Cultural Rounds in Mental Health

1. Cultural Rounds in Mental Health Domestic Violence in Latinos Presented by the Latino Newark team UBHC-UMDNJ Clinica Latina Cultural Rounds Sept 06

2. Special Thanks to Organizing Committee Carmelo Colon, ACSW, LCSW Latino Team Leader Newark Jeannine Burzynski, Mental Health Clinician II Evelyn Mejil, Mental Health Specialist Theresa Miskimen MD John Swanson, ACSW, LCSW Karen Somers, MA, MBA Esperanza Díaz, MD Clinica Latina Cultural Rounds Sept 06

3. Thanks to Participating Community Panelists Nancy Kessler, Esq. Domestic Violence Hearing Officer, Essex Jane Hanson, Esq. Executive Director Partners for Women and Justice Ruth Kleinman Director Babyland Violence Shelter for Women Clinica Latina Cultural Rounds Sept 06

4. And Speakers from UBHC-UMDNJ Jeannine Burzynski, Mental Health Clinician II Carmelo Colon, ACSW, LCSW Latino Team Leader Newark Clinica Latina Cultural Rounds Sept 06

5. Introduction • Domestic Violence in Latinos • The audience will learn specific characteristics of Latino victims to use in evaluation and specific approaches in treatment and interventions • This presentation is geared for professionals in mental health, judiciary system, health agencies and other areas addressing the cycle of violence Clinica Latina Cultural Rounds Sept 06

6. Agenda • Cultural remarks • Case presentation illustrating problem • Discussion from the panel Clinica Latina Cultural Rounds Sept 06

7. Cultural RemarksHispanic women deal with domestic violence in specific ways By Jeannine Burzynski Clinica Latina Cultural Rounds Sept 06

8. Cultural Barriers for a Latina in a Cycle of Domestic Violence 1 • Language barriers • Lack of education • Single motherhood • Dreams of furthering her education finding better jobs • Financial concerns but emotional obligation to send money to her relatives away • No supports from extended family • Possibly undocumented Clinica Latina Cultural Rounds Sept 06

9. Cultural Barriers for a Latina in a Cycle of Domestic Violence 2 • Frequently brought up to be subservient to her partner • Responsible for the upkeep of her home and child care • Religious beliefs affecting her ability to make constructive decisions about a destructive marriage. • Beliefs that anchored her to violence. Mother frequently modeled these beliefs Clinica Latina Cultural Rounds Sept 06

10. Cultural Barriers for a Latina in a Cycle of Domestic Violence 3 • Husband has power over her, forbidding her to take independent actions like work • Partner might exert control by giving very little money, being verbally or physically abusive • Reluctant to seek help even for injuries due to fears of retaliation when she gets back home Clinica Latina Cultural Rounds Sept 06

11. Cultural Barriers for a Latina in a Cycle of Domestic Violence 4 • She fears calling any authorities because of her undocumented status • She believes that if uncovered she would be deported • Dependent on her partner • Powerless due to lack of income, lack of job, lack of language, fear survival without her abusive partner Clinica Latina Cultural Rounds Sept 06

12. Consequences of this Powerless State • Depression • Isolation • Feelings of worthlessness • Constant fear • Lack of attention and concentration • Increased Startled reaction • Nightmares Clinica Latina Cultural Rounds Sept 06

13. Story Illustrating Domestic Violence in a Latina Presented By Carmelo Colon ACSW,LCSW “Identifying information was carefully removed to protect the confidentiality of this person. The facts are real and they resemble numerous cases of domestic violence.” Clinica Latina Cultural Rounds Sept 06

14. Story Illustrating Domestic Violence in a Latina • Latino woman in her mid 30’s • Consulted for nervousness, poor sleep, depression, crying spells, weight loss, decreased appetite, and suicidal ideation. • Complained of bruises on her abdomen and thighs that were explained by her as caused by small grotesque figures that made fun of her and poked her body. She also suffered from several physical problems. Clinica Latina Cultural Rounds Sept 06

15. Story Illustrating Domestic Violence in a Latina • Grew up poor and her education was limited. • She was victim of physical and sexual abuse during childhood. She witnessed domestic violence in her own home. • Initially she was given a Diagnosis of Schizoaffective Disorder and was offered treatment with tranquilizers and antidepressants. • Eventually she was referred to the UBHC- UMDNJ Domestic Violence program. In this program she was evaluated in Spanish by bilingual bicultural clinician. • She was able to trust and finally revealed she was being physically abused by her partner. Clinica Latina Cultural Rounds Sept 06

16. Story Illustrating Domestic Violence in a Latina Patient was treated for a total of 7 years in our Adult Outpatient Psychiatric Service with both individual and group psychotherapy, plus psychotropic medication maintenance Her psychotic symptoms responded quickly and favorably to anti-psychotic medications but her clinical depression became chronic and refractory to treatment Insight was very limited and she had exacerbation of her depressive symptoms in times of familial crisis, twice ending in hospitalization due to anger out of control and severe depression Clinica Latina Cultural Rounds Sept 06

17. Story Illustrating Domestic Violence in a Latina She was provided with support. The goal was to stop the violence cycle even though she continued with her maladaptive pattern of repetitive abusive relationships. The last one became the most violent with unlawful restraint, kidnapping, and battering. She consistently refused to engage the legal system against her assailants, and eventually this drove her adolescent children to abandon the family home. They eventually looked for help and protection The perpetrator then stopped beating her, but still was emotionally and verbally abusive. Frequently the victim stopped treatment being lost from service despite our outreach efforts Clinica Latina Cultural Rounds Sept 06

18. Newark Options Provided by Our Discussants: Nancy Kessler, Esq. Domestic Violence Hearing Officer, Essex County Jane Hanson, Esq. Executive Director Partners for Women in Justice Ruth Kleinman, Director Babyland Domestic Violence Shelter for Women Clinica Latina Cultural Rounds Sept 06

19. Preparing an Intervention in Domestic Violence 1 • 80% of women in domestic violence do not report the abuse • Intervention should be attempted only after prior preparations for the change to occur are in place • Consequences are discussed and well understood • There is a plan with necessary support systems in place Clinica Latina Cultural Rounds Sept 06

20. Preparing an Intervention in Domestic Violence 2 • Sufficient information in Spanish • Safe place to be for victim and her children -> know where she is going • Keep in mind Latinos do not have easy access to protection information -> there is a great need for education Clinica Latina Cultural Rounds Sept 06

21. Preparing an Intervention in Domestic Violence 3 • Information about shelter and options after shelter • Financial support what it is and it is not available • Legal proceedings explained and consequences understood Clinica Latina Cultural Rounds Sept 06

22. Legal Information • Family courts and local courts will not prosecute undocumented status in cases of domestic violence • Abuser is not going to come to court voluntarily thus there is a need to start legal proceeding but it could be done without pressing charges • Professionals need to have empathy for people with language barriers Clinica Latina Cultural Rounds Sept 06

23. Advice for Providers • Women in domestic violence develop ways to survive so they minimize, distanced themselves, detached, present a tough persona • Communication in their native language is crucial. If you cannot come across your immediate danger the situation will turn from bad to worse. Translators might missed the urgency and the negative impact on the victim finally calling for help could be tragic Clinica Latina Cultural Rounds Sept 06

24. Advice for Providers 2 • Starting a legal process is protective but it will take a life of its own. After starting it is hard to pull back • Victim is extremely ambivalent about the legal process • Victim faces a complex set of issues including undocumented, custody and visitation • Unless there is an immediate physical danger the first to do is to identify the domestic violence programs in the community and carefully prepare an intervention plan • Intervention should have the goal to stop the violence Clinica Latina Cultural Rounds Sept 06

25. Advice for Providers 3 • A call to 411 could be helpful • If finally police is called they will assist in reporting and they are required to make an arrest and to file criminal charges • Police is required by law to get a restraining order from a judge. The process goes emergency order->temporary order with a date in court-> final order: formal order of protection Clinica Latina Cultural Rounds Sept 06

26. Do not Want to Press Charges • If the woman does not want the police involved they could do a civil relief • They can come to the court when in session to look for protection and obtain a restraining order • Other protections could be obtained from the court but the woman needs to be trained to articulate her needs during the session: finances, custody, child support, etc These will not be discussed unless the woman asked for them to be included. Women should be prepared to ask for what they need Clinica Latina Cultural Rounds Sept 06

27. Babyland Shelter • Shelter in the Newark community • Offer many protections but for undocumented they have limitations due to lack of assistance • The core of the problem are the perpetrators but it is very hard to reach them. We need to address this problem. Court mandated orders doing some but not effective enough • Ideal is to have bilingual bicultural professionals. Translators useful as a last resource but they slow things down Clinica Latina Cultural Rounds Sept 06

28. Babyland Shelter Wisdom • A woman cannot ask for help. She is not supposed to talk. • Shelter is to protect. A protective environment is helpful but victims need time to heal and change choices • Referrals should be to a specialized program like the one at UBHC-UMDNJ Mental Health Clinic • Frequently women are fearful of revealing the violence and are protective of perpetrators (Movie presented) Clinica Latina Cultural Rounds Sept 06

29. Panel Wisdom for Mental Health Professionals • Instill hope • Empowerment by increasing self esteem • Identification of supports in the community • Provide clear useful information in their language as to how to protect themselves and to how deal with domestic violence • Concrete information about protection and support to develop a plan to stop the violence Clinica Latina Cultural Rounds Sept 06

30. Where to Get More Information • NJ Coalition for Battered Women 800 572 7233 http://www.njcbw.org/PDFs/spring2000new.PDF • www.njvictims.org • Linea de Ayuda de Violencia Doméstica Nacional 1 800 799 7233 • www.njsbf.org 1 800 free law • Domestic Violence Hotline 973 759 2154 • Servicio de atención telefónica de violencia familiar 800 572 SAFE Clinica Latina Cultural Rounds Sept 06