Partnering Health with Justice

He said it would never happen again. He only hit her because he was drunk. He hadn't meant it when he'd called her those horrible names. He even cried when he promised her he would make it up to her somehow. It would never happen again.

But it did.

Each year, an estimated 1 million women are beaten by their husbands or partners in a cycle of violence that often draws children into its path.

"Violence against women by their intimate partner is a national epidemic," said Judith McFarlane, Dr.P.H., a Texas Woman's University professor of nursing. "Some 10 million children witness this abuse. Frequently, the children are hurt as they try to protect their mother."

To prevent abuse to women and children, McFarlane designs and tests interventions that can be used to set health policy and direct local, state and national programs for abused women and their children.

McFarlane, who holds the Parry Chair in Health Promotion and Disease Prevention at TWU's Houston Center, currently directs a research project that offers an intervention to 150 severely abused women. The study - a partnership program with the Harris County District Attorney's Office - is funded by the National Institute of Justice.

"It partners health with justice," McFarlane said of the study, which will continue for a total of 18 months. Researchers are evaluating the effects of the interventions on stopping abuse, improving women's physical and mental health and employment productivity and reducing health care costs.

McFarlane believes this research is the first randomized clinical trial of a safety intervention for abused women.

"Although intimate partner violence is recognized as a major threat to women's health, few interventions have been developed or tested," she said. "These findings (after six months of study) clearly demonstrate that an intervention to increase safety behaviors of abused women is highly effective when offered following an abusive incident."

McFarlane added that the effectiveness of the safety intervention is maintained for six months.

The research team consists of Ann Malecha, Ph.D., a TWU assistant professor of nursing; Julia Gist, Ph.D., a TWU research associate; Iva Hall and Sheila Smith, TWU doctoral candidates; Kathy Watson, a consulting statistician; and Elizabeth Batten of the Harris County District Attorney's Office.

The team conducted the initial interview at a special family violence unit of the district attorney's office. Women who qualified for a protective order against a sexual intimate and who spoke English or Spanish were invited into the study. The 150 women who agreed to participate were divided into two groups. One group of 75 women received the standard services of the district attorney's office plus six telephone intervention sessions on safety behaviors. The other 75 received only the standard care (counseling and referral information is provided). One woman committed suicide six weeks into the study. The remaining 149 women completed the three- and six-month follow-up interviews.

A "Safety Behavior Checklist" provided the women in the intervention group with strategies to keep themselves and their children safe.

"Abused women want to protect themselves, but they don't know how," McFarlane said. She added that an abused woman faces even greater danger when she decides to leave, because the abuser realizes he has lost the control he had over her.

Safety behavior strategies offered to the women included hiding money and extra clothing, making an extra set of house and car keys, establishing a code with family and friends to signal the need for assistance, asking neighbors to call police if violence begins and removing weapons from the house. The women also were advised to obtain copies of birth certificates and Social Security numbers (theirs and their children's), as well as having bank account numbers and insurance policies and numbers available.

A convenient, private and safe time was established for the follow-up calls to the women, with the first call taking place within 48 to 72 hours of the initial visit. The remaining calls took place one, two, three, five and eight weeks afterward. Each call began with the safety behavior checklist, noting behaviors adopted since the last contact. The safety intervention ended with the sixth telephone call, eight weeks after the initial entry into the study. No safety information was provided during the three- and six-month follow-up calls.

Results after three months showed that significantly more women in the intervention group reported adopting safety behaviors than did those in the control group. At six months, four safety behaviors - hiding money, keys and clothing, and asking neighbors to call police if violence began - remained significantly higher for women in the intervention group compared to the control group.

The results also showed that the number and percentage of applicable behaviors performed significantly increased after each successive telephone call to women in the intervention group. Initially, 69 percent of the applicable safety behaviors were performed. By the eighth week of the intervention, 92 percent of the behaviors were adopted.

Intimate partner violence has been identified as a significant public health problem in the United States, McFarlane said. Research has shown that women who have been exposed to abuse by their intimate partners are more likely to smoke, drink alcohol regularly and seek medical treatment more often than are other women, she said.

The problem of intimate partner violence led the Department of Health and Human Services to set a national objective to reduce the rate of intimate partner physical assault by 20 percent by 2010.

McFarlane said nursing and other professional organizations responded by emphasizing the existence of partner violence and the need for routine assessment of all women. While specific protocols for identification, assessment and intervention in health care settings have been published, she said, evaluation of these protocols has been minimal.

"Routine abuse assessment has proven effective in women's disclosure of intimate partner violence," McFarlane said. "Health care providers in all settings must now go beyond assessment and documentation and implement tested intervention protocols that can stop violence, prevent future trauma and promote the safety and health of women."

NOTE - The National and Domestic Violence Hotline is 1-800-799-SAFE (7233)

- Reprinted with permission of QUEST, the Research Magazine of Texas Woman's University

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URL: http://www.tmc.edu/tmcnews/10_01_02/page_25.html