Heidi Gilroy

Testing two global models to prevent violence against women and children: methods and baseline data analysis of a seven-year prospective study.

Worldwide, two models of care are offered most often to abused women—safe shelter and justice services. No evidence exists on the differential effectiveness of the models. To provide evidence for best practice and policy, 300 abused women, 150 first-time users of a shelter and 150 first time-applicants for a protection order, participated in a seven-year study. Safety, abuse, and the emotional and physical functioning of the women and their children were measured. The procedural logistics, sampling process, metrics, and baseline descriptors for these 300 women and 300 children is presented along with implications for practice and policy.

Children in Distress: Functioning of Youngsters of Abused Women and Implications for Child Maltreatment Prevention

Intimate partner violence (IPV) is a global health problem impacting millions of women each year. Children of these women are exposed to the violence and are at high risk for significant behavioural problems. To protect children and promote healthy families, assessment of child functioning, by age and gender, is critical to identify “red flags” that trigger immediate child/family support services for abused women seeking assistance. The present study is the first to describe the behavioural dysfunction by age and gender of children of mothers experiencing IPV who reach out for assistance for the first time. This information is a part of a seven-year prospective research project evaluating the treatment efficacy of two models of care for abused women: safe shelter and justice services. Study findings indicated that boys of abused women, particularly younger boys, are more likely to exhibit clinically significant behaviour problems placing them at high risk for delinquency, hostility, and aggression. The child malfunctioning behaviour when viewed in the context of a family experiencing chronic stress (IPV) has the potential for child abuse. Implications for child health practice to minimise the risk for child maltreatment include awareness and education for child health professionals and advocates, implementing the mother–child unit of care when providing services to children, behavioural screen or assessment of the child when the mother screens positive for IPV, and the development/implementation of intergenerational programmes to address the mental and physical health needs of the abused mother and the behavioural function of the child.

Connecting Partner Violence to Poor Functioning for Mothers and Children: Modeling Intergenerational Outcomes

Violence against women, a global epidemic, frequently begins in childhood. Many abused women are mothers and many children witness the abuse of their mothers. To better understand the intergenerational impact and associated health outcomes, we tested 300 mother-child pairs using structural equation modeling. Mother’s history of abuse during childhood directly impacted the level of adult abuse, which predicted her child’s witness to the abuse. Maternal pain predicted maternal symptoms of depression, anxiety, and PTSD. Mother’s mental health predicted the degree of child dysfunction, such as aggression and depression. These findings offer evidence for the urgent need to provide mental health interventions to improve maternal functioning of abused mothers as a conduit intervention to prevent child dysfunction and promote mother-child health.

The association of pain severity and pain interference levels with abuse experiences and mental health symptoms among 300 mothers: baseline data analysis for a 7-year prospective study

Women who experience interpersonal violence are at increased risk for anxiety, depression, posttraumatic stress symptoms, and chronic pain and other physical disorders. Although the effects of mental health disorders on womens functioning and well-being are well established, less is known about the effects of pain. We examined participants’ (n = 300 mothers) experiences of pain severity and pain interference. Higher levels of pain severity and pain interference were significantly associated with anxiety, PTSD, and depression symptoms. Mental health symptoms compounded by pain, may leave abused women less able to access resources or practice safety behaviors to protect themselves and their children.

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

Abused Women With Children Who Are First-Time Users of a Shelter or Applicants for a Protection Order: Entry Data of a 7-Year Prospective Analysis

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.

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

Worldwide, two models of care are offered most often to abused women—safe shelter and justice services. No evidence exists on the differential effectiveness of the services. To provide evidence, 300 abused women, 150 first-time users of a shelter and 150 first-time applicants for a protection order, signed informed consent to participate in a 7-year study. Safety, abuse, and functioning of the women and their children were measured. Compared with women seeking justice services, women in shelters reported more abuse and depression and less support. The baseline characteristics of these 300 women are presented with implications for practice and policy.

Linking Cancer and Intimate Partner Violence

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

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

Millions of women in the United States experience physical abuse because of intimate partner violence (IPV) that results in injuries, social and family dysfunction, mental health disorders, chronic pain and illness, and death. Cancer causes a quarter of the deaths of women in the United States. When IPV and a cancer diagnosis intersect, a special population of women with unique needs is created. The purpose of the current study was to determine the rates of IPV and the types of cancer reported by women seeking services for IPV. Safety, community agency use, severity of violence, danger, psychological distress, post-traumatic stress disorder, self-efficacy, social support, pain, and marginality also were assessed. Three hundred abused women were interviewed in person to determine their health, safety, and functioning. Of the 300 women, eight reported receiving a cancer diagnosis, and most of those women had cervical cancer. The prevalence of cervical cancer reported by abused women was 10 times higher than the general population. Higher danger scores and risk for revictimization were reported. Increased awareness of the potential connection between IPV and cancer is needed, and evidence-based strategies that promote IPV screening in the oncology setting should be developed.

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.