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Practice Profile

Advocacy Interventions for Women Who Experience Intimate Partner Violence

Evidence Ratings for Outcomes:

Effective - One Meta-Analysis Victimization - Domestic/intimate partner/family violence

Practice Description

Practice Goals
Intimate partner violence can be defined as abuse of a woman by a male or female partner with whom she currently is, or formerly was, in an intimate relationship (Ramsay et al. 2009). Advocacy interventions for women who have experienced intimate partner violence aim to empower women and link them to helpful services in the community. The goals of advocacy interventions include helping abused women to access necessary services, reducing or preventing incidents of abuse, and improving women’s physical and psychological health.
 
Target Population
Advocacy interventions are targeted at abused women who are still with their partners, or who have left the abusive relationship. Although the interventions target women, services and support for any children involved in the abusive relationship may also be provided.
 
Practice Activities
Advocacy interventions may be primary, secondary, or tertiary. Primary interventions focus on preventing the onset of abuse. Secondary interventions focus on preventing further abuse, and tertiary interventions focus on dealing with the consequences of abuse once the abuse has ceased. For this review, the focus was on advocacy interventions that were considered secondary and tertiary.
 
The core activities of secondary and tertiary advocacy interventions can vary from program to program. The activities provided by advocacy interventions can include

  • Providing legal, housing, and financial advice
  • Facilitating access to and use of community resources such as shelters, emergency housing, and psychological interventions
  • Providing safety planning advice
In addition, advocates may also provide ongoing support and informal counseling. The amount of time that advocacy is provided for abused women will vary, depending upon the specific needs of each woman. Short-term, or crisis, advocacy usually involves the advocate working with the woman for a short period of time (though she may be referred for additional services with a specialized agency). The duration of short-term advocacy interventions can range from 1 hour  to about 12 hours, whereas long-term advocacy interventions, such as counseling services, can last as long as 12 months, if necessary.
 
Advocacy interventions can take place within healthcare settings such as hospitals, but may also take place in other settings, such as shelters.
 
Practice Theory
Advocacy interventions are based on the concept of empowerment. This includes talking with an abused woman about potential solutions (rather than being prescriptive and telling her what to do); helping her to achieve goals she has set (rather than setting the goals for her); and helping her to understand and make sense of the situation and how she responds to it (Campbell and Humphreys 1993; Ramsay et al. 2009).
 
Key Personnel
Advocates who work with abused women to identify their needs and connect them to resources in the community can include trained paraprofessionals, therapists, counselors, and social workers.

Meta-Analysis Outcomes

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Effective - One Meta-Analysis Victimization - Domestic/intimate partner/family violence
Ramsay and colleagues (2009) examined the results from two studies examining the effects of advocacy interventions in reducing physical abuse for women who have experienced intimate partner violence, at 12- and 24-month follow-up periods. The significant effect size (OR=0.43) suggested that women who received advocacy interventions experienced significantly less physical abuse, compared with women in the control groups. However, this finding should be taken with some caution as the analysis relied on the results from only two studies.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11992 - 20012295

Meta-Analysis 1
Ramsay and colleagues (2009) conducted a meta-analysis to assess the effects of advocacy interventions (within or outside of health care settings) on women who experienced intimate partner violence. A comprehensive search was conducted to look for relevant and eligible studies. Studies were included if they were randomized controlled trials (RCTs); that is, studies that allocated participants or clusters of participants by random or quasi-random methods. Study participants had to be women aged 15 years and older who had experienced intimate partner abuse. The participants could have been recruited from any setting, such as health care or criminal justice facilities, refuges, or domestic violence agencies. The advocacy interventions could be brief (less than 12 hours) or intensive (12 hours or more), compared with the usual care. The interventions had to incorporate safety planning for the woman, or the facilitation of access to and use of community resources (such as domestic violence refuges or shelters, emergency housing, and psychological care).
 
The outcomes of interest included measures of incidence of abuse, quality of life, depression, and anxiety. The primary outcome of interest for the CrimeSolutions.gov review was physical abuse at 12- to 24-month follow-up periods. Physical violence was measured by a revised version of the physical violence subscale of the Conflict Tactics Scale (CTS).
 
A total of 10 studies (all RCTs) involving 1,527 participants were identified for inclusion. Of those 10, only 2 studies (Jouriles et al. 2001; Sullivan et al. 1992) examined the impact of advocacy interventions 12 to 24 months after the program ended. The 2001 study by Jouriles and colleagues included mothers who had been recruited from a shelter and who had been physically abused by a male partner in the last 12 months. The average age of study participants was 28 years, and the race/ethnicity of the participants was 31 percent African American, 28 percent white, 33 percent Latino, and 8 percent other. The 1992 study by Sullivan and colleagues included women who had stayed at least one night in a shelter. The average age was 28 years, and the race/ethnicity of the study participants was 46 percent white, 42 percent African American, 7 percent Latina, 2 percent Asian American, and 3 percent other.
 
Both of the interventions described in the studies by Jouriles and colleagues (2001) and Sullivan and colleagues (1992) provided help that was tailored to each individual woman. The intervention in the 2001 study by Jouriles and colleagues also provided support for the children and taught child-management skills to the mothers. That intervention was administered by therapists and lasted approximately 23 hours. The intervention in the 1992 study by Sullivan and colleagues was administered by trained paraprofessional students and lasted approximately 60–80 hours.
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Cost

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There is no cost information available for this practice.
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Ramsay, Jean, Yvonne Carter, Leslie Davidson, Danielle Dunne, Sandra Eldridge, Gene Feder, Kelsey Hegarty, Carol Rivas, Angela Taft, and Alison Warburton. 2009. “Advocacy Interventions to Reduce or Eliminate Violence and Promote the Physical and Psychosocial Well-Being of Women Who Experience Intimate Partner Abuse.” Campbell Systematic Reviews 5.
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Additional References

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These sources were used in the development of the practice profile:

Campbell, Jacquelyn C., and Janice C. Humphreys. 1993. Nursing Care of Survivors of Family Violence. St. Louis, Mo.: Mosby.

Jouriles, Ernest N., Renee McDonald, Laura Spiller, William D. Norwood, Paul R. Swank, Nanette Stephens, Holly Ware, and Wendy M. Buzy. 2001. “Reducing Conduct Problems Among Children of Battered Women.” Journal of Consulting and Clinical Psychology 69:774–85.

Sullivan, Cris M., Cheribeth Tan, Joanna Basta, Maureen Rumptz, and William S. Davidson II. 1992. “An Advocacy Intervention Program for Women with Abusive Partners: Initial Evaluation.” American Journal of Community Psychology 20(3):309–32.
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Related Programs

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Following are CrimeSolutions.gov-rated programs that are related to this practice:

Project Support Promising - One study
A program designed to provide support to battered mothers and reduce conduct problems in their children. The program is rated Promising. Children in the program were less likely to exhibit clinical levels of conduct problems, were happier and had better social relationships. Program mothers were less likely to use aggressive child-management strategies, to return to their abusive partners or experience physical violence during follow-up; and they reported improved parenting skills.

Empowerment Training for Abused Pregnant Chinese Women Promising - One study
An empowerment training program designed to raise self-esteem, improve health, and reduce intimate partner violence among pregnant Chinese women who have been abused. The program is rated Promising. The experimental group showed a larger decline in intimate partner violence for some measures such as psychological abuse and minor physical violence; improved health-related quality of life for some measures; and lower levels of postnatal depression compared to the control group.

Community Advocacy Project Promising - More than one study
A 10-week community- and strengths-based advocacy intervention for women with abusive partners. The program is rated Promising. There were mixed results on social support satisfaction and reported reabuse between the treatment and control group. One study reported no statistically significant group differences on continued involvement with the assailant. Overall, participants were more effective in obtaining and seeking resources, had a better quality of life and psychological well-being.

Telephone Support Services for Victims of Intimate Partner Violence Recruited from a Midwestern Pediatric Emergency Department No Effects - One study
This program provided resources via telephone to women victimized by intimate partner violence (IPV). It provided referrals to community programs, helped participants overcome barriers to obtaining services, and provided social support. The program is rated No Effects. Results showed no statistically significant differences between the treatment and comparison groups on IPV victimization, feeling vulnerable to a perpetrator, depression, and posttraumatic stress disorder.
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Practice Snapshot

Age: 15+

Gender: Female

Race/Ethnicity: Asian/Pacific Islander, Black, Hispanic, Other, White

Targeted Population: Females, Victims of Crime

Settings: Other Community Setting, Residential (group home, shelter care, nonsecure)

Practice Type: Crisis Intervention/Response, Gender-Specific Programming, Individual Therapy, Victim Programs

Unit of Analysis: Persons