by Dr. Anchal Goyal
Editor(s): T.M. Chapman; Dr. A.D. Gray
Domestic violence is a serious social and public health problem that affects millions of Americans each year. Domestic Violence includes an array of physical and sexual violence, stalking, and psychological aggression. Its cost to individuals, to health systems, and society is enormous. It affects people in all stages of life from infants to the elderly and has a profound impact on lifelong health, opportunity, and well-being of victims and their families. More than 1 in 4 women (37 percent) and nearly 1 in 10 men (31 percent) in the United States have experienced contact sexual violence, physical violence, or stalking perpetrated by an intimate partner during their lifetime (Smith et al., 2018; Chen, Walters, Gilbert, & Patel, 2020).
Consequences of Domestic Violence
Approximately 35 percent of female survivors and more than 11 percent of male survivors experience some form of physical injury as a result of domestic violence. (Centers for Disease Control and Prevention, 2021; Stockman, Hayashi, & Campbell, 2015) In addition to physical health consequences, domestic violence often includes economic abuse, including preventing survivors from working or going to school, sabotaging their employment or housing, or ruining their credit which leads to job loss, homelessness, and financial ruin. (Alexander, 2011) Although the personal consequences of domestic violence are devastating, there are also many costs to society. The lifetime economic cost associated with medical services for domestic violence-related injuries, lost productivity from paid work, criminal justice, and other costs, was $3.6 trillion (Centers for Disease Control and Prevention, 2021; Peterson et al., 2018).
Domestic violence is preventable, according to the Centers for Disease Control and Prevention (Centers for Disease Control and Prevention, 2021). To prevent domestic violence, we must address the needs of victims of domestic violence, and apprehend the challenges and barriers in providing evidence-based interventions for this high-risk, high-need population from the perspective of both integrated behavioral health and domestic violence service providers.
Service Needs of Domestic Violence Victims
It is critical that when a domestic violence victim reaches out for help, the organization or system they interact with understands the needs related to that victim’s identity in order to provide the most useful and responsive support. In general, housing-related needs were listed as the most pressing when results for emergency shelter, transitional housing, and general affordable housing were combined. (Baker, Billhardt, Warren, Rollins, & Glass, 2010) After housing, the greatest needs survivors indicated were support groups for adults, a 24-hour domestic violence helpline, legal advocacy services, in-person support, safety planning, and physical and mental health services. (Lyson & Philips, 2012; Sullivan, 2018; Berg et al., 2020)
Challenges in providing evidence-based interventions from the perspective of both behavioral health and domestic violence service providers
Several challenges were indicated for behavioral health anddomestic violence service providers assessing risk including barriers at the systemic, worker-level, or staff-level challenges, and individual client level. (Van Deinse, Wilson, Macy, & Cuddeback, 2019; Olszowy, Jaffe, Dawson, Straatman, & Saxton, 2020; Youngson et al., 2021)
Domestic violence and behavioral health agency staff identified several system-level service challenges. These include:
A lack of integrated behavioral health and domestic violence treatment options: Both behavioral health and domestic violence agency staff indicated that the services available to individuals with severe mental illnesses with domestic violence in the behavioral health system were not necessarily the services that these individuals needed. (Van Deinse et al., 2019)
Lack of cross-training opportunities: Both behavioral health and domestic violence agency staff noted that lack of formal training in identifying and treating mental illnesses was a barrier to serving the population who experience domestic violence. (Van Deinse et al., 2019)
Low levels of service coordination between domestic violence and behavioral health services: Behavioral health and domestic violence agency staff noted the lack of protocols for identifying and addressing domestic violence among the victims served in their agencies. Moreover, there was little collaboration or communication across agencies regarding confidentiality policies and a lack of recommended best practices for service coordination between the DV and behavioral health sectors. (Van Deinse et al., 2019; Olszowy et al., 2020)
Instability of behavioral health services: Agency staff noted that when services run out, or when there is high turnover in the staff of a behavioral health agency, clients lose their therapist, victim advocate, medical provider, and other additional shelter or agency-related services. (Van Deinse et al., 2019)
Medication compliance policies at domestic violence and homeless shelters: Domestic violence agency staff noted that many DV programs have policies requiring individuals with a diagnosed mental health condition to have at least 30 days of medication compliance before they are allowed to stay in a shelter. Thus, victims with severe mental illnesses can be denied access to shelter services. (Van Deinse et al., 2019; Olszowy et al., 2020)
Worker-level or staff-level challenges
Domestic violence and behavioral health agency staff reported experiencing two types of challenges when working with domestic violence victims—developing therapeutic rapport and conducting accurate assessments. Both behavioral health and DV service providers reported experiencing challenges when trying to build trust and therapeutic rapport in their working relationships with clients who experience domestic violence. They also experienced challenges determining which of a client’s symptoms were related to a mental illness and which might be associated with domestic violence. (Van Deinse et al., 2019)
Behavioral health and domestic violence agency staff noted three client-level challenges to serving survivors with domestic violence: (a) clients with domestic violence present with high rates of other co-occurring or comorbid issues, such as co-occurring substance use or physical health problems; (b) clients with domestic violence present with heightened reluctance to engage in behavioral health treatment; and (c) clients with domestic violence lack stable and reliable prosocial support systems. (Van Deinse et al., 2019)
These findings suggest the need to decrease systemic barriers to improve how victims of domestic violence connect with support services and organizations. The findings also suggest the need for effective interventions that include trauma-informed approaches that meet the complex needs of clients who experience domestic violence. (Youngson et al., 2021)
In conclusion, behavioral health and domestic violence service providers need enhanced training, specialized interventions, universal screening procedures, enhanced attention to basic needs (e.g., housing), and greater peer and informal support networks for victims experiencing domestic violence. (Sullivan, 2018; Van Deinse et al., 2019)
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Chen, J., Walters, M. L., Gilbert, L. K., & Patel, N. (2020). Sexual Violence, Stalking, and Intimate Partner Violence by Sexual Orientation, United States. Psychology of violence, 10(1), 110–119.
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Sullivan C. M. (2018). Understanding How Domestic Violence Support Services Promote Survivor Well-being: A Conceptual Model. Journal of family violence, 33(2), 123–131. https://doi.org/10.1007/s10896-017-9931-6
Berg, K.A., Bender, A.E., Evans, K.E., Holmes, M.R., Davis, A.P., Scaggs, A.L., & King, J.A. (2020). Service needs of children exposed to domestic violence: Qualitative findings from a statewide survey of domestic violence agencies. Children and Youth Services Review, 118,105414. https://doi.org/10.1016/j.childyouth.2020.105414
Van Deinse, T.B., Wilson, A.B., Macy, R.J., & Cuddeback, G.S., 2019. Intimate Partner Violence and Women with Severe Mental Illnesses: Needs and Challenges from the Perspectives of Behavioral Health and Domestic Violence Service Providers. The journal of behavioral health services & research, 46(2), 1556-3308.
Olszowy, L., Jaffe, P.G., Dawson, M., Straatman, A., & Saxton, M.D., 2020. Voices from the frontline: Child protection workers’ perspectives on barriers to assessing risk in domestic violence cases. Children and Youth Services Review, 116, 105208. https://doi.org/10.1016/j.childyouth.2020.105208
Youngson, N., Saxton, M., Jaffe, P.G., Dawson, M., & Straatman, A., 2021. Challenges in Risk Assessment with Rural Domestic Violence Victims: Implications for Practice. Journal of Family Violence, 36, 537–550. https://doi-org.ezproxy.liberty.edu/10.1007/s10896-021-00248-7