AODA/Mental Health/Domestic Violence
There is current training available to all W-2 agency staff through the Enhanced Case Management courses on AODA, Mental Health, and Domestic Violence. This curriculum outline is not intended to replace that training. In fact, the Enhanced Case Management training is highly recommended as you work with your participants who have AODA, Mental Health, and/or Domestic Violence issues. People affected by AODA, Mental Health, and Domestic Violence issues are some of the most difficult populations with whom to work. Working with your participants who have AODA, Mental Health, and Domestic Violence issues will be challenging for a variety of reasons:
- It will test you in many ways -- your level of knowledge and compassion, your limits and strengths.
- It will determine to some extent whether you feel you can make a difference in your job since progress is often hard to measure.
- It will affect how you view human nature to some extent - the hope versus despair dichotomy will fluctuate due to the nature of your participant's problems.
- It may lead you to become introspective (to look within) in such a way that you begin to see how vulnerable we all are to some extent to the negative forces of life.
- It may humble you in some ways and challenge or reaffirm some basic values and beliefs about life and people in general.
A STUDY FINDING: NEARLY HALF OF ALL AMERICANS HAVE A PSYCHIATRIC DISORDER AT SOME TIMES IN THEIR LIVES -- USUALLY DEPRESSION, PROBLEM DRINKING, ANXIETY OR SOME KIND OF PHOBIA (Source: Archives of General Psychiatry, January 1994).
ALCOHOL AND OTHER DRUG ABUSE
THE IMPACT OF SUBSTANCE ABUSE
Any chemical that modifies the function of living tissues, resulting in a psychological or physical change, is a drug. When the body needs the drug, it may respond with aches, pains, muscle and stomach cramps, urges and cravings, etc., all of which suggest that a person has become physically or psychologically dependent on the substance. When a person develops what is known as drug tolerance, she will find that she needs more to get high, often resulting in having to take more drugs. And these are only the apparent and physical effects.
While it may be clear that active substances interfere with productive life functioning, it may be assumed that once people stop using drugs or alcohol, they can get a job and function independently and productively. The following are examples of how chronic substance abuse might have a negative impact on a person's life.
- Basic living skills: Homelessness, lack of income, and a repeated history of legal problems, including convictions and incarceration, isolation from family life, may result from chronic substance abuse.
- Health: Poor or deteriorating health often results from years of abuse and neglect of health. There are high rates of HIV infection and tuberculosis among substance abusers.
- Education: Substance abuse can lead to significant deficits in academic development and in basic learning skills.
- Employment: Early onset and lengthy periods of substance abuse often result in difficulty obtaining and maintaining meaningful employment. A well developed work personality and preparation for meaningful employment may be compromised. In addition, criminal convictions often preclude consideration for certain work opportunities.
- Relationships: Interpersonal and socialization skills may be poor because relationships were often based on the acquisition and use of drugs. The ability to communicate outside the drug subculture is frequently impaired.
For chronic abusers, the person's compulsion to seek and use substances may have made her unable to experience and benefit from life processes that lead to self-sufficiency. The earlier the age of onset the less likely it is that the person has reached emotional maturity and developed the necessary skills and abilities to become educated and employable. Issues of poor self-concept and low self-esteem result in difficulties with attaining self-knowledge, establishing strong, positive values, and making productive decisions.
THE CONTINUUM OF USE, ABUSE, AND DEPENDENCY
Not everyone who has tried or is taking drugs is a substance abuser. Understanding the continuum of use of illegal substances, alcohol, prescription drugs, and other chemicals provides a basis for understanding substance abuse. The following definitions cover the continuum of use:
- Experimental Users: Those who try various drugs once or twice out of curiosity about their effects.
- Recreational Users: People who use drugs to "get high" with friends or at parties, to be sociable, or to get into the mood of things.
- Regular Users: When people use drugs constantly to achieve or maintain a desired effect or state; often able to continue normal activities - functional at work, school, doing housework, etc.
- Dependent Users: These users experience mental or physical discomfort when they need drugs and will do anything to obtain them; they usually often relate to everything in life through a drug seeking and drug-taking frame of reference/mentality.
- Addiction: This term refers to the use of any chemical substance, whether legal or illegal, in ways that cause physical, mental, emotional or social harm to a person or people close to him or her. In addition, there is preoccupation with drugs and an abiding desire to acquire a supply. The addiction is displayed in escalating use despite the consequences.
COMMONLY ABUSED SUBSTANCES
- MARIJUANA AND HASHISH
Ethyl alcohol is the active ingredient in wine, beer, and liquors. In small doses, it has a calming effect, like all depressants. An occasional drink is usually not harmful and may be considered by some to have medicinal benefits. Those who have an addiction to alcohol (alcoholism) may, due to larger quantities of alcohol taken over a long period of time, suffer from damage to the liver, brain, and heart. Due to a range of alcohol-related social and psychological conflicts related to alcohol abuse, this drug has been considered a major problem in our country for a long time.
Marijuana and hashish come from a plant, cannabis sativa; the cigarettes or "joints" are made from the dried leaves of the plant, and hashish comes from the dark brown or black resin on the tops of the plant. Cannabis has over 400 chemicals, but it is THC (delta-9-tetrahydrocannabinol) that determines how strong the marijuana and hashish are in producing a "high."
These drugs, the "uppers," stimulate the nervous system and make people more active, alert, and nervous. They usually relieve drowsiness, and disguise the effects of fatigue and exhaustion. When people who use stimulants over a long period of time stop using them, they may feel depressed or get headaches or other symptoms of "withdrawal." Drugs in this category include:
- AMPHETAMINES - are often prescribed by doctors, some of these amphetamines (including diet pills and pep pills like Dexedrine and Benzedrine), get into the black market or are stolen form the family medicine cabinet. Use of amphetamines, especially when without a doctor's supervision, can lead to the yo-yo effect of "speed" - high one hour and down the next.
- COCAINE (coke) -- is most often sold in the form of a white powder, usually sniffed or "snorted." The "high" happens immediately after use and can last up to about 20 minutes. Long-term snorting can cause sleeplessness, anxiety, and sometimes delusions.
- CRACK -- usually comes in small lumps, pieces that look like shavings of soap; also "rock." It is a form of cocaine that has been chemically changed so it can be smoked. Smoking it causes cocaine to reach the brain faster than snorting, but also increases the chances for serious emotional reactions such as anxiety and paranoia. Both cocaine and crack negatively affect reflexes and judgment. Although rare, cocaine can cause death.
- METHAMPHETAMINE (crank) -- is produced in laboratories in powder, crystal, and chunk form. Methamphetamine use is growing rapidly, and according to a study entitled
National Admissions to Substance Abuse Treatment Services: The Treatment Episode Data Set (TEDS) 1992-1997
admissions for methamphetamine addiction have more than doubled in the five year period of time.
These are the "downers." They depress the central nervous system and make people calm or sleepy. Drugs in this category include:
- SEDATIVES (tranquilizers like Valium, Librium, Miltown, and Butisol)
- HYPNOTICS (sleeping pills like Nembutol, Seconal, Dalmane and Placidyl)
- BARBITURATES (Amytal, Butisol, Numbutal, and Seconal)
Although prescribed by doctors for a few medical conditions, twice as may people die from overdoses of barbiturates than from overdoses of heroin. Barbiturates (called barbs, downs, or reds) may cause mental confusion, dizziness and loss of memory. People sometimes forget how many pills
they've taken, and this confusion can result in overdose. Barbiturates are very addictive, and people dependent on them have to be careful. Sudden withdrawal from heavy doses can cause paranoia, restlessness, convulsions, even death. Barbiturates, sedatives or other downers when taken together with alcohol, make each other more powerful. Mixing even a few sleeping pills with alcohol is very dangerous.
Narcotics act like barbiturates -- they are all addictive. Narcotics make people both physically addicted and mentally dependent. They are used in medicine as pain-killers, either derived from Opium or made synthetically.
- CODEINE, EMPIRIN WITH CODEINE, AND DEMEROL are commonly prescribed narcotics.
- OPIUM, MORPHINE, METHADONE, AND HEROIN are among the "opiates," a more powerful class of narcotics derived directly from the opium poppy.
Heroin, usually injected, snorted, or smoked, creates a temporary high and is always addictive if used daily. Although the medical effects of the drug may be no more severe than barbiturates, the great need for heroin often leads to personal desperation and crime in an effort to get money to buy this illegal drug.
This class of illegal drugs called hallucinogens act differently in the body than stimulants and depressants. They seem to change the way people see and hear the world around them and produce hallucinations and delusions.
- LSD (acid) -- is probably the best known mind-changer and one of the most powerful chemicals known. An amount almost too small to see with the naked eye is enough to cause disorientation for up to 12 hours. Continued use of LSD can result in serious personality breakdown and brain damage.
- PCP -- Phencyclidine (hog or angel dust) is a tranquilizer for animals. Its effects can include a feeling of numbness in arms and legs, and hallucinations. Sprinkled on tobacco or marijuana cigarettes or taken in capsules, PCP can create temporary psychosis very much like acute schizophrenia. It often leads to paranoia and has been linked with serious violence.
- MESCALINE is the active ingredient in the peyote cactus.
- PSILOCYBIN is the psychedelic drug in the so-called "magic mushroom" found in Mexico.
Sniffing glue or inhaling other volatile chemicals -- hairspray, deodorant, correction fluid, or even gasoline fumes can be very dangerous. Their intoxicating effect comes in part from cutting off oxygen to the brain or affecting the lungs. Chemicals in these substances, like the propellant in aerosol, can enter the blood and affect the brain. Overdoses may lead to kidney and brain damage.
THE CHRONICITY OF SUBSTANCE ABUSE
Substance abuse occurs when the use of alcohol or drugs has become the central focus of a person's life. Consequently, the person gives up important life activities or events in order to continue substance abuse. Substance abuse may be so powerful that the person resumes abuse even after completing treatment or maintaining abstinence for some time. To understand the disabling effect of substance abuse, one must be able to fully appreciate that chronicity is an integral part of the total disease. It requires comprehension of how a person, who has been through several treatment programs and made certain life gains, could relapse and return to substance abuse. Often the pattern continues until the person has a crisis or reaches a particular low point and feels like the bottom has hit, life has deteriorated, or enough is enough.
IDENTIFICATION OF SUBSTANCE ABUSE
There are various approaches to identification of substance abuse that range from observation of behavior to diagnostic procedures. Staff members are most dependent on detection through observation. Substance abuse can be detected in the following ways:
- Biological -- Loss of weight, liver disease, abscesses at the point of needle injection, dermatological conditions, and gastrointestinal conditions.
- Psychological -- Increase in anger, irritability, sluggishness, and confusion.
- Social -- Hanging out with drug users; being isolated from friends; lacking family relationships; leisure or recreational time spent in drug or alcohol using environments; changes in patterns of attendance, or punctuality; loss of job; drop out from school; legal problems.
- Spiritual -- Loss of values or denial of morality.
- Medical detection -- Urinalysis detects the presence of certain drug-related electrolytes in the urine. This method is used to identify the drug but does not indicate substance abuse.
- Screening through written material -- A written assessment that assist in screening for substance abuse, or psychological distress. Many are easy to administer and are inexpensive (see Screening Tools chapter.)
- Self-reporting -- Admitting to having a substance abuse problem and seeking assistance in meeting challenges of overcoming abuse or addiction.
Defense mechanisms give the individual a feeling of power and control over a sense of helplessness and powerlessness. Difficulties in self-evaluation and regulation of mood are frequent underlying dynamics of defense mechanisms.
- Denial -- Denial is a normal ego defense mechanism, which protects the person from a full awareness of substance abuse. Denial is a common feature and the chief mechanism of substance abuse. Denial differs from lying in that the person is not consciously trying to "manipulate" anyone. The person who is abusing the substance is often not fully aware that the negative effects of the substance abuse are a result of their own behavior. They do not believe that they have a problem with drugs and seldom want to stop using or believe they can stop using at any time.
- Projection -- Sometimes substance abusers may perceive others to be the source of their problems, finding it easier to blame others for their behaviors while denying responsibility for their own problems.
- Displacement -- This mechanism is most often seen as anger in fear or frustration, and is directed toward a counselor, employer, coworker, or fellow substance abuser.
These defense mechanisms have been the primary coping strategies used by substance abusers to deal with change. Part of the recovery process is to help the person recognize what he or she is doing and introduce alternative ways of coping with stress, change, and the demands of a new way of living.
Enabling refers to behavior that directly or indirectly helps the substance-abusing individual to continue dependency on drugs or alcohol. Enablers are people who encourage the dependency by minimizing the substance abuse problem, making excuses for the person, covering up for the person, or protecting the individual from negative consequences of the person's behavior.
Relapse is the recurrence of substance use, negative behaviors, negative psychological responses, and/or associating with using friends in using environments. It may or may not include the use of drugs or alcohol, recurrence of troubled personal relationships, deteriorating living conditions, or poor health care. Relapse is usually not a surprise, there are often warning signs that can be seen. Some warning signs are:
- Frequent illness
- Poor excuses for inappropriate behaviors
- Failure to attend work/school or show up for appointments
- Changes in appearance
- Changes in friends and associates
- The presence of drug paraphernalia or the drug itself
- Increased stress and irritability
- Deterioration of a strong value system
Relapse prevention involves helping individuals identify their triggers and developing a plan to deal with them. Women are more likely than men to report negative emotions and interpersonal problems before they relapsed. Because relapse is a characteristic of substance abuse, it is important for staff to work together with the participant and the treatment provider in a case where relapse has occurred. In this way, the participant feels supported to return and continue with the recovery process.
IMPACT OF SUBSTANCE ABUSE ON
PERSONAL DEVELOPMENT AND PLANNING
People in recovery may be affected by their ability to function in the following areas:
- Decision Making
- Problem Solving
- Effective Communication
- Assuming Responsibility
- Becoming Self-sufficient
Cognitive development is stunted by long-term substance abuse. Identifying these functional limitations may assist the staff and the participant in developing realistic goals to enhance productivity and build on strengths, all the while maintaining participant accountability. During this process of exploration and planning, a person's old behaviors may emerge that may need to be addressed. Some of these issues may include:
- Confronting old failures (repeating old patterns.)
- Fear of new successes and responsibilities ("making it" where one has never succeeded before; the need to be the best, or at least look that way to others.)
- Discouragement due to lack of immediate results, length of time required for success, or lack of support during the process.
- Problems with overall living situation, that may include housing, child care, and income.
It is essential for staff to understand substance abuse and its relationship to career planning. Staff should remember that the person is a substance abuser, therefore recognize its chronicity and how it has impacted the person's ability to establish a career.
Substance abusers typically have a poor concept of self and a weak self-esteem, which is sometimes hidden by a display of grandiosity. The individuals perceive that they have little internal control over their lives and outcomes. Negative thinking patterns and perception of minimal possibility for change in their lives, are frequently demonstrated. Short-term, rather than long-term goals and the need for immediate gratification are more often presented. Substance abusers tend to blame other people, in one way or another, for the problems they have. It can be easy for the individual to take a less active stance with staff, expecting staff to "magically" make life better.
Staff can define the vocational counseling role to the participant by:
- Expecting the participant to think, make decisions, take action, and take personal responsibility.
- Setting limits on what staff can/cannot do for the participant and maintaining those boundaries.
- Letting the participant know what will be expected as responsible behavior.
- Educating the person about the goals of the W-2 program, participation requirements, time limits, the career planning process, choosing a realistic vocational goal, and employer expectations.
The pressure associated with change may trigger regression to old behaviors. Some of the components of work or school that are potential triggers are:
- Money, because it is associated with buying drugs or alcohol.
- Requirements of dress and personal appearance may trigger feelings of inadequacy in the workplace.
- Inability to interact appropriately with school or work authority figures.
- Transportation/commuting that requires going "out of the neighborhood."
- Inability to say "no" to co-workers who want to go out for a drink after work.
- Challenges to a personal value system.
By addressing these fears and challenges, staff can facilitate positive growth in the participant, and can help make the transition from "substance abuser" to "worker" a reality.
People who are mentally ill have a higher chance of becoming abusers of alcohol or illicit drugs than does the general population. Often they will use these substances to try to escape from their symptoms. The opposite is also true. Persons with a substance abuse problem have an increased incidence of mental illness. A 1998 study published in the Journal of American Medical Association entitled "The Epidemiological Catchment Study" showed that 55% of persons with a substance abuse problem has some type of mental illness.
Mental illness refers to a group of brain disorders that cause severe disturbances in thinking, feeling, and relating, often resulting in an inability to cope with the ordinary demands of life. Symptoms vary, and each person with mental illness is different. But all people with mental illness have some of the thought, feeling, or behavioral characteristics listed below.
- Changes in thinking or perceiving (hallucinations, delusions, excessive fears or suspiciousness, inability to concentrate.)
- Changes in mood (unexplainable sadness, extreme excitement or euphoria, pessimism, expressions of hopelessness, loss of interest in once pleasurable activities, thinking or talking about suicide.)
- Changes in behavior (inactivity, isolation, hostility, indifference, inappropriate laughter, inability to express joy, inability to cope, irrational statements, forgetfulness, drug or alcohol use.)
- Physical changes (hyperactivity or inactivity, deterioration in personal hygiene, unexplained weight loss or gain, sleeping too much or inability to sleep.)
Often the symptoms of mental illness are cyclic, varying in severity from time to time. The duration of an episode also varies; some people are affected for a few weeks or months, while for others the illness may last many years, or for a lifetime. Also, one person's symptoms may be very different from those of another although the diagnosis may be the same.
MAJOR MENTAL ILLNESSES
Schizophrenia: The word schizophrenia comes from Greek terms meaning "splitting of the mind." This Greek derivation is probably what has caused the term to be inappropriately used over the years to speak of a split personality. People with schizophrenia however, do not have more than one distinct personality; instead they have a disorder of the brain that affects the mental processes such as thinking and judgment, sensory perception, and the ability to appropriately interpret and respond to situations or stimuli.
Bipolar (manic depressive) disorder: In bipolar disorder, the individual swings between periods of depression and periods of mania, which is persistent, excessively "high" mood. There are usually periods of normal moods in between these two poles. Bipolar illness often first appears in childhood or adolescence, although the majority of cases begin in young adulthood. It almost never develops after the age of 35. Ironically, some of the symptoms of mania lead affected people to believe that they are not sick, in fact, that they have never felt better. The euphoric mood may continue even in the face of sad or tragic situations. The person may go days at a time without sleep, and does not even feel tired. While the person may feel euphoric and think there's nothing wrong, family and friends may notice serious problems. For example, people with mania often go on spending sprees, become promiscuous, drive recklessly, or abuse drugs and alcohol without realizing that these behaviors are, for them, abnormal. Fortunately, bipolar disorder is one of the most treatable mental illnesses. Lithium carbonate, a mood stabilizer prescription medication, is effective for 70% of people with bipolar disorder.
Major Depression: Depression is one of the most common mental illnesses, affecting as many as 20% of women at least once in their lifetime. Depression can appear at any age, it is also common for women to experience "postpartum depression" after giving birth. Although most sources describe depression by comparing it to the feelings of sadness or being "blue," which everyone experiences, it is far more serious than that comparison would suggest. People with the most severe depression find they cannot work or participate in daily activities, and often feel that death would be preferable to a life of such pain. Depression is thought to be the cause of as many as 75% of suicides. Probably more than with any other illness, people with depression are blamed for their problems and told to "snap out of it," or "pull themselves together," etc. Often others will say that a person "has no right" to be depressed. It is critical to understand that depression is a serious illness and the person with this illness can no more "snap out of it" than a person with diabetes can. There are many types of depression, and each responds somewhat differently to antidepressant medications and psychotherapy.
Anxiety Disorders (including panic attacks): There are several disorders, including panic disorder, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorders (OCD). Often people with other mental illnesses will also have symptoms of one or more anxiety disorders. In panic disorder, people have repeated "panic attacks" that come "out of the blue" when there is nothing to be afraid of. Post-traumatic stress disorders (PTSD) result from exposure to a traumatic event. People with PTSD often re-experience the event(s) in their memories or dreams of feel as if the event is actually reoccurring. In OCD, some people have only obsessions and some have only compulsions, but most will have both. Obsessions are repeated, intrusive, unwanted thoughts that cause extreme anxiety. Compulsions are ritual behaviors that a person does to diminish anxiety. Common examples are hand washing, counting, checking (to see if the door is locked or the coffeepot turned off) and repeating (a word or action).
ATTITUDES AND BELIEFS ABOUT MENTAL HEALTH
How we name something is important. There's a difference between saying someone has "mental health issues" vs. saying they're "mentally unstable." Even though "mental illness" is an accurate description, unless there is a clear organic reason and/or actual brain damage, we never know whether someone will remain emotionally and cognitively fixated in certain states of mind or whether their distress is psychosocial, developmental and/or part of certain life stages and challenges that provoke psychological instability.
- Be careful to avoid labeling someone by the disorder they have. Stereotyping may affect how we interpret everything -- even unrelated matters - about the person. "She's a manic-depressive" is inappropriate.
- Even when people are emotionally unstable at a given point, it doesn't necessarily predict that they will be emotionally unstable during another challenging period in their lives. Leaving room for how someone's condition is interpreted is important because a person can change their feelings, thought and behaviors. No one is ultimately so qualified as to be able to predict someone's inner self -- the extent to which someone has the ability to change and grow from various "conditions" and life experiences.
SPECIFIC BARRIERS AND INTERVENTIONS
STRATEGIES FOR PARTICULAR CLIENT SITUATIONS
A CLIENT WITH DEVELOPMENTAL DISABILITIES:
If a client is having difficulty understanding basic instructions or seems unable to follow a conversation, consider whether it's due to ability or emotional issues. Please consider:
- Clients who are developmentally disabled may feel incompetent and will often rely on defense mechanisms to compensate (notice whether they engage in denial a lot to downplay or minimize their sense of failure.)
- Understand and Acknowledge Differences in Ability - consider the context of client's educational background and abilities in general and consider getting client tested (for ability-related concerns).
WHAT STAFF CAN DO:
- Initially, be careful not to be too confrontational and harsh to the point of stripping a person of all their defenses. Why?
- It can do more damage to the person's fragile sense of self. A person without any defenses will experience everything as raw and painful because there's no buffer to protect one's ego.
- On the other hand, do not encourage the client to continue to use too many defenses. High Defensiveness is equally maladaptive.
- Learn what client's interests are; what she enjoys doing.
- Narrow down some questions to make them simple so you don't lose the client's involvement in discussions.
- Offer ability-appropriate options for jobs, educational/literacy programs.
CLIENT WHO STARTS COOPERATIVELY (GUNG-HO), then BECOMES NON-COMPLIANT:
- Consider whether there is shame involved because the person made a mistake.
- Consider whether the person is operating from an "all or nothing" kind of mentality that is, if they miss once, they believe it's not worth it; or if they fail one test, they want to drop out of GED classes altogether.
WHAT STAFF CAN DO:
- When dealing with clients who are resistant to participation (non-attendance), it's important to state the facts ("You missed these particular appointments on these dates") that puts the responsibility on the client's shoulders.
- Redefine what compliance means if appropriate by making an effort with the client to work up to a certain point in incremental steps rather than give the impression that it's all-or-nothing.
- Talk to your client compassionately about being human and reassure them we expect people will make some mistakes, explain that failing is not the end of the world; they can try again.
- If there's a pattern of non-compliance, ask whether they are afraid of achievement and success because it might mean leaving behind family and friends who are important to them.
Women are victims of domestic violence in ninety to ninety-five percent of documented cases. Domestic violence affects all social, economic, racial, ethnic, religious, and educational levels of society. Fifty-percent of all American women will be beaten at least once in the course of an intimate relationship. Battering by male partners is the single most common source of injury to woman, more common than auto accidents, muggings, and rape by a stranger combined. Child sexual abuse is domestic violence and one out of three females will be sexually abused before the age of 18; over 70% by someone in their extended family. Children who watch abuse are 700 times more likely to repeat it with their partners; children who are also abused are 1000 times more likely to repeat it with their partners. Studies also show that women who abuse alcohol and other drugs are more likely to be victims of domestic violence.
Domestic violence is a learned pattern of violent behavior and coercive tactics that control the thoughts, beliefs, and conduct of a particular individual. Domestic violence may be as subtle as verbal or emotional abuse or as visible as physical injuries. Any of these forms of abuse may affect the ability of the W-2 participant to comply with work requirements. Abusers may deliberately interfere with a participant's struggle toward self-sufficiency in an effort to control and isolate the participant. They can actively interfere with self-sufficiency activities by causing the participant to miss planned activities, job interviews, or appointments by:
- Sabotaging child care arrangements. This may include failing to watch the children as agreed or harassing child care providers;
- Calling the work site and telling lies about the individual;
- Preventing the participant from leaving the house;
- Verbally harassing the individual at work, by telephone, or in person;
- Cutting off the individual's hair;
- Destroying mail for the participant from the W-2 agency;
- Destroying or hiding clothing needed for classes, interviews, or work;
- Keeping the individual up all night before interviews, scheduled activities, or tests;
- Restricting access to the family car; or,
- Turning off the alarm clock.
Non-compliance with work and work-related activities may occur frequently in households affected by domestic violence and could be the result of attempts by the abuser to control the actions of the participant. A very high number of women on cash assistance end up being battered because of the combined effects of batterer control and limited financial resources. The effects of battering often prevent a W-2 participant from taking positive steps to control her life, and follow through with her Employability Plan. Although the participant's behavior may appear to be non-compliant, it could indicate the need for further assessment and referral to a community agency for domestic violence services.
The battered woman lives in an environment where she rarely knows what will trigger an abusive episode, and often there is little, if any, warning of its approach. She spends a great deal of time and energy trying to read subtle signs and cues in her partner's behavior and moods in order to avoid potential violence, but she is not always successful. Financial constraints and fear that the batterer will act on his threats to harm family members or continually harass, stalk, and possibly kill her often inhibit victims from leaving. If the batterer is also the victim's drug supplier, that further complicates the situation. Assuming all these issues can be resolved, the effects of continual abuse and verbal degradation can be so inherently damaging to self-esteem that the survivor may believe that she is incapable of "making it" on her own.
W-2 agencies are encouraged to post materials about domestic violence in the office and on public bulletin boards to create an environment where victims know their situation is taken seriously and they have permission to talk about it. Post materials in the privacy of rest rooms so participants can maintain dignity and confidentiality while they review the materials and learn how to seek help and safety. Abuse is so common, FEPs should ask every participant about abuse in her life, and provide all participants with information about community resources. If the participant does disclose this information, offer to allow her to use your phone to call a crisis line or shelter to receive help, while she is in the safety and confidentiality of your office.
Whether or not a suspected victim of domestic violence discloses the abuse to you, always have the information on community resources available. Try to work compassionately and creatively with her in seeking help as this may be an opportunity for a conversation about the suspected domestic violence. Many times FEPs do not learn of abuse situations until a sanction occurs. If a woman is sanctioned be frank and forthright with her about domestic violence and its risks for her as a W-2 participant. The conversation could include:
I am very concerned about a person when I see the following (identify what has aroused your suspicion: non-compliance, late to appointments, or no-call/no-show, absences from work/training activities, bruises or other marks, frequent address changes, seeming evasiveness, etc.) Sometimes these indicate that a person is being threatened or hurt by someone in their life.
I know this is frightening for you, and I know you may not want to talk to me about this now. But, while we have some privacy I want to be sure you know there are places that can help protect you, and there are things you can do to increase your safety and that of your children. (Provide the participant with the information on available community resources.)
I am concerned about you. I want you to know you can always call me, and you can use my phone and this office to make the calls you need. Can I call you in a few days to see how you are?
Despite the physical and emotional abuse that they endure, battered women are usually strong survivors. With adequate resources, support, and safety, many women may not only create new lives for themselves, but may also become advocates for battered women's rights.
EFFECTIVE HELPING SKILLS
- Ask clients "What do you need most right now?"
- Explain that how we get our basic needs met is important, and that to achieve some degree of well-being, people must have certain basic needs met.
- Explain that there are different levels of need for different people; individuals are unique in how they define a quality life (for example, some people spend most of their time striving to maintain their lives at a level at which most others would not be satisfied.)
- Explain that improving someone's quality of life means looking beyond the surface.
- Take a holistic approach. It is important to address their needs, responsibilities, capabilities, and interests.
- Show clients that you consider them a whole person -- a person with a body, mind and spirit.
- Help them feel less stigmatized for having problems -- whether AODA, Mental Health, or Domestic Violence issues.
- Help instill the possibility for hope that your clients can deal with their problems rather than avoid or run away from them.
- Understand that in certain people the level of goals and efforts may be permanently deadened or lowered -- a person who has experienced life at a very low level (such as chronic unemployment) may continue to be satisfied if only food needs are met.
- Understand that you cannot make anyone change if they don't want to.
- Remember that you are human too so take care of your own mental health in order to serve your clients well.