Background
Intimate partner abuse (including coercive control, physical, sexual, economic, emotional and economic abuse) is common worldwide. Advocacy may help women who are in, or have left, an ...abusive intimate relationship, to stop or reduce repeat victimisation and overcome consequences of the abuse. Advocacy primarily involves education, safety planning support and increasing access to different services. It may be stand‐alone or part of other services and interventions, and may be provided within healthcare, criminal justice, social, government or specialist domestic violence services. We focus on the abuse of women, as interventions for abused men require different considerations.
Objectives
To assess advocacy interventions for intimate partner abuse in women, in terms of which interventions work for whom, why and in what circumstances.
Search methods
In January 2019 we searched CENTRAL, MEDLINE, 12 other databases, two trials registers and two relevant websites. The search had three phases: scoping of articles to identify candidate theories; iterative recursive search for studies to explore and fill gaps in these theories; and systematic search for studies to test, confirm or refute our explanatory theory.
Selection criteria
Empirical studies of any advocacy or multi‐component intervention including advocacy, intended for women aged 15 years and over who were experiencing or had experienced any form of intimate partner abuse, or of advocates delivering such interventions, or experiences of women who were receiving or had received such an intervention. Partner abuse encompasses coercive control in the absence of physical abuse. For theory development, we included studies that did not strictly fit our original criteria but provided information useful for theory development.
Data collection and analysis
Four review authors independently extracted data, with double assessment of 10% of the data, and assessed risk of bias and quality of the evidence. We adopted RAMESES (Realist and meta‐narrative evidence syntheses: evolving standards) standards for reporting results. We applied a realist approach to the analysis.
Main results
We included 98 studies (147 articles). There were 88 core studies: 37 focused on advocates (4 survey‐based, 3 instrument development, 30 qualitative focus) and seven on abused women (6 qualitative studies, 1 survey); 44 were experimental intervention studies (some including qualitative evaluations). Ten further studies (3 randomised controlled trials (RCTs), 1 intervention process evaluation, 1 qualitative study, 2 mixed methods studies, 2 surveys of women, and 1 mixed methods study of women and staff) did not fit the original criteria but added useful information, as befitting a realist approach. Two studies are awaiting classification and three are ongoing.
Advocacy interventions varied considerably in contact hours, profession delivering and setting.
We constructed a conceptual model from six essential principles based on context‐mechanism‐outcome (CMO) patterns.
We have moderate and high confidence in evidence for the importance of considering both women's vulnerabilities and intersectionalities and the trade‐offs of abuse‐related decisions in the contexts of individual women's lives. Decisions should consider the risks to the woman's safety from the abuse. Whether actions resulting from advocacy increase or decrease abuse depends on contextual factors (e.g. severity and type of abuse), and the outcomes the particular advocacy intervention is designed to address (e.g. increasing successful court orders versus decreasing depression).
We have low confidence in evidence regarding the significance of physical dependencies, being pregnant or having children. There were links between setting (high confidence), and potentially also theoretical underpinnings of interventions, type, duration and intensity of advocacy, advocate discipline and outcomes (moderate and low confidence). A good therapeutic alliance was important (high confidence); this alliance might be improved when advocates are matched with abused women on ethnicity or abuse experience, exercise cultural humility, and remove structural barriers to resource access by marginalised women. We identified significant challenges for advocates in inter‐organisational working, vicarious traumatisation, and lack of clarity on how much support to give a woman (moderate and high confidence). To work effectively, advocates need ongoing training, role clarity, access to resources, and peer and institutional support.
Our provisional model highlights the complex way that factors combine and interact for effective advocacy. We confirmed the core ingredients of advocacy according to both women and advocates, supported by studies and theoretical considerations: education and information on abuse; rights and resources; active referral and liaising with other services; risk assessment and safety planning. We were unable to confirm the impact of complexity of the intervention (low confidence). Our low confidence in the evidence was driven mostly by a lack of relevant studies, rather than poor‐quality studies, despite the size of the review.
Authors' conclusions
Results confirm the core ingredients of advocacy and suggest its use rests on sound theoretical underpinnings. We determined the elements of a good therapeutic alliance and how it might be improved, with a need for particular considerations of the factors affecting marginalised women. Women's goals from advocacy should be considered in the contexts of their personal lives. Women's safety was not necessarily at greatest risk from staying with the abuser. Potentially, if undertaken for long enough, advocacy should benefit an abused woman in terms of at least one outcome providing the goals are matched to each woman's needs. Some outcomes may take months to be determined. Where abuse is severe, some interventions may increase abuse. Advocates have a challenging role and must be supported emotionally, through provision of resources and through professional training, by organisations and peers.
Future research should consider the different principles identified in this review, and study outcomes should be considered in relation to the mechanisms and contexts elucidated. More longitudinal evidence is needed. Single‐subject research designs may help determine exactly when effect no longer increases, to determine the duration of longitudinal work, which will likely differ for vulnerable and marginalised women. Further work is needed to ascertain how to tailor advocacy interventions to cultural variations and rural and resource‐poor settings. The methods used in the included studies may, in some cases, limit the applicability and completeness of the data reported. Economic analyses are required to ascertain if resources devoted to advocacy interventions are cost‐effective in healthcare and community settings.
Rethinking Rufus is the first book-length study of sexual violence against enslaved men. Scholars have extensively documented the widespread sexual exploitation and abuse suffered by enslaved women, ...with comparatively little attention paid to the stories of men. However, a careful reading of extant sources reveals that sexual assault of enslaved men also occurred systematically and in a wide variety of forms, including physical assault, sexual coercion, and other intimate violations.
To tell the story of men such as Rufus-who was coerced into a sexual union with an enslaved woman, Rose, whose resistance of this union is widely celebrated-historian Thomas A. Foster interrogates a range of sources on slavery: early American newspapers, court records, enslavers' journals, abolitionist literature, the testimony of formerly enslaved people collected in autobiographies and in interviews, and various forms of artistic representation. Foster's sustained examination of how black men were sexually violated by both white men and white women makes an important contribution to our understanding of masculinity, sexuality, the lived experience of enslaved men, and the general power dynamics fostered by the institution of slavery. Rethinking Rufus illuminates how the conditions of slavery gave rise to a variety of forms of sexual assault and exploitation that affected all members of the community.
Victims of intimate partner violence (IPV) are frequently blamed and disbelieved, which may affect their willingness to report their abuse experiences. This vignette-based online experiment examines ...whether victim attractiveness (attractive vs. unattractive) and the type of abuse suffered (psychological vs. psychological plus physical abuse) may impact attributions of victim blame or victim credibility. The final sample included 167 UK residents (79% females) aged between 18 and 66 years (M = 33.17, SD = 11.26). Results indicated that the attractive victim was judged as being more credible than the unattractive victim. Results are discussed in light of societal attitudes toward IPV.
A large body of research has examined the relationship between victimization and future offending, with results suggesting that crime victims are at higher risk of future criminal behavior—known as ...the victim-offender overlap. Prior studies have primarily examined the relationship between general victimization (e.g., violent victimization, sexual abuse, and more) and general offending (e.g., violence, sexual offending, and drug use), and focused on adult populations.
The goal of the present study is to expand on prior literature by examining if specific forms of childhood victimization increase the risk of specific and analogous forms of offending among delinquent youth.
Based upon a population of 64,329 high-risk youth offenders in Florida, this study evaluates the specificity of the overlap among youth who were physically abused, sexually abused, or witnessed illegal substance use at home during childhood to determine if these forms of victimization increased the risk of violence, sexual offending, and drug use, respectively, when assessed in multivariate logistic regression models.
Results provide considerable support for specificity in the victim-offender overlap, as hypothesized. Specifically, experiencing physical abuse (OR = 1.55, p < .001), sexual abuse (OR = 3.58, p < .001) and witnessing household substance abuse (OR = 1.66, p < .001) in childhood each significantly and substantially increased the risk of analogous criminal behavior in adolescence, even when controlling for other risk factors and forms of victimization.
This study provided novel evidence for specificity in the victim-offender overlap, even after controlling for confounding variables. Practical implications for early intervention and crime prevention are discussed, as well as implications for future research. Highlighting the importance of specificity in the victimization and adverse childhood experience (ACE) paradigms.
This article addresses the differences between girls and boys in the disclosure of sexual violence. The dataset combines data from the Finnish Child Victim Survey (FCVS) of 2008 (N = 13,459) and 2013 ...(N = 11,364), focusing on victims of sexual violence, ages 11 to 17 years, from the perspectives of disclosure and gender. Frequency and percentage analysis, cross tabulation, and a Chi-square test were used in the analysis. In the FCVS for both years, around 85% of the victims were girls. In almost two-thirds of the cases, the offender was a relative, friend, or some other known person, while in more than one-third of the cases, the offender was unknown to the victim. The second most common case was that the victim knew the offender, who was not, however, a friend. Sexual violence was found to be, in many ways, gendered. Most of the victims were girls, and most of the offenders were men. There was also a gender difference in the disclosure of experiences. Twenty-one percent of the girls and 45% of the boys reported that they had not told anyone about their experiences. Irrespective of the type of offender, the victims most often (63%) told a peer about their experiences, while 23% told parents, and only 10% told authorities. Moreover, victims reported shame and fear, distrust toward adults, and disbelief that disclosure would be helpful as reasons for not disclosing their experiences. To address this problem, raising awareness of the phenomenon, promoting an atmosphere that supports disclosing experiences of sexual violence, and improving readiness to address them are required.
While adolescents report the highest rates of sexual abuse victimization, few studies have investigated how child sexual abuse (CSA) cases involving adolescent complainants may differ from cases ...involving child complainants. The current study draws on 3,430 allegations of CSA in Canada to compare abuse characteristics and judicial outcomes in cases involving adolescent complainants to cases involving child complainants. Adolescent complainants were more likely than child complainants to be abused by a stranger or a person with a community connection to the complainant, while children were more likely than adolescents to be abused by a parent or other relative. Furthermore, compared to child complainants, adolescent complainants were more frequently involved in the most intrusive offenses and their cases were more likely to involve violence. Both groups were most likely to disclose the abuse to a parent, though a greater proportion of children disclosed the abuse to a parent. There were no differences in the delay to disclosure. Accused were equally likely to plead “guilty” and to be convicted in cases involving child and adolescent complainants. However, offenders convicted of the most intrusive offenses received longer probation sentences when the complainant was a child than when the complainant was an adolescent. These findings have implications for ensuring appropriate support and services to adolescent victims of CSA.
Every year in the U.S., thousands of women and hundreds of men participate in sexual assault forensic examinations. Drawing on four years of participatory research in a Baltimore emergency room, ...Sameena Mulla reveals the realities of sexual assault response in the forensic age. Taking an approach developed at the intersection of medical and legal anthropology, she analyzes the ways in which nurses work to collect and preserve evidence while addressing the needs of sexual assault victims as patients.Mulla argues that blending the work of care and forensic investigation into a single intervention shapes how victims of violence understand their own suffering, recovery, and access to justicein short, what it means to be a victim. As nurses race the clock to preserve biological evidence, institutional practices, technologies, and even state requirements for documentation undermine the way in which they are able to offer psychological and physical care. Yet most of the evidence they collect never reaches the courtroom and does little to increase the number of guilty verdicts. Mulla illustrates the violence of care with painstaking detail, illuminating why victims continue to experience what many call secondary rape during forensic intervention, even as forensic nursing is increasingly professionalized. Revictimization can occur even at the hands of conscientious nurses, simply because they are governed by institutional requirements that shape their practices.The Violence of Carechallenges the uncritical adoption of forensic practice in sexual assault intervention and post-rape care, showing how forensic intervention profoundly impacts the experiences of violence, justice, healing and recovery for victims of rape and sexual assault.
Efforts to understand and support the process of help seeking by victims of intimate partner violence are of considerable urgency if we are to design systems and responses that are capable of ...actively and appropriately meeting the needs of victims. Using data from the New Zealand Violence Against Women Study, which drew from a representative general population sample of women aged 18 to 64 years, the authors report on the help-seeking behaviors of the women who had ever in their lifetime experienced physical and/or sexual violence by an intimate partner (n = 956). More than 75% of respondents reported that they had told someone about the violence, indicating that it is not necessarily a “secret and private” problem. However, more than 40% of women indicated that no one had helped them. Informal sources of support (family and friends) were most frequently told about the violence but not all provided helpful responses. Fewer women told formal sources of help such as police, health care providers, and not all provided helpful responses. Women’s reasons for seeking help and for leaving violent relationships were similar and included “could not endure more,” being badly injured, fear or threat of death, and concern for children. Women’s reasons for staying in or returning to violent relationships included perception of the violence as “normal/not serious,” her emotional investment in the relationship, or staying for the sake of the children. The findings suggest that broader community outreach is required to ensure that family and friends are able to provide appropriate support for women in abusive relationships who are seeking help. Continued improvement in institutional responses is also required.
Transgender individuals may experience social discrimination and unfair legal considerations as crime victims. The current purpose was to investigate the relationship between the participant/jurors' ...gender, the victims' gender identity, and judge's instructions to ignore the gender identity of the victim on perceptions of the victim and the crime and verdicts rendered in a sexual assault case. Overall, crime severity ratings were significantly lower for the trans male victim compared to the cisgender female victim. Male participants reported lower crime severity ratings for trials involving transgender victims compared to cisgender victims. However, victim blaming, likelihood that the defendant committed the crime, sentencing recommendations, verdict confidence, and conviction rates did not vary by the victim's gender identity, the participant's gender identity, nor the judge's instructions. Participant gender as a predictor of verdict approached significance, indicating a trend for males to render more not guilty verdicts and females to render more guilty verdicts. In summary, male jurors perceived the crimes involving transgender victims as less severe and this may have impacted the rate of not guilty verdicts.
Adults in your church, small group, or other Christian organization are silently suffering the tragic consequences of having been sexually abused as children or youth. Why aren't they coming forward ...for help? Their reluctance may be related to wounds given by the faithful--religious people they trusted, who said things like "well, it wasn't rape" or "it's been thirty years--why is this such a big deal?" Such responses from people with religious authority deepen victims' need to shrink into anxiety, depression, and self-degradation. This book offers you the tools needed to undertake caring ministry to adults suffering in the aftermath of childhood sexual abuse. Once you understand the scientific research on such topics as trauma memory, consequences of abuse, and forgiveness, you will appreciate how caring collaboration can create hope and healing. In these pages every reader will find helpful content that will take you from feeling out of your depth to knowing you are empowered to be an effective companion in God's transforming work in the lives of survivors of abuse.
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