Robert Walker’s research while affiliated with University of Kentucky and other places

Purpose Safety planning is often recommended for stalking victims, yet there has been limited research on personal safety planning in general and specifically for stalking victims. This study has two overall objectives: (1) to examine whether frequency of safety scenario planning (thinking through various strategies in responding to threatening situations) among ex-partner stalking victims is associated with increased personal safety worry, safety efficacy, and other safety behaviors (e.g., seeking safety advice, carrying a safety device); and (2) to explore associations of frequency of safety scenario planning with partner abuse and stalking experiences, help-seeking, and mental health symptoms. Method Women stalking victims were recruited from Prolific. Three groups were developed for comparisons including stalking victims who: (a) did not engage in safety scenario planning in the past year (n = 121); (b) engaged in one safety scenario planning activity in the past year (n = 256); and (c) engaged in 2 or more safety scenario planning activities in the past year (n = 184). Results Bivariate results found that frequency of safety scenario planning was associated with increased personal safety worry, increased seeking and giving safety advice, and increased defensive safety behaviors. Additionally, the multivariate analysis found more frequent safety scenario planning was uniquely and significantly associated with increased personal safety worry, safety efficacy, work interference, the number of different help-seeking sources, PTSD symptoms, and sexual discomfort. Conclusions More research is needed to provide information about best practices in safety planning to better help victims manage the short- and long-term consequences of violence exposure in their recovery journey.

Firearms are used in over half of partner violence victim homicides, and many victims experience firearm-related threats from their abusive partners. It is unclear whether, and to what extent, abusers who make firearm-related threats also engage in other forms of control and violence. An online community-based sample of women whose abusive partners caused them to experience fear because of their access to guns or threats to use them were recruited for the study. This study examined coercive control, threats, violence, and help-seeking for women whose partner held them at gunpoint (n = 112) compared to women whose partners did not hold them at gunpoint (n = 125). Women whose partners held them at gunpoint experienced more severe and frequent firearm and non-firearm related threats and physical/sexual violence. Additionally, abusers used a variety of strategies to control victims including tactics to increase dependency, debility, and dread—all of which were more frequent and severe among women held at gunpoint by the abuser. Only about half of the women held at gunpoint, and 30% of those not held at gunpoint, talked to police or sought a civil protective order. Among those that sought help through the justice system, only about 70% told police or the court about the firearm threats. Current legal remedies that restrict firearms may reduce some lethality risk, but safety is far from guaranteed by solely restricting gun ownership underscoring the importance of assessment and safety planning for partner violence victims who experience firearm-related threats.

This study examined individual-level characteristics and factors associated with program completion, relapse, and multidimensional status at follow-up for 213 men and 248 women who entered one of 17 peer-led recovery programs and who completed a follow-up interview 12 months later. Study results found that although there were some significant gender differences at program entry among participants entering Recovery Kentucky, there were few gender differences at follow-up. In addition, although participants had significant psychosocial problems, polysubstance use patterns, and severe substance use disorder (SUD), the majority of both men and women reported completing the program (80.3%), a small minority reported relapse (9.5%), and about one third had worse multidimensional status about 12 months after program entry. Lower quality of life rating at program entry was associated with program completion and with better multidimensional status at follow-up. Study results suggest the recovery program provides an important option for some of the most vulnerable individuals with SUD.

A focus on the use of shared language to enhance congruence in interventionist-client dialogue is missing from traditional research on evidence-based practices and rural behavioral health. This study incorporates qualitative interactional sociolinguistics, which includes discourse analysis (typically written or audio recordings of face-to-face encounters with 11 clients and a study interventionist), to describe those speech patterns in a broad sense (dialect), as well as more specific use of communicative strategies to increase parity in the interaction between a rural interventionist delivering an evidence-based practice in the context of a research study with rural women opioid users in a non-therapeutic context. Study findings indicated that in the context of delivering the intervention, use of a shared language, language pattern congruence, and communication styles can greatly augment the intent of the approach with vulnerable populations. In addition, other communicative strategies connected with traditional Appalachian values - such as religion, home, and family - were also important. This study makes an important contribution to behavioral health research and practice by understanding critical factors that may influence evidence-based practice delivery, particularly in real-world settings with vulnerable populations. These findings have important implications for the utilization of creative approaches to understand critical components of the clinical interaction as indicators of fidelity.

Rising rates of incarceration in the United States and continuing use of the death penalty in over half of the states in the United States signal a need for more involvement of social workers in forensic roles to mitigate unjust sentencing. The National Association of Social Workers has consistently maintained a professional policy stance in opposition to the death penalty and in support for alternative sentencing plans, citing that the death penalty disproportionately impacts communities affected by poverty and communities of color, and is prone to error. The purpose of this article is to highlight the importance of educating social workers to mitigation as a primary role among forensic social workers, with a focus on death penalty mitigation with its critical skills and knowledge. After describing mitigation in death penalty cases, we examine four major social work roles in capital cases that expanded education should cover: (1) mitigation investigation, (2) consulting expert, (3) expert witness, (4) teaching expert. This article also addresses important ethical considerations when working as a member of capital defense teams and provides recommendations for social work graduate curricula to tailor content to better prepare students for capital mitigation practice.

The goal of research on substance use interventions is to develop evidence-based practices for use in the clinical environment. However, there are other, albeit unexpected, ways in which intervention research can inform clinical practice. This study was derived from a larger NIDAstudy examining incarcerated women’s responses to a brief, evidence-based HIV risk-reduction intervention targeting high-risk drug use and risky sexual practices using motivational interviewing. This paper provides an overview of study training efforts and adherence to the essential components of MI during jail-based intervention delivery. This study highlights the amount of infrastructure that should be employed to maintain basic fidelity in providing an evidence-based practice in a non-traditional setting like a jail. The importance of this study forthe practice environment lies in identifying the amount of supervision required to be able to saythat evidence-based practices are being employed by a provider. This study illustrates that “justoff the shelf” EBP implementation is likely a myth because achieving basic adherence to MIpractices required not only extensive training, but continuing monitoring to prevent ‘reversion to the mean’ in terms of routine clinical practices. Findings emphasize the critical role of assertive supervision and vigilant quality monitoring to actually implement EBPs in criminal justicesettings like jails.

In Asia, Mitragyna speciosa (e.g., “kratom”) has been used to mitigate alcohol and drug dependence. Some preliminary findings suggest kratom’s potential use as an informal harm-reduction method in the United States, such as an opioid substitute or as a means of lessening opioid withdrawal symptoms. To determine correlates of past-year kratom use among a sample of polysubstance users enrolled in residential recovery programs in Kentucky, an anonymous survey was completed by clients in April 2017. Logistic regression was used to identify significant associations with past-year kratom use. Of the final sample (N = 478), 10.4% reported past-year kratom use. Past-year heroin use, but not past-year prescription opioid (e.g., oxycodone, hydrocodone) use, was significantly associated with kratom use, such that individuals who reported past-year heroin use were 2.5 times more likely to also report past-year kratom use. Non-prescribed buprenorphine (i.e., Suboxone) use partially mediated the relationship between past-year heroin and kratom use by explaining 36% of the association between the two drugs. Though amphetamines were highly preferred, past-year use was negatively correlated with past-year kratom use. Rates of past-year kratom use were lower than rates of alcohol and illicit drug use. Kratom was not preferred over heroin or prescription opioids.

Research has consistently found that more women worry about their personal safety and feel vulnerable to most every crime compared with men suggesting there is a gender fear gap. Environmental risk and prior victimization history impact concerns about personal safety. However, few studies include stalking as part of the victimization history. Two reasons studies may not include stalking are that adding more questions to a research assessment increases participant burden and measurement of stalking has not always been clear. The current study used a community sample of 2,719 men and women and a five-item stalking assessment to examine the prevalence and impact of stalking and stalking-related fear on concern about personal safety, perceived vulnerability to an attack, perceptions that risk of victimization is higher due to personal characteristics, discomfort when thinking about safety, and posttraumatic stress symptoms controlling for victimization history, age, and environment risk by gender. Overall, 30% of women and 12% of men experienced stalking using the extreme fear standard which is double the national rates. Stalking-related fear, for both women and men, was associated with all of the outcome measures. Furthermore, there were significant main effects of gender after controlling for stalking-related fear on three of the outcomes consistent with the gender fear gap. Based on these results, research studies should consider including stalking as part of the victimization history as it is likely to impact health and mental health outcomes as well as personal safety concerns and responses for both men and women.

Background: With a rise in overdoses and medical emergencies related to opioids, buprenorphine-naloxone (bup-nx) is seen as a preferred treatment for opioid dependence. However, the research examining experiences with bup-nx among polysubstance users who may or may not be opioid dependent has been limited. Objectives: The purpose of the study was to examine use, characteristics of users, and experiences of bup-nx use among polysubstance users entering drug-free recovery programs. Methods: This study examined secondary data on 896 opioid or opiate user individuals (53.4% male) collected by drug-free, self-help-based residential recovery centers during intake. Results: One-quarter of users said bup-nx helped them with their substance use while 75% of bup-nx users reported that bup-nx either had no effect or a negative effect on their drug problems. Of the very few (4%-7%) obtaining bup-nx solely through a prescription, over 90% reported relief from withdrawal. However, over 80% of those who obtained bup-nx through illicit means reported using bup-nx until their preferred drug could be obtained and used it for its euphoriant effect. Three groups of opioid users were created including one group with no bup-nx use, one with lifetime but not recent bup-nx use, and one with recent (past 6 month) use. There were differences in substance use patterns and characteristics of bup-nx experiences between the different groups. Conclusions: Results suggest that the views of bup-nx by individuals in drug-free recovery centers are varied, with many seeing bup-nx as not unlike other opioids while others report bup-nx as self-medication.

Of all the advocacy services provided to partner violence and sexual assault victims, safety planning may be most central. However, unlike many community behavioral health or case management services, there is virtually no literature on standards of care in safety planning, ways to measure its effectiveness, or discussion of the challenges advocates face in their day-to-day practice of planning for victim safety. The purpose of this paper is to describe advocate perceptions of training and supervision, how they obtain feedback about their work with victims, and their personal challenges in safety planning with victims. Study results highlight the need for more guidance, training, and support as well as more coping strategies for the numerous personal challenges advocates face in their day-to-day safety planning work. Implications for research and practice are discussed.