Characterizing Physical Intimate Partner Violence-Associated Injuries Among Adults in Low- and Middle-Income Countries: A Systematic Review.

Forty-two percent of women who experienced intimate partner violence (IPV) reported that their experience of IPV resulted in an injury. This review aims to review the existing literature from low- and middle-income countries (LMICs) on IPV-related injuries as well as identify IPV-related injury patterns and locations. A systematic electronic database search was conducted between August and September 2021 (Prospero ID: CRD42021281519). Five databases yielded 408 articles; 328 remained for title and abstract screening after duplicates were removed. Of the 59 eligible for full-text review, 19 articles were eligible for extraction. After quality assessment, 18 articles were included in the study. Most (56%) studies were observational studies. Studies represented 15 different countries. The majority of the studies (89%) had authors whose institutional affiliation was located in the country where the study took place. Soft tissue injuries were the most commonly reported injury type followed by fractures and burns. The most common injury locations were the head, neck, and face followed by both upper and lower limbs. The most commonly cited injury mechanism was bodily force. The findings of this study echo what has been written in the literature regarding IPV-related injury patterns from high-income countries (HICs). One limitation of this study is that the search only included literature published in English. The injury patterns identified in this article confirm the need for awareness and action on the part of both medical and surgical providers in order to best address IPV in LMICs.

Prevalence and Correlates of Intimate Partner Violence in the Perinatal Period in a Representative Sample of Quebec Mothers.

Using a nationally representative sample of 1,264 biological mothers of children aged between 6 months and 5 years, this study identified the prevalence estimates of intimate partner violence occurring in the perinatal period (IPV-PP) and examined the associations between IPV-PP and various characteristics. Findings show that 10.9% of mothers reported victimization to at least one intimate partner violence episode during the perinatal period. Younger maternal age at childbirth, drug consumption, being a single mother, higher parental stress due to the child's temperament, and higher stress due to family and extrafamilial obligations were all associated with IPV-PP. Findings emphasized that IPV-PP is indeed an important public health matter in Quebec. Interventions should focus on victimization screening during the perinatal period and on enhancing victims' security and well-being.

Professionals' Readiness to Manage Violence Against Women.

Over recent years, community-based responses to domestic violence against women have become an important topic, and there is growing recognition that domestic violence requires a comprehensive response from agencies across a variety of community sectors. When reaching out for help, female survivors of domestic violence need to have access to a broad range of services, empowering professionals to manage violence against women, and coordinated community responses that promotes safety, autonomy, and integration. Since the early 1990s, Portugal has been gradually moving toward a community-based approach to domestic violence against women where local organizations and professionals are major stakeholders of this policy. Besides having had an increased network of services implemented, it is important to examine how prepared service providers are to respond effectively. The current study analyzed how ready professionals in Portugal are to deliver interventions targeting violence against women. A total of 585 professionals from different backgrounds completed a readiness survey. The results revealed that, despite their perceived readiness, professionals are not duly prepared to respond effectively to violence against women. They lack the appropriate knowledge and training to respond effectively to survivors. Hence, further efforts must be made to change professional practices and services to ensure that abuse is recognized, barriers are overcome, and interventions are more effective.

Risk Factors and Moderators of Intimate Partner Violence Victimization Versus Perpetration Among Women in Spain.

Bidirectional intimate partner violence (IPV) appears highly prevalent, but the extant literature, which has been dominated by work in North America, has not adequately accounted for how victimization overlaps with perpetration and how potential resources may interact with risk factors. A community sample of Spanish women completed measures of IPV approval, mental health risk factors (psychological distress and problematic substance use), and interpersonal resources (partner and social satisfaction). Using Mplus accounting for victimization and perpetration overlap, findings indicate that greater psychological distress and substance use were associated with IPV perpetration, and lower IPV approval was linked to victimization. Stronger partner satisfaction did not serve a buffering role but rather interacted to increase IPV perpetration; low social support was associated with victimization and exacerbated risk of perpetration.

Caseload factors predictive of family abuse and neglect treatment outcomes.

BACKGROUND: In child welfare, caseloads are frequently far higher than optimal. Not all cases are created equal; however, little is known about which combination and interaction of factors make caseloads more challenging and impact child and family outcomes. OBJECTIVE: This study aims to identify which case, provider, and organizational factors most strongly differentiate between families with favorable and less-than-positive treatment outcomes. PARTICIPANTS AND SETTING: Participants were 25 family advocacy program providers and 17 supervisors at 11 Department of the Air Force installations. METHODS: Following informed consent, participants completed demographic and caseload questionnaires, and we collected information about organizational factors. Providers were sent a weekly case update and burnout questionnaire for seven months. We used linear mixed-effects model tree (LMM tree) algorithms to determine the provider, client, and organizational characteristics that best distinguish between favorable vs. unfavorable outcomes. RESULTS: The LMM tree predicting provider-rated treatment success yielded three significant partitioning variables: (a) commander involvement, (b) case complexity, and (c) % of clients in a high-risk field. The LMM predicting client-rated treatment progress yielded seven significant partitioning variables: (a) command involvement; (b) ease of reaching tenant unit command; (c) # of high-risk cases; (d) % of clients receiving Alcohol and Drug Abuse Prevention and Treatment services; (e) ease of reaching command; (f) % of clients with legal involvement; (g) provider age. CONCLUSIONS: This study is a first step toward developing a dynamic caseload management tool. An intelligent, algorithm-informed approach to case assignment could help child welfare agencies operate in their typically resource-scarce contexts in a manner that improves outcomes.

Development and Evaluation of a Community Advisory Board for Family Violence.

Although intimate partner violence (IPV) is an important risk factor for child physical abuse, most IPV-exposed children are not evaluated for abusive injuries. A Community Advisory Board (CAB) was formed to (a) optimize a program to evaluate IPV-exposed children for abusive injuries and (b) inform research methods to engage IPV victims and their children. The objectives of this study were to implement and to evaluate the family violence CAB. Following best practices on CAB formation, we recruited local stakeholders with key roles as service providers, community leaders, and knowledge experts in IPV, child abuse, and emergency care. Fourteen members met bimonthly to develop a family-centered intervention and to inform research and advocacy activities. A shared memorandum of understanding outlined goals and objectives. One year after the CAB's implementation, a research assistant interviewed CAB members to understand their experiences, perceived benefits of participation, and desired improvements. Eleven CAB members, including an IPV survivor, participated. Emerging categories included (a) motivations to join the CAB (victim advocacy), (b) benefits of participation (development of relationships among members and increased acceptability of research methods), (c) facilitators of sustainability (program adaptability and development of trust), and (d) desired improvements (case-based follow-up). The CAB was successfully implemented and facilitated the development of collaborative relationships among stakeholders with key roles in IPV and child abuse. The CAB led to community member-proposed changes in research activities and clinical care for victims of IPV.

Mental Health Professionals' Perspectives on Group Intervention for Women Survivors of Intimate Partner Violence: A Qualitative Study.

Background: To examine the perspectives of mental health professionals on providing group intervention for female spouses of men with alcohol dependence who experienced intimate partner violence (IPV). Methods: A qualitative research design was used, and a purposive sample technique was used to select the participants. Nine experts with more than five years of experience in handling partner violence cases provided insights through in-depth interviews. The transcripts were carefully examined several times, coded and re-coded. The codes were subsequently organized into thematic categories. Results: Most of the experts were between the age of 35-45 years (66.7%), females (77.8%) and had more than five years of experience in mental health and IPV (55.6%). Most of the experts (66.7%) were working in teaching institutions related to mental health and IPV. The remaining one-third (33.3%) of the experts were legal and women empowerment practitioners. The thematic analysis generated six main themes and 19 subthemes, with 189 codes. The six mean themes were: psychosocial needs and concerns, psychosocial interventions, enhancing psychological well-being, enhancing the social support systems, challenges, and therapeutic strategies. Conclusion: Experts emphasized the importance of a holistic approach to IPV intervention. Group intervention addresses multiple issues that contribute to violence. Survivors need safe housing, counseling, legal help, and financial assistance.

Whose Expertise Counts? Women Survivors' Experiences With Psychologists.

Many women who experience intimate partner violence seek the expertise of psychologists to support their healing. However, there is a gap in the research about what women want from their psychologists. We interviewed 20 women survivors who had seen psychologists. Using reflexive thematic analysis, we constructed three themes: see all of me, see me for my expertise, and don't impose an agenda on me. We found that often psychologists acted as experts imposing their own agendas, rather than supporting survivors to make their own decisions. We discuss this in relation to the link between knowledge and power through dominant social science discourses and explore how resistance to this dominant discourse was taken up by many women.

Training Australian general practitioners to counsel women experiencing intimate partner abuse (WEAVE): a pre-post training analysis.

BACKGROUND: Evaluations of Intimate Partner Abuse training for general practitioners is limited. The Women's Evaluation of Abuse and Violence Care study trialled in Australia was a primary care intervention that included delivering the Health Relationships training, a program that educates practitioners on how to provide supportive counselling and assistance to women afraid of an intimate partner. We report on effectiveness of the Healthy Relationships training program within a cluster-randomised controlled trial. METHODS: General practitioners filled out a baseline survey and surveys before and after training, including quantitative and open-text questions on barriers and enablers to supporting victim-survivors. The Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool, a validated measure, was included to assess practitioner knowledge, skills, confidence, and attitudes. General linear model repeated analysis of variance tested the difference between trial groups over time. RESULTS: Fifty-two general practitioners completed the baseline demographic survey, with 65% (19 intervention, 18 comparison) completing both pre-and-post-training surveys. There were no between-group differences in baseline characteristics. Post-training, the intervention group had significantly higher average scores than the comparison on perceived preparation to address abuse (p = .000), perceived knowledge (p = .000), actual knowledge (p = .03), and greater awareness of practice-related issues (p = .000). There were no between-group differences in PREMIS opinion domain scores on workplace issues, self-efficacy and understanding of victims. Post-training, the qualitative data indicated that the intervention practitioners (n = 24) reported increased knowledge, awareness, and confidence, while time pressures and lack of referral options impeded addressing abuse. CONCLUSION: The Healthy Relationships Training program for general practitioners increased aspects of practitioner knowledge, skills, and confidence. However, more support is needed to change opinions and support victim-survivors sustainably. TRIAL REGISTRATION: The WEAVE trial was registered on 21/01/2008 with the Australian New Zealand Clinical Trial Registry, number ACTRN12608000032358.

Evaluating the Nature and Prevalence of Economic Empowerment Services Provided to Intimate Partner Abuse Survivors.

Economic empowerment (EE) services promote survivors' economic stability and well-being. A target for intervention and prevention, then, is to offer more effective EE services. The study purpose was to develop a clearer picture of what EE services agencies offer, and how prepared staff are to provide these services. We collected data from 154 providers. Survivors most requested, and agencies most frequently provided, housing services. EE services offered did not differ by agency location, staff size, or number of clients. Providers' confidence was greater if they completed high school; their agency offered more EE services; and they completed voluntary training.

Alcohol Use, Discrimination, and Psychological Partner Abuse Among LGBQ+ College Students: Results From a Daily Diary Study.

Alcohol use correlates with psychological partner abuse (PA) perpetration among lesbian, gay, bisexual, queer, and other nonheterosexual (LGBQ+) young adults. However, less is known about the proximal association between alcohol use and psychological PA within this population, which would provide valuable information for intervention development. Informed by minority stress and alcohol-related PA theories, we evaluated whether (a) psychological PA perpetration odds increased as the number of drinks consumed prior to psychological PA on a given day increased, (b) psychological PA perpetration odds were greater following heavy episodic drinking (HED) relative to non-HED, and (c) experiencing LGBQ+-specific discrimination (i.e., heterosexist harassment, incivility, and hostility) strengthened the association between daily alcohol use (number of drinks, HED) and subsequent psychological PA perpetration. LGBQ+ college students (N = 41; 75.6% women, 22.0% men, and 2.4% transgender/non-binary) completed a baseline survey of past-year discrimination before completing daily reports of their alcohol use and psychological PA for 60 consecutive days. Multilevel modeling revealed that drinking more than one usually does on a given day is positively associated with subsequent psychological PA odds (OR = 1.31, p < .001). Psychological PA was more likely following HED relative to non-HED (OR = 3.23, p < .001). Unexpectedly, experiencing discrimination was negatively associated with psychological PA odds across models (OR = .26 p = .01). No alcohol × discrimination interactions emerged. Results support alcohol use as a proximal risk factor for psychological PA among LGBQ+ college students and underscore the need for more nuanced examination of discrimination and other contextual variables in alcohol-related PA.

How Expert Are the Experts? Child Custody Evaluations in Situations of Domestic Violence in Italy.

In recent decades, scholars and professionals have investigated the courts' treatment of mothers and children who claim that an ex-partner/father is abusive, especially in child custody proceedings. In Italy, Laws 54/2006 and 154/2013 established that joint-custody and coparenting are critical to ensure the best interest of the child. In the process of custody determination, judges can appoint an expert to assess parenting skills. The aim of this qualitative study was to investigate the knowledge, opinions, and practices of the Court-Appointed Experts (CAEs) in child custody disputes in cases involving allegations of domestic violence (DV). Semistructured face-to-face interviews were conducted with 15 CAEs; the interviews' transcripts were analyzed with qualitative content analysis. Results suggested that in the management of child custody cases, most CAEs showed: strong prejudices against women victims of DV, who were often blamed and/or secondarily victimized; adherence to controversial models (e.g., parental alienation syndrome) and characterization of mothers as "alienators"; poor knowledge of DV and relevant laws. CAEs' overlooking DV underlines the urgent need to develop and implement guidelines on child custody decision-making in the context of DV.

Defiance and Strength: A Qualitative Study of Sex Trafficking Survivor-Advocate Coping Strategies.

In the two decades since federal law prohibited the trafficking of humans for sexual or nonsexual services, researchers have generated knowledge related to the mental and physical health consequences of the experience, the individual and environmental factors that facilitate exploitation, and the best practices for prevention and intervention. Despite these advances in knowledge about human trafficking, relatively scant research has explored the resiliencies of survivors, as a deficit-based narrative persists when exploring and contemplating survivor experiences. While the movement increasingly recognizes the need to situate the survivor voice in service delivery, advocacy, and research, an inquiry that values survivor strengths remains nascent. Using the Intersectional-Standpoint Methodology (ISM) and phenomenology, this qualitative study explores the nuances of resiliency during exploitation and exit among seven sex trafficking survivor-advocates in a small midwestern state. Themes related to coping strategies, intrapersonal coping skills, and interpersonal coping skills were revealed and contextualized through the four variables proposed in ISM. Implications for service provision and policy are provided.

Characterizing the impacts of public health control measures on domestic violence services: qualitative interviews with domestic violence coalition leaders.

BACKGROUND: Prior to the availability of pharmaceutical control measures, non-pharmaceutical control measures, including travel restrictions, physical distancing, isolation and quarantine, closure of schools and workplaces, and the use of personal protective equipment were the only tools available to public health authorities to control the spread of COVID-19. The implementation of these non-pharmaceutical control measures had unintended impacts on the ability of state and territorial domestic violence coalitions to provide services to victims. METHODS: A semi-structured interview guide to assess how the COVID-19 pandemic impacted service provision and advocacy generally, and how COVID-19 control measures specifically, created barriers to services and advocacy, was developed, pilot tested, and revised based on feedback. Interviews with state and territorial domestic violence coalition executive directors were conducted between November 2021 and March 2022. Transcripts were inductively and deductively coded using both hand-coding and qualitative software. RESULTS: Forty-five percent (25 of 56) of state and territorial domestic violence coalition executive directors representing all 8 National Network to End Domestic Violence (NNEDV) regions were interviewed. Five themes related to the use of non-pharmaceutical pandemic control measures with impacts on the provision of services and advocacy were identified. CONCLUSIONS: The use of non-pharmaceutical control measures early in the COVID-19 pandemic had negative impacts on the health and safety of some vulnerable groups, including domestic violence victims. Organizations that provide services and advocacy to victims faced many unique challenges in carrying out their missions while adhering to required public health control measures. Policy and preparedness plan changes are needed to prevent unintended consequences of control measure implementation among vulnerable groups as well as to identify lessons learned that should be applied in future disasters and emergencies.

The effectiveness and cost-effectiveness of a group domestic abuse perpetrator programme: protocol for a randomised controlled trial.

BACKGROUND: In contrast to evidence for interventions supporting victim/survivors of domestic violence and abuse (DVA), the effectiveness of perpetrator programmes for reduction of abuse is uncertain. This study aims to estimate the effectiveness and cost-effectiveness of a perpetrator programme for men. METHODS: Pragmatic two-group individually randomised controlled trial (RCT) with embedded process and economic evaluation. Five centres in southwest England and South Wales aim to recruit 316 (reduced from original target of 366) male domestic abuse perpetrators. These will be randomised 2:1 to a community-based domestic abuse perpetrator programme (DAPP) or usual care comparator with 12-month follow-up. Female partners/ex-partners will be invited to join the study. The intervention for men comprises 23 weekly sessions of a group programme delivered in voluntary sector domestic abuse services. The intervention for female partners/ex-partners is one-to-one support from a safety worker. Men allocated to usual care receive no intervention; however, they are free to access other services. Their partners/ex-partners will be signposted to support services. Data is collected at baseline, and 4, 8 and 12 months' follow-up. The primary outcome is men's self-reported abusive behaviour measured by the Abusive Behaviour Inventory (ABI-29) at 12 months. Secondary measures include physical and mental health status and resource use alongside the abuse measure ABI (ABI-R) for partners/ex-partners and criminal justice contact for men. A mixed methods process evaluation and qualitative study will explore mechanisms of effectiveness, judge fidelity to the intervention model using interviews and group observations. The economic evaluation, over a 1-year time horizon from three perspectives (health and social care, public sector and society), will employ a cost-consequences framework reporting costs alongside economic outcomes (Quality-Adjusted Life Years derived from EQ-5D-5L, SF-12 and CHU-9D, and ICECAP-A) as well as the primary and other secondary outcomes. DISCUSSION: This trial will provide evidence of the (cost)effectiveness of a DAPP. The embedded process evaluation will further insights in the experiences and contexts of participants and their journey through a perpetrator programme, and the study will seek to address the omission in other studies of economic evaluations. TRIAL REGISTRATION: ISRCTN15804282, April 1, 2019.

Rates and Correlates of Intimate Partner Abuse Among Indigenous Women Caregivers.

Intimate partner abuse (IPA) is a public health crisis that disproportionately impacts indigenous women. We know little about rates and correlates of IPA victimization (IPAV) and abuse directed at one's partner (ADP) among indigenous women caregivers (people who take care of children). The purpose of the current study was to address this critical gap in the literature. Participants were 44 indigenous women caregivers in the United States in a current relationship who completed a survey. Most women reported IPAV and ADP experiences in the past 6 months, and IPAV and ADP abuse directed at partner were positively associated. Further, IPAV was positively associated with adverse childhood experiences (ACEs), participants' engagement in harsh parenting, and depressive symptoms. IPAV was negatively associated with age, income, indigenous cultural identity, and social support. ADP was positively associated with ACEs, harsh parenting, and depressive symptoms. ADP was negatively associated with age and income. ADP was not associated with indigenous cultural identity and social support. These data suggest the urgency with which efforts are needed to prevent and respond to IPA among indigenous women caregivers, especially those who are younger and of lower income, and that culturally grounded initiatives that seek to build social support may be especially impactful.

Intentions to Call a Helpline Among Targets of Intimate Partner Violence: The Role of the Theory of Planned Behavior and Gender Role Conflict.

This research first aimed to test the Theory of Planned Behavior (TPB) as a model to understand the intentions to call a helpline of victimized males and females. A sample of 99 participants (53 males; 46 females) who were suffering violence at the time of participation were considered for analysis. Our results indicate that males and females' attitudes and subjective norms significantly predicted intentions. Second, this study aimed to measure Gender Role Conflict (GRC) in victimized men and test its association with TPB constructs. GRC occurs when rigid, sexist, or restrictive gender roles result in the restriction, devaluation, or violation of others or the self. Our results indicate that GRC was only negatively associated with perceived behavioral control. Additionally, in our sample of men who filled the GRC measure (n = 245), victimized men reported significantly higher GRC than non-victimized men. Overall, our findings indicate gender specificities in the intentions to call a helpline and suggest that GRC plays an important role in seeking help for men.

Methodological Challenges in Group-based Randomised Controlled Trials for Intimate Partner Violence Perpetrators: A Meta-summary.

Evidence for treatment effects of group-based Intimate Partner Violence (IPV) perpetrators programmes remains, at best, inconclusive. In the present review, systematic/meta-analytic reviews were used to identify randomised controlled trials and a meta-summary approach was employed to identify methodological challenges in the design and conduct of these trials. Of the fifteen studies identified, seven were comparative effectiveness trials. A range of methodological challenges were also identified by the trialists; source of outcome data, treatment modality, attrition and sample characteristics were the most frequently mentioned. Although there are only a few randomised controlled trials compared to non randomised studies, the findings of both highlight the need to invest in the development of innovative and/or combined IPV treatment programmes to address co-occurring issues such as substance use and trauma. The summary of methodological challenges will provide the first step in the development of methods guidance for researchers working in this area.

La evidencia del efecto del tratamiento de los programas de intervención grupal para agresores de pareja (IPV) siguen siendo, en el mejor de los casos, no concluyentes. En la presente revisión se emplearon revisiones sistemáticas/meta-analíticas para identificar ensayos controlados aleatorizados y se empleó un enfoque de meta-resumen para identificar los desafíos metodológicos en el diseño y la realización de estos ensayos. De los quince estudios identificados, siete fueron ensayos de comparación de la efectividad. Los autores de los ensayos también identificaron una serie de desafíos metodológicos: la fuente de la que se obtienen los datos relativos a los resultados, la modalidad de tratamiento, la mortalidad de la muestra y sus características fueron los mencionados con más frecuencia. Aunque son todavía escasos los ensayos controlados aleatorizados en comparación con los estudios no aleatorizados, los resultados de ambos tipos de estudios han destacado la importancia de invertir en el desarrollo de programas de tratamiento de IPV innovadores y/o combinados para tratar problemáticas conjuntas tales como consumo de substancias y trauma. El resumen de los desafíos metodológicos proporcionará el primer paso para el desarrollo de guías metodológicas para los investigadores que trabajan en este área.

Nonintimate Polyvictimization and the Severity of Intimate Partner Violence Experienced by Men.

There is a dearth of research on the relation of men's cumulative experiences of nonintimate victimization (polyvictimization) to their victimization in intimate relationships. This study examines the association between nonintimate polyvictimization (including being abused as a child, cyberbullied, stalked, physically assaulted, and experiencing property crime) and the severity of intimate partner violence victimization in men. The sample of 8,784 men in current married/common-law relationships was drawn from a random sample of the 2014 Canadian General Social Survey. About 3% of the men (an estimate of about 265,000 men in Canada) experienced the most severe forms of partner abuse, including the combination of emotional abuse and controlling behaviors, physical violence, and the resulted injuries. Among these severely abused men, about one-third were polyvictims. As expected, a nonintimate polyvictimization predicted the increased severity of male partner abuse victimization, controlling for sociodemographic variables. These findings highlight the importance of preventing nonintimate polyvictimization of men that can help reduce their partner violence victimization.

College students' perceptions of alcohol's role in disclosures of sexual assault and intimate partner violence.

Objective: Much is known about how alcohol increases the risk of sexual assault or intimate partner violence victimization during college. This research qualitatively explores perceptions about how alcohol influences disclosures about these events to informal supports. Participants: Participants included college students who received a disclosure wherein they or the survivor were drinking during the disclosure (n = 81). Methods: Responses were coded with regard to who was drinking and whether the effect of drinking during the disclosure was perceived as positive, negative, mixed, or neutral/none. Results: Participants perceived alcohol to have both positive (e.g., increasing the likelihood of discussing difficult topics) and negative (e.g., cognitive impairment increased negative emotions) effects on disclosures. Conclusion: Prevention and intervention efforts should identify targeted strategies (e.g., remembering one or two easy and helpful phrases; revisiting the topic again while sober) to help survivors and disclosure recipients have constructive conversations in the presence of alcohol.