Case Management: Domestic Violence Against Women

Introduction

Domestic violence against women is an international problem, which affects millions of lives. Therefore, it is a major healthcare concern since it has detrimental effects on women’s overall health and well-being, which are manifested in both physical and psychological aspects.

Such a problem can take many forms, but the consequences can be dire in all regards. The common risk factors of domestic violence against women are lack of education, absence of supportive channels, partner substance abuse, place of residence, socioeconomic status, and domestic violence against children. The described four case management models are the generalist model, assertive and intensive model, strengths-based model, and clinical case management model. The suggested practice is the clinical case management model, where both physical and mental health assessments are conducted to derive the risk factors and empower the victims through aid channels.

Background

Domestic violence is an urgent problem in modern society, and domestic violence against women is spreading across all social and cultural strata. Close people, members of their family, much more often than outsiders, are victims of aggressive actions. This also applies to situations of minor harm to health or situations of psychological pressure. Psychological pressure, unfortunately, is not always legally and evaluatively perceived as a situation of violence against a person’s personality. The same applies to more serious, both from a legal point of view and from an evaluative point of view, crimes, including, among other things, murder. The fact that the direction of aggression against family members is noted in almost all countries of the world allows us to reasonably speak about the universality and prevalence of this phenomenon.

Literature Review

To properly and effectively apply the case management models and approaches to the problem of domestic violence against women, it is important to evaluate and analyze the current state of the literature on the subject. According to one study, almost 30% of all women globally have experienced some form of violence from their intimate partners, which might include the context of familial marriage (Krahé, 2018). It is also accompanied by the fact that in addition to such a large number of violent acts, nearly 8% of women have experienced sexual assault from individuals who are not considered their partners (Krahé, 2018).

The adverse effects of domestic violence against women are severe, where victimization is a leading cause of mental disorders, such as depression and anxiety (Oram et al., 2017). Healthcare specialists play a central role in identifying such instances, but the current state of the given practice is relatively poor in the overall responsiveness, which results in non-engagement (Oram et al., 2017). Therefore, it is critical to design effective strategies for ensuring that women are identified and protected accordingly.

One should note that violence against women is an obstacle to equality, full development, and peace. All efforts to make women the masters of their lives will be wasted if the violence continues. Through violence, women are “kept in their place,” violence curtails and destroys women’s human rights. This phenomenon reflects the historical imbalance of power between the male and female parts of the population, which leads to further oppression of women, perpetuating and exacerbating discrimination. As the violence spreads in breadth and depth, women lose their rights, such as the right to speak, reproductive rights, and the right to work. Freedom from violence brings women closer to equality, and women can use human rights to protect themselves and other women from violence (Alesina et al., 2016).

An important gender analysis of changes in the socio-economic situation during the period of reforms indicates that such families constitute a significant share of the poor and the poor themselves. In the new economic conditions, in which the list of social guarantees has significantly reduced, and the level of social protection has decreased, a woman is a mother who brings up a child without a father and must herself be responsible for the welfare of her family.

It is important to point out that domestic violence against women is not an isolated issue. It is stated that there is a strong connection between violence against children and violence against women, where the former can contribute to the latter’s continuity (Guedes et al., 2016). In other words, one should be aware that children who experienced and grew up in an environment of domestic violence are more inclined to partake or become victims of domestic violence against women.

One of the most prominent influencing factors of the problem is manifested in socioeconomic conditions, where poorer families are more inclined to have higher rates of domestic violence in general (Alesina et al., 2016). It is the result of more prominent gender roles and family structures, which harness stronger male dominance and lack of education. The latter factors inevitably lead to the translation of socioeconomic pressures and stress towards violent acts against women, who are less protected and more exposed to dangers.

The issue of domestic violence against women became more prominent under the effects of the COVID-19 pandemic. It is stated that isolation and economic distress led to an increase in the occurrence rate of domestic violence against women, which is rooted in the fact that intimate partners are more exposed to each other (Roesch et al., 2020). In other words, the couples, which already were more inclined towards having confrontations with outcomes of domestic violence, are more likely to experience a more severe and dangerous form of it. Therefore, the current state of the pandemic made the issue even more serious since women are at higher risk for bodily injuries and mental disturbances. The role of the family in the life of society is determined by the fact that it has, on the one hand, the features of a social institution and, on the other, a small social group.

As a social institution, the family is characterized by a set of social norms, sanctions, and patterns of behavior that regulate the relationship between spouses, parents, children, and other relatives. As a primary small group, it is based on marriage or consanguinity, whose members are linked by a common life, mutual moral responsibility, and mutual assistance. The family includes its members, regardless of the factor of their joint or separate residence of persons who are in a legal or actual marriage, in a state of the kinship of any nature, degree, or property.

Moreover, there are an array of key determining factors, which are deeply intertwined with the problem of domestic violence against women. The research suggests that women are in more danger based on a family history of violence, alcohol or substance use by a male partner, and place of residence, which is tied to socioeconomic factors (Owusu Adjah & Agbemafle, 2016). In addition, the lack of education and knowledge on preventative and supportive measures makes a woman more vulnerable to both the occurrence rate and the degree of danger to her health (Owusu Adjah & Agbemafle, 2016). In other words, the problem of domestic violence against women requires outside intervention since the lack of aid through invaluable channels can lead to the notion of a woman being “trapped” with her partner.

It is important to note that violent actions of family members towards each other have occurred in all societies and at all times, but they were not always considered a social problem. However, in the past few decades, domestic violence has been recognized as a serious and widespread problem that gives rise to many other social and individual problems (Owusu Adjah & Agbemafle, 2016). In particular, an understanding was formed that it is not enough just to punish the perpetrators, it is also necessary to rehabilitate the victim of violence and work with the person who committed the violence to avoid a repetition of the situation.

Domestic violence is understood as behavior or act committed with intent or perceived as being committed with the intent to cause physical, including sexual or mental harm to the health of a person or several persons who are members of the same family.

Types of Domestic Violence Against Women

Violent actions of family members towards each other have occurred in all societies and at all times, but they were not always considered a social problem. However, in the past few decades, domestic violence has been recognized as a serious and widespread problem that gives rise to many other social and individual problems. In particular, an understanding was formed that it is not enough just to punish the perpetrators, it is also necessary to rehabilitate the victim of violence and work with the person who committed the violence to avoid a repetition of the situation. Domestic violence is understood as behavior or act committed with intent or perceived as being committed with the intent to cause physical, including sexual or mental harm to the health of a person or several persons who are members of the same family.

The most common classification of types of violence is based on the nature of the violent action. There are several types of violence against women, such as physical, sexual, emotional, and economic violence. Physical violence is deliberate harm to health, physical pain, imprisonment, housing, food, clothing, and other normal living conditions, as well as the evasion of parents of underage children from care, health, and safety. Sexual violence is violent sexual intercourse that forces a woman to have sexual intercourse without her consent, failed sexual intercourse with a sick or disabled woman, under pressure, or the influence of alcohol or drugs.

Economic violence is an attempt by one adult family member to deprive another of the opportunity to manage the family budget, to have funds and the right to dispose of them at their discretion, and economic pressure on minors. Mental abuse is a deliberate humiliation of the honor and dignity of one family member to another, moral threats, insults, and blackmail. Emotional violence several researchers consider this type of violence as mental, economic, and intellectual through the imposition of attitudes and values through the process of logical persuasion.

Emotional and mental abuse can be viewed as a whole, and sometimes, it is difficult to distinguish between emotional and mental abuse. Most often, there is a combination of several types of violence at the same time. The forms of manifestation of violence are varied because they can manifest themselves in several forms. Physical punishment is beating, slapping, torturing, hair pulling, or pinching. Emotional and mental abuse is not only intimidation, threats, and isolation, but also the humiliation of self-esteem and honor, verbal abuse, and rudeness. For example, this is the suggestion that the child is the worst, and the woman is a bad mother or wife, humiliated in the presence of other people, and constant criticism of the child or woman.

It should be noted that there is a cycle of violence because, in general, the situation of domestic violence develops cyclically, consisting of three successive phases. The first involves the emergence of cases of minor violence, the second is an uncontrolled release of tension that arose in the first phase, and the third phase is characterized by an extremely affectionate and repentant behavior of a man. Relapses in every phase of the cycle of violence are inevitable. The repetition of acts of violence against loved ones over and over again seems to be pre-programmed and follows the logic of the dynamic development of a violent situation. The contexts against which domestic terror unfolds can vary widely, but the dynamics are always the same.

Effective Practices

There is a wide range of effective practices, which can be used to combat the occurrence rate and the severity of domestic violence against women. Case management is a process of advocacy, evaluation, care coordination, facilitation, planning, and assessment (Summers, 2016). The selected problem assessment reveals that one of the most critical contributing factors to the prevalence of domestic violence against women is lack of education, risky behaviors of a partner, socioeconomic status, and the absence of supportive channels.

In regards to the latter, it is important to design and develop stronger identification measures for professionals through clinical case management models, who are more likely to be in direct contact with potential victims. Such individuals and organizations are healthcare experts who need to be eager and less reluctant to intervene if there are strong indicators of the fact that a woman is being violently abused by her partner. To properly conduct such a practice, it is important to derive critical information on a woman’s educational background, socioeconomic status, and partner’s risky behaviors.

Generalist Model

It is important to note that case management models vary in their complexity and use (Diane, 2002). The brokerage or generalist case management model primarily focuses on coordination as a discriminating characteristic, where the case the manager-client relationship is not as relevant as in other alternatives (Vanderplasschen et al., 2007). The main feature of the given framework is manifested in the fact that it is simple and requires little modification. The basis of the model is rooted in a lack of intricate complexities, but it also can be considered less suitable for the majority of cases, such as domestic violence against women.

The main goal is the stabilization of the worsened situation, which can be useful in the context of the selected issue, but the framework offers no long-term solution for reducing or eliminating the instances of violence against women. In other words, coordination between conflicting parties cannot be effectively conducted since the causes of the issue are ingrained in a broad spectrum of issues, such as poverty.

Assertive and Intensive Model

Another important case management model is the intensive or assertive community treatment model. It primarily focuses on a comprehensive approach and relies on the solidity of the case the manager-client relationship with outreaching measures put in place to ensure the maximum service provision (Vanderplasschen et al., 2007). The emphasis of the given framework is put on multidisciplinary team-based efforts, where the problem is addressed from different angles and perspectives. Such a framework attempts to cover all major issues regarding the problem, which is useful in the case of violence against women since it is fueled and catalyzed by an array of factors.

The model is also comprehensive, which means that it does not leave out important contributory elements, which is also necessary for the development of a proper solution based on the existing evidence. Violence against women tends to stem from a wide range of holistic health concerns, where the integration of individual management needs to focus on the provision of quality care across a continuum of procedural stages of improvement (Girard, 1994). Therefore, accentuation is lacking in the assertive and intensive model, but it compensates for these drawbacks through sheer encompassing scale.

Strengths-Based Model

One of the most widely used and applicable models of case management is a strength-based model. It primarily focuses on empowerment and strengths, where both service provision and coordination are critical, which are operated by a caseworker rather than a team (Vanderplasschen et al., 2007). The framework is highly useful in the case of violence against women because the victims usually already possess the capabilities to handle the issue through conventional means, where law enforcement and other authorities can be engaged. The model does not attempt to build new channels of support, but rather encourages victims or subjects to utilize the existing ones through empowerment.

For example, the Me Too movement is also primarily focused on the empowerment of women, and it does not design new strategies to combat the issues, but rather focuses on current measures of prevention and imposing repercussions on the perpetrators. In other words, the cases are handled by encouraging victims to speak out and reveal the fact that the problems are taking or took place.

The Me Too movement firmly believes in taking action by stating: “We believe that healing is a form of action and that taking action helps us to heal.” (“Take action,” 2021, para. 1). The caseworker mostly operates as a guide and support agent, where a victim, such as a woman experiencing domestic violence, is prompted to take action to improve his or her situation. Similar to the previous model, it is also growth-based and thus, it ensures that the issues are resolved rather than stabilized.

Clinical Case Management Model

The proposed clinical case management model is among the more precise and accurate options. It mainly focuses on positioning a case manager as a therapist and role model, where the highest emphasis is put on the case manager-client relationship (Vanderplasschen et al., 2007). Although it also focuses on coordination and service provision, the latter is more accentuated on precise and accurate assessment rather than subjective elements of previously described models.

It is important to point out that the given framework is more resource extensive, but it is the most effective one for addressing violence against women. In other words, it will ensure that there is either reduction or elimination of such cases by observing the critical signs and factors of the problem without a direct awareness of the victims, which is why it does not rely on subjects’ actions alone.

To facilitate the described practice, it is critical to understand that healthcare professionals need to be able to medically assess a woman to identify the presence of major risk factors. It can be conducted by providing a physical assessment of a potential victim, where the signs of domestic abuse are recorded. In addition, there is a need for a mental health evaluation since depression and anxiety are more likely to be present among women who are continuously suffering from domestic abuse. As it was stated previously, violence against children is tightly interlinked with violence against women, and thus, an effective practice needs to include a child assessment since the presence of one can suggest that there is a presence of another.

Conclusion

In conclusion, domestic violence against women is a global issue, which can have a detrimental effect on the target group’s overall health and well-being. The most evident risk factors of the problem are partner substance abuse, place of residence, socioeconomic status, lack of education, and absence of support channels, as well as domestic violence against children. The identified case management models are the generalist model, assertive and intensive model, strengths-based model, and clinical case management model. The proposed model is the clinical case management model, which focuses on identifying these factors through physical and mental assessments alongside the provision of supportive channels.

References

Alesina, A., Brioschi, B., & Ferrara, E. L. (2016). Violence against women: A cross-cultural analysis for Africa. NBER, 1, 1-59. Web.

Diane, H. (2002). The diversity of case management models. Lippincott’s Case Management, 7(6), 212-220. Web.

Girard, N. (1994). The case management model of patient care delivery. AORN Journal, 60(3), 403-415. Web.

Guedes, A., Bott, S., Garcia-Moreno, C., & Colombini, M. (2016). Bridging the gaps: A global review of intersections of violence against women and violence against children. Global Health Action, 9(1), 1-16. Web.

Krahé, B. (2018). Violence against women. Current Opinion in Psychology, 19, 6-10. Web.

Oram, S., Khalifeh, H., & Howard, L. M. (2017). Violence against women and mental health. The Lancet Psychiatry, 4(2), 159-170. Web.

Owusu Adjah, E. S., & Agbemafle, I. (2016). Determinants of domestic violence against women in Ghana. BMC Public Health, 16(1), 1-9. Web.

Roesch, E., Amin, A., Gupta, J., & García-Moreno, C. (2020). Violence against women during COVID-19 pandemic restrictions. BMJ, 369, 1-2. Web.

Summers, N. (2016). Fundamentals of case management practice: Skills for the human services (5th ed.). Cengage Learning.

Take action. (2021). Web.

Vanderplasschen, W., Wolf, J., Rapp, R. C., & Broekaert, E. (2007). Effectiveness of different models of case management for substance-abusing populations. Journal of Psychoactive Drugs, 39(1), 81-95. Web.