Impact of the COVID-19 pandemic on workplace violence at an academic emergency department.

STUDY OBJECTIVES: COVID-19 brought unique challenges; however, it remains unclear what effect the pandemic had on violence in healthcare. The objective of this study was to identify the impact of the pandemic on workplace violence at an academic emergency department (ED). METHODS: This mixed-methods study involved a prospective descriptive survey study and electronic medical record review. Within our hospital referral region (HRR), the first COVID-19 case was documented on 3/11/2020 and cases peaked in mid-November 2020. We compared the monthly HRR COVID-19 case rate per 100,000 people to the rate of violent incidents per 1000 ED visits. Multidisciplinary ED staff were surveyed both pre/early-pandemic (April 2020) and mid/late-pandemic (December 2020) regarding workplace violence experienced over the prior 6-months. The study was deemed exempt by the Mayo Clinic Institutional Review Board. RESULTS: There was a positive association between the monthly HRR COVID-19 case rate and rate of violent ED incidents (r = 0.24). Violent incidents increased overall during the pandemic (2.53 incidents per 1000 visits) compared to the 3 months prior (1.13 incidents per 1000 visits, p < .001), as well as compared to the previous year (1.24 incidents per 1000 patient visits, p < .001). Survey respondents indicated a higher incidence of assault during the pandemic, compared to before (p = .019). DISCUSSION: Incidents of workplace violence at our ED increased during the pandemic and there was a positive association of these incidents with the COVID-19 case rate. Our findings indicate health systems should prioritize employee safety during future pandemics.

The Pursuit of Research-supported Treatment in Batterer Intervention: The Role of Professional Licensure and Theoretical Orientation for Duluth and CBT Programs.

PURPOSE: The purpose of this study was to understand the importance of research-supported practice for batterer intervention programs. METHODS: This study applied descriptive statistics and chi-square analyses to a novel dataset from the Domestic Violence Perpetrator Treatment Survey (N = 411). This was a 69-item survey developed by domestic violence providers and researchers to understand the role of research-supported practice in the treatment of intimate partner violence (IPV). RESULTS: This study found statistically significant differences between Duluth oriented programs and Cognitive Behavioral Therapy (CBT) oriented programs with respect to the importance of research-supported practices and motivational interviewing, a strategy found effective in treatment of IPV by extant research. DISCUSSION: There appears to have been an evolution among practitioners toward more eclecticism, and an acknowledgment that programs should be research-supported. CONCLUSION: Implications of this study for education and treatment are discussed.

Occupational Well-Being in Sexual Assault Victims and Survivors.

Purpose: While researchers have established that sexual assault may adversely affect successful employment and academic achievement, little is known about the barriers and facilitators of occupational well-being from the perspective of sexual assault survivors. This study assessed the barriers and facilitators of occupational well-being. Design: Constructivist grounded theory. Method: Digitally recorded, semistructured interviews were used to collect data. Data were collected from 22 adult female sexual assault survivors. Analysis consisted of coding, creation of data matrices, and within and across case analysis. Findings: Theoretical saturation was achieved after interviews with 22 participants. Barriers to occupational well-being were mental health symptoms and diagnoses, substance abuse, inflexible attendance policies, and workplace bullying. Facilitators to occupational well-being were personal coping strategies, and organizational and social support. Conclusions: Sexual assault has significant effects on the occupational well-being of women. The work or academic environment can exacerbate the harms of sexual assault or facilitate healing in sexual assault survivors. To facilitate the occupational well-being of sexual assault survivors, workplaces and academic institutions can adopt a trauma-informed approach, create policies that allow for time off to deal with sequela of sexual assault, implement anti-bullying programs, and make resources for gendered violence available.

Informing Human Trafficking Clinical Care Through Two Systematic Reviews on Sexual Assault and Intimate Partner Violence.

BACKGROUND: There is a lack of evidence on the clinical management of patients who have suffered human trafficking. Synthesizing the evidence from similar patient populations may provide valuable insight. This review summarizes findings on therapeutic interventions for survivors of sexual assault and intimate partner violence (IPV). METHOD: We conducted two systematic reviews using the MEDLINE database. We included only randomized controlled trials of therapies with primary outcomes related to health for survivors of sexual assault and IPV. For the sexual assault review, there were 78 abstracts identified, 16 full-text articles reviewed, and 10 studies included. For the IPV review, there were 261 abstracts identified, 24 full-text articles reviewed, and 17 studies included. Analysis compared study size, intervention type, patient population, primary health outcomes, and treatment effect. RESULTS: Although our search included physical and mental health outcomes, almost all the studies meeting inclusion and exclusion criteria focused on mental health. The interventions for sexual assault included spiritually focused group therapy, interference control training, image rehearsal therapy, sexual revictimization prevention, educational videos, cognitive behavioral therapy, and exposure therapy. The interventions in the IPV review included group social support therapy, exposure therapy, empowerment sessions, physician counseling, stress management programs, forgiveness therapy, motivational interviewing, and interpersonal psychotherapy. CONCLUSIONS: Insights from these reviews included the importance of culturally specific group therapy, the central role of survivor empowerment, and the overwhelming focus on mental health. These key features provide guidance for the development of interventions to improve the health of human trafficking survivors.

Healing is not linear: Using photography to describe the day-to-day healing journeys of undergraduate women survivors of sexual violence.

The purpose of this study was to describe the day-to-day healing processes of women who experienced undergraduate sexual violence. We engaged 19 women in a photo-elicitation experience with follow-up individual interviews to identify themes of both healing and darker moments in survivors' everyday lives. Healing was found to function on a continuum influenced by darker moments (i.e., moments that elicited fear, anxiety, loneliness, guilt, anger, and worthlessness) and healing moments (i.e., rebuilding moments of self-care, self-love, connection, hope, peace, and freedom). Responses to darker moments included feeling overwhelmed, disconnected, and intentional vulnerability. Healing moments were influenced by self-reflection, authentic interactions, and resource utilization. The photographs taken in this study shed light on the impact of sexual violence in women's daily lives long after these traumatic and unjust experiences. This knowledge can be used to foster a sense of universality in survivors who are currently struggling and growing after their experiences as well as give service providers greater insight into what survivors' day-to-day needs may be.

Supporting survivors of sexual violence: protocol for a mixed-methods, co-research study of the role, funding and commissioning of specialist services provided by the voluntary sector in England.

INTRODUCTION: The voluntary sector provides a range of specialist services to survivors of sexual violence, many of which have evolved from grass roots organisations responding to unmet local needs. However, the evidence base is poor in terms of what services are provided to which groups of survivors, how voluntary sector specialist (VSS) services are organised and delivered and how they are commissioned. This will be the first national study on the role of the voluntary sector in supporting survivors in England. METHODS AND ANALYSIS: This study uses an explanatory sequential naturalistic mixed-methods design with two stages. For stage 1, two national surveys of providers' and commissioners' views on designing and delivering VSS services will facilitate detailed mapping of service provision and commissioning in order to create a taxonomy of VSS services. Variations in the national picture will then be explored in stage 2 through four in-depth, qualitative case studies using the critical incident technique to explain the observed variations and understand the key contextual factors which influence service provision. Drawing on theory about the distinctive service contribution of the voluntary sector, survivors will be involved as co-researchers and will play a central role in data collection and interpretation. ETHICS AND DISSEMINATION: Ethical approval has been granted by the University of Birmingham research ethics committee for stage 1 of the project. In line with the sequential and co-produced study design, further applications for ethical review will be made in due course. Dissemination activities will include case study and end-of-project workshops; good practice guides; a policy briefing; project report; bitesize findings; webinars; academic articles and conference presentations. The project will generate evidence about what survivors want from and value about services and new understanding about how VSS services should be commissioned and provided to support survivors to thrive in the long term.

Effects of an incremental theory of personality intervention on the reciprocity between bullying and cyberbullying victimization and perpetration in adolescents.

The incremental theory of personality interventions (ITPI) teaches adolescents that people can change. Researchers have found that these interventions can reduce the perpetration of bullying and cyberbullying. Moreover, there is reciprocity between perpetrating bullying behaviors and being a victim of them. The objective of this study was to examine whether the ITPI reduces the reciprocity between victimization and perpetration of bullying and cyberbullying. A sample of 858 high school students (52% boys) aged 12 to 17 at pretest (M = 14.56, SD = 0.97) participated in a double-blind randomized controlled trial (452 participants were assigned to the experimental condition and 406 to the control condition). Measures of bullying and cyberbullying were taken at baseline, six-month, and 12-month follow-ups. The results indicated that victimization was a strong predictor of perpetration for bullying and cyberbullying over time. Perpetration was not a predictor of victimization. Consistently, for both forms of aggressive behavior, the intervention reduced the intensity of the association between victimization and perpetration. This effect was not moderated by the age or sex of the participants. Finally, the effectiveness of the ITPI was moderated by age. Specifically, among the youngest (< 14.48 years), those who received the ITPI showed a slight tendency to reduce aggressive behavior that contrasted with the growing trend in the control group. Among the oldest participants (> 14.48), the trajectories were similar in the two groups. Our findings show that influencing adolescents' reactions to peer aggression victimization is one of the mechanisms that could explain the beneficial effects of the ITPI and other preventive interventions.

Protocol for the first large-scale emergency care-based longitudinal cohort study of recovery after sexual assault: the Women's Health Study.

INTRODUCTION: Worldwide, an estimated 10%-27% of women are sexually assaulted during their lifetime. Despite the enormity of sexual assault as a public health problem, to our knowledge, no large-scale prospective studies of experiences and recovery over time among women presenting for emergency care after sexual assault have been performed. METHODS AND ANALYSIS: Women ≥18 years of age who present for emergency care within 72 hours of sexual assault to a network of treatment centres across the USA are approached for study participation. Blood DNA and RNA samples and brief questionnaire and medical record data are obtained from women providing initial consent. Full consent is obtained at initial 1 week follow-up to analyse blood sample data and to perform assessments at 1 week, 6 weeks, 6 months and 1 year. These assessments include evaluation of survivor life history, current health and recovery and experiences with treatment providers, law enforcement and the legal system. ETHICS AND DISSEMINATION: This study is approved by the University of North Carolina at Chapel Hill's Institutional Review Board (IRB) and the IRB of each participating study site. We hope to present the results of this study to the scientific community at conferences and in peer-reviewed journals.

Effects of Topper Training on psychosocial problems, self-esteem, and peer victimisation in Dutch children: A randomised trial.

Most interventions aimed at improving social interactions either target internalising or externalising problem behaviour in children. However, a recent review shows that a transdiagnostic approach might fit better to the diversity of problems within a group and within an individual (comorbidity). We examined the effectiveness of a transdiagnostic intervention, called Topper Training: a cognitive behavioural intervention in the peer group with parents included, that targets both internalising and externalising behaviour problems. A randomised trial with a waiting list control group was conducted, using 132 children with mild to severe psychosocial problems. Children were randomised into 77 intervention and 55 waiting list children (50% boys; age = 8-11 years). GLM repeated measures analyses yielded significant intervention effects directly after the training on parent-reported (but not teacher-reported) emotional symptoms (Cohen's d = .70), peer relationship problems (d = .41), and impact of these problems (d = .59). Significant effects were also found for child-perceived peer victimisation (d = .62), self-esteem (d = .45) and teacher-reported conduct problems (d = .42). Parent-reported effects on emotional, conduct problems and impact of the problems and child-reported effects on self-esteem were clinically relevant. No significant effects of Topper Training were found for prosocial behaviour and bullying. Within-participant t-tests in the intervention group between post-intervention and follow-up indicated that effects extended over a six-month follow-up period. Depression decreased significantly from post-test to follow-up. In conclusion, children with mild to severe internalising and/or externalising problems can benefit from the transdiagnostic Topper Training intervention.

Current care for victims of sexual violence and future sexual assault care centres in Belgium: the perspective of victims.

BACKGROUND: Sexual violence is a global health problem. After ratifying the Convention of Istanbul in 2016, this Belgian study was set up to map the perspective of victims of rape on the current sexual violence care provision in Belgium and to inquire on their need for more specialised and holistic care in future Sexual Assault Care Centres. METHODS: Sixteen rape victims participated in this sub-study. A mixed-method design (questionnaire, in-depth interview or small focus group) was applied depending on the time elapsed between rape and participation. Descriptive Thematic Framework Analysis was performed in duo. RESULTS: The participants thought it of utmost importance that every victim should receive all medical, psychological and forensic care without necessarily having to involve the police first. They stated that the current Belgian sexual violence care provision could be much more patient-centred, specifically the forensic examination and psychological care. Alongside medical and psychological consequences, victims emphasised the high personal financial and relational burden of sexual violence. The holistic care offered in Sexual Assault Care Centres was perceived to enhance the recovery process of victims of sexual violence. Their doors should be open to all victims and their relatives. They should not only provide acute care for the victim, but also improve victims' reintegration into society while reducing their personal costs significantly. CONCLUSION: All care for victims of sexual violence, especially forensic and psychological care, needs drastic improvement in Belgium. All participants agreed that having specialised, multidisciplinary and longitudinal care in a Sexual Assault Care Centre that would be open 24/7 for everyone, victims and their significant others, would be an improvement to the currently available care all over Belgium. TRIAL REGISTRATION: This research was registered on April 1st 2016. Registration number B670201628242.

Prescription Opioid Misuse After a Recent Sexual Assault: A Randomized Clinical Trial of a Video Intervention.

BACKGROUND AND OBJECTIVES: Prescription opioid (PO) misuse is increasing and is associated with overdose. Individuals who experienced a recent sexual assault are at risk for increased substance use, yet limited interventions target PO misuse after sexual assault. The current study examined the efficacy of video interventions on PO misuse after sexual assault. METHODS: Adolescent girls and women (n = 154) were recruited in the context of a sexual assault medical forensic exam in the emergency department. Effects of a prevention of post-rape stress (PPRS) video and a pleasant imagery and relaxation instruction (PIRI) video were compared with treatment as usual (TAU) during a sexual assault medical forensic exam on PO misuse. Participants reported if they had used POs for non-medical purposes since the sexual assault at 1.5 month follow-up. RESULTS: Results from a logistic regression analysis indicated that participants with a prior sexual assault were less likely to misuse prescription opioids 1.5 months after the assault in the PIRI condition compared with TAU. There were no main effects for video condition and no interactions for the PPRS condition on PO misuse. DISCUSSION AND CONCLUSIONS: Providing the PIRI video, or teaching other types of mindfulness or relaxation exercises, may be warranted as a secondary prevention for individuals during the sexual assault medical forensic exam for those with a prior sexual assault history. SCIENTIFIC SIGNIFICANCE: This research provides an initial examination of the impact of mindfulness skills recently after traumatic event exposure on PO misuse. (Am J Addict 2019;28:376-381).

ACOG Committee Opinion No. 777: Sexual Assault.

Sexual violence continues to be a major public health problem affecting millions of adults and children in the United States. Medical consequences of sexual assault include sexually transmitted infections; mental health conditions, including posttraumatic stress disorder; and risk of unintended pregnancy in reproductive-aged survivors of sexual assault. Obstetrician-gynecologists and other women's health care providers play a key role in the evaluation and management of sexual assault survivors and should screen routinely for a history of sexual assault. When sexual violence is identified, individuals should receive appropriate and timely care. A clinician who examines sexual assault survivors in the acute-care setting has a responsibility to comply with state and local statutory or policy requirements for the use of evidence-gathering kits. This document has been updated to include model screening protocols and questions, relevant guidelines from other medical associations, trauma-informed care, and additional guidance regarding acute evaluation of survivors and evidence-gathering kits.

Cyber-Victimization of People With Chronic Conditions and Disabilities: A Systematic Review of Scope and Impact.

The victimization of individuals with chronic conditions or disabilities is prevalent with severe impact at psychological and physiological levels. With the increasing use of technology these experiences were further reshaped. This systematic review aimed at scoping the experiences of cyber-victimization of people living with chronic conditions or disabilities and examine the documented impact on them. Following a four-stage search strategy in several databases including MEDLINE, Embase, PsychINFO, CINAHL, Cochrane and snowballing of references, a total of 2,922 studies were scanned and 10 studies were eventually included. Quality assessment was done in two phases using tools specific to observational studies and cyber-victimization research. A narrative synthesis of reported results covered a total of 3,070 people. Sample size ranged between 42 and 823 participants, and the age range was 6-71 years with a majority of White ethnic backgrounds. Most studies (n=9) were cross sectional. The prevalence range of cyber-victimization was 2%-41.7% based on variable definitions, duration and methods. Targeted conditions included physical impairments, intellectual disabilities and specific chronic diseases. The most common documented impact was psychological/psychiatric, mainly depression followed by anxiety and distress. Somatic health complaints and self-harm were also reported. We concluded that people with chronic conditions and disabilities were consistently at higher risk of victimization with devastating health complications. Research gaps were identified such as the need to address more conditions and acknowledge differences between heterogeneous health conditions. Other recommendations include allowing flexibility and accountability to patients/victims in research design, education on victimization and health consequences, and improving primary care.

The Relationship Between Internalized Homophobia and Intimate Partner Violence in Same-Sex Relationships: A Meta-Analysis.

A meta-analysis was conducted to investigate the association between internalized homophobia and intimate partner violence (IPV) perpetration and victimization in same-sex relationships. The literature search and the application of the inclusion criteria made it possible to identify 10 studies, 2 of which were excluded due to missing data. Therefore, eight studies were finally included in the meta-analysis. The results showed positive and statistically significant associations between internalized homophobia and IPV perpetration and victimization, indicating that higher levels of internalized homophobia were related to higher levels of IPV. Specifically, the pooled effect size for the relationship between internalized homophobia and IPV perpetration (all forms), it was r+ = .147, 95% confidence interval (CI) = [.079, .214]; for the association between internalized homophobia and physical/sexual IPV perpetration, it was r+ = .166, 95% CI [.109, .221]; p < .0001; for the relationship between internalized homophobia and psychological IPV perpetration, it was r+ = .145, 95% CI [.073, .216]; and for the association between internalized homophobia and any type of IPV victimization, it was r+ = .102, 95% CI [.030, .173]. Implications of these results for clinical practice and future research are discussed.

A Meta-Analysis of Risk Markers for Intimate Partner Violence in Same-Sex Relationships.

Research on intimate partner violence (IPV) has largely focused on heterosexual relationships, but, in recent years, researchers have expanded their focus to include same-sex relationships. Using meta-analytic techniques, this study was conducted to examine the relative strength of various risk markers for men and women being perpetrators and victims of physical IPV in same-sex relationships. Articles were identified through research search engines and screened to identify articles fitting the inclusion criteria, a process that resulted in 24 studies and 114 effect sizes for the meta-analysis. The strongest risk marker among those with at least two effect sizes for both male and female perpetration was psychological abuse perpetration. The strongest risk marker among those with at least two effect sizes for IPV victimization was also perpetration of psychological abuse for males and psychological abuse victimization for females. Among same-sex-specific risk markers, internalized homophobia and fusion were the strongest predictors for being perpetrators of IPV for men and women, respectively. HIV status and internalized homophobia were the strongest risk markers for IPV victimization for men and women, respectively. Of 10 comparisons between men and women in risk markers for IPV perpetration and victimization, only 1 significant difference was found. The results suggest that although same-sex and heterosexual relationships may share a number of risk markers for IPV, there are risk markers for physical IPV unique to same-sex relationships. Further research and increased specificity in measurement are needed to better study and understand the influence of same-sex-specific risk markers for IPV.

Co-Occurring Substance Use, PTSD, and IPV Victimization: Implications for Female Offender Services.

The co-occurrence of substance use disorders (SUDs) and post-traumatic stress disorder (PTSD) among women who have been the victims of intimate partner violence (IPV) is complex and causal associations cannot be assumed. Although the presence of co-occurring disorders among IPV victims is a well-established research finding, there is a need for improved understanding of their prevalence and related mental health treatment requirements among female offenders. We review research indicating that service providers working with IPV victims can expect to encounter women with extensive concurrent problems and examine evidence for integrated treatment for SUD, PTSD, and IPV. We propose an outline for assessing and treating SUD and PTSD among female offenders who have experienced IPV victimization. We intend this review to build on previous calls in the co-occurring disorders literature and help integrate the research and treatment evaluation literatures in a way that points to practical implications for policy and practice in female offender services.

Integrated Multicomponent Interventions for Safety and Health Risks Among Black Female Survivors of Violence: A Systematic Review.

The epidemic of violence disproportionately affects women, including Black women. Black women survivors of violence have been found to face multiple safety and health issues such as depression, post-traumatic stress disorder, HIV, and poor reproductive health. Many health issues co-occur, and this co-occurrence can be associated with additional safety and health-related challenges for survivors. Consequently, there is a need for multicomponent interventions that are designed to concurrently address multiple health issues commonly faced by Black survivors of violence. This systematic review of literature determines the efficacy of various strategies used in the existing evidence-based multicomponent interventions on violence reduction, promotion of reproductive health, reduction in risk for HIV, reduction in levels of stress, and improvement in mental health. Sixteen intervention studies were identified. Examples of components found to be efficacious in the studies were safety planning for violence, skill building in self-care for mental health, education and self-regulatory skills for HIV, mindfulness-based stress reduction for reducing stress, and individual counseling for reproductive health. Although some strategies were found to be efficacious in improving outcomes for survivors, the limitations in designs and methods, and exclusive focus on intimate partner violence calls for more rigorous research for this population, particularly for Black survivors of all forms of violence. There is also need for culturally responsive multicomponent interventions that account for diversity among Black survivors.

Practitioners' Views on IPV and Its Solutions: An Integrative Literature Review.

There are ongoing debates in the scientific community and in practice settings about how intimate partner violence (IPV) should be defined and understood and about how various interventions must be carried out. If these debates are to bear fruit, however, we must first gain a comprehensive understanding of each stakeholder's viewpoints on IPV and its solutions. This article seeks to contribute to this goal by summarizing empirical studies investigating how practitioners who work with IPV perpetrators understand the problem and its solutions. Based on an integrative review of the literature, it focuses on how practitioners define IPV and its causes, how they perceive the perpetrators and victims, and on the solutions they put forward in order to work against this social problem. The limitations of our current knowledge are outlined as well as the implications of this review for IPV debates.