– HEALTH AND SOCIAL CARE ISSUES
Booklet 15C September 2016
Domestic
Violence
Domestic Violence
Compulsory
2A Contemporary issues of
vulnerability
(4) Family problems e.g.
child and elderly abuse, family violence
Elective
Extended Study on Health Promotion and Health Maintenance Services
- e.g. home safety, medical services for carers and the elderly who live in the
community
Extended Study on Community and Social Care Services
- e.g. Services for crisis intervention in domestic violence
Current Issues of Health and Social Care
- e.g. legislation and the tragedies
of domestic violence
Compulsory Part
•
Topic 2 - Health and Social Care in the Local and the Global Contexts
•
2AStructural issues related to health, social care and personal and social well-being
Aims
• To analyse the relationship, impact and implications of domestic violence in
relation to personal and social well-being
• To identify the support and services available for
people / families in need and suggest other possible means or solutions
Content
• 2A4 - Family problems e.g.
Child and elderly abuse,
family violence
Domestic Violence – Theories and concepts in Compulsory Part
Compulsory
• understanding domestic violence
Compulsory
• relationship, impact and implications of domestic violence in relation to personal and social well-being
Compulsory
• support and services available for people / families in need
• possible means or solutions
2A Structural issues related to health, social care and personal and social well-being
Domestic Violence
Family relationship
Conflicts
Violence
Cycle
Causes
Perspectives
Psychological
Social
Ecological
Levels
Individual
Inter-personal
Community
Society
Intervention
Solutions
Levels
Support Services
Primary
Secondary
Tertiary
Booklet 5 Social Relationships
Ill-being Well-
being
Conflict Management
Relationship Building
Family
Relationships
Key questions
How do relationships affect personal health?
How can we develop and
maintain healthy relationships?
Domestic
Violence
Booklet 5.4 Conflict Resolution
Strategies Description Example
Avoiding An individual does not deal with the conflict and ignores it
Act as if there is no conflict.
Take no action to deal with the conflict.
Competing An individual pursues his own interests at the expense of others
I am the winner and you are the loser.
Accommodating An individual neglects is/her own concerns to satisfy the concerns of others but
eventually causes conflict within an individual
Self-sacrifice to maintain good relationship.
Compromising The objective is to find some expedient, mutually acceptable solution that partially satisfies both parties
Meet each other halfway
Collaborating Respects others’ goals and involves an attempt to work with others to find some solution that fully satisfy their concerns, establishing a sense of belonging
Win-win
15C.1 - Domestic Violence (World Health Organization)
Venue
• Usually
occurs in the home with some
exceptions
Type
• Physical abuse
• Sexual abuse
• Psychological abuse
• Deprivation
• Neglect
Target
• Spouse battering, child abuse, and elderly abuse
• Among
persons who are or have been in an intimate or dependent kinship
relationship
Form
• Threatening
• Violence
• Abuse
15C.1D Cycle of Domestic Violence
• Calm phase
• the batterer ignores the victim (cold war)
• Tension building phase
• the batterer uses spoken language to humiliate the other side
• Acting-out phase
• the batterer punches the victim
• Honeymoon phase
• the batterer apologises to the victim and asks for forgiveness
Calm phase
Tension building
phase
Acting-out phase Honeymoon
phase
15C.1B Etiology of Domestic Violence
Perspective Etiology
Psychological • The violent behavior comes from the abuser’s characteristics (such as lack of security, personality disorder, impulsive and manipulative personality and being a victim of abuse in the past)
• Violent behavior is the result of accumulated pressure of the
abuser. Sources of pressure may include unemployment, difficulty in bringing up children, etc
Psychosocial A buser’s behaviour comes from imitation of people around him or the media
Ecological Social Ecological Model ( WHO )
Human beings live in interactions of different systems
Violence is the result of the complex interplay between individual, relational, social, cultural and environmental factors
Public health tries to understand how these factors relate to violence
15C.1C Factors Leading to Domestic Violence
•
Society
•
societal factors such as the cultural norms that give absolute authority and power to male over female
•
Community
•
organizations outside the family, including schools, companies, religious organizations, hospitals and community centres, in which domestic violence can be effectively discovered and intervened
•
Interpersonal Relationship / Family
•
how social relationships, e.g. family relationship, increase the risk for violence
•
Individual
•
biological factors and personal history causing domestic violence, including the individual’s
psychological response and characteristics such as impulsiveness
Society Community
Interpersonal Relationship
Individual
Individual Family Community / Society
C h ild A b u se
• Personality and behavioural characteristics of abusers:
• Low self-esteem, poor control of their impulses, mental problems and display anti-social behavior
• Inability to cope with stress and difficulties as well as to access social support systems
• unrealistic expectations about child development - greater irritation and annoyance in response to children’s mood and behaviour
• Prior history of abuse - parents maltreated as children are at higher risk of abusing their own children
• Family structure and resources - low education coupled with a lack of
income to meet the family’s needs increase the potential of physical violence towards children
• Family size and household composition - large family size and an unstable family environment, where family members move in and out and there are frequent changes to the composition of a household, often
characterize cases of chronic neglect
• Poverty - communities with high levels of unemployment and concentrated poverty
• Lack of social networks and/or weak neighbourhood connections
• Cultural norms for gender roles and parent-child relationship
15C.2B Factors leading to higher risk of elderly abuse
Individual Family Community / Society
E ld e rly A b u se
• Cognitive and physical impairments of the abused older person - owing to mental or physical
incapacity, they are unable to communicate their
circumstances to others
• Lack of personal resources, such as financial resources, awareness of personal
right, knowledge about services or resources for seeking help or achieving independence from the abusers
• Social isolation / lack of social support network because of loss of friends and other relatives during elderly
• The elderly physically, financially or emotionally depend on the abusers
• Substance abuse of the abusers leading them to extort money from their old parents by using violence
• Resentment by family members at having to
spend money on the care of the physically or mentally ill elderly
• Migration of young people to new towns, leaving elderly parents behind in deteriorating residential areas and seldom paying visits, leading to the elder neglect
• Cultural norms and traditions such as ageism, sexism and a culture of violence
• Inadequate social policies and services to support families taking care of the elderly
Individual Family Community
S p o u s e B a tte rin g
• Low income
/unemployment may lead to unstable
emotions and increase the chance of being a batterer
• Individuals with family history of domestic
violence/ mental health problem may have a higher chance of being a batterer
• Alcohol abuse causing a loss of control may increase the chance of being a batterer
• Difference in
parenting style may lead to conflicts in child rearing
• Poor marital
relationship may lead to more conflicts/ less tolerance
• Traditional and cultural believe make the victims tolerate the battering
• Insufficient public
awareness of the
needs to report
battering
Impacts on Holistic Health (e.g. elderly abuse)
Physical
• Death or physical injuries due to physical abuse
• Complications or degeneration due to the neglect
Social
• Social withdrawal due to the feeling of shame or unwilling to disclose family problems to others
• Poor social relationships within or outside the family due to the family conflicts
Mental
• Physical or any forms of abuse are stressors
• Low self-image and self-esteem due to the loss of control or being victimized
• Negative emotional health status or depression or due to the
unhealthy relationships with the abusers
15C.3 Support and Services Available for Individuals and Families
Level
Of prevention
Goals Strategies Examples of Service
Primary • To arouse public
concern on domestic violence
• To promote family
harmony
• Promotion of community collaboration
• Changing gender stereotype through education
• Promotion of family life education
• Family
education
service
15C.3 Support and Services Available for Individuals and Families
Level
Of prevention
Goals Strategies Example of Service
Secondary • To identify risk factors of violence
• To provide surveillance
• To provide early
identification and
intervention
Concept of risk management:
• Developing screening tools for investigating risk factors
• Early detection of medical practitioner, social worker, teacher and police
• Providing intervention to avoid deterioration
• Referral service
• Counseling
service
Individuals and Families
Level
Of prevention
Goals Strategies Example of Service Tertiary • To reduce
relapse and casualty of domestic violence
• Medical support • Accident and Emergency Services
• Legal assistance
• Police intervention
• Judicial proceeding
• Law
enforcement
• Safety plan formulation
• Emergent settlement
• Shelter home
• Crisis
Intervention and Support Centre
• Psychotherapy • Counseling
service
15.3 Multifaceted Intervention
Individual Family Community / Society
L e ve l o f i n te rv e n tio n
• Addressing individual risk factors, e.g.
stress and anger
• Taking steps to modify
individual risk behaviour
• Relationship building
• Working to create healthy family
environments
• Providing
professional help and support for dysfunctional families
• Developing community support
Building of neighbourhood and community bonds and networks to support families at risk
Providing education and campaigns to raise public awareness
• Addressing gender inequality and adverse cultural attitudes and practices that contribute to violence
• Legislation to prevent domestic
violence
Elective Part (Domestic Violence )
• Promotion of Home Safety (Neglect – child abuse)
• Rehabilitation and medical care for elderly in the community
Extended Study on Health Promotion and
Health Maintenance Services
• Crisis Intervention Service
• Integrated Family Service Extended Study on
Community and Social Care Services
• Legislation on domestic violence
• Family tragedies Current Issues of
Health and Social
Care
Examples of Field Learning Activities for Extended Study on
Community and Social Care Services:Integrated Family Service
Setting Observation Interview Service / Activity
Integrated Family Service Centre
Key concepts :personal growth (family roles) , family relationship, family problems, social welfare system, interpersonal relationship, communication among family members, holistic health
• Services provided
• Environment and facilities
• Characteristics of client groups
• Atmosphere of the centre
• Job duties of various workers in the unit
Clients
• Needs
• Views on services
• Experience of using the services
• Physical, intellectual, emotional and social aspects of health
• Family relationship Professionals
• Duties / division of work
• Intervention objectives, approaches and skills
• Work related training programmes / pathways
• Difficulties related to the jobs
Volunteer services can be provided through:
• Assist in organising family activities
• Community survey
• Neighbourhood scheme
Sit in / Be an observer in:
• Workshop on parenting skills
• Home safety seminar
• Activities to promote mutual help in
community
Health Maintenance Services :Rehabilitation and Medical Care for Elderly in the Community (Prevention of Elderly Abuse)
Setting Observation Interview Service / Activity
Elderly Centre
(Community Support Services) Hospital / care-and–
attention home /
day hospital (medical care)
Key concepts: health care system, ageing population, community care, eating habits, health literacy, infection control, residential care, community care, medical care, social support network
• Environment - elderly friendly community
• Services provided in the community
• Treatments provided by OT and/or PT
• Characteristics of elderly in the community
• Job duties of various workers in the centre
• Risk assessment
Elderly
• Physical, intellectual, emotional and social aspects of health
• Problems or needs: e.g.
medication and medical care
• Living in the community
• Social support network Carers of Elderly
• Stress management
• Care skills and related difficulties
Professionals
• Duties / division of work
• Work related training programmes / pathways
• Difficulties related to the jobs
• Skills to provide care to the elderly
Volunteer services can be provided through
• Home visits
• Game days with elderly and carers
• Check-up , such as measurement of blood pressure
• Community survey to identify the elderly at high risk
Sit in to be an observer in:
• Stress management workshop for carers
• Treatments provided by OT and/or PT
Examples of Study Questions for Current Issues of Social Care
Theme Child Abuse
Study questions
• Which type(s) of parenting styles is/are at a higher risk for child abuse? What are the common types of child abuse in Hong Kong?
• What are the features of high risk groups of child abuse? Analyse the causes of child abuse at individual, family and societal levels.
• What is self-esteem? What are the possible effects of abuse towards the self- esteem of a child?
• How different policy instruments could be used effectively to tackle child abuse?
Examples of Study Questions for Current Issues of Health Care
Theme Elderly Abuse
Study questions
• The elderly are considered to be a group which is vulnerable to domestic violence. Analyse the factors leading to this phenomenon at individual, family and community levels.
• According to the concept of holistic health, discuss the possible health risks to the abused elderly
• Based on the Action Means for Health Promotion, evaluate and suggest the ways to prevent elderly abuse in Hong Kong.