Effective Advocacy in Rural Domains: Applying an Ecological Model to Understanding Advocates' Relationships

Understanding Intimate Partner Violence Service Delivery for Latinx Survivors in Rural Areas

Using a statewide survey, this exploratory, cross-sectional study examined 78 domestic violence (DV) service organizations' service delivery practices and perceived challenges to serving Latinx survivors in the context of rurality. Findings showed that DV organizations in rural areas perceived more challenges to delivering culturally appropriate services for Latinx survivors compared to those in other geographic settings even after accounting for client characteristics, service provision characteristics, and community resources. The study finding offers critical insights to ensure and enhance the provision of linguistically and culturally accessible services for rural Latinx survivors of intimate partner violence.

"It Makes you Want to Go Out and Change the World": Shifts in Victim Advocates' Perspectives Following the Intimate Partner Homicide of a Client in the United States

Purpose

Intimate partner violence (IPV) victim advocates are exposed daily to the traumas of their clients, including the potential exposure to an intimate partner homicide (IPH). While research has examined the effects of daily secondary exposure to IPV on victim advocates, little is known about the specific effect of IPH. This study examined how the IPH of a client affected advocates' perception of and approach to their work.

Methods

Nine advocates were recruited from the northeastern U.S. and interviewed about their experience of the IPH of a client. Advocate interviews were analyzed using The Listening Guide Analysis which systematically isolates and listens to the different, and often contradictory, voices that a participant uses.

Results

Exposure to IPH changed participants' perception of their role, how they defined client, and how they interacted with future clients. At a macro-level, the IPH of a client motivated advocates to advance changes in agency protocol, multisector responses, and state policy based on what they had learned from the IPH. Opportunities to translate shifts in their worldview into tangible changes to protocol and policy were critical to advocate adjustment after the IPH.

Conclusions

In order to support advocates after IPH, organizations should acknowledge the potentially transformative effect of IPH and create opportunities for meaning making to assist in advocate adjustment. It is imperative for advocacy organizations to support their employees to prevent advocate burnout and the loss of experienced staff, and to continue to provide effective services to vulnerable members of their communities after IPH.

Responding to Violence Against Women in Sport: Challenges Facing Sport Organizations in Victoria, Australia

Purpose: Violence against women is a global epidemic. Such violence occurs in sport, although previous research has focused on child/youth sexual abuse or elite sport. Despite sport being identified as having a role in preventing violence against women, little is known about how sport organizations respond to violence against adult women in community sport. Methods: Twenty-two individual participants from 12 sports organizations based in Victoria, Australia participated in this empirical and applied Concept Mapping study to explore the perceived challenges sports organizations face in responding to violence against women. Concept Mapping is a mixed-method participatory approach and we analyzed the results using a socio-ecological framework. Results: Sports administrators considered training-related challenges as the most important but most difficult to address. Challenges related to organizational capacity/social environment were perceived as easier but less important to address. Conclusions: Key initiatives can be developed to support sport organizations to respond to violence against women in sport, but they will need assistance to prioritize initiatives addressing the most important challenges given a perceived lack of capacity to do so.

Crime Victim Service Providers' Needs and Barriers: Rurality and "High Need"

The crime victims' rights movement has led to the development of advocacy, rights, and services for crime victims. A growing body of research has examined victim service provision using victim/client samples and complementary research has utilized service provider samples. The latter have focused on crime victim service providers' (VSPs) perceptions regarding clients' needs and barriers, as well as perceptions of service provision, needs, and barriers pertaining to their agency's operations. Although relatively small, the body of provider-focused victim services research has commonly considered the influence of rurality on service provision. The present study adds to this body of research by examining reported needs and barriers of VSPs (N = 94) in a Mountain West state, considering the influence of rurality and concentrated need. Three research questions informed the descriptive analyses: (a) What are the most commonly identified needs and barriers for providers in the state? (b) Are there differences in identified needs and barriers between rural and urban providers? (c) Do certain agencies report more needs and barriers than others, and if so, what are the differences? Findings indicate that many of the needs and barriers identified by VSPs mirror those identified by previous research and that agencies serving rural communities report significantly more needed services than those who do not serve rural communities. Furthermore, approximately 30% of the sample was designated as "high need" due to reported needs and/or barriers exceeding the average of the rest of the sample. The high-need agencies were not exclusively rural in terms of agency location or population served. The potential nuances of rurality's influence on VSPs in an overwhelmingly rural state are discussed.

The Arizona Intimate Partner Homicide (AzIPH) Study: a Step toward Updating and Expanding Risk Factors for Intimate Partner Homicide

Despite the importance of intimate partner violence (IPV) and homicide research to women's health and safety, much remains unknown about risk factors for intimate partner homicide (IPH). This article presents the Arizona Intimate Partner Homicide Study, pilot research that is being conducted in one U.S. state to update and expand on risk factors for IPH. In the context of presenting this study, we summarize the literature on data collection techniques, various marginalized and under researched populations, and the importance of gathering data about the victim-offender relationship and situational IPH risk factors. Additional research is needed to update risk factors for IPH to account for changes in technology and to examine differential risk across diverse populations. Local, community based data collection strategies are likely to provide more comprehensive and nuanced insight into IPH; though, to understand risk factors among marginalized populations, it may be necessary to increase sample size through a national strategy. Although not a panacea, we present this ongoing research as a model for other states to emulate and improve upon, in the hopes of developing more comprehensive data examining risk for IPH among victims of IPV.

Shifting Sexual Assault Forensic Examiners Orientation From Prosecutorial to Patient-Centered: The Role of Training

Sexual assault forensic examiners (SAFEs) have a complex role that entails providing health care and medical forensic evidence collection. The literature indicates that there are two orientations that guide SAFEs in this role. A patient-centered orientation emphasizes attending to emotional needs, offering options, and respecting survivors' decisions, which has been linked to positive emotional outcomes. A prosecutorial orientation places emphasis on evidence collection and has been associated with providing fewer comprehensive services. SAFE training may play a pivotal role in guiding new SAFEs to adopt a patient-centered orientation. However, there is a paucity of research examining how training can bolster the adoption of this orientation. Thus, the current qualitative study explored if and how a national blended SAFE training influenced participants' adoption of a patient-centered orientation. Semistructured qualitative interviews were conducted with 64 health care professionals who participated in a national SAFE training. Utilizing analytic induction, the results suggest that the majority of participants entered the training with a prosecutorial orientation but shifted to a patient-centered orientation. Multiple elements of the training influenced this shift including (a) content that dispelled misconceptions of survivors; (b) providing explanations of how attending to survivors' well-being can lead to positive outcomes; (c) earlier placement of patient-centered content to allow instructors to explain how patient-centered care can be applied to each component of the SAFE role including the medical forensic exam; and (d) continual emphasis on patient-centered care.

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

BACKGROUND

Intimate partner abuse (including coercive control, physical, sexual, economic, emotional and economic abuse) is common worldwide. Advocacy may help women who are in, or have left, an abusive intimate relationship, to stop or reduce repeat victimisation and overcome consequences of the abuse. Advocacy primarily involves education, safety planning support and increasing access to different services. It may be stand-alone or part of other services and interventions, and may be provided within healthcare, criminal justice, social, government or specialist domestic violence services. We focus on the abuse of women, as interventions for abused men require different considerations.

OBJECTIVES

To assess advocacy interventions for intimate partner abuse in women, in terms of which interventions work for whom, why and in what circumstances.

SEARCH METHODS

In January 2019 we searched CENTRAL, MEDLINE, 12 other databases, two trials registers and two relevant websites. The search had three phases: scoping of articles to identify candidate theories; iterative recursive search for studies to explore and fill gaps in these theories; and systematic search for studies to test, confirm or refute our explanatory theory.

SELECTION CRITERIA

Empirical studies of any advocacy or multi-component intervention including advocacy, intended for women aged 15 years and over who were experiencing or had experienced any form of intimate partner abuse, or of advocates delivering such interventions, or experiences of women who were receiving or had received such an intervention. Partner abuse encompasses coercive control in the absence of physical abuse. For theory development, we included studies that did not strictly fit our original criteria but provided information useful for theory development.

DATA COLLECTION AND ANALYSIS

Four review authors independently extracted data, with double assessment of 10% of the data, and assessed risk of bias and quality of the evidence. We adopted RAMESES (Realist and meta-narrative evidence syntheses: evolving standards) standards for reporting results. We applied a realist approach to the analysis.

MAIN RESULTS

We included 98 studies (147 articles). There were 88 core studies: 37 focused on advocates (4 survey-based, 3 instrument development, 30 qualitative focus) and seven on abused women (6 qualitative studies, 1 survey); 44 were experimental intervention studies (some including qualitative evaluations). Ten further studies (3 randomised controlled trials (RCTs), 1 intervention process evaluation, 1 qualitative study, 2 mixed methods studies, 2 surveys of women, and 1 mixed methods study of women and staff) did not fit the original criteria but added useful information, as befitting a realist approach. Two studies are awaiting classification and three are ongoing.Advocacy interventions varied considerably in contact hours, profession delivering and setting.We constructed a conceptual model from six essential principles based on context-mechanism-outcome (CMO) patterns.We have moderate and high confidence in evidence for the importance of considering both women's vulnerabilities and intersectionalities and the trade-offs of abuse-related decisions in the contexts of individual women's lives. Decisions should consider the risks to the woman's safety from the abuse. Whether actions resulting from advocacy increase or decrease abuse depends on contextual factors (e.g. severity and type of abuse), and the outcomes the particular advocacy intervention is designed to address (e.g. increasing successful court orders versus decreasing depression).We have low confidence in evidence regarding the significance of physical dependencies, being pregnant or having children. There were links between setting (high confidence), and potentially also theoretical underpinnings of interventions, type, duration and intensity of advocacy, advocate discipline and outcomes (moderate and low confidence). A good therapeutic alliance was important (high confidence); this alliance might be improved when advocates are matched with abused women on ethnicity or abuse experience, exercise cultural humility, and remove structural barriers to resource access by marginalised women. We identified significant challenges for advocates in inter-organisational working, vicarious traumatisation, and lack of clarity on how much support to give a woman (moderate and high confidence). To work effectively, advocates need ongoing training, role clarity, access to resources, and peer and institutional support.Our provisional model highlights the complex way that factors combine and interact for effective advocacy. We confirmed the core ingredients of advocacy according to both women and advocates, supported by studies and theoretical considerations: education and information on abuse; rights and resources; active referral and liaising with other services; risk assessment and safety planning. We were unable to confirm the impact of complexity of the intervention (low confidence). Our low confidence in the evidence was driven mostly by a lack of relevant studies, rather than poor-quality studies, despite the size of the review.

AUTHORS' CONCLUSIONS

Results confirm the core ingredients of advocacy and suggest its use rests on sound theoretical underpinnings. We determined the elements of a good therapeutic alliance and how it might be improved, with a need for particular considerations of the factors affecting marginalised women. Women's goals from advocacy should be considered in the contexts of their personal lives. Women's safety was not necessarily at greatest risk from staying with the abuser. Potentially, if undertaken for long enough, advocacy should benefit an abused woman in terms of at least one outcome providing the goals are matched to each woman's needs. Some outcomes may take months to be determined. Where abuse is severe, some interventions may increase abuse. Advocates have a challenging role and must be supported emotionally, through provision of resources and through professional training, by organisations and peers.Future research should consider the different principles identified in this review, and study outcomes should be considered in relation to the mechanisms and contexts elucidated. More longitudinal evidence is needed. Single-subject research designs may help determine exactly when effect no longer increases, to determine the duration of longitudinal work, which will likely differ for vulnerable and marginalised women. Further work is needed to ascertain how to tailor advocacy interventions to cultural variations and rural and resource-poor settings. The methods used in the included studies may, in some cases, limit the applicability and completeness of the data reported. Economic analyses are required to ascertain if resources devoted to advocacy interventions are cost-effective in healthcare and community settings.

Beyond Advocacy: Mapping the Contours of Victim Work

In contrast to works on victim advocacy in specific organizational contexts, this article introduces the term "victim work" to capture the vast array of victim-related roles and tasks that have proliferated in recent decades. Data are derived from in-depth interviews with 30 "victim workers" in public and private agencies in two Midwestern states. The interviews revealed diverse work experiences that spanned hotlines, crisis response, legal proceedings, and postconviction support. Three themes emerged that characterize "victim work": flexibility, emotions, and the challenge of "fit"-the multifaceted difficulties of interacting with victims and agents of the justice system. Based on the findings, we offer a revised model of criminal justice vis-à-vis victims and implications for practice and future research.