How can we promote the integration of immigrants into our communities and end cultures of family violence?• Diane S. Morse, MD, University of Rochester School of Medicine,

Women’s Initiative Supporting Health• Lorraine McTarnaghan, Department of Public Safety, University of

Rochester• Afshan Qureshi, Saathi of Rochester• Mary W. Randall, Assistant District Attorney , Special Victim's Unit

Integration of immigrants

Who are they and why are they willing to sacrifice so much to come to US?

Dreams of freedom Opportunities for self and next generations

Educational, financialOnce they arrive how do they assimilate?

**Index cards

Change

Cultural transitionCan occur over many generations, but more

stress occurs if w/in 1-2 generations

Indices of new cultureIndustrialization and urbanization Attitudinal changes/ LifestyleMass mediaReligionLanguageChange from extended to nuclear/independent

familyGender rolesIncreasing occupational demands

Typical problems

• Isolated-leads to problems of acculturation

• Enmeshed-close boundaries to outside world, imposing strict limits

Typical problems

Transitional conflict-family members adjust at different rates

Some adapt to new environment and others struggle to retain traditional culture at any cost

Increased risk of family violenceIncreased sexual or physical victimization by

a male intimate partnerImmigrant women disproportionately

represented among female victims of male-partner-perpetrated homicide

May perpetrate violence against other family members than just spouse

Raj, Silverman, Haj-Yahia, Morse

Why increased risk?Culture, social context, and laws that often uphold

male control of female partners. Immigrant women can live in two conflicting culturesIsolated and viewed as otherMay have undocumented or nonpermanent

immigrant status, placing legal restrictions on themEconomic insecurityDo not know laws againstDo not trust police; rather go to cleric or familyFamily violence in US usually defined as intimate

partner so fewer resources if other family violence

Family Values/Dynamics

Female gender roles and cultureLatino, Asian, South Asian, Middle Eastern

Family and community first, themselves last Family harmony is their responsibility Be submissive; obey and serve husband Isolation within the family Passivity and silenceBoth men and women: if women do not stay

in prescribed roles, it is culturally acceptable for men to “discipline” them using physical abuse

Male gender roles and cultureBe dominant and aggressiveBe respected; respect means powerEconomic providerSexually entitled to female partnersJustification of violence towards women

Increased risk of family violenceWife unable to get pregnant or only girlsHaving an affairYoung woman coming of ageEconomic instabilityPerceived loss of honor

Culture of ViolenceTheir experience is family power /controlLabelled abuse/violence in their new home

countryCrime attached to the same behavior they had

found so commonly acceptable by the family member

What might have been acceptable there is now shifting, like shifting sands

Family dynamics shift ->power and control struggle ->violence

Community violence->community crisis

Lack of culturally informed mental health care

Relates to adjustment problemsThere is a lack of availabilityThere is a lack of recognition of needStigma attached to mental health problems

contributes to the challenge

Role of Saathi as Ally

Recognize need to link with resourcesAssist in linking with resources including

mental healthHelps to increase understanding between

family members who live together despite the family dynamics and still uphold their individual  dignity and rights as persons.

Role of SaathiLearn to live according to their own valuesHelp them move through the assimilation

pathway like the moving walkway at an airport people or like time travel

The shift of family dynamics is the final adjustment in assimilation

Dual Role of Public Safety in a University Environment

External VictimsHospital Patients

Victim’s of Violence requiring medical treatmentMandated Reports (certain wounds, burns)HIPAA concerns

Safety PlanningRevictimization in the hospitalVisitationLimiting patient’s access to social mediaOrders of Protection

Criminal Complaints versus internal reporting Police reports (jurisdiction, DIR, victim’s desire for

prosecution) Institutional necessity for documentation

Internal VictimsEmployees, Students, Patients & Visitors

Peace Officers provide law enforcement authority, resources & responsibility

Domestic Incident Reporting & Mandated ArrestsSafety Planning for victim and larger communityProviding Resources

Rochester Police Victim’s Assistance UnitTitle IX CoordinatorUniversity IntercessorEmployee Assistance ProgramUniversity Counseling CenterABWSAATHI

Next stepsEmployees & Students should report possible

safety concernsCare ReportTitle IX CoordinatorPublic SafetyHuman ResourcesUniversity Health Services/ Counseling CenterABWSAATHI

Employees & Students can link friends and coworkers to available resources

Legal SystemWhat is the role of the district attorney’s

office?

Legal boundariesRegardless of the culture and the act of

violence in immigrant or refugee communities the laws of USA are going to be upheld.

Along with the privileges come the responsibilities of integrating as immigrants in the USA.

Pleas or charges are not going to be reduced because of any cultural or religious excuseAre there cases where extreme emotional duress

will result in manslaughter rather than murder charges?

Legal solutions What measures are or have been taken

in high profile criminal cases that have taken place in Upstate NY including Rochester  area?

Is there anything people can do to best work with law enforcement and the district attorney’s office

Your questions & comments

How to be an ally

Predictors of behavioral ethnicityRecent immigration to US or older ageFrequent returns to country of originEmigration from rural areaLimited formal educationLower SESSegregation in ethnic subculture in USInexperience w/Western health careMajor differences in dress, language, diet

Kleinman

How to Ask-PrivatelyNormalize

“Violence is such a common problem that I find myself asking my friends about violence and safety at home”

Open ended-follow by direct inquiry“How does your partner/family treat you?”

Direct inquiry“At any time has a partner or family member hit,

kicked, forced you sexually, or otherwise hurt or frightened you?”

“Has he/she threatened you or controlled you?”“When I see someone with injuries or symptoms like

yours it is sometimes because someone has hurt her. Has someone been hurting you?”

How to Respond

First convey lack of judgment and validation“I’m very sorry that happened to you; you don’t

deserve to be hurt” “You are not alone”

Convey concern about safetyAssess abuse history

Attempts to leave and what happenedAny children’s emotional and physical safety

Safety PlanningIdeally with expert

Offer phone to call ABW or Saathi ABW offers shelters, support groups, 24 hr hotline,

childcare, 1:1 counselingSometimes they will not so know some basics

Ask about weapons and any near fatal attacks but not 100% reliable predictor

Key: plan leaving with an expert as can be dangerousDon’t stop to packHave papers, clothes, money ready out of house

Contact info• Diane S. Morse, MD, University of Rochester School

of Medicine, Women’s Initiative Supporting HealthDiane_morse@urmc.rochester.edu

• Lorraine McTarnaghan, Department of Public Safety, University of Rochester

lmctarnaghan@ur.rochester.edu• Afshan Qureshi, Saathi of Rochester

afshan_saathiofrochester@yahoo.com• Mary W. Randall, Assistant District Attorney ,

Special Victim's Unitmrandall@monroecounty.gov