“Denaturalizing” Ethical Dilemmas to Stimulate Hybrid Attention to Intimate Partner Violence and Alcohol and Other Drug Use

Background & Purpose:

Organizations addressing intimate partner violence (IPV) and alcohol and other drug use (AOD) together must navigate two fields with very different paradigms, resulting in challenges and tensions in everyday program implementation. This paper uses theoretical concepts from anthropology. “Naturalization” explains how individuals/groups take certain aspects of social practice for granted or make unacknowledged assumptions about how the world works, making it challenging to envision options outside the norm. “Denaturalization” describes processes that allow individuals and groups to learn to recognize these practices and understand them differently, which often stimulates innovation in situations previously thought unchangeable. This paper’s goals include a) identifying examples of how naturalized routines and assumptions create ethical and other dilemmas in organizations engaged in hybrid approaches, and b) examining the conditions under which these limit choices, or lead to developing creative alternatives.

Methods:

Examples of dilemmas encountered were systematically extracted from semi-structured interviews with key informants and comparative case study analyses from 35 organizations from 20 states and Canada, engaged in hybrid IPV/AOD work. Interviewees provided examples of successes, conflicts, and struggles in staff and organizational activities, which we coded for their foci, key characteristics, and how they were approached. We clustered examples by when and where they occurred within the organization and between the organizations and their environments. We then classified them as either constraining or facilitating alternative approaches, and identified factors influencing these outcomes.

Results:

Situations experienced by some as limitations and by others as opportunities include engaging with underlying assumptions about IPV/AOD correlation/causality, use of certain language/concepts, and goal setting practices that arise from these conceptual differences (like divergent understandings of accountability and power). Some organizations develop hybrid philosophies that incorporate both definitions, while others remain compartmentalized. Similarly, screening and assessment practices and legal and agency policies related to inclusion or exclusion of particular types of participants reflect different responses to very real dilemmas. Some organizations screen-out and refer those with especially difficult problems, while others conduct informal screenings with a commitment to address emergent issues later and learn from their efforts. When everyone recognizes and grapples with the conflicts, competing priorities and misunderstandings between administrators, practitioners, funders, and regulators across the two fields can lead to creative new approaches: for example, using housing vouchers to create IPV transitional housing for women with AOD problems. Unfortunately, even in hybrid organizations, staff struggle with unexamined dilemmas, experience them as existential predicaments, and are therefore unable to recognize possible alternatives.

Conclusions & Implications:

We discuss methodological challenges encountered in identifying clear examples and characterizing factors influencing whether dilemmas are barriers or facilitators of innovative hybridity. The most creative organizations reframed everyday challenges as ethical dilemmas and worked to define new choices. Indeed, some of the innovations are what allowed organizations to begin doing hybrid work in the first place. From these examples, we develop principles for identifying naturalized dilemmas to assist organizations to develop innovative alternatives for navigating common structural and paradigmatic barriers to hybrid IPV/AOD services.