[Show abstract][Hide abstract] ABSTRACT: Background Based upon therapeutic justice principles, mental health courts use legal leverage to improve access and compliance to treatment for defendants who are mentally ill. Justice-involved women have a higher prevalence of mental illness than men, and it plays a greater role in their criminal behavior. Despite this, studies examining whether women respond differently than men to mental health courts are lacking. Study goals were to examine gender-related differences in mental health court participation, and in criminal justice, psychiatric and health-related outcomes. Methods This study utilized a quasi-experimental pre-posttest design without a control group. The data were abstracted from administrative records of Kalamazoo Community Mental Health and Substance Abuse agency, the county jail and both county hospitals, 2008 through 2011. Generalized estimating equation regression was used to assess gender-differences in pre-post program outcomes (jail days, psychiatric and medical hospitalization days, emergency department visits) for the 30 women and 63 men with a final mental health court disposition. Results Program-eligible females were more likely than males to become enrolled in mental health court. Otherwise they were similar on all measured program-participation characteristics: treatment compliance, WRAP participation and graduation rate. All participants showed significant reductions in emergency department visits, but women-completers had significantly steeper drops than males: from 6.7 emergency department visits to 1.3 for women, and from 4.1 to 2.4 for men. A similar gender pattern emerged with medical-hospitalization-days: from 2.2 medical hospital days down to 0.1 for women, and from 0.9 days up to 1.8 for men. While women had fewer psychiatric hospitalization days than men regardless of program involvement (2.5 and 4.6, respectively), both genders experienced fewer days after MHRC compared to before. Women and men showed equal gains from successful program completion in reduced jail days. Conclusions Despite similar participation characteristics, findings point to greater health gains by female compared to male participants, and to lower overall psychiatric acuity. Mental-health-court participation was associated with decreased psychiatric hospitalization days and emergency department visits. Successful program completion correlated to fewer jail days for both women and men.
[Show abstract][Hide abstract] ABSTRACT: Every year, thousands of children become involved in the child welfare system. The responsibility for these children’s health and welfare lies with child welfare system. However, governmental mandates and funding streams dictated by the federal, state and local governments place limitations on what services agencies can offer and what interventions they can implement. This presentation will discuss findings from a two-year mixed method study funded by the Robert Wood Johnson Foundation’s Public Health Law Research Program to examine the impact of funding sources, both Title IV-E waivers as well as local levies, on child welfare outcomes. The community-based participatory research team was comprised of attorneys, a statistician, an anthropologist, and child welfare experts. The study included quantitative analysis of ten years of statewide county-level data, surveys with county child welfare leaders, and semi-structured interviews with key informants and a stratified sample drawn from counties with diverse funding structures and population levels. Findings suggest funding matters, as well as partnerships. The notion of the courtroom workgroup has been altered beyond the courthouse walls to include service providers, mental health professionals, substance abuse counselors, kinship care providers and myriad others. The ability to use funding streams in flexible manners influences outcomes, but also assists with partnerships forged and fostered. Future research plans are discussed for this portfolio of collaborative work with the ultimate goal of improving children’s lives.
142nd APHA Annual Meeting and Exposition 2014; 11/2014
[Show abstract][Hide abstract] ABSTRACT: Intimate partner violence (IPV), childhood abuse, and sexual assault in adulthood are profound public health concerns, particularly for women. Exposure to trauma can contribute to long-standing health problems and escalated medical costs. Unfortunately, these experiences are often intertwined. Sexual assault often occurs in intimate relationships in which there is concurrent IPV; likewise, many victims of IPV have experienced childhood abuse. The prevalent intersections of these struggles can lead to posttraumatic stress disorder (PTSD) symptoms. This article examines the contributions of childhood abuse histories and sexual assault to PTSD symptoms among women experiencing IPV. Findings suggest childhood abuse experiences account for more variance in PTSD symptoms than adult sexual assault. Clinical implications are discussed.
Journal of Interpersonal Violence 10/2014; · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Adverse childhood experiences (ACEs) are associated with several adulthood health problems, such as self-directed violence. For some individuals, enlistment in the military may be an instrumental act to escape adverse household environments; however, to our knowledge prevalence of ACEs among persons with a history of military service has not been documented in the United States using population-based data.
[Show abstract][Hide abstract] ABSTRACT: This study examined the relationships among victimization, demographic characteristics, and activity choices in a cross-sectional sample of 479 undergraduate students. In the sample, 74% was female and 65% was Caucasian, with an even distribution of ages ranging from 18 to 22+ years; all participants completed an online survey. Using survey feedback, the study team performed multivariate regression analysis and reported quantity and type of victimization experiences in relation to factors that may contribute to identifying groups at risk for experiencing violence. Findings suggest that gender, grade point average, and membership in student organizations or Greek-letter organizations influence students' potential for different types of victimization. Furthermore, alcohol use and household income did not have a statistically significant relationship with any victimization types. Finally, rates reported indicate student underreporting and illustrate difficulty implementing the Clery Act. Policy recommendations, future research, and limitations are discussed. With accurate victimization data, resources and services may be more efficiently allocated to meet the needs of students at greater risk for victimization.
Journal of Interpersonal Violence 06/2014; · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Legal leverage is broadly defined as the use of legal authority to promote treatment adherence. It is widely utilized within mental health courts, drug courts, mandated outpatient treatment programs, and other intervention strategies for individuals with mental illness or chemical dependency who have contact with the criminal justice system. Nonetheless, the ethics of using legal authority to promote treatment adherence remains a hotly debated issue within public and professional circles alike. While critics characterize legal leverage as a coercive form of social control that undermines personal autonomy, advocates contend that it supports autonomy because treatment strategies using legal leverage are designed to promote health and independence. Despite the controversy, there is little evidence regarding the impact of legal leverage on patient autonomy as experienced and expressed by patients themselves. This report presents findings from a qualitative study involving six focus groups with severely mentally ill outpatients who received legal leverage through three forensic assertive community treatment (FACT) programs in Northeastern, Midwestern, and West Coast cities. Findings are discussed in the context of the self-determination theory of human motivation, and practical implications for the use of legal leverage are considered.
Harvard Review of Psychiatry 06/2014; · 2.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Are intimate partner violence (IPV) victims safer if they use the criminal justice system? Concerns about perpetrator retaliation, in the face of data that protection orders can reduce future harm, make it important to understand how victim utilization (calling 911, talking to the prosecutor, and proceeding with prosecution) affects subsequent safety. We hypothesized participation would improve victims' safety, measured by decreases in subsequent IPV-related 911 calls and/or emergency department visits. Findings support contact with the prosecutor's office was associated with reduction in police-reported IPV, regardless of the victim's wish to proceed. Policy implications support pro-prosecution strategies coupled with victim contact.
Violence Against Women 06/2014; · 1.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Veterans comprise 10% of the population, and suicide among Veterans has garnered national media and policy attention. Existing research suggests that intimate partner violence (IPV) is a risk factor for suicidal behaviors among some high-risk populations. This report offers a new perspective: the intersection between Veterans' suicidal thoughts and IPV, both victimization and perpetration. The data were obtained from a northeast telephone survey of Veterans (n = 296) using Veterans Health Administration services and yielded a 27% participation rate. Findings suggest male Veterans who are IPV involved have increased odds of suicidal thoughts and behaviors.
American journal of men's health 02/2014; · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Although community-engaged research (CER), including community-based participatory research (CBPR), is a growing approach in addressing health disparities, little scientific study on how to enhance its processes or products exists. These fields are built on practice-based case studies, evaluations, and qualitative examinations of principles in action. This gap is as an emerging priority in the clinical and translation sciences.Objectives: We designed a 5-day workshop for academic-community research teams in suicide prevention and health promotion, broadly defined. Seasoned academic and community partners developed and implemented curriculum at three training institutes from 2007 to 2010. We developed self-report tools to evaluate this training model for CER practice. We crafted and evaluated both mediating processes and outcome measures for academic and community partners to assess team CER development.Methods: We analyzed post-training evaluation surveys completed late in 2010. We conducted exploratory factor analysis on survey data from 48 community or academic partners. These team members participated in at least one National Institutes of Health-funded CER training institute to advance suicide prevention, broadly defined.Conclusions: Partnership development measures that capture both academic and community perspectives demonstrate reliability and validity. Multidimensional latent constructs for inclusion in CER development models included partnership agency, personal knowledge and capacities, and benefits of collaborative research partnerships over time. We discuss the utility of findings to future CER training design and study.
Progress in Community Health Partnerships Research Education and Action 01/2014; 8(1):125-137.
[Show abstract][Hide abstract] ABSTRACT: A computerized sign language survey was administered to two large samples of deaf adults. Six questions regarding intimate partner violence (IPV) were included, querying lifetime and past-year experiences of emotional abuse, physical abuse, and forced sex. Comparison data were available from a telephone survey of local households. Deaf respondents reported high rates of emotional abuse and much higher rates of forced sex than general population respondents. Physical abuse rates were comparable between groups. More men than women in both deaf samples reported past-year physical and sexual abuse. Past-year IPV was associated with higher utilization of hospital emergency services. Implications for IPV research, education, and intervention in the Deaf community are discussed.
Journal of Interpersonal Violence 10/2013; · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We explored healthcare-related experiences of women drug court participants through combining context from the socio-ecological model with motivation needs for health behavior as indicated by self-determination theory. Five focus groups with 8 women drug court participants, 8 court staff, and 9 community service providers were examined using qualitative framework analysis. Themes emerged across the socio-ecological model and were cross-mapped with self-determination theory-defined motivation needs for autonomy, relatedness, and competence. Socio-ecological levels contained experiences either supporting or eroding women's motivation needs: 1) intrapersonal challenges participants termed an "evil cycle" of relapse, recidivism, trauma, and life challenges; 2) interpersonal context of parenting and stigma involving features of this "evil cycle"; 3) institutions with logistical barriers to legal and medical assistance; 4) community resources inadequate to support living and employment needs. Self-determination theory helps explain motivation required to address the women's healthcare needs and multiple demands at all levels of the socio-ecological model.
Journal of substance abuse treatment 09/2013; · 2.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Abstract Background: Scant literature exists on whether prior pregnancy loss (miscarriage, stillbirth, and/or induced abortion) increases the risk of postpartum psychiatric disorders-specifically depression and anxiety-after subsequent births. This study compares: (1) risk factors for depression and/or anxiety disorders in the postpartum year among women with and without prior pregnancy loss; and (2) rates of these disorders in women with one versus multiple pregnancy losses. Methods: One-hundred-ninety-two women recruited at first-year pediatric well-child care visits from an urban pediatric clinic provided demographic information, reproductive and health histories. They also completed depression screening tools and a standard semi-structured psychiatric diagnostic interview. Results: Almost half of the participants (49%) reported a previous pregnancy loss (miscarriage, stillbirth, or induced abortion). More than half of those with a history of pregnancy loss reported more than one loss (52%). Women with prior pregnancy loss were more likely to be diagnosed with major depression (p=0.002) than women without a history of loss. Women with multiple losses were more likely to be diagnosed with major depression (p=0.047) and/or post-traumatic stress disorder (Fisher's exact [FET]=0.028) than women with a history of one pregnancy loss. Loss type was not related to depression, although number of losses was related to the presence of depression and anxiety. Conclusions: Low-income urban mothers have high rates of pregnancy loss and often have experienced more than one loss and/or more than one type of loss. Women with a history of pregnancy loss are at increased risk for depression and anxiety, including post-traumatic stress disorder (PTSD), after the birth of a child. Future research is needed to understand the reasons that previous pregnancy loss is associated with subsequent postpartum depression and anxiety among this population of women.
Journal of Women's Health 09/2013; 22(9):760-8. · 1.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The World Health Organization has identified intimate partner violence (IPV) as a public health issue affecting both men and women, though significantly more information is available regarding female victimization. This study examines IPV through the lens of male victimization, focusing on a comparison of physical and mental health consequences among men who are and are not military veterans. Results from a secondary analysis of data from the Behavior Risk Factor Survey taken by 13,765 males indicated that all males, regardless of veteran status, should be screened for IPV victimization given the prevalence reported in this sample (9.5% to 12.5%). Furthermore, it was found that veteran status did affect prevalence of particular health consequences, such as depression, smoking, and binge drinking. Based on the specific comparisons examined in this study, implications for Veteran's Administration Health Services are discussed, as is the need for more research on IPV victimization rates for men and the particular health consequences that they suffer.
American journal of men's health 07/2013; · 1.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Trauma and related mental health disorders are common among incarcerated women, but empirically sound mental health interventions are lacking in prisons. Implementing such interventions is fraught with legal and logistical barriers. These barriers can be particularly detrimental for trauma-specific interventions given the unique needs of trauma survivors, yet there is little documentation of these issues or how to address them. This study describes a pilot study of an 8-week, strengths-based, trauma-focused intervention for 26 incarcerated women. Women reported considerable mental health problems and trauma. The study highlights the importance of adapting stringent research methodologies for prison-based trauma interventions. For instance, women with trauma were reluctant to participate in an intervention advertised as trauma-based. Moreover, a randomized wait list control design was unfeasible because women wanted the support of their friends when discussing trauma and could not control their schedules 9 weeks in advance. Ultimately, this work may inform future efforts to implement effective trauma-based interventions behind prison walls.
International Journal of Offender Therapy and Comparative Criminology 06/2013; · 0.84 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Research on the relationship between intimate partner violence (IPV) and postpartum depression (PPD) is limited. Numerous antecedents and consequences of both IPV and PPD are noted in the literature; however, understanding the mechanisms by which intimate partner violence impacts the postpartum mood are not clearly understood. This study utilized retrospective chart reviews from a pediatric/perinatal social work outreach program to explore urban minority women experiences with IPV and depression both during pregnancy and after. Findings do not suggest a direct relationship between IPV and PPD; however, there was a high co-occurrence of prenatal depression and PPD. The severity of IPV appears to influence the occurrence and acuity of prenatal depression suggesting an indirect relationship. Implications for health and social work practitioners are discussed.
Social Work in Health Care 04/2013; 52(4):332-50. · 0.62 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Adolescent girls with older male main partners are at greater risk for adverse sexual health outcomes than other adolescent girls. One explanation for this finding is that low relationship power occurs with partner age difference. Using a cross-sectional, descriptive design, we investigated the effect of partner age difference between an adolescent girl and her male partner on sexual risk behavior through the mediators of sexual relationship power, and physical intimate partner violence (IPV), and psychological IPV severity. We chose Blanc's framework to guide this study as it depicts the links among demographic, social, economic, relationship, family and community characteristics, and reproductive health outcomes with gender-based relationship power and violence. Urban adolescent girls (N = 155) completed an anonymous computer-assisted self-interview survey to examine partner and relationship factors' effect on consistent condom use. Our sample had an average age of 16.1 years with a mean partner age of 17.8 years. Partners were predominantly African American (75%), non-Hispanic (74%), and low-income (81%); 24% of participants reported consistent condom use in the last 3 months. Descriptive, correlation, and multiple mediation analyses were conducted. Partner age difference was negatively associated with consistent condom use (-.4292, p < .01); however, the indirect effects through three proposed mediators (relationship power, physical IPV, or psychological IPV severity) were not statistically significant. Further studies are needed to explore alternative rationale explaining the relationship between partner age differences and sexual risk factors within adolescent sexual relationships. Nonetheless, for clinicians and researchers, these findings underscore the heightened risk associated with partner age differences and impact of relationship dynamics on sexual risk behavior.
Journal of Interpersonal Violence 01/2013; · 1.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Traditionally, professionals working with intimate partner violence (IPV) survivors view a victim through a disciplinary lens, examining health and safety in isolation. Using focus groups with survivors, this study explored the need to address IPV consequences with an integrated model and begin to understand the interconnectedness between violence, health, and safety. Focus group findings revealed that the inscription of pain on the body serves as a reminder of abuse, in turn triggering emotional and psychological pain and disrupting social relationships. In many cases, the physical abuse had stopped but the abuser was relentless by reminding and retraumatizing the victim repeatedly through shared parenting, prolonged court cases, etc. This increased participants' exhaustion and frustration, making the act of daily living overwhelming.
Journal of Family Violence 11/2012; 27(8):773-781. · 1.17 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This article presents early findings in a 2-year mixed-methods study examining whether the source (federal/state/local) or type (restricted/flexible) of funding impacts quality outcome measures linked to mental health of children in foster care. The study, funded by the Public Health Law Program of the Robert Wood Johnson Foundation, focuses on three quality outcomes that are closely linked to the mental health of the children served by the child welfare system: days in placement, days awaiting adoption, and recurrent maltreatment. The authors are using community based participatory research to analyze ten years of county-based financial and child welfare outcome data for both quantitative and qualitative analyses. In Ohio, approximately half of the eighty-eight counties have a dedicated local tax levy for child welfare services, providing flexible funding at the local level. From 1997 to 2005, the federal government also provided flexible federal funding via Title IV-E waivers to fourteen “ProtectOhio” Counties and to an additional four counties through 2009. Early findings indicate that flexible funding is linked to reduced median days in care and days awaiting adoption. The study further indicates that community based participatory research is particularly helpful in designing the research questions that will provide relevant data for policy reform.
[Show abstract][Hide abstract] ABSTRACT: This qualitative study rooted in community-based participatory research principles utilized semi-structured interviews with 2 focus groups (n=9) with female healthcare volunteers (FCVs) and 3 male key informants who were community leaders (MCLs). The study aimed to examine how a rural Honduran community defines and responds to intimate partner violence (IPV) in order to lay the foundation for future interventions. Based on grounded theory, the authors assessed for common themes across transcripts. Authors found that a number of participants denied the existence of IPV. Perspectives on the causes and definitions of IPV varied between FCVs and MCLs. All participants affirmed the need for intervention and many participants mentioned healthcare and legal systems as potential venues to ameliorate IPV. The results highlight potentially important differences between FCV and MCL perspectives that may inform future interventions. Findings suggest health-care workers can play a role in IPV prevention and intervention in rural Honduras.
Journal of Family Violence 10/2012; 27(7):707-714. · 1.17 Impact Factor