domestic violence is complex: cycles, wheels, or systems
TRANSCRIPT
Domestic Violence is Complex: Cycles, Wheels, or Systems
August 29, 20172-3:30pm Central Time
Sandra Burge, PhD., University of Texas health Science Center, San Antonio, TX
Funding for this project was made available through the US Department of Health and Human Services, Grant #90EV0440-01-00. The viewpoints contained in this document are solely the responsibility of the author(s) and do not represent the official views or policies of the department and do not in any way constitute an endorsement by
the Department of Health and Human Services.
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Domestic Violence is Complex: Cycles, Wheels, Systems
Sandra K. Burge, Ph.D.
Professor, Department of Family & Community Medicine
University of Texas Health Science Center at San Antonio
Acknowledging…
Research Team
• David A. Katerndahl, MD, MA
• Robert L. Ferrer, MD, MPH
• Robert C. Wood, DrPH
• Jenna Becho, MA
• DiandreaGarza
• Jasmine Rodriguez
Funding
• 3 grants from the National Science Foundation
• National Institute on Alcoholism and Alcohol Abuse
• American Academy of Family Physicians
Who We Are
• School of MedicineDepartment of Family & Community Medicine
• Family Doctors
• Family Researcher
• Statistician
• Family Therapist
• Research Assistants (BA in Psychology)
Family Medicine
Family physicians are dedicated to treating the whole person.
Their understanding of health and illness is based in a biopsychosocial perspective.
The cornerstone of family medicine is an ongoing, personal patient‐physician relationship focused on integrated care.
Partner Violence –Prevalence
25%
17%
33%
14%
5%
1%
0% 10% 20% 30% 40%
Severe Physical Violence
Stalking
Rape
men
women
7
CDC National Intimate Partner & Sexual Violence Survey, 2010
Partner Violence –Health Impact
• Higher use of health care systems
• Difficulty falling or staying asleep
• Social limitations
• Poor physical health
• Poor mental health
• Chronic pain
• Frequent headaches
• Asthma
• Irritable bowel syndrome
• Diabetes
• Poor pregnancy outcomes
Complexity Science
Our research team has been using complexity science to study the day‐to‐day
patterns of intimate partner violence.
Complexity Science
• Complexity science is concerned with complex systems that are
• dynamic
• multi‐dimensional
• unpredictable
• consisting of a collection of interconnected relationships and parts.
Butz, Chamberlain, McCown: Strange Attractors 1996
A Complex System
•…is composed of many parts which interact with each other.
• Its actions are difficult to predict due to the relationships between parts, and between the system and the environment
•…is non‐linear, or unpredictable Examples:
Families, Weather, Ecology
Complex Systems
Patterns in systems can range from the very predictable to the totally unpredictable
Periodic Chaotic RandomVery
Predictable
Completely Unpredictable
Complex Systems
• Emergence ‐Unplanned organized behavior can emerge from a complex, nonlinear system
• Consider flock behavior
• Go the same direction as everyone else
• Steer toward the center of the group
• Don’t bump into anybody
• Spontaneous order – coordinate activity without a centralized plan
Complex Systems
• Attractors = A set of behaviors toward which a system evolves
• Repetition
• The system returns to these behaviors again and again.
• Families have repeating interaction patterns that influence each others’ behavior.
Complex Systems
• Interactions include feedback loopswhich influence members’ behavior
• Positive feedback encourages change in the system
• Negative feedback keeps the system the same
How Does Complexity Science Apply to Partner Violence?
Partner Violence –Patterns
• Cycle of Violence
• Family Systems Theory
• Power and Control Wheel
Periodic Chaotic RandomVery
Predictable
Completely Unpredictable
Partner Violence –Patterns
Periodic Chaotic RandomVery Predictable Completely
Unpredictable
Complex Dynamics: Periodic Systems
• Very predictable
• A causes X
• Or… A + B + C causes X
• Stable and repetitive
• If A changes, X will change proportionally.
• Interventions have predictable outcomes
20
What’s a Periodic System?
• Starbuck’s
• McDonald’s
• Consistent input (ingredients)
• Regulated equipment
• Consistent output (product)
Periodic Systems are like… Cycle of Violence
Tension Builds
Violent Event
Calm, Loving Respite
Walker, 1979
Partner Violence –Patterns
Periodic Chaotic RandomVery Predictable Completely
Unpredictable
Complex Dynamics:Chaotic Systems
• System patterns are sometimes predictable in the short term, but unpredictable in the long term
• Patterns can be repetitive but pathways vary
• The system responds to many different influences which are also influencing each other
• Small influences can lead to large changes
• Butterfly effect
• Interventions have no predictable outcomes24
What’s a Chaotic System?
• Weather
• Traffic
• Stock Market
• Ecology
Chaotic Systems are like… Family Systems
• A family system is made up of a set of people related by blood or intention
• Families have repeating interaction patterns that influence each others’ behaviors
• Families self‐organize with positive and negative feedback• positive promotes system change• negative keeps things the same
• “Families are predictable in general and unpredictable in detail.”
Giles‐Sims, Wife Battering: a Systems Theory Approach. 1986
Partner Violence –Patterns
Periodic Chaotic RandomVery Predictable Completely
Unpredictable
Complex Dynamics: Random Systems
• Patterns are not repetitive
• Behaviors result from constant stress
• No butterfly effect
• Cannot identify a specific cause
• Interventions have no predictable outcomes
28
What’s a Random System?
• Genetic mutations
• Solar flares
• Earthquakes
• Atomic decay
Random Systems are like...Power & Control Wheel
“The Duluth Model”
Pence & Paymar: Education Groups for Men Who Batter 1993
Complexity Science
Periodic‐Cycle of Violence
Chaotic‐Family Systems
Random‐Power & Control Wheel
Very Predictable
Completely Unpredictable
The Study:Dynamics of
Intimate Partner ViolenceApproved by the Institutional Review Board
University of Texas Health Science Center
at San Antonio
Funded by the National Science Foundation “Dynamics of Human Behavior” program
Award #0826812
Research Question
What are the day‐to‐day dynamics of intimate partner
violence?
33
Setting
• Six primary care clinics in San Antonio, Texas
• 4 clinics serve uninsured residents of Bexar County
• 57% Hispanic
• 7% African Americans
Participants
Inclusion
• 200 women (18‐64 years)
• Married /Living together 6+ months
• Verbal or physical abuse past 30 days
Exclusion• Pregnant
• Husband present
• Planning to leave husband in the next 3 months
• In a high danger, life‐threatening relationship
35
Safety Measures
• We excluded high‐danger women.
• We provided information re: community resources
• We provided a cover story: “Family Stress”
• Take‐home materials = business card
• She provided us safe phone numbers
• We offered pre‐programmed cell phone
• Telephone survey = password protected
• We monitored daily violence severity
• We reviewed participation in weekly team meetings
• Safety Monitoring Committee
Baseline Survey ($30)
• Characteristics of the participant, her husband, and their relationship
• Social networks, social support & stress
• Attitudes ‐Violence appraisal, coping, hope
•Health & mental health
Daily Telephone Survey x 12 weeks($5 day)
Daily Violence & Household EnvironmentHasslesStressArgumentsMarital HarmonyHusband's/Wife’s Alcohol UseHusband’s/Wife’s ViolenceUpset About ViolenceForgiveness
38
Automated survey, about 10 minutesRequired a password to listenResponses documented with touch‐pad
Weekly Contacts
• Maintain Weekly Contact with each subject for 3 months
• She called us
• Assess Safety
• Encourage Participation
• Listen; Provide Support
• Provide Resource Information
End‐of‐Study Survey and Interview ($30)
• Survey
• Attitudes ‐Violence appraisal, coping, hope
• Health & mental health
•Qualitative interview
• Experiences on the study
Study Results
41
Prevalence of Partner Violence
• We screened 1523 women in six primary care practices
• 232 (15%) screened positive for abuse in past 30 days.
• 8 (0.5%) were considered ‘high danger’
42
Participant Characteristics
Mean age 38 years ± 12
Ethnicity17% Caucasian76% Hispanic
Income 53% earn less than $20,000
Education32% < High School Grad21% High School Grad*45% Some College*
Employment15% employed part time25% employed full time
Relationship Characteristics
Mean #children
(1.5 ±1.4)
Type of Marriage
12% Church wedding27% Civil43% Common Law
Duration ofRelationship (9.6 ± 8.9 yrs)Marriage (7.3 ± 9.0 yrs)Abuse (5.5 ± 6.5 yrs)
Frequency of Partner Violence
•Data – 9,643 daily reports
• 3,813 (40%) Husband‐to‐wife abuse
• 2,209 (23%) Wife‐to‐husband abuse
• In 5% of couples, wife perpetrated no abuse.
45
Violence between partners was correlatedMen’s violence severity > women’s
His and Her Violent Behaviors
1.5%
1.9%
2.3%
5.0%
9.3%
5.8%
30.0%
0.0%
0.0%
1.8%
3.7%
4.8%
4.0%
20.9%
0.0% 10.0% 20.0% 30.0%
Threaten with weapon
Beat Up
Punch, Kick
Push, Grab, Slap
Throw Objects
Threaten to harm
Yell, Swear, Insult
Wife Perpetrated Husband Perpetrated 46
Example: Daily Reports
hassles
stress
upset
closeness
alcohol
arguments
violence
Impact of Study Participation
70 women (35%) sought help after the study
• 56 Sought professional counseling
• 18 Sought services at the Family Justice Center
• 6 Sought legal assistance
• 4 Enrolled in a survivorship group (FJC)
28 women (14 %) LEFT their relationship
during or after the study
Determining Patterns of Husband‐to‐Wife Violence
•With 84 daily reports, we can measure
• Nonlinearity (unpredictability)
• Attractors (repeating patterns)
135 Women were classified into groups this way:
Periodic Repetitive & Predictable
Chaotic Repetitive & Not‐Predictable
Random Not‐Repetitive & Not‐Predictable
Dynamic Patterns of Husband‐to‐Wife Violence
12%
30%59%
50
Periodic:
Random:
Chaotic
Do These Patterns Represent Cycles, Systems or Wheels?
12%
30%59%
51
Periodic: Cycle of Violence
Random: Power &
Control Wheel
ChaoticFamily Systems
Dynamic Patterns of His ViolenceFrom Baseline Surveys
Periodic
ChaoticRandom
5252
Appraisal Scale Least Predictable & Controllable
Controllable
Appraisal Scale =
PredictableControllable
Dynamic Patterns of His ViolenceFrom Daily Surveys
Periodic
ChaoticRandom
53
Violent Behaviors
Most Frequent 48%
Violent BehaviorsMost Severe
Violent BehaviorsLowest Frequency
& Severity
Violent BehaviorsHighest
Frequency of Verbal Abuse
Dynamic Patterns of His ViolenceFrom Daily Surveys
Periodic
ChaoticRandom
Violent BehaviorsHighest
Frequency of Verbal Abuse
54
Violent Behaviors
Most Frequent 48%
Violent BehaviorsMost Severe
Violent BehaviorsLowest Frequency
& Severity
Fewest StressorsFewest HasslesCloser Rel’ship
Highest Highest quantity of alcohol by
him
Dynamic Patterns of His ViolenceSame Day Correlations From Daily Surveys
Periodic
ChaoticRandom
55
For all groups, his daily violencewas correlated with same‐day:• His alcohol use• Their arguments• Her hassles• Her feeling stressed• Her feeling distant• Her violence• He seeks forgiveness• She forgives him
Strongest correlation between his violence & her
forgiveness
correlation between correlation between his violence & her drinking
Dynamic Patterns of His ViolencePrior Day Correlations From Daily Surveys
Periodic
ChaoticRandom
56
His daily violencewas correlated with prior‐day:• His violence• Her violence• Their arguments• Her feeling
distant
Conclusions
The Most Common Patternof Husband‐to‐Wife Violence
12%
30%59%
58
Periodic: Cycle of Violence
Random: Power &
Control Wheel
ChaoticFamily Systems
Patterns of Partner ViolencePeriod Dynamic = Cycle of Violence?
• Baseline Survey says:
• Women describe relationship as more predictable & controllable than the random group
• Daily reports
• More physical violence
• He drinks more alcohol than other groups
• Her forgiveness is strongly correlated with violence
• The day before violence, there are more arguments, violence, and marital distance (buildup of tension)
Patterns of Partner ViolenceRandom Dynamic = Power & Control Wheel?
• Survey says:
• Women describe relationship as less predictable and less controllable than the other groups
• Daily reports
• Most frequent violence overall – half of days
• Most frequent verbal abuse (Wheel: emotional abuse, intimidation)
• Her drinking is correlated with his violence, unique to this group
Patterns of Partner ViolenceChaotic Dynamic = Family Systems Theory?
• Survey says:
• Women describe relationship as controllable and predictable, about the same as Periodic group
• Daily reports
• Lowest frequency & severity of violence
• Lowest frequency of stress, hassles
• Highest level of marital closeness
• Same‐day correlates are the same as other groups
The Complexity Science Lens
• Periodic Group (Cycle)
• May be in a “steady state”
• Violence is controllable & predictable
• Random Group (Wheel)
• May be in a transformative state, adapting to external forces & changes in the system
• Feeling powerless, husband randomly grasps at strategies to stay in control
The Complexity Science Lens
• Chaotic Group (Family Systems)
• Also in a transformative state
• Remarkably different from others
• Closer marriages, lower severity & frequency of violence, lower stress, less alcohol use
• Complex, adaptive system – perhaps transitioning to a healthier system?
Implications for Intervention
• Most of these women were in verbally abusive or moderately violent relationships
• They did not see themselves as “abused”
• They fought back
• Systems of care may not recognize them
• Most preferred counseling interventions over divorce.
• We may need a different strategy of outreach
Implications for Intervention
• Most patterns of violence are unpredictable
• Outcomes of interventions will likewise be unpredictable
• Perhaps multi‐pronged interventions addressing multiple influences is the best approach for complex patterns
• Perhaps leaving the relationship is the best approach for complex patterns
Additional Research
Decision‐Making Study
• We were impressed with women’s help‐seeking during the study
• We conducted a follow up study about women’s decision‐making about ending the violence (funded by NSF).
• Daily, we asked about their “need to”
• Get counseling help
• Get legal assistance
• Leave the relationship
Need‐to‐change is unpredictable too.
• Patterns were most unpredictable in women• who lacked awareness of the abuse, • who were socially isolated, and • whose social networks were primarily family members
• who also suffered abuse.
• Perhaps… they live in a culture of abuse.
•Where opposite forces are at work:
• family loyalty and a desire to escape.
Patterns of Violence:Cycles, Systems or Wheels
12%
30%59%
69
Periodic: Cycle of Violence
Random: Power &
Control Wheel
ChaoticFamily Systems