(3), 332-357.

Chantler, K. (2006). Independence, dependency and interdependence: struggles and resistances of minoritized women within and on leaving violent relationships. Feminist Review, 27-49.

CPS (2011 ) accessed on 02 Dec 2015, available at: https://www.cps.gov.uk/publications/docs/DV_FAQ_leaflet_accessible_2011.pdf

Hague, G., Gangoli, G., Joseph, H.  & Alphonse, M. (2006) Domestic Violence, Marriage and Immigration If you are immigrating into the UK to marry, what you might need to know,  University of Mumbai, India  and University of Bristol, UK

Menjívar, C., & Salcido, O. (2002). Immigrant women and domestic violence common experiences in different countries. Gender & society, 16(6), 898-920.

Michau, L., Horn, J., Bank, A., Dutt, M., & Zimmerman, C. (2015). Prevention of violence against women and girls: lessons from practice. The Lancet, 385(9978), 1672-1684.

Minhas, N., Hollows, A., and Kerr  (2002) South Asian Women's Experience of Domestic Abuse: Pillar of Support. Sheffield Hallam University, Survey and Statistical Research Centre

Nandi, A., & Platt, L. (2010) Ethnic Minority Women’s Poverty and Economic Well Being, Government Equalities Office (GEO)

Reavey, P., Ahmed, B., & Majumdar, A. (2006). ‘How can we help when she won't tell us what's wrong?’Professionals working with South Asian women who have experienced sexual abuse. Journal of community & applied social psychology, 16(3), 171-188.

World Health Organization (WHO). (2013). Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization.


Author profile

Punita Chowbey is a Research Fellow at the Sheffield Hallam University. Her mainly sociological research interests and experience fall into the following themes: Household economies, household food consumption, and healthy eating, families and marital relationships, parenting, ethnic inequalities in health, and race/ethnicity.  Punita’s research focusses on the South Asian population in the UK and in South Asia.


Saturday, 5 December 2015

The usefulness of domestic violence perpetrator programmes (5 December 2015)

Nicole Westmarland



Over five years ago Respect – the national organisation for work with domestic violence perpetrator programmes – told us about the problems they were having in evidencing whether or not the programmes their members provided were really making a difference to the lives of (predominantly) women and children experiencing domestic violence.

Project Mirabal was named after the three Mirabal sisters who were murdered in Dominican Republic and became symbols of feminist resistance when November 25th was designated an international day to protest violence against women, and was led by Professor Liz Kelly and myself.

There was a lot of interest in our research from the start. Internationally, there have been few of these longitudinal outcome studies on any interventions aimed at reducing domestic violence. Given the attention domestic violence now attracts, it is both surprising and scary how little we actually know about ‘what works’. Studies of this nature are expensive, and we rightly felt a lot of pressure to ‘get it right’ and make sure that we conducted a nuanced and useful study that would be useful to the various stakeholders. Respect were very clear from the start that they were ready to hear anything we had to tell them – if they weren’t making a difference they wanted to change their programmes and rethink their approach.

We started by considering the question what does ‘work’ mean? What does it mean, from the perspective of different stakeholders, to say that a programme ‘worked’. From this pre-study we developed six ‘measures of success’. These measures include safety and freedom from violence and abuse but also better parenting, respectful communication, increased space for action, and self-awareness. These six measures were taken forward into our outcome study.

The quantitative part of the outcome study, based on 100 women’s reports of their partner or ex-partner’s behaviour over a 15 month period, found marked reductions in men’s use of physical and sexual violence. For example, ‘made you do something sexual that you did not want to do’ reduced from 30% of women saying this happened before the programme to 0% afterwards. Similarly, ‘used a weapon against you’ reduced from 29% to 0%. Far fewer women reported being physically injured after the programme (61% before compared to 2% after).

Improvements were also found in terms of men’s use of coercive control, women’s individual freedom and their ‘space for action’. However, these changes were not as marked as they were for physical and sexual violence. For example, ‘he tells me to change the way I dress or my appearance’ reduced from 57% of women to 16% and ‘he tries to prevent me seeing or contacting my friends/family’ reduced from 65% to 15%. Interestingly, hardly any change was seen for ‘he tries to use money/finances to control me’ – reducing only marginally from 50% to 47%. Most women continued to feel afraid of how their ex-partner would react if they got a new partner or felt they had to be careful around him if he was in a bad mood.

This is just a small extract of our findings from a long and complex research study. However, they do show some optimism in terms of steps towards change that can be made if perpetrators choose to do so. Some men only made a few halting steps forward, a minority took steps backwards. Others started taking small steps and ended up making great strides. What was clear in our study was that for many men, women and children, their lives were improved to some extent following a domestic violence perpetrator programme.


The final report is available here

Project Mirabal was funded by the ESRC and the Northern Rock Foundation.


Author profile

Professor Nicole Westmarland is Director of the Durham University Centre for Research into Violence and Abuse (CRiVA). Nicole is widely known as an academic activist in the area of male violence against women. She is committed to doing research to inform both policy and practice. Her career to date has been reflective of this, with work with grassroots violence against women groups informing and being informed by her academic research. She has sat on a number of governmental and non-governmental advisory committees and chaired Rape Crisis (England and Wales) for five years.

Friday, 4 December 2015

Intimate partner violence and suicide (4 December 2015)

Katie Dhingra


Research has highlighted the varied and often severe consequences of domestic violence and abuse (DVA). Of particular concern, a number of studies demonstrate a strong association between DVA victimisation and both suicidal thoughts and behaviour. Individuals who have experienced DVA are significantly more likely to report a suicide attempt than those without such history, with an estimated 35-40% making a suicide attempt at some point during or after the termination of an abusive relationship (Devries et al. 2011, Reviere et al. 2007). Although few studies have included male samples, DVA appears to be of clinical relevance for both males and females (Heru et al., 2006; Siemieniuk et al.2010). Consequently, it is important that screening for DVA and risk of suicide take place regardless of an individual’s gender.

Several recent studies have investigated the specific elements of DVA associated with suicidal behaviour. McLaughlin and colleagues (2012) in their recent systematic review reported a dose-response effect between the severity of abuse experienced and suicidality (thoughts and/or behaviour), with more severe DVA being related to greater suicide risk. Thus, in addition to DVA screening, healthcare professionals should also assess the severity of abuse experienced and suicide ideation. The available literature also draws attention to the relevance of assessing the type(s) of abuse experienced, as different abuse types have been found to have differential effects on suicidal thoughts and behaviour (e.g., Blasco-Ros et al. 2010, Pico-Alfonso et al. 2006). Ishida et al. (2010), using data from a population-based sample of Paraguayan women found that, for abuse in the past 12 months, physical and sexual violence were more important risk factors for suicidal thoughts than emotional abuse. For abuse experienced greater than 12 months ago, however, sexual violence had the largest adverse effect, indicating that sexual abuse had a longer lasting negative effect on individuals than either of the other two forms of abuse.

Although previous research has established a strong and positive association between DVA victimization and suicidal behaviour, it is difficult to establish whether violence precedes suicidal behaviour, and that other factors do not cause the suicidal behaviour. Theoretically, it could be hypothesized that DVA victimization increases suicide risk through habituation: repeated exposure to painful and provocative stimuli increases the ability to inflict harm to oneself, as one habituates to these experiences (Joiner, 2005). Alternatively, DVA might be considered as one stressor that contributes to feelings of defeat and entrapment, thereby increasing suicide risk (O'Connor, 2011). Studies of exposure to CSA and later suicidal behaviour provide some plausible support for a directional relationship between DVA experiences and suicidal behaviour (e.g. Devries & Seguin, 2013).

Available evidence highlights the relevance and importance of DVA screening in healthcare settings, and suggests that consideration of both the severity and type(s) of abuse experienced could be an important part of this process. It is important to identify all those at risk, and not to confine screening efforts to females. The strong association between DVA and suicidal behaviour that has been noted indicates that those who are identified as having experience of DVA should additionally be screened for suicidal thoughts and behaviours.



References

Blasco-Ros, C., Sánchez-Lorente, S., & Martinez, M. (2010). Recovery from depressive symptoms, state anxiety, and post-traumatic stress disorder in women exposed to physical and psychological, but not to psychological intimate partner violence alone: A longitudinal study. BMC Psychiatry, 10, 98.

Devries KM, Seguin M (2013) Violence against women and suicidality: does violence cause suicidal behaviour? In: Garcıa Moreno C, Riecher-Rossler A (eds) Violence against women and mental health. Key issues ment health., vol 178. Karger, Basel, pp 148-158.

Devries, K., Watts, C., Yoshihama, M., Kiss, L., Schraiber, L. B., Deyessa, N., & WHO Multi-Country Study Team. (2011). Violence against women is strongly associated with suicide attempts: evidence from the WHO multi-country study on women’s health and domestic violence against women. Social Science & Medicine, 73(1), 79-86.

Heru, A. M., Stuart, G. L., Rainey, S., Eyre, J., & Recupero, P. R. (2006). Prevalence and severity of intimate partner violence and associations with family functioning and alcohol abuse in psychiatric inpatients with suicidal intent. The Journal of Clinical Psychiatry, 67, 23–29.

Ishida, K., Stupp, P., Melian, M., Serbanescu, F., & Goodwin, M. (2010). Exploring the associations between intimate partner violence and women’s mental health: evidence from a population-based study in Paraguay. Social Science & Medicine, 71(9), 1653- 1661.

Joiner, T. (2005). Why people die by suicide. Harvard University Press.

O'Connor, R.C. (2011). The integrated motivational-volitional model of suicidal behavior. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 32, 295-298.

Pico-Alfonso, M. A., Garcia-Linares, M. I., Celda-Navarro, N., Blasco-Ros, C., Echeburua, E., & Martinez, M. (2006). The impact of physical, psychological, and sexual intimate male partner violence on women's mental health: Depressive symptoms, post-traumatic stress disorder, state anxiety, and suicide. Journal of Women's Health, 15, 599–611.

Reviere, S. L., Farber, E.W., Tworney, H., Okun, A., Jackson, E., & Zanville, H. (2007). Intimate partner violence and suicidality in low-income African American Women—a multimethod assessment of coping factors. Violence Against Women, 13, 1113–1129.

Siemieniuk, R. A. C., Krentz, H. B., Gish, J. A., & Gill, M. J. (2010). Domestic violence screening: Prevalence and outcomes in a Canadian HIV population. AIDS Patient Care and STDs, 24, 763–770.


Author Profile

Dr Katie Dhingra is a senior lecturer in criminological psychology at Leeds Beckett University. She is also the Editor-in-Chief of the Journal of Criminal Psychology. Her main research interest lies in the application of theoretical models to enhance our understanding of behaviour (suicide and criminal behaviour).





Thursday, 3 December 2015

Invisible: Older women’s experiences of domestic violence and abuse (3 December 2015)

Julie McGarry


In 1983 Barbara McDonald and Cynthia Rich published a collection of essays under the title Look Me in the Eye: Old Women, Aging and Ageism. This groundbreaking text described the experience of growing older for women and included personal narratives of ‘otherness’, a detailed examination of the attitude of society towards ageing and the invisibility of older women generally within the wider discourse. Though not centrally concerned with violence against women (VAW), the core tenets of this text, around the concept of ageing, marginalisation and invisibility, clearly has resonance for older women who have experienced domestic violence and abuse (DVA).

The previous blogs in this JAN interactive series have highlighted the significant impact that DVA exerts on the lives and health of those affected. However, survivors of DVA do not form a homogeneous group and the experiences of DVA for older women are significantly different to their younger counterparts. For example, the long term effects of abuse for older women as survivors of DVA may manifest in the form of physical disability or mental health issues in later life. This is because the impact of DVA does not automatically stop once the abuse itself has ceased. Practically, older women may have caring responsibilities which prevent them from leaving an abusive relationship or they may not know how or where to access the requisite specialist support and services (McGarry, et al. 2011).

Fundamentally, however, current service provision is not aligned to the particular needs of older women and health and social care professionals may not recognise the inherent complexities of DVA in later life or consider DVA to be an issue for older women. The apparent invisibility of older women within the context of DVA service provision has been highlighted by a number of commentators and include the ‘ageist assumptions’ or ‘misconceptions about ageing’ (Leisey, et al. 2009) which limit older women’s access to appropriate DVA services. For example, the blurring of the boundaries between DVA and elder abuse by professionals effectively ignores the particular difficulties that may face older women.  The  presumption of elder abuse largely ignores issues of power and gender and as such, and does not acknowledge the significance of the underlying complexities surrounding ‘the nature of power relations within abusive relationships in later life’ (Penhale 1999).     

Penhale & Goreham (2015) have recently used the term ‘triple jeopardy’ to encapsulate the experience of DVA within the wider context of ageing for women and this is defined as follows:

  • To be old is to be marginalised (single)
  • To be old and female is to be marginalised (double)
  • To be old and female and abused is to be marginalised (triple)


Reflecting on McDonald and Rich’s work over three decades after Look Me in the Eye: Old Women, Aging and Ageism was first published, alongside commentators such as Penhale & Goreham and others, it is clear that the issue of invisibility for older women remains. Within the context of DVA It is vital therefore, that health and social care professionals, alongside specialist and support agencies, are cognisant of the existence and complexity of DVA in later life and to challenge existing assumptions so that services and support for older women survivors of DVA can be developed effectively.   


References

Leisey, M., Kupstas, P., Cooper, A. (2009) Domestic violence in the second half of life. Journal of Elder Abuse and Neglect. 21: 141-155

McDonald, B & Rich, C (1983) Look Me in the Eye: Old Women, Aging and Ageism. Spinsters Ink Books.

McGarry J, Simpson C, Hinsliff-Smith K (2011) The impact of domestic abuse on the health of older women: a review of the literature Health and Social Care in the Community. 19(1), 3-14
Penhale B. (1999) Bruises on the soul: older women, domestic violence and elder abuse. Journal of Elder Abuse and Neglect 11 (1), 122.

Penhale, B & Goreham, B (accessed presentation November 2015) http://www.norfolk.gov.uk/view/ncc121000


Author's Profile

Julie McGarry is Associate Professor, School of Health Sciences, University of Nottingham and Chair of the Domestic Violence and Abuse Integrated Research Group (Social Futures in Mental Health Centre of Excellence, Institute of Mental Health, Nottingham).  Her clinical background is in adult and mental health nursing predominantly working with vulnerable adults across a range of settings. Julie’s education and research expertise centres on domestic violence and abuse and she has published and presented widely in this field. Research to date includes exploring older women’s experiences of intimate partner violence, service provision for older people who have experienced domestic and family abuse and evaluation of the domestic abuse nurse specialist role. Julie is currently developing a collaborative education resource exploring older women’s narratives of abuse and the impact on mental health though the use of an arts based approach.   




Old age and sexual assault: an invisible and silent issue (3 December 2015)

Sharron Hinchliff

One of the findings from the recent National Survey of Sexual Attitudes and Lifestyles (NATSAL 3) was that younger participants (aged 16-44 years) who had experienced ‘sex against their will’ were more likely than older participants (aged 45-74 years) to have told someone or reported it to the police. Women in the age group 55-64 were the least likely to have told anyone.

This finding resonated with me. Many years ago I interviewed women for a project at the University of Sheffield that explored women’s sexual well-being. As part of that project I talked to a woman who was in her 60s at the time of interview and had recently experienced a violent sexual assault. The perpetrator was known to her, the attack was unexpected, and she had not reported it to the police.

Sexual violence towards older women is not as uncommon as we might think. However, it is surrounded by silence and invisibility. A project led by colleagues in Australia, Norma’s Project - named after one of the researchers’ mothers who, at age 83, was sexually assaulted by a male carer while in respite care - explored the sexual assault of women aged 65 and older. They argued that silence around the issue was partly based on age stereotypes, in particular the assumption that older women were asexual, which meant they were seen as unlikely targets of sexual assault. The authors found that barriers to reporting the assault included disbelief, a lack of hard evidence and an absence of witnesses: all of which were complicated when the woman had a diagnosis of dementia.

In 2011 Linda Grant raised the issue in The Independent:
‘We may imagine that the rape of elderly women is a rare, horrible and peculiarly unnatural crime, but it is not. Looking at newspaper cuttings covering the past two or three years, it becomes clear that the rape of older women is not only commonplace but that the number of reported incidents are increasing.’
She listed a number of sexual assaults; it makes a harrowing read. But these are the assaults that have been reported. Other reasons why older women may not report a sexual assault include shame and trauma, particularly if the attacker is a family member, and being unsure whether or not an assault has taken place – after all, older women of today have lived through a time when rape within marriage was not considered a crime.

So what can we do? Ways to move forward include: providing education and training to health professionals so that they can recognise the signs of abuse; increase the visibility of the sexual assault of older women to improve professional and public awareness (it may also help to remove the stigma attached to sexual assault and give women confidence to come forward); and conduct research to identify the best ways to support women and their families after the attack. Finding ways to prevent the assault in the first place is critical. It’s time to break the taboo.


Author Profile:

Sharron Hinchliff is a Senior Lecturer at the School of Nursing and Midwifery, University of Sheffield. She has carried out research into gender and health for over 15 years. Her particular interests are in the following overlapping areas: ageing, sexuality, sexual and reproductive health, sexual well-being and the psychology of health behaviours. She is Deputy Director of the Centre for Gender Research at the University, and is co-editing a book on the Sexual Rights of Older People with Dr Catherine Barrett. See her website for more information.

Wednesday, 2 December 2015

Preventing domestic abuse in adolescence (2 December 2015)

Nicky Stanley

I think a good thing would be to add, like for an hour in high school, stuff like this to the curriculum,… if you did this with the whole year about healthy relationships, then the punishments for domestic violence and stuff, at least like an hour a week or even in assemblies and… maybe people who hadn't heard it was wrong would know it was wrong, and girls would be able to recognize it. (Lily, 15, UK, Hellevik et al. 2015)

Prevention is an essential ingredient of any comprehensive domestic abuse strategy: the problem is too widespread and too embedded to be tackled through treatment alone. National and international protocols and guidance emphasizes the importance of preventing domestic abuse through programmes delivered to young people in school. Adolescence is when young people are embarking on their own intimate relationships and preventive programmes can both prepare them to avoid abusive behaviour in their own relationships and enable them to seek support if they are experiencing domestic abuse at home.

There is now a body of evidence available that can inform the work of those who design or deliver such programmes. Most good quality evaluations show that preventive interventions can shift attitudes and knowledge (Stanley et al. 2015a). However, there is some robust evidence that these programmes can also achieve behavioural change, specifically in relation to boys’ use of physical violence in intimate relationships (Wolfe et al. 2009). Increasingly, interventions are being targeted at boys rather than aiming to equip girls to avoid abusive relationships. Bystander approaches which aim to empower young people to challenge abusive behaviour and language when they encounter it (Katz et al. 2011) are increasingly influential.

Many of the programmes for which there is strong evidence of effectiveness originate in North America, but there are risks in transporting programmes across cultures. Levels of gender equality, understandings of domestic abuse and language and concepts differ across cultures and interventions need either to be homegrown or adapted to ensure a cultural fit.

The use of drama or narrative which contribute to authenticity and ‘make it real’ for young people has been identified as a key feature of programmes that have an impact (Stanley et al. 2015b). It is important that those delivering these programmes in schools are competent and confident and teachers need specialist training if they are to take this work on.

School-based programmes should build close links with relevant support services or ensure that they have in-house capacity to respond to any disclosures of domestic abuse. Such services can enable those young people who are currently experiencing domestic abuse, either in their own or their parents’ relationships, to be identified and offered early help.

Interventions aiming to prevent domestic abuse in adolescence need to take account of power differences, particularly in relation to gender and sexuality. Currently, there is a lack of appropriate materials for Lesbian, Gay, Bisexual and Transgender young people.

Finally, preventive domestic abuse programmes need to be reinforced by the wider policy and social context. Making these programmes a required part of the curriculum delivers a strong message from the government that contributes to shifting social norms. This is not yet the case in England, although it is elsewhere in the UK. Media campaigns offer a means of opening up conversations and creating wider dialogues that can shift levels of awareness and challenge the attitudes that sustain interpersonal abuse. If these programmes are to make a real impact, the message that domestic abuse is unacceptable needs to be supported at all levels, from government policy down to the local culture of the school.


References

Hellevik, PM, Överlien, C., Barter, C., Wood, M., Aghtaie, N., Larkins, C. and Stanley, N. (2015) Traversing the Generational Gap: Young People’s Views on Intervention and Prevention of Teenage Intimate Partner Violence. In Stanley, N. and Humphreys, C. (eds) Domestic Violence and Protecting Children: New Thinking and Approaches. London: Jessica Kingsley.

Katz, J., Heisterkamp, H. A., & Fleming, W. M. (2011). The social justice roots of the mentors in violence prevention model and its application in a high school setting. Violence Against Women, 17, 684–702.

Stanley, N., Ellis, J., Farrelly, N., Hollinghurst, S., Bailey, S. and Downe, S. (2015a). Preventing Domestic Abuse for Children and Young People (PEACH): A Mixed Knowledge Scoping Review. Public Health Research, 3, 7, http://www.journalslibrary.nihr.ac.uk/phr/volume-3/issue-7#abstract

Stanley, N., Ellis, J., Farrelly, N., Hollinghurst, S., and Downe, S. (2015b). Preventing domestic abuse for children and young people: A review of school-based interventions. Children and Youth Services Review, 59, 120-131.

Wolfe, D. A., Crooks, C. V., Jaffe, P. G., Chiodo, D., Hughes, R., Ellis, W.,Stitt, L, Donner, A. (2009). A school-based program to prevent adolescent dating violence a cluster randomized trial. Archives of Pediatrics & Adolescent Medicine, 163,692–699.


Author Profile

Nicky Stanley is Professor of Social Work and Co-Director of the Connect Centre for Research on Interpersonal Violence and Harm at the University of Central Lancashire. She researches on domestic violence, child protection, parental mental health and young people’s mental health. She is currently working on a number of studies examining services for children and families experiencing domestic violence. She has published a research review on children experiencing domestic violence and produced books on domestic violence and child protection. She was a member of the NICE Programme Development Group producing guidance on domestic violence for health and social care in the UK.


‘Making Home’: re-making the self after childhood domestic violence (2 November 2014)

Lisa Procter


Childhood and adulthood have become understood as distinct stages of the lifecourse, which continue to shape idealised notions of relationships between children and adults (James 2013). Societally we hope that children are cared for and protected by adults to live happy childhoods. However, adult and children’s lives cannot be separated so easily. Children’s lives, as much as those of adults, are located within societal structures, including those of violence. One of the sites in which such structures can have significant effects can be within the domestic sphere. While research has shown that domestic violence can have detrimental effects upon children’s health and development (Cleaver et al. 2011, Edleson 1999, Kitzmann, Gaylord et al. 2003, Osofsky 2003), more research is needed that explicitly focuses on engaging with children’s perspectives on their experiences. While there are some exceptions (see for example Stanley et al.2012), overall there is a lack of understanding of the ways in which children make sense of early exposure to domestic violence. This is important because the ways that children come to understand such experiences, and their role within them, will also impact on the ways that they navigate their adult lives. Stories of how children live within and beyond violent homes need to be told.

While the home is often a site that is romanticised, homes can also be uncomfortable spaces where children can be unable to feel at home (Valentine 1993). They can be fearful spaces where children can learn to be on high alert (Nissen 2013), perhaps anticipating interpersonal violence between adults or towards them to occur at any moment. In the cases where violent acts might not be directly targeted at the child, children are still implicated in this violence (Nissen 2013). Children can learn to carefully manage their actions as they navigate an unstable emotional terrain in an effort to maintain some sense of equilibrium for themselves and their family members (Nissen 2013). The external violence they witness can become internalised, with the possibility of leading to acts of violence toward the self or others (Osofsky 1997). Their bodies absorb memories of trauma, not necessarily available to conscious thought (Walkerdine et al. 2013), but which can pattern children’s embodied knowledges of ways in which actions can seem to act as catalysts for violence. These emotional experiences live in the body and can continue to have resonance in adulthood in ways that cannot be spoken (Walkerdine et al. 2013). This recognition of childhood trauma as a bodily experience gives rise to questions about how early experiences are transmitted into adulthood.

Attending to home and homemaking might offer some insights here. Massey defines place ‘as a particular constellation within the wider topographies of space and as in process, as unfinished business’ (Massey 2005, p. 131). The homes of adults who were exposed to domestic violence in childhood are unfinished and layered within aspirations of what home could be and become (Blunt & Dowling 2006). New materialism studies account for the ‘nonhuman’ as well as ‘human’ forms of agency (Barad 2007), reflecting the ways in which the material world is implicated within children’s trajectories. For example, studies of home have shown how the use of family photographs enabled women to create a sense of 'homeliness' (Rose 2003). Blunt and Dowling (2006) also argue that 'the choice and placement of objects such as furniture can be part of making houses family homes' (pg. 112). Their research shows that the dwelling place is 'intimately connected to sites and relations beyond it' (pg. 114). The home I have made for myself as an adult represents a space of safety. It is a place full of constants, upon the walls hang paintings and photographs that I love, my favourite illustrated texts sit on my bookshelves waiting to fill my mind with wonder, my dog always sits dutifully beside me, the wood burning stove is ever eager to warm my living room, my collection of hats stir me into character in the morning, my piano (while underplayed) waits patiently to fill my house with sound. These objects house me as much as I house them. They are symbolic of the home I am making and aspire to make. My home is always moving, I make my home and at the same time it makes me. Thinking about how people’s lives and made are re-made within the home could offer insights into how people create new lives for themselves and their families after early exposure to domestic violence.


References

Blunt, A. & Dowling, R. (2006) Home: Key Ideas in Geography. Abingdon: Routledge.

Barad, K. (2007) Meeting the Universe Halfway: Quantum Physics and the Entanglement of Matter and Meaning. Duke University Press

Cleaver, H., Unell, I. & Aldgate, J. (2011) The Impact of Parental Mental Illness, Learning Disability, Problem Alcohol and Drug Use and Domestic Violence on Children’s Safety and Development (2nd edition). London: TSO.

Edleson, J. L. (1999) Children’s witnessing of adult domestic violence. Journal of Interpersonal Violence, 14, 839–870.

James, A. (2013) Socialising Childhood. Oxon: Palgrave

Kitzmann, K. M., Gaylord, N.K., Holt, A.R. & Kenny, E.D. (2003) Child witnesses to domestic violence: a meta-analytic review. Journal of Consulting and Clinical Psychology, 71, 339– 352.

Massey, D. (2005) For Space. London: Sage

Nissen, L. (2013) Curriculum and the Life Erratic: The Geographic Cure. Sense Publishers

Osofsky, J. D. (1997). Children in a violent society. New York: The Guildford Press.

Osofsky, J. D. (2003) Prevalence of children’s exposure to domestic violence and child maltreatment: implications for prevention and intervention. Clinical Child and Family Psychology Review, 6: 161–170

Stanley, N., Miller, P., & Richardson-Foster, H. (2012) Engaging with children’s and parents’ perspectives on domestic violence. Child and Family Social Work, 17: 192–201

Walkerdine, V., Olsvold, A., & Rudberg, M. (2013) Researching Embodiment and Intergenerational Trauma using the work of Davoine and Gaudilliere: History walked in the door. Subjectivity. 6: 272-297



Author profile

Dr Lisa Procter’s research foregrounds how children make meaning of their own lives and relationships to others through lived emotional experiences of place. Her research has explored the role of emotion across a range of locations, including schools, greens spaces and parks, neighbourhoods, and virtual spaces. She is editor of the book ‘Children’s Spatialities: Embodiment, Emotion and Agency.