Mona Mittal

Linking human systems: strengthening individuals, families, and communities in the wake of mass trauma.

This article presents an overview of the philosophy and practical principles underlying the Linking Human Systems Approach based on the theory of resilience in individuals, families, and communities facing crisis, trauma, and disaster. The Link Approach focuses on tapping into the inherent strength of individuals and their families and emphasizes resilience rather than vulnerability. It has been successfully used in combating critical public health problems, such as addiction, HIV/AIDS, and recovery from major trauma or disaster. Also, three specific models of Link intervention aimed at the individual, family, and community levels are discussed, with special emphasis on the family-level intervention. These interventions are directed toward mobilizing resources for long-term physical, emotional, psychological, and spiritual healing.

Mediators of the relation between partner violence and sexual risk behavior among women attending a sexually transmitted disease clinic.

Background: Intimate partner violence (IPV) is associated with a wide range of negative outcomes, including sexual risk behavior. This cross-sectional study explored mediators of the relationship between IPV and risky sexual behavior in 717 women recruited from a sexually transmitted disease (STD) clinic. Methods: Participants were recruited from a public STD clinic in upstate New York as part of a randomized controlled trial that was designed to evaluate several sexual risk reduction interventions. They completed an audio computer-assisted self-interview in a private room. Results: Among these women, 18% reported IPV in the past 3 months and 57% reported lifetime experience of IPV. Recent IPV was associated with greater sexual risk, as measured by more episodes of unprotected sex (overall and with a steady partner). Although IPV was associated with depressive symptoms and drug use before sex, these variables did not mediate the relationship between IPV and sexual risk behavior. Conclusions: The results indicate that IPV is common among women who attend an STD clinic and warrants increased attention. Research is needed to better understand the pathways linking IPV and HIV risk in women, to optimize the design of effective interventions.

Look who's talking : Measuring self-disclosure in MFT

While self-disclosure plays a prominent role in the development and maintenance of the therapeutic relationship, most marriage and family therapy clinical research fails to include measures of self-disclosure. A factor analysis of Chelunes (1976) Self Disclosure Situations Survey (SDSS) reduces the number of items in this measure from 20 to six. Researchers are encouraged to consider conducting clinical research with specific attention to the construct of self-disclosure. The revised SDSS could easily be added as part of the self-report information collected in clinical studies.

Fear of Violent Consequences and Condom Use Among Women Attending an STD Clinic

Intimate partner violence (IPV) has been associated with risk for HIV infection. This cross-sectional study tested the hypothesis that fear of violent consequences when negotiating condom use mediated the relation between IPV and condom use. Participants (n = 478) were recruited between March 1, 2004 and June 30, 2006 from a public clinic that treats sexually transmitted diseases in upstate New York as part of a randomized controlled trial. They completed an audio, computer-assisted, self-administered questionnaire with items on risky sexual behavior, intimate relationships, and related covariates and confounding variables. Seventeen percent of the sample reported IPV in the past three months. Recent IPV was associated with fear of violent consequences to requests for condom use, and such fear was associated with inconsistent condom use. Women who reported IPV also reported greater difficulties in negotiating safer sex behaviors with their abusers. So fear of violent consequences appeared to hinder their ability to protect themselves against HIV infection. The results were consistent with fear of violent consequences mediating the relationship between IPV and condom use. Health care providers involved in HIV prevention and sexual risk reduction interventions need to address IPV and, more specifically, fear of IPV when negotiating safer sex as part of their services for providing more comprehensive care to the women they serve.

Risk Factors for Severe Intimate Partner Violence and Violence-Related Injuries Among Women in India

Relying on an ecological framework, we examined risk factors for severe physical intimate partner violence (IPV) and related injuries among a nationally representative sample of women (N = 67,226) in India. Data for this cross-sectional study were derived from the 2005–2006 India National Family Health Survey, a nationally representative household-based health surveillance system. Logistic regression analyses were used to generate the study findings. We found that factors related to severe physical IPV and injuries included low or no education, low socioeconomic status, rural residence, greater number of children, and separated or divorced marital status. Husbands’ problem drinking, jealousy, suspicion, control, and emotionally and sexually abusive behaviors were also related to an increased likelihood of women experiencing severe IPV and injuries. Other factors included women’s exposure to domestic violence in childhood, perpetration of IPV, and adherence to social norms that accept husbands’ violence. Practitioners may use these findings to identify women at high risk of being victimized by severe IPV or injuries for prevention and intervention strategies. Policies and programs that focus on empowering abused women and holding perpetrators accountable may protect women at risk for severe IPV or injuries that may result in death.

They told me to leave: how health care providers address intimate partner violence.

Background: Intimate partner violence (IPV) victims frequently seek medical treatment, though rarely for IPV. Recommendations for health care providers (HCPs) include IPV screening, counseling, and safety referral. The objective of this study was to report womens experiences discussing IPV with HCPs. Methods: This study used structured interviews with women reporting IPV discussions with their HCP; descriptive analyses and bivariate and multivariate analyses were performed, and association with patient demographics and substance abuse was reviewed. We included women from family court; a community-based, inner-city primary care practice; and a tertiary care-based, outpatient psychiatric practice. Results: A total of 142 women participated: 44 from family court (31%), 62 from a primary care practice (43.7%), and 36 from a psychiatric practice (25.4%). Fifty-one percent (n = 72) of patients reported that HCPs knew of their IPV. Of those, 85% (n = 61) told a primary care provider. Regarding IPV attitudes, 85% (n = 61) found their HCP open, and 74% (n = 53) found their HCP knowledgeable. Regarding approaches, 71% (n = 51) believed their HCP advocated leaving the relationship. Whereas 31% (n = 22) received safety information, only 8% (n = 6) received safety information and perceived their HCP as not advocating leaving the abusive relationship. Conclusions: Half of participants disclosed IPV to their HCPs, and most perceived their provider advocated them leaving the relationship. Only 31% reported that HCPs provided safety planning despite increased risks associated with leaving. We suggest HCPs improve safety planning with patients who disclose IPV.

Expanding the Horizons of Marriage and Family Therapists: Towards Global Interconnectedness

Abstract The purpose of this paper is to share with academicians and practitioners our experiences as international, feminist women of color in the field of Marriage and Family Therapy (MFT). We highlight areas of concern regarding what we perceive as a lack of integration of broader political, socioeconomic, gender, and environmental contexts in the training, research, and practice of many MFTs. This paper is intended to propel further discussion regarding the complexities of these topics and their implications for how we conduct family therapy.

HIV Risk Among Women From Domestic Violence Agencies: Prevalence and Correlates

&NA; The co‐occurrence of HIV and intimate partner violence is a significant public health problem. Although these intersecting epidemics have been examined in various populations, limited data exist among recently abused women seeking services from domestic violence agencies. Our study examined sexual risk behaviors among 103 predominantly low‐income, urban women receiving services from domestic violence agencies. Results showed that 42% of women engaged in risky sexual behavior (e.g., inconsistent condom use, sexually transmitted disease diagnosis, sex with more than one partner) in the previous 3 months. Multivariable analyses revealed that women who engaged in sexual risk behaviors were more likely to have never been married, experienced greater fear of abuse when negotiating condom use, used substances before sex, and had lower self‐esteem compared to abused women who did not engage in sexual risk behaviors. Results underscore the need to integrate sexual risk screening and risk reduction programs into domestic violence agencies for women.

Relationship Factors and Condom Use Among Women with a History of Intimate Partner Violence

Women who experience intimate partner violence (IPV) are at increased risk for HIV infection. To further the understanding of the dyadic factors that impact condom use among women, we investigated the impact of three relationship factors (i.e., power, fear, and dependence) on the association between HIV-related information, motivation, and behavioral skills [constructs from the information-motivation-behavioral skills (IMB) model] and condom use among abused women. Data from 133 urban, low-income women recruited from several community-based agencies (e.g., domestic violence agencies, women’s health organizations, hospitals, Department of Health and Human Services, and Family Court) showed that these women experienced high levels of IPV and that relationship power, fear of abuse, and partner dependence were all associated with condom use. Multivariable models revealed that fear of abuse and partner dependence moderated the association between IMB constructs and condom use but relationship power did not. Results highlight the critical need to incorporate strategies to address relationship factors in HIV prevention programs with abused women.

Risk of Intimate Partner Violence and Relationship Conflict Following Couple-Based HIV Prevention Counseling Results From the Harlem River Couples Project

Heterosexual transmission of HIV often occurs in the context of intimate sexual partnerships. There is mounting evidence that couple-based HIV prevention interventions may be more effective than individual-based interventions for promoting risk reduction within such relationships. Yet, concerns have been raised about the safety of couple-based prevention approaches, especially with regard to the risk of intimate partner violence against women. Although several international studies have examined the potential for adverse consequences associated with couple-based interventions, with inconsistent results, there is little data from U.S. studies to shed light on this issue. The current study analyzed data from a randomized trial conducted in New York City with 330 heterosexual couples to examine whether participation in couple-based or relationship-focused HIV counseling and testing (HIV-CT) interventions resulted in an increased likelihood of post-intervention breakups, relationship conflicts, or emotional, physical, or sexual abuse, compared with standard individual HIV-CT. Multinomial logistic regression was used to model the odds of experiencing change in partner violence from baseline to follow-up by treatment condition. A high prevalence of partner-perpetrated violence was reported by both male and female partners across treatment conditions, but there was no conclusive evidence of an increase in relationship dissolution or partner violence subsequent to participation in either the couple-based HIV-CT intervention or relationship-focused HIV-CT intervention compared with controls. Qualitative data collected from the same participants support this interpretation. HIV prevention interventions involving persons in primary sexual partnerships should be sensitive to relationship dynamics and the potential for conflict, and take precautions to protect the safety of both male and female participants.