The Effects of Social Location and Situational Factors on Young Women's Disclosure of Intimate Partner Violence Across Relationships.

The goal of the study was to examine disclosure of physical and sexual intimate partner violence (IPV) victimization across abusive relationships within a sociodemographically diverse sample of young women. We recruited 283 participants, ages 18 to 24, from a university, a 2-year college, and community sites serving low-income young women, and assessed physical and sexual IPV victimization, and related disclosure, across each of their abusive relationships (415 total). We used multilevel modeling to examine the effects of social location and situational factors on the odds of any disclosure of abuse during first relationships and across relationships. The rate of physical IPV disclosure was 50%, vs. 29% for sexual IPV. Multilevel model results indicated setting, IPV type, high frequency sexual IPV, and fear were significantly related to any disclosure.

Randomized Controlled Trial of a Multilevel Intervention to Address Social Determinants of Refugee Mental Health.

Understanding processes that support the well-being of the unprecedented numbers of forcibly displaced people throughout the world is essential. Growing evidence documents post-migration stressors related to marginalization as key social determinants of refugee mental health. The goal of this RCT was to rigorously test a social justice approach to reducing high rates of distress among refugees in the United States. The 6-month multilevel, strengths-based Refugee Well-being Project (RWP) intervention brought together university students enrolled in a 2-semester course and recently resettled refugees to engage in mutual learning and collaborative efforts to mobilize community resources and improve community and systems responsiveness to refugees. Data collected from 290 Afghan, Great Lakes African, Iraqi, and Syrian refugees at four time points over 12 months were used to test the effectiveness of RWP to reduce distress (depression and anxiety symptoms) and increase protective factors (English proficiency, social support, connection to home and American cultures). Intention-to-treat analyses using multilevel modeling revealed significant intervention effects for all hypothesized outcomes. Results provide evidence to support social justice approaches to improving refugee mental health. Findings have implications for refugees worldwide, and for other immigrant and marginalized populations who experience inequities in resources and disproportionate exposure to trauma/stress.

Rural Residents' Depressive Symptoms and Help-Seeking Preferences: Opportunities for Church-Based Intervention Development.

This study examines rural residents' depressive symptoms, helps seeking preferences and perceptions of a church-based group depression intervention, informing feasibility of adapting evidence-based treatment for delivery in rural churches. A cross-sectional survey was administered to 100 members of 2 churches in a rural Midwestern community; 63 congregants responded. Depression was assessed via the Patient Health Questionnaire-9. Descriptive analyses were performed, and 12.9% of respondents screened positive for depression. Another 25% reported mild symptomatology. Respondents preferred informal help seeking, although reported more openness to formal providers to address others' depression. Results suggest receptivity to church-based treatment. Almost two-third of respondents reported they would consider attending a church-based group depression intervention, 80% would recommend it to a friend in need, and 60% indicated it would benefit their community. Delivering evidence-based depression treatment within church settings may provide a viable option for increasing access to care in this rural community.

A Practice-Based Evaluation of Distress Screening Protocol Adherence and Medical Service Utilization.

Background: This study examined the extent to which cancer programs demonstrated adherence to their own prescribed screening protocol, and whether adherence to that protocol was associated with medical service utilization. The hypothesis is that higher rates of service utilization are associated with lower rates of adherence to screening protocols. Methods: Oncology social workers at Commission on Cancer-accredited cancer programs reviewed electronic health records (EHRs) in their respective cancer programs during a 2-month period in 2014. Rates of overall adherence to a prescribed distress screening protocol were calculated based on documentation in the EHR that screening adherence and an appropriate clinical response had occurred. We examined documentation of emergency department (ED) use and hospitalization within 2 months after the screening visit. Results: Review of 8,409 EHRs across 55 cancer centers indicated that the overall adherence rate to screening protocols was 62.7%. The highest rates of adherence were observed in Community Cancer Programs (76.3%) and the lowest rates were in NCI-designated Cancer Centers (43.3%). Rates of medical service utilization were significantly higher than expected when overall protocol adherence was lacking. After controlling for patient and institutional characteristics, risk ratios for ED use (0.82) and hospitalization (0.81) suggest that when overall protocol adherence was documented, 18% to 19% fewer patients used these medical services. Conclusions: The observed associations between a mandated psychosocial care protocol and medical service utilization suggest opportunities for operational efficiencies and costs savings. Further investigations of protocol integrity, as well as the clinical care models by which psychosocial care is delivered, are warranted.

Countywide implementation of crisis intervention teams: Multiple methods, measures and sustained outcomes.

The crisis intervention team (CIT) is a tool that can be used to foster pre-booking diversion of individuals with mental illness from the criminal justice system and into community treatment services. Although CIT is often implemented solely as the training of law enforcement officers, the model stipulates that CIT is a vehicle for collaboration with community stakeholders who share a similar philosophy, as well as expanded mental health services offering a 24 hour-seven days per week drop-off option for law enforcement officers. This case study presents the countywide implementation of CIT and expands previous findings on the prevalence of officer interaction with persons with mental health issues and CIT training outcomes, including changes in officer perception of individuals with mental health issues. Furthermore, analysis of the disposition of calls for officer assistance coded as mental health or suicide found significant increases in officer drop-offs to the mental health crisis center post-CIT training. Interrupted time series analysis determined that this change has been sustained over time, perhaps owing to the unique communication between county law enforcement and mental health staff. Implications for policy and practice are discussed.

Forgotten evidence: A mixed methods study of why sexual assault kits (SAKs) are not submitted for DNA forensic testing.

Throughout the United States, hundreds of thousands of sexual assault kits (SAKs) (also termed "rape kits") have not been submitted by the police for forensic DNA testing. DNA evidence can help sexual assault investigations and prosecutions by identifying offenders, revealing serial offenders through DNA matches across cases, and exonerating those who have been wrongly accused. In this article, we describe a 5-year action research project conducted with 1 city that had large numbers of untested SAKs-Detroit, Michigan-and our examination into why thousands of rape kits in this city were never submitted for forensic DNA testing. This mixed methods study combined ethnographic observations and qualitative interviews to identify stakeholders' perspectives as to why rape kits were not routinely submitted for testing. Then, we quantitatively examined whether these factors may have affected police practices regarding SAK testing, as evidenced by predictable changes in SAK submission rates over time. Chronic resource scarcity only partially explained why the organizations that serve rape victims-the police, crime lab, prosecution, and victim advocacy-could not test all rape kits, investigate all reported sexual assaults, and support all rape survivors. SAK submission rates significantly increased once criminal justice professionals in this city had full access to the FBI DNA forensic database Combined DNA Index System (CODIS), but even then, most SAKs were still not submitted for DNA testing. Building crime laboratories' capacities for DNA testing and training police on the utility of forensic evidence and best practices in sexual assault investigations can help remedy, and possibly prevent, the problem of untested rape kits. (PsycINFO Database Record

Sexual misconduct in prison: What factors affect whether incarcerated women will report abuses committed by prison staff?

More than 80,000 prisoners each year are sexually victimized during incarceration, but only about 8% report victimization to correctional authorities. Complicating reporting is the fact that half of the perpetrators are staff members. Given the restrictive and highly regulated prison environment, studies that examine reporting behaviors are difficult to conduct and to date information available relied on those who have reported or hypothetical victimization studies. This study uses an ecological framework and archival data from a class action lawsuit of sexual misconduct to determine predictors of reporting. Relying on a subsample of 179 women, chosen because they have all experienced at least 1 penetration offense, we use bivariate and multivariable mixed effects logistic regression analyses to examine individual, assault, and context-level predictors of reporting on 397 incidents of staff sexual misconduct. The final model revealed that that 6 predictors (age at time of assault, physical injury, multiple incidents, perpetrator with multiple victims, the year the abuse began, and the number of years women have left on their sentence) account for 58% of the variance in reporting. Disclosure to inmate peers and/or family and friends was significant in the bivariate results. These findings indicate the need for stronger and more systematic implementation of Prison Rape Elimination Act guidelines and remedies that create and enforce sanctions, including termination, for staff violating policy and state law. (PsycINFO Database Record

Examining Perpetration of Physical Violence by Women: The Influence of Childhood Adversity, Victimization, Mental Illness, Substance Abuse, and Anger.

Research on women's perpetration of physical violence has focused primarily on partners, often neglecting perpetration against nonpartners. This study proposes a conceptual model with direct and indirect relationships between childhood adversity and different targets of violence (partners and nonpartners), mediated by victimization experiences (by partner and nonpartners), mental illness, substance abuse, and anger. Using survey data from a random sample of incarcerated women (N = 574), structural equation modeling resulted in significant, albeit different, indirect paths from childhood adversity, through victimization, to perpetration of violence against partners (ß = .20) and nonpartners (ß = .19). The results indicate that prevention of women's violence requires attention to specific forms of victimization, anger expression, and targets of her aggression.

Enculturation and attitudes toward intimate partner violence and gender roles in an asian Indian population: implications for community-based prevention.

This study examined the relationships among enculturation, attitudes supporting intimate partner violence (IPV-supporting attitudes), and gender role attitudes among one of the largest Asian Indian population groups in the US. Data were collected via computer-assisted telephone interviews with a random sample of Gujarati men and women aged 18-64 in Metropolitan Detroit. Using structural equation modeling, we modeled the effects of three components of enculturation (behavior, values, and community participation) on gender role attitudes and IPV-supporting attitudes among married respondents (N = 373). Analyses also accounted for the effects of respondent age, education, religious service attendance, perceived financial difficulty, and lengths of residence in the US. The second-order, overall construct of enculturation was the strongest predictor of IPV-supporting attitudes (standardized B = 0.61), but not gender role attitudes. Patriarchal gender role attitudes were positively associated with IPV-supporting attitudes (B = 0.49). In addition to the overall effect of the enculturation construct, two of the components of enculturation had specific effects. "Enculturation-values" had a specific positive indirect association with IPV-supporting attitudes, through its relationship with patriarchal gender role attitudes. However, "enculturation-community participation" was negatively associated with IPV-supporting attitudes, suggesting the importance of community-based prevention of IPV among this immigrant population group.

Patterns of women's aggression against partners and others: broadening our understanding of violence.

Research on women's aggression typically focuses on relational aggression. However, the study of violence must include multiple forms of violence such as aggression against partners and non-partner others, while also considering victimization experiences by partners and non-partners. The focus of this study is the multiple experiences of violence (perpetration and victimization) of women who are incarcerated. Incarcerated women are likely to experience higher rates of both than women in community settings, but most will be released in a brief period of time. Using a random sample (N = 580) we conducted cluster analyses to identify five patterns of women's aggression. Clusters varied depending on the target/s of aggression (i.e., partner and/or others), and type of aggression (i.e., physical and/or intimidation). Multinomial logistic regression was performed to determine the relationship between women's membership in a perpetration cluster and their victimization. Victimization history was related to an increased risk of perpetrating aggression, and varied depending on the target and type of aggression. Our findings provide support that research and interventions addressing women's use of aggression must also address their victimization history. Furthermore, results indicate that for some women, aggression towards partners and others is related. Future research should investigate multiple forms of aggression.

Beyond deficits: intimate partner violence, maternal parenting, and child behavior over time.

Exposure to intimate partner violence (IPV) has negative consequences for children's well-being and behavior. Much of the research on parenting in the context of IPV has focused on whether and how IPV victimization may negatively shape maternal parenting, and how parenting may in turn negatively influence child behavior, resulting in a deficit model of mothering in the context of IPV. However, extant research has yet to untangle the interrelationships among the constructs and test whether the negative effects of IPV on child behavior are indeed attributable to IPV affecting mothers' parenting. The current study employed path analysis to examine the relationships among IPV, mothers' parenting practices, and their children's externalizing behaviors over three waves of data collection among a sample of 160 women with physically abusive partners. Findings indicate that women who reported higher levels of IPV also reported higher levels of behavior problems in their children at the next time point. When parenting practices were examined individually as mediators of the relationship between IPV and child behavior over time, one type of parenting was significant, such that higher IPV led to higher authoritative parenting and lower child behavior problems [corrected]. On the other hand, there was no evidence that higher levels of IPV contributed to more child behavior problems due to maternal parenting. Instead, IPV had a significant cumulative indirect effect on child behavior via the stability of both IPV and behavior over time. Implications for promoting women's and children's well-being in the context of IPV are discussed.

Day-to-day discrimination and health among Asian Indians: a population-based study of Gujarati men and women in Metropolitan Detroit.

This study examined the relationship between experiences of day-to-day discrimination and two measures of health among Gujaratis, one of the largest ethnic groups of Asian Indians in the U.S. Data were collected via computer-assisted telephone interviews with a random sample of Gujarati men and women aged 18-64 in Metropolitan Detroit (N = 423). Using structural equation modeling, we tested two gender-moderated models of the relationship between day-to-day discrimination and health, one using the single-item general health status and the other using the 4-item emotional wellbeing measure. For both women and men, controlling for socio-demographic and other relevant characteristics, the experience of day-to-day discrimination was associated with worse emotional wellbeing. However, day-to-day discrimination was associated with the single-item self-rated general health status only for men. This study identified not only gender differences in discrimination-health associations but also the importance of using multiple questions in assessing perceived health status.

Culturally adapting an evidence-based parenting intervention for Latino immigrants: the need to integrate fidelity and cultural relevance.

Latinos constitute the largest ethnic minority group in the United States. However, the cultural adaptation and dissemination of evidence-based parenting interventions among Latino populations continues to be scarce despite extensive research that demonstrates the long-term positive effects of these interventions. The purpose of this article is threefold: (1) justify the importance of cultural adaptation research as a key strategy to disseminate efficacious interventions among Latinos, (2) describe the initial steps of a program of prevention research with Latino immigrants aimed at culturally adapting an evidence-based intervention informed by parent management training principles, and (3) discuss implications for advancing cultural adaptation prevention practice and research, based on the initial feasibility and cultural acceptability findings of the current investigation.

Adolescent sexual assault victims and the legal system: building community relationships to improve prosecution rates.

Adolescents are at high risk for sexual assault, but few of these crimes are reported to the police and prosecuted by the criminal justice system. To address this problem, communities throughout the United States have implemented multidisciplinary interventions to improve post-assault care for victims and increase prosecution rates. The two most commonly implemented interventions are Sexual Assault Nurse Examiner (SANE) Programs and Sexual Assault Response Teams (SARTs). The purpose of this study was to determine whether community-level context (i.e., stakeholder engagement and collaboration) was predictive of adolescent legal case outcomes, after accounting for "standard" factors that affect prosecution success (i.e., victim, assault, and evidence characteristics). Overall, 40% of the adolescent cases from these two SANE-SART programs (over a 10-year period) were successfully prosecuted. Cases were more likely to be prosecuted for younger victims, those with disabilities, those who knew their offenders, and instances in which the rape evidence collection kit was submitted by police for analysis. After accounting for these influences, multi-level modeling results revealed that in one site decreased allocation of community resources to adolescent sexual assault cases had a significant negative effect on prosecution case outcomes. Results are explained in terms of Wolff's (Am J Community Psychol 29:173-191, 2001) concept of "over-coalitioned" communities and Kelly's (1968) ecological principles.

A model of sexually and physically victimized women's process of attaining effective formal help over time: the role of social location, context, and intervention.

As empirical evidence has demonstrated the pervasiveness of sexual assault and intimate partner violence in the lives of women, and the links to poor mental health outcomes, attention has turned to examining how women seek and access formal help. We present a conceptual model that addresses prior limitations and makes three key contributions: It foregrounds the influence of social location and multiple contextual factors; emphasizes the importance of the attainment of effective formal help that meets women's needs and leads to positive mental health outcomes; and highlights the role of interventions in facilitating help attainment. We conclude with research and practice implications.

The impact of neighborhood factors on the well-being of survivors of intimate partner violence over time.

Intimate partner violence (IPV) is a pervasive social problem impacting the psychological well-being of millions of US women annually. The extant literature draws our attention to the devastating mental health effects of IPV, but largely overlooks how ecological factors may further explain survivors' well-being. This study examined how neighborhood disadvantage may contribute to survivors' compromised well-being, in addition to the abuse women experienced. Neighborhood disorder and fear of victimization significantly impacted survivors' well-being, over and above abuse. Although between-women effects of neighborhood disorder and fear were unrelated to change in women's depression or quality of life (QOL), significant within-woman effects were detected. Change in neighborhood disorder was negatively associated with change in QOL, and this relationship was fully mediated by fear. While no direct relationship between change in neighborhood disorder and depression was detected, an indirect effect through survivors' fear was revealed. Implications for future research and practice are discussed.

Predictors of Sexual Violence Across Young Women's Relationship Histories.

The goal of the current study was to identify risk factors that predict sexual intimate partner violence (IPV) victimization across young women's relationship histories, within a socioeconomically diverse sample recruited from a university, a 2-year college, and community organizations serving low-income young women. We interviewed 148 young women aged 18 to 24 years about partner victimization (physical IPV, coercive control, and sexual IPV) within each of their relationships (up to four relationships, beginning with their first; 388 in total). We used the life history calendar to structure the interviews and obtain detailed information about each relationship, including age difference between participants and their partners, and relationship length. We used multilevel modeling to examine primary caregiver highest grade completed (an indicator of socioeconomic status [SES]), participant age, age difference, relationship length, setting, and physical IPV/coercive control as predictors of sexual IPV during their first relationship and across Relationships 1 to 4. Sexual IPV during participants' first relationship was inversely associated with SES and age, and positively associated with physical IPV/coercive control; 2-year college and community participants reported lower rates of sexual IPV during the first relationship, compared with university participants. The trajectory of sexual IPV across Relationships 1 to 4 declined among university participants and increased among 2-year college participants; age difference and physical IPV/coercive control positively covaried with sexual IPV across Relationships 1 to 4. Low SES, young age, large age difference, and the presence of physical IPV and coercive control may be risk factors for sexual IPV victimization within adolescent relationships. Sexual violence prevention and intervention approaches should incorporate these risk factors, and be designed to reach an increasingly socioeconomically diverse population across a variety of settings, to be effective.

Incarcerated Women's Experiences of Staff-Perpetrated Rape: Racial Disparities and Justice Gaps in Institutional Responses.

Within correctional settings, incarcerated women have disproportionately high rates of experiencing staff-perpetrated sexual victimization. In addition, only a small proportion of incarcerated women formally report their victimization experiences to correctional staff and even fewer reports are fully investigated by internal investigators and found to be substantiated. Given the multiple steps in this process, incarcerated women face several possible justice gaps in receiving preventive and intervention-focused responses from correctional staff. Racial differences among incarcerated women's experiences of these steps have not been explored. This study used a structural intersectional framework to examine racial differences in these areas: incarcerated women's experiences of staff-perpetrated rape, reporting decisions, and correctional staff's investigation decisions. With a sample of 180 incarcerated women, this study included analysis of archival data (i.e., settlement claim forms and internal investigation files) from a class action lawsuit involving incarcerated women who had experienced staff sexual misconduct. Black women represented over half of the incarcerated women who experienced staff-perpetrated rape. There were no statistical differences between Black and White women with regard to the characteristics of their victimization experiences, and they had similar rates of reporting their victimization to institutional staff. However, significant differences were found between women with regard to prison staff's responses to their reports; Black women were less likely to have their reports investigated by staff and were more likely to have their investigated reports found to be unsubstantiated. A detailed analysis of 100 specific incidents showed similar findings. Thus, while justice gaps existed for all women, gaps in institutional responses were exacerbated for Black women. Centering incarcerated Black women's experiences is pivotal for guiding efforts to transform correctional settings, to prevent and address staff-perpetrated sexual victimization, and to build safety for incarcerated women.

Gender (A)Symmetry in Correlates of Perpetration of Intimate Partner Violence: Gender (A) Symmetry in IPV and the Role of Gender Attitudes.

This study examined, using structural equation modeling (SEM), gender differences and similarities in correlates of the perpetration of emotional aggression against intimate partners among one of the largest groups of Asian Indians in the United States, Gujaratis. Although most of the correlates of emotional aggression (e.g., patriarchal attitudes, spousal disagreement, and alcohol use) were similar for men and women, higher support for gendered domestic roles was significantly related to higher perpetration of emotional aggression for men but not for women. Multigroup latent SEM served as a unique analytical strategy to investigate gender (a)symmetry, a controversial but critical debate in the field.

The effects of community and family violence exposure on anxiety trajectories during middle childhood: the role of family social support as a moderator.

This 2-year longitudinal study investigated the relations between community and school violence exposure, witnessing intimate partner violence (IPV), family social support, and anxiety, within a sample of 100 school-age children (39% female, M age = 9.90 years). Using multilevel modeling, we found heterogeneity across children in terms of their initial levels of anxiety and their trajectories of anxiety over time. Initial community and school violence exposure and witnessing IPV were both positively associated with initial levels of anxiety. Over time, change in both community and school violence exposure and witnessing IPV positively covaried with anxiety. Further, gender, initial family social support, and change in family social support significantly moderated the effect of change in community and school violence exposure on anxiety.