Diane S. Morse, MD, University of Rochester School of Medicine, Women’s Initiative Supporting...
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Transcript of Diane S. Morse, MD, University of Rochester School of Medicine, Women’s Initiative Supporting...
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 [email protected]
• Lorraine McTarnaghan, Department of Public Safety, University of Rochester
[email protected]• Afshan Qureshi, Saathi of Rochester
[email protected]• Mary W. Randall, Assistant District Attorney ,
Special Victim's [email protected]