”NI-[I away. a .fi . . . ‘1‘ . ‘n. .2 . A .5151}, “3‘ 4‘ I". \~ 4 A. ‘1: K. ’ . .Jmf‘finfl. 251......» .r 7.... V .i e... . Wyflnuvw «Aggie rfifi . p \ .13... , Tnssvs I . If)“ This is to certify that the dissertation entitled AN EXPLORATION OF AFRICAN AMERICAN WOMEN’S EXPEREINCES WITH A CULTURALLY SPECIFIC DOMESTIC VIOLENCE INTERVENTION presented by TAMEKA LYNETTE GILLUM has been accepted towards fulfillment of the requirements for the Ph.D. degree in Ecological-Community Psycholgy _ Major Professor’s Signature 74,7, 07 Date MSU is an Affirmative Action/Equal Opportunity Institution LERARV'" ' Miohigan §tat§ WW PLACE lN RETURN Box to remove this checkout from your record. TO AVOID FINES return on or before date due. MAY BE RECALLED with earlier due date if requested DATE DUE DATE DUE DATE DUE AN EXPLORATION OF AFRICAN AMERICAN WOMEN’S EXPERIENCES WITH A CULTURALLY SPECIFIC DOMESTIC VIOLENCE INTERVENTION By Tameka Lynette Gillum A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Psychology 2004 ABSTRACT AN EXPLORATION OF AFRICAN AMERICAN WOMEN’S EXPEREINCES WITH A CULTURALLY SPECIFIC DOMESTIC VIOLENCE INTERVENTION By Tameka Lynette Gillum Despite over thirty years of tremendous progress addressing domestic violence, intimate partner violence still remains a serious problem. It remains the single greatest cause of injury to women in the United States. However, until recently, very little attention has been devoted to women of Color and women from disadvantaged backgrounds as distinct populations in the domestic violence research and literature. In general, research on intimate partner violence within families of Color remains sparse. This dissertation: 1) highlights the limited attention that has been given to examining intimate partner violence in the African American community; 2) defines and exemplifies culturally appropriate interventions and highlights the need for such interventions to address intimate partner violence within communities of Color; 3) argues for a qualitative investigation of African American women’s experiences with the only culturally appropriate domestic violence intervention in existence that targets the African American community, and 4) presents the results of this investigation and discusses its implications. There is limited research on intimate partner violence in the African American population and scarce attention has been paid specifically to the experiences of Afi’ican American women who have been battered. A number of researchers and theorists have identified some of the culturally specific factors that may contribute to intimate partner violence in African American interpersonal relationships. In light of the evidence and theorization on culturally specific factors contributing to domestic violence in African American relationships, several authors have indicated a need for culturally appropriate domestic violence interventions for African American survivors and perpetrators in order to adequately deal with the issues of intimate partner violence within the African American community. The purpose of this current study was to qualitatively investigate how helpful a culturally specific domestic violence program (Asha Family Services), which targets the African American community, has been to African American female survivors of intimate partner violence. The study also examined how women’s experiences with this culturally specific agency differed from their experiences with mainstream services. Fourteen African American female survivors of intimate partner violence who received domestic violence services from the Asha and three staff members from the agency were interviewed in order to define the agency and explore survivors’ experiences with it. Results suggest that this agency does indeed provide culturally specific domestic violence services which target the African American community and that survivors benefit greatly from these services. Survivors articulated many things that they found helpful about the services offered at Asha. In addition, survivors indicated that they benefited more from the culturally specific services provided by Asha than they had from mainstream domestic violence interventions. Implications for practice and research are presented. Copyright by Tameka Lynette Gillum 2004 This dissertation is dedicated to all women who are survivors of intimate partner violence and all those who have lost their lives at the hands of abusive partners. It is dedicated to all Women of Color survivors who have had to deal with the impact of racism in addition to dealing with their abusive experience. This work is done in hopes of improving services to survivors and the ultimate goal of a society free from violence against women and girls. ACKNOWLEDGEMENTS There are a number of people I wish to thanks for their assistance throughout the process of completing this dissertation. I will start with my dissertation committee. I want to thank my chair, Dr. Cris Sullivan, for her assistance in the conceptualization of this research project and for her guidance and support throughout the process of conducting this research. I wish to also thank Dr. Deborah Salem for her assistance in the creation of the measures and the data analysis process, which included long discussion meetings and reading and providing feedback on numerous coding schemes, and for her support throughout this process. I wish to thank Dr. NiCole Buchanan for her valued input in the planning stages of this research. I wish to thank Dr. Steve Gold also for his advice in the planning of this research, including advice surrounding the preliminary site visit. I wish to thank my research assistant, Jillian Henry, for her assistance in the conducting of this research. Jillian assisted with a wide variety of things including transcription, data verification, coding, and obtaining references, among other things. Her dedication to this work was well demonstrated and appreciated. I wish to thank the F ounder/CEO of Asha Family Services for allowing me to conduct this research at her agency and Asha’s staff for their assistance in recruitment of participants and providing space at the agency, which sometimes included their office space, to conduct interviews. I most importantly wish to thank all of the survivors who shared their experiences with me in order to make this research possible. vi I wish to thank my daughter, Shanae, for her support and patience throughout these seven years that I have been here at Michigan State working toward this ultimate degree. I hope I have provided a wonderful example for you and what you can obtain in life if you dedicate yourself to it. Lastly, I wish to thank my partner, Jaki, for her support and understanding during this intense last year of this process. vii TABLE OF CONTENTS LIST OF TABLES INTRODUCTION Domestic Violence in the African American Community Culturally Appropriate Interventions The Current Study METHODS Setting Procedures RESULTS Research Question Number One Research Question Number Two Research Question Number Three Research Question Number Four DISCUSSION Asha as a Culturally Specific Domestic Violence Agency Asha as a Helpful Resource for Survivors Limitations Implications and Recommendations for Practice Implications for Research APPENDIX A APPENDIX B APPENDIX C APPENDIX D REFERENCES viii 158 162 166 178 TABLES Table 1: Components of Culturally Appropriate Interventions 10 Table 2: Demographics of Survivor Sample 30 Table 3: Culturally Specific Components of Asha Consistent with Those Identified In the Literature 51 Table 4: Elements of Asha that Survivors Find Helpful 53 Table 5: Common Themes Identified as Helpful by Both Survivors and Staff 109 Table 6: Mainstream Services Compared With Asha 111 ix INTRODUCTION Despite over thirty years of tremendous progress addressing domestic violence, intimate partner violence still remains a serious problem. It remains the single greatest cause of injury to women in the United States, more common than car accidents, muggings, and rapes combined (Huang & Gunn, 2001; Russo, Koss, & Goodman, 1995; Thomas, 2000). It has been estimated that anywhere from 3 to 4 million women annually are physically abused by their partners, costing the US. health care system an estimated $5 - $10 billion yearly (Russo, Koss, & Goodman, 1995; Thomas, 2000). Domestic violence often results in injury, chronic health problems, heightened stress, and other mental health problems (Russo et al., 1995; Sutherland, Bybee, & Sullivan, 1998, 2002), as well as puts women at increased risk of poverty, divorce and unemployment (Browne, Salomon, & Bassuk, 1999; Russo et al., 1995). Intimate partner violence is a problem that cuts across all races, cultures and social classes (Coley & Beckett, 1988; Gillum, 2002; Huang & Gunn, 2001; Williams, 1993, 1994). However, until recently, very little attention has been devoted to women of Color and women from disadvantaged backgrounds as distinct populations in the domestic violence research and literature (Asbury, 1987; Hampton, 1989; Gillum, 2002; Harrison & Esqueda, 1999; Sorenson, 1996; Thomas, 2000; Thompson, Kaslow, Kingree, Rashid, Puett, Jacobs, & Matthews, 2000). In general, research on intimate partner violence within families of Color remains sparse (Thomas, 2000). Bearing this in mind, this dissertation: 1) highlights the limited attention that has been given to examining intimate partner violence in the Afi'ican American community; 2) defines and exemplifies culturally appropriate interventions and highlight the need for such interventions to address intimate partner violence within communities of Color; 3) argues the need for a qualitative investigation of Afiican American women’s experiences with the only culturally appropriate domestic violence intervention in existence that targets the African American community, and 4) presents the results of this investigation and discuss its implications. Domestic Violence in the African American Community There is limited research on intimate partner violence in the African American population and scarce attention has been paid specifically to the experiences of Afi'ican American women who have been battered (Gillum, 2002; Harrison & Esqueda, 1999; Huang & Gunn, 2001; Thomas, 2000; Williams, 1992, 1993). Due to the limited amount of available research, it is difficult to specifically assess the prevalence of intimate partner violence within the Afiican American community. However, from what research does exist we can assess that African American women experience incidence and negative affects of intimate partner violence at least at levels comparable to women in the general population (Brice-Baker, 1994; Thomas, 2000). Though early research on intimate partner violence within the Afiican American community asserted that rates were higher within this community (Straus, Gelles, & Steinmetz, 1980), subsequent research has dispelled this myth, validating that once socio-economic status is controlled for, African American families are no more violent, and may even be less violent, than their white counterparts (Cazenave & Straus, 1979; Coley & Beckett, 1988; Hampton, Gelles, & Harrop, 1989). However, more recently West (2002) has argued that Black women experience an alarmingly high rate of intimate partner violence. A number of researchers and theorists have identified some of the culturally specific factors that may contribute to intimate partner violence in Afiican American interpersonal relationships (Asbury, 1987; Brice-Baker, 1994; Brown, 1985; Cazenave & Straus, 1979; Collins, 1991; Hampton, 1980; Hampton, 1989; Hine, 1989; Willis, 1989). Staples (1982) was one of the first to do this. He suggested that Black families are under greater stress because of a belief held by many Black husbands that their wives will seek sexual satisfaction outside of marriage if they are not satisfied at home. He argued that jealousy, in conjunction with community norms that encourage extramarital affairs and regard marriage as a license to physically dominate women, contribute to violence in African American relationships. Asbury (1987) was another early pioneer in this work. She utilized an Afrocentric perspective to examine the experiences of African American women in violent relationships. From a review of the literature she identified many factors that may be contributing to violence in African American relationships. These factors included 1) flexibility and fluidity with the roles of African American males and females, 2) economic difficulty, which is pervasive in many African American families, 3) early exposure of children to violence in some Afiican American communities, 4) substance abuse, 5) arguments over children and pregnancy, and 6) questions about the wife’s fidelity and sexual problems. Asbury also identified factors that influence an African American woman’s decision to seek help or not, which included 1) feelings of social isolation, 2) feelings that they may not be understood or welcomed at shelters, and 3) reluctance to seek help because of internalized common stereotypes about African American women including that of sexual temptress, ugly mammies, bridges that hold the family together, and/or emasculating matriarchs. Willis (1989) proposed that when the African American male meets the African American female he sees someone whom he has been told is dominant in the family, “a castrating black woman (the matriarch)” He argued that Afiican American males and females have been programmed from an early age, by society, to be destructive of each other, and as a result mate selection in the African American community is predicated on negative stereotypes, which increases the likelihood of problems in the relationship. Patricia Hill Collins (2000) identified stereotypes of African American women (e. g., mammies, matriarchs, jezebels and welfare mothers) as controlling images that cause Afiican American men to objectify African American women. Collins (2000) contended that these images, created by White Americans during the slave era and beyond, have served to control and oppress African American women and reflect the dominant group’s interest in maintaining Black women’s subordination. With this in mind it is not difficult to conceive that a belief in these images by Afiican American men may also prompt a desire to control, oppress, and subordinate African American women in relationships, especially since it is believed that some African American men may wish to become “masters” in their relationships by fulfilling traditional, Eurocentric, white defined definitions of masculinity. Collins (2000) also argued that if these Afiican American men are blocked from doing this they may become dangerous to those closest to them, implying that attitudes formed from a belief in these stereotypes increases the risk of violence in relationships between African American men and women. More recently, other authors have begun to take a much Closer look at the links between cultural issues specific to the African American community and intimate partner violence. Brice-Baker (1994) examined domestic violence in African American and Afiican Caribbean families. The author began by presenting factors that interfere with researchers being able to get an accurate estimate of the prevalence of domestic violence and then presented some theories that have been proposed to explain family violence. She indicated that a societal tolerance for violence against Blacks in this country, as well as the myth that violence is an acceptable and condoned part of Black culture and Black family life, contribute to intimate partner violence in Afiican American communities. Also highlighted was the impact of the harsh realities of institutional and internalized racism experienced by African American men and their contribution to low-self esteem (a characteristic often attributed to batterers) of African American men. Economic distress in Afiican American communities was discussed as a possible contributor to the infliction of violence on Afi'ican American women by African American men as well as a possible reason why Afiican American women stay in these abusive relationships. The impact of stereotypes about African American women was also identified as a contributing factor. Brice-Baker argued that Afiican American women have been stereotyped as l) unattractive, 2) the glue that holds the family together, 3) matriarchs, and 4) love objects and sexual temptresses. These images suggest that African American women are somehow at fault for the violence they experience. Thomas (2000) also theorized about cultural factors that contribute to intimate partner violence within the Afiican American community. He cited the tolerance for violence against Blacks in this country and the myth of violence as an accepted and condoned part of African American family life. He also suggested that environmental factors, including but not limited to unemployment, economic difficulties, racism, racial stereotyping, and economic inequalities, all of which disproportionately affect African Americans, sustain environments which promote or allow interpersonal violence. Thomas also asserted that racial stereotypes of African American women can serve to undermine their self-esteem and must be addressed in any type of intervention designed to assist African American female survivors of intimate partner violence. Most recently, Gillum (2002) provided evidence for a link between stereotypes about African American women and intimate partner violence in the African American community. She found that Afi'ican American men’s beliefs in the matriarch and jezebel stereotypes were positively related to their belief in the justification of intimate partner violence against African American women. In light of the evidence and theorization on culturally specific factors contributing to domestic violence in African American relationships, several authors have indicated a need for culturally appropriate domestic violence interventions for Afiican American survivors and perpetrators in order to adequately deal with the issues of intimate partner violence within the African American community (Brice-Baker, 1994; Coley & Beckett, 1988; Gillum, 2002; Gondolf & Williams, 2001; Sorenson, 1996; Uzzell & Peebles- Wilkins, 1989; Williams, 1992; Williams, 1993, 1994a, 1994b). Thomas (2000) indicates that while services for survivors have necessarily been gender specific, they have not generally been culturally specific. Culturally Appropriate Interventions Culturally appropriate interventions are those designed specifically for a target population (Alcalay, Alvarado, Balcazar, Newman, & Huerta, 1999; DeLamater, Wagstaff, & Havens, 2000; Robinson, Uhl, Miner, & Bockting, 2002; Young, Gittelsohn, Charleston, Felix-Aaron, & Appel, 2001). They utilize language and settings familiar to the culture of the target population as well as staff that represent that culture. They are designed in collaboration with members of the target population and take into account their culture-specific values, norms, attitudes, expectations and customs (Alcalay et al., 1999; DeLamater et al., 2000; Nicholson & Kay, 1999; Peterson & Mar'in, 1988; Pruett, Davidson, McMahon, Ward, & Griffith, 2000; Robinson et al., 2002; Thompson, Davis, Gittelsohn, Going, Becenti, Metcalfe, Stone, Harnack, & Ring, 2001; Young et al., 2001). These interventions are delivered in synchrony with the participants’ cultural framework (Gregg, Narayan, Kumanyika, & Agurs-Collins, 1998). Researchers have identified culturally appropriate interventions as important for a number of reasons. Mainstream interventions have often failed to reach certain racial/ethnic minority populations for various reasons from language barriers to isolation of these populations from mainstream American society due to cultural differences, prejudice, and racism. Many mainstream interventions fail to diverge from their standard modes of operation and dissemination, which often are not effective in reaching minority populations (Alcalay et al., 1999; Peterson & Mar'in, 1988). Pruett et al. (2000) have indicated that in order for an intervention to be acceptable to a target population, it must be culturally sensitive and appropriate and developed in collaboration with the population being served. Erickson & El-Timimi (2001) have argued that in order to effectively work with “culturally different” populations one must use culturally appropriate interventions. Nicholson & Kay (1999) also see culturally appropriate interventions as important for the purposes of re- connecting those they serve to their own cultural values, beliefs, and networks. Gondolf and Williams (2001) point out that African Americans are often suspicious of mainstream social services because they tend to be dominated by whites and they tend to see whites as unfamiliar and unsympathetic to their social reality and experiences. So, what are the components of a culturally appropriate intervention? Many researchers have suggested components for the development of such interventions. One important component is that they should be developed in collaboration with members of the target population and relevant stakeholders (Alcalay et al., 1999; Pruett et al., 2000; Thompson et al, 2001; Young et al., 2001). Next, they must use language that is familiar to the target population (Alcalay et al., 1999; DeLamater et al., 2000; Young et al., 2001). For example, if an intervention is targeting a population of whom the majority speak Spanish as their first language, materials and instruction should be made available in Spanish as well as English. If an intervention is targeting an adolescent population, language should be used that is consistent with the adolescent lingo of that generation. Also, channels of information dissemination must be used that will actually reach the target population (Alcalay et al., 1999; Peterson & Mar’in, 1988). If a target population is more likely to watch television or listen to the radio than pick up and read literature, an intervention must utilize these forms of media to successfully reach the population. Further, staff implementing the intervention should be representative of the target population, persons with whom the recipients can identify (Alcalay et al., 1999; DeLamater et al., 2000; Nicholson & Kay, 1999; Robinson et al., 2002; Thompson et al., 2001). Participants are more likely to feel comfortable in an environment where they see and interact with staff members that are “like them.” This is especially true for people of Color who may typically interact with predominantly White staff in service provision agencies and feel invalidated or disempowered in those interactions, or for youth who are used to adults “telling them what to do.” In addition, interventions should be conducted in an environment that feels comfortable and safe to participants. This type of environment may take more time and effort to build for racial/ethnic minority groups who may be distrustful of social services in general or come from cultures where it is frowned upon to discuss or share “family business” or personal issues with “strangers” or “outsiders” (Al-Krenawi & Graham, 2000; Erickson & Al-Timimi, 2001; Gondolf & Williams, 2001; Nicholson & Kay, 1999; Young et al., 2001). This may include carrying out the intervention in a physical space that is familiar and comfortable to participants and/or including artwork or other items culturally relevant to the target population in the intervention space, in addition to representative staff. It would also include adequate time for the building of trust and rapport. Another important component is that the cultural values, norms, expectations, and attitudes of the target group need to be integrated into the messages and into the format of the intervention (Alcalay et al., 1999; Al-Krenawi & Graham, 2000; DeLamater et al., 2000; Erickson & Al-Timimi, 2001; Gondolf & Williams, 2001; Nicholson & Kay, 1999; Peterson & Mar'in, 1988; Pruett et al., 2000; Robinson et al., 2002; Thompson et al., 2001; Young et al., 2001). Included in this is consideration for the family-centeredness of collectivist cultures. Most mainstream interventions in the US. have been designed according to the values of western individualist societies. For collectivist cultures, as many communities of Color are, consideration needs to be given to the family, both immediate and extended, and inclusion of them, whenever possible and necessary, in the intervention process (Al-Krenawi & Graham, 2000; Erickson & Al-Timimi, 2001; Gondolf & Williams, 2001; Nicholson & Kay, 1999; Peterson & Mafin, 1988; Pruett et al., 2000; Young et al., 2001). Also included in this is the importance of building social support networks for intervention participants (Nicholson & Kay, 1999; Young et al., 2001). African American women specifically have mentioned social support as a motivating factor in intervention efforts (Young et al., 2001 ). For target populations that have been especially isolated, assisting them in building support networks with people who share common cultural values can be especially helpful and validating (Nicholson & Kay, 1999). See table 1 for a concise list of these components. Table 1 - Components of Culturally Appropriate Intervention Developed in collaboration with the target population and relevant stakeholders (Alcalay et al., 1999; Pruett et al., 2000; Thompson et al, 2001; Young et al., 2001) Use of language familiar to the target population (Alcalay et al., 1999; DeLamater et al., 2000; Young et al., 2001) Use of channels of dissemination which will successfully reach the target population (Alcalay etal., 1999; Peterson & Mafin, 1988) Representative staff (Alcalay et al., 1999; DeLamater et al., 2000; Nicholson & Kay, 1999; Robinson et al., 2002; Thompson et al., 2001) Conducted in an environment comfortable for participants (Al-Krenawi & Graham, 2000; Erickson & Al-Timimi, 2001; Gondolf & Williams, 2001; Nicholson & Kay, 1999; Young et al., 2001) Incorporation of cultural values, norms, expectations and attitudes of target group into the intervention (Alcalay et al., 1999; Al-Krenawi & Graham, 2000; DeLamater et al., 2000; Erickson & Al-Timimi, 2001; Gondolf & Williams, 2001; Nicholson & Kay, 1999; Peterson & Marin, 1988; Pruett et al., 2000; Robinson et al., 2002; Thompson et al., 2001; Young et al., 2001) 10 Some culturally appropriate intervention programs have begun to be implemented which target the African American community. One such program was a culturally appropriate STD/AIDS education intervention which targeted Black male adolescents (DeLamater, Wagstaff & Havens 2000). The authors’ intervention consisted of two distinct components: a videotape intervention and a health educator intervention. Both were developed with the intention of promoting condom use among African American males aged 15 to 19. The culturally appropriate videotape was created through collaboration with an African American video production team with the assistance of local African American male adolescents. These adolescents helped develop and film the video as well as acted in the video. The video used actors, music, dress and language salient to the target population. The video included information geared toward educating youth about STDs and HIV including dispelling prevailing myths about the contraction of STD/HIV, facts about contracting STD/HIV, instructions on how to properly use condoms and the stories of African American youth who had contracted an STD or HIV. The use of video allowed the intervention designers to use dialogue, music, lyrics, images and personal stories to present their messages. The other component of this intervention included the relaying of this same information in a face-to-face session with an African American trained health educator. The use of a trained educator of the same racial/ethnic group allowed for the incorporation of a more personal, concerned touch. Both types of intervention proved beneficial to the youth, increasing condom use and knowledge (DeLamater et al., 2000). ll Similarly, Robinson, Uhl, Miner & Bockting (2002) implemented a culturally appropriate sexual health intervention targeting low income, urban, primarily African American women. This intervention incorporated HIV and sexually transmitted disease prevention strategies combined with sexuality education. First, this program was developed through collaboration between a university based Human Sexuality program and three community-based organizations serving the African American community. In addition, focus groups with the African American target group were conducted prior to curriculum development and prior to the study’s design phase. Second, innovative recruitment strategies were used. Participants were recruited through the three collaborating community agencies, community-based organizations, businesses serving primarily African Americans, community newspapers, and community activities and celebrations. Third, professional and paraprofessional African American staff served as intervention facilitators and small-group leaders. In addition, since this was a trial, female interviewers were recruited from the target population and from collaborating agencies and trained to administer the interview protocol. Benefits of this intervention included improved sexual anatomy knowledge and increased positive attitudes towards the female condom. Young et a1. (2001) utilized results from focus groups conducted with African American women to develop two culturally appropriate interventions designed to increase healthy physical activity among African America women. The first, Project EXE-L, was designed to increase daily physical activity behavior among African American women. This intervention was conducted in Churches, creating a comfortable environment for participants. It used language familiar to the target population. The 12 program was designed to optimize social support among women in the intervention, including such approaches as pairing women with “buddies” who regularly provided support for participants. Classes conducted as part of the intervention incorporated prayer and inspirational scripture. They were led by certified aerobic instructors from the African American community and were accompanied by gospel music. The second intervention, WIN, was designed with the intention of controlling high blood pressure among African American women. This included working toward goals not limited to but including weight loss, increased intake of fruits and vegetables, and increased physical activity. This intervention was also conducted in a community church. Again, language was used that was familiar to the participants and motivational pieces were incorporated into group sessions. Results from these interventions are still forthcoming (Young et al., 2001). Examples of successful culturally appropriate interventions targetinggother communities of Color exist as well. Salud para su corazon was an intervention designed for the Latino/a community with the goals of increasing awareness about heart disease, raising knowledge about cardiovascular disease (CVD) prevention and promoting heart- healthy lifestyles. First, a community profile was generated which gave the intervention designers insight into identifying the target audience. Then, focus groups were conducted with the target population in order to identify the community’s knowledge and attitudes about heart disease and its risk factors, media usage and preferences as well as publication and material needs preferences. The authors used this information as a basis for selecting and developing messages and deciding the type of materials most appropriate for their awareness campaign. Interviews were also conducted with 13 community leaders for added insight and to secure the community’s involvement and support of the intervention. A Community Alliance of relevant stakeholders was created whose purpose was to have a partnership role in the planning, development, and implementation of the campaign and to serve as a link between the sponsoring organization and the community. Hence, incorporation of the target community’s voice was done in several ways. A multimedia intervention program was then designed. It included the creation and dissemination of bilingual materials for health care professionals; the use of Spanish language television to broadcast a series of 30-second humorous narrative public service announcements which were in Spanish, starred a Latino family, and used culturally appropriate settings and language; discussion groups; and the development of training materials, an implementation manual, and motivational videos. This program also showed great benefits to the community, including increased awareness of risk factors for CVD (Alcalay et al., 1999). Nicholson & Kay (1999) discussed the development and implementation Of a culturally appropriate group treatment intervention aimed at Cambodian refugee women to help them deal with their adjustment to their new lives in the United States. Several features made this a culturally appropriate intervention. First, group leaders (there were two) included a bilingual Cambodian social worker. This was important as it created the presence of someone the women could identify with and also left the women free to speak in their native language, Khmer. The other group leader, although white, was an older woman. This was also significant in that Cambodian culture attributes wisdom to age. Culturally appropriate activities and discussions were conducted in order to help provide a safe environment for women. Group sessions included sharing traditional 14 Cambodian meals, which allowed for more informal socialization and helped facilitate an increase in women’s social support networks. Women were also provided the opportunity to express topics and activities they would like to see in the groups, which were subsequently included, as well as had the opportunity to lead groups themselves. This group also resulted in significant benefits for the women involved. Culturally specific domestic violence programs Some authors have made additional suggestions for culturally specific domestic violence interventions targeting the African American community. They include recognition that many African Americans turn to family and religious leaders for sources of support (Brice-Baker, 1994). It is also important to understand that women may want the abuse to stop but not want anything “bad” to happen to their spouse (Brice-Baker, 1994). The incorporation of both support groups and individual work in treatment plans for Afiican American women has also been suggested. The groups should include structured exercises focused on self-esteem building, including emphasis on how racial stereotypes of Black women affect self-esteem. They should also include development and reinforcement of existing coping skills, including exploration of the fact that Black women need not accept mainstream standards of success and can create their own standards based on their cultural norms. These groups should also serve to decrease isolation and provide emotional support (Brice-Baker, 1994; Thomas, 2000). In reference to working with African American men who batter, an intervention must be capable of communicating disapproval of battering behavior without perpetuating racial stereotypes. There also must be recognition of oppression and other negative experiences that African American men encounter without excusing their behavior (Brice-Baker, 15 1994; Thomas, 2000; Williams, 1992, 1994a). In addition, these men need to be educated about the origins of stereotypes about African American women and made aware of the ways in which they permeate our society and how they negatively affect their relationships with Afiican American women (Gillum, 2002). The Current Study The purpose of this current study was to qualitatively investigate how helpful a culturally specific domestic violence program (Asha Family Services), which targets the African American community, has been to Afiican American female survivors of intimate partner violence. The study also examined how women’s experiences with this culturally specific agency differed from their experiences with mainstream services. Therefore, the specific research questions posed for this study were: 1) How does Asha define their culturally specific domestic violence intervention? 2) What elements of African American women’s experience at Asha Family Services have been most helpful to them? a. Do women identify culturally specific components as helpful and if so, which ones? 3) For women who have a history of service involvement with mainstream services, what were their experiences with these agencies and how is their experience with Asha different from those experiences? 4) What culturally specific intervention components, if any, do survivors and staff identify as desirable that do not yet exist? As the domestic violence movement is beginning to pay attention to issues of 16 diversity and recognize the need for culturally appropriate interventions, it is important to investigate women’s experience with one such existing program to find out which aspects are particularly helpful to women so that they may be modeled in subsequent programs. It is also important to examine how experiences with culturally specific programs differ from experiences with mainstream services to highlight the importance and usefulness of culturally appropriate programs. There has been a general call for additional research to aid in the development of culturally specific programs (Gregg et al., 1998; Peterson & Mafin, 1988). Gregg et al. (1999) have specifically called for the use of qualitative methods for such research indicating that these techniques are optimal for obtaining adequate understanding of culturally specific group interventions. METHODS This study used qualitative methodology in order to achieve its research goals. A primary strength of qualitative inquiry is its capacity to allow for an exploration of research participants’ interpretations of their experiences and the meanings they create from these experiences. This approach is also empowering to participants as it allows for individuals to tell their stories in their own words (Banyard & Miller, 1998). Therefore, the use of qualitative methods allowed for me to explore, in depth, women’s experiences with Asha through an empowering mode of inquiry. Participants were afforded the opportunity to talk about their experiences and tell their own stories, in their own words. A phenomenological approach was used in this research process. The main purpose of this approach is to understand the essence of lived experience of an individual or group of individuals. Individual interviews specifically are particularly useful for understanding individuals’ perspectives and gathering their stories (Patton, 2002). With 17 this research I was seeking to understand the experiences of Afiican American women who utilized the services of Asha Family Services, the only known program in the country that defines itself as a culturally specific domestic violence intervention targeting the African American community. Therefore, a phenomenological approach was most in line with the purpose of this study. Setting What is Asha Family Services? Asha Family Services, located in Milwaukee, Wisconsin, is the only culturally specific domestic violence intervention serving the African American community. Milwaukee itself is a mid-sized, midwestem city. Milwaukee County, in which the city of Milwaukee is located, is home to approximately 940,164 residents according to the 2000 Census. Twenty-five percent of the county’s residents are African American, compared to 5.7% total in the state of Wisconsin. Asha Family Services was founded in 1989 by its current Chief Executive Director, Ms. Antonia A. Vann. Asha Family Services defines itself as follows on their agency website: “Asha Family Services, Inc. is a private, non-profit, spiritually-based agency whose goal through collaborative efforts is to provide comprehensive family violence and substance abuse intervention for victims and perpetrators of domestic violence that is culturally specific (Asha Family Services, Inc., Website, http:/hvww.Ashafamilyservices.gry_r_; Annual reports 200-2002, 2002).” Asha Family Services also defines itself as follows on their agency paperwork: 18 “Asha Family Services, Inc. is a community-based, private, non-profit, people of color- governed organization committed to providing effective family violence intervention and prevention for all families and persons affected by violence in their home. Specializing in skilled services specific to African American populations since 1989, our goal through collaborative efforts is to treat ills and facilitate healing and growth in families. Asha employs spiritual, holistic, and culturally specific treatment methods with the background, training and skill to provide treatment specific to many Afiican American families.” Asha further specifies that its services target high-risk populations (women, children, and men who are at or below poverty level residing in the city and county of Milwaukee) with the ability to provide culturally specific services and programming for many Afiican American families (Asha Family Services, Inc., Annual Report, 2000- 2001; Asha Family Services, Inc., Website, http://www.Ashafamilvservices.com). Mission Asha Family Services’ Mission is as follows: Asha believes in the preservation and strengthening of the African American family. To this end, we are committed to the provision of a spiritually-based, holistic and culturally responsive service designed to end violence against African American women and children specifically, families of other communities of color and all families in general. Our belief is that in order to adequately address family violence and promote healthy living, we must treat the abuser as well as the abused. Asha Family Services also believes in the provision of a continuum of care, not only for the transformation, restoration and empowerment of injured families, but also for 19 a range of clientele including persons at high risk for HIV infection and other communicable diseases, mental health and substance abuse outpatients, and those incarcerated and transitioning back into the community. A healthy and vibrant community is a reflection of strong, healthy, vibrant, and resourceful families residing in it and Asha is committed to promoting this positive symbiotic relationship (Asha Family Services, Inc., Website, hgp://www.Ashafamilyservices.cor_n; Annual Reports 2000- 2001, 2002). Philosophy Asha articulates its philosophy as follows: Asha Family Services proceeds from the assumption that the total person -- mind, body and spirit — must be recognized and attended to for restoration. Therefore, Asha’s approach is holistic, meaning an individual is not addressed on the basis of a single issue, but by the unique combination of circumstances and needs that each presents (V ann, 2003) Programs and Services Asha Family Services offers a variety of programs services at various points in time. Below is a complete list of all the programs and services they offer. What programs and services are offered at certain points is contingent upon funding that the agency receives during a particular time point. Programs for Women Asha women of Color “Sister Circles Since 1989, Asha has provided a safe space for survivors to exchange ideas and discuss their experiences. The group seeks to help to eliminate fears and foster feelings of friendship, respect, sisterhood and trust 20 between women of the same group ancestry. Sister Circle groups are active for women of color and those who wish to join them. Members may receive domestic abuse and sexual assault information and prevention, safety planning, intimate partner and sex related issues education, HIV/AIDS and other STDs education, information and referrals. Services are via peer-support and credentialed staff counseling. Sister Circle groups include groups for those who are post and currently incarcerated women via our Corrections Care Continuum. Groups are offered twice a week for l‘/2 hours each group session. Transportation is also provided (Asha Family Services, Inc., Website, hgp://www.Ashafamilvservicesxorg) Programs for Men The Ujima men’s educational program. Since 1995, Asha has run a 24—session, non-traditional abuser treatment program which was developed by and for Afiican American men. Its culturally specific curriculum was designed for Black males over the age of 17 who are having problems with inappropriate expressions of anger, conflict resolution, and physical violence towards a spouse or partner. Men are given domestic abuse and sexual assault information and education, information and education on intimate partner relationships and other sex related issues, HIV/AIDS and other STDs education, information and referral. There are day, evening and weekend groups (Asha Family Services, Inc., Website, http://wwwAMilyservicesxog) The “Brother to Brother ” fatherhood initiative. This program serves as a stand- alone aftercare of Ujima. It is a resource designed for the self-development and relationship development, training and support for healing between Afiican American 21 males, their women, children, families and community (Asha Family Services, Inc., Website, http:l/www.Ashafamilyservicesxom) Brothers Against Domestic Violence. Through this service Asha offers a bodyguard escort service and emotional support to help women feel safe while going through the process of obtaining a restraining order, court appearances, or any outing that the victim may feel unsafe (Asha Family Services, Inc., Website, http:l/www.Ashafamilyservices.com). C o-Gender Programs Corrections Care Continuum (CCC). Since 1990, Asha has provided comprehensive services to male and female offenders incarcerated in facilities around the state of Wisconsin. In-custody victim support groups are established in female prisons and transition case management services are provided for women re—entering the community. Family violence education groups are conducted regularly in prisons for men. Services are set up to support a smother transition of these men who are re-entering the community. CCC also serves as a community-based after-care including AODA and mental health case management for ex-offenders who have completed treatment programs while in custody (Asha Family Services, Inc., Website, ht_tp://www.Ashafamilyservices.cor_nQ. Programs for Children Our Children Advocacy Project (OCAP). Since 1990, Asha has provided services on site and at area schools. OCAP provides direct services, advocacy, and support for children who witness or experience domestic violence. OCAP’s goals are to break the isolation of children who experience violence in the home, teach children and youth how 22 to protect themselves by developing safety and support systems, promote emotional and physical health as well as strengthen self-esteem (Asha Family Services, Inc., Website, ht_tp://www.Ashafamilyservices.corn). Young Sisters support group. This program uses a didactic/experimental approach to address the life management needs of the participants. It is designed to assist participants in the development of emotional competencies, alternatives to aggressive thinking strategies and anger management of females ages 13-17 with the primary focus on African American females (Asha Family Services, Inc., Website, ht_tp://www.Ashafamilyservicesxorn). Ujima Jr. for teens. This 16 week group is an “alternative to aggression” course for African American males ages 13-17. The curriculum is designed to address emotional competence, including the expression, understanding and regulation of emotions such as anger, as well as alternative thinking strategies. Drugs, illegal behaviors, sex-related issues, HIV/AIDS and other STD education and referral, relationship issues, and abusive behaviors are addressed (Asha Family Services, Inc., Website, ht_tp:l/www.Ashafamilyservices.com ). Services SOAR Resource (Solutions & Options Applied with Respect). Since 1998, Asha has provided services, including domestic abuse, mental health and substance abuse treatment, for Welfare to Work job seekers in Milwaukee county. Family and individual case management. Since 1995, qualified family violence prevention advocates at Asha have provided intense case management, advocacy and referral services for families who need assistance in accessing a variety of community 23 services and supports. Services are provided both on-site and through home visits (Asha Family Services, Inc., Website, hgp://www.Ashafamilyservices.com). Substance abuse and mental health treatment services. Since 1995, Asha has operated a community-based, state-licensed outpatient mental health and substance abuse treatment clinic that targets the African American community and specializes in family counseling regarding childhood and adult victimization, anger, grief and stress behaviors and the intersections between family abuses, mental health and substance abuse problems. Frequency and duration of sessions vary by individual need and services are offered on a sliding scale based on income (Asha Family Services, Inc., Website, h ://www.Ashafami services.cor_n_). Asha also provides a number of other services including: pre/post partum depression screening by which assessment is applied for depression during and around the time of pregnancy and linkages enhanced to community-based intervention services for depression that are age and culturally specific for women of reproductive age; HIV/AIDS outreach and education provided by trained Disease Intervention Specialists (DIS) who actively seek and engage individuals within Milwaukee County who may be at high risk for HIV infection and other communicable diseases; OCAP parenting sessions for parents and child caregivers which utilizes a didactic/experiential approach for the enhancement of basic parenting skills and a strengths based approach to women and their families; TTY telephone information service for deaf and hearing impaired; computer classes for adults and children to train and educate them on current computer programs; and community education/training which provides inter-personal violence presentations for schools, churches, correctional facilities, social service agencies and 24 other organizations and businesses on the issues of family violence and working with African American populations (Asha Family Services, Inc., Website, http://wwwAshafamm/services.com). Asha served 5,099 clients in 2000 and 3,987 clients in 2001. At least 678 clients in 2000 and 845 clients in 2001 were women seeking services because of domestic violence (Asha Family Services, Inc., Annual Report, 2000-2001; Asha Family Services, Inc., Website, http://www.Ashafamilvservicescom). Asha Family Services works primarily out of two sites located in close proximity to each other in the city of Milwaukee. One is the administrative office, which handles all administrative business and houses all staff related to such business. The other office, considered the “Customer Care” center, is the site from which the majority of client services are conducted. Setting Access I gained access into the site through the CEO and founder of the agency, and conducted a preliminary site visit with the agency. It was at this point that I met the majority of staff in the agency. I was welcomed into the agency and assured that I would have access to participants and programs as needed for the purposes of this research. An administrative agreement outlining these arrangements can be found in Appendix A. Access to this setting was relatively easy throughout the process of this research. I received assistance in obtaining respondents from agency staff, and was afforded space in the agency for recruitment and interviewing. 25 Procedures Multiple sources of data were used for this study, including archival analysis, interviews with agency leaders and staff, and interviews with survivors receiving agency services. Research Question One In order to answer research question number one, “How does Asha define their culturally specific domestic violence intervention?” two data sources were utilized: archival analysis and interviews with agency leaders and staff. Archival Analysis A content analysis of archival data was conducted in order to get a better understanding of the agency. This involved the collection of agency paperwork related to the agency philosophy, mission, programs, and activities. Included in this were annual reports for years 2000-2001 and 2002, pamphlets, brochures, advertisements, program descriptions and website information. Some of this information was obtained during a preliminary site visit and examination of the agency’s website, and the remainder were received during subsequent visits to the agency. This paperwork was compiled and coded in respect to which of the following areas it contributed insight into: defining the agency itself, agency philosophy and mission, agency programs and services, culturally specific elements of the intervention and the agency’s funding sources. Culturally specific elements were identified by both what the agency itself identifies as culturally specific component of their intervention as well as what has been identified as culturally specific intervention components by the literature. This information was then used to describe the agency. 26 Key Stafir and Leader Interviews Key staff members were interviewed in order to obtain some of this same information, as well as to gain their perceptions of women’s utilization and experience with the agency. Sample. Interviews were conducted with the Coordinator of Victims Services, for an administrative perspective, and two of Asha’s women’s advocates for a direct service provider perspective. One of these advocates was also the facilitator for a Sister Circle support group. The Coordinator of Victim’s Services was selected because it is believed that her role is integral to women’s programs at Asha. The decision to interview two women’s advocates was made in order to incorporate the perspective of those who provide direct services to women at Asha, including running the support group. The Coordinator of Victim’s Services had worked at the agency for approximately three years. Of the advocates, one had worked at the agency for approximately three years and the other, who facilitated the support group, had worked at the agency for over eleven years. Interview protocol. These were in-depth, semi-structured interviews and general questions included: 1) Why do they think Asha Family Services was founded? 2) How do women come to receive services at Asha? 3) What services at Asha do female survivors utilize most frequently? 4) What would they identify as the culturally specific components of Asha’s services? 5) How do they think women feel about their overall experiences at Asha? and 6) If they were to design their own culturally appropriate domestic violence intervention targeting the African American community, what things would they include? The staff interview protocol can be found in Appendix B. 27 Data analysis. Two of these interviews were tape-recorded and one staff member preferred not to be tape-recorded. Tape-recorded interviews were transcribed verbatim and verified by the researcher. Handwritten notes were recorded and typed for the respondent who refused tape recording. The data were then sorted according to question for those interview items related to this research question. These question responses were then coded in respect to which of the following areas it contributed insight into: the agency itself, agency programs, agency philosophy, culturally specific elements of the intervention, agency’s affiliations, as well as the agency’s overall operation. This information, in addition to that obtained from the content analysis of archival, was used to describe the agency. A set of codes was generated through the first reading of interview transcripts. Using this list of codes, the transcripts were individually reviewed again to ensure that all material for each code was coded. Research Questions Two, Three, and Four Two sources of data were used in order to answer the remaining research questions: “What elements of Afiican American women’s experience at Asha Family Services have been most helpful to them;” “Do women identify culturally specific components as helpful and if so, which ones;” “For women who have a history of service involvement with mainstream services, what were their experiences with these agencies and how is their experience with Asha different from those experiences;” and “What culturally specific intervention components, if any, do survivors and staff identify as desirable that do not yet exist?” These sources were interviews with survivors who were receiving services and leader/staff interviews. 28 Survivor Interviews In-depth, semi-structured interviews were conducted with women who received survivor services from the agency to talk with them personally about their experiences with the agency. Sample. A total of fourteen survivors who had received services at Asha were interviewed. At the time of the interviews respondents had had at least three service contacts with Asha and had received services from the agency for anywhere from one and a half months to five years. Survivors ranged in age from 25-55 years. Education level among respondents ranged from completion of 8th grade to completion of a Bachelor’s degree. Of those respondents who indicated employment status they included one student, not working, one student working part time, one employed part time, four disabled and three unemployed. Respondents had at least two and as many as eleven children. Annual income levels among respondents ranged from under $5000 to between $35,000-49,999. (See Table 2) 29 Table 2: Demographics of Survivor Sample N = 14 Age 25-55 years, Mean = 40 Annual Income Under $5000 $5000-9999 $10000-14999 $1 5000-24999 835000-49999 missing my—st—iLfiNN Education Level Less than high school High school graduate/GED Trade school Bachelor’s degree missing what—“bi.” Employment Status Student, not working Student, working part time Employed, part time Disabled missingfi Number of Children 39 years 1 1 l 4 Unemployed 3 4 2 -ll, ages 1- Length of Involvement with Asha 6 months or less 6 months — two years over two years w-hfl Sample Recruitment. Some survivors were recruited through conversations with the advocates who worked with women in the agency. Advocates were asked to identify women who were currently receiving survivor services from Asha. Of these women, advocates were asked to identify those who utilized multiple services at the agency, such as advocacy, support group, the children’s program, alcohol or drug treatment services, and/or mental health services and those they believe have also received such services 30 from mainstream agencies. The purpose of these different requirements was to get a diversity of women’s experiences with the agency. Advocates supplied lists of their most recent clients and an attendance roster from a recent support group. Advocates were able to identify some women who were receiving multiple services but were unable to identify which women had received domestic violence services from another agency. Lists generated by the advocates were short, including only seven women. I attempted calling each of these women in order to solicit their participation. The results of these attempted contacts were as follows: one woman was in the hospital at the time that I placed a call to her home, I spoke with her mother who indicated that the woman should be home by the end of the week but would not be in a condition to talk; one woman’s name was given without a phone number so could not be contacted; a third woman listed was not African American and thus did not qualify; I placed a call to reach the fourth woman but was told by a woman who answered the phone that the woman I was trying to reach no longer lived there and that she did not know where this woman was; a fifth woman self- identified as a batterer, not a survivor, and thus did not qualify; the sixth woman on the list was successfully interviewed; the seventh woman agreed to participate but was leaving to go out of town the day that I reached her and would not be back during my stay in Milwaukee. In addition, I also attempted calling women listed on the support group attendance roster, which was a total of fourteen women. Seven of the women on the support group attendance roster resided in a residential substance abuse treatment home to which I went in person to solicit participation. I recruited three of these seven women and plus three others temporarily residing in the shelter. Of the other seven women listed on the support group attendance roster, one was the woman who self- 31 identified previously as a batterer, one was not Afiican American and thus did not qualify, three did not have phone numbers listed for contact and the remaining two I did reach and interview. To those women who were able to be reached by these means I explained to them the project purpose, proposed length of the interview (1 ‘/2 hours), and payment ($20 for completed interview). It was explained to the women that their decision whether or not to participate would not affect the services they were receiving from Asha Family Services. They were then asked whether they wished to participate. Nine of the fourteen survivors were recruited through the above means. Overall, all women who were successfully reached by these means agreed to participate in the study. No one refused. The one woman who was reached but leaving town that day had agreed to participate but we could not schedule a time during my visit (which was my last) in light of her departure to conduct the interview. She did indicate that if I needed to come back at some point to conduct more interviews, I could contact her. Survivors were also recruited through support group meetings at the agency. Five additional woman were recruited through this means. During the time frame that I obtained my sample, the support group was the main means by which survivors were obtaining services from the agency. Considering that none of the women asked refused participation and most of the survivors in this sample were support group attendees (obtained from support group attendance rosters and solicitation during support groups) this sample was indeed representative of those survivors receiving services from Asha during the time of this data collection. 32 For women who agreed to participate, interviews were conducted with them at a time and place they identified as most comfortable, convenient and safe for them. As a result, interviews were conducted at Asha and at women’s homes and temporary shelters. Interview Protocol. These in-depth, semi-structured interviews included such question as: 1) How did women come to receive services at Asha? 2) What specific programs do women participate in at Asha? 3) What would they identify as the culturally specific components of Asha’s services? 4) How do women feel about the culturally specific components of Asha’s services? 5) Have women received services from other domestic violence programs? 6) How do women feel about their overall experiences with Asha? and 7) Do women have additional suggestions for the development of culturally appropriate domestic violence programs targeting the African American community? The survivor interview protocol can be found in Appendix C. All interviews were audiotaped for subsequent analysis and consent for doing so was received from participants prior to the interview’s commencement. All interviews were transcribed verbatim and verified. Key Staff and Leader Interviews Similar information gathered from staff interviews was the second source of data for addressing research questions two and four. Interview questions were also included that address these research question (see Appendix B, questions 2, 3, 10, & l 1). Staff/leader interviews were used to secure more than one perspective on these issues and to reinforce or enhance survivor information. 33 Data Analysis Analysis of these questions involved both cross case and within case data analysis. Cross-case analysis. A cross-case analysis approach was used to address research question numbers two, three and four, which address which elements of women’s experiences of the agency they found most helpful, which aspects of the culturally appropriate services offered by Asha women found helpful, how women’s experiences with Asha related to their experiences with mainstream agencies and what culturally specific intervention components, if any, survivors and staff identified as desirable that do not yet exist. Cross-case analysis is a means of grouping answers from different people to common questions or analyzing different perspectives on a particular issue (Patton, 2002). For research question number two, the coding process utilized a combination of emergent and literature-guided approach. Prior to starting data analysis, potential culturally specific components of the intervention were identified through the content analysis of agency paperwork, the staff interviews and the literature review and a preliminary coding scheme was developed. The data were first coded for predetermined codes and any emergent codes and problems with the coding scheme were noted. The coding scheme was then revised and the data was recoded for the emergent and changed themes. This process allowed me to identify which elements, across women and staff, were identified as being the helpful to them. For research question number three, only emergent coding was utilized as there were no pre-determined notions of how women would relate their experiences with Asha to mainstream services. A set of codes was generated through the first reading of 34 interview transcripts. The coding scheme was then reviewed and revised. Using this list of codes the transcripts were again individually coded using the final coding scheme. To address research question number four, only emergent coding was utilized as there were no pre-determined notions of what survivors or staff/leaders would identify as useful but non-existent. Since no elements were identified as non-existent and desirable no re-coding coding or revisions of coding schemes were necessary for this question. Throughout the process of analysis, I read each interview transcript with the coding of each of these three research questions, noted emergent themes and revived these themes to identify larger meta-themes. I identified commons ideas and larger patterns that seemed to be consistent across cases for each of these questions. Emergent themes for each question were then discussed with a committee member with extensive knowledge of qualitative methods. This committee member reviewed codes and relevant quotes and provided feedback, differences of opinion were discussed, and when necessary, codes were redefined and renamed. A PSY 490 student was then used to review the revised coding scheme. Her insights were also incorporated and revisions made accordingly. Once a final coding scheme was reached after this process, I then went back and recoded each individual interview with this final coding scheme. Within-Case Analysis. A within-case level analysis was used to explore the question of how women’s experiences with Asha differed from their experiences with mainstream services. A within-case level analysis is often used for the purposes of exploring, describing, and explaining individual case experiences (Miles & Hubennan, 1994). The data were sorted and compiled according to question for those interview items related to women’s experiences with mainstream agencies. This allowed me to 35 explore each woman’s individual story of her experiences with mainstream services and how this related to her experiences of receiving services at Asha. Each woman’s answers to these question were explored. For each individual woman who indicates having had experience with mainstream agencies, I described her experience utilizing her story, creating a within-case summary. These individual within-case summaries were reviewed by the above-mentioned qualitative committee member who provided feedback and I made revisions accordingly. My research assistant (the PSY 490 student) also created within-case summaries for each of these participants. I compared my within-case summaries with those of my research assistant for verification. Our stories were very consistent. These within case summaries were summarized and common patterns of stories emerging across participants were identified and documented. This summary and common themes were also reviewed my the above mentioned qualitative committee member. Data Collection T imeline In order to collect this data three weeklong site visits at the agency were conducted. During the first visit, I observed agency activities and women’s support groups solely for the purpose of getting a feel for the agency. In addition, I documented culturally specific features of the agency setting, which included cultural artwork or posters on the walls, Afrocentric artifacts on tables and reading materials portraying Afiican American interests. Staff interviews were also conducted during this first visit with the agency. At this time I began a search for survivors to interview at the following visit. During the second and third visits, interviews were conducted with survivors. 36 Protection of the Rights of Research Participants All necessary procedures were taken in order to ensure the protection of informants. UCRIHS approval was received from Michigan State University. A signed administrative agreement with Asha’s CEO was obtained. In addition, informed consent was obtained from all participants by my reading over the consent form with participants and having them sign a consent form, indicating their understanding of the project purpose and their agreement to participate. I assured survivors’ confidentiality by keeping the names of survivors separate from their taped interviews and interview transcripts. In addition, in presenting the findings of this research, fictitious names are used for the survivors who participated. Every effort was made to assure confidentiality of staff, although it is acknowledged that since this is a small organization and only a small number of staff were interviewed, complete confidentiality was not guaranteed. Also, the real identities of staff are not used in the write-up of these findings. All information was securely stored in a locked file cabinet in a locked research office throughout the process of this research. Authentication Authentication is a process by which one ensures that participant voices are represented accurately and fairly in the presentation of results. Authentication of these qualitative results took place in a number of ways. First, throughout the data analysis process emergent trends and patterns in the data were discussed with a committee member well versed in qualitative research methods (as described above). Second, a PSY 490 student was enlisted for the process of verification. This student was first trained in qualitative methodology and went through the interviews as well. She independently 37 coded data as well and gave assessments of her interpretations of women’s experiences (as described above). Notes were compared across persons for confirmation of themes and ideas, and adjustments were made accordingly (as described above). Afterwards, a “member check” session was conducted to validate the interpretations of the data (Lincoln & Guba, 1989). Results from research question two and three were presented in a lay reader friendly format to a small group (5 women) of survivors who were receiving services from Asha for feedback. This included one of the survivors who was previously interviewed for this study. Attempts were made to contact all women who agreed, at the time of their interview, to a follow-up contact via the contact numbers they had at the time of the interview. However, none of these women could be reached by this means for participation in this member check session. These five women were asked to give feedback in reference to whether these results reflected their experience with Asha and when applicable, with mainstream agencies. They were also asked whether they disagreed with any of the results that were presented to them. These women indicated that these results were accurate reflections of their experiences and elaborated on some of the results presented by relating some of their personal experiences with Asha and with mainstream agencies. Consequently, there was convergence between the experiences of the survivors participating in the “member check” session and the interpretations and finding from this study. According to Guba and Lincoln (1989), a “member check” is the most important technique for establishing credibility. Women were given $10 for participation in this session and snacks were provided. Staff interview transcripts were given to them for verification and feedback if the staff so desired to give it. Each staff member received a copy of their interview transcript 38 (notes) along with a note from me indicating that they were free to review the transcripts and contact me if they wished to provide feedback, add to or elaborate on anything they discussed at the time of the interview. I provided them with contact numbers and my e- mail address. Personal Relationship with Research Participants I had the opportunity to interact with a majority of the staff during my time at the agency and worked to keep a good rapport with them in order to continue my welcome at the site. I conversed with staff, dined with them and enjoyed leisure activities with them. I also interacted in a casual way with some of those receiving services at the agency. Although this type of relationship existed with informants I was still able to be objective in data collection for several reasons. First, I was not directly invested in the agency. Although I was glad that such a service existed for African American women in the Milwaukee community and that the need for culturally specific intervention was being validated in at least some area of the country, I did not have a vested interest in glamorizing the agency for reputation sake. I did not work at the agency so my personal economic welfare was not at stake. Also, my purpose at the agency was made known to agency staff as well as women receiving services whom I interviewed or observed in groups or meetings. Finally, I believed that the best way for African American intimate partner violence survivors, Asha Family Services, domestic violence agencies, researchers, domestic violence advocates, people wishing to design and implement culturally specific domestic violence interventions, and myself to benefit from the time and work at Asha was to give an honest assessment of the agency and the experiences of the women who receive services there. 39 Preliminary Biases and Suppositions In order to do this work justice I had to admit first to my own biases and suppositions, which undoubtedly influenced my approach to this research and my reading of the data that resulted from this investigation. I have engaged in several activities over the years that have influenced the way I see and think about the issue of culturally appropriate interventions and domestic violence. First, I have been involved in the domestic violence movement for over eight years in various capacities. This includes but is not limited to volunteering at domestic violence shelters, working crisis lines, serving as an advocate for survivors, interviewing survivors, training advocates, researching the issue, and working with a state coalition. Throughout this work I have had the opportunity to interact with survivors as well as those who work with survivors. Throughout this I have heard the dissatisfaction of African American women, as well as other women of Color, who have received domestic violence services from mainstream agencies. I have also engaged in reading literature that discusses the shortcomings of mainstream interventions in relation to their serving women of Color, and Afiican American women in particular. I have read the works of ntnnerous prominent researchers and theorists, particularly in the area of addressing domestic violence in the African American community, call for culturally appropriate interventions. I have also read literature addressing the importance of culturally appropriate interventions and their successes, in various capacities. I have conducted focus groups and interviews with African American female survivors that gave me insight into their experiences as well as their needs. I have talked 40 with them extensively about their experiences with mainstream services as well as how shelters have fallen short of meeting their culturally specific needs and what types of services they would like to see available to them. Some of these things are consistent with the services that Asha offers. I have also had extensive interaction with survivors and workers at the numerous family violence related conferences that I have attended over the years, some specific to addressing domestic violence within the African American community and other communities of Color. At these conferences I have heard survivors as well as prominent researchers and activists talk about the shortcomings of mainstream interventions and call for better services to meet the needs of survivors of Color. Over the past few years I have also had considerable involvement with the National Institute on Domestic Violence in the African American Community (IDVAAC). I have attended many of their conferences and meetings, helped them conduct focus groups, as well as interacted in various capacities with numerous members of their steering committee. In addition, I have been active with the Michigan Coalition Against Domestic and Sexual Violence Women of Color Task Force where I have had the opportunity to commrmicate with many women of Color working in mainstream domestic violence and sexual assault agencies. Through these interactions I have again heard many of the sentiments expressed above. As a result of my engagement in these various capacities I believe certain things. I believe that most mainstream domestic violence interventions do not adequately meet the needs of Afiican American women, as well as other women of Color. I believe that women of Color do have culturally specific needs and that interventions need to be 41 designed to meet these needs. I also believe that culturally specific interventions are appropriate and necessary in order to adequately serve women of Color who are survivors of intimate partner violence. In addition, I believe that more research needs to be done to explore these culturally specific needs so that the results can be incorporated into the development of these interventions. I also feel that more research needs to be done on existing culturally specific interventions to examine what they are doing and how they are doing it. RESULTS Research Question Number One: How does Asha define their culturally specific domestic violence intervention? A Culturally Specific Domestic Violence Intervention Generally speaking, Asha Family Services defines itself as a culturally specific domestic violence intervention which targets the African American community. “Asha Family Services, Inc. is a private, non-profit, spiritually-based agency whose goal through collaborative efforts is to provide comprehensive family violence and substance abuse intervention for victims and perpetrators of domestic violence that is culturally specific.” (Asha Family Services, Inc., Website, http:l/www.Ashafamilyservicesxom; Annual reports 200-2002, 2002) “Specializing in skilled services specific to Afiican American populations since 1989, our goal through collaborative efforts is to treat ills and facilitate healing and growth in families. Asha employs spiritual, holistic, and culturally specific treatment methods with the background, training and skill to provide treatment specific to many A fiican American families. ” 42 “Asha believes in the preservation and strengthening of the Afiican American family. To this end, we are committed to the provision of a spiritually-based, holistic and culturally responsive service designed to end violence against Afi'ican American women and children specifically, families of other communities of color and all families in general.” (Asha Family Services, Inc., Website, http:llwww.Ashafamilyservicesxom; Annual Reports 200-2001, 2002) Culturally Specific Components Asha Family Services identifies, by agency literature and staff accounts, a number of culturally specific components of its program. These include (1) Afro-centric curriculum, (2) Afro-centric environment, (3) family centered approach, (4) holistic approach, (5) representative staff and board, and (6) spiritually based approach. Afi'o-centric Curriculum Staff members at Asha identified their curriculum as culturally specific in that the issues covered in groups and programs tended to center around Afiican American culture, lifestyles and experiences. This includes discussion of African American history and culture and the ways in which various social ills differentially impact the African American community including domestic violence, substance abuse problems, and the HIV/AIDS epidemic. Staff #1: I think um...the curriculum... When, I say culturally specific, I think it ’s more or less, um, based on... our culture and how...and how our culture...relates to, you know, like lifestyles and...and how... you know, how we came about, you know, as a people...slavery... you know, to me, all of that plays a part in the services that you give. All of that plays a part and a lot of times... in the groups and. in the conference sessions, 43 we talked about that. You know, we talked about um... family... family lifestyles and family issues and you know, how you came up... you know, how you were brought up as a child because 1...] think that has a lot to do with how you...how you come out, you know, and the decisions that you make...(p. 13) Staff #2: Well, our batterer ’s treatment program is culturally specific for the men because they get the Afi'o-American men that’s abusers, you know. So we talk to them about.... we talk to them about the black culture. How black men are, you know, are treating... to care about women more, you know? More so than, you know, beating women, you know, so they...they talk to them about more on that realm of things. You know...and most of the men that come to the group they really love it you know? Because that ’s what we give them. We give them that history, you know, of Black Americans, Afro- American ’s, you know? Where they come from so they know, you know... you know... uh... we not really abusive people. It’s a learned behavior, it’s not nothing you, you was brought up through the years, you know? It ’s a learned behavior so you learn that to, yourself you know? So if it ’s learned then it can be unlearned. (p.6) Afro-centric Environment Both staff and agency literature emphasized the importance of the environment of Asha being Afro-centric. This manifests itself in two ways, first, the agency is located in a predominantly African American area of the city, second, the environment inside the agency is a reflection of African American culture. During my time at the agency I observed many things in the environment which would characterize the space within this agency as Afro-centric, this included: Afro-centric art on the walls; photographs of Black women, children and men hanging on the walls; Afro-centric artifacts on shelves and 44 tables; educational and ad campaign posters depicting Black women, men, children and families; agency literature and program brochures depicting Black women, children, men and families; books on bookshelves by African American writers, and; popular African American culture magazines resting on tables (field observation, 2003). “One of the first things you should consider is the physical location and the environment where participants will come for services. Ask yourself the following questions: Is your agency located within the target group ’s community...1s the art or other information on the walls of the oflice reflective of your clientele?” (V ann, 2003) Staff #1: Because to come in and see yourself... They say that [when] a person come in for services they have to see themselves and then it goes back to that comfort level too and then [when you] come in for services, you want to feel like you ’re welcome and you want to feel like you ’re comfortable... Uh-huh. We... we... we were talking about that yesterday, you know, just being able to go somewhere and feel comfortable. That ’s... that ’s very important. When you ’re dealing with someboay who, you know, who ’s been in a domestic violence situation and you know... that ’s... that ’s very important. (p.2 1) Staff #2: Well, people walk in the door and...and they smile at it or some people walk in the door and say yeah, this is a culturally specific, culturally specific agency, you know? Because they see it surrounds them so they know that’s what we all about... Uh-huh, yeah, uh-huh. It ’s just like a family setting, you know. That ’s what the family ’s all about. Just like a family when you’re in your home and you know how you want your family setting to be so it ’s the same thing just how you want your agency setting to be. (p.14-15) 45 Family Centered Approach Asha F arnily Services “believes in the preservation and strengthening of the African American family” as indicated in their mission statement. To this end they provide services to each individual member of the family who wishes to stay together in the aftermath of family violence. Children may participate in the children’s program, survivors may participate in the Sister Circle group and other applicable services and perpetrators may participate in the Ujima Men’s Program and other applicable services. Staff reflected on the importance of this component and why it is culturally specific. Staff #1: Because, I mean...1 think in a lot of the other, you know, I ’m just saying that I believe that in a lot of cultures, it ’s just leave, you know, leave. If you ’re in a violent situation you leave but a lot of...a lot of the women don ’t want to leave. They want to learn how to work through that...through that family component. You know, a lot...a lot of the women don ’t want to leave and I think taking that, working with the whole family. It is what, what you need to do, you know? If...i ifthe whole family is willing to work, you know? If the family is willing to work at it, though... Because I think there ’s with Afi'ican-American families...I just...1 just think our history plays so much.... you know, a big part. You know? I ’m not saying...making excuses, you know, or acceptance for domestic violence but it ’s... it 's...I think a lot of...a lot of people feel like, you know, we ’ve already been through so much, you know? You know, a lot...a lot of the women...a lot of the women feel guilty, you know? There ’s so much guilt and I think it ’s because a lot of the women feel like, in this society, the Afiican-American male is already being put down so she...she...she feels like to, to almost get on, you know, get on the band wagon that ’s going to put him down even farther, you know?...(p. 1 6-1 7) 46 Holistic Approach Asha believes that “healing requires healing all parts of one’s life” (Annual Reports 2000-2001, 2002). Through conversations with staff at the agency they believe that domestic violence is just the root of many women’s problems and that there are multiple problems that stem from that. This is why they offer multiple programs and services in addition to those that specifically address domestic violence including mental health services and substance abuse treatment services (personal communication, 2003). Staff address why this is particularly important for the African American community. Staff #2: Uh, yeah, yeah. It is, for one thing we have...look at mental health, okay. For one thing, how we... uh... like I was saying history. How we let fears control our life. And our fear... With Black Americans, the same thing like history. How we grew up with abuse and we grew up with uh...sexual abuse, we ’ve been knocked around. We’ve been put down. We ’ve been taught, I mean all our lives...even by our parents, you know being through abuse and witnessing abuse. I mean, that brings on the same thing as saying that some people have so much trauma in their lives... they traumatized... that we have to handle that part too so that ’s coming with the mental health part...And the AOD part, whew, lord. AODA part, it ’s like, that...okay, like... fear, well fear causes people to get on drugs, you know. Fear causes the people to get on alcohol. So we had to provide all these services to help them with that so I guess all of it... the whole thing... encompass the whole... the whole thing for Afio-American people...(p.7-8) Representative Staff and Board Asha believes the following: 47 “It is essential for providers who serve a large minority population to assure that their stafl reflect those they serve. This is just as important for the governing body and administration of the agency who will set policy for these folks. The organizational leadership must actively seek out and recruit stafl and Board members who are able to represent authentic realities of clients and their varying needs. Without this understanding and input, programs cannot begin to create culturally appropriate responses.” (V arm, 2003) As a result, the majority of staff members employed at Asha Family Services and the entire Board consist of Afiican American individuals. Staff again reflected on the importance of this component. Staff #1: ...so to be able to come to somebody and identify with somebody that ’s... that means a lot. You know? That means a lot. And when you have the difikrent races, you... you have to... you have to understand the background of that culture because if you don’t, I ’m not going to reach you... You know? I’m not going to reach you. You know? Because it ’s... it 's... it ’s diflerent levels of respect. You know? There ’s... it ’s just... it ’5 just so much understanding that culture. (p.14) Staff #2: Well the thing, like I said before, uh, we know, we know more of they needs because we have the same back ground. Know, women know...like Afio-American women know what most Afro women, Afro-American women want, you know? What we want to see this person be, you know? And like the men, you know... you know, we want to make you a better person. We want to talk to you about what you ’re doing. You know, how you ’re hurting our Afro-American women. . .(p.l4) 48 Spiritually Based Approach Asha Family Services takes a spiritually based approach to the provision of their services because they believe as follows: “Religion plays heavily in the lives of many Afiican American. Service providers must support and make space for women who rely on religious and spiritual practices. ” (V arm, 2003) Asha Family Services does not promote a specific religious doctrine but incorporates spirituality by such actions as having prayer upon the conclusion of a group and hiring non-denominational ministers to run some of the support groups and provide spiritual guidance and advocacy (personal communication, 2003). Other Culturally Specific Components Asha encompasses other culturally specific components as identified in the literature although they do not specifically address these as such in their literature and reports from staff. Developed in Collaboration With the Target Population and Relevant Stakeholders Asha Family Services was founded in 1989 by its Executive Director, an African American woman who is a survivor of intimate partner violence (Asha Family Services, Inc., Website, hgp:l/www.Ashafamilyservicesxom). Uses Channels of Dissemination Which Will Successfully Reach the Target Population Asha Family Services engaged in an “It’s Your Business” campaign which is a culturally specific domestic violence prevention/intervention campaign developed by the Family Violence Prevention Fund to target the African American community. Through 49 this campaign they have advertised their agency via culturally specific posters, fliers, ads on buses and billboards and radio announcements. Uses Language Familiar to the Target Population English is the primary language Of most African Americans, therefore, language is not the same issue here as it would be for those who speak a foreign language. However, African American staff would be more familiar with the slang terms and language that may be used at times among African Americans. Asha Family Services also incorporates other components that they feel are important to working within communities of Color. These include woman-defined advocacy where women identify the priorities and needs, respectful interaction with clients, effectively responding to cultural dynamics, understanding that African American women may engage in differing helpseeking behaviors than their White counterparts and understanding how mental health problems manifest themselves among African Americans (Vann, 2003). In sum, Asha Family Services defines itself as a culturally specific domestic violence agency which targets the African American community. They are very specific in their literature in identifying how they seek to make their services culturally specific. Staff accounts of the culturally specific services that Asha provides are consistent with this literature (see table 3). 50 Table 3: Culturally Specific Components of Asha Component Supported Supported by by Staff Literature Account Afro-centric Curriculum Afro-centric Environment Family Centered Approach Holistic Approach Representative Staff and Board Spiritually Based Approach Developed in collaboration with target population and relevant stakeholders Uses channels of dissemination which will successfully reach the target population NNXX xx X X XXXX XXX Uses language familiar to target population Research Question Number Two: What elements of African American women’s experiences at Asha Family Services have been most helpful to them? All fourteen of the respondents interviewed identified elements of their experiences with Asha Family Services that they found to be helpful. There were also a number of things that women identified as potentially helpful to them, meaning that they had not yet utilized that particular aspect of Asha’s services but planned on using it in the future or just found it helpful to know that Asha had certain things available to them in case they needed to use them in the future. Women also identified aspects of Asha’s services which they had not used themselves but indicated that it was helpful that these things existed so that others in the African American community who needed them could benefit. In summary, women identified a great number of things about Asha family services that they found helpful to themselves and to others in their community. These are all presented in the following. 51 Overall, survivors identified six general things that they found helpful about what is offered at Asha Family Services. 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