Framework for Working Together

Relationship violence (RV) is any form of physical, emotional, spiritual and financial abuse, negative social control or coercion that is suffered by anyone that has a bond or relationship with the offender. In the literature, we find words such as intimate partner violence (IPV), neglect, dating violence, family violence, battery, child neglect, child abuse, bullying, seniors or elder abuse, male violence, stalking, cyberbullying, strangulation, technology-facilitated coercive control, honour killing, female genital mutilation, gang violence and workplace violence. In couples, violence can be perpetrated by women and men in opposite-sex relationships (Carney et al., 2007), within same-sex relationships (Rollè et al., 2018) and in relationships where the victim is LGBTQ2SAI+ (lesbian, gay, bisexual, transgender, queer, Two-Spirit, intersex and asexual plus)  (The Scottish Trans Alliance, 2010; Rollè et al., 2018). RV occurs as a result of multiple impacts such as taken for granted inequalities, policies and practices that accept sexism, racism, ageism, xenophobia and homophobia. It can span the entire age spectrum. It may start in-utero and end with death.

In this chapter, we continue the discussion on NEVR and explain our framework and how the community and academia can work together to address RV. We also describe how mentoring students allows service providers to share real-world experiences with students. It allows service providers and students to address a social issue with limited funding.

NEVR – Inclusive Framework

The Network to Eliminate Violence in Relationships (NEVR) is a committee that was conceived by Dr. Balbir Gurm, Nursing Faculty at Kwantlen Polytechnic University (KPU), Surrey Women’s Centre (SWC), and Progressive Intercultural Services Society (PICS).  At its inaugural meeting, there were over 60 individuals from the community including Royal Canadian Mounted Police (Surrey, BC), the City of Surrey, DIVERSEcity, Sophie’s Place, YWCA, Options Community Services Society, Kwantlen Polytechnic University (KPU), Surrey Women’s Centre (SWC), Progressive Intercultural Services Society (PICS), etc. Below is information on the background and process.

Background and Purpose

[Everyone] is responsible for the continued assaults on women and in some cases their deaths; the friends and neighbours who ignore or excuse violence, the physician who does not go beyond the mending of bones and the stitching of wounds, the social worker who defines wife-beating as a failure of communication, and the police or court officials who refuse to intervene. The violence is meted out by one man, but the responsibility for that violence goes far beyond him (Dobash & Dobash, 1980 p. 222).

Dobash & Dobash (1980) are pointing to the responsibility of all members of society to prevent RV.

Recent research shows that women and girls are the most discussed victims of relationship violence; nonetheless, it is critical to recognize that there are other cohorts suffering from relationship violence. Read chapter 5 for RV prevalence rates.

Data on RV is interdisciplinary in scope; it comes from academic, government, and community partnerships, in such professions as nursing, social work, psychology, gender studies and criminology. Violence in relationships not only results in physical harm, but also “undermines the social, economic, psychological, spiritual, and emotional well-being of the victim, the perpetrator, and the society as a whole” (Kaur & Garg, 2008, p. 74).

In the first RV participatory action cycle (Gurm et al., 2013) the first item of business was for service providers in the anti-violence sector to identify the steps that occur when a survivor calls the police for assistance.

The following are the potential steps and contact with services when dealing with domestic violence, in each case these are lists of possible outcomes and actions.

The first is to decide if the Incident is an emergency – call 911 if it is an emergency. For non-emergency – call or text 211, 7 days a week, 24 hours per day and get assistance in multiple languages in Metro Vancouver, Fraser Valley, Squamish-Lillooet and Sunshine Coast Regional Districts. In other areas of BC, call VictimLinkBC at 1-800-563-0808.  You can also email VictimLinkBC@bc211.ca for assistance. 

Figure 3.1 shows the process that is followed from when police respond to a 911 call for relationship violence until the matter goes to court (if it goes to court).

Figure 3.1 – Steps followed after a 911 call

As mentioned in chapter 1,  health is a positive concept, emphasizing personal resources as well as physical capacities. In the case of RV in family circles, the family does not function in a healthy way and does not have personal resources to cultivate healthy relationships. Intervention, then, must take the form of health promotion, which can be approached either from a medical, behavioural, and/or socio-environmental lens. In this paper, an innovative, multidisciplinary program targeting reduction in RV is introduced. The program framework is outlined and discussed.

Methods and Procedures

The Network to Eliminate Violence in Relationships (NEVR) originated as a result of an early (2011) qualitative research project conducted to provide an analysis of the scope of RV, its causes and definitions from multiple standpoints. You can click here to read the full report.

Here we discuss not the methods of any one project, but how NEVR developed as a series of continuous cycles of research and activism. The methods and procedures employed by NEVR are informed by the Action Framework and an understanding of the Intersectionality framework, cultural safety, multiple ways of knowing and appreciative inquiry. In addition, the procedures employed in each PAR cycle are meetings, action, conference and evaluation.

The goal of the original project was to gain a better understanding of the effectiveness, and the efficiency of current resources and services available for individuals affected by the cycle of female domestic abuse within the community of Surrey and surrounding areas. It also made recommendations to address the gaps identified. Six cohorts of participants were interviewed via a semi-structured interview format along with demographic questionnaires. The six cohorts included 14 male offenders, 10 female survivors, 10 healthcare service providers, 17 community service providers, six police unit representatives, and four members of the crown counsel. In 2011, the findings of this research initiated a further research project involving twelve individuals. Through continuous PAR (participatory action research – PAR cycles) it has grown to a membership of more than 200 people from over 50 organizations. Perspectives include those of criminal justice system personnel, educators, medical services personnel, service providers as well as the clients of existing programs and services (the perpetrators of violence in relationships as well as the victims/survivors).

The recommendations from the first cycle were to:

• Strive for increased program funding and staff resources
• Provide treatment for all involved in the abuse cycle
• Improve and implement screening tools
• Increase interpreter services
• Improve collaboration and resource sharing among agencies
• Use personalized empowering models for clients
• Improve system efficiencies.

It was also concluded from this cycle that more transformative changes are needed such as:

• The establishment of a dedicated judicial system
• A community conflict resolution system
• A central resource centre
• Education and networking for service providers.

Recommendations from the first cycle created NEVR and continuing PAR cycles have shaped the role of NEVR. The goal of NEVR is to create a society where RV is neither accepted nor tolerated, and it is conceptualized as both a research project and a community clinical placement for nursing students. It is hoped that participants will be able to use this process and framework to address the issue of relationship violence in their communities through utilizing NEVR’s action framework and the findings and resources that result from the continuous cycles of work. In PAR, the entire group (all stakeholders and allies) is involved in identifying the topic of focus in the real world setting, planning actions, taking actions, and analyzing and reflecting on the actions. After the analysis and reflection the process starts again because now the current situation is redefined and the cycle repeats.

Figure 3.2 Participatory Action Research Cycle

 Source

NEVR Action Framework

Socio-environmental Model of Health

NEVR’s action framework springs from a socio-ecological understanding of relationship violence. That is, the understanding that health is a positive state defined by connectedness to one’s family/friends/community, being in control, having the ability to do things that are important or have meaning, as well as community and societal structures that support positive human development. In this approach, RV is defined in terms of psychosocial risk factors and socio-environmental risk conditions, such as poverty, homelessness, isolation, powerlessness, stressful environments, hazardous living and working conditions; and social factors such as race, gender, disability and normalizing and acceptance of RV by the community (Capaldi et al., 2012; Centers for Disease Control and Prevention [CDC], 2017; Kantor & Jasinski, 1998; Stith et al., 2004; Vagi et al., 2013). NEVR recognizes the broad framework for implementing the healthy public policy of the Ottawa Charter for Health Promotion (1986) which in addition to stating that “prerequisites and prospects of health cannot be ensured by the health (or any) sector alone,” (p. 3) calls for action by all concerned: by governments, by health and other social and economic sectors, by non-governmental and voluntary organizations, by local authorities, by industry and the media…professional and social groups and health personnel have a major responsibility to mediate between differing interests in society for the pursuit of health. (Public Health Agency of Canada, 1986, p. 3).

The interventions and actions in the socio-environment model of health prevention are community development, coalition building, political action and advocacy and societal change. As such, the high-risk societal conditions are targeted and political and economic policies are introduced at the community level. NEVR works with multiple stakeholders to address these societal conditions and reject the normalizing of relationship violence. Interventions are aimed at family, work/school, communities and society. Indeed, the benefit of viewing relationship violence from a socio-environment perspective is that it allows RV to be targeted at a family and community level, rather than an individual level. It allows for looking at circumstances and events rather than blaming individuals. For a fuller discussion on the socio-environmental model, see chapter 6.

Intersectionality Framework

NEVR utilizes a socio-environmental framework, as well as an intersectional approach; intersectionality means utilizing the sociological insight that people are shaped by the interactions of different social concepts (i.e., all of the psychosocial risk factors and socio-environmental risk conditions) such as race, class, gender, sexuality, ethnicity, nation, age, and religion and that these interactions occur within a context of connected systems and structure of power (Collins, 2015). An individual can have power and privilege in one role and be oppressed in another role.  This is experienced simultaneously, is dynamic and is influenced by context. Of note, the systems and power structures are of great significance for NEVR, particularly in regard to cultural safety. To learn more about Intersectionality, see chapter 6.

Appreciative Inquiry

Cooperrider & Srivastva (1987) describe Appreciative Inquiry (AI) as a process used to develop positive change in organizations. Additionally, AI is a form of action research that attempts to create new theories, ideas, and images that aid in the developmental change of a system. It is a strengths-based approach that allows for social change. Instead of viewing clients, families, and organizations as machines, it views them as organisms—that is, adaptive, and above all, interactive within themselves and with other organisms (systems).

The concept of social construction is inherent in the philosophy of AI. “Reality” is created by those in the system. Our ability to change is limited by collective will and imagination. To effect change from an AI perspective, it is imperative to be respectful of the experiences of the group members. AI does not view an issue as a problem, per se, and does not use a traditional problem-solving approach. Instead, it looks at the desire for something—it asks people to look into their past for successful experiences, locate how they felt, recall what they did in order to amplify that in the present (Cooperrider & Srivastva, 1987). For RV, this means asking clients, stakeholders, and communities to focus on their feelings when they are in control, free, and healthy, and to ask them to identify what they need currently to make the change. In these cases, images and language must be used with intentionality.

Cultural Safety

When working with individuals in Canada, a diverse population with many cultural backgrounds, cultural safety is paramount, as misunderstandings can reduce the efficacy of care offered. When working in RV, an issue that is pervasive and normalized in different ways across cultures, it becomes even more important due to the connection between different cultures and RV. In fact, it is widely accepted that knowledge of culture is an important part of effective therapeutic communication that can improve health outcomes (National Institute for Children’s Health Quality, 2005).

The concept of cultural safety was first used in nursing by Irihapeti Ramsden (1990), a registered Maori Nurse in New Zealand. It is based on the premise that historical, social and political processes have a lasting influence on marginalized groups (e.g., the Maori in New Zealand, First Nations, Inuit, and Métis people in Canada), and must be recognized. Cultural safety accepts that we all belong to a culture, and unequal power relations exist within and between cultural groups at the family, community, and societal level. Also, cultural safety involves the recognition that stereotypes and negative attitudes exist in scientific literature, which can be carried then into practice (Ramsden, 1990).

Practicing cultural safety ensures that health care staff are respectful of nationality, culture, age, sex, sexuality, political and religious beliefs, and the position of their patients. Awareness of these intersecting systems has the potential (consciously or unconsciously) to influence the power balance between clinicians and patients, as well as between colleagues. In nursing, cultural safety is understood to mean there is no damage or harm by interactions between people, and that dignity and respect are maintained for all parties in an interaction (College of Registered Nurses of British Columbia, 2017). Creating a culturally safe environment requires practitioners to have cultural humility. It requires self-reflection on personal oppression and privilege as well as identification of biases to create respectful partnerships based on trust. This empowers all involved in the relationship and aims to equalize power in the practitioner-client relationship or colleague-colleague relationship.

At NEVR meetings the facilitator ensures each individual at the meeting is respected and provided an equal opportunity to voice their opinion and the decisions are made from an inclusion perspective. From the cultural safety perspective when working with survivors, one of the goals of NEVR is to ensure no harm is done to the service provider, and their specific current situation and any historical oppressions are considered. Although originally developed to work with individuals, cultural safety applies to work between groups, organizations, and communities. Emphasis is placed on the desires of the service provider, and where they are positioned in terms of family, workplace, and community roles and dynamics. This is respectful and empowering to the service providers who may also face their own institutional or political challenges and oppressions. It is recommended that this approach also be carried out with survivors and offenders.

Multiple Ways of Knowing

Carper’s (1978) and Chinn & Kramer’s (2008) framework of multiple ways of knowing was adapted to work within the NEVR context by Gurm (2013). The premise is that each individual has a unique personal understanding and view of the world based on their own experiences that are derived in multiple ways. These include empirical, ethical, personal, aesthetic, and emancipatory.

Empirical knowledge provides the theories about conducting and applying knowledge—to date, there is much literature and many theoretical frameworks for why RV exists and how it is perpetuated, as well as programs on effective prevention and intervention—these theories and programs may not address the fact that there is much variation in RV at the group and individual levels. As such, general theories may not work in particular situations, such as when dealing with a multidisciplinary and widespread issue like RV (and NEVR, itself) because collaborations by definition are not closed systems; they are open.

Aesthetic knowledge is the art of practicing. Aesthetic knowledge recognizes that knowledge can be derived by acting—the practical skills required to work with clients. Those who are driven by aesthetic knowledge tend to draw from previous experiences, rather than empirical frameworks. It requires a deep appreciation of the context and moves beyond surface elements of the situation to a greater understanding of the whole. It may involve an intuitive, creative approach to action and decision. It is aesthetic—practical—knowledge that leads to transformation.

Emancipatory knowledge is built on understanding that aims to critically examine the context or the environment in which they practice, programme, or decision occurs; that is, the social and political process of the organization, province or state, and country. It is about understanding both the mission and goals of agencies, as well as the social barriers or challenges involved in achieving those goals. It includes a historical understanding of those involved in partnerships (e.g., historical oppression) to better understand the multiple roles of partners. It requires facilitators and leaders with the capacity to recognize oppressive hegemonic practices, as well as to recognize the changes that are required to “right the wrongs” that exist. Emancipatory knowing is developed through action with reflection.

Personal knowledge is knowledge of the self and participation in action. It is based on the assumption that interpersonal engagement and interaction must include personal experiences and understandings. In contrast to empirical knowledge, where the researcher aims for objectivity, good personal knowledge practice acknowledges subjectivity and authenticity. The team or group (in this case, NEVR) is an open system that interacts and moves toward what Maslow calls self-actualization, or growth of human potential (Maslow, 1943 in Huitt, 2007). For NEVR, the research aims to reconcile this personal way of knowing with the role of controlling and managing the study—that is, an accepted norm or a more standardized approach (Gurm et al., 2013).

These multiple ways of knowing are key components in NEVR’s framework. Only through understanding the diverse ways that individuals and groups conceptualize the problems of RV can any solution be formulated to address it.

The NEVR framework was presented at the Sigma Theta Tau International Society’s nursing conference (2018). Gurm et al Participatory Action Research Addressing Domestic Violence from a Constructivist Framework