Intimate Partner Violence (IPV) and problems with Alcohol/Other Drugs (AOD) are frequently intertwined, with studies showing that 25 to 70 % of people affected by one are also affected by the other. Each is a stigmatized condition; many costly societal, family, and personal consequences are associated with each separately, and these are more severe when both are present. IPV and AOD are rarely addressed in a coordinated way, within communities, human services, or social policy, despite growing evidence that doing so reduces barriers to change and improves outcomes. Separate intervention fields for IPV and AOD have evolved, with different origins, histories, conceptual paradigms, and approaches as well as significant controversies within each field. Practitioners report many conflicts and problems in working across fields and creating “hybrid” approaches. As a result, we know little about strategies for addressing both in a coordinated way, or how to reduce the many barriers to this work. To address these gaps in knowledge, Beth Glover Reed, has developed a mixed methods services research project, with both theoretical and practical goals, to learn from the experiences of innovative organizations and practitioners. Read More
Collaborators include Larry M. Bennett, Indiana University, Elizabeth M. Armstrong and Lauren Whitmer, joint Social Work doctoral program students in Sociology and Anthropology, respectively, and many MSW students.
Historical and current contexts
The programs and policies that address IPV and AOD have evolved as separate fields, with different rationales, approaches, and funding mechanisms. Components within them do not work together well because they have different goals (e.g., safety in one, recovery in the other), and many experience their rationales and approaches as not very compatible. The AOD field is older, and has worked to define AOD problems not as moral problems but as health conditions that deserve funding similar to other health issues (now often bundled as “behavioral health”). The IPV field arose from feminist activism in the late 1960’s and 70’s, and has worked to redefine IPV from a private family issue to a crime. Both fields are gendered, but in very different ways. Practitioners in both fields often have misinformation about basic assumptions and practices in the other field. The presence of AOD problems in either partner changes how the legal system and others in their lives perceive and react to IPV, and thus interferes with implementing effective interventions. Legal, mental health, and child welfare issues are frequently present, and also issues related to employment, a survivable income, social support for change, and housing. The different origins, logics and approaches in the two fields, and diverse and inadequate funding mechanisms and regulations make it very hard for organizations and practitioners in the two fields to collaborate or develop “hybrid” approaches that can address both IPV and AOD.
There is a great need for “hybrid” approaches, which this project defines as “addressing IPV and AOD together in ways appropriate for particular people, circumstances, settings, and communities”. When both are not addressed in a coordinated way, the presence of one interferes with addressing the other, and a growing number of studies are showing improved outcomes from coordinated approaches. Despite significant efforts at local, state and Federal levels to stimulate and support such efforts, and much more attention to at least screening for both IPV and AOD, very few programs and organizations are fully hybrid. But some innovative programs are working hard to address both and much can be learned from their experiences.
Research questions and goals
This project studies organizations and has both practical and theoretical goals. These include:
- How much are organizations engaging in hybrid approaches for both IPV and AOD, how are they doing this, and what have they learned?
- What are important methodological challenges and strategies for studying hybrid approaches for IPV and AOD?
- What specific programmatic strategies are being used to address intertwined IPV and AOD and how have these evolved? What are practitioners actually doing to implement these?
- What organizational and service elements characterize different approaches?
- What led these innovator organizations to address both IPV and AOD when most do not, what barriers have they encountered, and how have they addressed these?
- What are major lessons learned by the implementers to inform future services and research?
The study employs theories about field development and overlap, and how organizations can stimulate and navigate complex and contested fields and create conditions that allow for “field overlap”. It also explores what conditions help to shape choice of strategies and how field characteristics are being changed by the actions of these organizations. Results will have relevance both for general strategies for addressing complex needs when the resources for these are located in different human service organizations and fields, as well as particular suggestions and examples for IPV and AOD.
Methods
This project uses what Proctor (2003) called “trench to bench” approaches, or practice-based research and knowledge development, to learn from innovative practitioners. It uses mixed methods, with a survey, intensive organizational case studies, and comparative case study analyses.
The survey is a purposive sample of organizations that reported addressing both IPV and AOD (N=222). These were identified from list-serves, nominations from experts, snowball methods, and the literature. The survey was designed to identify different types and levels of IPV/AOD hybridity, plus key features of their organizations. Respondents represented all regions of the USA, with some from international locations.
We identified many of those completing the survey as especially hybrid, or using interesting approaches, and created 36 organizational case studies from these. Data for case studies were drawn from at least one intensive interview, information from websites, tax submissions, program documents, and, in some cases, site visits. Cases were completed from organizations in 21 states and Canada. We categorized them by populations targeted, approaches used, and how hybridity is accomplished. Ten are primarily AOD or behavioral health (one focused on women), 12 primarily IPV, and 9 multiservice. Three are woman-centered multiservice organizations, and two more specialize in both IPV and AOD [w survivors]. 17 have a batterers’ intervention program (BIP), 26 focus on survivors of IPV (7 work with both survivors and batterers). All of them address AOD in some way, but only some have gender-specific components.
Using comparative case study methods, we identified and analyzed data on nine core dimensions across the organizations: 1) overall organizational and field characteristics, 2) staff patterns and development; 3) methods and rationales for screening and assessment; 4) approaches for working with AOD with perpetrators of IPV, 5) approaches to working with AOD with survivors of IPV, 6) coordinating community resources to meet complex participant needs, 7) interacting with community systems to work for change; 8) key innovations; and 9) barriers/challenges and successes. We characterized organizations on each of these, and then defined how their locations and approaches differed and what influenced how they approached both issues.
Some knowledge learned
From survey data, we have identified some differences and similarities in approaches among organizations of different types (primarily IPV, primarily AOD or behavioral health, and multi-service/or with a primary mission other than IPV and AOD—for instance, addressing homelessness). Organizations who work with perpetrators differ from those who work primarily with survivors of IPV, with those who address both somewhere in between. We created several dimensions for how they approached their work, including different philosophical approaches (especially how much they employed a gender-related analysis), how much they used “evidence based practices” for AOD work, and what approaches they used to address IPV. Relationships with legal systems and other community collaborations were especially important in mediating many other elements. We then characterized the case studies by where they fell on these overarching dimensions to provide examples of how those on these different dimensions implemented hybrid approaches that reflected dimensional differences.
The case studies show a wide range of approaches to addressing both IPV and AOD. Some work primarily on either IPV or AOD, but facilitate attention to the other when they can. Others are fully hybrid and able to address most aspects and levels of severity for both IPV and AOD. The literature suggests two primary strategies for working across fields. One involves a collaboration between two organizations, one from each field (in this case an IPV organization and one with resources for AOD). The other is an internal expansion strategy, in which an organization with capacity in one field adds or changes services to address the “other” problem. Our case studies show much more complexity than this. Some of those that are the most hybrid have expanded their approaches internally so they no longer look like other programs in their fields, or they have developed strong partnerships with a program in the other field, and many do a mix of both. Some have developed an overarching philosophy and set of practices that differs from dominant models in either field, but allow attention to both IPV and AOD in very substantial ways. Approaches reflect different ideologies, the passions and capacities of key staff, and incentives and constraints in their environments.
All programs report routinely encountering many barriers and challenges (from complex funding and policy options and restrictions, and from the very strong and different philosophies and approaches in the two fields). Some have lost previous progress, while others have developed creative ways to continue to expand innovative resources and approaches. Selecting, training, and supporting staff for demanding hybrid work was identified by everyone as crucially important. Some report creating a variety of “teams” to coordinate the work of staff with different types of expertise, and everyone engages in a lot of cross-system trainings. Some suggest that it is better to hire people not strongly “imprinted” in either field, so they can be open to creative hybrid approaches.
Programs were stimulated to begin these approaches sometimes by incentives and requests from their environments (especially the legal system), but more often because they recognized a need in their program participants and that not addressing both issues impeded their ability to address either. Often the “champions” who initiated these efforts were “hybrid/boundary-spanning people” with personal or professional experience with both issues and fields. We are currently compiling examples of different kinds of hybrid approaches and working on ways to make these available to practitioners.