This annual report - Taranaki District Health Board

Family ViolenceThis section reviews the evidence base for interventions aimed at addressing familyviolence in pregnancy, while Table 72 on Page 316 and Table 90 on Page 344 provide abrief overview of interventions aimed at addressing child abuse and family violence ingeneral.Antenatal care for women who experience family violenceThe NICE guidance on pregnancy and complex social factors includes a systematic reviewaddressing service provision for women who experience intimate partner violence [139].The review examined access to antenatal services, barriers to care, maintaining contact,additional supports and information requirements for young women. No studies were foundthat investigated interventions aimed at improving access to services. Common barriers tocare were: women‘s fear of the potential involvement of social services; women‘s anxietythat her partner will find out she has disclosed the abuse; insufficient time for healthcareprofessionals to deal with the issue appropriately; and insufficient support and training forhealthcare professionals in asking about domestic abuse. Two before and after studiesshowed that education and training for health professionals on responding to domesticabuse, and how to provide care to women who are victims of domestic abuse, wereeffective in improving staff attitudes. There was a lack of good quality evidence to supportthe benefits of any specific intervention, including counselling, outreach or use of police.However, the studies identified suggested that a combination of education, advocacy,counselling (not necessarily conducted by professional counsellors) and/or communityreferral increases adoption of safety behaviour and reduces the risk of domestic abuse.Home visitingThe evidence base for home visiting interventions aimed at addressing intimate partnerviolence and the prevention of family violence in pregnancy is limited. Sharps et al.reviewed the evidence for perinatal home visiting with a specific focus on intimate partnerviolence [203]. Eight studies (4 RCTs, 2 studies linked to RCTs, one pre-post testintervention study without control group and one cross-sectional study) were identified, allof which included assessment for IPV although none of the interventions was designed toaddress IPV specifically. One study found that the presence of IPV limited the ability of theintervention to improve maternal and child outcomes. The interventions usingparaprofessional home visitors identified difficulties communicating, responding andmaking appropriate referrals where IPV was identified. The effectiveness of nurse homevisitors in addressing IPV was not demonstrated but lack of education and training wereidentified as barriers across all the studies. The authors identify a need for trials of homevisiting interventions that include components addressing IPV.TreatmentIn their review of IPV treatment studies Stover et al. (see page 346) found limited evidenceof the effectiveness of interventions on reducing repeat violence [273]. Most interventionsshowed minimal benefit above arrest alone, and consistent recidivism rates ofapproximately 30% within six months. The lowest recidivism rates were found in a trial ofbehavioural couples therapy (BCT), an integrated treatment that simultaneously addressesproblems with substance abuse and aggression within couples (18% recidivism rate forBCT versus 43% for individual substance misuse treatment at 12-month follow-up). Thereview identified one antenatal clinic intervention in which 329 Hispanic victims of IPV wererandomly assigned to: provision of wallet-sized resource cards; or unlimited access tosupportive, nondirective counselling; or unlimited counselling plus support from a “mentormother.” Follow up at two, six, 12, and 18 months postnatally found that women whoreceived both counselling and mentorship, and women who received the resource cardonly, reported less violence at two months post-delivery than the counselling-only group.However, there were no significant differences among the groups at 12 or 18 months postdelivery.Advocacy interventionsAdvocacy interventions, which aim to help abused women by providing them withinformation and support to facilitate access to community resources, have been assessedIn-Depth Topic: Adversity in Pregnancy - 301