Sowing the Seeds of Recovery: A Qualitative Study of Women in Recovery From Addiction and Victimization.

The purpose of this study was to understand the lived experiences of women with histories of victimization and addiction who were recently admitted to a sober living home (SLH). From the 17 interviews conducted, five themes (i.e., experiences of violence, challenges leaving an abusive relationship, chaos, using substances to cope, and social support) and one constitutive pattern (i.e., sowing the seeds of recovery) emerged from the data. These results highlight the importance of social support in promoting recovery and that social support may foster positive relationships with safe and trustworthy individuals as well as empower and support others with similar experiences.

What relates to length of stay in a sober living home among women with histories of victimization and addiction? A longitudinal analysis.

Despite preliminary research suggesting that length of stay in sober living homes (SLHs) is related to sustained sobriety, little research has examined factors that relate to length of stay in SLHs. The purpose of the proposed exploratory study was to prospectively examine baseline characteristics of women with histories of addiction and victimization as correlates of length of stay in a trauma-informed, gender-responsive SLH. Participants (N = 45) were surveyed three times over a 1-year period. Women were invited to participate within a week of their arrival to the SLH. Nearly two-thirds (62.2%, n = 28) of women stayed under 3 months, and 37.8% (n = 17) of women stayed over 3 months. Whereas older age and greater financial worries were associated with staying over 3 months at the SLH, other variables (e.g., demographics, mental health, recent victimization, recent substance use) were unrelated. Findings indicate that efforts may be needed to ensure that younger women as well as women with less financial worries, who may be less likely to stay for longer periods of times at SLHs, have adequate support for sobriety.

Post-traumatic Growth in Women With Histories of Addiction and Victimization Residing in a Sober Living Home.

Research consistently documents the deleterious sequelae of interpersonal trauma, including domestic and sexual violence (DSV). More recently, however, researchers and practitioners have focused on positive outcomes, such as post-traumatic growth (PTG), in survivors of DSV. Although research has begun to document the prevalence and correlates of PTG, no study to our knowledge has explored PTG in a sample of women with histories of addiction and victimization residing in a trauma-informed sober living home (SLH). The purpose of the current study was to examine this gap in the literature. Participants were 59 women (89.8% White; 86.4% heterosexual; mean age = 41.6) who completed a survey while residing in a SLH. Most women reported moderate to high levels of PTG. At the bivariate level PTG was related to less depression, post-traumatic stress disorder, and financial worries, and greater active coping, and sense of community. PTG was also related to the absence of past 6-month physical intimate partner violence. In regression analyses, PTG was related to less depression and greater sense of community. These data offer insights into modifiable factors such as fostering a sense of community while also promoting mental health treatment that could be the focus of interventions to increase PTG in women with histories of addiction and victimization residing in SLHs.

Reactions to Participating in Trauma and Addiction Research Among Women in a Sober Living Home: A Brief Report.

The purpose of this study was to examine reactions to participating in trauma and addiction research among women in a sober living home. Participants were 59 women who completed a comprehensive survey battery while living in the sober living home. The survey assessed women's victimization and addiction history along with current psychological and behavioral health symptoms and resilience characteristics. At the end of the survey, women were asked about their reactions to participating in the survey. Results suggested that whereas 40.7% (n = 24) of women reported being upset immediately after completing the survey, 96.6% (n = 56) of women reported that they personally benefited from being in the research study. Women who reported being upset, compared with those who were not upset, had higher levels of depressive and posttraumatic stress disorder (PTSD) symptoms and housing and financial instability and lower levels of empowerment, posttraumatic growth, and sense of purpose. We also asked women to tell us, in their own words, their reasons for being upset (e.g., questions about victimization experiences, loss of children), as well as their reasons for benefiting (e.g., catharsis/venting, learning something new about oneself, the chance to meet the researcher who had nice qualities). In general, the research was well tolerated by most of the participants, and almost all women, including those who were initially upset, reported personal benefits. These data shed light on the factors associated with positive and negative emotional reactions to research participation, which could be important information to include in consent forms in future research with this population.

It's HERstory: Unhealthy Relationships in Adolescence and Subsequent Social and Emotional Development in College Women.

The current study sought to expand our understanding of how early relationships characterized by intimate partner violence (IPV) influence college women's transition into emerging adulthood. We used a longitudinal qualitative design in which women (n = 13) with histories of IPV victimization participated in interviews twice a year beginning their first semester in college and ending in their final semester of college. Four primary themes were uncovered: making sense of the relationship, recognizing needs in the relationship, posttraumatic growth, and social cognitive maturity. The constitutive pattern across all four themes was resilience (i.e., positive adaptation during and after experiencing adversity).

Zimbabwean Stakeholders' Perspectives on Causes of and Solutions to Gender-Based Violence in Their Community: Findings From a Focus Group.

Gender-based violence (GBV) rates are high in Zimbabwe. Looking toward a partnership to prevent GBV in the Victoria Falls region, which lacks GBV prevention initiatives, the current study's aim was to learn about stakeholders' perceptions of GBV causes and their ideas for GBV prevention, and to gauge potential community reactions to GBV prevention. Focus group participants emphasized lack of women's empowerment, alcohol, violence normalization, and tourism as GBV causes, and ideas for prevention included school-based curricular, social marketing campaigns, involving men in prevention, and home visiting programs. Consistent with community-based models, participants emphasized involving all community stakeholders in prevention.

Intimate partner homicide: new insights for understanding lethality and risks.

Research on covictims, family members, and close friends who have lost loved ones to intimate partner homicide (IPH) is a neglected area of study. We conducted phenomenological interviews with covictims to gain insights into risk and lethality, examined affidavits from criminal case files, and reviewed news releases. The data uncovered acute risk factors prior to the homicide, identified changes in the perpetrators' behavior and the perpetrators' perceived loss of control over the victim, and described barriers that victims faced when attempting to gain safety. Findings suggest that recognizing acute risk factors is an important area for future IPH research.

Adult Disclosure of Child Sexual Abuse: A Literature Review.

Victims of childhood sexual abuse carry the experience of abuse into adulthood. One of the dilemmas victims face during adulthood is the decision to disclose or conceal the abuse. Although adult disclosure may be affected by former disclosure during childhood, adult survivors face new challenges and dilemmas, such as to whom, when, and how to tell. The purpose of this article is to review the domains found in the literature on survivors' experiences regarding disclosure of child sexual abuse during adulthood, all of which were published between 1980 and 2013. Domains include decisions to disclose during adulthood, barriers and facilitators to disclosure and potential recipients of the disclosure, as well as the process of telling and its impact on survivors' well-being. The authors present implications for policy, practice, and research.

Police reporting practices for sexual assault cases in which "the victim does not wish to pursue charges".

Prior research examining sexual assault case attrition has focused on the processing of cases across the justice system. Studies have examined arrest decision making and prosecutorial decision making in an attempt to better understand where and when cases drop out of the system. Less explored are police reporting practices during the initial stage of processing for cases in which the officer stated that the victim chose to drop her case. We addressed this gap in the literature by reviewing law enforcement incident reports at their onset, specifically; we examine reports of cases in which the officer reported the victim chose to drop the case. Results indicated that of the 125 cases of sexual assault reported to the police, 41 reports (32.8%) stated that the victim decided to no longer pursue charges. However, few police reports (30.2%) provided a clear rationale for why the victim decided to no longer pursue charges. Results of this study call for more standardized police reporting practices and point to the need for future research into the initial stage of law enforcement involvement in adult sexual assault cases.

Patient-centered cancer treatment planning: improving the quality of oncology care. Summary of an Institute of Medicine workshop.

The Institute of Medicine's National Cancer Policy Forum recently convened a workshop on patient-centered cancer treatment planning, with the aim of raising awareness about this important but often overlooked aspect of cancer treatment. A primary goal of patient-centered treatment planning is to engage patients and their families in meaningful, thorough interactions with their health care providers to develop an accurate, well-conceived treatment plan, using all available medical information appropriately while also considering the medical, social, and cultural needs and desires of the patient and family. A cancer treatment plan can be shared among the patient, family, and care team in order to facilitate care coordination and provide a roadmap to help patients navigate the path of cancer treatment. There are numerous obstacles to achieving patient-centered cancer treatment planning in practice. Some of these challenges stem from the patient and include patients' lack of assertiveness, health literacy, and numeracy, and their emotional state and concurrent illnesses. Others are a result of physician limitations, such as a lack of time to explain complex information and a lack of tools to facilitate treatment planning, as well as insensitivity to patients' informational, cultural, and emotional needs. Potential solutions to address these obstacles include better training of health care providers and patients in optimal communication and shared decision making, and greater use of support services and tools such as patient navigation and electronic health records. Other options include greater use of quality metrics and reimbursement for the time it takes to develop, discuss, and document a treatment plan.

An examination of SANE data: clinical considerations based on victim-assailant relationship.

The current study analyzes adult female sexual assault data, collected by sexual assault nurse examiners (SANEs) in New Hampshire, United States, between 1997 and 2007. The purposes of this study were to (1) explore the relationship between patient and assailant, (2) examine patients' physical findings according to assailant type, (3) describe characteristics of both the patients and the assaults, and (4) make care recommendations. Secondary analysis was conducted on data gathered by SANEs from responses to a standardized questionnaire based on the medical/forensic examination of each patient over an 11-year period. Of the 741 women in this study, 53% were sexually assaulted by a nonstranger, 18% were assaulted by an intimate partner, and 11% were assaulted by a stranger. The relationship between patient and assailant is an important variable that requires SANEs to take a closer look at assessing for lethality, and assisting with safety planning, intervention, and treatment for victims.

Informatics in action: lessons learned in comparative effectiveness research.

Comparative effectiveness research (CER) is meant to provide evidence about the relative risks and benefits of different treatment options. It is gaining visibility as a tool to address the evidence gaps that clinicians struggle with every day; however, CER is particularly challenging in oncology as there is great variability in how individuals respond to interventions, and a wide range of drugs and procedures are available. In order to overcome these obstacles and conduct reliable CER studies, it is critical to create a robust data infrastructure to support it.The Center for Medical Technology Policy held its first annual CER Summit in November 2010, with a particular focus on oncology. A number of critical informatics themes emerged including the need for consistent data standards, registry reform, tools to assist trial accrual, and data to integrate into value deliberations. Addressing the data issues highlighted in this report will provide a significant opportunity to improve the health of our medical system.

Findings from Sexual Assault Nurse Examiners (SANE): A case study of New Hampshire's pediatric SANE database.

The purpose of this article is to provide child sexual abuse data gathered by sexual assault nurse examiners (SANEs) in New Hampshire at the time of the medical/forensic examination. This study provides demographic, victim and assault characteristics from 696 child sexual abuse patients between 1997 and 2007. The study is a collaborative project between the SANE Advisory Board, a team of university researchers, and the Research Committee of the New Hampshire (NH) Governor's Commission on Domestic and Sexual Violence.

Special challenges in comparative effectiveness research on children's and adolescents' health.

The United States is undertaking a major expansion of comparative effectiveness research, with the potential to achieve systemwide improvements in health care quality, outcomes, and resource allocation. However, to achieve these improvements in children's health and health care, comparative effectiveness research needs to be targeted, designed, conducted, and reported in ways that are responsive to the unique circumstances of children and adolescents. These include clinically important differences in the type and course of disease in children; demographic differences between the overall child and adult population in the United States, such as racial and ethnic makeup; and methodological issues involving study design. Our overarching point is that the base of evidence in pediatrics must not fall even further behind that for the adult population in an era of rapid advancement and funding of comparative effectiveness research.

Rapid-learning system for cancer care.

Compelling public interest is propelling national efforts to advance the evidence base for cancer treatment and control measures and to transform the way in which evidence is aggregated and applied. Substantial investments in health information technology, comparative effectiveness research, health care quality and value, and personalized medicine support these efforts and have resulted in considerable progress to date. An emerging initiative, and one that integrates these converging approaches to improving health care, is "rapid-learning health care." In this framework, routinely collected real-time clinical data drive the process of scientific discovery, which becomes a natural outgrowth of patient care. To better understand the state of the rapid-learning health care model and its potential implications for oncology, the National Cancer Policy Forum of the Institute of Medicine held a workshop entitled "A Foundation for Evidence-Driven Practice: A Rapid-Learning System for Cancer Care" in October 2009. Participants examined the elements of a rapid-learning system for cancer, including registries and databases, emerging information technology, patient-centered and -driven clinical decision support, patient engagement, culture change, clinical practice guidelines, point-of-care needs in clinical oncology, and federal policy issues and implications. This Special Article reviews the activities of the workshop and sets the stage to move from vision to action.

The American Society of Clinical Oncology Cancer Foundation Grants Program: a 25-year report and a look toward the future.

The American Society of Clinical Oncology (ASCO) Grants Program began in 1984 with a single $16,000 grant to a young investigator for start-up research funding. In 2009, the Grants Program, now administered by The ASCO Cancer Foundation, awarded more than $6.5 million to 70 different investigators. This article, celebrating the 25th anniversary of this initiative, describes the history and evolution of the Grants Program, attempts to measure the impact of the program on clinical cancer research through an analysis of the career paths of past recipients, and addresses challenges that the program will face as it enters its second 25 years.

End points to establish the efficacy of new agents in the treatment of acute leukemia.

Federal regulations provide 2 pathways for approval of new agents for the treatment of acute leukemia, regular and accelerated approval. Regular approval requires evidence of clinical benefit, which is generally defined as either prolongation of life or improved quality of life, or an effect on an end point established as a surrogate for clinical benefit. Accelerated approval can be obtained based on demonstration of an effect on a surrogate measure "reasonably likely" to predict clinical benefit, but requires demonstration of clinical benefit after approval as well. The acute leukemias are a heterogeneous and relatively uncommon group of diseases. The design and execution of prospective randomized clinical trials demonstrating prolongation of life or improved quality of life for patients with these disorders can be difficult and costly and require lengthy follow-up. Thus, the development of novel trial design and inclusion of validated surrogate markers for clinical benefit are needed. To explore some of the issues pertinent to the choice of end points for drug approval in acute leukemia, the Food and Drug Administration invited the American Society of Hematology to participate in the organization and conduct of a joint workshop. In this report, we present the results of that effort.