Omission is Oppression; Substantiation of Intimate Partner Violence Through Social Ecological Models
- Martha Pierce
- Feb 28, 2022
- 6 min read
Updated: Mar 7, 2022
The Social Ecological Model (SEM) identifies health to be influenced by the interactions between individual, community, and the physical, social and political environments; moreover, the SEM considers the entire ecological system in which growth occurs is required to be taken into account when related to health (Crawford, 2020). Founded on the Ecological Systems Theory by Brofenbrenner (Golden & Earp, 2012), who sought to, “craft a view of human development that could explain growth without examining deficits within the person” (Crawford, 2020, p. 1), the SEM emphasizes how one thing affects another, and existence does not occur in a siloed approach but in a relation to ever-changing circumstances. This is characterized with a symbiotic relationship between each level; specifically, how change in one level affects change in another. These levels are recognized as levels of influence and identified as the following:
Individual
The individual level is characterized by domains unique to the individual such as age, sex, socioeconomic status, race, knowledge and skills, and attitudes and behaviours (White, 2015). The consideration of the individual level from a health care perspective encourages trust and relationship building between individuals and the health care system.
Relationship
The interpersonal level considers how the social support of families, friends and other networks can influence individual behaviours (White, 2015). These factors must be considered as they form social and cultural norms and are based on the values of a society, which ultimately affect everything from laws to personal outcomes.
Community
Community level includes many settings such as schools, workplaces, and neighborhoods, where social relationships take place and can impact behaviours. Healthcare strategies in this context are designed to, “impact context, process and policies”(White, 2015, p. 108). In combination, the community, organizational and policy levels of influence can impact social norms and values.
Societal
Examples of the societal level are organizations and social institutions that affect how well programs and services are provided to an individual or group. Factors at this level play an important role in influencing the degree to which people have access to, or opportunities to change, and they can influence social norms and values (White, 2015).
Policy/Enabling Environment
This level includes systems at a local and national level and can influence on the broadest scale. Similar to the organizational level, the global/policy level can affect how well programs and services are provided to an individual or group. On this level, professionals have chances to pinpoint and progress strategies such as law, legislation, and policy to foster high level coalitions for widespread adoption (Crawford, 2020).
Intervention on many levels is encouraged with the SEM, in order to obtain a sustained impact and effectiveness overall (White, 2015).
As a result of the COVID 19 pandemic and the strain on Alberta’s health care system and staffing, I have recently been redeployed from my Addiction and Mental Health Policy Social Work position to work the front line as a Social Worker in the Emergency Department. As a reflection of this change in practice, I chose to apply the SEM to Intimate Partner Violence (IPV). The occurrence of IPV in emergency departments is highly elevated, and statistically significant (Cunradi et al., 2021). When we use the social-ecological approach in relation to IPV, it has the potential for disrupting traditions of abuse at the individual, family, community, and societal levels. IPV has presence throughout the world and does not discriminate with regard to its population. Incidents and occurrences of IPV span a significant amount of age, race, culture, and socio-economic backgrounds (Cunradi et al., 2021). Applying the SEM to IPV allows for understanding of the range of factors contributing to placing people at risk for violence; or, protect them from either perpetrating or experiencing violence (Centre for Disease Control and Prevention, 2022). The entire system is held accountable and responsible for both the factors for causation and prevention of IPV.
The Centre for Disease Control and Prevention (CDC) adapts the SEM and identifies four major factors.
In relation to the individual level, significant correlation for IPV is associated with an individual offender being a male in addition to this individual witnessing marital violence as a child (Ali & Naylor, 2013). These individual characteristics can contribute toward the reinforcement of violence and encourage recidivistic behaviours. Ali and Naylor (2013) further emphasized an individual who has an absent or rejecting father, in addition to significant alcohol use and childhood trauma are attributed to perpetrating violence, and IPV. When we identify the potential for these contributory factors with IPV, we can identify how lived experiences, socialization, and the unavoidable may contribute to the likelihood and threat of IPV. In my experience in both the emergency department and forensics, I have familiarized myself with the relationship of the individual and IPV; as it supports my assessment skills and clinical judgement abilities for both victims and perpetrators of IPV. As per Cunradi et al. (2021), regarding individual factors, “adverse childhood experiences were positively associated with frequency of IPV, and severe IPV, among men and women” (p.9).
A person’s closest social circle-peers, partners and family members influences their behavior and contributes to their range of experience. IPV applied in the relationship level of the CDC’s SEM identifies how the relationships we engage in such as marital, parental, and the attachments experienced from other family and friends subsidize IPV in society. Sometimes there is conflict within these relationships, fueled by stresses and ideological frameworks; such as males controlling the wealth and decision making within these relationships (Ali & Naylor, 2013). Furthermore, with regard to the community level, the CDC’s SEM highlights the institutions within our communities such as schools, hospital systems, neighborhoods, and workplaces and how the characteristics of these settings impact IPV. Viewing IPV from the community level considers the factors with potential to, “increase a person's vulnerability to commit or sustain violent acts” (Ali & Naylor, 2013, p. 7). It is imperative to identify if these communal spaces are safe, and what are the dynamics and conditions that may give rise to violence within these communal settings. Some of these conditions may be neighborhood poverty, residential segregation, and instability, high density of alcohol outlets (Centre for Disease Control and Prevention, 2022). IPV among women in neighborhoods below the poverty line had a significant correlation and positive association (Cunradi et al., 2021).
With regard to the Society level, IPV is impacted by the norms granting control over female behaviours. Patriarchal structure of societies, power and control issues, and learned helplessness are examples of how society impacts IPV; moreover, society has an acceptance of violence as a way to resolve conflict, in addition to the notion of masculinity being linked to dominance and honor (Ali & Naylor, 2013). Our society has rigid gender roles where we construct what these roles should look like (Ali & Naylor, 2013). On numerous occasions, in the emergency department, I have seen examples of how victims of IPV relay feelings of oppression, domination, and feelings of guilt towards inability to fit society standards of what a good wife or partner is.
After reading the work of my peers, it becomes apparent the SEM may be applied to numerous health issues effectively. A significant number of my peers highlighted the importance of interweaving the multi-levels of the SEM through comparison and analysis to illustrate their health topic at hand. Moreover, to successfully demonstrate how the SEM affects health issues, it was obvious in the work of my peers how the social determinants of health play a significant role. It was also observed from the work of my peers, there are both pros and cons when applying SEM’s to health issues; however, the elucidation of IPV from an interconnected multi-level model such as the CDC’s SEM is beneficial toward the successful development of strategies for prevention, treatment, and understanding (Centre for Disease Control and Prevention, 2022). When we identify how these levels interconnect, we provide perspective towards the complexity and dynamic nature of IPV; subsequently, validating the victims experience in addition to recognizing the contributing factors of IPV perpetrators. IPV ought to be combated cohesively, much like the importance of understanding the interconnected and combined roots of IPV’s inception. When we neglect to utilize the CDC’s SEM for IPV we continue to oppress the opportunity to reduce IPV by enabling victim blame, singularity, and normalizing violence. I view the CDC’s SEM as a macro level of advocacy within my social work practice, and hope to be able to attribute it’s veracity on a systemic level within AHS policy and governance.
References
Ali, P. A., & Naylor, P. B. (2013). Intimate partner violence: A narrative review of the feminist,
social and ecological explanations for its causation. Aggression and Violent Behavior, 18(6), 611–619. https://doi.org/10.1016/j.avb.2013.07.009
Centre for Disease Control and Prevention. (2022). Violence Prevention. The Social-Ecological
Model: A Framework for Prevention.https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html
Crawford, M. (2020). Ecological Systems Theory: Exploring the Development of the Theoretical
Framework as Conceived by Bronfenbrenner. Journal of Public Health Issues and Practices, 4(2), 2–7. https://doi.org/10.33790/jphip1100170
Cunradi, C. B., Ponicki, W. R., Caetano, R., & Alter, H. J. (2021). Frequency of intimate partner
violence among an urban emergency department sample: A multilevel analysis. International Journal of Environmental Research and Public Health, 18(1), 1–14. https://doi.org/10.3390/ijerph18010222
Golden, S. D., & Earp, J. A. L. (2012). Social Ecological Approaches to Individuals and Their
Contexts. Health Education & Behavior, 39(3), 364–372. https://doi.org/10.1177/1090198111418634
Lumen Learning (n.d.). Social ecological model [Clip art]. Google Images.
White, F. (2015). Primary health care and public health: Foundations of universal health systems.
Medical Principles and Practice, 24(2), 103–116. https://doi.org/10.1159/000370197
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