Phoenix VHA Domestic Violence Treatment: The STOP Program

Transcription

1 Phoenix VHA Domestic Violence Treatment: The STOP Program

2 Intimate Partner Violence (IPV) Veterans who experience or use violence in a current or former intimate relationship. DV/IPV must be understood in context that is, treatment must address and consider the role of contributing factors such as combat trauma; childhood trauma; ethnic, gender and cultural oppression; relationship dynamics; gender norms; mental health symptoms; and beliefs about violence, among others

3 Prevalance Veterans and active duty service members are at significantly higher risk than their civilian counterparts for using and/or experiencing violence (Marshall, 2005; O Campo, 2006; Sadler, 2004; Teten et al., 2010). Rates of use of DV/IPV across military populations range from 13.5 % to 58%, and rates of victimization among women Veterans range from 33% to 71%, depending on the setting (Coyle, 1996; Dichter, 2011; Iverson, 2012; Latta, 2010; Sadler, 2000).

4 Prevalance, cont. For Veterans, PTSD is an important correlate that may account for the relationship between combat exposure and the use of DV/IPV (Marshall, 2005; Taft, 2009). Additional correlates include military service factors, such as multiple deployments, prolonged separation from family, combat-related stress, financial stressors; relationship adjustment; childhood trauma; and demographic factors (Bell, 2006; Gerlock, 2004; Marshall, 2005).

5 Prevalance, cont. The multiple deployments of our youngest generation of Veterans put them at high risk for PTSD and interpersonal aggression, which increase their risk of using violence (Jakupcak et al., 2007; Millikin, 2007; Sayers, et al., 2010). Multiple studies have suggested that Veterans with PTSD are not only at higher risk for use of DV/IPV, but that severity and frequency of violence may increase over matched civilian samples (Glenn et al., 2002; Orcott, 2003; Taft, 2007).

6 Prevalance, cont. A small body of research has also demonstrated a relationship among co-occurring PTSD and substance use and use of DV/IPV among Veterans (Gondolf, 1991; Savarese, 2001; Zoric, 2003). One study found that frequent consumption of large quantities of alcohol and co-occurring hyperarousal symptoms of PTSD are related to use of DV/IPV among Veterans (Savarese, 2001).

7 Men s Issues in Treatment Gender Role Conflict- when men appraise a situation as representing manhood and perceive themselves as failing or potentially failing. Preoccupation with physical inadequacy Emotional inexpressiveness Preoccupation with subordination to women Presumption of intellectual inferiority Sensitive to performance failure

8 Men s Issues in Treatment Men are supposed to be Men are supposed to do Men are supposed to have Men are not supposed to

9 Typologies of IPV Offenders Generally Violent Aggressor (GVA)- early experiences that develop positive attitudes towards violence, negative attitudes towards women. Their relationship violence is a part of their general pattern of violent and criminal behavior. Generally antisocial. Family-Only (FO)- physical aggression emerges as a result of poor partner-specific communication skills, dependence on and preoccupation with the partner, and mild problems with impulsivity.

10 Typologies of IPV Offenders Low Level Antisocial (LLA)- overlap GVA and FO, don t meet full antisocial GVA criteria. Borderline/Dysphoric (BD)- Emotionally dysphoric/borderline domestic violence offenders, when confronted with relationship conflicts typically perceive them as threats of abandonment. Lacking skills, they impulsively use physical aggression to express their distress and anger. Holtzworth-Munroe (2ooo)

11 The Stop Program/Relationship Skills Training (RST Group) Group Facilitators/Treatment Team: Tyler Gabriel, PhD Clinical Psychologist Penny Miller, LMSW Veterans Justice Outreach Specialist Cindy Huerta-Montoya, LISW Social Work Case Manager Todd Dahl, LCSW Veterans Justice Outreach Specialist Kimberly Baerresen, MA Psychology Intern

12 The Stop Program/Relationship Skills Inclusion Criteria Training (RST Group) Must be Court Ordered Screening- Lethality Assessment by Veteran s Justice Outreach Staff, meeting IPV criteria Court Report Reviewed RST Group Orientation RST Group FAQ s 15 Commandments of STOP Provisional Status Policy Signed by Member

13 The Stop Program/Relationship Skills Training (RST Group) Structure of RST Group (Wexler, 2013) 26 sessions 15 member limit Males only Female Vet meeting criteria are referred to community programs New Members Admitted Once per Month Co-ed facilitators

14 The Stop Program/Relationship Skills Training (RST Group) Session Format Weekly Check-in Review of Homework Assignment New Lesson

15 The Stop Program/Relationship Skills Training (RST Group) 11 Graduates 2 Dismissed 13 Current Members

16 The Stop Program/Relationship Skills Training (RST Group) Member Evaluations Comments I thought it would be 26 weeks of hell- I was way wrong! I use the skills from this class towards all interactions with people. I appreciated the camaraderie with my fellow veterans in the group. I found I was not the only one with my specific problems or needs. Group leaders never missed a beat when it came to handling an issue. Glad they got rid of before I did.

17 The Stop Program/Relationship Skills Training (RST Group) Discussion and Questions