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.
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.
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.
All female applicants qualifying for a protection order
against a sexual intimate partner living in Harris County, Texas.
Individuals.
Data were collected using telephone interviews with
women qualifying for the sample criteria.
survey data
experimental data
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.
The response rates for the follow-up interviews
were not available.
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).