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

DOI: 10.3310/hta13160 Health Technology Assessment 2009; Vol. 13: No. 16
and still had a significantly higher quality of life
than women in the control arm. Subsequent to the
review by Ramsay and colleagues, a 3-year followup
130 has been conducted. This shows that advocacy
continued to have a positive impact on the women’s
quality of life and level of social support, although
there was no continuing benefit in terms of
revictimisation.
Advocacy and associated services also benefited
pregnant abused women who were still in a
relationship with the abuser, according to a parallel
group intervention study conducted by McFarlane
and colleagues. 131–133 The women, attending an
antenatal clinic, were offered an intervention of
three brief sessions of individual advocacy (not
described in any detail) – education, referral and
safety planning – spread over their pregnancies.
Additionally, half of the intervention group was
offered three further support group sessions at
a local refuge, but outcomes for these were not
considered separately. The investigators found
that women receiving the intervention significantly
increased their use of safety behaviours, including
hiding keys, hiding clothes, asking neighbours to
call the police, establishing a danger code with
others, and hiding money. At a 12-month followup,
women in the intervention group reported
significantly improved resource use but not use
of the police, and there were also significant
reductions in violence, threats of violence and nonphysical
abuse against the women compared with
women in the control group
Another advocacy study was also conducted in an
antenatal setting by McFarlane and colleagues. 134 In
this randomised controlled trial, abused Hispanic
women were allocated to one of three intervention
groups: (1) ‘brief ’, where women were offered a
wallet-sized card with information on community
resources and a brochure; (2) ‘counselling’, where
for the duration of the pregnancy women were
offered unlimited access to a bilingual domestic
violence advocate who was able to provide support,
education, referral and assistance in accessing
resources; and (3) ‘outreach’, which included all
aspects of the ‘counselling’ intervention, plus the
additional services of a bilingual trained nonprofessional
mentor mother who offered support,
education, referral and assistance in accessing
resources. The investigators found that violence
and threats of violence decreased significantly
across time for all three intervention groups. At
2 months postdelivery, violence scores for the
‘outreach’ group were significantly lower compared
with the ‘counselling’-only group; but there was
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no significant difference when compared with the
‘brief ’ intervention group women who had received
only a resource card and brochure. Subsequent
follow-up evaluations at 6, 12 and 18 months
found no significant differences between the three
intervention groups. Use of resources was low for
each of the groups and did not differ significantly
by type of intervention at any of the follow-up
evaluations.
A third advocacy study by the same research group
was a randomised controlled trial, 135,136 based in
a family violence unit of a large urban district
attorney’s office. All women received the usual
services of the unit, which included processing
of civil protection orders and optional advocacy
referral, and the phone number of a caseworker
for further assistance. They also received a 15-item
safety-promoting behaviour checklist. In addition
the intervention group received six follow-on
phone calls over 8 weeks to reinforce the advice on
adopting safety behaviours. The number of safetypromoting
behaviours increased significantly in
the intervention group, both compared with the
control group and up to 18 months later.
An advocacy study by Feighny and Muelleman 137
took place in a hospital’s accident and emergency
department. The advocate saw the woman within
30 minutes of disclosure, discussed the incident
with her, addressed safety issues, provided
education about the cycle of violence, and
informed her of community resources. A beforeand-after
design with historical controls was
employed to evaluate outcomes, with data obtained
from police/judicial, refuge and medical records.
Women receiving advocacy significantly increased
their use of refuges and refuge-based counselling
services in comparison with preintervention
controls. However, there was no effect on
subsequent experience of abuse as measured by the
number of repeat visits to the department over a
mean follow-up period of 65 weeks, nor was there
any significant difference in the number of police
calls made by women after their initial visit, or in
the number of women who went on to obtain full
protection orders.
Tutty 138 considered the effects of advocacy for
women leaving refuges using a before-and-after
study design. The intervention programme of
support and advocacy, of longer duration than
the model used by Sullivan, was provided by a
graduate social worker and provided counselling
and other help for the women. The main goals
of the advocacy were to respond to the individual
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