Predicting the timing of women's departure from abusive relationships

Intimate Partner Violence, Economic Insecurity, and Health Outcomes Among American Indian and Alaska Native Men and Women: Findings From a National Sample

Limited data are available on experiences of intimate partner violence (IPV) and sexual violence (SV) and health outcomes among American Indian and Alaska Native (AIAN) populations. This study explores the relationship between IPV and SV, food insecurity, housing insecurity, healthcare access, and self-reported physical and mental health status in a nationally representative sample of AIAN adults (N = 3,634). IPV and SV were associated with poorer physical and mental health at the bivariate level, but not in multivariate analyses. Economic inequalities are a salient predictor of health and may be compounded by demographic and geographic contexts.

Food security for survivors of intimate partner violence: Understanding the role of food in survivor well-being

Intimate partner violence (IPV) and food security are two leading public health issues that disproportionately impact women in the United States. Despite this connection, the relationship between IPV and food security has been relatively unexplored. While food security is a known factor in increased well-being, it is not often explicitly included in care for survivors. As part of a larger study on survivors of domestic violence who are receiving services from a domestic violence and sexual assault agency in the Southern United States, we analysed participant responses (n = 26) to various scales (i.e. depression, anxiety, PTSD, disability, well-being, hope, food security) to determine the relationships between mental health and food-related variables. Importantly, findings from our study show that survivors experience low food security at higher rates (53.8%) than the U.S. national average (11.5%). Additionally, the proportion of survivors in our sample who are receiving some form of food aid and remain food insecure is high (26.9%), leading to questions about the adequacy of food aid. Finally, our results underpin the relationship between food security and mental health for survivors, as low food security is positively correlated with depression, PTSD, disability, trouble concentrating, lack of hope and decreased well-being. These findings have implications for how we evaluate food security and the role it plays in well-being for survivors.

Beyond Domestic Violence Shelter: Factors Associated With Housing Placements for Survivors Exiting Emergency Shelters

Domestic violence (DV) shelters are a critical resource for many survivors facing housing instability. Although DV shelter programs may address an array of survivor needs, DV survivors often identify the most pressing concerns as the need for safe housing and the financial resources to maintain housing. This study examines the factors associated with housing placements for DV survivors residing in emergency shelters. Data for this study came from program data collected by one organization operating six DV emergency shelters in an urban northeastern city. Among the sample of 347 DV survivors, findings revealed that there were significant associations between sociodemographic variables, services received, and post-discharge variables and post-shelter housing. Among this sample, three out of four residents (74.9%) left the DV shelter with housing in place. However, the findings suggest that there are areas for improved services and policy efforts to further support survivors in accessing safe and affordable housing. Our findings invite researchers and practitioners to consider further examination of best practices around program and policy options that support survivors in gaining economic independence and securing safe and affordable housing.

"My Sister Is the One That Made Me Stay Above Water": How Social Supports Are Maintained and Strained When Survivors of Intimate Partner Violence Reside in Emergency Shelter Programs

While social support is critical in helping intimate partner violence (IPV) survivors heal and build hope, social isolation is a frequent experience for survivors. For survivors residing in domestic violence (DV) emergency shelters, the isolation from social supports is often exacerbated by shelter rules and policies. This study uses a 20th century feminist framework to understand the ways in which social support networks are maintained and/or strained when survivors reside in DV emergency shelters. Among this sample of 76 survivors, 40 participants identified family members as their support system, with siblings and mothers most frequently identified, and 14 participants identified friends as their social support. Prior to entering the DV shelter, survivors reported that their support networks provided encouragement and motivation along with emotional support, financial and material support, and support with children. Participants spoke about the process of informing their support systems of the transition into a DV shelter, the positive and negative impacts of the transition on their support system, and the roles that frequent telephone calls and texts played in maintaining their support networks. Participants reported positive impacts of residing in a DV shelter including improved emotional and physical health, strengthened emotional relationships, and improved physical and emotional resource provision. For those participants reporting negative experiences, they frequently identified logistical barriers, including the inability to receive visitors at the shelter, the distance between them and their friends and family, and strict rules around curfew and child care. Our findings invite researchers and practitioners to consider further examination of best practices around programming that supports survivors in maintaining social supports while residing in shelter programs.

Transitioning Out of an Urban Domestic Violence Emergency Shelter: Voices of Survivors

Domestic violence (DV) shelters play a critical role for survivors and lead to a range of positive outcomes for families. However, transitioning in and out of temporary homelessness involves a range of stressors and research indicates that survivors transitioning out of DV shelters continue to have a multitude of needs. The focus of this study is to utilize an empowerment-based feminist lens to understand the process of transitioning out of a DV emergency shelter among 27 shelter residents in urban emergency shelters. Participants described the successes, challenges, and lessons learned while transitioning from the emergency shelter setting. The findings indicate that survivors transitioning out of DV shelters face a multitude of risks, challenges, and stressors. Our findings invite researchers and practitioners to further examine best practices that support families transitioning from shelter.

Successful Rules Reduction Implementation Process in Domestic Violence Shelters: From Vision to Practice

Domestic violence (DV) shelters provide safety for survivors to consider their options and heal from abuse. Unfortunately, survivors have reported negative experiences associated with shelter rule enforcement. Rules, such as curfew, decreased access to community social networks; and staff's rule enforcement may trigger survivors' past experiences with abusive control and structural racism. Rule enforcement may deter safe, trusting relationships between staff and residents. Statewide DV coalitions have been innovation leaders in shelter rules reduction efforts over the past decade. Seven DV shelter directors and coalition trainers with expertise implementing reduced-rule shelter models were interviewed for this study. Interview data were then analyzed using modified constructivist grounded theory methods. A three-stage implementation process emerged from the data. The initial stage highlighted efforts to create an organizational vision rooted in shared values. Shelters then intentionally focused on enhancing organizational capacity through staff development and team building. Third, rule-reduction practices were enacted through specific shelter policies and staff practices. Findings have broader implications for social work organizations also implementing anti-oppressive, survivor-centered, trauma-informed approaches, as this process involves considerable intention, training, and resources beyond services as usual. Social workers can support these efforts through student training, program development, and research efforts.

To Stay or to Leave: Factors Influencing Victims' Decisions to Stay or Leave a Domestic Violence Emergency Shelter

Domestic violence (DV) emergency shelters play a vital role in supporting victims who seek to leave abusive partners and gain independence. Research indicates that numerous positive outcomes for victims and their children are associated with utilization of DV shelter programs. Yet, research also suggests that DV shelter programs may be unable to comprehensively meet the needs of all victims, and many choose to leave shelters soon after their arrival. To better understand the ways in which DV shelter programs support victims but also fail to meet their needs, this article explores the factors that influence victims' decisions to stay or leave a DV emergency shelter program through qualitative interviews with 33 DV shelter residents. Study participants indicate that three types of factors influence their decision to stay or leave the shelter program: (a) contextual factors, (b) partner or family relationship factors, and (c) shelter-specific factors. Shelter-specific factors cited as important contributors to satisfaction or dissatisfaction with shelter living include policies, staff and services, displacement from one's home community, and facilities. Findings provide information from the perspective of victims on the factors that influence one's decision to stay or leave a DV program and can be used to support service providers and advocates in building programs that are both supportive of victims' needs and conductive to longer shelter stays.

The impact of comorbid diagnoses on the course of posttraumatic stress disorder symptoms in residents of battered women's shelters

OBJECTIVE

The current investigation sought to explore the impact of the comorbidities of substance use disorder (SUD), major depressive disorder (MDD), and borderline personality disorder (BPD) on the trajectory of intimate partner violence (IPV)-related posttraumatic stress disorder (PTSD) symptoms across a 6-month follow-up period in IPV survivors who seek shelter. Research has found significant comorbidity of SUD, MDD, and BPD with PTSD (see Green et al., 2006; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Pagura et al., 2010); however, little to no research has explored these relationships in this unique population over time.

METHOD

A sample of 147 residents of battered women's shelters completed study measures at baseline, 1 week, and 3 and 6 months following shelter stay. Participants completed measures assessing for demographics, abuse, and Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision) diagnoses.

RESULTS

Results of latent growth modeling with the time-invariant covariates of SUD, MDD, and BPD yielded a significant effect of SUD (β = .002, p = .007) on the slope of IPV-related PTSD symptoms controlling for IPV victimization. Significant effects were not identified for BPD (β = .001, p > .05) or MDD (β = .002, p > .05). Results suggest IPV survivors with SUD demonstrated less improvement in PTSD symptoms over 6 months after they left shelter as compared to women without SUD.

CONCLUSION

Findings emphasize the deleterious effects of SUD, above and beyond MDD and BPD, on IPV-related PTSD and highlight the need for assessment and treatment of SUD and PTSD simultaneously in residents of battered women's shelters. Clinical Impact Statement: Findings suggest the need to go beyond standard shelter services to more effectively address and treat co-occurring SUD-PTSD in IPV survivors. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Intimate Partner Violence Screening Practices in California After Passage of the Affordable Care Act

Under the Affordable Care Act (ACA), insurance coverage should include screening for intimate partner violence (IPV). In this article, we present self-reported IPV screening practices and provider confidence from a post-ACA cross-sectional survey of 137 primary care clinicians in California. Only 14% of the providers reported always screening female patients for IPV and about one third seemed never to screen. Female providers were more likely to screen and use recommended direct questioning. Most providers lacked confidence in screening, referral, and record-keeping. Serving a low-income population predicted more frequent screening and better record-keeping. Overall, IPV screening in primary care was inadequate and needs attention.

Determinants of Intimate Partner Violence in Sub-Saharan Africa: A Review of Prevention and Intervention Programs

Intimate partner violence (IPV) in sub-Saharan Africa affects 36% of the population. Several African countries rank among the highest globally. In this article, we present evidence on the prevalence, determinants, and impact of IPV across several sub-Saharan African countries interpreted against the backdrop of social ecological theory. We also describe prevention or intervention programs tested in different regions of Africa, selecting only those programs which were published in a journal outlet and which met a high criteria of implementation and methodology (n = 7). Based on our review of the empirical literature, some risk factors for violence documented in Western societies are the same in Africa, including poverty, drinking, a past history of child abuse or posttraumatic stress disorder, and highly traditional gender role beliefs. Low education is also associated with IPV for both women and men. In Africa, partner abuse intersects with the HIV pandemic, making violence prevention especially urgent. African programs to prevent IPV are often incorporated with HIV prevention; community building and community engagement are emphasized more in Africa than in North America or Europe, which invoke more individually focused approaches. Some programs we review lowered HIV exposure in women; others contributed to reduced violence perpetration among men. The programs show sufficient promise to recommend replication and dissemination in sub-Saharan Africa.

The role of PTSD and length of shelter stay in battered women's severity of re-abuse after leaving shelter

Intimate Partner Violence (IPV) is associated with significant morbidity, including high rates of re-abuse even after women have taken steps to achieve safety. This study evaluated the roles of posttraumatic stress disorder (PTSD) symptom severity and length of shelter stay in the severity of re-abuse in 103 IPV victims over a six month period after leaving a battered women's shelter. Results suggest that the length of shelter stay is inversely related to re-abuse severity after leaving shelter. Additionally, more severe PTSD symptoms upon shelter exit were associated with greater re-abuse severity after leaving shelter. Furthermore, additional study findings support prior research suggesting that the emotional numbing symptoms of PTSD are a significant risk factor for re-abuse among IPV victims after leaving shelter.

Characteristics of Women Who Do and Do Not Receive Onsite Shelter Services From Domestic Violence Programs

Shelter services are an essential means of providing help to women who are victims of intimate partner violence (IPV), but not all victims receive shelter. This article reports the results of a secondary analysis of statewide data from women using IPV services, comparing victims who did and did not obtain shelter. The demographic characteristics, abuse experiences, and service patterns of these survivors are examined. A model predicting characteristics associated with the likelihood of shelter receipt indicates that women who obtain shelter are more vulnerable and obtain more services than women who do not obtain shelter. The implications of these results are discussed.

Shelter and service receipt for victims of domestic violence in Illinois

There is little empirical research about the services victims of violence in shelters receive and when, yet such information would increase our understanding of their unmet service needs especially after they leave shelter. This article utilizes data from a randomly selected sample of individuals in shelter to examine their service trajectories. Results indicate that most individuals receive service while in shelter. Individual counseling is likely to continue after shelter, but group counseling, employment, and educational assistance tend to end once shelter is over. The policy and practice implications of these results are discussed.

Reducing HIV and partner violence risk among women with criminal justice system involvement: a randomized controlled trial of two motivational interviewing-based interventions

Women with histories of incarceration show high levels of risk for HIV and intimate partner violence (IPV). This randomized controlled trial with women at risk for HIV who had recent criminal justice system involvement (n = 530) evaluated two interventions based on Motivational Interviewing to reduce either HIV risk or HIV and IPV risk. Baseline and 3, 6, and 9-month follow-up assessments measured unprotected intercourse, needle sharing, and IPV. Generalized estimating equations revealed that the intervention groups had significant decreases in unprotected intercourse and needle sharing, and significantly greater reductions in the odds and incidence rates of unprotected intercourse compared to the control group. No significant differences were found in changes in IPV over time between the HIV and IPV group and the control group. Motivational Interviewing-based HIV prevention interventions delivered by county health department staff appear helpful in reducing HIV risk behavior for this population.

Assessing intimate partner violence in health care settings leads to women's receipt of interventions and improved health

OBJECTIVE

This study investigated whether disclosure of violence to health care providers and the receipt of interventions relate to women's exit from an abusive relationship and to their improved health.

METHODS

A volunteer sample of 132 women outpatients who described intimate partner violence during the preceding year were recruited from multiple hospital departments and community agencies in suburban and urban metropolitan Boston. Through in-person interviews, women provided information on demographics, past year exposure to violence, past year receipt of interventions, and whether they disclosed partner violence to their health care provider. They also described their past month health status with the 12-Item Short-Form Health Survey and further questions.

RESULTS

Of the 132 women, 44% had exited the abusive relationship. Among those who were no longer with their partner, 55% received a domestic violence intervention (e.g. advocacy, shelter, restraining order), compared with 37% of those who remained with their partner. Talking to their health care provider about the abuse increased women's likelihood of using an intervention (odds ratio [OR]=3.9). Those who received interventions were more likely to subsequently exit (OR=2.6) and women no longer with the abuser reported better physical health based on SF-12 summary scores (p=0.05) than women who stayed.

CONCLUSIONS

Health care providers may make positive contributions to women's access to intimate partner violence services. Intimate partner violence interventions relate to women's reduced exposure to violence and better health.