How far does screening women for domestic (partner) - NIHR Health ...

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Review Question IV
access resources when these were available; and
provided an environment where they could talk
with a counsellor and friends. Follow-up did not
extend beyond the intervention period. At the
end of the programme the experimental group
had significant improvements on the ‘belonging’
function of social support, and had significant
reductions in psychological distress and health-care
utilisation. The authors reported non-significant
improvements in ‘tangible’ social support and total
social support, but no data were presented.
An individually randomised controlled trial
conducted by McFarlane and colleagues in two
urban primary care public health clinics and two
women, infants and children clinics compared a
nurse case management intervention with a referral
card that listed a safety plan and sources of partner
violence services. 123 Project nurses received a 40hour
training programme based on the March of
Dimes protocol prior to study implementation.
Advocacy sought to empower the women by
increasing independence and control through
encouraging the use of a 15-item safety-promoting
behaviour checklist, supplemented with supportive
care and anticipatory guidance by a nurse and
guided referrals tailored to the women’s individual
needs, such as job training. There were five
20-minute case management sessions. The control
group received standard refuge services provided
to all residents. No effect for the intervention was
found at the 24-month follow-up: all outcomes
(use of safety behaviours and community
resources, threats, assault, homicide risk and work
harassment) improved over time, regardless of
group allocation. Study participants did not report
any adverse effects. For findings relating to the
children of the participants, see Interventions with
children of abused women below.
Sullivan and colleagues tested the effect of an
advocacy intervention aimed at abused women and
their children (aged between 7 and 11 years) using
an individually randomised controlled trial study
design. 124 The intervention took place in women’s
homes in an urban setting. Advocacy was based on
the individual needs of the mother and child, but
all sessions actively assisted mothers in accessing
community resources. The majority (79%) of the
women were recruited when leaving a domestic
violence refuge and the remainder were recruited
from community family service organisations or
social services. Unspecified control group care was
compared with a multicomponent intervention
consisting of: (1) a highly trained paraprofessional
who worked for 16 weeks and helped mothers to
mobilise and access community resources; (2) the
same paraprofessional who advocated similarly for
the children for 16 weeks; (3) a 10-week support
and education group attended by the children
within the 16 weeks. Families saw their advocates
for a mean of 10 hours a week, averaging 5 hours
with the children and an additional 2.7 hours
with the women. The basis of advocacy and the
content of the sessions was similar to that of
earlier intervention studies by Sullivan and her
colleagues 125–129 (reported under Studies included
in our previous review below). An important part
of the intervention was ensuring that the advocate
was no longer needed after 16 weeks. At a 4-month
follow-up, women in the intervention group had
significantly reduced depression and improved
self-esteem. Mothers who received advocacy also
reported better quality of life than mothers in the
control group, although this was not statistically
significant. However, the intervention did not have
an effect on the incidence of actual abuse or social
support. For findings relating to the children,
see Interventions with children of abused women
below.
Studies included in our
previous review
Here we summarise the findings of studies
examined in our previous review. 11 In two separate
randomised controlled studies (a pilot and a
main study) by Sullivan and colleagues, 125–129
undergraduate psychology students were trained
to provide 10 weeks of community-based advocacy
to severely abused women exiting from refuges.
Advocacy was tailored to the individual women’s
needs to help them to access community resources
(such as housing, employment, legal assistance,
transport and childcare), as well as empowering
the women themselves. A number of beneficial
outcomes were observed over time. In the main
study, at the end of the advocacy period, there
was a significant improvement in the women’s
perceived effectiveness in obtaining resources,
quality of life and perceived social support as
compared with baseline and control group scores.
At 10 weeks postintervention, the women who
received advocacy reported improvement in
their quality of life, and this was maintained at
6 months after the cessation of the programme.
Initial improvements in perceived effectiveness in
obtaining resources and perceived social support
were no longer statistically significant at 6 months.
However, when followed up 2 years after the
cessation of advocacy, women in the advocacy
group reported significantly less physical abuse