Mid-Point: Reflecting on the Past to Improve Tomorrow

While sitting at my desk working patiently on data entry and file review, I can’t help but hear my HSSP professor’s words echoing in my mind… “prevention, intervention, and follow-up of patient cases are essential to health care!” Professor Conrad’s course Health and Society reflected on the various forms of illness, how society defines and perceives illness, and the methods by which illness can be treated. As I read files from the 1970s, I can see how our nation’s mentality has shifted over the decades regarding mental illness and treatment. HSSP courses usually begin with a review of the historical timeline of health and health care in the United States, and so it’s basic knowledge by senior year for HSSP students that the taboo surrounding mental health persisted in our country up until 10 or 15 years ago. Recently, this trend has abated in light of the development of legislation that mandates health insurance coverage for mental health services and grants funding for non-profits focused on mental health services.

When looking through files dated before 1985, I am reminded of the lack of support for individuals who require some form of counseling or therapy, and the faulty networking between agencies involved for that matter. Initially, Emerge adopted a political agenda, operating on the belief that the response to domestic violence should be social action rather than medical or psychological intervention. The creators of Emerge were activists, not medical administrators or health care providers. Therefore, the majority of these first case files are not standardized, meaning that the folder contains errant papers, scribbled notes, and blank/missing information. Some vital information, such as the client’s date of birth or social security number(important for identifying clients who are also on probation or have pending court cases) are not even required fields on some of the older forms.

The forms Emerge uses to keep records have changed drastically since 1980. The referral source in 1980 was more likely to be a family member, informational pamphlet, or co-worker. Abuse history is brief, especially in comparison to the modernized form.

The forms Emerge uses to keep records have changed drastically since 1980. The referral source in 1980 was more likely to be a family member, informational pamphlet, or co-worker. Abuse history is brief, especially in comparison to the modernized form.
The forms Emerge uses to keep records have changed drastically since 1980. The referral source in 1980 was more likely to be a family member, informational pamphlet, or co-worker. Abuse history is brief, especially in comparison to the modernized form.

Furthermore, not all clients were interviewed in the same manner, and so information that would otherwise be useful in identifying the socio-economic status of the client was consistently left blank, which created a gap in quality of service in many cases. The purpose of the program was geared towards providing support services for victims and partners, but the consequential development of a client-base who sometimes require long-term counseling meant that Emerge had to adapt.

In contrast, the newest intake forms require personal identification information such as DOB, SSN, and car make/model. This information is relevant for clients who have been referred by a Probation Office or DCF Agency for violence against a partner or abuse of children. This form, in comparison with the 1980 version, allows clients to record the number, names, and ages of their children, in addition to the other biological parent. The older forms did not account for non-traditional families.

In contrast, the newest intake forms require personal identification information such as DOB, SSN, and car make/model. This information is relevant for clients who have been referred by a Probation Office or DCF Agency for violence against a partner or abuse of children. This form, in comparison with the 1980 version, allows clients to record the number, names, and ages of their children, in addition to the other biological parent. The older forms did not account for non-traditional families.
In contrast, the newest intake forms require personal identification information such as DOB, SSN, and car make/model. This information is relevant for clients who have been referred by a Probation Office or DCF Agency for violence against a partner or abuse of children. This form, in comparison with the 1980 version, allows clients to record the number, names, and ages of their children, in addition to the other biological parent. The older forms did not account for non-traditional families.

It is clear that a significant amount of progress has been made since the founding of Emerge. All new files have a comprehensive background on all clients – today’s files are so detailed that we request partner contact information for not only the “victim” and “current partner” but also 2-3 ex-partners. Sometimes, to provide better services for the client, we investigate incidences of violent and controlling behaviors in previous relationships. The increased demand for accurate information ensures that Emerge can follow up with victims and partners to get firsthand reports of incidences of violence or abuse. The agency also contacts victims regarding the status of the client: whether he has been attending, has completed, or has been terminated from the program. Clients can use group sessions as a form of social support, to continue to work on themselves in a familiar, comfortable setting among men who can relate, either through cultural identity, family history, or lifestyle, etc. Emerge still emphasizes a focus on abusive behavior and not on the psychopathology of the abuser. Its relevancy in the field of social services and mental health services is evident.

This unique lens of being able to see the real-time applications of my HSSP courses for the coming semester is a huge motivator. I can attest to Professor Conrad’s principle that prevention and intervention are major elements of confronting the issue of domestic violence and other mental health problems, such as co-morbid substance abuse or long-term anger/violence. I recall another HSSP course, “Perspectives on Behavioral Health: Alcohol, Drugs, and Mental Health,” which provided me with an academic background of the current problems that Emerge clients deal with: ending addiction, understanding their own behavior, coping with past traumas and current stressors. I am enthused that I can apply information from my past classes to gain a greater understanding of the clientele, such as the impact of drug use on self-esteem and interpersonal relationships. Using this knowledge will allow me to conduct thorough personal history interviews and deduce key concerns related to the individual’s progress. Streamlining my own methodology will only allow me to better serve the needs of the client and victim, which is paramount to improving the nation’s Social Services in future decades.

Reflecting on the progress that Emerge has made as a pioneer domestic violence counseling center, it is obvious that there are still a few hurdles to overcome. Emerge offers services in Spanish and for other minority groups like LGBTQ individuals, and has a much higher completion rate than in decades past. Still, client attendance records suggest that we have yet to truly validate mental health care services as irrefutably necessary in today’s world. Social stereotypes still exist that may prevent clients from continuing group counseling, as many men believe that “real men don’t need help.” Agencies like Emerge have minimal influence to enforce attendance and participation. By examining Emerge’s past, and observing the present group sessions, I believe that I have a clear picture of where we have come from as a nation and where we are looking to go in the next few decades to improve the quality and image of mental illness and health services in the United States.

Elsie Bernaiche ’15

Back on the Horse: First Week Reflections

Last summer, I dove head first into the realm of domestic violence prevention and treatment services. I was doe-eyed and fresh out of my first few HSSP courses, eager and inspired to affect change and challenge inequality. As all internships are meant to do, my previous summer’s experience gave me exposure and insight into a field with complex sociopolitical quandaries, and with only surface knowledge in the subjects of women’s health, mental health, and public policy, I was determined to get back on the horse and pursue another summer internship educating myself. Through the recommendation of my program director at NoVA (The Non-Violence Alliance, CT), I found Emerge, a Domestic Violence and Anger Management Counseling Service centered in Boston, MA, which, as I discovered within my first week, had more than enough resources to expand my knowledge in the field of social services. Founded in 1977, Emerge was the first abuser education program in the nation, and has been at the forefront of combating domestic violence and sexual abuse, taking an intersectional approach within the design of the curriculum.

David Adams, Executive Director of Emerge: Domestic Violence Training Video

I emailed the office manager, per request of the Emerge website, and heard back regarding a Skype interview within the week. By the next week, I was meeting with the program director and office manager via webchat to conduct a brief interview. I demonstrated my passion for the kind of work Emerge accomplishes, as well as my pseudo-expertise in working with clientele, probation offices, and DCF agencies, and soon enough, I was invited to come into the office for an introduction to the office setup and procedures. I was familiar with the design of the program: the client type was primarily male offenders, court-ordered to our program as part of their probationary conditions, referred by DCF as part of a service plan, or self-referred to better their current relationship. The program focused on two stages: an educational stage in which the men are instructed on the basics of respectful communication, self-talk, and various behaviors considered violent and abusive, such as verbal, psychological, or financial abuse, and a second stage where the group members are encouraged to hold each other accountable and provide a forum for discussion under the guidance and supervision of counselors.

The office initially introduced me to old client files, cases that had been completed or terminated, so that I could read original docket paperwork, monthly client status reports, and police reports. Working with files dating back to 1980, I had a plethora of data to peruse. I would manually enter the basic client information (date of birth, address, SSN, etc.) by default, but what enraptured me was always the life that was hidden within the paperwork. The image of each client began to take shape: ‘of X origin’, ‘carpenter’, ‘homeless’; bits of data that actually were significant indicators of the individual’s biopsychosocial environment, information that would prove essential to both understand the violent and abusive behaviors of the client and to develop an approach through which to communicate with the client. However, these cases were long-since closed, and I felt myself itching to get some hands-on interactive experience.

A chart listing agencies across Massachusetts that provide services for groups such as teens, battered women, and lesbian, gay, transgender, or bi-sexual victims of violence. These agencies are safe houses, shelters, transitional housing, and multilingual/Spanish-speaking organizations.
A chart listing agencies across Massachusetts that provide services for groups such as teens, battered women, and lesbian, gay, transgender, or bi-sexual victims of violence. These agencies are safe houses, shelters, transitional housing, and multilingual/Spanish-speaking organizations.

The program directors invited me into a second-stage group to begin observations of those sessions, and this gateway to living, breathing clients enabled me to connect the dots between what I could discover on paper about an individual versus what could be gleaned from interpersonal interactions. As in intern, I was not invited to participate, but rather was able to study the approaches of the counselors, analyze the behaviors and language of the clients, and form my own conclusions. After each session, the counselors were more than happy to answer my questions or respond to any comments I had regarding the group. I will continue to observe one English-speaking group, but I am hoping to travel to the Jamaica Plain location to observe the Spanish-speaking group sessions later this summer. I am especially interested to compare how different communication styles will translate in the Spanish-speaking group, as I am a Hispanic Studies and HSSP double major looking to pursue higher education in linguistics and counseling.

While Emerge will be another stepping stone in my path to navigating my place within the field of Social Services, I am not yet ready to move on from the field of domestic violence. There are infinite ways in which one can affect positive change, especially in this line of work; I have since pursued working with Prevention Services at Brandeis, and I intend to apply all the skills that this internship will instill in me to volunteer at a rape crisis center in the Waltham area. Working at Emerge, I hope, will allow me to find my niche, a job within the Social Services where I flourish, where I can produce positive outcomes in the lives of others; at Brandeis, I have found that the bureaucracy of state-funded or federally administered programs can hinder progress for both agency and client alike. Through my summer at Emerge, I expect to learn how to combat this dilemma and provide actual support services for clients to reduce the failure rate for men who have given up on the system. Furthermore, I am ecstatic to develop my spoken-language comprehension in Spanish and to foster connections with other counselors, social workers, and professionals in this field of work that will direct me in my career as a student and (soon-to-be) professional!

Elsie Bernaiche ’15