Domestic Violence Intervention In JacksonvilleEllen Siler The Prevalence Of Domestic Violence In JacksonvilleDomestic violence is the leading cause of injury to women in this country. In Duval County in 1998, the Jacksonville Sheriff's Office filed 6,126 domestic violence-related incident reports and made 4,398 arrests. Injunctions for protection against abusive partners were sought by 4,634 victims.1 Despite that fact, domestic violence remains one of the most misunderstood and under-identified crimes, both nationally and on the local level. Since I first began working with victims of domestic violence in 1990, there has been an increase in publicity on the issue of domestic violence; however, there are still many misconceptions about victims of abuse and their batterers. These misconceptions have hampered the ability of victims to obtain the assistance they so desperately need. This is true of law enforcement personnel, the criminal justice system and the medical profession. In June 1992, the Journal of the American Medical Association reported that between 22 and 35 percent of women presenting at emergency departments were there because of symptoms related to partner abuse.2 To victim advocates, that report confirmed what they had observed with victims of domestic violence, and was seen as an important step in improving the relationship between victims and the medical community. In the past year, Hubbard House received 6,007 hotline calls, sheltered 972 victims of domestic violence and their children, and provided counseling and support services on a non-residential basis to more than 5,000 victims. Our Emergency Response Team, which meets with victims at the scene of the crime and at hospital emergency rooms, provided crisis intervention to 557 victims. A record number of children who had witnessed violence in their homes were enrolled in our Helping at-Risk Kids (HARK) program. Due to the tremendous increase in the identification of children living with violence who become involved in the criminal justice system, HARK II was implemented for violent juveniles. Both programs served 546 children last year. More than 800 men were enrolled in Hubbard House's batterers' intervention program, First Step. Jacksonville has a long tradition of being on the cutting edge when it comes to addressing domestic violence. When it was founded in 1976, Hubbard House was the first domestic violence shelter in Florida and only the thirteenth in the United States. Our new shelter, built in 1997, is a state-of-the-art facility that can shelter 80 victims and their children at a time, more than doubling our previous capacity. But Hubbard House does not work alone. We have community collaborations in place to provide victims and their children with the comprehensive services they need. Yet the problem of domestic violence continues. In this article, I will share with you some of what I have learned in the last nine years about victims, the children and the batterers. It is my hope that what you learn will help you the next time you are sitting across from someone you suspect may be a victim of domestic violence. You know victims, we all do, although they may not be easily identifiable. The VictimStatistically, women comprise approximately 95 percent of victims of domestic violence. Because of this, most advocates use "she" when referring to a victim and "he" when referring to a batterer, more as a matter of avoiding the complex "he/she" wording than of presenting a sexist viewpoint. However, doing so should not be seen as negating or downplaying the presence of domestic violence with male victims. Any violence is wrong and Hubbard House serves every victim, male or female. One thing I learned early on in my work in the domestic violence field is that battered women do not identify themselves with the label "battered woman" and often don't realize they are victims of domestic violence. I once talked on the hotline for 20 minutes with a woman who, although she described the typical behaviors we see in violent relationships, insisted the abuse was all verbal and not physical. I told her I found it hard to believe that, with all she had told me, the abuse had never gotten physical; that she had never been pushed or shoved or restrained from leaving. She then said, "He choked me once until I passed out. Does that count?" As we continued talking I found out she had been repeatedly forced to have violent, painful sex, but again did not recognize that this behavior was, in actuality, domestic violence. I soon learned to ask about specific behaviors, not to ask, "Are you a victim of domestic violence?" The Florida statutes define domestic violence as any "assault, aggravated assault, battery, aggravated battery, sexual battery, stalking, aggravated stalking, kidnapping, false imprisonment, or any criminal offense resulting in personal injury or death of one family member by another ..." Despite what appears to be a broad definition of behaviors, it is important to understand that battered women experience much more in the way of abuse than what is identified as abuse by law. This includes psychological and emotional abuse, economic abuse, isolation, intimidation, coercion, and threats of physical abuse. Dynamics And Cycle Of ViolenceWhen I first started doing this work, my reaction to victims was typical of most people who do not fully understand the dynamics of domestic violence. I couldn't understand why the victim didn't just leave the batterer. I didn't understand the terror she lived with or that the violence doesn't necessarily end when she tries to leave. The Bureau of Justice reports that women separated from their husbands were 3 times more likely to be vicimized by spouses than divorced women, and 25 times more likely to be vicimized by spouses than married women.3 For the victims who are able to successfully leave an abusive relationship, it has been an exhausting struggle. Most report that they have attempted to leave eight times before finally being successful. Understanding the dynamics of abusive relationships should help physicians better understand why victims appear to act in ways that do not seem to be rational and logical. Recently, the state has grappled with the controversial issue of mandatory reporting of domestic violence by the medical community. Should physicians report all domestic violence as they do for child abuse, or is this treating battered women like children? Does mandatory reporting increase the danger to victims, or increase their safety? Victim advocates have staunchly insisted that mandatory reporting is not in the best interest of the victim. While it may seem to a physician -- someone dedicated to providing assistance to all victims -- that making that first step for the victim by reporting the abuse is the right thing to do, just the opposite is true. When the victim is made to confront the violence and the batterer before she is ready to do so, the potential exists for increased lethality. And, because of the victims' understanding of that fact, many of them avoid obtaining medical help for their injuries, fearing retaliation by the abuser if the crime is reported by the medical professional. Advocates know that a victim of domestic violence cannot be helped until she is ready, and only she knows when that time comes. This is one of the most frustrating aspects of advocacy, but one of the most important to understand. There are many reasons why a battered woman is reluctant to leave, but most center on fear: fear for her safety, fear for the safety of her children, fear that she will not be able to support them or meet their basic needs, fear that she cannot make it on her own. She has been subjected to tactics meant to exert power over her and thus control her through intimidation, isolation and fear. Diana's story is typical of many of the victims we see. When Diana first came to shelter she told us she had left her abuser once before. But he had kidnapped her one-year-old son and disappeared for a year. Even with this history, the courts gave her husband unsupervised weekend visitation as part of her Injunction for Protection. The courts failed Diana. She returned to the abuser rather than risk losing her son once again. Battered women are told every day by their abusers what they should and should not do and what they can and cannot do. One of my jobs as a victim advocate is to help empower victims, to get them to the point where they begin to make decisions for themselves, even if it isn't the decision I would make. I also need to help them plan for their own safety and the safety of their children. There was a time when many in the domestic violence field believed that domestic violence followed a cycle: an acute violent incident, followed by a honeymoon phase, followed by increased tension, leading to an acute violent incident. We now know that many victims never hear an apology, never have a honeymoon phase. Although some batterers are violent when they abuse alcohol or drugs, for many there is no way to predict when the next incident will occur or what will trigger a violent episode. Because of this, victims live in a constant state of crisis and fear, less at some times and more at others, but always there. Some victims use alcohol or drugs to cope, and some are abusive to their own children. It takes the effort of the entire community working together to make it safe enough for victims to leave. The question shouldn't be, "Why does she stay?" but, "Why doesn't he stop battering?" The Impact On ChildrenAlthough the cycle of abuse mentioned above does not always exist, there is a pattern to domestic violence. It is an intergenerational one. Children learn their behaviors from their parents and imitate them. This is one of the most common indicators of future domestic violence. Approximately 70 percent of male batterers say they were raised in violent homes. At Hubbard House, many of our programs focus on children. Four out of five children from violent homes witness extreme violence directed at themselves or others in the family. In about half the homes where the moms are abused, the children are also abused. Identification of both domestic violence and child abuse go hand in hand. If you have identified child abuse, you need to look for partner abuse. If you have identified partner abuse, you need to look for child abuse. I carry with me the image of a three-year-old boy saying to his mother, "Get me some juice right now, you stupid bitch." I was shocked, but the mom had heard this so often from her abusive husband that she didn't even seem to be conscious of the child's tone and words. Living in a violent home affects children at all age levels. Infants may cry more often and be more irritable, may experience sleep disturbances and digestive disorders, may resist being held or fed and may be developmentally delayed. Toddlers and preschoolers may lack self confidence, and may be more aggressive or more withdrawn than other children. Many exhibit high levels of anxiety and fearfulness with physical manifestations such as stomach aches and nightmares. Older children also may have self-esteem and confidence problems. They may lack social skills, do poorly in schools, and may be aggressive with violent outbursts. Some are suicidal. Many older children may feel guilty and inadequate for not being able to protect their mothers. This is especially true of boys. Imagine seeing your mother being beaten over and over again and not being able to help. Some will be violent to others or become involved in the criminal justice system for other crimes. A recent survey of juveniles in the Duval County Jail indicated 66 percent had witnessed violence in their homes. I was at the shelter one day when an abuser showed up at the door looking for his wife and child. The mom and eight-year-old daughter had heard him and were huddled together inside the shelter. I stood in the doorway watching them and was struck by how terrified the girl was. I could not imagine what it would be like to be that afraid of your own father. The mom held her daughter and told her, "I promise you I will never let him hurt us again." But she had made a promise to her child that she may not have been able to keep. A history of domestic violence does not ensure that the victim will get custody of the children or that any visitation granted as part of an injunction or divorce will be supervised. Although we have a system where the victim can leave and be safe, children may be ordered to spend time with the violent person without the mother's protection. Understanding this, many victims choose to stay. The BattererA batterer could be anyone, of any age, ethnic background or socioeconomic level. Abusive behavior is outlined in the Power and Control Wheel (Figure 1), which was developed by the Domestic Abuse Intervention Project in Duluth, Minnesota. It identifies common behaviors of batterers. Although every batterer is different, there are some characteristics that batterers have in common. From the physician's perspective, two very important indicators are fairly easy to observe in the interaction between a patient (the victim) and the batterer.
The first warning sign is a husband or boyfriend who appears so concerned about his partner that he does not want to leave her side for a minute, not even when she is being examined by the physician. Another warning sign is any indication of extreme jealousy and possessiveness toward the victim by the partner. However, if a patient reveals to you that she is a victim of domestic violence, do not confront the batter. Doing so could increase the danger to the victim. But you are in a position to provide information and options, although the victim may not be ready to act on them at the time. Call the Hubbard House hotline and give the victim the opportunity to talk to a victim advocate, if she is willing. You can also encourage her to develop a safety plan (Table 1). Remember that you cannot force a victim to do anything she is not ready to do.
A few months ago we received a call from a physician who was upset because we had denied shelter to a woman in danger. The woman had revealed to the physician that she was a victim of domestic violence, she had left her husband and he was now looking for her. The physician called our hotline, told us she had a patient who needed shelter, then left the room to give the victim privacy while on the phone. The victim told the hotline advocate that she was not ready to come to the shelter at that time. However, instead of telling the physician of her decision not to go to Hubbard House, the victim said she was denied shelter. When the facts were discerned by Hubbard House staff, we explained to the physician, without breaking client confidentiality, that we had not denied anyone shelter but that a victim had turned down services at that time. Fortunately, the victim came to the shelter later that same day. Impact On Community And The Community ResponseMany collaborative efforts in Jacksonville have been addressing the problem of domestic violence for some time. In 1988, Hubbard House was instrumental in starting the Domestic Violence Intervention Project, whose membership includes judges, law enforcement personnel, the State Attorney's Office, the Clerk of the Court and others involved with domestic violence issues. In 1997, a Mortality Committee was formed within the DVIP to look at deaths from domestic violence, determine patterns and draw conclusions in the hope of preventing future homicides. Earlier this year a report was produced on the 23 murders and 5 suicides related to domestic violence that occurred in Jacksonville between January 1997 and November 1998. Another community initiative is the Partnership for the Protection of Children, a cooperative effort between Hubbard House and the Department of Children and Families. Its main focus is improving the protection of children from abuse and neglect through communication and training. In November 1998, after 18 months of intensive study, the Mayor's Domestic Violence Task Force, chaired by Judge Brian Davis, issued its report, the Strategy to Eradicate Domestic Violence. It challenges every citizen to support the implementation of the 78 specific recommendations designed to raise community awareness, increase collaboration, adopt a zero-tolerance attitude, improve the injunction process, and provide training and education. Jacksonville Mayor, John Delaney has taken the lead on the implementation of the strategy by passing Executive Order 98-218, which establishes a domestic and workplace violence policy for the city and requires all city employees to receive training on those issues. Hubbard House will conduct that training over the next twelve months. A multidisciplinary group that includes Hubbard House, the State Attorney's Office, the Clerk of Court, the judiciary and the City of Jacksonville recently presented a proposal to the Duval Delegation to fund a one-stop office within the courthouse where victims of domestic violence could go for the assistance they need, such as filing an injunction for protection, help with criminal matters, enforcement of violations of injunctions and child custody issues. If funded, this initiative would greatly improve the availability of services to all victims. Although positive things are happening locally to improve service to victims of domestic violence, there is still much to be done. The current system is confusing for victims and, often, the protections that should be in place don't work as well as they should. Part of the problem is that victims aren't always believed, even by those whose job it is to help them. Too many people think that victims claim abuse and seek injunctions in order to gain an upper hand in divorces and to get custody of their children. While this may be true in a small percentage of the cases, the vast majority of people who seek help are truly in need. Another area that needs to be addressed is the service of injunctions for protection. Only about half of the victims who seek injunctive protection get it because the perpetrators are not served with the paperwork. More resources need to be devoted to finding and effectively serving batterers. Too often batterers are convicted of domestic violence two or three times, yet are not ordered to a batterers' intervention program and only get minimal jail time. This oversight cost two women their lives last year in Duval County. I urge each of you to request a copy of the Mayor's Domestic Violence Task Force Report by calling 630-1776 and find out what you can do to make the recommendations a reality. By working together in a coordinated community response we will end domestic violence in Jacksonville.
REFERENCES
May, 1999/ Jacksonville Medicine
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