Comparing health systems readiness for integrating domestic violence services in Brazil, occupied Palestinian Territories, Nepal and Sri Lanka.

Domestic violence (DV) is a global prevalent health problem leading to adverse health consequences, yet health systems are often unprepared to address it. This article presents a comparative synthesis of the health system's pre-conditions necessary to enable integration of DV in health services in Brazil, Nepal, Sri Lanka and occupied Palestinian Territories (oPT). A cross-country, comparative analysis was conducted using a health systems readiness framework. Data collection involved multiple data sources, including qualitative interviews with various stakeholders; focus-group discussions with women; structured facility observations; and a survey with providers. Our findings highlight deficiencies in policy and practice that need to be addressed for an effective DV response. Common readiness gaps include unclear and limited guidance on DV, unsupportive leadership coupled with limited training and resources. Most providers felt unprepared, lacked guidance and felt unsupported and unprotected by managers and their health system. While in Brazil most providers felt they should respond to DV cases, many in Sri Lanka preferred not to. Such organizational and service delivery challenges, in turn, also affected how health providers responded to DV cases leaving them not confident, uncertain about their knowledge and unsure about their role. Furthermore, providers' personal beliefs and values on DV and gender norms also impacted their motivation and ability to respond, prompting some to become 'activists' while others were reluctant to intervene and prone to blame women. Our synthesis also pointed to a gap in women's use of health services for DV as they had low trust in providers. Our conceptual framework demonstrates the importance of having clear policies and highlights the need to engage leadership across every level of the system to reframe challenges and strengthen routine practices. Future research should also determine the ways in which women's understanding and needs related to DV help-seeking are addressed.

The Uptake and Measurement of Alternative Approaches to Domestic Violence Intervention Programs: A Scoping Review.

This scoping review explores the breadth and depth to which Domestic Violence Intervention Programs (DVIPs) in the United States and globally: (a) incorporate components that address the relationship between intimate partner violence (IPV) and social injustice, racism, economic inequality, and adverse childhood experiences (ACEs); (b) use restorative (RJ)/transformative justice (TJ) practices, individualized case management, partnerships with social justice actors, and strengths-based parenting training in current programming; and (c) measure effectiveness. In 2021, we searched 12 academic databases using a combination of search terms and Medical Subject Headings. In all, 27 articles that discussed at least one key concept relative to DVIP curricula were included in the final review. Findings suggest that very few DVIPs address ACEs and/or the relationship between structural violence, social inequality, and IPV perpetration. Even fewer programs use restorative practices including RJ or TJ. Furthermore, DVIPs use inconsistent methods and measures to evaluate effectiveness. To respond to IPV perpetration more effectively and create lasting change, DVIPs must adopt evidence-informed approaches that prioritize social and structural determinants of violence, trauma-informed care, and restoration.

Primary care system-level training and support programme for the secondary prevention of domestic violence and abuse: a cost-effectiveness feasibility model.

OBJECTIVES: This study aimed to evaluate the prospective cost-effectiveness of the Identification and Referral to Improve Safety plus (IRIS+) intervention compared with usual care using feasibility data derived from seven UK general practice sites. METHOD: A cost-utility analysis was conducted to assess the potential cost-effectiveness of IRIS+, an enhanced model of the UK's usual care. IRIS+ assisted primary care staff in identifying, documenting and referring not only women, but also men and children who may have experienced domestic violence/abuse as victims, perpetrators or both. A perpetrator group programme was not part of the intervention per se but was linked to the IRIS+ intervention via a referral pathway and signposting. A Markov model was constructed from a societal perspective to estimate mean incremental costs and quality-adjusted life years (QALYs) of IRIS+ compared with to usual care over a 10-year time horizon. RESULTS: The IRIS+ intervention saved £92 per patient and produced QALY gains of 0.003. The incremental net monetary benefit was positive (£145) and the IRIS+ intervention was cost-effective in 55% of simulations at a cost-effectiveness threshold of £20 000 per QALY. CONCLUSION: The IRIS+ intervention could be cost-effective or even cost saving from a societal perspective in the UK, though there are large uncertainties, reflected in the confidence intervals and simulation results.

[The Family Health Strategy and addressing violence against children and adolescents: an integrative review]. / A Estratégia Saúde da Família e o enfrentamento à violência contra crianças e adolescentes: revisão integrativa.

The scope of this study was to highlight what has been discussed about addressing violence against children and adolescents in the context of the Family Health Strategy in the scientific literature. It involved an integrative review of the literature, conducted in the Medical Literature Analysis and Retrieval System Online (Medline), Latin American and Caribbean Literature on Health Sciences (LILACS), Web of Science and American Psychological Association (PsycINFO) databases. In the survey, the controlled descriptors in Health Sciences (DeCS) and the Medical Subject Headings (MeSH) were used, including domestic violence, child abuse, educational technology and primary health care for DeCS and MeSH. A total of 2,403 results were obtained, with the application of the inclusion and exclusion criteria, and 15 articles were analyzed. Violence has been seen as a public health problem, being identified as a sensitive problem in PHC. Despite the identification of cases of violence against children and adolescents in the FHS, the lack of preparedness of professionals and the fragility in the coping network prejudice the adequate care for this public. Thus, there is a need to strengthen the network available and encourage the capacity building and training of professionals working in PHC.

Objetivou-se evidenciar na literatura científica o que se foi discutido sobre o enfrentamento à violência contra crianças e adolescentes no âmbito da Estratégia Saúde da Família. Trata-se de uma revisão integrativa da literatura, realizada nas bases de dados Medical Literatute Analysisand Retrieval System Online (Medline), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Web of Science e American Psychological Association (PsycINFO) e nestas, utilizaram-se os descritores controlados em Ciências da Saúde (DeCs) e do Medical Subject Headings (MeSH), sendo estes: "domestic violence", "child abuse", "educational technology", "primary health care" para DeCs e MeSh. Obteve-se um total de 2.403 resultados, com aplicação dos critérios de inclusão e exclusão foram analisados 15 artigos. A violência é vista como um problema de saúde pública, sendo identificada como um problema sensível a APS. Apesar da identificação de casos de violência contra crianças e adolescentes na ESF, o despreparo dos profissionais e a fragilidade na rede de enfrentamento fragmentam a assistência adequada a este público. Assim, há necessidade de fortalecimento da rede disponibilizada e incentivo a capacitação e formação dos profissionais atuantes na APS.

Why do mothers stay? Challenging attitudes in decision making about children at risk because of domestic violence.

BACKGROUND: This article reports findings from research commenced in 2019. Stage one assessed the attitudes and beliefs of child protection practitioners towards domestic violence. Stage two considered the impact of combining Structured Decision Making (SDM - the standard assessment approach) with Response Based Practice (RBP - a contemporary approach to understanding violence), on child protection decisions. OBJECTIVE: To improve the child protection response to children who experience domestic violence. This article reports on stage three; considering the impact of practitioner attitudes and beliefs on child protection decisions and whether the combined assessment approach (SDM + RBP) moderated the impact of practitioner attitudes and beliefs. PARTICIPANTS AND SETTING: 1041 child protection practitioners participated in the research while attending one of 17 practice conferences across New South Wales, Australia. METHODS: An innovative video vignette experiment with a between-subjects design was used, relying on professional actors to play the roles of practitioner and mother of the children reported. Participants watched a video interview of a safety assessment and completed a survey. RESULTS: Practitioner attitudes and beliefs were not significantly correlated with assessments about the children's safety; but attitudes did impact decisions about the likelihood of the children being brought into care. Attitudes and beliefs moderated the impact of misinformed attitudes, to some extent. CONCLUSIONS: The research confirms the value of the combined SDM + RBP approach to guide practitioners to a more holistic understanding of domestic violence. It also confirms that assessment approaches are only ever as good as the beliefs and attitudes of the people who apply them.

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.

Barriers and facilitators to pharmacists' engagement in response to domestic violence: a qualitative interview study informed by the capability-opportunity-motivation-behaviour model.

BACKGROUND: Domestic and sexual violence and abuse (DSVA) is a global public health problem resulting in health inequalities. Community pharmacies are uniquely placed to help people affected by DSVA. We examined factors that impact pharmacists' engagement in response to DSVA when providing public health services. METHODS: Semi-structured qualitative interviews with community pharmacists (n = 20) were analyzed thematically, with inductive themes mapped to the Capability-Opportunity-Motivation Behaviour (COM-B) model. RESULTS: Pharmacists were confident in providing public health services, but a lack of DSVA training meant there is a need to support their 'Capability' to respond to DSVA. Pharmacies were perceived as highly accessible healthcare providers on the high street, with sexual health consultations offering an ideal 'Opportunity' to enquire about DSVA in a private consultation room. Pharmacist's 'Motivation' to enquire about DSVA was driven by potential positive client outcomes and a desire to be more involved in public heath interventions, but organisation- and system-level support and remuneration is needed. CONCLUSIONS: Community pharmacy offers opportunities for integrating DSVA work in existing public health services. Pharmacists need training on DSVA, ongoing support, allocated funding for DSVA work, and awareness raising campaign for the public on their extended public health role.

Examining the Effectiveness, Acceptability, and Feasibility of Virtually Delivered Trauma-Focused Domestic Violence and Sexual Violence Interventions: A Rapid Evidence Assessment.

The COVID-19 pandemic has forced a rapid shift to virtual delivery of treatment and care to individuals affected by domestic violence and sexual violence. A rapid evidence assessment (REA) was undertaken to examine the effectiveness, feasibility and acceptability of trauma-focused virtual interventions for persons affected by domestic violence and sexual violence. The findings from this review will provide guidance for service providers and organizational leaders with the implementation of virtual domestic violence and sexual violence-focused interventions. The REA included comprehensive search strategies and systematic screening of and relevant articles. Papers were included into this review (1) if they included trauma-focused interventions; (2) if the intervention was delivered virtually; and (3) if the article was published in the English-language. Twenty-one papers met inclusion criteria and were included for analysis. Findings from the rapid review demonstrate that virtual interventions that incorporate trauma-focused treatment are scarce. Online interventions that incorporate trauma-focused treatment for this at-risk group are limited in scope, and effectiveness data are preliminary in nature. Additionally, there is limited evidence of acceptability, feasibility and effectiveness of virtual interventions for ethnically, culturally, and linguistically diverse populations experiencing domestic violence and sexual violence. Accessing virtual interventions was also highlighted as a barrier to among participants in studies included in the review. Despite the potential of virtual interventions to respond to the needs of individuals affected by domestic violence and/or sexual violence, the acceptability and effectiveness of virtual trauma-focused care for a diverse range of populations at risk of violence are significantly understudied.

Indigenous Cultural Safety in Recognizing and Responding to Family Violence: A Systematic Scoping Review.

This systematic scoping review synthesizes the recommended approaches for providing culturally safe family violence interventions to Indigenous peoples in health care and social service settings. A total of 3783 sources were identified through our electronic database searches, hand-searching of Indigenous-focused journals, and backward and forward citation chaining. After screening those sources in duplicate, 28 papers were included for synthesis in June 2020. Forward citation chaining of these 28 included articles in June 2022 identified an additional 304 possible articles for inclusion; following the screening of those 304 articles, an additional 6 were retained in the review. Thus, a total of 34 articles were included for data extraction and narrative synthesis. Initial results were presented to members of the Six Nations of the Grand River Youth Mental Wellness Committee, and their feedback was incorporated into our inductive organization of findings. Our findings represent three thematic areas that reflect key recommendations for health care and social service provision to Indigenous families for whom family violence is a concern: (1) creating the conditions for cultural safety; (2) healing at the individual and community level; and (3) system-level change. These findings demonstrate the need to center Indigenous peoples and perspectives in the development and implementation of cultural safety approaches, to acknowledge and address historically contingent causes of past and present family violence including colonization and related state policies, and to transform knowledge and power relationships at the provider, organization, and government level.

Health insurance expansion and family violence prevention: A conceptual framework.

Family violence, including child maltreatment (CM) and intimate partner violence (IPV), plagues far too many American families, particularly those in low-income communities. CM and IPV are intertwined and impose a significant emotional, health and financial burden on children and families and an economic burden on our country. Although these and other forms of violence are influenced by shared risk factors across the socioecological spectrum, prevention efforts typically intervene on a single type of violence at a microsystem level via individual or family intervention. Research is needed to identify policies operating at macrosystem levels that reduce, at scale, multiple forms of violence affecting children. In this paper, we propose a three-step theory of change through which health insurance expansions might reduce rates of CM and IPV, using Medicaid expansion as an exemplar. The proposed framework can inform research examining the link between health insurance and the primary prevention of CM and IPV.

Hairdos and Help-seeking: Mandatory Domestic Violence Training for Salon Workers.

Traditional methods to prevent and respond to domestic violence include criminal laws, national hotlines, and community programming to promote healthy relationships. Despite these methods, domestic violence continues to be a prevalent public health issue. In recent years, some states began to focus prevention and intervention efforts on the beauty industry. States including Arkansas, Illinois, Tennessee and Washington enacted laws that mandate domestic violence training for salon workers and other beauty professionals. The laws largely require salon workers to attend an informational training on domestic violence before obtaining or renewing their license. However, they do not require any affirmative action on the part of the salon worker if the client discloses that he or she is experiencing domestic violence. This paper investigates how the legislation uses the historically close relationship between hairdressers and their clients in order to achieve a unique way of reaching domestic violence victims, as well as the drawbacks to the legislative structure and atypical public health approach.

[Domestic Violence and Intimate Partner Violence - a Challenge within the Health Care Sector - Result of a Survey Among Physicians]. / Häusliche Gewalt und Partnerschaftsgewalt ­ eine Herausforderung im Gesundheitssektor.

Domestic violence evidently endangers health. Since physicians are seen as primary contact persons by victims of violence it is necessary to understand their perception of their role. 1346 of all physicians and dentists registered in 2015 with the Saxony Board of Physicians filled in a questionnaire on contact with victims, knowledge on support structures and willingness to take part on specific medical education. Frequency of contact was estimated to be low, while readiness to approach patients in case of suspicion was high. There was uncertainty about where to refer, as well as a limited level of awareness of existing support structures. Most indicated a high request in further education. In conclusion, motivation and readiness contrast with uncertainty and lack of awareness. Education focusing on key players and major network interfaces should endorse physicians in their significant role within the care and prevention system of violence.

Gender inequality and health disparity amid COVID-19.

Gender inequalities could lead to grave human and economic consequences, especially amid global health crises of the coronavirus 2019's (COVID-19) scale. The COVID-19 pandemic exacerbated gender inequalities women face and introduced new challenges that are unprecedented to society at large. Adverse effects of COVID-19, compounded by unintended consequences caused by public health policies such as lockdowns (e.g., delayed or canceled health services), have forced women to face issues ranging from COVID-19 infections and deaths, prolonged unemployment, to unparalleled scale and severity of domestic violence. However, though women face a canopy of debilitating challenges, there is a shortage of research that examines health solutions that can mitigate, if not offset, challenges women experience amid COVID-19. In this paper, we aim to shed light on why timely solutions are needed to mitigate gender inequalities and health disparities women face amid COVID-19 promptly. Furthermore, we underscore the imperative for cost-effective interventions that could shed light on the current health crisis and future pandemics.

Analyzing the relationship between air pollution and various types of crime.

Air pollution has a severe impact on human physical and mental health. When the air quality is poor enough to cause respiratory irritation, people tend to stay home and avoid any outdoor activities. In addition, air pollution may cause mental health problems (depression and anxiety) which were associated with high crime risk. Therefore, in this study, it is hypothesized that increasing air pollution level is associated with higher indoor crime rates, but negatively associated with outdoor crime rates because it restricts people's daily outdoor activities. Three types of crimes were used for this analysis: robbery (outdoor crime), domestic violence (indoor crime), and fraud (cybercrime). The results revealed that the geographically and temporally weighted regression (GTWR) model performed best with lower AIC values. In general, in the higher population areas with more severe air pollution, local authorities should allocate more resources, extra police officers, or more training programs to help them prevent domestic violence, rather than focusing on robbery.

HARMONY: a pragmatic cluster randomised controlled trial of a culturally competent systems intervention to prevent and reduce domestic violence among migrant and refugee families in general practice: study protocol.

INTRODUCTION: Domestic violence and abuse (DVA) is prevalent, harmful and more dangerous among diaspora communities because of the difficulty accessing DVA services, language and migration issues. Consequently, migrant/refugee women are common among primary care populations, but evidence for culturally competent DVA primary care practice is negligible. This pragmatic cluster randomised controlled trial aims to increase DVA identification and referral (primary outcomes) threefold and safety planning (secondary outcome) among diverse women attending intervention vs comparison primary care clinics. Additionally, the study plans to improve recording of DVA, ethnicity, and conduct process and economic evaluations. METHODS AND ANALYSIS: Recruitment of ≤28 primary care clinics in Melbourne, Australia with high migrant/refugee communities. Eligible clinics need ≥1 South Asian general practitioner (GP) and one of two common software programmes to enable aggregated routine data extraction by GrHanite. Intervention staff undertake three DVA training sessions from a GP educator and bilingual DVA advocate/educator. Following training, clinic staff and DVA affected women 18+ will be supported for 12 months by the advocate/educator. Comparison clinics are trained in ethnicity and DVA data entry and offer routine DVA care. Data extraction of DV identification, safety planning and referral from routine GP data in both arms. Adjusted regression analysis by intention-to-treat by staff blinded to arm. Economic evaluation will estimate cost-effectiveness and cost-utility. Process evaluation interviews and analysis with primary care staff and women will be framed by Normalisation Process Theory to maximise understanding of sustainability. Harmony will be the first primary care trial to test a culturally competent model for the care of diverse women experiencing DVA. ETHICS AND DISSEMINATION: Ethical approval from La Trobe University Human Ethics Committee (HEC18413) and dissemination by policy briefs, journal articles and conference and community presentations. TRIAL REGISTRATION NUMBER: ANZCTR- ACTRN12618001845224; Pre-results.

Promoting Cross-Sector Collaborations to Address Intimate Partner Violence in Health Care Delivery Systems Using a Quality Assessment Tool.

Background: As part of a Domestic Violence and Health care Partnership (DVHCP) project in California, 19 leadership teams consisting of representatives from domestic violence agencies and health care delivery systems in California came together to improve care related to intimate partner violence (IPV). We evaluated the impact of a Quality Assessment/Quality Improvement (QA/QI) tool on health care delivery systems' ability to collaborate with victim service agencies to address IPV. Methods: Each leadership team completed the QA/QI tool every 6 months between 2014 and 2017. Fifteen clinics that completed the tool at least twice are included in this analysis. Results: The largest changes noted in the QA/QI tool were having written protocols for assessing for IPV, providers distributing educational safety cards about IPV to patients, scripts for providers on how to assess and support survivors of IPV, trainings led by IPV agency advocates, and support for staff to discuss difficult cases. Conclusions: Implementation of a QA/QI tool can guide health care delivery systems to make changes in provider practices and clinic protocols to improve care and support for survivors of IPV. Such clinic-level changes may support providers to more readily or consistently integrate addressing IPV in clinical encounters while facilitating and promoting cross-sector collaborations with victim service advocacy and related social service agencies.

Victorian maternal and child health nurses' family violence practices and training needs: a cross-sectional analysis of routine data.

This study investigated maternal and child health (MCH) nurse family violence clinical practices, practice gaps and future family violence training needs. Descriptive analysis was conducted of routine data collected as part of a larger MCH nurse family violence training project conducted in 2018. A purposive sample of routine data (2017-18) was analysed from six Victorian metropolitan and four regional and rural areas that were experiencing high rates of violence, as indicated by police reports. Descriptive statistics and regression analyses were used to identify rates of nurse family violence screening, safety planning and referral, with practice differences analysed across locations. MCH nurses ask only one in two clients about family violence at the mandated 4-week postnatal clinic visit. Overall, metropolitan nurses screen for family violence at higher rates than rural nurses. Safety planning rates were low (1.3%), suggesting that screening is not translating to disclosure rates equivalent to state-wide prevalence (~14-17%) or police data. Nurse referrals are even lower (<1%), with practice differences noted across reporting systems. Despite data collection limitations, analysis of routine data shows significant gaps in nurse family violence screening and response practices. This evidence reinforces the need for systems changes to address family violence and other maternal health and social issues.