ENRICHING KNOWLEDGE FOR THE HEALTH MANAGEMENT AND SOCIAL CARE CURRICULUM SERIES–HEALTH AND SOCIAL CARE ISSUES Booklet 15CSeptember 2016Domestic Violence

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– HEALTH AND SOCIAL CARE ISSUES

Booklet 15C September 2016

Domestic

Violence

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

(20)

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

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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

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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.

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