Effects of a culturally informed intervention on abused, suicidal African American women.

This study examined (a) the relative efficacy of a culturally sensitive empowerment group intervention (Nia) aimed at increasing 3 protective factors-self-esteem, hopefulness, and effectiveness of obtaining resources-versus treatment as usual (TAU) for low-income, abused African American women who recently had attempted suicide and (b) the impact of participants' readiness to change with regard to their abusive relationship and suicidal behavior on their levels of each protective factor in the 2 conditions. The sample included 89 African American women who reported intimate partner violence (IPV) exposure and a recent suicide attempt. Multivariate general linear modeling revealed that those in Nia showed greater improvements in self-esteem, but not in hopefulness or effectiveness of obtaining resources. However, significant interactions emerged in which participants who were "less ready to change" (i.e., earlier in the stages of change process) their IPV situation and suicidal behavior endorsed greater levels of hopefulness and perceived effectiveness of obtaining resources, respectively, following Nia. Findings suggest that abused, suicidal African American women who are more reluctant initially to changing their abusive situation and suicidal behavior may benefit from even a brief, culturally informed intervention.

From Blue to Green: The Development and Implementation of a Therapeutic Horticulture Program for Residents of a Battered Women's Shelter.

The delivery of therapeutic services to clients is influenced by service providers' understanding of the "fit" of a specific program with their service mandate as well as their perceptions of the potential benefits of the program. This article discusses the development and implementation of a therapeutic horticulture (TH) program at a battered women's shelter that serves 17 counties in Central Kentucky. Through semistructured interviews, we gauge the shelter staff's perceptions of the relationship of the TH program to the shelter's overall mission; their sense of the program's benefits for residents, for the shelter as a community organization, and for themselves; and their concerns about the TH program. We consider how these findings may impact future programming at the shelter, and we discuss plans for further evaluation of the TH program in terms of its impact on shelter residents' long-term outcomes.

Reducing the Harm of Criminal Victimization: The Role of Restitution.

Restitution is a court-ordered payment by offenders to their victims to cover the victims' economic losses resulting from the crime. These losses can be substantial and can harm victims and victims' families both directly and indirectly. But most victims do not receive reparation for their injuries, both because judges do not always impose restitution and because of problems with collecting restitution payments, even if there is a court order to do so. In this article, we review the literature on restitution and suggest that this compensatory mechanism is necessary to restore victims to where they were before the crime occurred. But monetary restitution alone is not sufficient. Making victims whole requires not only financial compensation from the offender but also procedural, informational, and interpersonal justice from the criminal justice system.

Screening and counselling in the primary care setting for women who have experienced intimate partner violence (WEAVE): a cluster randomised controlled trial.

BACKGROUND: Evidence for a benefit of interventions to help women who screen positive for intimate partner violence (IPV) in health-care settings is limited. We assessed whether brief counselling from family doctors trained to respond to women identified through IPV screening would increase women's quality of life, safety planning and behaviour, and mental health. METHODS: In this cluster randomised controlled trial, we enrolled family doctors from clinics in Victoria, Australia, and their female patients (aged 16-50 years) who screened positive for fear of a partner in past 12 months in a health and lifestyle survey. The study intervention consisted of the following: training of doctors, notification to doctors of women screening positive for fear of a partner, and invitation to women for one-to-six sessions of counselling for relationship and emotional issues. We used a computer-generated randomisation sequence to allocate doctors to control (standard care) or intervention, stratified by location of each doctor's practice (urban vs rural), with random permuted block sizes of two and four within each stratum. Data were collected by postal survey at baseline and at 6 months and 12 months post-invitation (2008-11). Researchers were masked to treatment allocation, but women and doctors enrolled into the trial were not. Primary outcomes were quality of life (WHO Quality of Life-BREF), safety planning and behaviour, mental health (SF-12) at 12 months. Secondary outcomes included depression and anxiety (Hospital Anxiety and Depression Scale; cut-off ≥8); women's report of an inquiry from their doctor about the safety of them and their children; and comfort to discuss fear with their doctor (five-point Likert scale). Analyses were by intention to treat, accounting for missing data, and estimates reported were adjusted for doctor location and outcome scores at baseline. This trial is registered with the Australian New Zealand Clinical Trial Registry, number ACTRN12608000032358. FINDINGS: We randomly allocated 52 doctors (and 272 women who were eligible for inclusion and returned their baseline survey) to either intervention (25 doctors, 137 women) or control (27 doctors, 135 women). 96 (70%) of 137 women in the intervention group (seeing 23 doctors) and 100 (74%) of 135 women in the control group (seeing 26 doctors) completed 12 month follow-up. We detected no difference in quality of life, safety planning and behaviour, or mental health SF-12 at 12 months. For secondary outcomes, we detected no between-group difference in anxiety at 12 months or comfort to discuss fear at 6 months, but depressiveness caseness at 12 months was improved in the intervention group compared with the control group (odds ratio 0·3, 0·1-0·7; p=0·005), as was doctor enquiry at 6 months about women's safety (5·1, 1·9-14·0; p=0·002) and children's safety (5·5, 1·6-19·0; p=0·008). We recorded no adverse events. INTERPRETATION: Our findings can inform further research on brief counselling for women disclosing intimate partner violence in primary care settings, but do not lend support to the use of postal screening in the identification of those patients. However, we suggest that family doctors should be trained to ask about the safety of women and children, and to provide supportive counselling for women experiencing abuse, because our findings suggest that, although we detected no improvement in quality of life, counselling can reduce depressive symptoms. FUNDING: Australian National Health and Medical Research Council.

Support by trained mentor mothers for abused women: a promising intervention in primary care.

BACKGROUND: Intimate partner violence (IPV) against women is a major health problem and negatively affects the victim's mental and physical health. Evidence-based interventions in family practice are scarce. OBJECTIVE: We aimed to evaluate a low threshold home-visiting intervention for abused women provided by trained mentor mothers in family practice. The aim was to reduce exposure to IPV, symptoms of depression as well as to improve social support, participation in society and acceptance of mental health care. METHODS: A pre-post study of a 16-week mentoring intervention with identified abused women with children was conducted. After referral by a family doctor, a mentor mother visited the abused woman weekly. Primary outcomes are IPV assessed with the Composite Abuse Scale (CAS), depressive symptoms using the Symptom Checklist (SCL 90) and social support by the Utrecht Coping List. Secondary outcomes are analysed qualitatively: participation in society defined as employment and education and the acceptance of mental health care. RESULTS: At baseline, 63 out of 66 abused women were referred to mentor support. Forty-three participants completed the intervention programme. IPV decreased from CASt otal 46.7 (SD 24.7) to 9.0 (SD 9.1) (P ≤ 0.001) after the mentor mother support programme. Symptoms of depression decreased from 53.3 (SD 13.7) to 34.8 (SD 11.5) (P ≤ 0.001) and social support increased from 13.2 (SD 4.0) to 15.2 (SD 3.5) (P ≤ 0.001). Participation in society and the acceptance of mental health for mother and child improved. CONCLUSIONS: Sixteen weekly visits by trained mentor mothers are a promising intervention to decrease exposure to IPV and symptoms of depression, as well as to improve social support, participation in society and the acceptance of professional help for abused women and their children.

The impact of legislative standards on batterer intervention program practices and characteristics.

Changes in social policy are often pursued with the goal of reducing a social problem by improving prevention efforts, intervention program practices, or participant outcomes. State legislative standards for intimate partner violence intervention programs have been adopted nearly universally across the US, however, we do not know whether such standards actually achieve the intended goal of affecting programs' policies and practices. To assess the effect that batterer intervention program (BIP) standards have on policies and practices of programs, this study used longitudinal surveys collected as part of an ongoing evaluation conducted from 2001 to the present to compare intervention program (N = 74) characteristics and practices at three time points before and after the adoption of standards in Oregon. Analyses were conducted to examine all BIPs in Oregon at each time point, as well as change among a subset of programs in existence at all survey assessments. Results indicate that across all programs, the use of mixed gender group co-facilitation increased by 14% between 2004 and 2008, while program length increased by approximately 12 weeks. However, other practices such as programs' coordination with community partners were unchanged. Analyses of within-program change revealed fewer differences, with only program length increasing significantly over the three assessments. These and other findings indicate that while standards affected program length as intended, other practices commonly addressed by legislative standards remained unchanged. The findings provide needed information regarding programs' compliance with components of the standards, the potential need for compliance monitoring, and the potential impact of state standards on program effectiveness and on the prevalence of intimate partner violence.

Barriers to compliance with Oregon batterer intervention program standards.

Although standards for batterer intervention programs (BIPs) have been adopted in nearly all U.S. states, there is no evidence that standards are implemented and no information about challenges programs may encounter in efforts to comply with standards. This study uses qualitative survey data from BIPs in the state of Oregon (N = 42) to identify barriers to implementation during a 2-year period following the introduction of state standards. Nine challenges were identified including difficulty finding qualified facilitators, inadequate funding, difficulty meeting training requirements, high workloads, trouble creating and maintaining collaborations, inability to accommodate diverse participant needs, conflict between state standards and county requirements, and perceived gaps between standards and evidence-based practices. These findings inform controversy surrounding BIP standards and efforts to increase BIP effectiveness.

A glimpse into the world of battered ultra-Orthodox Jewish women in Israel: a follow-up study on women who resided in a shelter.

Using a mixed-methods approach to content analysis, we interviewed 88 ultra-Orthodox Jewish women who had endured spousal abuse and chose to find refuge in the only shelter in Israel specifically designated for religious women. All had experienced some type of spousal abuse for several years. The majority summarized the period they spent in the shelter in positive terms and reported that they had developed personal strength and that their social and family relationships had improved. About half of them described the postshelter period in positive terms, while the rest described it in both positive and negative terms or in negative terms only. Negative themes were mostly related to the women's economic situation and to emotional and behavioral problems of their children. Further research is required to expand existing knowledge regarding this population.

PERCEIVED FEASIBILITY OF ESTABLISHING DEDICATED ELDER ABUSE PROGRAMS OF CARE AT HOSPITAL-BASED SEXUAL ASSAULT/DOMESTIC VIOLENCE TREATMENT CENTETR.

BACKGROUND: Elder abuse is an increasingly important issue that must be addressed in a systematic and coordinated way. OBJECTIVE: Our objective was to evaluate the perceived feasibility of establishing an elder abuse care program at hospital-based sexual assault and domestic violence treatment centers in Ontario, Canada. METHOD: In July 2012, a questionnaire focused on elder abuse care was distributed to all of Ontario's Sexual Assault/Domestic Violence Treatment Centre (SA/DVTC) Program Coordinators/Managers. RESULTS: We found that the majority of Program Coordinators/ Managers favored expansion of their program mandates to include an elder abuse care program. However, these respondents viewed collaboration with a large network of well trained professionals and available services in the community that address elder abuse as integral to responding in a coordinated manner. DISCUSSION: The expansion of health services to address the needs of abused older adults in a comprehensive and integrated manner should be considered as an important next step for hospital-based violence care programs worldwide.

[Psychological consequences and treatment of female victims of violence]. / Conséquences psychologiques et prise en charge des femmes victimes de violences.

Domestic violence often just reproduces the repeated violence suffered as a child. The treatment of a female victim depends a lot on her traumatic past, and the care is designed in coordination with various partners. By improving the identification and care of children who are so-called witnesses to family violence, but who are really co-victims, in other words abused, it is possible to avoid violence in all its forms being reproduced across the generations.

Evaluation of a single-session brief motivational enhancement intervention for partner abusive men.

The current study evaluated the efficacy of a single-session brief motivational enhancement (BME) interview to increase treatment compliance and reduce recidivism rates in a sample of 82 recently adjudicated male perpetrators of intimate partner violence (IPV). Batterer intervention program attendance and completion as well as re-arrest records served as the primary outcome measures and were collected 6 months post-adjudication. Results indicated that BME was associated with increases in session attendance and treatment compliance. BME was not directly associated with reductions in recidivism. The relationship between BME and treatment compliance was moderated by readiness to change such that BME participants with low readiness to change attended more sessions and were more likely to be in compliance with the terms of a treatment than control participants with low readiness, while participants with high readiness attended sessions equally, regardless of study condition. Results indicate that outcomes may be improved through treatment efforts that consider individual differences, such as one's readiness to change, in planning interventions for IPV perpetrators.

Children exposed to intimate partner violence and the reported effects of psychosocial interventions.

Using a repeated measures design posttraumatic stress (PTS), psychological and behavioral problems significantly decreased following intervention in children exposed to intimate partner violence (IPV), with use of traditional group analyses. Analyses using the reliable change index (RCI), however, revealed that few children were improved or recovered, implying that interventions in common use should be evaluated for their significant impact on the individual level in addition to group level statistics. Positive changes in children's behavioral problems were related to the mother's improvement of their own mental health. Direct victimization by the perpetrator was not associated with treatment changes but with higher symptom levels at study entry. Amount of contact with the perpetrator was neither related to symptom load nor to changes following treatment.

Advancing career counseling and employment support for survivors: an intervention evaluation.

The purpose of this research was to conduct a replication-based and extension study examining the effectiveness of a 5-week career group counseling intervention, Advancing Career Counseling and Employment Support for Survivors (ACCESS; Chronister, 2008). The present study was conducted in a markedly different geographic region within a larger community as compared with the original investigation conducted by Chronister and McWhirter (2006). Women survivors of intimate partner violence (N = 73) participated in ACCESS, with career-search self-efficacy, perceived career barriers, perceived career supports, anxiety, and depression assessed at preintervention, postintervention, and 8-week follow-up. Women survivors demonstrated significant improvements in career-search self-efficacy and perceived career barriers at postintervention. Moreover, these same improvements were maintained at the 8-week follow-up assessment with the addition of significant improvements in perceived future financial supports, anxiety, and depression compared with preintervention scores. This work replicates the initial findings regarding the effectiveness of ACCESS with respect to career-search self-efficacy (Chronister & McWhirter, 2006) as well as extends the initial research to include improvements in perceived career barriers and perceived career supports. Moreover, the present study extends the work to include the mental health outcomes of anxiety and depression; results demonstrated improvements in these areas at 8-week follow-up. This investigation begins to fill a critical need for evaluated career-focused interventions for the underserved population of women survivors of intimate partner violence.

Desistance from intimate partner violence: the role of legal cynicism, collective efficacy, and social disorganization in Chicago neighborhoods.

This paper examined the relationship between reported Intimate Partner Violence (IPV) desistance and neighborhood concentrated disadvantage, ethnic heterogeneity, residential instability, collective efficacy and legal cynicism. Data from the Project on Human Development in Chicago Neighborhoods (PHDCN) Longitudinal survey were used to identify 599 cases of IPV in Wave 1 eligible for reported desistance in Wave 2. A Generalized Boosting Model was used to determine the best proximal predictors of IPV desistance from the longitudinal data. Controlling for these predictors, logistic regression of neighborhood characteristics from the PHDCN community survey was used to predict reported IPV desistance in Wave 2. The paper finds that participants living in neighborhoods high in legal cynicism have lower odds of reporting IPV desistance, controlling for other variables in the logistic regression model. Analyses did not find that IPV desistance was related to neighborhood concentrated disadvantage, ethnic heterogeneity, residential instability and collective efficacy.

Profiles of distress in sheltered battered women: implications for intervention.

Heterogeneity in patterns of distress and psychological functioning was investigated using a person-oriented approach to data analysis in two diverse samples of battered women in shelters. In order to provide some empirically derived guidance to clinicians, scores on measures of depressive symptoms as well as state and trait anxiety were cluster analyzed. A four-cluster solution provided the best fit for both samples of women, and despite the demographic differences in the women, generally similar clusters were found in both samples. One cluster contained women with minimal distress; another, those who were mildly anxious; in a third cluster, the women were moderately to highly depressed and anxious; and in a fourth cluster, the women were reporting severe levels of distress. Implications for treatment include the importance of providing individually tailored interventions for the women, based on differential combinations of depression and anxiety, especially for women whose distress levels are in the high and severe ranges of distress.

The role of mutual in-feeding in maintaining problematic self-narratives: exploring one path to therapeutic failure.

According to the author's narrative model of change, clients may maintain a problematic self-stability across therapy, leading to therapeutic failure, by a mutual in-feeding process, which involves a cyclical movement between two opposing parts of the self. During innovative moments (IMs) in the therapy dialogue, clients' dominant self-narrative is interrupted by exceptions to that self-narrative, but subsequently the dominant self-narrative returns. The authors identified return-to-the-problem markers (RPMs), which are empirical indicators of the mutual in-feeding process, in passages containing IMs in 10 cases of narrative therapy (five good-outcome cases and five poor-outcome cases) with females who were victims of intimate violence. The poor-outcome group had a significantly higher percentage of IMs with RPMs than the good-outcome group. The results suggest that therapeutic failures may reflect a systematic return to a dominant self-narrative after the emergence of novelties (IMs).

Racial differences in treatment effect among men in a substance abuse and domestic violence program.

BACKGROUND: It is unclear whether racial differences in treatment effect exist for individuals in substance abuse and domestic violence programs. OBJECTIVES: This study examined racial differences in treatment effect among substance dependent Caucasian and African-American male intimate partner violence (IPV) offenders court mandated to an integrated substance abuse and domestic violence treatment. METHODS: From baseline to completion of treatment (week 12), 75 participants (39 Caucasian; 36 African-American) were assessed on demographics, substance use, legal characteristics, and use of violence (physical, verbal, and psychological). RESULTS: African-American men served more months incarcerated in their life than Caucasian men. Both groups showed decreases in their use of physical violence and alcohol abuse over treatment. Caucasian men also showed a decrease in their use of verbal abuse. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: At treatment completion, both groups showed a reduction in physical abuse and alcohol abuse. Caucasian men showed a reduction in their use of verbal abuse, but African-American men did not. Substance dependent African-American male IPV offenders may benefit from interventions that thoroughly target communication skills in addition to issues of substance abuse and IPV to reduce use of verbal abuse and improve treatment outcomes among African American men.

Transformative ties: gendered violence, forms of recovery, and shifting subjectivities in Chile.

Although a significant body of scholarship on trauma has emerged in medical anthropology, there has been little examination of how gendered expectations shape the aftermath of extreme human experience, forms of recovery, and subjectivity. Here, I show how domestic and other forms of violence have shaped Luz's suffering in the dictatorial (1973-90) and officially democratic (1990-present) eras in Chile. I then elucidate how Luz's engagement with Safe Space, an NGO connected to UN violence against women frameworks, and other globally connected women's groups, have allowed her to generate transformative ties with other women. These relationships provide support for Luz's self-defined project of transforming herself and society, largely in relationship to gendered expectations, so that her recovered sense of self will have more of a home in the world, outside the boundaries of narrowly defined gender roles. This analysis is based on ethnographic research in Santiago, Chile, over 19 months in 2000-04 and 2009, including participant-observation at two domestic violence centers and life history interviews with 18 women who sought help there.

The effectiveness of parent-child interaction therapy for victims of interparental violence.

This study compares the effectiveness of Parent-Child Interaction Therapy (PCIT) in reducing behavior problems (e.g., aggression, defiance, anxiety) of 62 clinic-referred, 2- to 7-year-old, maltreated children exposed to interparental violence (IPV) with a group of similar children with no exposure to IPV (N=67). Preliminary analyses showed that IPV-exposed dyads were no more likely to terminate treatment prematurely than non IPV-exposed dyads. Results of repeated-measures MANCOVAs showed significant decreases in child behavior problems and caregivers' psychological distress from pre- to posttreatment for IPV-exposed and IPV nonexposed groups, and no significant variation by exposure to IPV. Stress in the parent role related to children's difficult behaviors and the parent-child relationship decreased from pre- to posttreatment, but parental distress did not decrease significantly over the course of PCIT. Results of an analysis testing the benefits of a full course of treatment over the first phase of treatment showed that dyads completing the full course of treatment reported significantly greater improvements in children's behavior problems than those receiving only the first phase of treatment.