"Our services are not the same": the impact of the COVID-19 pandemic on care interactions in women's shelters.

BACKGROUND: Guidelines and regulations in response to the COVID-19 pandemic have significantly impacted the health care sector. We explore these impacts in the gender-based violence (GBV) services sector and, more specifically, in the context of women's shelters. METHODS: Using an interpretive description and integrated knowledge mobilization approach, we interviewed 8 women's shelter clients, 26 staff, and conducted focus groups with 24 Executive Directors. RESULTS: We found that pandemic responses challenged longstanding values that guide work in women's shelters, specifically feminist and anti-oppressive practices. Physical distancing, masking, and closure of communal spaces intended to slow or stop the spread of the novel coronavirus created barriers to the provision of care, made it difficult to maintain or create positive connections with and among women and children, and re-traumatized some women and children. Despite these challenges, staff and leaders were creative in their attempts to provide quality care, though these efforts, including workarounds, were not without their own challenges. CONCLUSIONS: This research highlights the need to tailor crisis response to sector-specific realities that support service values and standards of care.

Measuring Trauma- (and Violence-) Informed Care: A Scoping Review.

Trauma- (and violence-) informed care (T(V)IC) has emerged as an important practice approach across a spectrum of care settings; however how to measure its implementation and impact has not been well-examined. The purpose of this scoping review is to describe the nature and extent of available measures of T(V)IC, including the cross-cutting concepts of vicarious trauma and implicit bias. Using multiple search strategies, including searches conducted by a professional librarian from database inception to Summer 2020, 1074 articles were retrieved and independently screened for eligibility by two team members. A total of 228 were reviewed in full text, yielding 13 measures that met pre-defined inclusion criteria: 1) full-text available in English; 2) describes the initial development and validation of a measure, that 3) is intended to be used to evaluate T(V)IC. A related review of vicarious trauma measures yielded two that are predominant in this literature. Among the 13 measures identified, there was significant diversity in what aspects of T(V)IC are assessed, with a clear emphasis on "knowledge" and "safety", and less on "collaboration/choice" and "strengths-based" concepts. The items and measures are roughly split in terms of assessing individual-level knowledge, attitudes and practices, and organizational policies and protocols. Few measures examine structural factors, including racism, misogyny, poverty and other inequities, and their impact on people's lives. We conclude that existing measures do not generally cover the full potential range of the T(V)IC, and that those seeking such a measure would need to adapt and/or combine two or more existing tools.

The Impact of the COVID-19 Pandemic on Staff in Violence Against Women Services.

The COVID-19 pandemic has been harmful to survivors of abuse. Less understood is the impact on staff in the violence against women (VAW) service sector. Using interpretive description methodology, we examined staff experiences during the pandemic in Ontario, Canada, and found four core themes: (1) the emotional toll of the work; (2) remote (doesn't) work; (3) work restructuring; (4) efforts to stay well and subthemes nuancing staff experiences in a sector vulnerable to vicarious trauma. This research underscores the need to mitigate experiences of stress, heavy workloads, and guilt for staff in VAW services during crises and provides action-oriented recommendations.

Navigating multiple pandemics: A critical analysis of the impact of COVID-19 policy responses on gender-based violence services.

COVID-19 illustrated what governments can do to mobilise against a global threat. Despite the strong governmental response to COVID-19 in Canada, another 'pandemic', gender-based violence (GBV), has been causing grave harm with generally insufficient policy responses. Using interpretive description methodology, 26 interviews were conducted with shelter staff and 5 focus groups with 24 executive directors (EDs) from GBV service organizations in Ontario, Canada. Five main themes were identified and explored, namely that: (1) there are in fact four pandemics at play; (2) the interplay of pandemics amplified existing systemic weaknesses; (3) the key role of informal partnerships and community support, (4) temporary changes in patterns of funding allocation; and (5) exhaustion as a consequence of addressing multiple and concurrent pandemics. Implications and recommendations for researchers, policy makers, and the GBV sector are discussed.

"We're so limited with what we actually can do if we follow all the rules": a qualitative study of the impact of COVID-19 public health protocols on violence against women services.

BACKGROUND: Violence against women (VAW) is a major public health problem that grew worse during the COVID-19 pandemic. While all services were impacted by changing pandemic guidance, VAW shelters, as congregate settings with multiple funders and regulators, faced unique challenges. METHODS: We conducted a qualitative analysis of interviews with 26 women's shelter staff and eight women accessing care, as well as 10 focus groups (five each at two time points approximately a year apart) involving 24 leaders from VAW and related services in Ontario, Canada. RESULTS: We identified eight overlapping themes specific to government and public health COVID-19 regulations and their application in women's shelters. Overall, inconsistency or lack of clarity in rules, and how they were communicated, caused significant stress for women using, and staff providing, services. Staff and leaders were very concerned about rules that isolated women or replicated other aspects of abusive relationships. Women wanted to understand what options were available and what was expected of them and their children in these spaces. Leaders sought clarity and consistency from their various government funders, and from public health authorities, in the face of ever-evolving directives. As in the broader public, there was often the perception that the rules did not apply equally to everyone, for example, for women of colour using VAW services, or those whose first language was not English. CONCLUSIONS: In the absence of consistent pandemic guidance and how to implement it, many VAW services devised tailored solutions to balance safety from COVID-19 with women's physical and emotional safety from abuse and its impacts. However, this was difficult and exhausting. A key policy implication is that women's shelters are a distinct form of congregate housing; they are very different in terms of services provided, size, type and age of facilities from other congregate settings and this must be reflected in public health directives. Better communication and synchronization of policies among government funders and public health authorities, in consultation with VAW sector leaders, would mean protocols tailored to minimize harm to women and children while protecting health and safety.

Experiences of Women Accessing Violence Against Women Outreach Services in Canada During the COVID-19 Pandemic: a Brief Report.

The COVID-19 pandemic has had significant impacts on violence against women (VAW), including increased prevalence and severity, and on VAW service delivery. The purpose of this research was to study women's experiences with VAW services in the first stages of the pandemic and describe their fears and concerns. This cross-sectional study was conducted from May through October 2020. Our VAW agency partners across Ontario, Canada invited women using outreach services to participate in a study about their experiences during the pandemic. In total, 49 women from 9 agencies completed an online survey. Quantitative data were analyzed with descriptive statistics and open-ended responses are presented to supplement findings. Women's experiences with VAW services during the pandemic varied greatly; some found technology-facilitated services (phone, video, text) more accessible, while others hoped to return to in-person care. Over half of women reported poorer wellbeing, access to health care, and access to informal supports. Many women reported increased relationship-related fears, some due specifically to COVID-19 factors. Our results support providing a variety of technology-based options for women accessing VAW services when in-person care options are reduced. This research also adds to the scant literature examining how some perpetrators capitalized on the pandemic by using new COVID-19-specific forms of coercive control. Although the impacts of the pandemic on women varied, our findings highlight how layers of difficulty, such as less accessible formal and informal support, as well as increased fear - can compound to make life for women experiencing abuse exceptionally difficult.

A Genderfluid Approach to Aesthetic Language in Dermatology.

Dermatologists are in a unique position to help transgender and non-binary individuals achieve an appearance that corresponds to their identity. Minimally invasive procedures for gender affirmation are relatively safe and customizable, providing an increasingly favorable treatment niche for these patients.1-4.

Women's Experiences of the Intersections of Work and Intimate Partner Violence: A Review of Qualitative Research.

The impacts of intimate partner violence (IPV) on work, workplaces, and employment are receiving increasing attention from researchers, employers, and policy makers, but research synthesis is needed to develop evidence-based strategies to address the problem. The purpose of this review of qualitative research is to explore abused women's experiences of the intersections of work and IPV, including the range of benefits and drawbacks of work. Multiple search strategies, including systematic database searches by a professional librarian, resulted in 2,306 unique articles that were independently screened for eligibility by two team members. Qualitative research articles were eligible for inclusion and were also required to (1) sample women with past and/or current IPV experience and (2) report results regarding women's experiences or views of the benefits and/or drawbacks of work. Ultimately, 32 qualitative research articles involving 757 women were included and analyzed using thematic synthesis. Results revealed the potential of work to offer survivors a great range of benefits and drawbacks, many of which have received little research attention. The importance of work for women survivors has been emphasized in the literature, often with respect to financial independence facilitating the leaving process. However, our research underscores how the impact of work for many women survivors is not straightforward and, for some, involves a "trade-off" of benefits and drawbacks. Those developing work-related interventions, services (e.g., career counseling), or policies for women who experience IPV should consider the range of benefits and drawbacks in their planning, as "one-size-fits-all" solutions are unlikely to be effective.

Successful, Easy to Access, Online Publication of COVID-19 Data During the Pandemic, New York City, 2020.

Making public health data easier to access, understand, and use makes it more likely that the data will be influential. Throughout the COVID-19 pandemic, the New York City (NYC) Department of Health and Mental Hygiene's Web-based data communication became a cornerstone of NYC's response and allowed the public, journalists, and researchers to access and understand the data in a way that supported the pandemic response and brought attention to the deeply unequal patterns of COVID-19's morbidity and mortality in NYC. (Am J Public Health. 2021;111(S3):S193-S196. https://doi.org/10.2105/AJPH.2021.306446).

Impacts of trauma- and violence-informed care education: A mixed method follow-up evaluation with health & social service professionals.

OBJECTIVES: Trauma- and violence-informed care (TVIC) creates safety by understanding the impacts of trauma on health and behavior, and the intersecting impacts of structural and interpersonal violence. This study examined the impact, 1-2 years later, of TVIC professional education. DESIGN, SAMPLE AND MEASUREMENTS: We conducted a mixed method descriptive follow-up evaluation (online survey, n = 67, and semi-structured interviews, n = 7) with health and social service providers, leaders and researchers who attended TVIC workshops. Participants were asked how the workshop impacted their thinking, actions and perceptions of organizational changes. RESULTS: Participants reported greater impact on attitudes than on behaviors. The most common change in awareness and thinking related to better understanding of the links among trauma, pain and substance use. Practice changes included more active listening and empathy, less use of jargon and less judgement in care encounters. Participants linked these practices to better care interactions, and more trust, openness and satisfaction among service users. CONCLUSION: Educating health professionals and others (e.g. educators) about trauma, violence, and discrimination is not easy. TVIC education can help shift potentially stigmatizing attitudes which can then precipitate practice change. These approaches are emerging as an important way to improve health and quality of life.

Experiences of Intimate Partner Violence Victims With Police and the Justice System in Canada.

Legal responses to intimate partner violence (IPV) can determine whether and how those exposed to IPV seek help. Understanding the victim's perspective is essential to developing policy and practice standards, as well as informing professionals working in policing and the justice system. In this survey study, we utilized a subset of 2,831 people who reported experiencing IPV to examine (a) rates of reporting to the police; (b) experiences with, and perceived helpfulness of, police; (c) rates of involvement with the criminal and family law systems, including protection orders; and (d) experiences with, and perceived helpfulness of, the justice system. Data were analyzed using descriptive statistics for closed-ended survey questions and content analysis of text responses. More than 35% of victims reported a violent incident to the police, and perceptions of helpfulness were mixed. Fewer victims were involved with the criminal and family law systems, and their satisfaction also varied. Text responses provided insight into possible reasons for the variability found in experiences, for example, the proposed role of victim and system expectations, and respondents' perception that getting help depends on "being lucky" with the officials encountered.

Intimate Partner Violence and Work: A Scoping Review of Published Research.

Increasingly, intimate partner violence (IPV) is recognized as having important impacts on work. The purpose of this scoping review is to describe the nature and extent of research on IPV and workers, the workplace, and/or employment. Using multiple search strategies, including searches conducted by a professional librarian from database inception to May 2018, 2,306 unique articles were retrieved and independently screened for eligibility by two team members. A total of 235 articles met predefined inclusion criteria, which were that articles must: (1) report findings of a research study, (2) be published in a peer-reviewed journal, and (3) be focused on IPV and the workplace, workers, and/or employment. The most common topics examined were the relationship between IPV and employment, IPV- and work-related factors, and the impacts of IPV on work. Most articles were quantitative and cross-sectional and focused on the abuse of women by men. Major research gaps include evaluations of interventions to address IPV and work and research focused on the experiences and needs of perpetrators and gender and sexual minorities. Further evidence synthesis is recommended in several areas and implications for policy and practice are discussed.

Five Waves of an Online HIV Self-Test Giveaway in New York City, 2015 to 2018.

BACKGROUND: HIV self-tests increase HIV status awareness by providing convenience and privacy, although cost and access may limit use. Since 2015, the New York City (NYC) Health Department has conducted 5 waves of an online Home Test Giveaway. METHODS: We recruited adult cisgender men who have sex with men (MSM) and transgender and gender-nonconforming (TGNC) individuals who had sex with men, who were living in NYC, not previously HIV diagnosed, and using paid digital advertisements (4-8 weeks per wave). Eligible respondents were e-mailed a code to redeem on the manufacturer's website for a free HIV self-test and an online follow-up survey ~2 months later. For key process and outcome measures, we present means across 5 waves. RESULTS: Across the 5 waves of Home Test Giveaway, there were 28,921 responses to the eligibility questionnaire: 17,383 were eligible, 12,182 redeemed a code for a free HIV self-test, and 7935 responded to the follow-up survey (46% of eligible responses). Among eligible responses, approximately half were Latino/a (mean, 32%) or non-Latino/a, black (mean, 17%). Mean report of never testing before was 16%. Among 5903 follow-up survey responses who reported test use, 32 reported reactive results with no known previous diagnosis (0.54%), of whom 78% reported receiving confirmatory testing. Report of likelihood of recommending the Home Test Giveaway to friends was high (mean, 96%). CONCLUSIONS: We recruited diverse NYC MSM and TGNC and distributed a large number of HIV self-tests to them. Among respondents who reported newly reactive tests, the majority reported confirmatory testing. This seems to be one acceptable way to reach MSM and TGNC for HIV testing, including those who have never tested before.

Identifying children exposed to maltreatment: a systematic review update.

BACKGROUND: Child maltreatment affects a significant number of children globally. Strategies have been developed to identify children suspected of having been exposed to maltreatment with the aim of reducing further maltreatment and impairment. This systematic review evaluates the accuracy of strategies for identifying children exposed to maltreatment. METHODS: We conducted a systematic search of seven databases: Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Cochrane Libraries, Sociological Abstracts and the Education Resources Information Center. We included studies published from 1961 to July 2, 2019 estimating the accuracy of instruments for identifying potential maltreatment of children, including neglect, physical abuse, emotional abuse, and sexual abuse. We extracted data about accuracy and narratively synthesised the evidence. For five studies-where the population and setting matched known prevalence estimates in an emergency department setting-we calculated false positives and negatives. We assessed risk of bias using QUADAS-2. RESULTS: We included 32 articles (representing 31 studies) that evaluated various identification strategies, including three screening tools (SPUTOVAMO checklist, Escape instrument, and a 6-item screening questionnaire for child sex trafficking). No studies evaluated the effects of identification strategies on important outcomes for children. All studies were rated as having serious risk of bias (often because of verification bias). The findings suggest that use of the SPUTOVAMO and Escape screening tools at the population level (per 100,000) would result in hundreds of children being missed and thousands of children being over identified. CONCLUSIONS: There is low to very low certainty evidence that the use of screening tools may result in high numbers of children being falsely suspected or missed. These harms may outweigh the potential benefits of using such tools in practice (PROSPERO 2016:CRD42016039659).

Minimally Invasive Procedures for Gender Affirmation.

Despite an increase in the visibility of the transgender population, those who transition continue to face barriers to receiving care through traditional medical providers. Dermatologists can play an important role in the care of transgender patients, through increased understanding and awareness, better outreach, modified medical forms, improved office procedures, and safer and immediately available minimally invasive aesthetic treatments. Minimally invasive aesthetic enhancements that help align appearance with aesthetic goals and gender identity can enhance confidence and improve quality of life. This article discusses gender transition, applicable minimally invasive procedures for the face and body, and illustrative case examples.

Children's and caregivers' perspectives about mandatory reporting of child maltreatment: a meta-synthesis of qualitative studies.

OBJECTIVE: To systematically synthesise qualitative research that explores children's and caregivers' perceptions of mandatory reporting. DESIGN: We conducted a meta-synthesis of qualitative studies. DATA SOURCES: Searches were conducted in Medline, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Criminal Justice Abstracts, Education Resources Information Center, Sociological Abstracts and Cochrane Libraries. ELIGIBILITY CRITERIA: English-language, primary, qualitative studies that investigated children's or caregivers' perceptions of reporting child maltreatment were included. All healthcare and social service settings implicated by mandatory reporting laws were included. DATA EXTRACTION AND SYNTHESIS: Critical appraisal of included studies involved a modified checklist from the Critical Appraisal Skills Programme (CASP). Two independent reviewers extracted data, including direct quotations from children and caregivers (first-order constructs) and interpretations by study authors (second-order constructs). Third-order constructs (the findings of this meta-synthesis) involved synthesising second-order constructs that addressed strategies to improve the mandatory reporting processes for children or caregivers-especially when these themes addressed concerns raised by children or caregivers in relation to the reporting process. RESULTS: Over 7935 citations were retrieved and 35 articles were included in this meta-synthesis. The studies represent the views of 821 caregivers, 50 adults with histories of child maltreatment and 28 children. Findings suggest that children and caregivers fear being reported, as well as the responses to reports. Children and caregivers identified a need for improvement in communication from healthcare providers about mandatory reporting, offering preliminary insight into child-driven and caregiver-driven strategies to mitigate potential harms associated with reporting processes. CONCLUSION: Research on strategies to mitigate potential harms linked to mandatory reporting is urgently needed, as is research that explores children's experiences with this process.

Patient satisfaction and our clinical experience with 459 microfocused ultrasound treatments.

PURPOSE: Microfocused ultrasound (MFUS) is a safe and effective method for noninvasive skin tightening. Previous clinical studies demonstrate a 60-100% patient satisfaction after MFUS. We used an anonymous online platform after MFUS to assess patient satisfaction. DESIGN: Patients treated with MFUS between January 2013 and 2016 were invited to complete an anonymous online survey at least 4 months post-treatment. Patients were asked to rate improvement in skin tightening as none (0%), mild (0-25%), moderate (26-50%), significant (51-75%), or dramatic (76-100%) and treatment satisfaction as disappointed, neutral, satisfied, or extremely satisfied. SUMMARY: Between January 2013 and 2016, 253 patients received 459 MFUS treatments at our center. A total of 83 surveys were received with data. Nearly 80% of responders reported at least mild improvement, with 14.5% indicating significant improvement, 27.7% indicating moderate, 37.3% indicating mild, and 20.5% indicating none. In addition, 53.1% of responders reported being satisfied or extremely satisfied with the results. 44.6% of responders did not feel treatment results met expectations. CONCLUSION: Patient satisfaction with elective cosmetic procedures is an important indicator of success. Our current study demonstrates a high response rate, with almost 80% of responders indicating at least mild tightening with MFUS treatment. Interestingly, only 53.1% of patients reported satisfaction after treatment, a lower satisfaction rate than reported in previous non-anonymous studies and lower than patients report in our office follow-up appointments. This discrepancy may be due to gratitude bias. Anonymous surveys likely provide a more accurate assessment of patients' perceptions and will improve physician's future counseling efforts. Lasers Surg. Med. 51:495-499, 2019. © 2019 Wiley Periodicals, Inc.