Sanctuary in a Domestic Violence Shelter: A Team Approach to Healing

For survivors of domestic violence, the ongoing effects of trauma are compounded by the context of their abusive experience. Injury caused by a person one has loved and trusted damages beliefs about oneself, other people, and the world. Staff members of various disciplines and educational backgrounds who work in domestic violence shelters are dealing with this damage as well as the impact of trauma on shelter residents. They face the challenge of observing and responding to the effects of recent and past abuse, to traumatic reenactments within the setting, and to their own secondary trauma reactions. This paper explores the process of implementing the Sanctuary® model in a domestic violence shelter as a way to address trauma and its impact on clients and staff. The Sanctuary model was chosen because of its focus on teamwork, and the guidelines for treatment it provides that are accessible to all members of the treatment community.     

Domestic Violence Intervention in an Urban Indian Health Center

This report describes a domestic violence program in an urban Indian health center. The failure of office-based interventions and the importance of developing interventions that are sensitive to the needs of this population is discussed. Successful interventions including home visits and a domestic violence group that incorporated American Indian traditions and values are presented.     

Depression and Impulsivity as Pathways to Violence: Implications for Antiaggressive Treatment

Background: Difficulties with affect regulation and impulse control have a strong influence on violence. The objective of this study was to determine whether baseline depression and impulsivity predict aggression and whether they predict differential response to antiaggressive treatment. This is important, as we lack knowledge as to the selection of antipsychotics for the treatment of aggression. Methods: Physically aggressive inpatients with schizophrenia who received an evaluation of depression and impulsivity at baseline were randomly assigned in a double-blind, parallel group, 12-week trial to clozapine, olanzapine, or haloperidol. Trait impulsivity was measured by the Barratt Impulsiveness Scale; depression by the Positive and Negative Syndrome Scale Depression factor. The number and severity of aggressive events, as measured by the Modified Overt Aggression Scale (MOAS), were the outcome measures. Results: Baseline depression and impulsivity predicted higher levels of aggression, as measured by the MOAS total score, over the 12-week treatment period across all 3 medication groups. In addition, there was a strong interaction effect between baseline depression/impulsivity and medication grouping in predicting MOAS score. In particular, when higher depression and impulsivity were present at baseline, patients on haloperidol presented with more aggression than patients on the other 3 medications. Conclusions: Depression and impulsivity are important predictors of aggression and of differential response to antiaggressive treatment. This is most likely due to the medications’ dissimilar neurotransmitter profiles. By identifying patients who will respond better to a given medication, we will be able to develop individualized strategies for the treatment of violent behavior.Key words: depression, aggression, prediction, clozapine, olanzapine     

Interviewing Victims of Repeated Domestic Violence: Investigators' Beliefs and Strategies

Most victims of domestic violence are abused repeatedly over time. Hence, investigative challenges arise concerning victims' ability to recall particular events. This research focuses on investigators' understanding of memory-based problems associated with repeated victimization and their strategies to facilitate recall. Eighty-one Swedish police officers completed a questionnaire probing their beliefs about memory for repeated events, aims of witness interviews and specific memory-enhancing techniques. A large proportion reported not making any extra preparations or using specific techniques to tackle the challenges of interviewing victims of repeated violence. However, respondents were largely aware of problematic memory features, including source monitoring errors, and they reported using scientifically supported techniques.     

Trends in Special Education Code Assignment for Autism: Implications for Prevalence Estimates

There is considerable controversy over reasons for observed increases in the prevalence of autism spectrum disorders. We examined trends in British Columbia education database coding of children with autism from 1996 to 2004. There was a significant linear increase in autism prevalence. The proportion of children identified by age 6 increased significantly from 1996 to 1999. When we calculated prevalence assuming onset prior to age 3, previously unidentified cases, particularly among girls in 1996 and 1997, accounted for substantial increases in estimated prevalence. The magnitude of under-identification decreased from 1996 to 2000, and rose slightly in 2001. Analyses of prevalence trends must take into account effects of earlier age at identification and inclusion of previously undetected cases on prevalence estimates.     

Domestic Violence and Couples Counseling: The Importance of Assessment and Understanding Typologies in Treatment

This article provides an overview of research related to the treatment of domestic violence, with particular focus on distinguishing among specific typologies during the assessment process of couples counseling. After discussing research related to the assessment process, the authors include fictional case examples that illustrate scenarios in which couples counseling may be appropriate and when couples treatment is wholly inappropriate.     

Consumer Turnover in Service Utilization Patterns: Implications for Capitated Payment

Risk-adjusted capitation rates based on a group's expected cost to a provider have been proposed to create incentives for including people with severe mental disabilities in managed healthcare systems. The most appropriate methods for classifying people according to levels of risk, however, have yet to be determined. This research employed cluster analysis statistical techniques to identify patterns of services delivered to a sample of 4,346 consumers in Ohio. Findings about the extent of client movement in and out of service clusters over time suggest caution in the implementation of risk-adjusted capitation plans, particularly those based primarily on past service utilization.     

Dimension and Socio-demographic Correlates of Domestic Violence: A study from Northeast India

Present study was aimed to find out dimension and socio-demographic correlates of domestic violence in Assam, Sikkim and Meghalaya, Northeast India. Two districts from each state were selected at random and women aged 18–35 years from rural and urban localities were interviewed to obtain relevant information. The study included a total of 2249 participants (Rural?=?1577 and Urban?=?672) from Assam (650), Sikkim (1148) and Meghalaya (451). Domestic violence was recorded in 26.4% of study participants and highest in Meghalaya. Of all types, psychological violence was predominant. A number of socio-demographic factors have been identified as independent predictors for domestic violence in pooled and state specific analysis. Findings of our study may help in formulating strategies to prevent domestic violence.     

The Mentally Ill in Jails and Prisons: Towards an Integrated Model of Prevention

Jails and prisons have become a final destination for persons with severe mental illness in America. Addiction, homelessness, and fragmentation of services have contributed to the problem, and have underscored the need for new models of service delivery. Project Link is a university-led consortium of five community agencies in Monroe County, New York that spans healthcare, social service and criminal justice systems. The program features a mobile treatment team with a forensic psychiatrist, a dual diagnosis treatment residence, and culturally competent staff. This paper discusses the importance of service integration in preventing jail and hospital recidivism, and describes steps that Project Link has taken towards integrating healthcare, criminal justice, and social services. Results from a preliminary evaluation suggest that Project Link may be effective in reducing recidivism and in improving community adjustment among severely mentally ill patients with histories of arrest and incarceration.     

Disabled Women and Domestic Violence: Making the Links,a National UK Study

This article reports on the first-ever national study of domestic violence and disability in the United Kingdom. The multi-method study used the social model of disability and was mainly qualitative in design. It reports distressing findings of the abuse which disabled women may experience, confirming similar findings in Australia and other countries. Less provision than that available proportionally to non-disabled women is accompanied by a greater need for such focussed and specialist services. Disabled women in the United Kingdom therefore lose out on both counts. The paper concludes that a cultural shift or sea-change is required in relevant service provision at both management and operational levels, informed by disabled women themselves wherever possible. The study made wide-ranging recommendations at both the strategic level across localities and for relevant agencies in the United Kingdom. These recommendations have wide relevance in other countries.     

Pharmacoepidemiology of Antipsychotic Use in Youth with ADHD: Trends and Clinical Implications

Although concern has been raised about antipsychotic prescribing to youth with attention-deficit/hyperactivity disorder (ADHD), the available database is limited to individual studies. Therefore, in order to provide a synthesis of prevalence and time trends, we conducted a systematic review and pooled analysis of pharmaco-epidemiologic data on antipsychotic use in ADHD youth. Of 1806 hits, 21 studies (N) were retained that reported analyzable data for three separate populations: 1) antipsychotic-treated youth (N?=?15, n?=?341,586); 2) ADHD youth (N?=?9, n?=?6,192,368), and 3) general population youth (N?=?5, n?=?14,284,916). Altogether, 30.5?±?18.5 % of antipsychotic-treated youth had ADHD. In longitudinal studies, this percentage increased over time (1998–2007) from 21.7?±?7.1 % to 27.7?±?7.7 %, ratio?=?1.3?±?0.4. Furthermore, 11.5?±?17.5 % of ADHD youth received antipsychotics. In longitudinal studies, this percentage also increased (1998–2006) from 5.5?±?2.6 % to 11.4?±?6.7 %, ratio?=?2.1?±?0.6. Finally, 0.12?±?0.07 % of youth in the general population were diagnosed with ADHD and received antipsychotics. Again, in longitudinal studies, this percentage increased over time (1993–2007): 0.13?±?0.09 % to 0.44?±?0.49 %, ratio?=?3.1?±?2.2. Taken together, these data indicate that antipsychotics are used by a clinically relevant and increasing number of youth with ADHD. Reasons for and risk/benefit ratios of this practice with little evidence base require further investigation.     

Acute Service Delivery in a Police-Mental Health Program for Children Exposed to Violence and Trauma

The Child Development Community Policing Program represents a national model of community-based collaboration between police and mental health professionals for violence-exposed and traumatized children. Administrative data from clinical records of a 24-hour consultation service were examined through stepwise multivariate logistic regression to identify child and event characteristics associated with a direct, in-person response at the time of police contact. Of 2361 children, 809 (34.3%) received a direct, in-person response. Relative to Caucasian children, Hispanic youth were more likely to receive this form of response (OR = 1.36). An acute clinical response was more likely for incidents of gang involvement (OR = 8.12), accidents (OR = 5.21), felony assaults (OR = 2.97), property crimes (OR = 2.30), family violence (OR = 1.53) and psychiatric crises (OR = 1.29). Acute response was less likely when juvenile conduct problems (OR = 0.61), fires (OR = 0.59), child maltreatment (OR = 0.57), and domestic violence (OR = 0.44) were involved. Incidents that were more severe or involved a primary mental health component were related to utilization of intensive CDCP resources.     

Impact of transitional care for discharged elderly stroke patients in China: an application of the Integrated Behavioral Model

Background: Transitional care (TC) has been shown to improve stroke rehabilitation in discharged stroke patients. Previous TC interventions did not report satisfactory stroke rehabilitation outcomes or risk management. Incorporating a health behavior theory in interventions can effectively improve health behaviors and metabolic indicators.

Objectives: This study was a clinical controlled trial to investigate the impact of the Integrated Behavioral Model (IBM)-based 3-month TC on health behaviors, clinical outcomes, and stroke knowledge in discharged elderly stroke patients.

Methods: Sixty elderly patients were recruited from two wards of a public teaching hospital in China. To prevent potential treatment contamination, patients were allocated into either a control or intervention group depending on which wards they were admitted to. The TC intervention considered all the IBM constructs to provide patients assistance in implementing health behaviors as recommended by the Chinese stroke guidelines. The TC intervention commenced one day before discharge and lasted three months after discharge. A linear mixed model was used to measure the impact of the intervention.

Results: The TC intervention improved the discharged elderly stroke patients’ health behaviors, activities of daily living, quality of life, and stroke knowledge. The intervention also controlled the patients’ systolic blood pressure, body mass index, total cholesterol, triglycerides, and low-density lipoprotein cholesterol.

Conclusions: This study provided evidence of concurrent self-reported and objective clinical indicators in discharged elderly stroke patients for the impact of the IBM-based 3-month TC intervention, which can be recommended for clinical practice.