Presented by Renee Harrison, MSW University of Utah 2012 Interventions to reduce violence and promote the physical and psychosocial well-being of women who experience partner violence: a systematic review of controlled evaluations -Ramsay, Rivas, & Feder Presented by Renee Harrison, MSW University of Utah 2012

Need for this review Screening can lead to an increase in the number of abused women being identified by health professionals What interventions are most appropriate Recommendations for interventions are generally not based on empirical findings, but rather on expert opinion, anecdotal evidence, personal experience, and logic.

Objectives To examine the evidence provided by controlled intervention studies, interventions targeting only women who have been abused, and organizations/ professionals that may have contact with abused women.

Continued… Examine the evidence systematically Determine which women most likely are to benefit, and in what ways How the interventions might work Consult with key stakeholders and to elicit their views on the findings Compare the findings with other reviewers Discuss policy implications NHS (National Health Service) for recommendations incorporating views of key stakeholders

Search Strategy Primary studies were identified by searching a wide selection of biomedical, psychosocial and legal electronic databases: Medline, Embase, Cinahl;, Database of Abstracts of Reviews for Effectiveness, National Research Register, Cochrane Collaboration Central Register, Campbell Collaboration Library, PsycInfo, BIDS International Bibliography of the Social Sciences, Institute for Scientific Information Proceedings (Social Science and Humanities edition),

Searched Continued… Social Science Citation Index, Social Trends, Violence and Abuse Abstracts, Westlaw, and Lexis/Nexis, Databases were searched from their respective inception dates to September 30, 2004.

Search continued… Westlaw, a multiple database search was used: “Legal Journals Index” contains details of articles in approximately 430 journals published in the UK and Europe, but not the USA. American law journals were accessed separately, using the “Index to Legal Periodicals”. The UK Journals were also searched. And “All Law Reviews” and Jurisprudences and Law Reviews” for the USA

Searched continued… Hand searched journals for primary studies for the years l985 to the end of September 2004. The journals searched were: American Journal of Public Health, Australian and New Zealand Journal of Public Health, Journal of Family Violence, Medical Journal of Australia, Violence and Victims, and Women’s Health.

Medline search and key words: Appendix II: Medline search To determine central subject matter Interventions Outcomes Study types –maximally sensitive for study type, extra lines added to capture extra time series and parallel group studies. Lines relating to placebo have been deleted. Negative impact- outcomes that are worse after intervention or might have been missed during search. Search results-multiple separate lines, rather than combining, the effect of different choices on final sample size is evident

Identification of studies and selection Fig. 1: Stages in the review process ______________________________ Potentially relevant articles identified From sources and screened for retrieval (n=16295) from search 3 from recommendations by experts Articles excluded, with reason (n=15287) 3758 duplicates 1464 intervention 4272 participants 1353 study type 1706 design 575 outcomes 4 not paper printed media the 2154 identified through the Westlaw and Lexis legal searches, all were either duplicates or not considered relevant

Continued. . . Articles retrieved in full for more Detailed evaluation (n=1008) Articles excluded, with reasons (n=946) 4 not available 46 intervention 82 participants 594 study type 165 design 55 outcomes 0 not printed media Potential primary study articles (n=62) Articles withdrawn after correspondence with authors, with reason (n=14)1 no data, 3 outcomes, and 10 more outcomes, all after no author reply 3 outcomes

continued Included articles, by intervention (n=48) 17 advocacy (including safety planning) support groups 14 psychological 10 health care setting with structured training 1 health care setting without structured training 4 non-health Number of included authors who provided more information concerning missing data (n=6)

Continued. . . Primary studies, by intervention, Represented by the 48 included articles (n=36) 9 advocacy (including safety planning) 1 support groups 11 psychological 9 health care setting with structured training 1 health care setting without structured training 5 non-health care Studies excluded from the meta- analyses, with reason (n=28) missing data 3 advocacy, 3 psychological, 6 health care setting with structured training no appropriate controls 2 advocacy, 1 psychological

Continued. . . outcomes not comparable 2 advocacy, 1 support groups, 3 psychological, 1 health care setting without structured training, 5 not health care setting 2 advocacy studies were suitable for abuse outcomes but not worth pooling two studies Studies included in meta-analysis (n=17) 4 psychological 3 health care with structured training

Inclusion Criteria Types of Interventions: Women-centered Advocacy Support groups Psychological (therapy and counseling) Female Aged at least 16 years old

Continued… System-centered – To improve the response of organizations/professionals that come into contact with abused women by targeting the organization 1) structured training (health care) 2) without structured training (health care) 2) non-health care No inclusion criteria relating to organizations or their staff

Continued.. Evaluate evidence from intervention studies initiated in health care settings Also, evidence from interventions conducted outside of health care systems were included if studies reported data on health outcomes or levels of abuse from abused women There were no restrictions on geographical or national setting

Exclusion Criteria Partner violence interventions involving couples or family therapy That sought to change behaviour of abuser That sought to help children of abused mothers That sought to increase societal awareness Non-partner violence interventions addressing: Child, elder, and other familial abuse

Strength of the Evidence

Principal findings Most of the primary studies used weak research designs for answering questions about effectiveness of interventions and the quality of execution of many of the primary studies is poor. However, they provide a basis for policy within health care settings. Evidence from the advocacy studies suggests this form of intervention, particularly women seeking help from professional services or in a refuge setting, can reduce abuse, increase social support and their quality of life

Continued. . . Support group intervention resulted in a reduction of abuse and improved psychological outcomes, including self esteem and coping with stress Psychological interventions are effective in reducing depression in women with a history of partner violence System-centred interventions with at least some degree of staff training and supportive materials, including health care settings, increase referral rates in the short-term. Follow-up: There is evidence training of new staff is needed.

Continued. . . System-centred non-health care intervention studies, largely police-based, are problematic and do not contribute to health service policy. However, one of the studies supports the usefulness of multi-agency case conferences, and the overall positive effect of these interventions improve the response to partner violence.

Research recommendations More randomized controlled trials with better reporting of interventions and studies and using standardized or comparable outcome measures Studies with longer follow-up to assess the medium term benefits of interventions on individual women Cost-effectiveness studies, particularly when assessing the value of interventions of variable intensity Systems for recording adverse effects of interventions that are not addressed in the outcome measures

Citation Feder, G., Ramsay, J., & Rivas, C. (2005) Interventions to reduce violence and promote the physical and psychosocial well-being of women who experience partner violence: a systematic review of controlled evaluations. Cochrane Database of Systematic Review. Barts and The London, Queen Mary’s School of Medicine and Dentistry.