A 4-year-old boy was brought into a North Carolina hospital emergency room in August after his mother’s boyfriend picked him up by his legs and threw him across the room. He told his grandmother, “Mommy didn’t protect me.”
Family violence happens every day in every state, and it affects people in every stage of life, from infants to the elderly.
“There is no area of practice that domestic violence doesn’t intersect with,” said Tricia Bent-Goodley, a professor at the Howard University School of Social Work in Washington, D.C., where she is director of the Interpersonal Violence Prevention Program.
The social work profession is targeting solutions, as the American Academy of Social Work and Social Welfare named Stop Family Violence one of its 12 Grand Challenges for Social Work, calling it “a common American tragedy.”
All Too Common
Family violence “occurs throughout the country every day” and “may involve years of emotional and psychological trauma as well as physical injuries which may become increasingly more severe and occur more frequently over time,” the National Criminal Justice Reference Service states.
Unlike most other crimes, intimate-partner or domestic violence is usually not a sudden, isolated and unexpected incident. It may involve years of emotional and psychological trauma and physical injuries.
It has a devastating impact on all involved, including children living with and experiencing it as witnesses and not direct victims, the NCJRS stated.
In a July report, the Centers for Disease Control and Prevention said homicide caused the deaths of 3,519 U.S. women and girls in 2015, and nearly half were killed by a current or former intimate male partner.
More than 11 percent of those experienced some form of violence in the month preceding their deaths. Non-Hispanic black women and women who were American Indian or Alaska natives experienced the highest rates of homicide.
The Grand Challenge group’s policy action paper in March states abuse and neglect claimed the lives of 1,670 children in 2015 and 1,580 in 2014.
“Severe and fatal maltreatment represents the tip of the maltreatment iceberg,” it says.
Approximately half the children who die from abuse and neglect are infants younger than 1 year old, and approximately three-quarters are under 3 years of age, says ”Within Our Reach,” a 2016 report by the Commission to Eliminate Child Abuse and Neglect Fatalities.
It may involve a “single, impulsive incident” or repeated abuse over time, the report says.
“It’s hard to pin down the numbers,” said Shanti J. Kulkarni, a challenge co-leader. “We’re talking about an issue that’s been hidden. It occurs in a private sphere behind closed doors.”
“This grand challenge focuses our attention on the specific issue of family violence in itself, but it’s linked to other problems — physical, emotional, financial, sexual,” said Kulkarni, associate professor of social work at the College of Health and Human Services at the University of North Carolina at Charlotte. “When we address something like that, we’re also addressing all the things that follow, all the issues that ripple out from that.”
It is important because so many people are affected, said Jill Messing, an associate professor at Arizona State University’s School of Social Work in Phoenix and
“One in three women is a victim of intimate partner violence in their lifetime,” she said. “Intimate partner violence can lead to a lot of negative health outcomes as well as injuries. On the mental health side, it can lead to depression, anxiety and PTSD.”
“I think the thing that’s important to understand is, if you live with abuse, you have no safe space.”
Richard P. Barth, dean of and professor at the University of Maryland School of Social Work in Baltimore, said the harms from family violence “are among the most significant in society,” and it is a cause of long-term, life-shortening health problems.
“Since its inception, social work has been involved in addressing family violence,” said Barth, who is a founding board member and founding president of the AASWSW and challenge co-leader. “No other profession provides as much leadership in this area. Thus, there is a great opportunity in this grand challenge to achieve change because social work has such a central role.”
The range of family violence encompasses physical; sexual; emotional or mental; economic; and spiritual abuse, where use of a person’s spirituality or religion is used to control their behavior, said Bent-Goodley, who is a member of the Prince Georges County (Maryland) Violence Fatality Review Team, editor-in-chief of NASW’s “The Journal of Social Work,” a national board member for the Institute on Domestic
Violence in the African American Community, and is a past chairwoman of the NASW National Committee on Women’s Issues.
Some of the short-term impacts could be health issues that impede a person’s ability to function, she said.
“Maybe they’ve moved or lost their job. An individual may not be able to retain employment or go to school. They may have been displaced or have to live in a shelter. Particularly, this form of trauma does not allow optimum functioning. They can’t deal with crises.”
Long-term impacts are not that dissimilar, Bent-Goodley said, but health impacts might include traumatic brain injury if there’s been choking, strangling or the person was hit in the head.
“Then they can’t function, and they’re unable to function in a relationship at all,” she said. “If it’s a child, they may have difficulty being in school, difficulty moving forward. There are a wide range of implications depending on the family violence that has been experienced.”
Child maltreatment is a huge public health issue, said Patricia “Trish” L. Kohl, associate professor and associate dean for social work at the George Warren Brown School of Social Work at Washington University in St. Louis.
Working to prevent child maltreatment is essential because the short-term and long-term costs “are extraordinary,” she said. Maltreatment can lead to mental health issues, substance abuse and criminal activity.
“There’s not only human cost, but economical cost as well,” said Kohl, a challenge co-leader. “It’s essential to work toward preventing maltreatment from occurring, and when it does occur, that we respond effectively to support children and families in mitigating these consequences.”
Maltreatment encompasses all forms of child abuse: physical, sexual, emotional and multiple forms of neglect, she said. Emotional abuse includes threatening, screaming and name-calling, and it “has a substantial impact on children.”
One of the findings in a national survey of child well-being is that emotional abuse is “one of the most robust predictors” of a child’s internal and external behavior, Kohl said.
“It has a clear impact on mental health and occurred across all forms of child maltreatment and neglect,” she said. “It does, in fact, occur quite frequently.”
In its September 2016 Policy Brief No. 3, the challenge group outlines three recommendations for meeting the grand challenge:
- Increase federal funding for prevention and intervention activities, including efforts to reduce the structural inequalities that perpetuate gender-based violence.
- The National Institute of Justice, the National Institutes of Health and the Administration for Children and Families should increase research funding for evidence-based interventions that strengthen and enhance safety in families victimized through abuse and violence.
- Link data systems to identify opportunities for preventive services.
In the 1970s, states began adopting the approach that required the arrest of those who used violence, even though those whom the violence was used against often do not think this is the best strategy, Barth said.
“The assumption was that violence predictably escalates from the less severe to the most severe — often called the cycle of violence,” he said. “That led to a lot of people being arrested and incarcerated with the intention of saving those who experience violence from accelerating harms. We now know much family violence does not accelerate, and couples often want to stay together and get violence to a lower, less frequent level. We have not figured out how to use this new information to strengthen families and help them to be safe.”
Social work’s expertise is in social relationships, Barth said. “We believe in decarcerating society rather than more incarceration. If we can find ways to work with families so they are acceptably safe, perhaps we can help more parents live together safely. This is what many of those who use and experience violence are asking for help with. That will help children and lower decarceration.”
Messing said the criminal justice system has the specific goal to hold offenders accountable.
“That’s a good aim, but it only addresses part of the problem,” she said. “If we can prevent violence in families from occurring, there’s no hurt, no pain, no injuries. That’s always the best way to go. At the same time, we can’t prevent all domestic violence from occurring.”
Messing focuses on using risk assessment.
“If we can determine what could lead to homicide, we can prevent it,” she said. “We need to watch and to help with interventions with victims.”
One way is to work with police departments to know when intervention is necessary, Messing said.
Jails and prisons generally do not teach people to stop partner violence, she said, although some facilities have social workers who engage in treatment with offenders to help them stop abusing their partners.
Bent-Goodley focuses on African-American communities.
“There are some issues we see, some ways that law enforcement enacts with communities of color that creates a barrier of trust,” she said. “In our criminal justice system, black children are disproportionally removed from homes. That creates barriers to people using the system as an option.”
“We need to listen to people. We tell social work students a lot of what domestic violence is, but there’s so much diversity within that experience. We need to ask people ‘What do you think domestic violence is?’ We need to do all those things that good social workers do, including listening without judging and not assuming we know the answers.”
A CDC report in July “affirmed we’re seeing black women disproportionally affected by domestic-violence related homicides,” Bent-Goodley said.
Part of it is they mistrust the system, she said. Also, many have experience dealing with domestic violence providers, law enforcement and the child welfare system. People talk about it being a private issue, so there are messages around it, and there still are messages around not wanting to bring shame to the community.
“One of the things that makes domestic violence so hard is you want to get people out of these dangerous situations,” Bent-Goodley said. “One of the core social work values is for people to have self-determination.
People should be empowered to make their own decisions. We have to support those even when it doesn’t make sense to us.”
Kulkarni sees a lot of reasons why prevention is a better approach than using the criminal justice system.
“By the time these families enter the criminal justice system, things have gotten pretty bad,” she said. “It’s a more complex problem to solve, and we don’t have a really robust intervention we can offer perpetrators. The evidence isn’t very strong that it’s effective.”
Poor people and people of color are more likely to become involved in the justice system and have their children removed, while the whole other group of people doesn’t find themselves there, Kulkarni said.
“Family violence is such a generational problem,” she said. “In order to address it, we have to break that cycle, break that chain.”
The family’s conditions need to be changed, and they must get services, Kulkarni said. “That’s the opportunity to heal adults and for the young to grow. Criminal justice is never going to help us break that chain.”
Kohl said social workers know effective intervention is inter-relationally based.
“When you set the tone for families in a criminal justice model and focus on all the family’s deficits, it’s hard to make a change,” she said, adding that it’s better to move to an assessment model, identify strengths and know how to intervene earlier before the situation exacerbates into more abuse.
Whether family violence is passed on is a challenging question, she said. Many children who suffer from abuse and neglect are at more risk to do the same.
“However, not all go on to do that,” Kohl said. “Many go on to live happy and productive lives. But there is greater risk, and it’s what we need to mitigate.”
The whole community must be engaged in efforts to stop family violence, Bent-Goodley said.
“When we look at domestic violence within African-American communities, we need to think of how we mobilize communities to respond,” she said. “We have to do better in how we engage men. We don’t teach enough, we don’t focus enough about that in our work.”
The Obama administration in 2014 used a community strategy in the “It’s On Us” campaign for preventing sexual assault in college campus communities by engaging students and all members of campus communities in preventing sexual assault.
Messing said a lot of her work focuses on “using risk assessment in an evidence-based framework to connect people with the appropriate treatment,” and on intervention work — “risk-informed collaborative intervention.”
“Think about police interventions,” she said. “After police arrest the perpetrator, they leave a victim with no help. We’re encouraging social workers to offer help for social services because if victims use them, it reduces their risk in the future.”
She also encourages social workers to think about out-of-the-box interventions like the online Safety Decision Aid — an app for abused women — which provides immediate feedback in assessing the woman’s level of danger, balancing their priorities and providing information.
“It’s a good way for a woman to make decisions and connect them with social services,” Messing said. A public version is available for iPhones and androids at www.myplanapp.org.
Kulkarni’s area of interest is intervention research on intimate partner violence, and she views trauma-informed care as an “exciting evidenced-based intervention that can help prevent family violence and make intervention more effective.”
Because intimate partner violence has so much to do with power and control, the victim feels powerless and isolated, she said. “Intervention restores that power and builds more resources that have been removed or are missing.”
Child abuse and domestic violence usually don’t happen just one time, resulting in cumulative trauma, she said.
“When living in the condition of trauma, living in the continual state of fear, intervention is needed,” Kulkarni said. “You have to feel safe again, build safety. When that’s stable, you have to make sense of that and be able to move beyond. I think (trauma-informed care) has been a huge innovation in domestic violence, sexual violence and child violence.”
It also takes secondary trauma into account, which can be important for child welfare workers, she said. “They hear stories every day and can become burned out. That impact on service providers also impacts the quality of care they can deliver.”
“We have to really take care of service providers and help them understand the impact on them and how they can separate from the work that they do, she said.”
Improved data use can help us better address family violence, Barth said.
“There are ways to predict child fatalities and child maltreatment by using information already collected on a family,” he said. “For example, if a family member has already been charged or convicted of maltreating one of the children, early outreach, support and care and coordination can be provided when a new child is born.”
“Birth match offers an example,” the grand challenge policy brief states. “It harnesses technology for social good by linking electronic data from child welfare agencies, short-form birth certificates and criminal justice records, enabling officials to identify children at high risk of severe and fatal maltreatment.”
Record matches may trigger assessments if a family should be offered services to “offset future risk,” it states.
Four states have implemented various versions of it.
Often when a family is reported to a child welfare system, it’s a second or third or fourth report, Kohl said.
“It’s not unusual for a family to enter our system multiple times,” she said. “That’s one of the things we must do — make sure families are getting services at the first point of contact. It could save both human cost and economical cost if we could intervene sooner.”
“As we talk about data, social workers need to know how to use that data. They should be trained to use it — to analyze and interpret it and make decisions.”
Social Work Education
Messing said information about gender-based violence can be incorporated in a range of student’s courses, including human behavior, diversity and policy.
“I think we could infuse the social work curriculum with more information to ensure students leave social work programs able to assess gender-based violence and intervene when they see it in their practices,” she said.
Arizona State University developed a certificate on domestic
violence, she said.
Bent-Goodley said she talks about it in her policy classes.
“Some could be included in HBSE classes and research classes,” she said. “So many courses present the opportunity to talk about domestic violence so students know what it is and what they should and shouldn’t do in how they respond.”
“Including it in courses would be helpful, and having a specialized course is even better,” Bent-Goodley said. “Just hearing it one time is not enough. As you learn more, you understand it better. The psychology of why it exists, how it shows up and how pervasive it is are just some of the areas a practitioner should understand.” Kulkarni agrees about coursework and believes all field instructors should be involved.
“Some may be very knowledgeable, and some may not know about practices,” she said. “I think that’s another link that could be stronger.”
“Rape and Sexual Assault: A Renewed Call to Action,” is a January 2014 report by the Obama administration’s White House Council on Women and Girls.
The Trump administration removed the report from the White House website, according to Aug. 30 and Sept. 1 reports on the Huffington Post website.
In the current political climate, many social programs and services have been or are being eyed for cuts.
“That is the challenge,” Kohl said. “In this political-based climate, I think we have to ensure that our voices are being heard and that data is part of the discussion. As a researcher, I have to say that science does matter.”
Kulkarni said working at the local level is important.
Cross-sector collaboration also is possible, especially on issues like prevention, teen violence and substance abuse, she said.
“I think we can create more capacity within the community,” Kulkarni said. “It’s tough when money is part of it, but we can educate our constituencies on how it matters and how it affects the bottom line. Data show prevention is cost-effective. We can take that message out to policymakers.”
Social Work’s Role
Kohl said the role for social work is “across the board,” from practitioners and facilitators to policymakers to program directors within organizations — or by leading those groups.
Social work, said Bent-Goodley, offers a unique lens: the ability to see both the macro and the micro and the ability to respond.
Messing said social workers see people in their own environments and help people harness their own strengths.
Kulkarni believes social work can address this issue because practitioners are embedded in so many systems — like police departments, schools and hospitals.
“We’re really positioned to educate and advocate and intervene,” she said. “I think it’s ours to own if we want it.”
Barth said: “We need to take the lead on this. We have much to give to it, and we have much to