Can This Provider Be Trusted? A Review of the Role of Trustworthiness in the Provision of Community-Based Services for Intimate Partner Violence Survivors.

While there is a growing literature on intimate partner violence (IPV) survivors and service providers, it is limited by its largely atheoretical and descriptive nature, and its emphasis on individual-level survivors' help-seeking. We seek to broaden our understanding by shifting the focus onto organizations and service systems and introducing the concept of these providers' trustworthiness toward survivors. Provider trustworthiness in delivering services includes benevolence (locally available and caring), fairness (accessible to all and non-discriminatory), and competence (acceptable and effective in meeting survivors' needs). Guided by this conceptualization, we conducted an integrative review drawing on four databases: PsycINFO, PubMed, Web of Science, and Westlaw. We identified studies for inclusion that were published between January 2005 and March 2022, and we examined the trustworthiness of community-based providers serving adult IPV survivors in the United States, including domestic violence services, health and mental health care, the legal system, and economic support services (N = 114). Major findings include (1) many survivors live in communities with no shelter beds, mental health care, or affordable housing; (2) many services are inaccessible because they lack, for example, bilingual staff, sliding fees, or telehealth options; (3) too many providers are harmful or discriminatory toward survivors, especially those who are, for example, sexual or gender minorities, immigrants or non-English-speaking, poor, or Native, Black, or Latinx; (4) many providers appear to be incompetent, lack evidence-based training, and are ineffective in meeting survivors' needs. We call on researchers, advocates, and providers to examine provider trustworthiness, and we offer an introduction to measuring it.

An Exploratory Study of Financial Health as an Antecedent of Economic Abuse Among Women Seeking Help for Intimate Partner Violence.

Economic abuse is a common component of intimate partner violence (IPV). This study explored whether IPV victim and perpetrator financial health at relationship outset are associated with two types of economic abuse-restriction and exploitation-during the relationship. With a sample of 315 women seeking services for male-perpetrated IPV, the study showed increased use of economic restriction when perpetrators were advantaged in terms of assets or disadvantaged in terms of debt. There was increased use of economic exploitation when victims were advantaged in terms of assets or credit and when perpetrators were disadvantaged in terms of assets, debt, or credit. Implications for research and intervention are discussed.

The Effects of Social Location and Situational Factors on Young Women's Disclosure of Intimate Partner Violence Across Relationships.

The goal of the study was to examine disclosure of physical and sexual intimate partner violence (IPV) victimization across abusive relationships within a sociodemographically diverse sample of young women. We recruited 283 participants, ages 18 to 24, from a university, a 2-year college, and community sites serving low-income young women, and assessed physical and sexual IPV victimization, and related disclosure, across each of their abusive relationships (415 total). We used multilevel modeling to examine the effects of social location and situational factors on the odds of any disclosure of abuse during first relationships and across relationships. The rate of physical IPV disclosure was 50%, vs. 29% for sexual IPV. Multilevel model results indicated setting, IPV type, high frequency sexual IPV, and fear were significantly related to any disclosure.

Who We Are Today: a National Survey of Diversity Among Psychiatry Program Directors.

OBJECTIVE: In March 2018, the American Association of Directors of Psychiatric Residency Training (AADPRT) formed the Diversity and Inclusion (D&I) Committee. One of the committee's goals was to understand the AADPRT membership's composition and their perceptions of D&I. This study's objective was to identify the demographic characteristics of the AADPRT membership. METHODS: Program directors were invited by email to participate in an anonymous survey. The survey collected participants' demographic information including gender, race/ethnicity, training background, age, disability/differently abled status, job role, geographic region where their program is located, type of program, and their program's community setting. RESULTS: Two hundred fifty six of 657 AADPRT members (39%) completed the survey. Respondents were mostly White (64.5%) followed by Asian/Southeast Asian (17.6%), Hispanic/Latinx (4.3%), and Black (1.6%). Only 13.3% of the participants were international medical graduates. Women were more prevalent (61.7%) than men (37.5%), and 9.4% self-identified as members of the LGBTQ+ Community. CONCLUSIONS: This study represents the first systematic investigation into the diversity among psychiatry program directors throughout the USA and Canada. Future qualitative studies are needed to better understand the reasons behind this initial study's findings. Potential concerns requiring exploration include the possibility of the program director role serving as a "glass ceiling" for some women and a "leaky pipeline" in academia for groups underrepresented in medicine.

The Frequency, Nature, and Effects of Coerced Debt Among a National Sample of Women Seeking Help for Intimate Partner Violence.

This study examines the frequency, nature, and effects of coerced debt, defined as non-consensual, credit-related transactions that occur in intimate relationships where one partner uses coercive control to dominate the other. The sample includes 1,823 women who called the National Domestic Violence Hotline. Results suggest that coerced debt, from both coercive and fraudulent transactions, is a common problem and is significantly related to control over financial information, credit damage, and financial dependence on the abuser. This study supports the need for policy reform and victim services aimed at addressing coerced debt, thereby mitigating a potentially significant economic barrier to safety.

The Effects of Cumulative Violence Clusters on Young Mothers' School Participation: Examining Attention and Behavior Problems as Mediators.

Using a cluster analysis approach with a sample of 205 young mothers recruited from community sites in an urban Midwestern setting, we examined the effects of cumulative violence exposure (community violence exposure, witnessing intimate partner violence, physical abuse by a caregiver, and sexual victimization, all with onset prior to age 13) on school participation, as mediated by attention and behavior problems in school. We identified five clusters of cumulative exposure, and found that the HiAll cluster (high levels of exposure to all four types) consistently fared the worst, with significantly higher attention and behavior problems, and lower school participation, in comparison with the LoAll cluster (low levels of exposure to all types). Behavior problems were a significant mediator of the effects of cumulative violence exposure on school participation, but attention problems were not.

Evidence of the Construct Validity of the Scale of Economic Abuse.

This study investigated the construct validity of the Scale of Economic Abuse (SEA). Evidence of construct validity was assessed by examining the relationship between the SEA and an economic outcome, financial resources, as perceived by participants. A sample of 93 women with abusive partners were recruited from a domestic violence organization and interviewed 3 times over a period of 4 months. Hierarchical linear modeling was used to examine the relationship between economic abuse and financial resources over time, controlling for the effects of physical and psychological abuse. The findings indicate that baseline economic abuse was significantly related to baseline financial resources, and within-woman change in economic abuse was significantly predicted change in financial resources over time. The findings suggest that the SEA measures what it is intended to measure: an economic dimension of intimate partner abuse that has damaging economic consequences.

Beyond deficits: intimate partner violence, maternal parenting, and child behavior over time.

Exposure to intimate partner violence (IPV) has negative consequences for children's well-being and behavior. Much of the research on parenting in the context of IPV has focused on whether and how IPV victimization may negatively shape maternal parenting, and how parenting may in turn negatively influence child behavior, resulting in a deficit model of mothering in the context of IPV. However, extant research has yet to untangle the interrelationships among the constructs and test whether the negative effects of IPV on child behavior are indeed attributable to IPV affecting mothers' parenting. The current study employed path analysis to examine the relationships among IPV, mothers' parenting practices, and their children's externalizing behaviors over three waves of data collection among a sample of 160 women with physically abusive partners. Findings indicate that women who reported higher levels of IPV also reported higher levels of behavior problems in their children at the next time point. When parenting practices were examined individually as mediators of the relationship between IPV and child behavior over time, one type of parenting was significant, such that higher IPV led to higher authoritative parenting and lower child behavior problems [corrected]. On the other hand, there was no evidence that higher levels of IPV contributed to more child behavior problems due to maternal parenting. Instead, IPV had a significant cumulative indirect effect on child behavior via the stability of both IPV and behavior over time. Implications for promoting women's and children's well-being in the context of IPV are discussed.

A 12-week comparison regarding symptom improvement in an urban university-based outpatient child psychiatry clinic.

To compare the efficacy of pharmacotherapy versus combination pharmacotherapy and psychotherapy for externalizing, conduct, and aggressive behaviors in children aged 6 through 18 years in an urban academic outpatient facility. Data from a child psychiatry outpatient population whose scores were identified as "at risk" or "clinically significant" based on a validated and standardized assessment tool were assessed at baseline and 12 weeks or more after treatment. Conduct symptoms worsened with medication management alone but improved with combination treatment (P < 0.05). Females and older youth were more likely to have therapy included in their treatment. Conduct problems that can be seen in a variety of youth disorders, such as disruptive behaviors, mood, and anxiety disorders, have a better probability of improving with treatment that includes psychotherapy versus medication management alone.

Does job stability mediate the relationship between intimate partner violence and mental health among low-income women?

Intimate partner violence (IPV) has detrimental consequences for women's mental health. To effectively intervene, it is essential to understand the process through which IPV influences women's mental health. The current study used data from 5 waves of the Women's Employment Study, a prospective study of single mothers receiving Temporary Assistance for Needy Families (TANF), to empirically investigate the extent to which job stability mediates the relationship between IPV and adverse mental health outcomes. The findings indicate that IPV significantly negatively affects women's job stability and mental health. Further, job stability is at least partly responsible for the damaging mental health consequences of abuse, and the effects can last up to 3 years after the IPV ends. This study demonstrates the need for interventions that effectively address barriers to employment as a means of enhancing the mental health of low-income women with abusive partners.

The effects of adolescent intimate partner violence on women's educational attainment and earnings.

Intimate partner violence (IPV) is a serious, widespread problem that negatively affects women's lives, including their economic status. The current study explored whether the financial harm associated with IPV begins as early as adolescence. With longitudinal data from a sample of 498 women currently or formerly receiving welfare, we used latent growth curve modeling to examine the relationships between adolescent IPV, educational attainment, and women's earnings. We found that women who had been victimized by a partner during adolescence obtained less education compared with nonvictimized women, with victimization indirectly influencing women's earnings via educational attainment. The findings support the need for intervention strategies aimed at preventing IPV and promoting women's educational and career development over the life course.

A model of sexually and physically victimized women's process of attaining effective formal help over time: the role of social location, context, and intervention.

As empirical evidence has demonstrated the pervasiveness of sexual assault and intimate partner violence in the lives of women, and the links to poor mental health outcomes, attention has turned to examining how women seek and access formal help. We present a conceptual model that addresses prior limitations and makes three key contributions: It foregrounds the influence of social location and multiple contextual factors; emphasizes the importance of the attainment of effective formal help that meets women's needs and leads to positive mental health outcomes; and highlights the role of interventions in facilitating help attainment. We conclude with research and practice implications.

The impact of intimate partner violence on low-income women's economic well-being: the mediating role of job stability.

This study sought to extend our understanding of the mechanisms by which intimate partner violence (IPV) harms women economically. We examined the mediating role of job instability on the IPV-economic well-being relationship among 503 welfare recipients. IPV had significant negative effects on women's job stability and economic well-being. Job stability was at least partly responsible for the deleterious economic consequences of IPV, and the effects lasted up to three years after the IPV ended. This study demonstrates the need for services and policies that address barriers to employment as a means of improving the economic well-being of low-income women with abusive partners.

"What has it been like for you to talk with me today?": the impact of participating in interview research on rape survivors.

The purpose of this project was to conduct a qualitative study of how participating in in-depth interviews impacted rape survivors. These interviews contained both open-ended, free response section and closed-ended, standardized assessments. The implementation of the interviews was informed by principles of feminist interviewing, which emphasized reducing hierarchy between the interviewer and interviewee, providing information and resources, and creating an emotionally supportive and compassionate setting. Narrative data were analyzed from rape survivors (N = 92) regarding how they were affected by participating in these interviews. Results suggested that the overwhelming majority of survivors found the interview to be a helpful, supportive, and insightful experience. Additional analyses revealed that the feminist interviewing principles were noticed and appreciated by the participants and contributed to their overall positive participation outcomes.

Main, mediating, and moderating effects of social support on the well-being of survivors of intimate partner violence across 2 years.

Intimate partner violence is a serious and pervasive social problem with deleterious consequences for survivors' well-being. The current study involved interviewing 160 survivors 6 times over 2 years to examine the role of social support in explaining or buffering these negative psychological consequences. The authors examined both between- and within-persons variability to explore women's trajectories regarding their experiences of abuse, social support, depression, and quality of life (QOL). Findings revealed the complex role of social support on women's well-being. Evidence was found for main, mediating, and moderating effects of social support on women's well-being. First, social support was positively related to QOL and negatively related to depression. Social support also partially explained the effect of baseline level and subsequent change in physical abuse on QOL and depression over time, partially mediated the effects of change in psychological abuse, and moderated the impact of abuse on QOL. The buffering effects of social support were strongest at lower levels of abuse. Implications for future research and intervention are discussed.

Training interviewers for research on sexual violence: a qualitative study of rape survivors' recommendations for interview practice.

Face-to-face interviewing is a common data collection technique in violence against women research. To guide the development of interviewer training programs, the authors conducted an empirical study on adult rape survivors' recommendations for interview practice. They asked survivors what interviewers should know about rape and how they should interact with participants. Data from 92 survivors revealed that interviewer training needs to emphasize diversity so that researchers are capable of working effectively with individuals with different life circumstances. The survivors also emphasized that interviewers need to show warmth and compassion and allow them to exercise choice and control during the interview process.

Why do rape survivors volunteer for face-to-face interviews? A meta-study of victims' reasons for and concerns about research participation.

There is growing interest in understanding how different research methods are perceived by victims of violence and what survivors will reveal to researchers (termed meta-research or meta-studies). The purpose of this project was to conduct a qualitative meta-study on why rape survivors chose to participate in community-based, face-to-face interviews. Participants mentioned four primary reasons for why they decided to participate in this study: (a) to help other survivors, (b) to help themselves, (c) to support research on rape/sexual assault, and (d) to receive financial compensation. Implications for designing research recruitment protocols are discussed.

A participatory evaluation project to measure SANE nursing practice and adult sexual assault patients' psychological well-being.

This paper describes a collaborative project between a team of researcher-evaluators and a Sexual Assault Nurse Examiner (SANE) program to develop an evaluation survey of SANE nursing practice and patient psychological well-being. Using a participatory evaluation model, we followed a six-step process to plan and conduct an evaluation of adult sexual assault patients treated in one Midwestern SANE program. Our collaborative team developed a logic model of "empowering care," which we defined as providing healthcare, support, and resources; treating survivors with dignity and respect; believing their stories; helping them reinstate control and choice; and respecting patients' decisions. We created a corresponding survey that can be administered to patients following exam procedures and tested it with N= 52 sexual assault victims. Results indicated that nursing practice was consistent with this empowering care philosophy as the overwhelming majority of patients reported positive psychological well-being outcomes. Implications for evaluating forensic nursing practice are discussed.