Evaluating a Collaborative Intervention Between Health Care and Criminal Justice in Harris County, Texas, 2001-2002 (ICPSR 3542)

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Study Purpose View help for Study Purpose

Violence against women largely involves intimate partners, such as husbands, boyfriends, and dates. The urgency and magnitude of the problem of intimate partner violence have caused service providers, policy-makers, and advocates to implement treatment and intervention programs in the absence of scientific evidence. The rush to do something has resulted in a broad array of interventions, many with origins in local and national advocacy efforts, such as shelters and social support programs. These interventions remain mostly undocumented and unanalyzed in the research literature. Abused women often turn to the justice system for protection, preferring to file for protection orders rather than filing assault charges against their abusers. Several studies have demonstrated that intimate partner violence decreases after a woman receives a protection order. The purpose of this study was to evaluate the Advocacy-Case Management Intervention designed to increase victim safety and increase the efficiency of the protection order process. The intervention was performed by registered nurses as part of a collaborative partnership between justice and health care agencies.

Study Design View help for Study Design

A two-group experimental design with an intervention using random assignments to control and experimental groups was used. The study subjects were women who qualified for a civil protection order against a sexual intimate. Women randomized to the control group were offered standard services of the specialized district attorney's (DA) office, which consisted of individual counseling and community referral information on violence. All applicants were routinely given the name and phone number of their intake interviewer and encouraged to telephone the DA's office for further assistance. Following routine DA procedures, control group women were offered a card with contact information and appointment times for the three-, six-, 12-, and 18-month interviews. Women were compensated for each interview. Women randomized to the intervention group were offered the standard services of the DA's office plus six advocacy case management intervention telephone calls. The advocacy case management intervention was comprised of two parts. The first part consisted of six telephone contacts with the victim. The first intervention phone call occurred within 48 to 72 hours of the protection order application by the victim. The victim was recontacted at one, two, three, five, and eight weeks thereafter. The focus of each call was on victim safety. Each call began with the safety behavior checklist, noting behaviors adopted since the last contact. During each phone call, the advocate offered suggestions and strategies for adopting safety behavior. The advocate also offered educational information and tailored referral sources to each woman's unique situation. During each of the six planned advocacy phone contacts, the victim was offered a status update on any missing information from her protection order application. The advocate advised the woman on securing needed pieces of information, such as divorce or paternity decrees, medical records, or certified birth certificates. The advocate supported, encouraged, and complimented the woman's efforts toward completion of her protection order file. The telephone calls ranged in duration from three minutes to 25 minutes, with a average of nine minutes per call. The telephone calls stopped eight weeks after application for the protection order. The second part of the advocacy case management intervention entailed the advocate checking the progress of protection orders for women in the intervention group. Appropriate offices were called to ascertain whether essential papers had been received and how many attempts had been made to serve legal papers to the abuser. All female applicants who qualified for a protection order against a sexual intimate, and who spoke English or Spanish, were invited to participate in the study. All but one of the women completed the three-, six-, 12-, and 18-month follow-up interviews and were compensated monetarily for their participation in each separate interview. Each interview used six different instruments to measure the victim's safety-seeking behavior, levels of experienced violence, physical and emotional functioning, and employment productivity. First, a 15-item safety survey was administered to assess for present use of safety behaviors and chart future adoption. At the first assessment, the woman was asked "Have you ever ...?" At subsequent sessions, the women were asked "Since the last time we talked, have you ...? The second instrument, Severity of Violence Against Women Scale, was a 46-item questionnaire designed to measure threats of physical violence (19 items) and actual physical trauma (27 items). For each behavior, the woman responded using a four-point scale to indicate how often the behavior occurred. The next instrument was a Stalking Victimization Survey (SVS), an 18-item yes/no questionnaire. Eight items were developed by Tjaden and Thoennes (1998) as part of the VIOLENCE AND THREATS OF VIOLENCE AGAINST WOMEN IN AMERICA SURVEY [VIOLENCE AND THREATS OF VIOLENCE AGAINST WOMEN AND MEN IN THE UNITED STATES, 1994-1996 (ICPSR 2566)]. Examples of items included were: being followed or spied on, receiving unsolicited letters or written correspondence, or finding the perpetrator standing outside the victim's home, school, or workplace. The SVS also included ten items from the Sheridan (1998) HARASS instrument. The fourth instrument, Danger Assessment Scale, was a 15-item questionnaire with a yes/no response format designed to assist women in determining their potential risk for becoming a homicide victim. All items referred to risk factors that had been associated with murder in situations involving abuse. The fifth instrument used was the Medical Outcomes Study Short Form (MOS SF-12) Health Survey, a shorter version of the SF-36 survey, which was used to assess health status across physical and emotional domains. The last instrument used dealt with work site harassment.

Sample View help for Sample

The sample for this study consisted of all women, 18 years or older, applying and qualifying for a protection order against a sexual intimate. At the agency where this study was completed, criteria for qualification for a protection order included (1) being a victim of family violence, (2) a likelihood that family violence would occur again in the future, and (3) a current or former intimate relationship that included cohabiting or being the biological parents of the same child. Women were informed at the time of application at the district attorney's office whether they qualified for a protection order. Only qualifying applicants were invited to participate in the study. Other sample criteria included the requirement that the woman speak either English or Spanish. A two-group randomized control design was followed. Sampling with randomization to treatment or control groups continued for 28 days until 75 women were entered into the control group and 75 women were entered into the treatment group. A total of 154 women qualified for the study and were invited to participate. Four women refused to participate. The primary reason given for refusal to enter the study was pain from physical injuries. One woman committed suicide three weeks into the study. All remaining 149 women completed the three-, six-, 12-, and 18-month follow-up interviews.

Universe View help for Universe

All female applicants qualifying for a protection order against a sexual intimate partner living in Harris County, Texas.

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Description of Variables View help for Description of Variables

Variables consisted of items taken from a safety behavior checklist that asked victims if they hid money, extra house and car keys, or a bag with extra clothing, established a secret code with family and friends, asked neighbors to call the police if violence began, or removed weapons. Additional items indicated whether the victim had the following readily available: Social Security numbers for herself, the perpetrator, and her children, rent and utility receipts, birth certificates for herself and her children, an identification card or driver's license, bank account numbers, insurance policies and numbers (medical, auto, life, or house), a marriage license, valuable jewelry, and important phone numbers. A severity of violence-against-women-scale instrument was used to determine the frequency with which the abuser threw an object, or threatened to destroy property, hurt someone, kill himself, or kill the victim, and the frequency with which the abuser pulled, spanked, bit, grabbed, choked, punched, burned, or raped the victim. A stalking survey captured behaviors such as whether the abuser followed the victim, sent unsolicited letters, stood outside the victim's home or workplace, killed the victim's pet, or threatened the victim's family and friends. A danger scale instrument captured whether physical violence increased in frequency or severity and whether there were drugs or firearms in the home. Victims were asked whether their health limited them in moderate activities, and whether they felt calm, down-hearted, or had energy. Victims were also asked a series of questions about harassment in the workplace. Demographic variables include age, level of education, race, ethnicity, and income of victim and abuser.

Response Rates View help for Response Rates

The response rates for the follow-up interviews were not available.

Presence of Common Scales View help for Presence of Common Scales

The following scales were used for this study: Severity of Violence Against Women Scale (Marshall, 1992), Medical Outcomes Study Health Survey, Short Form-12 (MOS SF-12) (Ware, 1993), Stalking and Harassment (Sheridan, 1992), and Campbell Danger Assessment (Campbell, 1993).

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Original Release Date View help for Original Release Date

2003-05-16

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