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Practice Profile

Advocacy Interventions for Women Who Experience Intimate Partner Violence

Evidence Ratings for Outcomes:

No Effects - 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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No Effects - One Meta-Analysis Victimization - Domestic/intimate partner/family violence
Rivas and colleagues (2016) did not find any significant differences in incidences of physical abuse for women who participated in advocacy interventions, compared with control group women who did not participate.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11991 - 2010132141

Meta-Analysis 1
Rivas and colleagues (2016) conducted a meta-analysis to examine the effects of advocacy interventions for women who experience intimate partner violence (IPV). Between 2011 and 2015, the researchers searched electronic databases for international peer-reviewed and non-peer-reviewed studies. The researchers also conducted website searches, manually searched journals, tracked citations, and emailed authors to inquire about potential new studies. The search spanned literature available from 1948 to 2015. Studies were eligible for inclusion if participants were at least 15 years of age and were randomly or quasi-randomly assigned to receive either an advocacy intervention or no care/care as usual. Eligible studies recruited women from healthcare settings, criminal justice facilities, refuges/shelters, or domestic violence agencies. Interventions could be brief (less than 12 hours) or intensive (12 or more hours) and could be delivered in individual or group settings. Interventions incorporated safety planning with the women or facilitated access to and use of community resources, such as refuges or shelters, emergency housing, and psychological care. Interventions that provided these services, either with or without ongoing informal support or counselling, were included.

In a prior review (Ramsay et al. 2009), the researchers only included multicomponent intervention studies where advocacy was the sole difference between the treatment and comparison groups (i.e., both groups received intervention A, but only the treatment group received the additional advocacy intervention). For the present review, multicomponent intervention studies included advocacy in addition to some other form of intervention, and these were compared with no care or care as usual. The present review also incorporated a more stringent definition of “usual care,” defining this type of care as including a minimal element of advocacy, such as providing information cards or leaflets listing addresses and telephone numbers of local support agencies. If more substantive advocacy was offered, then the study could be included only if fewer than 20 percent of women in the control group had received such care.

The search yielded 13 eligible studies from 1991 to 2011. Eleven of the studies were randomized controlled trials, and two were quasi-experimental designs. Twelve of the studies were published in peer-reviewed journals, and one was a published doctoral dissertation. Eight of the studies recruited women in healthcare settings, three in domestic violence shelters, one primarily in a domestic violence shelter but also through social and family service agencies, and one from a community center in a large urban area. The severity of abuse faced by the women varied considerably across studies, ranging from minor to severe physical, sexual, or emotional abuse. A total of 2,141 women took part in the trials. Sixty-one percent were recruited because they were experiencing current (within the last 12 months) physical or sexual abuse. Seven studies extended this inclusion to women who were experiencing emotional or non-physical abuse. Most of the women were still living or intimately involved with the abuser at study entry. The women ranged in age from 15 to 65; however, most were between the ages of 24 and 45. Seven studies included white, black, and Latina women; four studies focused on single ethnic groups (one was with Latina only, one was with black women only, and two were conducted in Hong Kong with Chinese women); one study focused predominantly on women who identified as Mestizo; and one study was conducted in Australia where nearly half of the women were born in Vietnam or a country other than Australia.

Interventions varied in length. In general, interventions described in non-healthcare settings were longer, typically taking place over a period of 2 to 4 months. Most of the interventions recruiting women in healthcare settings were relatively brief; three were one-off sessions and lasted 20 to 30 minutes, 30 minutes, and 90 minutes. Four other trials offered advocacy sessions over a prolonged period but were still generally brief. Follow-up length also varied by studies. Four studies did not conduct a further follow up after assessing outcomes upon completion of the intervention, and the remaining nine studies conducted follow ups from 10 weeks to 3 years postintervention.

The 13 studies included 25 outcome measures. Eleven studies measured some form of abuse (using eight different scales), six assessed quality of life (three scales), six measured depression (three scales), and three measured anxiety or psychological distress (three scales). Eight studies measured physical abuse, six of which evaluated brief advocacy interventions, and two that evaluated intensive interventions. Effects sizes were calculated for five of the six studies that offered brief advocacy. Fixed-effect models were used in all analyses given that all analyses were based on subsets of studies that were deemed clinically heterogeneous. Effect sizes were restricted to the latest sample or latest follow up. The researchers did not indicate use of weighting.
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Cost

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There is no cost information available for this practice.
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Other Information

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This practice has been updated to reflect findings from a more recent meta-analysis. In 2015, the practice was rated Promising for reducing physical abuse, based on the review of a meta-analysis by Ramsay and colleagues (2009). In 2019, an updated version of the original meta-analysis (Rivas et al. 2016) was reviewed. Based on information from the updated meta-analysis, the practice is now rated No Effects for reducing physical abuse.

The rating was updated to reflect the review of the revised meta-analysis for the following reasons: 1) The original meta-analysis (Ramsay et al. 2009) included two studies with a total sample size of 295, whereas the updated meta-analysis (Rivas et al. 2016) included 13 studies with a total sample size of 2,141. The increase in the number of studies adds more confidence to the findings of the updated meta-analysis. 2) In the original meta-analysis, all studies that compared advocacy interventions with no care or usual care were included. However, in the updated meta-analysis, the authors acknowledged that sometimes usual care can still incorporate elements of advocacy. Therefore, in the updated meta-analysis, studies were excluded if the usual care condition included a substantial element of advocacy that was received by more than 20 percent of women in the control group.
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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
Rivas, Carlos, Jean Ramsay, Laura Sadowski, Leslie Davidson, Danielle Dunne, Sandra Eldridge, Kelsey Hegarty, Angela Tat, and Gene Feder. 2016 “Advocacy Interventions to Reduce or Eliminate Violence and Promote the Physical and Psychosocial Well-Being of Women Who Experience Intimate Partner Abuse.” Campbell Systematic Review 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.

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.

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
This program is designed to provide support to battered mothers and reduce conduct problems in their children. The program is rated Promising. There were statistically significant effects in favor of the treatment group on measures of children’s conduct problems, happiness, and mothers’ aggression toward children. However, there were no statistically significant effects on children’s internalizing behaviors, mothers’ return to abusive partners, or recurrence of physical violence.

Empowerment Training for Abused Pregnant Women in China Promising - One study
This is an empowerment training program for pregnant women in China who have been abused. The program is rated Promising. For the experimental group, there were statistically significant declines in levels of psychological abuse, minor physical violence, physical functioning, physical and emotional role limitation, and postnatal depression. However, there were no statistically significant effects on severe physical violence, sexual abuse, and other health-related, quality-of-life measures.

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 - 65

Gender: Female

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

Targeted Population: Females, Victims of Crime

Settings: Inpatient/Outpatient, 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