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Larry W. Bennett University of Illinois at Chicago Beth Glover Reed University of Michigan Elizabeth Marie ArmstrongUniversity of Michigan Priti PrabhughateUniversity.

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Presentation on theme: "Larry W. Bennett University of Illinois at Chicago Beth Glover Reed University of Michigan Elizabeth Marie ArmstrongUniversity of Michigan Priti PrabhughateUniversity."— Presentation transcript:

1 Larry W. Bennett University of Illinois at Chicago Beth Glover Reed University of Michigan Elizabeth Marie ArmstrongUniversity of Michigan Priti PrabhughateUniversity of Illinois at Chicago 2009 Annual Program Meeting Council on Social Work Education, San Antonio, TX

2 Goals for the panel Present compelling reasons for integrating or coordinating the substance abuse and domestic violence fields Apply Bourdieu’s concept of field to the development of domestic violence interventions and substance abuse interventions Utilize survey research and organizational case studies to illustrate relevant concepts

3 Prevalence of Co-Occurrence (Battering & Substance Abuse) Over half of partnered men entering AOD treatment have battered in the past year (Chermack, et al., 2000; Fals-Stewart & Kennedy, 2005) Men in AOD treatment are 11 times as likely to batter on a day in which they have been drinking (Fals-Stewart, 2003) Half of the men in batterer intervention programs appear to have AOD issues (Gondolf, 1999) and are eight times as likely to batter on a day in which they have been drinking (Fals-Stewart, 2003).

4 Prevalence of Co-Occurrence (Victimization & Substance Abuse) 55-99% of women who have AOD have been victimized at some point in their life (Moses, et al., 2003) 67-80% of women in AOD treatment are DV victims (Cohen, et al., 2003; Downs, 2001) Between a quarter and half of the women receiving victim services for DV have AOD problems (Bennett & Lawson, 1994; Downs, 2001; Ogle & Baer, 2003).

5 Data Suggest Coordinated/ Integrated Approaches Improve Outcomes Integrated trauma-informed practice improves outcomes for women victims with co-occurring disorders (Morrissey, Ellis, Gatz, Amaro, Reed, Savage, Gindelstein, Mazelis, Brown, Jackson, Banks, 2005). Integrated approaches superior to serial approaches for substance abusing men who batter (Goldkamp, Weiland, Collins, & White, 1996) Not all AOD/DV outcomes (e.g. victim fear) will necessarily improve as expected (Bennett & O’Brien, 2007)

6 Challenges to doing integration History and position of separate fields Language Agencies, policies, and confidentiality issues Belief systems And many others

7 What is a Field? In Bourdieu’s framework, fields are semi- autonomous spaces of social relations that operate according to distinct logics. Temporary state of power relations Organized around a particular stake or goal Social actors may be in either dominant or dominated positions in a field depending on the volume and type of capital they possess

8 Women’s Movement The Field of DV Services Legal System Health & Behavioral Health DV Service Provision Child Welfare

9 The Field of SU Services Health & Behavioral Health The Legal System Recovery Communities Substance Abuse Service Provision

10 The Field of Service Provision The Legal System Health & Behavioral Health Domestic Violence Service Provision Substance Use Service Provision

11 11 TIP 25 Substance Abuse and Mental Health Services Administration

12 12 Manual of the Illinois Domestic Violence/ Substance Abuse Interdisciplinary Task Force (2 nd Edition, 185 pp.)

13 13 Iowa Integrated Services Project

14 Resource Manual Getting Safe and Sober: Real Tools You Can Use A Teaching Kit For Use With Women Who Are Coping with Substance Abuse, Interpersonal Violence and Trauma (Available in English and Spanish) This project was supported by the Office of Women’s Health Region X Grant # HHSP233200400566P and by Grant #’s 2003-MU-BX-0029, 2004-MU-AX-0029 awarded by the Office on Violence Against Women, U.S. Department of Justice. The opinions, findings, conclusions and recommendations expressed here are those of the presenters and authors and do not necessarily reflect the views of the Department of Justice, Office on Violence Against Women or the Office of Women’s Health. Principal Authors : Patricia J. Bland, M.A. CCDC CDP and Debi Edmund, M.A. L.P.C. For more information contact: Alaska Network on Domestic Violence and Sexual Assault 907-586-3650

15 15 Trauma-informed Services for Women With Co-occurring Substance Use/ Mental Health Disorders and Victims of Violence (SAMHSA)

16 16 Field Analysis as Framework for Understanding Innovation and Barriers to Change Elizabeth Marie Armstrong The University of Michigan School of Social Work

17 17 Why Field Analysis? Provides insight into the interaction between macro- meso- and micro-level contexts of service provision Highlights the significance of social location (i.e., positionality) and power in dynamics between and within DV and AOD service providers Locates barriers to collaboration in histories, contexts and relationships Helps identify the types of organizations likely to engage in innovative practices and the particular strategies that allow them to do so

18 18 Key Concepts in Field Analysis Field (A particular social arena united by a common pursuit and shared logic) Capital (Resources that determine a social actor’s position/power relative others) Doxa (Taken for granted assumptions about the naturalness of a field’s logic) Habitus (Enduring characteristics of social actors that shape and are shaped by that actor’s position within the field)

19 19 Levels of Analysis Field of Social Problem Construction Field of Social Service Provision Field of Domestic Violence Service Provision Organization-as-Field Field of Substance Use Service Provisions Organization-as-Field

20 20 The logic of field Forms of capital – resources associated with power Economic – financial resources Social – institutionalized connections to other social actors, including those in other fields Cultural – educational, social and intellectual capacities Symbolic – the forms of capital that are most valued within a particular field Positions within a field depend on Total volume of capital Types of capital

21 21 The logic of field (continued) Actors attempts to distinguish themselves through position-takings Strategies of conservation Strategies of subordination The strategies that are available depend on habitus Primary and secondary Split-habitus

22 22 Position-Taking at the Macro-Level Social Problem Construction (examples) From Female Masochism to Patriarchal Terrorism (DV)? From Moral Failing to Brain Disease (AOD)? Shifting Relationships within the Field of Social Service Provision (examples) Away from the Grass-roots and towards alliance with the Justice System (DV)? Away from the Justice System and towards alliance with Health & Behavioral Health (AOD)?

23 23 A Brief History of DV Interventions Roots in the Women’s Movement Tension between grass-roots organizing and professionalism Early efforts to de-stigmatize survivors and move away from medical models Institutionalization Alignment with the legal system Expansion of services to better include women of color Development of services for perpetrators of violence Current debates Trauma-informed models and realignment with mental health

24 24 The Field of DV Services Circa 1960 Women’s Movement Law Enforcement Community Mental Health Psychiatric Institutions Child & Family Welfare

25 25 The Field of DV Services 1970s: Emergence of the Battered Women’s Movement Women’s Movement Law Enforcement Community Mental Health Psychiatric Institutions Child & Family Welfare Domestic Violence Service Provision

26 26 The Field of DV Services 1980s: Towards Legal Accountability Women’s Movement Law Enforcement Community Mental Health Psychiatric Institutions Child & Family Welfare Domestic Violence Service Provision

27 27 The Field of DV Services 1990s: From Criminal to Civil Interventions Women’s Movement Law Enforcement Child & Family Welfare Domestic Violence Service Provision Mental Health Services

28 28 The Field of DV Services 2000s: Trauma Informed Treatment Women’s Movement Law Enforcement Civil Courts Criminal Courts Health & Behavioral Health Child & Family Welfare Domestic Violence Service Provision

29 29 A Brief History of AOD Interventions Differentiation between alcohol and narcotics Long-standing tension between community-based and residential-models 19 th century: Temperance Societies & Inebriate Asylums 1940s: Alcoholics Anonymous & the Minnesota Model Substance use and criminality The Harrison Anti-Narcotic Act (1914) Prohibition (1918-1933) Current tensions Harm Reduction versus Abstinence Medical Models versus Mutual Aid (12-Step) Recovery Oriented Systems of Care

30 30 The Field of SU Services 1930s-1940s Law Enforcement Psychiatric Institutions Hospitals 12-Step Programs Alcohol Treatment Narcotics Treatment

31 31 The Field of SU Services 1950s-early 1960s Law Enforcement Psychiatric Institutions Hospitals 12 Step Programs Alcohol Treatment Narcotics Treatment

32 32 The Field of SU Services late 1960s-1970s Law Enforcement Psychiatric Institutions Hospitals 12 Step Programs Alcohol Treatment Narcotics Treatment Counter Culture

33 33 The Field of SU Services 1980s-1990s Law Enforcement Community Mental Health Hospitals 12 Step Programs Alcohol Treatment Drug Treatment

34 34 The Field of SU Services 2000s Law Enforcement 12 Step Programs Alcohol Treatment Health & Behavioral Health Drug Treatment Child Welfare

35 35 Position-Taking within Domestic Violence and Substance Use Fields Conflicting stakes within each field Domestic Violence: Safety Substance Use: Accountability Types of capital Domestic Violence: Substance Use:

36 36 The Field of DV Service Provision Primary Stake - Safety Tensions Professionalization/Grassroots Advocacy/Institutionalization Systems change/Individual service provision Support/Confrontation Distinct forms of capital Security Activism Security Activism

37 37 The Field of AOD Service Provision Primary Stake - Accountability Tensions Professional Expertise/Direct Experience Treatment/Prevention Abstinence/Harm Reduction Support/Confrontation Distinct forms of capital Structure Self-Direction Structure

38 38 Position-Taking by Organizations External characteristics such as The availability of funding Changes to federal, state or local laws Collaboration with other organizations May lead to internal shifts in Organizational structure Mission statement Specific services provided Characteristics of staff And vice versa

39 39 Position-taking within Organizations Formal rules and official positions Required credentials Job descriptions Line-of-reporting Personal dispositions (habitus) and informal practices Presence of champions Accidental and intention production of split-habitus Doxa as a barrier to integration

40 40 Theorizing Change Domestic violence and substance use are marked by Distinct histories Unique alliances and strategies of institutionalization Different goals, paradigms, and methods Innovation occurs through the interaction of position- takings within organizations and by organizations within broader fields and can result in Individual or organizational failure Transformation of an existing field Creation of a new field

41 41 References Bourdieu, P. & Wacquant, L. (1992). An Invitation to Reflexive Sociology. Chicago: University of Chicago Press. Emirbayer, M. & Johnson, V. (2008). Bourdieu and Organizational Analysis. Theory & Society, 37: 1-44 Emirbayer, M. & Williams, E.M. (2005). Bourdieu and Social Work. Social Service Review, 79(4): 689- 751. White, W.L. (1998). Slaying the Dragon: The History of Addiction Treatment and Recovery in America. Bloomington, IL: Chestnut Health Systems

42 Larry W. Bennett, Ph.D., L.C.S.W. Priti Prabhughate, M.A., M.Phil. 2009 Annual Program Meeting Council on Social Work Education, San Antonio, TX

43 PRIOR WORK IN ILLINOIS The substance abuse counselors and DV staff disconnection (Bennett & Lawson, 1994) Women, DV & Substance Abuse demonstration project (O’Brien, 2002; Bennett & O’Brien, 2007) Safety & Sobriety (Illinois Dept. Human Services, 2000, 2005) Substance Abuse Recovery and Domestic Violence Initiative (Great Lakes Addiction Technology Transfer Center, 2007)

44 Thanks to: Division of Alcoholism and Substance Abuse, Illinois Department of Human Services Office of Drug Control Policy, Michigan Department of Community Health Division of Mental Health and Addiction of the Indiana Family and Social Services Administration Ohio Department of Alcohol and Drug Addiction U.S. Substance Abuse and Mental Health Services Administration

45 NEEDS ASSESSMENT RESEARCH QUESTIONS What are the beliefs and attitudes of SA providers regarding the causes, treatment of domestic violence ? What are the current practices reported by SA providers to screen, treat domestic violence? What are the needs of SA providers to deal with domestic violence? What are the obstacles faced by SA providers in dealing with domestic violence? What are the beliefs of SA providers about collaborating with domestic violence agencies for addressing domestic violence? What SA providers are likely to screen domestic violence?

46 METHODOLOGY Survey Feedback from advisory committee. Pilot test survey with 50 respondents Online survey administration Sampling SA providers were recruited through SSAs 394 SA providers completed the survey (6 respondents did not consent to the survey) Over-representation of supervisors (26%) and administrators (23%) suggest self screening of participants in survey

47 SAMPLE CHARACTERISTICS DemographicsMean/Percent Age 48.6 (10.4) More than 10 years in SA field 61% Women69 % Education: Master/Doctoral74 % Ethnicity/Race: Caucasian/White African American Latino 80 % 12% 7% Urbanity: Urban Suburban Rural/Small Town 44 % 25 % 31 %

48 The “Must Screen” Mandate In 1992, 25% of SA counselors refused to refer to DV while identifying nearly half their clients as DV-involved 70% of women in SA services are victims of DV (and some are perpetrators) All current protocols for DV/SA call for screening all women in SA treatment for DV– “best practice” 48

49 IS DV SCREENED? How often do you ask questions/screen for DV victimization? Always59% Frequently23 Sometimes12 Rarely 4 Never 2

50 Predictors of Always Screen: Agency Characteristics Predictor (prevalence)Odds Ratio (95% CI) Batterer intervention program in the area (.75) 1.81 (1.09-3.00) Other Agency Characteristic Predictors: Illinois (OR=2.01); Michigan (OR=.61), Agency Characteristic Non-Predictors: Most clients are women (.33); Most clients are ethnic minority (.48); Most clients mandated to treatment (. 46); Indiana (.15); Ohio (.09); Urban (.44); Suburban (.25); Small town or Rural (.31)

51 Batterer Programs Most substance abuse providers think of violence as an "anger" problem. Then they send them to anger management (often in house) instead of referring to an Indiana Coalition Against Domestic Violence Batterer Intervention Program. I would be reluctant to refer any patient to a batterer's program because I don't agree w/ the typical protocal used - it is not gender-neutral and the batterer is coerced by threat of legal repercussion... targets males as being the perpetrator and females as victims. Domestic violence is not a gender issue, it's a mutual perpetration, but the DV community disregards this and feeds into the victim mentality of females

52 Predictors of Always Screen: Agency Is Engaged with DV Condition (Prevalence)Odds Ratio (95% CI) Agency meets with DV providers (.48)2.16(1.38-3.37) ** Has formal DV format/questions (.46)2.67(1.68-4.25) *** Other Agency Characteristic Predictors: Linkage agreement with DV agency (.39); Has a DV specialist on Staff (.38); Has DV guidelines (.59); Has adequate DV policies in place (.63) Agency Characteristic Non-Predictors: None

53 Agency Engagement with DV We work collaboratively with a DV shelter and counseling center. We have a staff member on site at this facility. I do not know about the agency as a whole. I am only aware of what we do in our program. Even though we are not licensed domestic violence specialists, we have had training and education about this serious crime and have good resources available to refer clients. We do not have a specific linkage agreement. We have a strong working agreement and relationship with our DV provider. They do substance abuse screenings for all their clients and vice versa. We do quarterly cross-trainings with our staff, etc. we believe there is 'under reporting' both by victims and perpetrators. Therefore, we continue to assess for issues throughout treatment and often individuals at our agency and at our DV agency

54 Predictors of Always Screen Participant Characteristics: Supervisor Condition (Prevalence)Odds Ratio (95% CI) Supervisor (.26) 2.05 (1.17-2.60) * Participant Characteristic Non-Predictors: Male (.31); African American (.10); Caucasian (.60); Latino (.04); Graduate degree (.74); More than 10 years in addiction field (.61); Six or more years at current agency (.54); Manager (.23); Therapist (.35)

55 Supervisor Influence No formal guidelines. It is discussed with clinical supervision and we can refer to special services if deemed necessary Request supervisory input from clinical supervisor on how best to proceed We first report any evident threat to victim or potential victim, we develop an intervention plan do a batterers evaluation if this individual is on supervision it is immediately referred to the P.O or supervising agency for recommendations. We would seek supervision, and go from there… We don’t have a typical routine in my experience. Unfortunately, there is no typical procedure at the agency. DV is not seen as an important primary issue to be addressed. Supervisors may suggest referring someone to a local DV agency, but do not have a full understanding of the issue...

56 Predictors of Always Screen Screening Condition (Prevalence)Odds Ratio (95% CI) Always screens for HIV/AIDS (.56) 3.24(2.05- 5.10) *** Always screens for batterers (.46)153.23(46.55-504.38) *** Always screens for childhood trauma (.71) 15.40 (8.62-29.33) *** Non Predictors: None

57 Screening is the Norm We use a specific screening tool/s in the assessing the DV situation. I am unable to name them, but do know that clinical specialist uses them. All clients are screened for DV issues. We use a standardized screening tool from a SAMHSA TIP best practices manual. Three of my staff have completed the state certified '40 hour DV training' offered through our DV local provider. Screening for domestic violence and childhood trauma can be an integral part of developing an effective treatment plan, when working with substance abusers. We always ask as a part of our assessment; depending on the response, we may screen further. These screenings are a mandatory piece in our assessment process questions pertaining to HIV risks, DV, and childhood abuse are on all assessments. We do a separate DV screen to further assess. All clients are screened for all issues and offered wrap-around services to address the multiplicity of their needs.

58 Predictors of Always Screen Participant Knowledge, Attitudes, Beliefs Condition (Prevalence)Odds Ratio (95% CI) Predictors: Knows DV laws (.63) 1.88 (1.19-2.97) ** Other: DV is usually result of AOD (.43) Non Predictors: SUD and DV are very different (.39), Most DV victims are MI (.25); Most batterers are MI (.29), Most DV victims have SUD (.17), Most batterers have SUD (.46); Women are as violent as men (.41), Most DV victims were abused as children (.66), Most batterers were abused as children (.67), Most DV victims are co-dependent (.66), Not much confidence in the DV agencies around here (.18)

59 DV Perps & Victims are Characteristically Disturbed I find that women are more likely to deny any form of physical abuse toward their partner. Men will acknowledge and justify their abuse. As a general rule I find that women are often abusers and the partner (male) who puts his arm up to prevent being hit in self defense is the one who is charged. Males are assumed to be the abuser and this is not always the case. In either case it takes two individuals for a conflict to escalate therefore both individuals should be charged and/or treated. They may be co-dependent some women can be as violent as men, however overall, I believe men are more violent.

60 Predictors of Always Screen Readiness To Change Condition (Prevalence)Odds Ratio (95% CI) Most staff unaware of DV procedures (.40).45 (.28-.73) ** We already deal with DV at this agency (.52)2.07 (1.30-3.29) ** Other Readiness Predictors: Staff at agency untrained in DV (.56); Training in AOD/DV knowledge is important (.57) Non Predictors: Would definitely take a DV education program if offered (.43), Can't work with DV at this agency (.20), Training in screening is important (.56), Networking with DV agencies is important (.46)

61 Exposure ?

62 Predictors of Always Screen Continuous Variables Condition (Prevalence) Not Always Screen Always Screent Prevalence estimate: Proportion of female clients at agency women who are battered.39 (.21).49 (.24) 3.36 ** Non Predictors: Prevalence estimate: Agency men who batter (.29), Prevalence estimate: Substance abusing men who batter (.38), Prevalence estimate: Agency women who batter (.20), Prevalence estimate: Substance abusing women who batter (.23), Prevalence estimate: Agency men who are battered (.17), Prevalence estimate: Substance abusing men who are battered (.19), Amount would pay for DV training ($43.92), Participant age (48.6), Staff would greatly benefit from DV training (.74)

63 Our Clients are the Exception Our data indicates that 80% of the women who seek substance abuse assessments at our agency are currently in, or have been in, an abusive relationship. I estimate a greater number of my male clients have been abused by their partners, but few admit/discuss it. We do not see a high incidence of DV at our agency. However, I believe it is very frequent in the population at large… I have evidence indicating most batterers in my program are not victims of childhood abuse. Our experience is that many men and women with DV histories have dx related to depression, anxiety, PTSD, and sometimes bipolar disorder. Up until now no client has admitted to be the victim of DV. All clients are males. I seldom meet a woman at our facility who has not experienced abuse.

64 Summary of Qualitative Findings DV is for others to do Victims should leave DV is a couples-anger problem Lack of resources prevent screening Silo Mindsets & Turf Wars Confidentiality

65 Examples from 17 Case Studies. For this paper, concentrating on programs for women/survivors

66 Acknowledgements Robert Wood Johnson Foundation (028811), Substance Abuse and Mental Health Services Administration (C- 00M007512 ), University of Michigan, Office of the VP for Research and the School of Social Work, Fahs-Beck Foundation Thanks to Deirdre Shires and Maureen Bernard for data collection and first wave analyses, Leah Potvin, Grace Chee and Elizabeth Armstrong for current analyses

67 Goals Present data and examples from a set of 17 full or partial case studies of domestic violence (DV) and substance abuse/alcohol and other drugs (AOD) and multi-focused organizations providing services and advocacy for both DV and AOD Illustrate promising practices and different strategies for negotiating fields at different levels Include relevance of historical, cultural and social contexts, and different types of position-taking

68 Sample Criteria for selection included engagement in some significant linked work focused on both domestic violence and substance use/abuse We completed at least one intensive interview with a knowledgeable informant at each site, and conducted site visits and additional interviews at 5 sites, with considerable knowledge of some additional sites through other means

69 Sample (continued) Four cases consisted of a DV and AOD partner working together (exchange, or coordinated) Nine cases were either DV or AOD programs that had incorporated considerable attention to the other set of issues (expanded) Four programs considered themselves to be fully integrated, and some also included other components as well.

70 Overview of Results: More than one program reported addressing both AOD and DV in all of the following External to program Internal to Program/policy and administrative Create new collaborations Initiate inter-organizational training programs Increase common language, communicate across fields New funding sources Agency Policy—shifts in priorities, revised language, change in requirements Increased staff training Changed referral sources Services priority & philosophy Revised staff composition Supervision/case consultation

71 Addressing AOD and DV (cont) Services level Structural arrangements—changed staff configurations, new sub-units, teams Outreach Screening Eligibility Assessment Resource coordination and advocacy Individual services Groups Children and family services New “technologies and tools”

72 Bourdieusian Field Analyses Allows exploration of not only the relationships between different organizations and their broader contexts, but also identity factors within & without these organizations that underlie facilitators and barriers to collaboration, innovation, and organizational change

73 Cross Field Tensions Domestic/Intimate Partner Violence (survivor program) Safety Empowerment Autonomy, self-direction Advocacy Woman-centered pacing Social support Substance Abuse, Alcohol and Other Drugs Working the program Surrender Sobriety, abstinence Recovery, relapse Structured steps Motivational interviewing

74 Organizational Position-Taking within External Fields Case One: Family multi-service organization with well- established AOD program for women, expanding to address DV Tries to collaborate with violence agencies Finds them in different places of readiness, with proximity problems as well Develops region-wide jointly planned and implemented multi-month educational series Decides to do internal changes alone

75 More Org-Position-Taking within External Fields Case Two: Multi-service organization with AOD and DV components, fully integrated In order to create receptivity for coordination Initiated regional collaborative to Coordinate approaches Develop a common vision Identify common resources Emphasize developing systems of care

76 External Position Taking: Negotiating Legitimacy, Referrals Many reports of paradigm differences with AOD and DV programs; these shift as organizational policies and services change AOD programs that expand to include DV report increased tensions with other AOD programs, suspicion from DV programs DV programs that expand to include AOD have much better relationships with women’s AOD programs than others Need different language for funding proposals

77 Impacts of External Fields on Orgs Case three: Program began as DV, early on incorporated AOD and integrated the two After about 10 years, separated into two separate programs under one umbrella Separation a response to evolution in both fields— AOD struggling to become more professionalized; DV creating stronger boundaries to evolve into defined field

78 Organizations as Fields (Internal) Strengthening match between organizational culture and staff position-taking and habitus Develop or hire staff with split habitus— Those with primary habitus operating in fields with different requirements—e.g., AOD advocates within DV programs Issues in selecting staff open to combined paradigms or expanding habitus (“sense of possibilities”) through training & supervision Many reports of losing staff unable or uninterested in revised approaches

79 Organizations as Fields: Creating Hybrid Resources and Culture Working with existing organizational technologies to expand, modify, and assist staff to use them (e.g, expanded power and control wheel and Jellinek chart) Negotiating different kinds of capital Programs described major efforts in almost all cases to make doxa and different types of capital more visible and conscious so can revise and expand concepts & assumptions

80 Organizations as Fields: Stimulating Internal Change Hiring staff with different competencies—may not infuse through the organization unless the culture changes In one case, new staff assumed roles of consultation, training, and co-facilitation, not assume own caseload, in order to infuse Created a “Rapid Response Team”—multi- disciplinary, charged with creating policies and training, as well as immediate response to DV crises—safety, legal, counseling

81 Organizations as Fields: Creating Structural Changes Case four: DV program with multiple shelter locations working to address AOD better Major conflict trying to deal with women who were actively using; created many management and safety issues: Established one house only for those using AOD. Implemented readiness to change. Many contestations with other AOD & DV

82 Impetus for change: Importance of Social Capital and Split Habitus In some cases, primary impetus was funding or policy changes externally In most, is a person or persons with extensive social capital (multiple networks with both AOD and DV fields) and split habitus, or hybrid In other theories, might call them champions or culture-brokers

83 Discussion Usefulness of the frameworks? Precariousness of the integration—collaborative models, in particular, seem to require outside support to be maintained unless significant internal changes are made Innovations are occurring, important to understand them and learn from them

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