Social work research

Evidence-based practice is integral to social work, as it often informs best practices. Competent social workers understand this connection in general and the ways it benefits clients in particular. For this Assignment, consider your informed opinion on the relationship between qualitative analysis and evidence-based practice.

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Choose two qualitative research studies from this week’s resources and analyze the relationship between qualitative analysis and evidence-based practice.
Consider how the qualitative study contributes to social work practice and how this type of knowledge would fit into building evidence-based practice.

Required Readings
Yegidis, B. L., Weinbach, R. W., & Myers, L. L.  (2018). Research methods for social workers (8th ed.). New York, NY:  Pearson.

Chapter 6, “Qualitative Research” (pp. 126-145)

Lietz, C. A., & Zayas, L. E. (2010). Evaluating qualitative research for social work practitioners. Advances in Social Work, 11(2), 188-202. Retrieved from https://journals.iupui.edu/index.php/advancesinsocialwork/article/viewFile/589/1790
Contact Irregular’: a qualitative analysis of the impact of visiting patterns of natural parents on foster placements Deborah Browne* and Ann Moloney† 
Browne, D., & Moloney, A. (2002). Contact irregular: A qualitative analysis of the impact of visiting patterns of natural parents on foster placement. Child and Family Social Work, 7, 35–45. 
Over the years there has been much debate about the effect of parental visiting on children in foster care. While some contend that it is essential to maintain attachment bonds to the birth family, others argue that contact undermines the new relationship with the foster family. By studying descriptions of visiting patterns of 113 foster placements this study attempts to examine how parental access affects the foster child. A qualitative analysis of the written accounts offered by social workers yielded four distinct visiting patterns: Regular and Frequent, Regular but Infrequent, Infrequent, and No Access. The nature of the analysis also allowed for a redefinition of placement outcome into three categories: Successful placements, Ambiguous placements and Crisis placements. Because the categories that emerged from the qualitative analysis were mutually exclusive it was possible to examine, using chi square, whether there was a quantitative relationship between the variables ‘Placement status’ and ‘Visiting patterns’. Analysis of the categorical data showed a statistically significant relationship between visiting patterns and placement outcome. This relationship, however, was not based on how visiting related to Successful or Crisis placements. Instead it was evident that those placements categorized as Ambiguous were far more likely to report Infrequent visiting patterns. Case examples offer an opportunity to examine possible reasons for this relationship. The paper also describes qualitative accounts of how children reacted to the visits. The unique approach to defining placement status in this study may help explain the conflicting findings on this topic over recent years. Impact of visiting patterns of natural parents on foster placements D Browne and A Moloney Child and Family Social Work 2002, 7, pp 35–45 © 2002 Blackwell Science Ltd terns have on children and young people in foster care. The aim of this paper is to look again at how visiting patterns affect placement outcome. It is hoped that, by using more qualitative techniques than previous studies, new associations will emerge. The response to contact of those involved is also described. The importance of continuing ties The theoretical purpose of fostering is to provide a temporary safe home for a child because his or her parents are unable to do so, with the eventual aim of returning the child successfully to the family of origin. With this in mind it is important the child continues to identify with his natural family. As Oyserman & Benbenishty (1992, p. 541) state, ‘if children are to return home . . . their emotional connection to their biological parents must be promoted. One important way to do this is via mutual visitation during the child’s stay in foster care’. Research indicates that such contact does indeed help to promote biological attachments (Weinstein 1960; Aldgate 1977; Triseliotis 1989; O’Higgins 1993). After examining the case records of 92 children in long-term foster care Poulin (1992), for instance, concluded that there was a highly significant relationship between kin visiting and biological family attachment (BFA). The more a child was visited by the natural family, the greater the attachment they had to them. Children who were visited at least once a month had highest average BFA scores, indicating that regular and frequent visiting patterns gave children the most positive sense of attachment with their biological family. Fanshel & Shinn (1978) reported that children whose parents visited regularly were far more likely to have been discharged by the end of their five-year study than children who received infrequent visits or children whose parents’ visits deteriorated over time. Children who were frequently visited also showed greater gains in IQ, better emotional adjustment, and positive behaviour changes, and visiting was also a significant predictor of overall classroom assessment (Fanshel & Shinn 1978, p. 487). The disadvantages of parental visiting Because the evidence has suggested that ‘parental visiting of placed children is essential to the resolution of the function of placement in each family’s problem’ (Hess 1988), many agencies have concluded that they should attempt to arrange visits at any cost. It should also be acknowledged, however, that visiting patterns may not always be conducive to success. Indeed, many researchers have found that, after initial enthusiasm, visiting patterns deteriorate as the placement progresses (e.g. Fanshel & Shinn 1978; Rowe et al. 1984; Wilkinson 1988).There can be many reasons for this, such as how the social worker encourages the natural parent, or the attitudes of the foster parents to the visits (Triseliotis 1989). Therefore, visiting cannot always be seen as positive and desirable. Many children may even react badly to an impending visit, or will behave poorly after a visit (Rosenfeld et al. 1997; Quinton et al. 1998). Additionally, parents may make promises of reuniting the family that are unrealistic and cause older children unnecessary confusion. The reinforcing of these birth family ties may serve only to endanger the new and more positive bonds with the foster family. The issue is appropriately summed up by Bowlby (1965, p. 141) who commented: ‘[T]he records of all agencies are full of evidence of the difficulties created for children in long-term care by their parents’ inability to permit them to settle in a foster-home and feel part of it . . . The children are left in a turmoil of conflicting loyalties. In one child guidance clinic by far the most difficult cases of disturbed foster-children were those whose parents remained in a conflict of feeling about placement and “carried on an active but irregular connexion with the child”.’ In these cases it would arguably be in the child’s best interest to minimize birth family contact. Indeed Quinton et al. (1997) argued that there was little evidence that contact improved chances of a successful outcome in any case. This view has fuelled an interesting debate (e.g. Quinton et al. 1999; Ryburn 1999) to which the current paper may provide some answers. The purpose of this paper is firstly to attempt to redefine visiting patterns based on the accounts offered by social workers, and then to examine what effect, if any, these patterns have on the progress of the placement. Case studies are offered to illustrate the effects noticed in the analysis. In addition, the children’s reactions to visiting are outlined. METHOD Participants Seventeen social workers completed questionnaires for 127 foster placements.The children in these placements had been fostered for varying episodes over a three-year period. They ranged in age from birth to 36 Impact of visiting patterns of natural parents on foster placements D Browne and A Moloney Child and Family Social Work 2002, 7, pp 35–45 © 2002 Blackwell Science Ltd 20 years. Seventy-four foster families participated in the study.To give due regard to external validity it was important that the sample was representative of the population in general (Fernandez 1996). To this end, social workers from both city community care teams and a special fostering project were involved. This ensured a wide spectrum of socio-economic groups and backgrounds, as each area has a different economic emphasis. Attempts were made to obtain similar numbers from each community care area. Materials Social workers and foster parents completed questionnaires that examined various aspects of each foster placement. The questionnaires were designed to look at a wide variety of psychological issues that affect foster children. Questions, or derivations of them, used in previous studies (e.g. George 1970; Baxter 1989) were included where possible. This procedure also served to enhance consensual validity (Fernandez 1996, p. 73). In relation to the current paper, social workers were asked to give detailed accounts of contact patterns. Specifically they were asked: ‘Please describe in detail interaction between [child] and his or her natural parents, mentioning such things as how often they meet, where they meet, how the child looks forward to these meetings, and how the child feels and behaves after these meetings’. The questionnaires also gave information that determined how the placement would be classified in terms of outcome. These details was derived from questions that were asked of both the social worker and the foster parent in relation to how the placement was progressing, or the manner in which it had terminated – whichever was applicable. Examples of the type of information that was used to determine this are given later. Qualitative analysis There are many ways of analysing qualitative data. The approach adopted for the purposes of analysing the written accounts of the social workers and foster parents has been described as ‘interpretive’ (Miles & Huberman 1994; Berg 2001). In this case the interpretation is quite reductive, condensing the content of the written data into units (or categories) that reflect themes or concepts in an attempt to discover patterns of meaning or explanation of what is happening in the foster placement. Care is taken, however, not to lose the impact of the written words of the social workers by overemphasizing categories or quantities. This is done by analysing sample statements and case studies. The accounts given by the social workers and foster parents were coded for meaningful words, phrases and sentences. At this point every attempt was made to follow the coding process described by Miles & Huberman (1994). These ‘chunks’ of information were then grouped into conceptually similar categories. After the categories had been generated, each questionnaire was worked through again to record whether the category was present or not. Reliability of the categories generated through qualitative analysis was tested using an independent assessor. Unreliable categories (inter-rater score of less than 85%) were dropped from the study. Data that are reduced to categories in the manner described here can be subjected to content analysis. There is some debate about whether this is actually a qualitative method at all (e.g. Silverman 1993) as it emphasizes the quantity more than other qualitative techniques (especially the more feminist approaches that are commonly applied to this type of personal account data). Berg (2001), however, argues that content analysis is a valuable tool when used with qualitative data as it ‘is a passport to listening to the words of the text, and understanding better the perspective(s) of the producer of these words’ (p. 242). Seale (1999) also advocates the use of numbers in qualitative research, commenting that ‘there is a variety of ways in which attention to quantification can enhance qualitative work’ (p. 123). These views reflect the beliefs of the present authors, and an attempt is made to use numbers to help to explain and interpret the themes and concepts found in the written accounts. RESULTS Visiting patterns Out of 127 foster placements, data on parental visiting were unavailable for seven placements. The question of visiting did not apply to a further seven, which were either day fostering or of too short a duration for parental visiting to be an issue. This left 113 foster placements for which data were available on visiting patterns during the index placement. In most cases patterns of visiting were readily identifiable and very easily recorded in a quantifiable manner. For instance, in a large number of accounts social workers indicated that contact occurred regu37 Impact of visiting patterns of natural parents on foster placements D Browne and A Moloney Child and Family Social Work 2002, 7, pp 35–45 © 2002 Blackwell Science Ltd larly, with at least one parent, and also quite often. In this case ‘regular’ means that the visit could be expected to happen after a specified period of time. For example: ‘. . . meets his family once every six weeks.Visits mother in her own apartment with his siblings. Met with mother on his own every 4th week.’ ‘[Child] loves his mother and loves seeing her and looks forward to it. During current placement he sees his mother once/twice a month for 2 hours approx. – quality is basic as they have no appropriate accommodation. However, mother of late has been visiting the foster home.’ ‘. . . goes home to his natural family for an afternoon every 2 weeks. He sometimes goes for a visit on Sundays or foster father takes his younger brother with him for a spin.’ ‘. . . for past 2 years 6 weekly supervised access – try to vary venues. Can be difficult to do so.’ In these cases it is clear that visits occur on a regular basis, and also quite frequently, so they were categorized as Regular and Frequent. They were distinguishable from other placements where visiting was also regular (in that the child knew it would happen after a certain period of time) but not as frequent as in the examples given above. These cases were termed Regular but Infrequent. Social workers reported: ‘. . . meetings about 6 times yearly at most.’ ‘About twice a year . . . [child] went to stay with her mother for 3 days at Christmas, and again for 3 days last August.’ ‘Child meets her mother and sisters about twice a year (supervised access) at her own request.’ There were other cases where contact patterns could not be described as regular at all. In these cases the child did not know when he or she could expect to meet his or her parents. For example: ‘Access now very irregular – at parents’ request.’ ‘Occasional, irregular contact from mother (address unknown).’ ‘. . . meets mother about once a year.’ ‘. . . father now lives in the USA. He writes to [child] occasionally and phones him . . . [last year] he spent 6 weeks at home and [child] spent weekends with his father . . . Mum sees him infrequently – twice last year and not yet this year.’ Finally there were the cases where the child did not have contact with his or her natural family, or where contact had ceased. Social workers noted: ‘. . . has had no contact with her mother since late ’92.’ ‘. . . has not seen her mother in a number of years.’ ‘No access.’ In summary, then, four distinct placement patterns were noticed. In the first, the child received Regular and Frequent visits from at least one parent (regular indicating that the child could expect the visit after a certain time). It is interesting to note – as is evident from the examples offered above – that social workers describing these placements were more likely to offer more information.This possibly reflects a positive attitude to a perceived success in this area. Descriptions of other visiting patterns tend to be more succinct, to the point of abruptness in some cases. The second pattern was also regular (as defined above) but could be differentiated by the fact that visits did not occur very often: Regular but Infrequent visits could generally be expected to happen between two and six times a year. The third pattern of visiting was neither regular nor frequent: in the Infrequent pattern, children were not sure when to expect visits, and visits tended to happen about once a year or less. In this pattern the quantity of visits was considered less important than the fact that visits were never certain or at fixed intervals (note for instance the example where the child’s father lived in the USA). The final pattern, No Access, consisted of those who did not currently receive access visits. Once inter-rater reliability scores confirmed that these categories were valid, a content analysis was performed to discover how the 113 placements were distributed across the visiting patterns. Figure 1 illustrates this distribution. As indicated by Fig. 1, most birth parents (n = 52) visited on a Regular and Frequent basis. Parents in only 17 cases visited in an Infrequent pattern and only 13 placements (12%) had parents who visited on a Regular but Infrequent basis. Some of the children (17, or 15% of those for whom data are available, and 21% of those who received access visits) were allowed weekend visits to their parents’ home. Thirty-one placements, or 27% of the 113 for whom data are available, were not in receipt of access visits, or access had ceased during the index placement. Reactions of children to contact As Fig. 1 shows, 73% (n = 81) of the placements looked at were receiving parental visits. Social workers described a number of different ways in which children reacted to these visits. As these reactions are bound to have an impact, even if momentarily, on the placement, it is useful to look at how social workers perceived the children’s responses to visiting. A large number of social workers described reactions that could only be expressed as Positive.Table 1 notes that 62% of all those who received parental visits had some positive reactions. An interesting point that was noted for this category is that social workers often 38 Impact of visiting patterns of natural parents on foster placements D Browne and A Moloney Child and Family Social Work 2002, 7, pp 35–45 © 2002 Blackwell Science Ltd added a comment that the child did not react badly (e.g.‘Enjoys meetings with mother – does not show any adverse reaction afterwards’; ‘Looked forward to these meetings and he was not distressed after them’). This appears to imply that the social workers are more aware of negative consequences. Indeed, children in a very high percentage (53%) of placements reacted negatively to visits. Some of these reactions, as is illustrated in Table 1, are quite extreme (e.g. ‘Fear, inability to speak . . .’). A small number of children (n = 9) appeared apathetic and indifferent towards the visits, but it is possible that this hid deeper feelings. When parents reacted negatively it was either because they treated the child inappropriately or offered unrealistic promises about a reunited family. Another category that emerged was Situation improving. While it was reported that only 13 of the 81 foster placements that were receiving access visits had situations that were improving, this is still an important category. Many social workers reported that inadequate access was a cause of concern for some children (e.g. ‘Very upset when they [meetings] were cancelled – became very quiet in himself’; ‘[Access] was often cancelled – in the beginning he was very upset about this but as time passed he accepted it more and more’), and when the situation improved it can only be seen as a positive outcome. In a small number of cases social workers indicated that the child was suffering because of the behaviour or reactions of their natural parent(s) to the visit.This poor reaction was also not appreciated by the children’s foster parents, who had to deal with upset children after the visits (e.g. ‘Very difficult young mother. Very upsetting visits to [fostering agency] what left [child] very upset and I always had to be there for her’ [sic]). Quinton et al. (1998) reported similar reactions in their study, where foster parents expressed concern about mixed or inappropriate messages from birth parents. Table 1 describes the categories of reactions that were recorded and the frequency with which each category occurred. It should be noted that these categories are not mutually exclusive, and that social workers could describe more than one type of reaction for each placement. It is evident from this table that most of the response to visiting was either positive (62%) or improving (16%). Nonetheless, 53% of placements with visits included some sort of negative reaction of the child to the visit, and a further 11% of children were apathetic towards contact. It is evident that visiting was not always to the advantage of the child. Placement status Probably because of the nature of the analysis, the definition of placement outcome differed qualitatively from other foster care studies. Three levels of placement status emerged in the present study: Successful, Ambiguous and Crisis.These can be defined as follows (SW indicates social worker accounts, and FP indicates foster parent accounts): Successful placements No serious problems were reported or expected to occur. Comments on these placements were very positive: ‘Placement is progressing very satisfactorily.’ [SW] ‘Children returned home . . . all settled down and outlook is very promising.’ [SW] ‘He is treated like one of the family in every way. We all get on well most of the time . . . he has also brought a bit of happiness into our everyday routine . . . we will be sorry to see him go but that is what fostering is all about.’ [FP] ‘[Child] has been integrated very successfully. Is greatly loved and appreciated by all family members. Has improved in school and gained in confidence.’ [SW] ‘I think it is fair to say we all consider [child] very much part of our family now. She is with us now for as long as she wants.’ [FP] Ambiguous placements One or two categories of uncertainty or specified problems were reported by either the foster family or the social worker. Examples of statements that made a placement Ambiguous included: ‘Some anxiety on foster parent’s part in dealing with child’s background (sexual abuse).’ [SW] 39 Regular but Infrequent 12% Regular and Frequent 46% No Access 27% Infrequent 15% Figure 1 Patterns of parental visits (n = 113). Impact of visiting patterns of natural parents on foster placements D Browne and A Moloney Child and Family Social Work 2002, 7, pp 35–45 © 2002 Blackwell Science Ltd ‘[Child] happy at present with foster family . . . Problem is with other family members and other foster children, which may affect [child’s] placement . . . One [other foster placement with the family] has recently broken down.’ [SW] ‘Both the child and the social worker are somewhat unsure of the foster parents’ continuing commitment . . . these issues are all going to arise during her adolescence.’ [SW] ‘[Child] has enormous difficulty trusting his foster parents. The difficulty will be holding on to [child] during adolescence.’ [SW] Crisis placements These are cases in which breakdown, imminent breakdown, report of the onset of serious problems, or three or more examples of uncertainty or problems were reported by the foster family or the social worker. Comments by foster parents and social workers on these placements were quite negative: ‘The whole family was falling apart while [child] was here . . . she had a devastating effect on us all. I finally gave the social worker a deadline when the child had to move on and to be honest everyone was relieved when she left.’ [FP] ‘This child is unhappy in this placement. He was placed with his brother originally but . . . it [the brother’s placement] broke down after 11 months . . . his brother was transferred to another family . . . [Child] is the same age as foster mother’s own child and this has led to a number of difficulties . . . Child also feels isolated . . . Foster parents place huge emphasis on academic achievement and this has put a lot of pressure on the child . . . These foster parents have advanced in age [and I] would recommend that only short-term babies be placed with them [in future].’ [SW] ‘We had reached no compromise with [child’s] drinking and it was no longer possible for [him] to stay in our home and be seen not to care what we thought or felt about his drinking and his idea of why he was staying with our family . . . We asked [child] to leave. I was very angry when [he] left.’ [FP] Foster parents describing Crisis placements were likely to give long and detailed accounts of the problems that arose. The experience of completing the questionnaires appeared quite cathartic; it gave foster 40 Table 1 Reactions of foster children to parental visits No. of % of placements Reaction Illustration cases reported with access visits Positive ‘Looks forward to these visits.’ 50 62 ‘[Child] loves his mother and loves seeing her and looks forward to it.’ Negative ‘Fear, inability to speak, refuses 43 53 to go on some occasions. Once got physically sick.’ ‘The foster parent said he was usually upset and bedwetting for a few days after the access visits.’ ‘After last visit he was visibly upset.’ ‘This contact invariably causes distress for [child].’ Response to parent’s ‘Mother spends more time talking to 5 6 behaviour social worker than to children.’ ‘Expects child to act in infantile manner.’ Apathy towards ‘Child has no interest in seeing natural 9 11 contact parents.’ ‘[Child] would be ambivalent about these occasions . . . her relationship with [parents] appears to be fairly superficial.’ Situation improving ‘[Child] met her mother in July for the first 13 16 time in about 7 years …visits mother’s home more now… looks forward to these visits.’ ‘Sporadic [visits] became more regular. Eventually trial periods at home.’ No. of placements with access visits = 81. Impact of visiting patterns of natural parents on foster placements D Browne and A Moloney Child and Family Social Work 2002, 7, pp 35–45 © 2002 Blackwell Science Ltd parents the opportunity to vent a lot of anger and frustration in relation to a very stressful event (something that perhaps other foster parents with similar experiences would benefit from). Social workers were more likely to point out weaknesses on the foster parents’ side. Placements that were categorized as Ambiguous were very often defined in this way because of statements made by the social worker – foster parents appeared more reluctant to prophesize problems in a placement that was progressing satisfactorily on the surface. The only exceptions were cases where the foster parent pointed out that one or more family members were unhappy with the placement. The majority of placements were successful, and the accounts of these were very positive indeed. Ultimately, and despite the failures and the uncertain cases, it is the heartening descriptions such as those above that offer the most persuasive reason for continuing to develop fostering programmes. Fifty-two (46%) of the 113 foster placements were classified as Successful, 32 (28%) as Ambiguous, and 29 (26%) as Crisis. Two of these levels are similar to the concepts of ‘success’ and ‘failure’ as used in other studies (e.g. Trasler 1960; George 1970; Berridge & Cleaver 1987). Crisis placements have traditionally been referred to as ‘failed placements’, although not all of them had actually suffered a breakdown at the time of the study. Several previous studies have grappled with the problem of defining a failed placement. Many have used definitions based on the length of the placement (e.g. Trasler 1960; Berridge & Cleaver 1987) because alternative more abstract definitions (e.g. social and personal adjustment as used by Fanshel & Shinn 1978) are difficult to measure. The category Crisis placements that emerged in this study is defined not in terms of length of placement, but rather in terms of whether it has reached a state of (literally) crisis. The concept of Ambiguous is new. These placements were not suffering serious problems (i.e. could not (yet) be described as being in crisis), but could not strictly be defined as Successful either. Two examples of Ambiguous placements are offered as vignettes later in this paper. As discussed below, an interesting relationship seems to have emerged between this level of placement status and visiting patterns. Visiting patterns and placement status This section describes the relationship between visiting patterns and placement status. Because these two variables are made up of mutually exclusive levels, it is possible to perform a chi-square analysis on the categorical data. Table 2 illustrates how the patterns are divided among the levels of placement status. It was found that Successful cases were far more likely to follow either Regular and Frequent (n = 18) or No Access (n = 22) patterns than the infrequent patterns. Crisis placements were also more likely to fall into these two visiting patterns. Chi-square analysis of these categories showed that there was a significant relationship at the 0.05 level (c2 = 16.66056, P < 0.02) between ‘Parental visiting patterns’ and ‘Placement status’. A closer examination of how the contingency table is divided reveals more details about this relationship (Figs 2 and 3). Figure 2 illustrates what percentage of each level of ‘Placement status’ falls under each of the ‘Visiting pattern’ headings. It can be seen that of all the Crisis cases (total n = 29, as seen in Table 2), 51.7% had Regular and Frequent visiting patterns. Indeed, for each 41 Table 2 Visiting patterns and levels of placement status Parental visiting patterns Placement status No Access Infrequent Regular but Infrequent Regular and Frequent Total Successful 18 4 8 22 52 Ambiguous 4 11 2 15 32 Crisis 9 2 3 15 29 Total 31 17 13 52 113 c2 = 16.66056, P < 0.02. Impact of visiting patterns of natural parents on foster placements D Browne and A Moloney Child and Family Social Work 2002, 7, pp 35–45 © 2002 Blackwell Science Ltd of the levels of placement status, Regular and Frequent patterns were most common. The interesting information to be derived from Fig. 2 is in the Ambiguous column. Only 12.5% of Ambiguous placements (total n = 32) were No Access, a frequency that more than doubled for both other placement outcome variables. It is also apparent that far more Ambiguous placements had Infrequent visiting patterns compared with the other two placement statuses. As Fig. 3 illustrates, the No Access and both of the Regular categories showed approximately one quarter of cases as Crisis. These patterns all also showed the highest percentage of Successful cases, especially the Regular but Infrequent (total n = 15) pattern (61.5%). When parental access was Infrequent (total n = 17), however, most cases fell into the Ambiguous group (64.7% of the Infrequent category). The Ambiguous placements were ones where there was a certain amount of uncertainty about their ability to survive, and it is interesting that this status seems to have a relationship with Infrequent patterns of parental access (see Fig. 3). These patterns of access were also uncertain, and often happened unexpectedly or after many unsuccessful attempts to establish a visiting pattern. It is very possible that the unstable and uncertain nature of the children’s relationship with their birth family contributed to the ambiguous nature of their foster placements. Ambiguity and instability To highlight the possibilities of this argument further, individual foster placements were looked at more closely. Below are two case examples of Infrequent access patterns (categorized on the basis of the most recent pattern) as described by the social workers. Vignette 1 Annie’s placement was progressing quite well at the time of the study, but the social worker expected problems to arise in the future. Because the foster parents also made some reserved comments about Annie’s behaviour and her future with them, this placement was categorized as Ambiguous. Her social worker commented on parental access. ‘Access was arranged by the [social work] department on a regular basis but parents frequently failed to keep appoint42 34.6 12.5 31 7.7 34.4 6.9 15.4 6.3 10.3 42.3 46.9 51.7 0 10 20 30 40 50 60 70 80 90 100 Successful Ambiguous Crisis Regular and Frequent Regular but Infrequent Infrequent Percentage No Access Figure 2 Percentage of each visiting pattern within each level of placement status. 58.1 23.5 61.5 42.3 12.9 64.7 15.4 28.8 29 11.8 23.1 28.8 0 10 20 30 40 50 60 70 80 90 100 No Access Infrequent Regular but Infrequent Regular and Frequent Crisis Ambiguous Successful Percentage Figure 3 Percentage of each level of placement status within each visiting pattern. Impact of visiting patterns of natural parents on foster placements D Browne and A Moloney Child and Family Social Work 2002, 7, pp 35–45 © 2002 Blackwell Science Ltd ments. Access is now very irregular – at parents’ request. Child has no interest in seeing natural parents.’ Vignette 2 John had been fostered for some time by parents who had also fostered him the last time he came into care. His social worker, however, had some significant reservations about the placement’s ability to survive. Although John’s behaviour was not difficult, his foster parents were beginning to see it as such. He was described as bright and articulate and his foster parents might not have been able to cope with his questions and opinions. Because of these problems, his placement was categorized as Ambiguous. His social worker described the access pattern in the following way. ‘No access with mother over the past 12–18 months – mother in prison – father involved in new relationship – seldom contacts . . . visits rare . . . Initially 6 weekly access organized by social worker – parents frequently failed to keep appointments.’ These vignettes show a typically careless attitude on the part of the natural parents in cases where access was infrequent. It is evident that the two children do not really have behavioural problems, but the unresolved issues that the social worker recognizes as possible future crises can be associated with the inconsistent patterns of contact. This attitude could feasibly be linked to the confusion of the child. Such a relationship is far more disconcerting than the more stable relationship or the Regular access placements or even the poor relationship of the No Access children. This latter group may have formed a healthy identity with their foster family because they are not confused by erratic contact patterns; these are the ‘conflicting loyalties’ that Bowlby (1965) mentioned, as discussed earlier. DISCUSSION AND CONCLUSIONS Four different patterns emerged from the qualitative analysis of the data about these visits: ∑ Regular and Frequent; ∑ Regular but Infrequent; ∑ Infrequent; and ∑ No Access. It was noted that the children’s responses to these visits were not always positive. This is a cause for apprehension for many reasons. Besides the obvious concerns over the welfare of the child, it must also be remembered that foster parents are often left to deal with an upset child without adequate support. It is likely that the impact of visiting depends on a variety of connecting factors including the natural parents’ involvement, their relationship with the foster parents and how quickly the agency intervenes (e.g. Poirier 1998). Visiting patterns can have a long-term, and apparently quite critical, influence on placement outcome, so it is important that the immediate reactions are monitored carefully. This paper has demonstrated the interesting point that the relationship between parental visiting patterns and placement status was based not on certain patterns being more associated with Successful or Crisis placements, but on certain patterns being more associated with Ambiguous placements. Infrequent visiting patterns were far more likely to be Ambiguous. This appears to indicate that those placements that were experiencing less stable visiting patterns were also those that had underlying but (so far) nondisruptive problems. As far as family identity and attachment is concerned, Infrequent visiting patterns would be more likely to result in uncertainty about their status for the children involved. As Bowlby (1965) pointed out, these visiting patterns leave the children somewhat in limbo. Unlike children who maintained regular contact with their parents, or children who had obviously been abandoned by their natural families, these children were more likely to be confused about their probable futures. This was illustrated in the short examples highlighting the situations of two children, Annie and John. The theory is further backed up by the findings of other researchers. Fanshel & Shinn (1978) found that children who were visited infrequently were far less likely to return home than children who were visited regularly, which would indicate that children who are visited infrequently have every reason to be concerned about their futures. Poulin (1992) found that the more often a child was visited by his/her parents the greater the attachment s/he had for them. The divided loyalty issue has been recognized by agencies who realize the dangers of this (despite the benefits) in the new ‘open’ policies for contact (Quinton et al. 1998). The issues discussed in this paper – visiting patterns, reactions to contact, and the impact of visiting on placement outcome – relate to how visiting is arranged and monitored by the fostering agency. Hess (1988) commented that findings indicate that caseworker contact with natural parents is infrequent.This is probably due to heavy caseloads. Fanshel & Shinn 43 Impact of visiting patterns of natural parents on foster placements D Browne and A Moloney Child and Family Social Work 2002, 7, pp 35–45 © 2002 Blackwell Science Ltd (1978, p. 483) maintain that ‘more careful monitoring of parental visiting and judicious casework intervention where visiting falters, particularly early in the child’s placement, seems . . . to be a prime responsibility faced by an agency’. One of the influential predictors of visiting patterns seems to be the relationship between the foster family and the natural family (Oyserman & Benbenisty 1992) and this is something that needs to be carefully regulated by the agency. If, as Oyserman & Benbenisty (1992) suggest, frequency of home visits by the foster child are influenced by the degree to which the foster family encourages or enables a relationship with the child’s family of origin, then it should be the duty of the fostering agency to ensure that such encouragement takes place. Unfortunately, probably due to heavy caseloads and a high rate of staff turnover, visiting patterns and resulting problems are not monitored as carefully as they might be. This is despite the fact that the evidence, from both the present paper and previous research, indicates that visiting patterns can determine how successful is the fostering process. This success may be measured not only by a smooth and successful return home, but also by the attachments of the child or young person placed in care. It should be remembered that the best interests of the child might not necessarily be served by continuous contact with the birth family at all costs. Without a doubt regular contact is essential if the child is to maintain healthy attachments to a birth family to which s/he is likely to return. When this is not the case, however, and contact is likely to be superficial and disruptive, it may be best to minimize access to allow healthy and uncomplicated attachment to develop with the foster family. The question is not a simple one, though, and cannot be dismissed with a perfunctory answer. More research is needed to determine what contact patterns are best for individual children. 

Crandall, M., Senturia, K., Sullivan, M., & Shiu-Thornton, S. (2005). Latina survivors of domestic violence: Understanding through qualitative analysis. Hispanic Health Care International, 3(3), 179–187.

Abstract
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Domestic violence (DV) has been observed in diverse populations and communities, suggesting that it is a pervasive problem affecting all ethnic and cultural groups worldwide, including Latin Americans, or Latinas. This article presents findings from community-based participatory action research of DV and utilization of DV resources among Latina women. Our findings indicate that there is little awareness in the Latino community about the negative impact of abuse, and Latina women are reluctant to discuss their abuse with outsiders due to shame and embarrassment. Survivors called for emotional support and advice, community education, housing, English language advocacy and help with Child Protective Services. [PUBLICATION ABSTRACT]
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Headnote
Domestic violence (DV) has been observed in diverse populations and communities, suggesting that it is a pervasive problem affecting all ethnic and cultural groups worldwide, including Latin Americans, or Latinas. This article presents findings from community-based participatory action research of DV and utilization of DV resources among Latina women. Our findings indicate that there is little awareness in the Latino community about the negative impact of abuse, and Latina women are reluctant to discuss their abuse with outsiders due to shame and embarrassment. Survivors called for emotional support and advice, community education, housing, English language advocacy and help with Child Protective Services.
La violencia (DV) doméstica se ha observado en poblaciones y comunidades diversas, sugiriendo que es un problema penetrante que afecta todos grupos étnicos y culturales mundiales, inclusive mujeres latinoamericanas, o Latinas. Este artículo presenta conclusiones de la investigación participativa de actión de DV basada en comunidad y la utilizacion de recursos de DV entre mujeres Latinas. Nuestras conclusiones indican que hay poco conocimiento en la comunidad Latina acerca del impacto negativo del abuso y Latinas son reacias a discutir su abuso con intrusos debido a la verguenza y el desconcierto. Los sobrevivientes llamaron para el apoyo y el consejo emocionales, la educación de la comunidad, el apoyo del idioma ingles, y la ayuda con los Servicios Protectores de los Niños.
Keywords: Latina; domestic violence; abuse; family violence
We [the women] keep quiet, and most of all, partly because Latin American women think first about our children, we do not want any scandal and we try to keep it confidential. This is because we know that’s very hard for the children. Then we tend to endure it, and this way we don’t improve anything.
-Latina survivor
Domestic violence (DV) is a widespread problem that significantly impacts women’s health and wellbeing. The lifetime risk of DV ranges from 26% to 37% (Bensley, MacDonald, & Van Eenwyk, 1998; Greenfield, 1998; Plichta & Falik, 2001). Half of battered women will suffer injury related to the violence, and 30% to 50% of female homicide victims are murdered by a current or former partner (Greenfield, 1998; Pratt & Deosaransingh, 1997). Women in battering relationships are also more likely to suffer noninjury-related illnesses, including mental health problems, digestive diseases, and gynecological problems (Kernic, Wolf, & Holt, 2000; Lown & Vega, 2001). DV has been observed in diverse populations and communities, suggesting that it is a pervasive problem affecting all ethnic and cultural groups worldwide, including Latin Americans, or Latinas. We know that abuse exists among all ethnic groups, and research indicates that abused Latina women, like other battered women, suffer from chronic somatic and mental health problems related to the abuse (Lown & Vega, 2001).
The term “Latino” commonly refers to individuals from the Americas originally colonized by Spain. The National Institutes of Health definition of Hispanic/Latino states: “a person of Cuban, Mexican, Puerto Rican, Central or South American, or other Spanish culture or origin, regardless of race” (National Institutes of Health, 2001). Most Latinos are ethnically mixed, with indigenous, European, and African roots. Latinos are currently the second-largest and fastest-growing ethnic minority group in the United States; by 2010, they are expected to be the largest ethnic group in the country. As of the 2000 Census, over 130,000 Latinos were residents of Seattle/King County.
Latinos as a group are tremendously heterogeneous, with diverse racial, economic, and historical backgrounds. Despite the heterogeneity, however, there are only sparse data highlighting differences between Latinos of varying countries of origin with respect to domestic violence (Jasinski, 1998). Indeed, most DV studies have treated Latino participants as a unified group and have attempted to define similarities and shared cultural values within Latino communities (Perilla, 1999; Vandello, 2000). The single study that we found examining cross-cultural differences did find significant differences between groups in terms of prevalence, and this remains an area to be explored.
There is growing recognition that understanding how different cultural communities perceive and respond to DV is essential for designing effective, culturally appropriate interventions (Rodriguez, Bauer, Flores-Ortiz, & Szkupinski-Quiroga, 1998). In the present study, we used a qualitative, in-depth approach to capture the experiences of DV among Latina women in Seattle/King County. This work was part of a larger project that examined the unique circumstances and issues that women from nine different ethnic and cultural groups in the Seattle/King County area face in accessing DV services. Some of this work has been published elsewhere (Bhuyan & Senturia, 2005; Crandall, Senturia, Shiu-Thornton, & Sullivan, 2005; Shiu-Thornton, Senturia, & Sullivan, 2005; Sullivan, Bhuyan, Senturia, Shiu-Thornton, & Ciske, 2005; Sullivan, Negash, Senturia, Shiu-Thornton, & Giday, 2005). Similar to the research methods used with women from other ethnic and cultural communities, we asked Latinas to describe their experiences of domestic violence, DV service utilization, and suggestions for change. Because little is known about the issues that ethnic minorities face in accessing DV services, a qualitative approach that seeks to understand these issues inductively is appropriate.
Qualitative methods are useful for gaining depth of knowledge and illuminating the context of a problem (Glaser & Strauss, 1967). In qualitative open-ended interviewing, response categories are not proscribed, allowing informants flexibility to describe their experiences in rich detail. Additionally, qualitative interviewing emphasizes nonjudgmental understanding of individual experiences in their cultural context, an important consideration in this study since much of the focus of this project concerns cross-cultural understanding of sensitive issues and the richness of this report lies in the stories that women told, illustrating the depth and complexity of DV in a nonmajority community. Qualitative methods are useful for gaining depth of knowledge and illuminating the context of a problem (Morgan & Krueger, 1998).
PURPOSE OF THE PROJECT
This project explored three specific topic areas: the cultural experience of DV among Latinas in Seattle/King County, Washington; access to and satisfaction with domestic violence services among these women; and survivor solutions for addressing DV in the Latina community. The research was conducted through close partnership between the local health department, the University of Washington, and community-based DV service agencies that were involved at all stages of the project.
This study followed a Participatory Action Research (PAR) approach by partnering with DV service providers, advocates, and victims of DV. With PAR, researchers and community participants work together to develop and conduct the research project, participate in the research, summarize and analyze results, and collectively formulate recommendations. By using this approach, a coordinated, culturally relevant response to DV can be formulated, and Seattle’s DV services can benefit profoundly (Whyte, Greenwood, & Lazes, 1991).
METHODS
Research Team Organization
The Qualitative Research Team (QRT) was composed of the Health Department/University researchers and bicultural, bilingual representatives from members of the Latino community who were staff at Consejo Counseling Service. Consejo is a Spanish-language service provider in the Seattle/King County area. Consejo’s services include DV counseling, offering support, giving strength and knowledge, helping with legal issues, helping children and providing other needed social services. The agency also provides non-DV-related services to the Spanish-speaking community, such as mental health services, substance abuse counseling, and HIV-related services.
A Project Advisory Group (PAG), comprised of representatives from the city’s Domestic Violence Coalition, Seattle’s Domestic Violence Council, victim services agencies, legal services, law enforcement, and health and social services agencies, advised the project on recruitment and safety issues. The PAG informed and reviewed each stage of the project. Upon completion of the study, the PAG worked together to incorporate results into improved, culturally informed DV services.
Interview Structure
Focus groups and semistructured interviews were used for data collection. Data from semistructured interviews (in which interviewers ask specific questions to focus the interview but responses are open-ended) complement information gained through focus groups by providing indepth individual accounts of people’s experiences. Women who chose to participate were offered the choice between focus groups and individual interviews. Offering women an interview allowed women to participate who would not be safe or comfortable participating in a focus group. Allowing the informant to choose represents both PAR and culturally competent research.
Interviewers and Facilitators
Focus groups and interviews were conducted in Spanish. Facilitators and interviewers were bicultural and bilingual and were trained in focus group facilitation and interviewing techniques. Care was taken to ensure that facilitators and interviewers worked with research participants who were unknown to them and not accessing services at the facilitator’s agency whenever possible. Attention to the safety of participants and a culturally appropriate approach were key factors in planning. Crisis counselors were present at all focus groups. All participants were offered access to resources and written outreach materials from local service agencies.
Topics covered in the focus groups and interviews included: the cultural context of DV, including community definitions of DV and abuse; awareness of DV services, cultural factors affecting service utilization, problems with service delivery; and recommendations for helping victim/survivors experiencing DV. Consejo was instrumental facilitating outreach among survivors in Seattle’s Latino community.
Participants
Participants were recruited from Consejo’s clientele and through distributed flyers. One focus group and four individual interviews were conducted with Latina survivors. Nine Latina women participated in total. The mean age of participants was 33 (range: 21-48), six women reported family incomes under $10,000/year, all had been abused by their partner, and eight had accessed DV services.
The PAG and the QRT implemented safety protocols and guidelines for providing service referrals to participants who asked for help in the context of the research, and participants at risk of violence due to their participation in the research project were given assistance but excluded from the study. Participants in focus groups and interviews were compensated for their time and were provided with free child care and transportation vouchers.
Analysis
With permission of participants, focus groups and interviews were audiotaped and then transcribed. Focus groups and interviews were first transcribed in Spanish, and then translated into English by a professional translator and then proofed by a second professional translator.
Analysis of qualitative data began toward the end of data collection and continued until all transcripts had been reviewed and coded. As focus groups and interviews were transcribed, researchers and QRT members intensively reviewed transcripts to identify main themes and concepts. Main themes and concepts were organized into “codes” that gave structure to analyzing and compiling the data. NUD* 1ST software was used to analyze this textbased data (NUD + IST, 1996).
Grounded Theory, as described by Glaser and Strauss (Glaser & Strauss, 1967), describes an approach to understanding people’s experiences in context and is often applied in situations in which little formal knowledge exists. Data collection typically ends when the data are saturated, that is, no new information about main themes is being collected. We determined the total number of focus groups and interviews with each community in this project by two criteria: data saturation and recruitment possibilities. In the Latina community, we were limited by recruitment challenges and, though we have a strong body of data, we were unable to confirm data saturation. Therefore, Grounded Theory drove the design of this project, but we chose to use Content Analysis to interpret the data (Krippendorf, 1980). Content Analysis utilizes the frequency and relationships of words, phrases, and concepts in communication to help identify intention and guide interpretation.
RESULTS
The Cultural Experience
COMMUNITY AND FAMILY AWARENESS AND ATTITUDE TOWARD DOMESTIC VIOLENCE. Latina women who were interviewed felt that there is very little awareness of DV as being inappropriate or abnormal in their community. Women said that because it occurs in so many marital relationships, many Latino men and women see it as the norm. This makes it very difficult for victims to identify domestic violence as being “wrong” and makes it much more difficult for them to turn to friends and family for help when needed. Women have also seen it happen in their families of origin and sometimes then believe it is normal. Some families are supportive of women leaving relationships while others are reluctant to hear about a woman’s victimization, and fear retaliation by the husband. Embarrassment and shame keep women from talking about it. Two women described their experiences as follows:
Men that beat women, many times consider it normal because they have grown up in a culture where they have seen it happen. They think it’s normal, since they have seen people in his family doing it. They think that everybody does it, and men are also victims.
We [the women] keep quiet, and most of all, partly because Latin American women think first about our children, we do not want any scandal and we try to keep it confidential. This is because we know that’s very hard for the children. Then we tend to endure it, and this way we don’t improve anything.
DESCRIBING THE VIOLENCE. For Latina women, DV takes many forms, some of them similar to mainstream descriptions and some more unique to the cultural traditions of Latino communities. Women described a range of abusive behavior including verbal threats, isolation and intimidation, use of male privilege, physical abuse, and sexual abuse. Latina women were clearly devastated by abusive behavior witnessed or experienced by their children. As three women explained:
When I recently arrived here with my husband, he never helped me to go out or find out how people were here. He always had me stay at home. I was not allowed to go out of the house, because he would threaten me, telling me that something bad could happen to me on the street, and he didn’t want to be blamed for it.
He used to tell me “You have to do whatever I told you to do, because I am your husband and I am a man.’
I don’t know how to explain to her [daughter] about the time that he almost killed us.
PREVIOUS ABUSE IN FAMILY OF ORIGIN. Some women witnessed abuse growing up in their country of origin, while others never did. One woman described her childhood experiences as follows:
I saw it in my own family. I saw it happened to my parents; but, fortunately, my mother was a person that believed that if this should happen to you, you shouldn’t give any opportunity to let it happen again. Also, one should look for the well-being and protection of the children.
RESPONDING TO ABUSE. Women respond to abuse in various ways depending on their backgrounds and resources. Their responses were described as either feelings or actions.
How Women Feel. Feelings as a result of DV were varied. Women described fear, flashbacks, gradual dissipation of anger and hopelessness. The women did not speak at length about this, but did give individual examples or descriptions of their own feelings. One woman received counseling and said that she is learning that she has been traumatized by what happened to her. Another woman said that because she is out of the situation she finds that her anger toward her husband is dissipating, as if time is helping to heal the wounds. Another observed that a woman’s upbringing, education and where she comes from influence her reactions to abuse. She emphasized that everyone who experiences domestic abuse feels pain and that women need relief from experiencing so much emotional and physical pain: “I kind of continue to live it every day, every day because of the program I’m in. I have to talk about him and remember everything, especially when I had to go to Court. Even though I’m not with him, I have to live it again, and this is all what he left me.” Another woman mused, “Sometimes I wonder what could I possibly do to make my husband change and wouldn’t treat me like this. …” Still another woman described how “I still have nightmares daily with that man … I don’t know if it’s fear, because I am in the same apartment as before … and I hope he is not going to show up …”
Survivor Needs. Latina participants expressed a strong sense of isolation. As noted before, lack of social support from friends and family contributes to this feeling: “It is very important to receive some support at that moment of crisis. Especially when one needs to leave the home, and like in my case, one doesn’t have relatives close by.” Women felt isolated from their community, which appeared accepting and tolerant of DV. They also felt isolated from mainstream DV services, often due to lack of knowledge of public services, or language and cultural barriers. Latina women’s needs relate to countering these feelings of isolation. Women mentioned four primary needs: emotional support and advice, housing, English language advocacy in court and assistance in negotiating with Child Protective Services. As one desperate mother described, “I want my children back. My baby is almost 8 months old, and she was taken away from me when she was only 3 weeks old. My God!” Family, friends, and Consejo were cited as people or places to receive help for such needs.
Actions Women Take. Only two women talked about actions they took as a result of experiencing DV. One woman described using medication to calm her nerves. She also stated that she became suicidal at times. Another woman said she began to feel stronger at some point when her husband tried to abuse her. She said that she was able to stop him and felt mentally stronger to oppose him.
1. Staying in the Relationship. Many women referred to the belief that a woman is supposed to stay with her husband, no matter what, as a very strong reason to stay with an abuser. Cultural ties and childhood influences can be very strong. DV to some is seen to be normal and a natural part of family life. Other women talked about the fear of being alone as one of the reasons they stay. Additionally, family and friends can be very convincing if women turn to them for help and are told, “quarrels are normal in any relationship.” One woman stated that lack of information about available resources was one reason that she stayed. She did not know that she had options. Another explained that her Mexican upbringing had indoctrinated her to tolerate the abuse: “No matter what happens, we are supposed to stay with the husband. This is because life over there [Mexico] is very different from here. Therefore, many of us keep quiet and stay in it.” One woman declared that being with her abuser was better than being all alone: “They say no. What am I going to do all alone; I better stay here [with him].”
2. seeking Help. Three major themes emerged among women who sought help: some women had just learned about available services, some realized their partner was not going to change, and other women realized their children were suffering. One woman who endured spousal rape noted that it was the rape that triggered her helpseeking. In each case, help-seeking seemed to be precipitated by women’s increased awareness, be it of available resources or the chronic pattern of domestic violence in their relationships. As one survivor explained, “I didn’t know that places like these really existed. I thought that maybe the interpreter or the social worker were going to take me to their home or something like that… [T]hen in less than half an hour, she was there with the nurse. They took me to the shelter.”
Access to and Satisfaction With Services
AWARENESS OF DOMESTIC VIOLENCE SERVICES. Word of mouth tends to be the most common way for women to learn about services. Women learn from friends and family about resources they have accessed in the past. Also, having a good relationship with a nurse or doctor allows for a woman to feel comfortable and eventually ask for help. Since many Latina women do not read or write in English, they depend on others who may have been through a similar situation to provide support and referrals. The consensus among focus group participants was that most women did not know that DV was something for which they could receive help. One woman said that when she arrived in the US, she did not realize how many services were available to women and she didn’t know there was help for victims of DV. Another woman said that she did not know about any services for victims of DV until her social worker gave her the information. Another said that the Latino community is not very aware of available resources. Many women think that they have no alternative but to live with the abuse. Some thought that only their family could help them by listening to them and possibly talking to the abuser on their behalf.
USE OF SERVICES. The major services women mentioned having accessed were:
1. Consejo, a Spanish-language DV service provider.
2. Health clinics. Women reported that clinic staff provided referrals for women to shelters and to Consejo.
3. Shelters.
4. Seattle Housing Authority.
5. Courts.
6. Social workers.
How SERVICES WORK. Women described a number of services that had worked very well for them. Consejo was said to have provided emotional as well as material help with housing, food, and clothing. As a focus group participant explained, “All the people here at Consejo were very good. It is important to know that there are people that can make you feel that you are not alone and insecure, and that help you change and strive in order to move forward for the children’s sake and yourself.” Advocates connected women to counselors for themselves and their children. As one mother described, “Well, it [counseling] has been very helpful to me because they have really given me … the social workers have worked with my children with counseling, they have sent them to school, they have made sure that somebody is there with them to teach them how to read and write and they have helped us all.” One woman was particularly grateful for help in finding a job. Many women expressed gratitude for the encouragement that Consejo’s support group has offered; they felt they have been given a new outlook on life and are growing stronger: “For example … that you need to go to Court. Well they come with you and all. This is very good! They don’t leave you all by yourself.” They have also learned about the dynamics of DV. This helped one woman to feel stronger when she had to communicate with her husband. They said they also felt less lonely thanks to the group. One woman said that it was worth it to her to take two buses and walk uphill in order to come to Consejo’s support group.
Women also had good experiences with domestic violence shelters. One woman found shelter space with the help of a friend. The shelter in turn connected her to Consejo, and shelter staff helped her to find transitional housing. Another woman praised the shelter support groups, where she met other women who helped give her “courage and strength to keep on with” her life.
Other services that women said had been effective were certain medical clinics and social workers. One social worker escorted a woman to a shelter and connected her with Consejo. Women praised providers who were attentive and affectionate toward their children: “Well, whenever I would bring my daughter to the clinic for checkups, the nurse was very attentive would always ask if she was alright, if she had everything she needed like clothes . .. The same happened at the shelter.”
When it comes to services that worked poorly, women stated that the language barrier was a main problem: “When I arrived here [the LJS], I didn’t understand any English. So, when they [from the shelter] came to get me, I started to cry, and I cried and cried.” Latinas felt frustrated when they could not express themselves or understand the court system or Seattle Housing Authority. As one Latina described, “Sometimes, when I try to speak to the judge, he doesn’t understand what I’m trying to say… and when I’m nervous, I cannot say a word.” Some also felt that discrimination based on their economic status prevented them from receiving appropriate assistance: “They [lawyers] don’t do it [help] if you don’t have money.”
IMPORTANCE OF SAME CULTURE/LANGUAGE PROVIDER. For the most part, participants felt it was important that providers share their culture and language. Additionally, for non-English-speaking women, bilingual and bicultural providers are critical. This is to ensure that the provider understands the background of the Latina women, makes them feel more comfortable. In regard to having mixedethnicity support groups, several women felt that it was important that everyone share the same cultural background. This commonality enables them to understand their situations better, and to know that they are not alone. Women saw it as essential that all participants speak the same language in order to help and listen to each other “because they need to understand where are we coming from when we have been mistreated and how does the Latino woman react.”
One woman disagreed and felt that it was not important where the provider came from or the language that they spoke, as long as they were able to provide the women with help: “No, this is not important. What is important is to receive some help regardless of the language and culture. ”
CHILDREN AND TEENS: NEEDS AND ISSUES. Most women with children expressed that their children’s needs were at least as high as their own when in crisis. They felt mostly satisfied with counseling referrals but still feel as though they as mothers need more help with their children. Daycare for children while their mothers are working was identified as a persistent problem. Many women wanted to see more special programs for children such as field trips and recreational activities. As a participant declared: “They should take children out for rides so that they get distracted and they can see different things. Take them to the park to see the flowers or something like this; play ball games; let them have some sports.”
Survivor Solutions
OUTREACH. Ideas for ways to reach other Latina victims/survivors were varied. First, the women said information could be given out in churches and in communities where Latinos live. Another way was to offer various activities for women. This would give them the opportunity to go out and interact with others. This was important because it takes trusting someone in order to open up to them about their personal pain. Making friends with someone who may be suffering abuse was another option. One woman gave the simple directive to “talk to her [an abused woman], and tell her that you don’t know how is her life, but if she is suffering, give a telephone number where somebody can help her. ” This would enable women to support each other in the community. Radio programs were suggested as a forum for educating about DV. Many people listen to the radio and this could be a safe way to provide information about services. Educational information should be on Spanish language programs.
PREVENTION. Women thought that educating men, women and children is essential in order to prevent DV; women noted specifically that educating children is a way to stop the cycle of violence, “to educate the parents because the children are the ones who are going to continue that violence. In order to cut off violence parents need to be educated so that they can, in turn, educate their children.” Participants would also like to see more programs for families, to educate both men and women about the effects of DV. Some women stated that men are victims of cultural expectations and of personal abuse, and may not feel as though they know any other way to be.
A common theme for how to help women was to build, find, or provide safe housing for women and their children. Women highlighted the need for shelters: “My way of thinking is that one can help the victims of DV by setting up a shelter, because I know that for the women it is hard, and many think like I used to think: that there is nobody that can help you. So, I think one should help them with shelters and trained people so that they can receive counseling and let them know that there is a way out.” One idea was to have women work cleaning and fixing up run-down houses, following the Habitat for Humanity model of work-to-own. Women highlighted the importance of child care in order for mothers to be able to work, and the necessity of free child care for women to be able to escape abuse.
SUMMARY
Findings in this study illustrate that the experience of domestic violence in the Latino community shares commonalities with the majority population. Latina women endure physical, psychological, and sexual abuse at the hands of their partners, as do other women. However, our study found several challenges unique to Latina survivors.
It has been demonstrated in studies of both Anglos and Latinos that adherence to strict gender roles and cultural acceptability of violence are significantly associated with the occurrence of DV (Anderson & Umberson, 2001; Galanti, 2003; Vandello, 2000). Traditional Latino masculinity, “machismo,” may create a set of expectations for male behavior that exalts aggressiveness and reinforces unequal power relationships (Vandello, 2000; Vandello & Cohen, 2003). In addition, the centrality of family and the mythos of the Latina woman as the heart of the family, ever supportive and self-abnegating, may create barriers to seeking help for the abused Latina (Rodriguez, Sheldon, Bauer, & Perez-Stable, 2001). Less acculturated Latinas are also more likely to tolerate violence in relationships (Ayala, 2001). Some of our participants voiced these same observations.
Many of the women in our study described a culture of origin that is accepting of violence against women and female subservience, in agreement with previous research (Champion & Shain, 1998; Perilla, Bakerman, & Morris, 1994). We found that important sources of social support for the Latina woman, such as family or the Catholic Church, may discourage divorce or separation from an abuser (Perilla et al., 1994). Survivors emphasized the importance of community and family and culturally appropriate services in their decisions surrounding resource utilization. Bilingual, culturally sensitive information is very important, as protection orders have been shown to decrease the risk of subsequent violence among abused Latinas (McFarlane et al., 2004). Our participants also strongly emphasized the need for concrete assistance, such as help with shelters, the court system, and job searching.
External stresses likely contribute to DV within Latino communities, as well. Latinos face many challenges as an ethnic minority in the United States. In addition to societal racism, immigrant Latinos may face language and cultural barriers to access of services. Abused Latina women, in particular, might find it difficult to obtain legal, medical, or social assistance (West, Kantor, & Jasinski, 1998), particularly less acculturated women (Bauer, Rodriguez, Quiroga, & Flores-Ortiz, 2000) or undocumented immigrants (Raj & Silverman, 2002). Our participants, like Latinas in earlier studies (Perilla et al., 1994; Rodriguez, Bauer, Flores-Ortiz, & Szkupinski-Quiroga, 1998), noted language and cultural barriers navigating mainstream DV services.
Recent longitudinal research has demonstrated a slightly higher incidence of DV among Latino couples than among Anglo couples (Caetano, Nelson, & Cunradi, 2001; Cunradi, Caetano, Clark, & Schafer, 2000). It is not fully clear why this is so. However, we do know that family abuse in America is significantly associated with neighborhood poverty (Cunradi et al., 2000), which is more common among Latinos. Underemployment and lower SES are stressors that have been shown to contribute to higher rates of violence in Latino families (Pearlman, Zierler, Gjelsvik, & Verhoek-Oftedahl, 2003). Several of our participants felt that alleviating some of these sociocultural factors would help to diminish family violence in their communities.
Socioeconomic status is extremely important when thinking about DV; Centerwall (1995) studied Anglos and African Americans in two different cities and found that when adjustments are made for socioeconomic status, differences in domestic homicide rate between the groups are completely accounted for (Centerwall, 1984, 1995). More recent data have confirmed these findings among Latinos, as well (Krishnan, Hubert, VanLeeuwen, & Kolia, 1997; Kyriacou, Hutson, Anglin, Peek-Asa, & Kraus, 1999). Finally, coexisting health difficulties or substance abuse problems within the family are known to increase the risk of partner violence among Latino families (Caetano, 2003; Schafer, Caetano, & Cunradi, 2004). Addressing the issue of unmet health care needs might decrease the risk of violence toward at-risk women who choose to remain with their partners.
Limitations
This research had a number of limitations. Recruitment of Latina survivors was challenging. As a result, our sample size was small and, as such, we were unable to reach saturation. When saturation is not achieved, it means that other, potentially relevant themes might have been identified if further participants had been interviewed. However, themes that have been identified are no less valid. In this case, we believe our findings are valid for two reasons: Our findings support previous research and hypotheses, and common themes were clearly identifiable from the dialogues.
Possible reasons for the difficulties recruiting may include the short time frame in which to recruit, religious norms which may have inhibited open discussion of DV, and heightened fears of confidentiality due to small community size. In addition, it was necessary for recruitment in several groups to use facilitators known to the survivors, QRT members (agency advocates), rather than neutral alternates. This could potentially bias the results toward a favorable evaluation of local services. These limitations suggest the need for further research to confirm and expand our findings. Utilizing focus groups for small communities might also influence participants’ willingness to speak based on cultural norms or the difficulty of subject matter. Though the one-on-one interview format was also offered, we cannot fully evaluate this effect.
Language was a potential limitation: The initial openended questions used in the interviews and focus groups were translated prior to utilization. However, because the concepts of DV are so complex and culturally constructed, facilitators often found themselves re-translating on the spot to clarify questions for focus group participants. This struggle with language clarity may have affected the conversations and thus the data.
Finally, participants of low socioeconomic status (SES) dominated the sample. It is possible that this may limit study validity. However, many of the findings seem to reflect cultural issues rather than economic ones, and these may still have general applicability. Specifics of the domestic violence experience may differ between women in lower versus upper SES, but we know that domestic violence is a phenomenon affecting all social strata and there are a paucity of SES-specific DV data for any ethnic group.
Recommendations
Efforts to address DV in the Latino community must address underlying social issues such as racism, language barriers, and cultural differences, and recognize the relationship of these forces to DV. Government agencies must maintain existing social and public health services, giving special consideration to DV victims/survivors. In general, we need to support increased access to, and increased diversity of, shelters, legal and economic assistance, and access to medical care. An important goal is to continually improve access to the criminal justice system, reducing barriers of language, culture, and racism for nonmainstream women.
Women entering the US should be provided with information in Spanish about DV resources, U.S. law, and available government and immigration services. Local Spanish-language media could provide public service announcements about DV, culturally appropriate community services should be funded and expanded, and advertisement on buses and through community institutions could improve outreach. In addition, mainstream services must make their services more accessible to all victims by reaching out to women of color, lesbians, gays, and transgender people, hiring bilingual and bicultural staff and training staff on the issues women from diverse cultural groups face in responding to DV.

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