Anne Koci

Informing Practice Regarding Marginalization: The Application of the Koci Marginality Index

The 49th World Health Assembly of the World Health Organization (WHO) declared violence as the leading worldwide public health problem with a focus on the increase in the incidence of injuries to women. Violence against women is an international epidemic with specific instruments required to measure the impact on womens functioning. This article describes the application of the Koci Marginality Index (KMI), a 5-item scale to measure marginality, to the baseline data of a seven-year prospective study of 300 abused women: 150 first time users of a shelter and 150 first time applicants for a protection order from the justice system. Validity and reliability of the Koci Marginality Index and its usefulness for best clinical practice and for policy decisions for abused womens health are discussed. The 49th World Health Assembly of the World Health Organization (WHO) declared violence as the leading worldwide public health problem and focused on the increase in the incidence of injuries to women (Krug et al., ). Violence against women in the form of intimate partner violence (IPV) is costly in terms of dollars and health. In the United States in 2003, estimated costs of IPV approached

Effect of abuse during pregnancy on maternal and child safety and functioning for 24 months after delivery.

8.3 billion (Centers for Disease Control and Prevention [CDC], 2011). Outcomes related to severity of IPV vary but in 2003 victims suffering severe IPV lost nearly 8 million days of paid work, and greater than 5 million days of household productivity annually (CDC, 2011). Besides the evident financial cost of IPV, research confirms that exposure to IPV impacts a womans health immediately and in the long-term (Breiding, Black, & Ryan, ; Campbell, ; CDC, 2011). Such sequela adversely affect the health of women and may increase their marginalization, a concept akin to isolation that may further increase negative effects on health outcomes. Immigrant women are at high risk for IPV (Erez, ) and those without documentation are at higher risk for marginalization (Montalvo-Liendo, Koci, McFarlane, Nava, Gilroy, & Maddoux, 2012). This paper explores marginality with reference to IPV and the development and application of an instrument to measure marginality.

Is Length of Shelter Stay and Receipt of a Protection Order Associated With Less Violence and Better Functioning for Abused Women? Outcome Data 4 Months After Receiving Services

OBJECTIVE: To evaluate the long-term safety and functioning outcomes for abused women reporting abuse during pregnancy and their childrens behavior compared with abused women who do not report abuse during pregnancy. METHODS: Forty-six abused women seeking assistance for partner abuse and reporting being pregnant during the preceding 4 months were evaluated every 4 months for 24 months to compare levels of abuse, danger for murder, anxiety, depression, somatization, and posttraumatic stress disorder (PTSD) for abused women who report abuse during pregnancy (n=24) compared with abused women reporting abuse only outside of pregnancy (n=22). Internalizing and externalizing behavior scores were evaluated for the children. RESULTS: At entry into the study, abused women reporting abuse during pregnancy reported significantly greater (P<.05) threats of abuse, sexual abuse, physical abuse, danger for murder, and PTSD compared with abused women not reporting abuse during pregnancy. Effect sizes were large. When evaluated over the course of 24 months after delivery, risk for murder remained higher for women reporting abuse during pregnancy for 8 months after delivery, depression was higher at 4, 8, 16, and 20 months after delivery, and PTSD was appreciably higher for 24 months. Children living with mothers abused during pregnancy displayed more behavioral problems for the entire 24-month period, especially problems of depression and anxiety. CONCLUSION: The study documents the negative safety and function effects of abuse in pregnant women that remain for at least 24 months after delivery. This warrants incorporating abuse screening during the antenatal and postdelivery periods and a protocol of care during the antenatal period and beyond. LEVEL OF EVIDENCE: II

Women's functioning following an intervention for partner violence: new knowledge for clinical practice from a 7-year study

To provide differential effectiveness on length of stay at a shelter and receipt versus non-receipt of a protection order (PO), and outcomes of violence, functioning, and resiliency, in 300 abused women (150 first-time users of a shelter and 150 first-time applicants for a PO) who participate in a 7-year study with outcomes measured every 4 months. Four months after a shelter stay or application for a PO, abused women staying 21 days or less at a shelter reported similar outcomes compared with women staying longer than 21 days. Similarly, women receiving and not receiving a PO reported overall equivalent outcomes. Seeking shelter or justice services results in similar improved outcomes for abused women 4 months later, regardless of length of stay at the shelter or receipt or no receipt of the PO. Contact with shelter and justice services results in positive outcomes for abused women and indicates the urgent need to increase availability, accessibility, and acceptability of shelter and justice services.

The Intersection of Partner Violence and Adverse Childhood Experiences: Implications for Research and Clinical Practice

Intimate partner violence affects one in three women worldwide, with women who experience violence almost twice as likely to experience poor mental health, especially depression, compared with women who are not abused. To learn the impact of interventions of safe shelter and justice services on improved mental health and behavior functioning, 300 abused women are interviewed every 4 months in a 7-year prospective study. For this paper, abuse, mental health and resiliency status of these women, 1 year after accessing services for the first time, are reported. Measures of mental health (depression, anxiety, post-traumatic stress disorder (PTSD), somatization), and adult behavioral functioning are reported. At 4 months following a shelter stay or justice services, a large effect size was measured for improvement in all mental health measures; however, improvement was the lowest for PTSD. All mental health measures plateaued at 4 months with minimum further improvement at 12 months. Both internal behavioral dysfunctions (withdrawal and somatic complaints) were worse with increased depressive symptoms, as were external behavioral dysfunctions (aggressive and rule-breaking behaviors). A concerning 39.2% of the women had clinical PTSD scores at 12 months following receipt of safe shelter or justice services, compared with a much lower percentage of women with clinical depression (14.2%), clinical somatization (9.4%), and clinical anxiety (13.5%). Depression was a significant positive predictor of internal and external behavioral dysfunctions, indicating that women who had higher levels of depression tended to report more internal dysfunctions (withdrawal, anxiety, somatization) and more external behaviors (aggression and rule-breaking).

Problem-Solving and Mental Health Outcomes of Women and Children in the Wake of Intimate Partner Violence

Violence against women continues to be a serious public health issue afflicting women worldwide. The intersection of Adverse Childhood Experiences (ACEs) and intimate partner violence is detrimental to a womans well-being. This review aims to identify the types of ACEs reported by women who also report partner violence and the subsequent negative impact of this combination of experiences on the womens health. The evidence supports the cumulative effects of Adverse Childhood Experiences on women, particularly when coupled with experiences of intimate partner violence. Early interventions by providers have the potential to mitigate negative health outcomes of abused women and interrupt the intergenerational transmission of violence to their children.

Marginality and Physical and Sexual Abuse in Women

The environmental stress of intimate partner violence is common and often results in mental health problems of depression, anxiety, and PTSD for women and behavioral dysfunctions for their children. Problem-solving skills can serve to mitigate or accentuate the environmental stress of violence and associated impact on mental health. To better understand the relationship between problem-solving skills and mental health of abused women with children, a cross-sectional predictive analysis of 285 abused women who used justice or shelter services was completed. The women were asked about social problem-solving, and mental health symptoms of depression, anxiety, and PTSD as well as behavioral functioning of their children. Higher negative problem-solving scores were associated with significantly (P < 0.001) greater odds of having clinically significant levels of PTSD, anxiety, depression, and somatization for the woman and significantly (P < 0.001) greater odds of her child having borderline or clinically significant levels of both internalizing and externalizing behaviors. A predominately negative problem-solving approach was strongly associated with poorer outcomes for both mothers and children in the aftermath of the environmental stress of abuse. Interventions addressing problem-solving ability may be beneficial in increasing abused womens abilities to navigate the daily stressors of life following abuse.

Poverty, Partner Abuse, and Women's Mental Health: New Knowledge for Better Practice

We examine the role of marginality as a social determinant of physical and sexual abuse in women. In this study of a community sample of 568 women of reproductive age, and women with a history of physical and sexual abuse reported significantly more marginality than women without a prior history of abuse. An inverse relationship between socioeconomic status (SES) and marginality existed. Sexual abuse initially experienced in childhood had a more profound impact on marginality in women than when the abuse initially occurred in adolescence or adulthood. Early identification of abused women in clinical practice may help to prevent further marginality and adverse health outcomes.

The simulated hospital environment: a qualitative study applying space industry techniques.

ABSTRACT. To better understand how poverty and poor mental health impact women who are abused by intimate partners, a convenience sample of 300 abused women using shelters or justice services for the 1st time were interviewed. The 300 women were categorized as having no income, being above poverty, and being below poverty according to U.S. Poverty Guidelines. Results indicated that no direct effect of income on poor mental health was noted; however, an interaction between type and severity of abuse and income level had an impact on poor mental health. Abused women who were above poverty with the highest incomes reported the highest levels of depression in the presence of high physical and sexual abuse. In contrast, women reporting no income reported no significant effect of severity or type of abuse on depression scores. Women just above the poverty level who experienced severe abuse were at highest risk for mental health problems. Poverty impacts the mental health of abused women according to the degree of poverty and type and severity of abuse. More research is needed to specify programs to maximize the mental health functioning and economic solvency of abused women.

U.S.-born compared to non-U.S.-born abused women: analysis of baseline data.

Patterned after the integrated simulation approach utilized in the space industry, we report results of an innovative simulation in nursing, a 96-hour continuous simulated hospital environment. Training objectives for our study emphasized the integrative and critical thinking skills needed by new graduate nurses. The purpose of this study was to determine the process for development and the experience of participating in a simulated hospital environment. We sought to (a) translate space industry-integrated simulation techniques into development of a simulated hospital environment and (b) determine the experience of participating in an integrated simulation experience among undergraduate (UG) and graduate nursing students and nursing faculty. We used a qualitative mixed-methods design. Data were collected from participant focus groups, debriefing sessions, research team field notes, and electronic health record documentation. The sample, 72 student focus group participants, consisted of 12 baccalaureate-level soon-to-graduate students and 60 graduate nurse practitioner students as patient actors and providers. Important themes emerged from the project. We were able to design a simulated hospital environment that was true to life. Notably, student knowledge-practice gap was a major theme of the study, consistent with studies of employer concerns of new graduate nurses.