A realist review of which advocacy interventions work for which abused women under what circumstances.

BACKGROUND: Intimate partner abuse (including coercive control, physical, sexual, economic, emotional and economic abuse) is common worldwide. Advocacy may help women who are in, or have left, an abusive intimate relationship, to stop or reduce repeat victimisation and overcome consequences of the abuse. Advocacy primarily involves education, safety planning support and increasing access to different services. It may be stand-alone or part of other services and interventions, and may be provided within healthcare, criminal justice, social, government or specialist domestic violence services. We focus on the abuse of women, as interventions for abused men require different considerations. OBJECTIVES: To assess advocacy interventions for intimate partner abuse in women, in terms of which interventions work for whom, why and in what circumstances. SEARCH METHODS: In January 2019 we searched CENTRAL, MEDLINE, 12 other databases, two trials registers and two relevant websites. The search had three phases: scoping of articles to identify candidate theories; iterative recursive search for studies to explore and fill gaps in these theories; and systematic search for studies to test, confirm or refute our explanatory theory. SELECTION CRITERIA: Empirical studies of any advocacy or multi-component intervention including advocacy, intended for women aged 15 years and over who were experiencing or had experienced any form of intimate partner abuse, or of advocates delivering such interventions, or experiences of women who were receiving or had received such an intervention. Partner abuse encompasses coercive control in the absence of physical abuse. For theory development, we included studies that did not strictly fit our original criteria but provided information useful for theory development. DATA COLLECTION AND ANALYSIS: Four review authors independently extracted data, with double assessment of 10% of the data, and assessed risk of bias and quality of the evidence. We adopted RAMESES (Realist and meta-narrative evidence syntheses: evolving standards) standards for reporting results. We applied a realist approach to the analysis. MAIN RESULTS: We included 98 studies (147 articles). There were 88 core studies: 37 focused on advocates (4 survey-based, 3 instrument development, 30 qualitative focus) and seven on abused women (6 qualitative studies, 1 survey); 44 were experimental intervention studies (some including qualitative evaluations). Ten further studies (3 randomised controlled trials (RCTs), 1 intervention process evaluation, 1 qualitative study, 2 mixed methods studies, 2 surveys of women, and 1 mixed methods study of women and staff) did not fit the original criteria but added useful information, as befitting a realist approach. Two studies are awaiting classification and three are ongoing.Advocacy interventions varied considerably in contact hours, profession delivering and setting.We constructed a conceptual model from six essential principles based on context-mechanism-outcome (CMO) patterns.We have moderate and high confidence in evidence for the importance of considering both women's vulnerabilities and intersectionalities and the trade-offs of abuse-related decisions in the contexts of individual women's lives. Decisions should consider the risks to the woman's safety from the abuse. Whether actions resulting from advocacy increase or decrease abuse depends on contextual factors (e.g. severity and type of abuse), and the outcomes the particular advocacy intervention is designed to address (e.g. increasing successful court orders versus decreasing depression).We have low confidence in evidence regarding the significance of physical dependencies, being pregnant or having children. There were links between setting (high confidence), and potentially also theoretical underpinnings of interventions, type, duration and intensity of advocacy, advocate discipline and outcomes (moderate and low confidence). A good therapeutic alliance was important (high confidence); this alliance might be improved when advocates are matched with abused women on ethnicity or abuse experience, exercise cultural humility, and remove structural barriers to resource access by marginalised women. We identified significant challenges for advocates in inter-organisational working, vicarious traumatisation, and lack of clarity on how much support to give a woman (moderate and high confidence). To work effectively, advocates need ongoing training, role clarity, access to resources, and peer and institutional support.Our provisional model highlights the complex way that factors combine and interact for effective advocacy. We confirmed the core ingredients of advocacy according to both women and advocates, supported by studies and theoretical considerations: education and information on abuse; rights and resources; active referral and liaising with other services; risk assessment and safety planning. We were unable to confirm the impact of complexity of the intervention (low confidence). Our low confidence in the evidence was driven mostly by a lack of relevant studies, rather than poor-quality studies, despite the size of the review. AUTHORS' CONCLUSIONS: Results confirm the core ingredients of advocacy and suggest its use rests on sound theoretical underpinnings. We determined the elements of a good therapeutic alliance and how it might be improved, with a need for particular considerations of the factors affecting marginalised women. Women's goals from advocacy should be considered in the contexts of their personal lives. Women's safety was not necessarily at greatest risk from staying with the abuser. Potentially, if undertaken for long enough, advocacy should benefit an abused woman in terms of at least one outcome providing the goals are matched to each woman's needs. Some outcomes may take months to be determined. Where abuse is severe, some interventions may increase abuse. Advocates have a challenging role and must be supported emotionally, through provision of resources and through professional training, by organisations and peers.Future research should consider the different principles identified in this review, and study outcomes should be considered in relation to the mechanisms and contexts elucidated. More longitudinal evidence is needed. Single-subject research designs may help determine exactly when effect no longer increases, to determine the duration of longitudinal work, which will likely differ for vulnerable and marginalised women. Further work is needed to ascertain how to tailor advocacy interventions to cultural variations and rural and resource-poor settings. The methods used in the included studies may, in some cases, limit the applicability and completeness of the data reported. Economic analyses are required to ascertain if resources devoted to advocacy interventions are cost-effective in healthcare and community settings.

Relationship Dissolution and Psychologically Aggressive Dating Relationships: Preliminary Findings From a College-Based Relationship Education Course.

This study evaluated the impact of a relationship education program, delivered as part of a college course, among students (N = 152) who reported experiencing psychological aggression in their exclusive dating relationship. Preliminary results showed that compared to those in the control group, participants receiving relationship education were significantly more likely to end their romantic relationship, even after controlling for relationship satisfaction. Furthermore, when relationship termination occurred, those in the intervention group were significantly more likely to attribute the breakup to their participation in the class as compared to those in the control group. The tentative findings are an important preliminary step in assessing the benefits of relationship education in reducing the risk of psychological aggression among college students.

Gender-Based Violence following Social Media Acquaintance in Nigeria.

In Nigeria, the growth in mobile phone use has provided the opportunity for increased access to the internet, and through this, the social media. The social media in turn offers tremendous communication benefits but also results in some undesirable consequences. One of such is the experience of Gender-Based Violence (GBV). Internet searches using Google Search and Google Scholar in addition to information available to the authors from news media is reported in this study. Five cases were selected for reporting. All cases selected had first contact with their perpetrator(s) on Facebook. The perpetrators were usually men, older than the victims (24-34 years for perpetrators compared with 17-25 years for the victims). The victims experienced physical, psychological, sexual and economic violence from their aggressors. One case resulted in the death of the victim, while two required hospitalization following severe trauma. Three of the victims were raped, while rape was attempted for the other two cases. GBV associated with acquaintances made on social media channels is emerging as a new social problem in Nigeria. Interventions to educate female social media users about this potential danger are urgently necessary.

[Domestic and sexual violence against women. Implications of WHO guidelines for Germany]. / Häusliche und sexuelle Gewalt gegen Frauen. Implikationen der WHO-Leitlinien für Deutschland.

Domestic violence and sexual violence are widespread and have serious health effects for those affected. If the problem is identified and confidence in responding exists, healthcare providers can make a significant contribution to support and intervention. In 2013 the WHO published evidence-based guidelines for responding to the issue in healthcare, training of healthcare providers and health policy. In principle, the guidelines confirm existing recommendations, best-practice guidelines and handbooks. They also encourage a review and further development-for example, regarding the issue of sexual violence. If and how the present recommendations are put into practice in healthcare and training of healthcare staff can currently be looked at only with the use of examples, given the lack of data in Germany. Examples from Berlin show that implementation is quite possible. However, there is a lack of clear mandate, of sustainability and of obligation. Existing good practice models are highly reliant on organisations' and employees' commitment. For Germany, the WHO guidelines indicate the need to develop national standards for healthcare in cases of domestic and sexual violence. A (legal) obligation for the healthcare system should be drawn up. A systematic embedding in training curricula of health care professions is needed. Quality assurance and a systematic evaluation of the practical implementation are required.

Police officers' collaboration with rape victim advocates: barriers and facilitators.

Secondary victimization may occur when rape victims make police reports. This can compromise the quality of official statements and jeopardize criminal cases. Rape reporters receive better treatment by police officers when advocates are involved and best practice police work includes such collaboration. Studies of advocates have described tension, role confusion, and poor communication with police officers. Many variables, including rape myth acceptance (RMA) and training on sexual assault dynamics, may affect officers' collaboration with advocates. There were 429 police officers who responded to a survey measuring their victim interviewing skill, formal training about rape, years on the job, number of victims known personally, number of recent rape cases, RMA, and collaboration with advocates. Results suggest that officers' interviewing skill, years on the job, and specific training are related to collaboration with victim advocates on rape cases. Professional, rather than personal, variables were most predictive of collaboration. Implications for officer selection and training are explored.

The forensic nursing in sexual assaults: the immunochemical diagnosis and prevention of its adverse effects.

Sexual assault was a ubiquitous and serious problem in our society. The world's care centers and forensic associations, which were at the forefront of scientific research in sexual assaults, discussed the role of the Forensic Nursing in their early diagnosis and their prevention, but little has been written in literature regarding their appropriate management. This article focuses on the immunochemical laboratory investigation in diagnosis and prevention of its adverse effects in sexual assaults and the role of the Forensic Nursing played in this task. After a careful reading of all the material received from many of the care centers and the associations contacted, a Forensic Nursing Examination Program, with specific immunochemical address, is identified.

[What should a physician do facing drug facilitated crimes?]. / Conduite à tenir devant une suspicion de soumission chimique.

Chemical submission is the administration, for criminal purposes, of psychoactive substances to an individual without their knowledge. It is clear that general practitioners remain helpless against such a phenomenon. Most of the time, diagnosis is negatively affected by delayed management, due to omitted diagnosis or inappropriate samples. The purpose of our paper is therefore to provide a few simple recommendations. A victim suspecting of being drugged without knowing should be adequately interviewed, examined and informed about the possibility of pressing charges. A quick referral to an emergency unit or a forensic medicine unit is necessary to collect biological samples for toxicological testing as promptly as possible. In the event of a prosecution, these samples will be submitted for toxicological analysis, a critical step in identifying the psychoactive substance used.

Reducing the risk of being a victim of crime in South Africa: you can tell and be heard!

People who use Augmentative and Alternative Communication (AAC) know that silence is not always golden. Persons with disabilities and in particular those with complex communication needs, have a heightened risk of becoming victims of crime, abuse, and neglect. This study looked at the vocabulary needed to disclose or report crime or abuse in South Africa, and also focussed on the development of communication boards for this purpose, in four of the 11 official South African languages (Afrikaans, English, Sepedi, and isiZulu). Thirty-six participants in four language-based focus groups (English, Afrikaans, Sepedi, and isiZulu) were asked to generate a list of possible words they deemed important when wanting to disclose a crime, abuse or neglect. Participants then prioritized the top 55 words. A total of 56 words appeared on two or more of the lists from the four language groups. The board was developed using Picture Communication Symbols (PCS), the most frequently used symbol set in South Africa, according to an electronic mail survey. A discrepancy analysis revealed that these 56 words could be represented by 219 symbols. Symbols were developed for two words (swear, threaten) for which no PCS symbols existed. The process of developing the communication boards described in this paper may be useful to AAC communities in other countries, and the boards can serve as templates for other languages.

Human smuggling in Austria: a comparative analysis of data on smuggled migrants from former Yugoslavia and the Russian Federation.

This article provides a summary of the author's research on human smuggling in Austria comparing migrants from Former Yugoslavia and the Russian Federation. The project's primary intent was to collect more detailed information on migrants seeking asylum in Austria and their use of smuggling services to leave their home countries, including detailed information on demographics, force or threat of force by smugglers, routes and methods of transportation, costs of smuggling, payment methods, and deeper perceptual questions regarding the flight. Another central premise of the article discusses how current distinctions between human smuggling and human trafficking are arbitrary in many regards.

Watching the detectives: crime programming, fear of crime, and attitudes about the criminal justice system.

Research demonstrates a complex relationship between television viewing and fear of crime. Social critics assert that media depictions perpetuate the dominant cultural ideology about crime and criminal justice. This article examines whether program type differentially affects fear of crime and perceptions of the crime rate. Next, it tests whether such programming differentially affects viewers' attitudes about the criminal justice system, and if these relationships are mediated by fear. Results indicated that fear mediated the relationship between viewing nonfictional shows and lack of support for the justice system. Viewing crime dramas predicted support for the death penalty, but this relationship was not mediated by fear. News viewership was unrelated to either fear or attitudes. The results support the idea that program type matters when it comes to understanding people's fear of crime and their attitudes about criminal justice.

Public school segregation and juvenile violent crime arrests in metropolitan areas.

Previous research has established an association between residential segregation and violent crime in urban America. Our study examines whether school-based segregation is predictive of arrests of juveniles for violent crimes in U.S. metro areas. Using Census, Uniform Crime Report, and Common Core data for 204 metro areas, a measure of school-based racial segregation, Theil's entropy index, is decomposed into two components: between- and within-district segregation. Findings reveal evidence of a significant interaction term: Within-district segregation is inversely associated with arrests for juvenile violence, but only in metropolitan areas with higher than average levels of between-district segregation.

UK: the reality behind the "knife crime" debate.

This study of teenage violent crime in Britain in 2008, extracted from a longer briefing paper published by the Institute of Race Relations, aims to provide a description of who was killed, by whom and in what circumstances ­ a factual description which has been largely missing from much media and political evaluation.

Role of self-esteem and family-level social capital in the pathway from victimization to aggression.

BACKGROUND: Children's aggressive behaviors remain a critical global concern that may cause harm to other children's behavioral, emotional and psychological, social, and academic functions. However, in this context, the possibility that children's aggressive behaviors might be responsive consequences triggered by the antecedent victimization should not be dismissed. In order to explore the pathway from victimization to later aggression, the structural relationships among victimization, self-esteem, social capital within the family, and aggression were tested, followed by further examination of the mediating roles of social capital within the family and the sequential mediating role of self-esteem and social capital in the pathway. METHOD: To test this hypothesized model, the responses of 2,844 fourth graders (48.4 % female), extracted from the Korean Youth Panel Survey (KYPS) were used. Structural Equation Modeling (SEM) was employed to test the hypothesized model using Mplus 7.4. RESULTS: According to the findings, victimization indirectly influenced later displays of aggression, but not directly. In addition, social capital either from parent(s) or sibling(s) was significantly mediated in the pathway from victimization to aggression. Lastly, when considering self- esteem in the model, the sequential mediating role of self-esteem and social capital from parent(s) was confirmed in the pathway, but not for the other sequential mediating role of self-esteem and social capital from sibling(s). CONCLUSION: The study's findings reveal the necessity of reconsidering the adequacy of a punitive approach towards children who display aggression. They also provide guidance for determining where to intervene in preventing victimized children from developing aggression. Practical implications are discussed accordingly.

The moderating role of teacher-student relationships on the association between peer victimization and depression in students with intellectual disabilities.

BACKGROUND: Students with intellectual disabilities (ID) are at increased risk of peer victimization and depressive symptoms. Little is known about the protective and aggravating factors that influence the association between peer victimization and depressive symptoms among students with ID. AIMS: This study assesses the moderating role of two facets of teacher-student relationships (TSR)-warmth and conflict-on the association between peer victimization and depressive symptoms. METHODS: A sample of 395 students (aged 11-22) with mild and moderate ID was recruited in Canada and Australia. RESULTS: Hierarchical multiple regressions indicated that victimization and TSR conflict were both associated with higher levels of depressive symptoms, and that TSR conflict moderated the associations between both TSR warmth and victimization, and depressive symptoms. TSR warmth was related to lower levels of depression only for students who also reported a low level of TSR conflict. Similarly, associations between victimization and depression were weaker among students exposed to more conflictual TSR. CONCLUSIONS: Students with ID are at increased risk of developing depressive symptoms when exposed to negative social relationships (i.e., peer victimization or TSR conflict). For these students, the benefits of TSR warmth were far less important than the consequences of conflict.

The impact of a peer counselling scheme to address bullying in an all-girl London secondary school: a short-term longitudinal study.

BACKGROUND: A variety of peer support schemes are now widely used in schools, notably to reduce bullying. However, there has been little systematic investigation of the impact and effectiveness of these approaches. AIMS: To assess the impact of a peer counselling scheme on peer counsellors and the school community. SAMPLE: The research was conducted in a North London all-girls state secondary school. Data were collected from all lower school classes (years 7, 8, and 9) and some staff members, in addition to year 10 peer counsellors and an age equivalent comparison group. METHODS: A detailed 1-year longitudinal study combined qualitative and quantitative methods of assessment. RESULTS: Peer counsellors benefited from their involvement through an acquisition of transferable communication and interpersonal skills, and, compared to age-matched control pupils, had increased social self-esteem. There were no reductions in self-reported bullying and victimization, but in general pupils believed that there was less bullying in school and that the school was doing more about bullying, with year 7 students showing the most positive changes. CONCLUSIONS: Peer-counselling schemes can improve self-esteem of peer supporters, and also impact positively on perceptions of bullying in the school; but impact on actual experiences of bullying is less clear, and there may be problems with the acceptance and use of such programmes by older students.

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.

Intervention in social skills and bullying.

OBJECTIVE: to verify if the improvement of social and emotional skills reduces bullying victimization in 6th grade students 12 months after the end of the intervention. METHOD: Quasi-experimental study with 78 students who were bullying victims. A cognitive behavioral intervention based on social skills was conducted with the intervention group. The eight sessions addressed politeness, making friendships, self-control, emotional expressiveness, empathy, assertiveness and solution of interpersonal problems. Data were analyzed using Poisson regression with random effect. RESULTS: Quasi-experimental study with 78 students who were bullying victims. A cognitive behavioral intervention based on social skills was conducted with the intervention group. The eight sessions addressed politeness, making friendships, self-control, emotional expressiveness, empathy, assertiveness and solution of interpersonal problems. Data were analyzed using Poisson regression with random effect. CONCLUSION: Social skills are important in anti-bullying interventions and can be the basis for intersectoral interventions in the health area, aimed at favoring the empowerment of victims by improving their social interactions and quality of life in school.

Long-term impacts of college sexual assaults on women survivors' educational and career attainments.

OBJECTIVE: To examine the well-documented mental and physical health problems suffered by undergraduate women sexually assaulted while on campus with an exploration of how the trauma impacts a survivor's lifetime education trajectory and career attainment. PARTICIPANTS: In November and December 2015, researchers recruited US participants using an online crowdsourcing tool and a Listserv for sexual violence prevention and response professionals. METHODS: Of 316 women who completed initial screening, 89 qualified to complete a Qualtrics survey. Eighty-one participants completed the online survey, and 32 participated in phone interviews. RESULTS: Ninety-one percent of the participants reported health problems related to the assault that they attributed to difficulties they faced in their attainment of their education and career goals. CONCLUSIONS: The findings suggest the importance of simultaneously examining the effects of human capital losses and mental and physical health problems attributed to the costly public health problem of campus sexual assault.