Women's Healthcare Utilization Following Routine Screening for Past-Year Intimate Partner Violence in the Veterans Health Administration.

BACKGROUND: Experience of intimate partner violence (IPV) can have adverse health impacts and has been associated with elevated rates of healthcare service utilization. Healthcare encounters present opportunities to identify IPV-related concerns and connect patients with services. The Veterans Health Administration (VHA) conducts IPV screening within an integrated healthcare system. OBJECTIVE: The objectives of this study were to compare service utilization in the 6 months following IPV screening between those screening positive and negative for past-year IPV (IPV+, IPV-) and to examine the timing and types of healthcare services accessed among women screening IPV+. DESIGN: A retrospective chart review was conducted for 8888 female VHA patients across 13 VHA facilities who were screened for past-year IPV between April 2014 and April 2016. MAIN MEASURES: Demographic characteristics (age, race, ethnicity, marital status, veteran status), IPV screening response, and healthcare encounters (based on visit identification codes). KEY RESULTS: In the 6 months following routine screening for past-year IPV, patients screening IPV+ were more likely to utilize outpatient care (aOR = 1.85 [CI 1.26, 2.70]), including primary care or psychosocial care, and to have an inpatient stay (aOR = 2.09 [CI 1.23, 3.57]), compared with patients screening IPV-. Among those with any utilization, frequency of outpatient encounters within the 6-month period following screening was higher among those screening IPV+ compared with those screening IPV-. The majority of patients screening positive for past-year IPV returned for an outpatient visit within a brief time frame following the screening visit (> 70% within 14 days, >95% within 6 months). More than one in four patients screening IPV+ had an emergency department visit within the 6 months following screening. CONCLUSIONS: Women who screen positive for past-year IPV have high rates of return to outpatient visits following screening, presenting opportunities for follow-up support. Higher rates of emergency department utilization and inpatient stays among women screening IPV+ may indicate adverse health outcomes related to IPV experience.

Alcohol-Focused Behavioral Couple Therapy.

Alcohol Behavioral Couple Therapy (ABCT) has emerged over the last 30 years as a highly efficacious treatment for those with alcohol use disorders. This review highlights the historical and conceptual underpinnings of ABCT, as well as the specific treatment elements and structure. Proposed active ingredients, moderators, and mediators of treatment outcome are discussed. Efficacy is evaluated for reductions in identified patient drinking, improved relationship functioning, and reductions in intimate partner violence. Adaptations of ABCT for substances other than alcohol are described. Other adaptations, including brief interventions, interventions addressing PTSD and TBI along with alcohol use, and interventions deliverable via technology platforms are described. Additional cost-benefit and cost-effectiveness findings supporting the economic value of ABCT are noted. Future directions for research in this area include possible adaptations for female identified patients, nontraditional couples, LGBT partners and dyads involving nonintimate partner relationships. The development of more flexible models and enhanced dissemination strategies may improve clinical uptake and utility as well as increasing the feasibility of this treatment for integrated healthcare settings.

Protocol for a randomised controlled trial of a web-based healthy relationship tool and safety decision aid for women experiencing domestic violence (I-DECIDE).

BACKGROUND: Domestic violence is a serious problem affecting the health and wellbeing of women globally. Interventions in health care settings have primarily focused on screening and referral, however, women often may not disclose abuse to health practitioners. The internet offers a confidential space in which women can assess the health of their relationships and make a plan for safety and wellbeing for themselves and their children. This randomised controlled trial is testing the effectiveness of a web-based healthy relationship tool and safety decision aid (I-DECIDE). Based broadly on the IRIS trial in the United States, it has been adapted for the Australian context where it is conducted entirely online and uses the Psychosocial Readiness Model as the basis for the intervention. METHODS/DESIGN: In this two arm, pragmatic randomised controlled trial, women who have experienced abuse or fear of a partner in the previous 6 months will be computer randomised to receive either the I-DECIDE website or a comparator website (basic relationship and safety advice). The intervention includes self-directed reflection exercises on their relationship, danger level, priority setting, and results in an individualised, tailored action plan. Primary self-reported outcomes are: self-efficacy (General Self-Efficacy Scale) immediately after completion, 6 and 12 months post-baseline; and depressive symptoms (Centre for Epidemiologic Studies Depression Scale, Revised, 6 and 12 months post-baseline). Secondary outcomes include mean number of helpful actions for safety and wellbeing, mean level of fear of partner and cost-effectiveness. DISCUSSION: This fully-automated trial will evaluate a web-based self-information, self-reflection and self-management tool for domestic violence. We hypothesise that the improvement in self-efficacy and mental health will be mediated by increased perceived support and awareness encouraging positive change. If shown to be effective, I-DECIDE could be easily incorporated into the community sector and health care settings, providing an alternative to formal services for women not ready or able to acknowledge abuse and access specialised services. TRIAL REGISTRATION: Trial registered on 15(th) December 2014 with the Australian New Zealand Clinical Trials Registry ACTRN12614001306606.

Violencia física y psicológica ejercida en parejas adolescentes: relación con el autoconcepto y la violencia entre iguales / Psychometric properties of the Five Facets Mindfulness Questionnaire (FFMQ-M) in Mexico

La violencia física y psicológica en parejas adolescentes constituye una importante problemática debido a sus graves consecuencias. Un primer objetivo de este estudio es analizar su prevalencia en adolescentes, diferenciando entre violencia ocasional y frecuente. Un segundo objetivo es analizar su relación con el autoconcepto y la violencia entre iguales. Participaron 672 adolescentes (48,4% chicos; 51,6% chicas), entre 12 y 19 años (M= 14,45; DT= 1,62), que cumplimentaron la "Escala de conflicto en parejas adolescentes", el "Autoconcepto AF-5" y la "Escala de conductas violentas". Los resultados obtenidos indican que los adolescentes, chicos y chicas, implicados de forma frecuente en violencia de pareja, física y psicológica, muestran también más conductas violentas hacia los iguales y menor autoconcepto familiar. En chicos, se observa menor autoconcepto social y emocional y en chicas menor autoconcepto académico. Estas variables podrían ser relevantes para la prevención de la violencia de pareja en adolescentes

Physical and psychological teen dating violence is a major problem due to its serious consequences. A first objective of this study was to analyze the prevalence of physical and psychological teen dating violence, both occasional and frequent. A second objective was to analyze its relationship with self-concept and peer violence. 672 adolescents (48.4% boys; 51.6% girls) from 12 to 19 years old (M=14.45, SD= 1.62) completed the Conflict in Adolescent Dating Relationships Inventory, the Self-Concept AF-5, and the Scale of Aggressive Behavior. Results indicate that adolescent boys and girls who are frequently involved in dating violence, physical and/or psychological, also show more peer violence and lower family self-concept. Boys show lower social and emotional self-concept, while girls show lower academic self-concept. These variables may be relevant to the prevention of teen dating violence

Women's health and behavioral health issues in health care reform.

As health care reform promises to change the landscape of health care delivery, its potential impact on women's health looms large. Whereas health and mental health systems have historically been fragmented, the Affordable Care Act (ACA) mandates integrated health care as the strategy for reform. Current systems fragment women's health not only in their primary care, mental health, obstetrical, and gynecological needs, but also in their roles as the primary caregivers for parents, spouses, and children. Changes in reimbursement, and in restructuring financing and care coordination systems through accountable care organizations and medical homes, will potentially improve women's health care.

A qualitative analysis of beginning mindfulness experiences for women with post-traumatic stress disorder and a history of intimate partner violence.

This article presents the beginning mindfulness experiences of low income, minority women with a history of intimate partner violence. Ten women participated in a Mindfulness-Based Stress Reduction group, three interviews and a focus group over 15 months. Using an interpretive phenomenological analysis approach, we derived the following themes: struggles to practice meditation; a vision of growing and helping; personal improvements, and interpersonal improvements. We share recommendations for clinical practice.

Promoting successful collaborations between domestic violence and substance abuse treatment service sectors: a review of the literature.

Women who experience intimate partner violence (IPV) victimization are more likely to struggle with substance abuse problems than are women who do not experience IPV. Given the connection between IPV victimization and substance abuse, recommended practices urge collaboration between domestic violence service agencies and substance abuse treatment agencies to provide comprehensive services for women with these co-occurring problems. However, domestic violence and substance abuse services have unique histories of development that have led to distinct ways of service delivery. To promote successful collaborations, service providers and researchers are developing strategies to foster relationships across the two service sectors. The authors conducted a review of this emerging body of knowledge with the aim of assembling recommendations for strategies to foster collaboration between domestic violence and substance abuse services. The authors identified 15 documents for review inclusion and our analysis established 5 categories of documents. Findings yield key collaboration strategies and recommended service models. In addition, the review determined the existence of considerable challenges to promoting collaborative relationships between domestic violence and substance abuse treatment service sectors.

An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up.

BACKGROUND: Malaysia has been at the forefront of the development and scale up of One-Stop Crisis Centres (OSCC) - an integrated health sector model that provides comprehensive care to women and children experiencing physical, emotional and sexual abuse. This study explored the strengths and challenges faced during the scaling up of the OSCC model to two States in Malaysia in order to identify lessons for supporting successful scale-up. METHODS: In-depth interviews were conducted with health care providers, policy makers and key informants in 7 hospital facilities. This was complemented by a document analysis of hospital records and protocols. Data were coded and analysed using NVivo 7. RESULTS: The implementation of the OSCC model differed between hospital settings, with practise being influenced by organisational systems and constraints. Health providers generally tried to offer care to abused women, but they are not fully supported within their facility due to lack of training, time constraints, limited allocated budget, or lack of referral system to external support services. Non-specialised hospitals in both States struggled with a scarcity of specialised staff and limited referral options for abused women. Despite these challenges, even in more resource-constrained settings staff who took the initiative found it was possible to adapt to provide some level of OSCC services, such as referring women to local NGOs or community support groups, or training nurses to offer basic counselling. CONCLUSIONS: The national implementation of OSCC provides a potentially important source of support for women experiencing violence. Our findings confirm that pilot interventions for health sector responses to gender based violence can be scaled up only when there is a sound health infrastructure in place - in other words a supportive health system. Furthermore, the successful replication of the OSCC model in other similar settings requires that the model - and the system supporting it - needs to be flexible enough to allow adaptation of the service model to different types of facilities and levels of care, and to available resources and thus better support providers committed to delivering care to abused women.

Psychological trauma and substance abuse: the need for an integrated approach.

There is consensus that an integrated approach which addresses the clinical needs of individuals who have histories of substance abuse and psychological trauma concurrently is an acceptable and preferred approach to treatment. Several integrated models have emerged in recent years. In this paper we first define the concepts of substance abuse and psychological trauma, investigate the relationship between both and proceed to discuss why an integrated approach is most compelling. Finally, we review and critically examine the different integrated models that have been developed in terms of efficacy, effectiveness and empirical evidence. The paper concludes with suggestions on how the field can be improved.

Substance abuse by men in partner abuse intervention programs: current issues and promising trends.

This article discusses key studies linking intervention for co-occurring substance abuse and partner abuse. Findings are grouped into three areas: (a) the effect of addictions treatment on partner violence; (b) application of transtheoretical, motivational, and culturally focused approaches to improve engagement and prevent attrition; and (c) assessment-based matching of services. Finally, the relative value of serial, coordinated, and integrated substance abuse programs and partner abuse intervention programs are considered. We reached three primary conclusions: (a) Addiction treatment alone reduces the risk for future domestic violence in a subset of men who batter, (b) screening and assessment for substance abuse by all men in partner abuse intervention programs is a standard of practice but needs to extend beyond "intake" and occur periodically, and (c) coordinated and integrated substance abuse and domestic violence programs probably offer more safety than traditional serial substance abuse treatment followed by partner abuse intervention.

A framework for treating partner aggressive women.

Women are increasingly referred to intervention programs to address their use of physical violence against intimate partners. This article reviews the scant treatment outcome and attrition literature for partner aggressive women and describes important characteristics of partner aggressive women that must be taken into consideration in designing treatment. Recommended treatment modules are described in detail and include skill-building to enhance safety planning, conflict management, emotional regulation, communication and negotiation, and stress management. Additional modules should be included for some women based on individualized needs. These may include parenting skills and education and referral for treatment of conditions that undermine emotional stability, such as posttraumatic stress symptoms, substance abuse, and mood disorders. Treatment structure is outlined and pragmatic issues regarding the implementation of treatment are discussed. Interventions for partner aggressive woman must be designed to address women's victimization experiences as well as their perpetration.

A preliminary investigation of the effects of giving testimony and learning yogic breathing techniques on battered women's feelings of depression.

Researchers have shown that mood and sense of control over one's life are significantly affected by testimony and other forms of disclosure and that learning to control breathing has positive effects on mood and anxiety. This preliminary experiment tests whether African American and European American abused women who give testimony about their experiences of intimate partner violence and learn how to use yogic breathing techniques have reduced feelings of depression. Results indicate that learning yogic breathing techniques alone and combined with giving testimony significantly reduces feelings of depression. Recasting women as authorities on domestic violence and teaching them how to calm their minds by focusing on yogic breathing may be simple and effective ways to help women take control over their bodies and lives.

Enhancing spiritual well-being among suicidal African American female survivors of intimate partner violence.

Spirituality has been identified as one component of a culturally competent therapeutic intervention for African American women. The present study was designed to investigate the ability of factors, such as level of hopelessness and the use of positive religious coping strategies, to predict spiritual well-being over time. Seventy-four low-income African American women were administered self-report questionnaires measuring hopelessness, use of religious coping strategies, and two domains of spiritual well-being. Path analysis indicated that hopelessness, existential well-being, religious well-being, and positive religious coping are correlated with one another. Further, lower levels of hopelessness predict increases in existential well-being over time; higher levels of positive religious coping predict increases in religious well-being over time. Results were consistent with the study hypotheses and highlight the need to attend to predictors of spiritual well-being when implementing culturally relevant interventions with abused, suicidal African American women. Therapeutic strategies for reducing hopelessness and enhancing positive religious coping to improve spiritual and existential well-being are presented; such strategies will ensure the interventions are more culturally competent.

Effects of coordinated services for drug-abusing women who are victims of intimate partner violence.

This article summarizes outcomes from a demonstration project on collaboration between substance abuse and domestic violence agencies. Researchers recruited women seeking services for substance abuse or intimate partner violence at 1 of 6 participating agencies. Admitted women were both victims of domestic violence and abusing alcohol or drugs. Following an initial screening, participants were interviewed at program entry (n = 255) and again 4 to 6 months later (n = 128, 50%). Key outcomes were the number of days substances were used in the past 30 days, women's perceptions of harm from battering, and domestic violence self-efficacy. Results suggest participants used substances less frequently and experienced themselves as more efficacious following services, but they were also more fearful of the consequences of domestic violence. Repeated-measures MANOVA found that substance abuse days and domestic violence self-efficacy significantly contributed to the multivariate function. Implications for services for women with co-occurring substance abuse and domestic violence victimization are discussed.

Identifying signs and symptoms of intimate partner violence in an oncology setting.

Domestic violence (DV), or intimate partner violence (IPV), is a prevailing problem in public health. Often, healthcare providers may be the first people that victims of DV will approach to reveal their problem or seek assistance. IPV is a pattern of control using assault and intimidating behaviors that has devastating effects on individuals, their families, and communities. Oncology nurses need to become familiar with common indicators of DV so that signs and symptoms of abuse can be identified when assessing patients in an oncology setting. Standards of oncology nursing practice support that the psychosocial impact of cancer on patients and their families or significant others needs to be considered at all stages of diagnosis and treatment. The psychosocial impact of other personal situations or concerns, such as IPV, can add to the complexity of cancer management. Routine screening for signs and symptoms of psychosocial distress helps identify patients who require additional interventions. Oncology nursing practice is based on a holistic approach to patient care, which supports that identification of physical and psychosocial needs are equally important. Oncology nursing provides many unique opportunities to help patients cope with cancer. Routine nursing assessment for signs and symptoms of abuse will provide an opportunity to assist patients with cancer to manage not only the life-threatening aspects of their diagnosis but also the life-threatening aspects of IPV.

The most important things learned about violence and trauma in the past 20 years.

In the past 2 decades, important insights have been gained regarding violence and trauma. Complications occur in how violence and trauma, their causes, and their effects on victims should be defined. Violence and abuse to women--physical, sexual, and emotional--are not rare events and are most often perpetrated by partners or acquaintances rather than strangers and occur in nonmarital as well as marital relationships, including same-sex relationships. A promising methodological innovation in the study of violence and trauma is the use of longitudinal designs. Innovations in treatments for victims such as evidence-based interventions have been slow to emerge; they include eye movement desensitization and reprocessing (EMDR) and the Seeking Safety group intervention for drug-abusing women with trauma histories. Future research should address increased understanding of variation in individual responses to violence and trauma, matching of treatment to different types of male offenders, better understanding of how culture affects violence perpetration and victimization, and evaluation of domestic violence interventions.

The relative effectiveness of EMDR versus relaxation training with battered women prisoners.

Five women prisoners with a history of being battered and who met the DSM-IV criteria for post-traumatic stress disorder were assessed (A phase) and provided with structured relaxation training (RT) (B phase, or placebo treatment), followed by eye movement desensitization and reprocessing (EMDR) therapy (C phase). Using the Beck Anxiety Inventory and the Impact of Events Scale's avoidance behavior and intrusive thoughts subscales as outcome measures, RT alone did not result in any clinical improvements. The subsequent provision of EMDR did not improve upon this lack of success with 4 of the 5 participants; 1 did improve on anxiety and intrusive thoughts. The apparent ineffectiveness of EMDR with these participants may be attributed to several explanations. Foremost perhaps is the hypothesis that EMDR is not sufficient to ameliorate the effects of chronic abuse.

Who's afraid of the big bad wolf? Confronting wife abuse through folk stories.

Because many world folk stories describe wife abuse with remarkable insight, these stories are useful in addressing the sensitive issues that arise when counseling battered women. Following the views of Milton Erickson and Joan Laird about the importance of stories as a therapeutic tool, techniques were developed in a regional Coalition for Battered Women in North Carolina to use folk stories as an aid in redefining problems, increasing self-esteem, decreasing resistance, and encouraging alternative solutions to difficult situations. A case study of the use of a story in a battered women's support group session illustrates the value of folk stories in the counseling process. On the basis of experience to date, additional uses of the stories to help abused women are suggested.