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