Intimate Partner Violence

INSPIREEmpowering Women to Improve

Quality of Life & Reduce Re-victimization in San Diego County

Dominique Hernandez, Ganesh Kulkarni, Griselda Cervantes, Sara Langesiepen

Intimate Partner Violence (IPV)

•Definition: a pattern of assaultive and coercive behaviors that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivations, intimidations, and threats.

(Family Violence Prevention Fund, 2009)

Characteristics of IPV

•Intimate partners are: -current spouses-former spouses-dating partners

•Four types of behavior: -Physical violence-Sexual Violence-Threats-Emotional abuse

•Exists as a continuum (single episode ongoing battering)(CDC, 2009)

The Dynamics of IPV

•Power& Control Wheel

-Must consider the reasons that influencevictims to stay in such unhealthy relationships. *Fear/Helplessness

-The four types of behavior that compromise IPV are the result of need to exert power and control of victims.

-IX efforts should work on these elements

The Dynamics of IPV

•The Cycle of Violence

The Cycle

•IPV is cyclic in nature•Three distinct phases:

-Tension building-Explosion (acute battering)

-Absence of tension (reconciliation/”honeymoon phase”)

Who Are The Victims?

•IPV can affect people from all socioeconomic, educational, and religious backgrounds.

-regardless of gender, age, race, ethnicity, sexual preference

•Women are disproportionately affected.-leading cause of serious injury

(UNICEF, 2000; Bugarin, 2000)

Epidemiology

•Worldwide:-48 population-based surveys estimate that 10-69% of

women reported IPV

•United States:-Women ages 16-24 are most likely to be victims-4.8 million adult women are abused each year-30% of women experience IPV at some point in their

lives-Women are 7 to 14 times more likely to suffer a severe

physical injury from IPV than men-40-50% of all murders /year are a result of IPV

(Campbell et al., 2003; Krug et al, 2002; Tjaden & Thennes, 2000, WHO, 2003)

Risk Factors

•Risks:-alcohol and drug use -victim of violence as a child-unemployed-environment with increased levels of stress

•Barriers to leaving:-fear-financial dependence-familiarity-fantasy-family

(Kyriacou, D. et al., 1999)

The Impact of IPV: Why is IPV a Public Health

Problem?

•Medical care costs: $8.3 billion in 2003. -acute care -mental health services

•U.S. businesses costs: $5.8 billion/year -absenteeism-lower productivity-turnover -safety

•Social costs: ?-family

(CDC, 2003; Max et al., 2004)

Consequences of IPV

•Physical trauma: injury (disability), chronic pain syndromes, or even death•Emotional trauma: increased stress, depression, lowered self-esteem, anxiety, Post-Traumatic Disorder•Higher rates of smoking, substance abuse, other harmful behaviors

IPV in San Diego County

•In 2007, SDPD received the highest number of domestic violence cases among all law enforcement jurisdictions in CA.•Victims:

-20-29 years of age-89% women

•Over 20 domestic homicides in SD County in 2007•The Central Region of SD has the greatest domestic violence activity rate: 286 per 10,000 households.

(ARJIS, 2007; SDPD, 2007; County of SD HHSA, 2007)

Domestic Violence Incidents 2006-2007 

(DVFRT ,2008)

IPV Best Practices

Community, Health Care Settings

• Screening • Hotlines • Crisis Intervention• Community

education and outreach

Shelters, Transitional Homes

• Counseling• Social Support• Children’s Programs• Advocacy

• Financial• Legal

• Skill Building• Empowerment• Case Management

Outcomes of Shelter Interventions

(ARJIS, 2007)

Even with these programs in place, 40% to 60% of women return to their abusers after receiving services.

Re-victimization.

Why?

Current Practices in San Diego County

 

Stay Case Mngt

Advocacy

Social Couns Kids Work/Ed

Empower

DV prev.

Skill Build

YWCA 30d/18m yes yes yes yes yes yes Yes yes

CCS 90d/24m yes yes yes yes yes yes yes

ECS 30d/24m yes yes yes yes yes some

El Nido

12-18m yes yes yes yes yes yes

Crisis House

30d/? yes yes yes yes yes Yes yes yes

Current Focus: Advocacy, treatmentfinancial, legal

Our Focus: Empowerment, sustainability

Enhanced social support, increased quality of life

INSPIREA program to increase quality of life and

decrease re-victimization

Increase Physical Activity

Increase Empowerment

Increase Quality of Life

Increase Social Support

DecreaseRe-victimization

Proposed Intervention: INSPIRE

Study Design:6 Transitional Homes Recruitedin San Diego

N = 150

3 T.H. in San DiegoIntervention GroupN = 75

3 T.H. in San Diego Comparison Group N = 75

Random Assignment

Design Notation

R O1 X O2 O3 O4

R O1 O2 O3 O4

Target Population

Women residing in transitional homes in San Diego because of IPV

Implementation of INSPIRE

This intervention seeks to empower and enhance the quality of life of women who suffer from IPV

Training of staff on curriculum & motivational interviewing

10 week empowerment curriculum 1 session/week; 2 hours each, led by current staff

member Each session reflects important topics from the Best

Practice Guidelines Emphasize: modeling, role-playing, group learning, and

shared experience

Implementation of INSPIREIntervention Modules

Promoting Positive Relationships

Right to Autonomy

Communication Skills and Conflict Resolution

IPV Education

Understanding and Coping with Stress

Goal Setting and Decision Making

Communication Practice

Finding Resources in the Community

IPV Advocacy Using your experiences, tools,

and resources to help others (Sponsor program, similar to AA sponsors)

Summary, Practice

Implementation of INSPIRE

Physical Activity Component Provides several health benefits Offered 7 days a week, twice a day (am/pm) Hire 3 Certified Physical Activity Instructors Yoga, Dance, Pilates, Tai-Chi, & Aerobic/Strength-

Training Donated Equipment: yoga mats & stretch mats

Process Evaluation/Formative Evaluation•Documents reach, quality and the capacity of the program

Reach: Process objective is to obtain at least an 80% attendance rate in each classInvolvement of shelter home staffDaily attendance sheets

Quality and Capacity:Reviews and feedback from the participants and the shelter home staff obtained by a survey

Evaluation

Impact Evaluation•Difference in improved health knowledge, skills and motivation, and changes to health actions and behavior

Impact objectives: increase levels of knowledge, skills, perceived social support, empowerment, physical activity, and overall quality of life for the women

 

Health, knowledge, skills and motivation, and behavior changes:Pretest-post-test survey data (baseline and post-10 week intervention).

Evaluation

Outcome EvaluationOutcome objective : decrease re-victimization of women participating in the INSPIRE intervention by 50%

Collect data from participating women at different points in time,Baseline (at the time of shelter admission),At the end of 10 week program, At the time of leaving shelter, 1month follow up,6 month follow up. The survey used will include and empowerment scale, a perceived social support scale, questions on physical activity, a quality of life scale, and questions regarding re-victimization.

Evaluation

Domestic Violence Act (1999) Change in Criminal Justice System

Women’s Leadership and Enhancement Institute Empowering & Enhancing women’s lives in various

aspects Decreasing Re-Victimization

The focus of shelters and transitional homes: Majority of the efforts target rehabilitation Less efforts made to empower and enhance women

personally and professionally

CAFRA (2000)

Discussion:

Future Directions:

MERGINGING THE GAP BETWEEN PRACTICE & POLICY TO DECREASE VIOLENCE AGAINST WOMEN

Changes to the criminal justice system Intervention programs that empower women Develop strong social networks- victim support

programs that are ongoing within communities Increasing community awareness of IPV

A NEED FOR EVIDENCE-BASED DATA & INCREASEDFINANCIAL SUPPORT

References

•Saltzman LE, Fanslow JL, McMahon PM, Shelley GA. Intimate partner violence surveillance: uniform definitions and recommended data elements, version 1.0. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2002. Available from: http://www.cdc.gov/ncipc/pub-res/ipv_surveillance/intimate.htm•Tjaden P, Thoennes N. Stalking in America: Findings from the National Violence Against Women Survey. Washington (DC): Department of Justice (US); 1998. Publication No. NCJ 169592. Available from: http://www.ncjrs.gov/pdffiles/169592.pdf•CDC (2009): http://www.cdc.gov/violenceprevention/pdf/IPV_factsheet-a.pdf•Family Violence Prevention Fund (2009): http://www.endabuse.org/•Kyriacou, D. et al. (1999). Risk factors for injury to women form domestic violence. New England Journal of Medicine, 241 (25): 1892-1898.•Coker, A. (2005). Opportunities for prevention: addressing IPV in the health care setting. Family Violence Prevention and Health Practice, 1, 1-9.•Campbell, J.C.,Webster, D., & Koziol-McLain, J., Block, C.R., Campbell, D.W., Curry, M.A., et. al. (2003). Assessing risk factors for intimate partner homicide. National Institute of Justice Journal, 250, 14-19.•Bugarin, A. (2002, Nov.) The prevalence of domestic violence in California. California Research Buraeau, 74.•UNICEF , June 2000 report•Krug, E. et al. (Eds.) (2002). World report on violence and health. Geneva, World Health Organization•ARJIS, 2007•SDPD, 2007•County of San Diego, HHSA, 2007•WHO, 2003: http://www.who.int/violence_injury_prevention/publications/violence/intervening/en/index.html