Digging Deeper to End Domestic Violence

How Sojourner Center, one of the largest shelters in the U.S., is evolving its programs to serve communities better

Domestic violence affects one in three women worldwide. More than 15 million children in the U.S. are exposed every year, and its effects ripple far beyond the home. Domestic violence exacts an enormous toll—on individuals, on families, and on society. Forbes recently estimated the financial cost to the U.S. at more than $8.3 billion annually: a combination of higher medical bills ($5.8 billion) and lost productivity ($2.5 billion). 

The problem is persistent and pervasive. Despite the relentless efforts of those working on behalf of women and children who live with domestic violence, the field has evolved very little over the past 40 years. There are minimal empirical data. No one has reached a clear understanding of why domestic violence occurs. Nor do we know which forms of intervention work best to stop it. The effect of domestic violence on children has only recently started garnering attention, and there has been little study of the long-term effects on abused women. 

As a result of the domestic violence field failing to evolve and embrace evidence-based practices most shelters don’t go beyond providing emergency shelter and basic needs for women and children, nor have service models changed. That’s the view of Maria E. Garay, M.S.W. Ph.D., Chief Executive Officer of Phoenix-based Sojourner Center, one of the largest domestic violence shelters in the U.S. Dr. Garay and her team believe that if Sojourner Center can reinvent how domestic violence is viewed and treated in Arizona, it can offer new models and best practices for other service providers worldwide. 

Listen. Learn. Act.

“We need to see domestic violence not as a social issue, but as a public health epidemic.”

Under Dr. Garay’s leadership, Sojourner Center is among the first to begin asking critical questions, questioning societal norms and digging deeper to better understand and care for the nearly 9,000 individuals–most of them women and children–who receive the center’s services each year. 

The most important “best practices,” according to Dr. Garay, are listening and learning to inform action. For the domestic violence field to evolve, it must pay close attention to program participants and clearly understand the steps that lead them to seek shelter. Providing temporary housing is only the first step in serving the needs of families affected by domestic violence. 

Since 1977, Sojourner Center has provided vital short- and long-term shelter that includes a continuum of care to the most vulnerable women and children. However, Sojourner Center operates in a challenging environment. Arizona consistently ranks among the states with the highest homicide rates of women murdered by men. Statistics show that every three days in Arizona, someone dies in a domestic violence related incident. Given that bleak record, Sojourner Center understands that much more than housing is needed to effectively break the cycle.

“These are hard conversations to have and there are no easy solutions, but if we don’t listen to those impacted by domestic violence and learn through effective research the underlying factors, we will never understand the scope of the problem nor its dynamics,” says Dr. Garay.

 Dr. Garay, who brings an extensive background in social work and social services, wants her staff at Sojourner Center and other professionals in the field to approach domestic violence in unconventional ways. The goal: to understand its roots and pursue innovative methods to stop it.  

“I bring a deep-rooted personal connection to domestic violence, having grown up in a family where my mother experienced decades of abuse at the hands of my father,” says Dr. Garay. “I see clearly that to develop programs that effectively treat women and children, as well as establish prevention practices in the community, we need to shift our view. We need to see domestic violence not as a social issue, but as a public health epidemic.”  

Bridging the Gap Between Researcher and Practitioner

As a master’s student and Ph.D. candidate in social work at the University of Southern California, Dr. Garay became dedicated to the idea that if she and her siblings could overcome the domestic warfare that afflicted generations of her family, other families could do the same. She began to conceptualize a way to stop domestic violence’s “ripple effect”: a system where care providers could offer a comprehensive circle of care that links trauma treatment for the whole family unit with tools and education aimed at changing deep-seated beliefs and behaviors linked to violence.

At Sojourner Center, Dr. Garay has had an opportunity to build on that concept. She has heard about abuse as it is experienced through unfiltered stories from the women living at the shelter, and she has pondered the gulf between what shelter participants are telling her and the conventional wisdom about domestic violence. Her strategies to reinvent the domestic violence field combine a scientific approach with intensive and open dialogue with the families beset by violence.

Dr. Garay believes a key strategy to uncovering the root cause of domestic violence is to establish strategic partnerships with universities, foundations, and medical organizations to explore new approaches to treatment and prevention. “Nearly all of the research published on domestic violence to date has been conducted by academics rather than those practicing in the field. By providing this bridge between researcher and practitioner, we can identify the specific traumas and issues facing women and children and apply evidenced-based approaches–some new and some borrowed from other fields–to better address their needs.”

Evolving the Shelter Environment

“Culture can play a large role in the prevalence of domestic violence … or can influence why a woman stays in a violent relationship.”

Sojourner Center is well positioned to remodel its domestic violence shelter into a center of help and healing. The organization’s five-year strategic plan launched in late 2014 aims to bolster the essential services of a domestic violence shelter while addressing priority areas where Dr. Garay and her team believe they can do better.

Culture matters

Sojourner Center serves the diverse population of Phoenix and the surrounding areas: 41% Hispanic, 6.5% African American, 3% Asian and 2% Native American. These demographics provide a unique window into diverse cultural norms, and give Sojourner Center an existing foundation for building even better understanding.

Dr. Garay, a Latina who moved to the U.S. from Mexico as a child, understands that culture can play a large role in the prevalence of domestic violence in a community or can influence why a woman stays in a violent relationship. She remembers how the priest from her small hometown in Mexico condoned–and sometimes even encouraged–domestic violence.

“We won’t have any success at changing cultural norms that support domestic violence unless we listen to our shelter participants and understand the values that formed them and their families,” Dr. Garay says.

Assessing potential trauma

Intake staffers at domestic violence shelters are often the first point of contact after a woman and her children have escaped an abuser. However, U.S. shelters currently inquire very little about the specific trauma those seeking shelter have experienced. The reason: an outdated theory that asking women or children to recount their experiences will re-traumatize them.

Head trauma is one major health issue where proper screening can make a significant difference in quality of life. According to one published study, 92% of women in shelters reported having been hit in the head by their partners at least once; 40% reported loss of consciousness. The injuries sustained are comparable to the traumatic brain injuries (TBIs) that are generating increasing concern among military doctors and sports medicine practitioners because of their long-lasting effects.

In 2015, Sojourner Center will begin providing TBI screenings at intake to determine whether a connection between domestic violence and TBI exists. It is working with the CACTIS Foundation, the University of Arizona College of Medicine at Phoenix and a consortium of medical partners on a collaborative project to address TBI in a domestic violence shelter setting, turning the shelter into a venue for diagnosis, prognosis and therapeutic intervention. When launched, the Sojourner Traumatic Brain Injury Institute will be the first in the world to integrate TBI screening innovations into a shelter environment.

Children are the key to ending domestic violence

Children are the hidden victims of domestic violence. They comprise about 40% of the population of domestic shelters nationwide, and more than half the population of Sojourner Center.

When a child or youth is exposed to an abusive parent, either through witnessing domestic violence or becoming a direct victim of abuse, it has a lasting, negative effect and can contribute to the cycle of violence for the next generation. Despite clear and compelling needs, most domestic violence shelters fail to provide a continuum of care for children and youth in the areas of mental health, comprehensive pediatric care, dental care or academic readiness.

Sojourner Center’s Childhood Development Center already provides many of these services, and is exploring how it can better respond to trauma in young children and work directly with mothers to reinforce parenting skills. “Children are extremely resilient,” says Dr. Garay. “They are also the key to ending the cycle. As practitioners, we need to stop being afraid of asking children about their domestic violence experience and instead start inquiring about how they coped, how they survived and how can we help them lead lives free from violence.”

Beyond the Shelter

On a societal level, Dr. Garay observes stereotypes about both the abusers and the abused have become barriers to understanding domestic violence and thus to developing needed best practices.

Despite her father’s rages and violent behavior, Dr. Garay says she knows her father loved his family. “My father was not the monster that society paints abusers to be. For him and many others, it is not about power and control. He recognized that his violence was destroying everything that mattered to him. He wished he could stop, but could not.”

She explains how society failed her father and the millions of other abusers who would have sought help if help had been accessible. “We have ignored, silenced and managed to alienate the abuser – as a society, we have let these men down,” Dr. Garay says. “For those abusers who want and need help, we need to start listening to them, too.”

The stereotype of the controlling abuser is usually paired with another cliché: the weak victim who fearfully allows the abuse to continue and tries to conceal it. Contrary to widespread public perceptions, women who do not leave homes afflicted by domestic violence are brave, intelligent, and uncommonly resilient. Dr. Garay’s experience has taught her that many women stay with abusive spouses because they have a strong will to keep the family together, fighting against the chaos caused by the abuse to keep some order for the sake of their children.

“The fact is that most women do not leave their abusers,” Dr. Garay says. “We need to respect this couple. We must listen without judgment and support their process. This is what we do at Sojourner Center.”

The concern extends to family pets. Sojourner Center learned that some 40% of women in an abusive relationship remain in the household out of fear for their pets’ safety. As a result, Sojourner Center formed a partnership with Lost Our Home Pet Rescue to create a pilot program that will offer both shelter for pets, pet therapy, and vocational training in pet care for shelter participants. The Sojourner Pet Companion Shelter will launch in May 2015.

Making a Difference

“I am not a victim. I am not the problem. I am the solution.”

Dr. Garay is aware that some of her views are controversial. Many sincere advocates for domestic violence victims have long viewed domestic violence as simply one more manifestation of societal discrimination against women. It is hard for some to hear that the abusers can be victims too; or that many women want their abusers to get help so they can gain the needed self-control that would allow the family to remain together.

Her unique perspective is at the heart of Sojourner Center’s commitment to a “Comprehensive Circle of Care and Transformation” in order to help victims break the cycle of violence in their lives and in the lives of their families. Dr. Garay is certain that through listening to the hard truths of domestic violence and gathering scientific data, new solutions will emerge and the field will evolve.

“I’m not afraid to ask the right questions to get to solutions that work because I know firsthand what it feels like to live with domestic violence,” says Dr. Garay. “I will continue to heal for the rest of my life, but it does not define me. I am not a victim. I am not the problem. I am the solution.”