Violence and Abuse Issues

Cross-Cultural Perspectives for Health and Social Services

Lee Ann Hoff

• Publisher: Routledge
• Year: 2009
• ISBN:
  9781134037834
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

After centuries of being considered a private matter in most societies, violence and its profound effect on the physical health, mental health, and social well-being of victims and their families, as well as on the assailants themselves, has started to take centre stage as a public issue of worldwide concern.

Health and social service providers are in pivotal positions to provide preventive and restorative services to those affected by violent and abusive behaviour. This comprehensive textbook presents theoretical background and practical strategies for doing so, providing a solid knowledge base for good practice in this area. It emphasizes the interdisciplinary aspects of violence and victim/survivor care and addresses violence over the lifespan, covering:

• child sexual and physical abuse
• sexual assault of adults
• battering and emotional abuse of intimate partners
• elder abuse
• perpetrators of violence and abuse
• violence in learning and work environments
• vicarious trauma and self-care
• interconnections between various forms of violence, including socially approved violence in the media and in war.

This text is an essential resource for qualified practitioners wanting to learn more about this area and for students starting out in health and social care. Each chapter includes case studies and thinking points, and suggestions for application in practice settings. A companion website provides materials for students and educators, enabling the inclusion of violence issues in an already busy curriculum.

Lee Ann Hoff is a nurse-anthropologist and crisis specialist. She has published widely and is the author of the award-winning textbook People in Crisis. She has extensive experience as an educator, consultant, clinician, and crisis service manager.

Part I
Overview, theoretical perspective, and essential content

Part I lays the foundation for all remaining chapters. As an international public health issue with profound implications for the health and mental health of individual victim/survivors and their assailants, Chapter 1 presents forerunners to this book, its interdisciplinary scope and particular relevance for public health and front-line providers, and a brief review of unfinished business on this topic in the global community. Chapter 2 summarizes the contributions that grassroots advocates and many professionals have made to our understanding of this issue, and reaffirms the importance of collaboration to replace discipline-specific turf wars that can compromise the progress needed by a united front on the urgent global epidemic of violence. These interdisciplinary offerings constitute the book’s theory framework, assumptions, values, beliefs, and the social structures that figure strongly in the origins of violence and abuse, and which are essential in violence prevention and helpful responses to both victims/survivors and perpetrators of violence. Chapter 3 follows with evidence-based essential content proposed for the education of front-line health and social service providers who, for optimal results, need to collaborate across disciplines in the best interests of victim/survivors as well as perpetrators of violence and abuse.

1
Violence prevention and victim/survivor care

An international public health issue

• Background and overview

• Purpose and scope

• Disciplinary and interdisciplinary issues

• Unresolved issues in global perspective

• Cross-cultural approach to education on violence issues

After centuries of definition as a private matter in most societies, violence and its impact on women, children, and the assailants themselves have taken center stage as a public health and social issue of worldwide concern. In virtually every country, violence and oppression against women remains firmly rooted – women and children are the major victims of male aggression and homicide both inside and outside the home – and the greatest risk for women and children is from men they know (UN Population Fund, 2000; US Department of State, 1998; WHO, 2004). Increasingly, countries such as the United States and Canada, and international bodies such as the United Nations (UN), the World Health Organization (WHO), and the International Council on Women’s Health Issues are declaring physical and sexual abuse as a violation of human rights.

One of the major domains of social life is health and its preservation. It therefore follows that health and social service providers are in key positions to teach violence prevention and provide preventive, healing, and restorative services to those affected by violent and abusive behavior among intimates, family members, and others. Yet, the survivors of trauma and abuse, along with their advocates, have been the major players in bringing this poignant topic to international attention. Criminal justice professionals followed with activism and reform on the issue; while health professionals were the last influential group to lend their voice to the effort (Hoff, 1991).

During recent decades, many volumes have been written by social science and health professionals on the topic, and diverse professional and community groups have devoted vast time and energy to prevent violence and abuse and alleviate its devastating effects on victims. This includes the offer of shelter or refuge for those in imminent danger, as well as inclusion of victimization assessment in routine health assessment protocols. Yet, attention to the topic in formal curricula preparing health professionals is incidental rather than systematic (Ross et al., 1998; Woodtli, & Breslin, 1996, 2002).

Thus, for example, the American Association of Colleges of Nursing (AACN, 1999) has only recently issued a Position Paper on this topic as essential content in nursing curricula. In 2004, the WHO produced a handbook to aid health professionals in documenting and preventing interpersonal violence, and encouraged implementation of its recommendations based on resolutions for adoption by these WHO members: The World Health Assembly, the African Union, and the World Medical Association (WHO, 2004). While this document focuses on the all-important topic of prevention (in public health terms, vulnerable population groups, primarily women and children), this book complements such violence prevention efforts in concert with the clinical practice facets of secondary and tertiary levels of care, where attention is on detection and treatment of individuals already injured or abused, and efforts toward psychological recovery

and prevention of re-abuse. (See Part IV: Online resources, for further information.)

The nature of this topic, deeply embedded as it is in social structures and cultural values, suggests an upward crawl toward change and reform in how health and social service professionals are prepared to deal with this worldwide plague and its implications for the health of individuals, families, the economy, and entire nations. Despite much progress, this book focuses on the serious work that lies ahead, particularly for health and social service educators and future providers who depend on their basic preparation for effective practice in this challenging arena. Whether acknowledged or not by providers, most victim/survivors appear sooner or later in healthcare settings with manifest or latent symptoms of victimization by violence and sexual abuse. When this happens later rather than early in the course of recovery from abuse, the difficult healing process is often unnecessarily compounded.

Background and overview

The impetus for this book is situated in two major initiatives – one national, the other a series of international events. As a nation dedicated to leadership in world peace and non-violent conflict resolution, provincial and federal governments of Canada sponsored a number of initiatives directed to violence prevention and the particular role of health and social service professionals in the care of victims.

In 1992, the Ontario Ministry of Colleges and Universities funded the development of curriculum materials on violence for faculty use in three higher education programs: Early Childhood Development, Law, and Nursing. Recognizing the important role in violence prevention and the care of victims played by these disciplines, the intent was to design discipline-specific curriculum guides for educators in higher education to systematically address this issue in their curricula. In developing the Curriculum Guide for Nursing (Hoff, & Ross, 1993), the forerunner to this book, it quickly became apparent that effective nursing practice in this health issue demanded collaboration with other disciplines, for example, medicine, social work, and psychology. In short, a comprehensive approach to the topic cuts across disciplines – albeit with specific functions among particular disciplines.

As the Curriculum Guide for Nursing went to press, Health Canada – following sponsorship of earlier initiatives on the issue – conducted a nation-wide interdisciplinary consultation process focused on collaborative strategies among health professionals on behalf of persons and families traumatized by violence and abuse. This process underscored the vital link between effective practice and the educational programs preparing various health professionals in pre-service, graduate, and continuing education programs.

A major result of these consultations was Health Canada’s commission of Violence Issues: An Interdisciplinary Curriculum Guide for Health Professionals (Hoff, 1994). Soon after its publication, the UN sponsored the 1995 Women’s Conference and Forum in Beijing. At this conference, attended by some 36,000 people from all corners of the globe, there were numerous workshops and speak-outs on all forms of violence against women – battery, sexual assault, and rape as the spoils of war. However, at this conference the very low visibility of health professionals dedicated to violence prevention and care of victims was disproportionate to the enormous and often untapped potential of health providers to make a difference on this topic. However, during two workshops targeted specifically to health professionals and networking throughout the conference (Hoff, & Adamowski, 1995) we established a network of international collaborators dedicated to expanding and adapting the Canadian Curriculum Guide for use cross-culturally. This book – addressing public health and clinical facets in tandem – is the result of that effort and perseverance against great odds.

The thoughtful reflection by many concerned players on these major Canadian projects and the Beijing conference underscored a central tenet of violence and abuse as it concerns health professionals: Violence detection, prevention, and the care of survivors – in society and among intimates and family members – in essence is an interdisciplinary, community concern. Nevertheless, while recognizing role blurring in certain instances and the need for collaboration among healthcare workers, members of particular disciplines must first master the distinct role of their professions on behalf of survivors in...

Table of contents

• Contents
• Illustrations
• Acknowledgements
• Preface
• Part I Overview, theoretical perspective, and essential content
• Part II Illustrations of violence issues across cultures
• Part III Professional, continuing education, and practice applications
• Part IV Online resources
• Index