Trapped in housing insecurity: Socioecological barriers to housing access experienced by intimate partner violence survivors from marginalized communities.

Homelessness and intimate partner violence (IPV) do not impact all communities equally. Survivors from marginalized communities-that is communities that have been historically and structurally excluded from social, economic, and political resources-face additional challenges weathering IPV and housing crises. Understanding the housing experiences of marginalized survivors is necessary to achieve housing equity for all survivors. Community-based participatory research methods were utilized to convene 14 listening sessions (7 primary/7 validation) with Black and Latinx IPV survivors with intersectional identities (n = 92). Listening sessions were held in community-based locations including a church, health clinic, social service agency, and private residence. The last five validation sessions were conducted virtually on Zoom due to COVID pandemic protocols. All listening sessions were digitally recorded and transcribed verbatim. Latinx population listening sessions were conducted in Spanish and were implemented and translated with attention to linguistic justice principles. The research team used a modified constructivist grounded theory approach for data analysis. Four overarching themes (and seven subthemes) related to survivors' housing experiences emerged: (1) safety and healing challenges, including living in unhealthy physical environments, not being safe in their homes, and contending with community violence, sexual exploitation threats, and eviction fears; (2) formal service fragmentation/bureaucracy that hampered access to housing resource information and resources; (3) resource scarcity associated with limited affordable housing stock; and (4) systemic oppression resulting from discriminatory treatment and gentrification. Comprehensive multileveled approaches are needed to disrupt the cycle of housing insecurity for IPV survivors from marginalized communities.

Individual and community socioeconomic factors related to the quality of antenatal care: a multilevel analysis of West and Central Africa.

Antenatal care (ANC) can improve maternal health. We examined associations of individual and community socioeconomic status (SES) with the quality of ANC in West and Central Africa. Data were from the 2009-2011 UNICEF Multiple Indicator Cluster Surveys for women in seven countries (n = 24,718). Individual SES variables included women's education and wealth; community SES was defined as low or high poverty index. ANC quality was defined as receiving six services: blood pressure monitoring, blood tests, urine tests, malaria prophylaxis, tetanus vaccine, and HIV screening, and coded low or high. We used multilevel logistic regression to estimate fixed and random effects of individual and community SES on ANC quality. Less than one-fourth of women received high-quality ANC. Only small percentages of women had malaria prophylaxis and were counseled and tested for HIV. In adjusted country-stratified results, living in a poor community was associated with reduced odds of receiving high-quality ANC in six countries (Central African Republic: odds ratio, OR = 0.76; 95% confidence interval, CI:0.58-0.98; Chad: OR = 0.48; CI:0.32-0.74; Ghana: OR = 0.86; CI:0.61-0.97; Nigeria: OR = 0.74; CI:0.61-0.92; Sierra Leone: OR = 0.71; CI:0.57-0.91; and Togo: OR = 0.80; CI:0.47-0.91). The health system may be missing important opportunities to provide high-quality ANC and, thereby, improve pregnancy outcomes in these settings.

Factors associated with health facility delivery in West and Central Africa: A multilevel analysis of seven countries.

We examined associations between individual and community socioeconomic status (SES) and childbirth in a health facility in West and Central Africa using data from the 2009-2011 United Nations Children's Fund (UNICEF) Multiple Indicator Cluster Survey for women in seven countries (n = 34,487). Individual SES measures were education and wealth; community SES was low or high poverty index. In adjusted results, women residing in communities with high poverty had significantly lower odds of facility delivery than those who lived in more affluent communities in five countries (all p < 0.001). Reducing out-of-pocket healthcare costs may improve women's access to delivery in health facilities.

Factors Associated With Batterer Intervention Program Attrition.

Batterer intervention programs' (BIPs) curriculum have been criticized for their one-size-fits-all approach to rehabilitation with recent research suggesting specialized and client-centric approaches to batterer intervention may be more effective than traditional programming. Adverse childhood experiences (ACEs) have been examined as a risk factor for intimate partner violence (IPV) perpetration and numerous studies suggest a relationship between ACEs and low mental health treatment engagement. However, absent from the conversation is how ACEs may influence BIP treatment engagement and more specifically how ACEs influence BIP program attendance and attrition. The current study used administrative data from a sample of 268 men enrolled in a county-operated BIP to explore this question. BIP participants who experienced any ACEs, only household dysfunction ACEs, and/or both household dysfunction ACEs and child abuse/neglect ACEs had decreased odds of BIP attrition compared to participants with no ACEs. These findings have practical implications regarding screening, service delivery, and BIP curricula and highlight additional research needed on this topic.

"I feel like their relationship is based on the media": Relationship Between Media Representation and Adolescents' Relationship Knowledge and Expectations.

Teen dating violence (TDV) is a serious public health issue associated with negative physical and behavior outcomes that disproportionately impact African-American adolescents. Despite the emergence of effective TDV prevention strategies, more knowledge is needed about how African American adolescents understand healthy and unhealthy relationships. Adolescents' analysis of media representations can provide important insight into social norms around adolescent romantic relationships, which can inform the development of TDV prevention strategies. We conducted nine focus groups (n = 86) to explore perceptions of healthy and unhealthy relationships and the influence of media representations on romantic relationships. We transcribed focus group interviews verbatim and coded them line by line. Participants were primarily African American (90%), female (67%), and high school aged (13-17 years). Consistent with other studies, participants reported significant engagement across traditional and social media platforms that exposed them to a wide variety of fictional, celebrity, and peer relationships. A modified constructivist grounded theory analytic approach produced four major relationship themes: commitment, authenticity, privacy, and maturity. These themes captured participants' reflections about romantic relationships and how the media interact with relationship processes and perceptions. Results show that adolescents are using media representations of romantic couples to clarify their own romantic relationship expectations and desires. Future prevention strategies should support youths' use of critical thinking, perspective taking, and analysis to help align their relationship choices and expectations with their own values and preferences.

Intimate Partner Violence in the Workplace: Exploring Gender Differences in Current Health-Related Quality of Life.

Workplace restraint and interference (WRI) behaviors represent a distinct form of intimate partner violence (IPV) that undermines survivors' employment. This study explored relationships between WRI, gender, and health-related quality of life. Eight linear regressions tested the relationship between WRI and health-related quality of life measures within a large corporate sample. Overall, female employees reported poorer outcomes on all health-related quality of life domains compared with males. WRI experiences uniquely contributed to female employees' anxious moods, sleep disruptions, and reduced vitality, as well as male employee pain, beyond other factors. Helping employees, supervisors, and co-workers to understand WRI as IPV increases opportunities to enhance employee safety, health, and well-being. Future research, including WRI measurement development, can deepen our understanding WRI experiences on specific health outcomes.

"He gets mad that I'm sober": Experiences of substance use coercion among postpartum women in recovery.

PURPOSE: The number of women with substance use disorders (SUDs) is growing in the U.S. Many women with SUDs are of childbearing age, and studies show that women who abstain from substance use during pregnancy often relapse in the postpartum period. Given the high overlap between substance use and intimate partner violence, these women may be in relationships that make recovery more challenging. This study aimed to better understand how substance abuse coercion in intimate relationships may affect substance use and to identify and describe the presence of substance use coercion in postpartum women. METHODS: The study conducted qualitative interviews with 30 women with substance use disorders who had given birth within the past six months. Researchers recruited women from a larger intervention study providing home visit support to postpartum women in substance use recovery. Thematic analysis was then identified overarching themes in the interview data. RESULTS: Analysis of the impact of IPV on substance use revealed four themes: 1) sabotaging sobriety, 2) making substance use a condition of the relationship, 3) portraying her as a "bad mom," and 4) furthering social isolation. CONCLUSIONS: Findings showed that women with SUDs have specific vulnerabilities that partners may exploit as a way of exerting control. Implications for practice with postpartum women who are working toward recovery are discussed.

"We're Constantly Learning": Identifying and Disrupting White Supremacy Within a Victim Services Organization.

Many victim service organizations are seeking to realign service delivery around principles of racial equity. Dismantling institutional racism is a complex, intensive, and long-term process. Therefore, despite this imperative from the field, our knowledge about how social service organizations can effectively advance anti-oppressive practice is limited. This study examined victim advocate perspectives on the role institutional racism played within their work and the supports needed to undo institutional racism within their organization. Six focus groups were conducted with a meaningful cross section of staff members (n = 53) across the organization. Semi-structured interview guides included questions in four domains: (1) racism within client work, (2) challenges to addressing racism, (3) effective solutions, and (4) helpful organizational supports. Transcripts were thematically analyzed using modified constructivist grounded theory methods. Two overarching themes, Identifying Institutional Racism in the Workplace and Advancing Anti-racist Practice, and six subthemes emerged from the analysis. Advocates identified that naming and becoming comfortable talking about race was essential. Further, they believed it was important to acknowledge the ways in which that racism was implicitly built into helping systems at large. Advocates explored how internalized racial stereotypes influenced interactions between black, indigenous, and people of color (BIPOC) and white advocates and their clients in complex ways. Advocates highlighted organizational efforts that supported ongoing personal reflection, the creation of an accountable community, and staff empowerment within the organization as being critical to advancing anti-racist practice. Some advocates also wanted to see the organization move further in the direction of standing with BIPOC communities, particularly around criminal justice concerns. Findings provide important timely insights into how institutional racism manifests within victim service organizations and what organizational actions encourage anti-oppressive practices and culture.

Examining the relationship between Latinas' perceptions about what constitutes domestic violence and domestic violence victimization.

Domestic violence is a serious issue for U.S. Latinas. Better understanding of the potential risk or protection that cultural perceptions about what constitutes domestic violence may convey can help strengthen interventions. Therefore, a convenience sample of 93 Latinas was surveyed about their current levels of domestic violence victimization, acculturation, and demographics, as well as about whether 5 behavioral scenarios constituted domestic violence. Hierarchical multiple regressions were performed to examine the relationships between the 5 perception items and domestic violence victimization. After adjusting for established risk factors, only viewing male partner stalking and female verbal aggression as domestic violence were significantly associated with decreased domestic violence victimization. Findings can be integrated into the development and implementation of culturally competent interventions targeting Latinas.

"The Propellers of My Life" The Impact of Domestic Violence Transitional Housing on Parents and Children.

Housing and homelessness are frequent issues facing domestic violence (DV) survivors and their children. Several DV programs provide transitional housing (DVTH) to address the housing needs of DV survivors and their children. Despite wide use, little is known about the impact of DVTH, especially on child and parenting related needs and outcomes. Multiple structured interviews (82) were conducted with 27 parents with minor children living in DVTH in order to explore housing program experiences. Thematic analysis techniques produced three themes and seven subthemes about DVTH impact on parenting and child wellness. Overarching themes include: (1) DVTH helps to strengthen the parent-child relationship through a focus on family connection and health; (2). Transitional housing provides an opportunity for family stability via housing, material, and economic stability; (3). Time at DVTH allows family to access a diverse range of trauma-informed resources and social support to meet family goals. Barriers to these potential impacts are explored. Implications for practice with youth and parents include the need for extensive mental health and legal advocacy, programmatic models that emphasize resources, safety and the transition to permanent housing, and build on family strengths. Further research is needed to evaluate DVTH program outcomes.

Compassion Fatigue Among the Intimate Partner Violence and Sexual Assault Workforce: Enhancing Organizational Practice.

Gaps in knowledge related to occupational stress among the intimate partner violence (IPV) and sexual assault (SA) workforce remain. This study examined associations between key risk factors for occupational stress and compassion fatigue among a sample of IPV/SA service providers in the Southwestern United States (N = 520). Results of the hierarchical regression analysis identified microaggressions, age, recent life stress, direct practice, and workload as factors associated with compassion fatigue. The findings point to the importance of incorporating trauma-informed organizational approaches to address microaggressions, reduce workload, and support staff experiencing recent stress and providing direct services.

Interprofessional student hotspotting: preparing future health professionals to deliver team-based care for complex patients.

BACKGROUND: Interprofessional student hotspotting involves experiential and longitudinal learning about team-based care for patients with complex medical and social needs. As an emerging strategy for interprofessional education, there have been few research studies to examine student perspectives. PURPOSE: This study used a descriptive qualitative approach to examine the experiences and perspectives of health professions students who participated in a six-month interprofessional student hotspotting program. METHODS: At the end of the program, focus group interviews were conducted with 24 health professions students from medicine, social work, pharmacy, nursing, and health psychology. RESULTS: Thematic analysis revealed four themes: Observed benefits of interprofessional collaboration; Gained skills for collaborative care; Experienced difficulty managing group dynamics; and Learned approaches to caring for complex patients. CONCLUSION: The hotspotting program helped deepen students' appreciation for interprofessional team-based care. Repeated practice of teamwork skills during the six-month clinical learning experience resulted in students feeling more prepared to provide collaborative care for complex patients.

Why don't they follow through? Intimate partner survivors' challenges in accessing health and social services.

Intimate partner violence (IPV) screening and referral are routinely practiced by various healthcare providers. Although facilitators and barriers to IPV disclosure have been previously explored, healthcare providers' role in linking patients to longer-term IPV-related resources has received only superficial attention. This focus group study explored IPV survivors' service seeking experiences, using the complementary perspectives of advocates from a national domestic violence hotline (n = 24) and survivors from a domestic violence program (n = 30). Both advocates and survivors identified key service needs and access barriers. Advocates also shared successful strategies for "coaching" survivors that increased the likelihood of receiving services.

Playing by the Rules: Agency Policy and Procedure in Service Experience of IPV Survivors.

More than 1,800 programs exist in the United States, providing not only shelter but also transitional housing, advocacy and support, transportation, legal aid, and group and individual counseling for women who have experienced intimate partner violence (IPV). Shelter and transitional housing provide critical support for survivors, but have also been critiqued for having too many restrictive rules and code of conduct. More information is needed about the impact of rules and agency policy on women seeking services in IPV residential settings. This qualitative study explored the central research question, "How do rules shape IPV residential environment and survivor experiences in services?" Twenty-five women in four programs in two states who were currently residing in IPV residential services were interviewed about their experiences. Data were analyzed using grounded theory methods. Findings indicated rules affect individual survivors' and families' experiences and responses in services and of healing from IPV (micro), the relationships among residents and between residents and staff (mezzo), and participants' relationships with the agency as an institution and the help-seeking community (macro). An intriguing paradox is noted in that at their best, rules provide stability and motivation for some survivors. At their worst, rules create isolation and force exit from shelter into unsafe circumstances, causing a ripple effect of impact. Implications include the need to restructure rules and policies collaboratively with residents, and reduce the amount of rules used in services. Addressing rules will better enable IPV services to be survivor-centered and trauma-informed, ultimately increasing safety and healing.

Successful Rules Reduction Implementation Process in Domestic Violence Shelters: From Vision to Practice.

Domestic violence (DV) shelters provide safety for survivors to consider their options and heal from abuse. Unfortunately, survivors have reported negative experiences associated with shelter rule enforcement. Rules, such as curfew, decreased access to community social networks; and staff's rule enforcement may trigger survivors' past experiences with abusive control and structural racism. Rule enforcement may deter safe, trusting relationships between staff and residents. Statewide DV coalitions have been innovation leaders in shelter rules reduction efforts over the past decade. Seven DV shelter directors and coalition trainers with expertise implementing reduced-rule shelter models were interviewed for this study. Interview data were then analyzed using modified constructivist grounded theory methods. A three-stage implementation process emerged from the data. The initial stage highlighted efforts to create an organizational vision rooted in shared values. Shelters then intentionally focused on enhancing organizational capacity through staff development and team building. Third, rule-reduction practices were enacted through specific shelter policies and staff practices. Findings have broader implications for social work organizations also implementing anti-oppressive, survivor-centered, trauma-informed approaches, as this process involves considerable intention, training, and resources beyond services as usual. Social workers can support these efforts through student training, program development, and research efforts.

An integrative feminist model: the evolving feminist perspective on intimate partner violence.

The feminist perspective on intimate partner violence is a predominant model in the field, although not immune to criticism. In this research, frontline workers in the violence against women movement responded to critiques of the feminist model. The project used a focus group and a modified grounded theory analysis. Participants agreed with some criticisms, including an overreliance on a punitive criminal justice system, but reported skepticism toward proposed alternatives. Findings led to the development of the Integrative Feminist Model, which expands the feminist perspective in response to critiques, new research, and alternative theories while retaining a gendered analysis of violence.

Associations between women's perceptions of domestic violence and contraceptive use in seven countries in West and Central Africa.

OBJECTIVES: This study examined associations of women's attitudes toward domestic violence (DV) and contraceptive use in West and Central Africa. STUDY DESIGN: We used data from the Multiple Indicator Cluster Surveys for women in seven countries in West and Central Africa (2009-2011, n=80,055). MAIN OUTCOME MEASURE: We measured contraceptive use as none, traditional, or modern contraceptives. DV approval was measured as no, low, or high tolerance of wife beating. Multinomial logistic regression estimated odds of using traditional or modern methods versus none, adjusting for age, education, wealth, residence, parity, marital structure, spousal age-difference, and religion. RESULTS: Many women had no or low DV tolerance (41%, 44%, respectively); most used no contraception (81%). In adjusted results, women with low DV tolerance had lower odds of using traditional contraceptive methods (odds ratio, OR=0.87; 95% confidence interval, CI: 0.78-0.98) or modern methods (OR=0.86; 95% CI: 0.78-0.95) compared to women with no tolerance. Women with high DV tolerance had 28% lower odds of traditional contraceptive use (95% CI: 0.60-0.90), and 38% lower odds of modern contraceptive use (95% CI: 0.59-0.88) compared to women with no tolerance. CONCLUSION: The high prevalence of DV approval may threaten the success of programs aimed at improving women's reproductive health, including contraceptive use.

Interpersonal violence at the crossroads between adolescence and adulthood: learning about partner violence from young mothers.

This article examines partner violence at the crossroads between adolescence and adulthood by talking with adolescent mothers--young women who straddle that crossroad. Drawing on ethnographic interviews conducted with 30 adolescent mothers, the accounts of 13 young mothers were analyzed to shed light on the ways in which their experiences of partner violence intersected with their developmental stage. Thematic analysis produced four general categories of themes that included physical proximity of family members, chaos at home, growing up in the shadow of abuse, and making the relationship work. Implications for future research and practice are explored.

Back to basics: essential qualities of services for survivors of intimate partner violence.

Survivor voice is essential to effectively implement survivor-focused IPV (intimate partner violence) services. In this focus group study, domestic violence survivors (n = 30) shared detailed perspectives as service seekers and recipients, whereas national hotline advocates (n = 24) explored relationships between service providers and survivors based on their interactions with both. Four thematic categories related to enhancing IPV services emerged: providing empathy, supporting empowerment, individualizing care, and maintaining ethical boundaries. Advocates identified additional factors that interfered with quality services, including the following: inadequate organizational resources, staff burnout, lack of training, and poor integration with other community resources. Respectful, empowering relationships are the centerpiece for quality IPV services.