Most of the literature is about violence against women and girls (Dixon & Graham-Kevan, 2011) from a feminist perspective, and the literature is in silos. It is also normalized to heterosexual relationships from this perspective where men are seen as perpetrators and women as survivors (Dobash & Dobash, 1984, 2004),  even though studies indicate that it is perpetrated by females on males in heterosexual groups and by sexual and gender diverse groups  ( Archer, 2000, 2006; Dixon & Graham-Kevan, 2011;  Jones, 2018; Lien & Lorentzen, 2019; Straus & Gelles, 1986; Walters et al., 2013). Please also note that we are aware that there are debates around how statistics are counted, and what is counted, leading to contradictions in figures from different studies – see chapter 5 for a fuller discussion of this point.

Gender (male or female)/sexual and gender diversity (LGBQT2SIA+) is only one of the contributing factors because relationship violence is a multifactorial issue. We acknowledge that after decades of addressing RV from the feminist perspective, we have over time seen policy changes and a move towards equity. With this understanding, we believe that knowledge from women’s programs and services may be adapted for use across genders, sexual and gender diverse groups. That does not mean services for women need to decrease, but all groups who suffer RV, with any prevalence, need to be served. However, we are also aware that Ristock (2002) argues that a simple, direct transfer of services without awareness of, and sensitivities to, the uniqueness of, in her case lesbian relationships, can have limited utility. See chapter 19 for Indigenous populations, chapter 20 for LGBTQ2SIA+ and chapter 21 for immigrants and refugees, for a fuller discussion of these nuances in serving the specific communities.

Our intent is to thaw the academic silos and offer practitioners, the public, governments, judiciary and academics more comprehensive ways to bring forward the complexities of RV. We also aim to show the many interacting variables and acknowledge similarities and differences in addressing the issue. This might promote a better understanding, and hopefully the possibility of everyone working together on this global pandemic without arguing who is impacted the most. Since this is a living book, we see it as the beginning of sharing knowledge and wish for others to contribute their understandings. You can email NEVR@kpu.ca if you wish to contribute. Also, this is not meant to be an exhaustive literature review but a synthesis of understandings from various jurisdictions and fields. We present integrated models for understandings and actions.

Integrated Models

NEVR RV Model

Current knowledge related to RV is fragmented and in silos, but it needs to be brought together. The NEVR action framework draws from multiple overlapping frameworks. Each framework is discussed and the integrated NEVR RV Model presented. It is based on the fact that no two perpetrators or survivors are the same in any given group and there are similarities within and across groups. A comprehensive understanding of the complex web of RV needs to drive laws, policies and actions and reduce the risk for all affected groups.

Multiple ways of knowing – Multiple perspectives and understandings can help illuminate health challenges such as relationship violence. We draw on the adaptation by Gurm (2013) of Carper’s (1978) and Chin & Kramer’s (2008) framework of multiple ways of knowledge and knowing. This is based on the social constructivist theory that illuminates 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.

1. 1. Empirical. The empirical knowledge/way of knowing is based on science; it is conscious reasoning and problem-solving, predicting, explaining, and describing. Empirical knowing is used to develop formal theories and descriptions about laws, theories, and explanations that are generalizable to other situations. This is what drives the academic literature.
   2. Ethical knowledge/way of knowing is essentially a moral understanding of how to behave in multiple roles. This requires experiential and empirical knowledge of social norms and values, as well as ethical reasoning. Ethical knowledge can come from a professional code of ethics, social norms, or maybe philosophical positions including duty and social justice. Ethical knowledge must include judgment—that is, going beyond code to consider all actions that are deliberate and involve a decision of right and wrong. Ethical knowing involves understanding of different philosophical positions designed to deal with moral judgment and notion of service.
   3. Personal knowledge/way of knowing 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, in which the researcher aims for objectivity, good personal knowledge practice acknowledges subjectivity and authenticity. The team (in this case, NEVR) is an open system that interacts and moves toward what Maslow calls self-actualization, or growth of human potential (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 more standardized approach).
   4. Aesthetic knowledge/way of knowing 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.
   5. Emancipatory knowledge/way of knowing is understanding that critically examines the context or the environment in which they practice, develop programmes, 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 (Gurm, 2013).

These multiple ways of knowing are key components in NEVR’s framework for we value all our members and their understandings and perspectives on relationship violence. While 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 programmes on effective prevention and intervention. These theories and programmes not always address the fact that there is great 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, because collaborations by definition are not closed systems, but they are open and constantly changing.

Socio-environmental framework – As well as accepting that there are different ways of knowing, we accept the social-ecological framework for health promotion. That is, the understanding that health is a positive state defined by connectedness or relationship 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 having control is seen as a major concept for a  state of well-being (Lalonde, 1974). Also, 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, ability and normalizing and acceptance of RV by the community (Capaldi et al., 2012; Centers for Disease Control and Prevention [CDC], 2016; Kantor & Jasinski, 1998; Stith et al., 2004; Vagi et al., 2013). Part of the reason why the feminist perspective that relationship violence is a gendered issue and only exists against women has explained RV well in the past is that most societies that the theories were developed from were on the extreme spectrum of patriarchy whilst today there is a range from more equitable societies in western nations to more patriarchal societies in less developed nations.

Figure 6.1 – Health Promotion Model (Government of Canada, 2001)

The socio-environmental model explains how relationship violence is a result of behaviours and social situations that occur in multiple interacting systems. It is a health promotion framework that looks at the individual, family, community and societal levels and is adopted by Health Canada (2001). The context may include demographic, neighbourhood, school or community (Capaldi et al., 2012). It looks at various elements in each system and incorporates individual and societal level theories. It indicates that health is a result between the combination or interaction of multiple factors (i.e., social determinants of health) and explains that actions need to be aimed at all systems. Social determinants that have been identified for Canadians are:

1. 1. Aboriginal Status
   2. Early Childhood Development
   3. Education
   4. Employment and working conditions
   5. Food insecurity
   6. Gender
   7. Health care services
   8. Housing
   9. Income and its distribution
   10. Social Exclusion
   11. Social Safety net
   12. Unemployment and job security
   13. Disability (Ability)
   14. Geography
   15. Immigrant status
   16. Race (Raphael, 2016; Mikkonen & Raphael, 2010)

These 16 social determinants contribute to relationship violence, and they make up the risk factors identified. How much they contribute to a particular person is unique to the individual. NEVR recognizes the broad framework for implementing the healthy public policy of the Ottawa Charter for Health Promotion (World Health Organization [WHO], 1986) which in addition to stating that “prerequisites and prospects of health cannot be ensured by the health (or any) sector alone,” (p. 3). It calls for action by all concerned such as governments, health and other social and economic sectors, non-governmental and voluntary organizations, local authorities, industry and the media. Professional, 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. We have been building coalitions and this living book is another way for us to build a coalition and develop ourselves and our colleagues to engage in advocacy and social change together.

To understand the complexity of RV, we have integrated the Intersectionality and Cultural Safety frameworks because within each system (i.e., individual, family, community, sector, society) exists power and privilege and taken for granted internalized practices of power that may have been passed on for generations. Everyone within the system needs to be aware of their own social location, positionality and question received knowledge. There also needs to be an awareness of history and its impacts that are transferred through generations.

Intersectionality Theory – explains how identity, experience and positionality intersect to create oppression that underpins interactions and in turn relationship violence (Cramer & Plummer, 2009; Meyer, 2010). See the Intersecting axis of power and privilege below and place the survivor on the wheel to understand the totality of the person. Intersectionality theory explains that individuals have multiple roles and identities. Each individual life within systems of power and privilege is the sum of power/privilege in a specific situation, that may contribute to RV. Also, it illuminates the diversity of populations and individuals to help create more specific and relevant programs.

Figure 6.2 – Intersecting Axis of Power and Privilege (Roberts et al., 2019)

Within systems, the risk may be increased due to historical, political, and socioeconomic realities, and the normalization and generational transmission of violence that leads to a culture that normalizes abuse. The history and impact of experiences and the code of silence to protect the family and community all contribute to increased RV.

Racism and gender inequality through many elements like barriers to voting and denying positions of leadership to minorities and women may also contribute to RV. In addition, economic dependency, poverty, lack of parenting skills, formal education, geographic isolation, government, and historical structures in remote communities increase the risk of abuse for some groups including immigrants, refugees and Indigenous peoples (Brassard et al., 2015). A collaborative framework, as well as an intersectional approach, is part of the model. 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 above) such as race, class, gender, sexuality, ethnicity, nation, age and religion. They all impact a person’s positionality and either oppress or privilege them depending on accepted social norms. Also, these interactions occur within a context of connected systems, relationships and structures of power (Collins, 2015). An individual can have power and privilege in one role and be oppressed in another role. This is experienced simultaneously, and it is influenced by context. Context also determines power and privilege. Of note, the systems and power structures are of great significance, particularly regarding cultural safety.

Cultural Safety (CS) – Across Canada and in many nations around the world, there is a history of colonialism, racism and white privilege. For many years, practitioners were told to become culturally competent and many books and articles were written on how to deal with Indigenous and racialized populations. However, generalizations were published about groups leading all to believe that these groups were homogeneous. However, when generalizations are applied to every single person of a given group, it leads to stereotyping. Cultural safety recognizes that stereotypes and negative attitudes exist in scientific literature, which carries into practice (Ramsden, 1990). This may explain why oppressed people feel that the system and its services revictimize them. This results in many individuals not having a sense of 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 to address RV, an issue that is pervasive and normalized in different ways across cultures, it is more important still. This recognition of normalized as taken for granted practices that overlap with the concept of emancipatory knowing. Also, it is widely accepted that knowledge of culture is an important part of effective therapeutic communication that can improve health outcomes (Kreps, 2006).

Cultural safety accepts that all individuals belong to a culture, and unequal power relations and racism exist within and between cultural groups at the family, community, and societal level. In nursing education, cultural safety was first introduced by Irahapeti Ramsden, a Maori nurse in her doctoral dissertation, to address the historical oppressions that have led to higher rates of illness in the Maori population. 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 (Ramsden, 2002). Cultural safety examines prejudice, power and bicultural relations. It can be applied to any person or group that differs on any axis of privilege, domination and oppression (age, ability, ethnicity, sexual orientation, migrant status, religious belief, socioeconomic status, education, etc.). It is about the unique bicultural relationship of two people and the focus is on the service provider/employer/educator/boss (privileged person) to create a trusting environment and equal partnership with the person who is in an oppressed position. Only the recipient (the oppressed person) can decide if cultural safety has been achieved. The focus is on the one with the power to reflect on their power and assumptions in order not to stereotype but listen to and understand the other person. This can also be applied to multicultural relationships with three or more people.

Cultural safety is practiced through cultural humility and the following occurs:

• Service providers become curious and reflective practitioners
• Listen to understand
• Practitioners reflect on their own biases and confront their prejudices
• Communicate in a respectful manner that recognizes historical and systematic (organizational/societal) oppression
• Create an equal partnership between those who are communicating with each other
• Create a trusting environment

Practicing cultural safety ensures that health care staff (all service providers) are respectful of nationality, culture, age, sex, sexuality, political and religious beliefs, and the position of their clients. Awareness of these intersecting systems has the potential (consciously or unconsciously) to influence the power balance between clinicians (service providers) and patients (recipients of care), 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 [CRNBC], 2010). 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 and to create respectful partnerships based on trust. It is about creating equity in partnerships that is consistent with the concept of social justice.

Figure 6.3 – NEVR Relationship Violence Model

Using these overlapping frameworks, the high-risk societal conditions are targeted, and political and economic policies are introduced at the community level. We work with multiple stakeholders to address these societal conditions and reject the normalizing of relationship violence. Interventions are aimed at family, school, work, 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. The NEVR RV Model is used to understand the complex health global epidemic of RV. It shows that RV results from socio-environmental factors as well as individual choices. These choices are constrained by the individual’s diversity and power within relationships and structures that operate within taken for granted practices. In this model, we are aware of these constraints so try to create equal power, engage in a culturally safe manner to create trust. In order to collaborate and work with others, we add the change model of Appreciative Inquiry.

Appreciative Inquiry (AI) – 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). It is believed that they are all open systems. It overlaps with all the previous frameworks discussed for 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 a problem 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, locate how they felt, recall what they did when they experienced a positive state, and 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 of relationship violence, and healthy, and to ask them to identify what they need currently to have those feelings and make that change. In these cases, images and language must be used with intentionality and in programs on healthy relationships, parenting, employment skills, etc.

Figure 6.4 – NEVR Collaboration and Action Framework

At all meetings, the model on the left (Figure 6.4) is integrated by NEVR. In the constructivist framework, Cultural Safety (CS), appreciative inquiry (AI), Multiple ways of knowing (MWK) and Intersectionality theory interact and are constantly changing to address RV. We imagine NEVR similar to an amoeba system.  Just like an amoeba changes its shape, so does NEVR because the committee is constantly evolving as it interacts with members (i.e., internal environment) and organizations/policies/law/allies (external environment). Each member has multiple roles and identities that interact to provide innovative perspectives and understanding (intersectionality). The committee values all members’ ideas because it believes in multiple ways of knowing (MWK) creating equal power and trust which in turn results in cultural safety (CS). NEVR focuses on its mission (i.e., dream) of eliminating relationship violence and not on the statistics of today (AI). 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 is to ensure no harm is done to the service provider, and their specific current situation and any historical oppression are considered. Although originally developed to work with individuals, cultural safety applies to 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. Also, it is acknowledged that interactions are dynamic constantly change like the amoeba in the figure. It is recommended that this approach be carried out in all collaborations between individuals and organizations and when working with survivors and perpetrators.

Risk Factors for RV

The world is becoming smaller and knowledge is shared freely through the internet. We know that relationship violence occurs from conception to death and impacts all genders with a consensus that some groups are at greater risk than others. Identifying risk factors allows for the development of appropriate services and programs in order to safely plan programs to prevent abuse. Risk factors are a combination of environmental and social conditions and individual’s biology/genetics).

In our literature review of Canadian studies, certain populations are identified as more vulnerable than the general population to RV; for instance, Indigenous, Northern and Remote Communities, children, older women, LGBQT2SIA+, immigrants and refugees, those who live with an impairment or disability  (Jeffrey et al., 2018), low socioeconomic status (SES), low education, dependency, low control, oppression, witnessed abuse, suffered abuse or maltreatment (CDC, 2019). As well, the most severe form of RV like death is 4.5 times higher among women versus men. In addition, children considered one of the most vulnerable groups, face an extremely high risk of death, for they may be killed in a variety of situations including revenge or crossfire (Jeffrey et al., 2018). Although some groups might show higher risk depending on social situations, there is a great overlap in risk factors between groups. While much of the literature and our later chapters focus on each group across the lifespan separately, in this chapter we focus on bringing together the risks and successful initiatives and apply an integrative model. See chapter 15 for details about RV against women,  chapter 16 for children, chapter 17 older adults, chapter 18 for men, chapter 19 for Indigenous populations, chapter 20 for LGBQT2SIA+, chapter 21 for immigrants and refugees, and chapter 22 for workplace violence. 

Figure 6.5 – Common Risk Factors of RV among Children, Women, Men and Older Adults (CDC, 2014; Renzetti, 1992; Stith et al., 2004)

We know that for all age groups the risk factors for being abused are disability (cognitive or physical impairment), LGBQT2SIA+ groups, need of care, dependency, social isolation (CDC, 2014) and intergenerational trauma (Franco, 2020; Stith et al., 2004). Notice there are overlapping risk factors across groups. Substance use, dependency, intergenerational trauma, relationship satisfaction (Renzetti, 1992; Stith et al., 2004) jealousy, anger, and/or control (Graham-Kevan & Archer, 2005) are risk factors for all adults (men, women, older adults). For example, young age is a risk factor for women and men and some authors believe abuse peaks at adolescents (Kim et al., 2008; Nocentini et al., 2010). Table 6.1 is created from available data on risk factors for different groups.

Table 6.1 – Comparison of RV Risk Factors among Groups (Derived from: CDC, 2014; Graham-Kevan & Archer, 2005; Kim et al., 2008; Nocentini et al., 2010; Renzetti, 1992; Stith et al., 2004)

Besides risk factors for victims/targets, there are risk factors for perpetrators to commit relationship violence. There are a number of already tested tools that are used to assess the risk to become an offender of RV. See chapter 13 on measurement tools to assess risk. The general risk factors for perpetration of RV that we can find data on are listed below in table 6.2 (CDC, 2020a; CDC, 2020b, CDC, 2020c).

Table 6.2 – Relationship Violence Risk of Perpetration across Groups (Derived from CDC, 2020a, b, and c)

Several overlapping frameworks that help address RV have been outlined as part of the NEVR model. Also the risk factors that are common between groups identified. It is important to note that risk factors are just that, they are not causal.

References