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

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Review Question IV
developing a number of life skills. Women were
recruited primarily through the victim witness
programmes of two district attorney offices.
Follow-up did not extend beyond the 12-week
intervention. At the end of the intervention, selfefficacy
scores improved for the women receiving
group counselling, but declined slightly for women
in the control arm of the study. There was an
improvement in women’s perception of abuse
across time in both groups. There were no betweengroup
comparisons, no scores for the outcome
measures and no reporting of any statistical
analysis.
Variable results were obtained by Melendez and
colleagues 156 in a randomised controlled trial of
group counselling, in which abused and nonabused
women recruited from a family planning
clinic were offered four or eight group sessions of
cognitive behavioural therapy to prevent human
immunodeficiency virus (HIV)/sexually transmitted
disease (STD) infection. (The data for the abused
and non-abused women were reported separately
and only those relating to the abused women
are given here.) Two measures were used to test
safe-sex practices: condom use in general and
episodes of unprotected sex. At 1 month and 12
months of follow-up, abused women who received
eight sessions of counselling were significantly
more likely to say that they used condoms at
least sometimes, compared with controls or with
women receiving only four sessions of counselling.
However, there was no difference between groups
in the number of unprotected sex occasions.
Short-term benefits were reported in the use of
alternative safer-sex strategies in both intervention
groups, and negotiation over safer sex after eight
sessions of therapy, but these were not maintained
at 12-months’ follow-up. There was no difference
in abuse outcomes between the intervention and
control groups at any postintervention assessment.
A parallel group study by Rinfret-Raynor and
Cantin in Canada evaluated feminist-informed
therapy for survivors referred to social services,
either in individual or group sessions. 157 The
intervention was compared with the normal nonstructured
therapy provided to clients by the
agencies. The therapies were administered in a
number of settings, including community health
centres. When followed up after 12 months, women
in all three arms of the study showed similar
improvement over time in terms of abuse, selfesteem
and assertiveness.
Another group intervention was reported by
Kim and Kim 158 in a parallel-group evaluation in
Korea, conducted with women survivors of partner
violence residing long-term in a refuge. The
intervention group women were given eight weekly
sessions of counselling based on an empowerment
crisis-intervention model that was problem focused
and goal directed. Follow-up was restricted to an
immediate postintervention assessment. Women
who received counselling had significantly reduced
levels of trait anxiety compared with women in the
control group. There were no differences between
groups for state anxiety and depression scores,
which decreased in both. Self-esteem did not
change between or within groups.
A before-and-after evaluation conducted by
Howard and colleagues 159 considered counselling
delivered by 54 partner violence providers in
Illinois, USA. These providers varied in terms
of theoretical framework and delivery. Generic
counselling significantly improved the well-being
and coping of physically abused women who
approached support services for help, and was of
particular benefit to women who had been both
physically and sexually assaulted as compared with
women who had suffered physical assault on its
own.
In summary, there was a wide range of individual
psychological interventions, which demonstrated
improvements in psychological outcomes including
depression, PTSD and self-esteem. Two fairly wellexecuted
trials 125–129,145,146 of individual cognitive
therapy-based interventions for women with PTSD
who were no longer experiencing violence provide
reasonable evidence for this intervention, but this
cannot be extrapolated to the women who were still
in an abusive relationship. Consideration of only
the high-quality studies 142,143,145,146 for individual
interventions did not alter the findings.
Although there are 10 studies of group
psychological interventions, all showing
improvement in one or more psychological or
mental health outcome, all but one are poorly
executed. Consequently, the effectiveness of this
type of intervention remains uncertain, particularly
for women who are still experiencing partner
violence.