Coordinated Community Response Research Articles

Predictors of veteran attendance in an intimate partner violence intervention.

This study examined session attendance data from 2,754 veterans who participated in a national implementation of a trauma-informed intimate partner violence intervention, Strength at Home, across the Veterans Affairs Healthcare System. Potential correlates of attendance were demographic characteristics, posttraumatic stress disorder (PTSD) symptom severity, alcohol use, court involvement, current military involvement, and intervention modality (in-person vs. virtual). Given the trauma-informed nature of the intervention, it was expected that trauma-relevant risk factors, specifically PTSD symptom severity and racial minority status, would be less strongly associated with attendance than barriers related to other demographic variables and higher alcohol use, intervention modality, and court involvement. Results indicated that age, education level, employment status, retirement status, PTSD symptom severity, alcohol use, and court involvement were associated with session attendance in the expected direction at the bivariate level. Only education level, employment status, retirement status, alcohol use, and court involvement emerged as unique predictors of attendance such that more educated, employed, retired, and court-mandated veterans with less alcohol use attended more sessions. These findings suggest the importance of a trauma-informed, coordinated community response to intimate partner violence intervention and integration of motivational components surrounding problematic alcohol use to enhance compliance and mitigate barriers to attendance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Advancing a Comprehensive Multilevel Approach to Sexual Violence Prevention Using Existing Efficacious Programs.

Sexual violence (SV) is a serious and long-standing public health problem on college campuses. At institutions of higher education, campus administrators, activists, and practitioners have worked for decades to address campus SV. Despite federally mandated campus SV prevention programming, rates of campus SV remain unchanged. The purpose of this commentary is to outline a strategy for enhancing campus SV prevention efforts using a comprehensive multilevel approach utilizing existing efficacious programs. The following three strategies for implementing optimal campus SV prevention are proposed, which include (a) the need to prioritize efficacy, (b) targeting multiple levels of the social ecology, and (c) leveraging the benefits of in-person programming and technology-driven prevention. A call to action is included for both institutions of higher education administrators and practitioners to implement and invest in comprehensive multilevel interventions using existing, efficacious SV programs, ideally combining a technology-based program with an in-person component. Furthermore, a coordinated effort between prevention and response is needed to achieve successful prevention of campus SV and revictimization, including a connection with the community for postassault interventions. Thus, implementing multilevel interventions on college campuses using existing evidence-based programs in combination with a coordinated community response of postassault interventions can bring the campus community together and is optimal to moving the needle on rates of campus SV.

A descriptive analysis of children seeking medical attention for problematic sexualized behavior.

Problematic Sexualized Behavior (PSB) in children is an increasingly prevalent and often misunderstood issue that impacts the well-being of children. Quantifying the numbers of affected children is challenging due to inconsistencies in how these children are identified, as well as misperceptions surrounding the issue and lack of a coordinated community response. In this single-center retrospective case review, we attempt to report data on child demographics and case characteristics for children presenting to one Child Protection Program (CPP) medical specialty team for concern of PSB. A total of 224 children were identified as having engaged in PSB during the study period. 110 (49%) of these children were referred to the CPP for medical evaluation and medically triaged by the team. The remaining 114 children (51%) were identified through the medical triage of the presenting cases as having engaged in PSB with the index children, but were not referred to CPP for medical care themselves. The majority of children who were referred (69%) were the recipient of the PSB, compared to being the displayer of the behavior (20%). Of the recipient cases, the child displaying PSB was also referred to the CPP only 14.5% of the time. These results highlight that the number of children presenting for medical evaluation with concern of PSB is a significant underestimation of the prevalence of PSB in the community. This notable gap in identification of children engaging in PSB prevents service delivery for these children, including medical evaluation. The results also demonstrate that children displaying PSB were disproportionately missing from care and represent a specific area of missed opportunity for intervention and support by medical professionals.

Challenges to an Individualized Approach Toward Batterers Intervention Programs in the Context of Coordinated Community Response to the Intimate Partner Violence in Lithuania.

Although batterers' intervention programs (BIPs) constitute an important part of the coordinated response to intimate partner violence (IPV) and contribute to increasing the perpetrators' accountability and keeping victims safe, the effectiveness of these programs is still debated. Only recently has the focus of these debates shifted away from researching outcomes by measuring overall program effectiveness toward specific qualities of interventions across program models that may be effective for the distinct client (Babcock et al., Clinical Psychology Review, 23(8), 1023-1053, 2004; Zarling et al., Psychology of Violence, 9(3), 257-266, 2019). The discussion on the practical implementation of BIPs was supplemented by various significant concepts emerging from new empirical findings, such as differential treatment, motivational interviewing, and effective facilitator-client alliances (Hamel et al., Partner Abuse, 11(4), 387-414, 2020; Holtrop et al., Journal of Interpersonal Violence, 32(8), 1267-1290, 2017). This paper aimed to address some of the abovementioned concepts by identifying challenges that arise during the implementation of BIPs in Lithuania. Using qualitative data from semi-structured interviews and focus group discussions with BIPs facilitators, BIPs attendees, and various stakeholders, the paper discusses how to contribute to more effective BIPs outcomes. According to this study, the process of implementing BIPs in Lithuania should be systematized by incorporating existing instruments, such as motivational interviewing, risk-based assessment, and differential treatment, evidence-based programs focused on different theoretical approaches, and forms of implementation. The study found that the consistency and integrity of the entire BIP implementation process should be prioritized, and institutional cooperation in Lithuania needs to be improved to achieve a successful coordinated response to intimate partner violence.

Coordinated community response to prevent elder abuse, neglect, and financial exploitation: randomized control trial

Coordinated community response to prevent elder abuse, neglect, and financial exploitation: randomized control trial

Coordinated community response to prevent elder abuse, neglect, and financial exploitation: randomized control trial

ObjectivesTo test if the Community Complex Care Response Team (C3RT), a coordinated community response model, impacts the likelihood of abuse, neglect, and financial exploitation among at-risk community-dwelling older adults.MethodsOne hundred forty-six participants were randomly assigned to receive either the C3RT intervention (n = 74) or the standard practice (n = 72). Cox regression analyses were used to test whether the intervention delayed incidents of EANF victimization measured by when adult protective services opened an investigation, when the police recorded a victimization, and when a hospital admission took place.ResultsAssignment to the C3RT intervention program did not significantly delay incidents of EANF victimization indicator.ConclusionsThis C3RT approach did not produce the desired outcomes, though the project demonstrates that it is ethical and feasible to implement an RCT to test an intervention with vulnerable populations.

Proposing a Unified Framework for Coordinated Community Response

The CSW65 agreed conclusions call for a multisectoral coordinated response to all forms of violence against women. The term coordinated community response (CCR) is commonly used in various models of such a response. However, the term itself has different meanings to various actors in the sector, and therefore it is difficult to evaluate its success with any degree of certainty. This article seeks to (i) propose a broader unified framework for thinking about the term; (ii) remove any underlying assumptions of its positive or negative connotations; and (iii) revisit the term from a theoretical standpoint. The goal of this effort is to (a) guide policy, programming, and advocacy efforts across different sectors that respond to VAW; (b) provide clarity to practitioners in the implementation of a CCR; and (c) make its effectiveness measurable in different contexts.

Pragmatic Randomized Control Trial of a Coordinated Community Response: Increasing Access to Services for At-Risk Older Adults.

Elder abuse, neglect, and financial exploitation (EANF) impacts over five million community-dwelling older adults. Yet, no evidence-based intervention models exist that prevent EANF. In this article, we describe the assessment of process outcomes for a Community Complex Care Response Team (C3RT) model developed, via a practitioner-researcher partnership, to reduce instances of EANF victimization among higher risk community-dwelling older adults by identifying and coordinating their service needs. Specifically, we evaluated whether this C3RT approach produced more service coordination among providers (measured as documented interagency communications), more referrals for services, and more enrollment in services. A pragmatic randomized control trial using a 1:1 randomization scheme allocated participants to either the C3RT intervention (N = 74) or standard practice (N = 72) group offered by a local Area Agency on Aging. Outcome data were extracted from the participants' administrative service records. The participants assigned to C3RT had significantly more interagency communications and services provided (p < 0.05) than those in standard practice. Communications and services increased across a broad range of multidisciplinary services, which attend to the social determinants of health. This study is the first to use objective outcome measures to evaluate the processes of a coordinated community response approach systematically.

Development and Implementation of a Coordinated Community Response to Address Elder Abuse and Neglect

Elder abuse, neglect, and financial exploitation impacts over five million community-dwelling older adults in the United States. Although services are available to help these victims, they are often fragmented within communities with service providers having limited means to provide preventative services. The coordinated community response (CCR) is a type of coalition intended to overcome siloed services through a single-point-of-entry system and more team-based approaches to prevention. This article describes the development, implementation, and evaluation of the interagency functioning of a local CCR. The main goal of the CCR has been to better serve victims of elder abuse, neglect, and financial exploitation. However, through the coalition's evolution, the mission of how to do this shifted from a victim service model to a prevention approach. Unique features of this CCR include a uniform consent form to allow sharing of protected client data among all service providers and a technology-supported infrastructure for service record documentation and referrals. Using available data from administrative records, the number of unique interagency referrals for services to older adults at risk increased 450% from 2016 to 2018. The strength and type of connections between agencies changed over time. Among all eligible clients offered services, most (77%) agreed to provide uniform consent to allow data sharing among other local partner agencies. The evaluation showed that the coalition met most of its planned measurable outputs in the original logic model guiding the CCR programmatic development. The evaluation findings and lessons learned inform updated guidelines for self-assessment of CCRs.

The Best of Times, the Worst of Times: “Best Practices” for Survivor Support and Gender Violence Prevention Education on College Campuses

This article reports on a five-year project (2015–2020) to provide a campus-wide, systemic approach to survivor support and gender violence prevention education at one large, state university by a team of violence prevention educators, seasoned program development experts, and victim advocates and practitioners. Tasked with developing a “best practice” blueprint, we report on three overarching initiatives: the reliance on a strong campus/community partnership through our Coordinated Community Response Team and engagement with faculty and staff; a gender violence prevention model that focuses on leadership engagement at all levels of the organization, bystander approaches to cultural norms change, and social justice and gender transformative paradigms considered central when engaging on these issues with people of all gender identities, including men, women, and non-binary individuals; and a set of priorities that includes organizational leadership, attention to sustainability, a strong collaboration with students and community partners, and the collection of data at all stages of the process.

Comparing 911 and Emergency Hotline Calls for Domestic Violence in Seven Cities: What Happened When People Started Staying Home Due to COVID-19?

Research Summary: We examine changes in help-seeking for domestic violence (DV) in seven U.S. cities during the COVID-19 pandemic. Using Bayesian structural time-series modeling with daily data to construct a synthetic counterfactual, we test whether calls to police and/or emergency hotlines varied in 2020 as people stayed home due to COVID-19. Across this sample, we estimate there were approximately 1,030 more calls to police and 1,671 more calls to emergency hotlines than would have occurred absent the pandemic. Policy Implications: Inter-agency data sharing and analysis holds great promise for better understanding localized trends in DV in real time. Research-practitioner partnerships can help DV coordinated community response teams (CCRTs) develop accessible and sustainable dashboards to visualize data and advance community transparency. As calls for drastic changes in policing are realized, prioritization of finite resources will become critical. Data-driven decision-making by CCRTs provides an opportunity to work within resource constraints without compromising the safety of DV victims.

Comparing 911 and emergency hotline calls for domestic violence in seven cities: What happened when people started staying home due to COVID-19?

Research Summary: We examine changes in help‐seeking for domestic violence (DV) in seven U.S. cities during the COVID‐19 pandemic. Using Bayesian structural time‐series modeling with daily data to construct a synthetic counterfactual, we test whether calls to police and/or emergency hotlines varied in 2020 as people stayed home due to COVID‐19. Across this sample, we estimate there were approximately 1030 more calls to police and 1671 more calls to emergency hotlines than would have occurred absent the pandemic. Policy Implications: Interagency data sharing and analysis holds great promise for better understanding localized trends in DV in real time. Research‐practitioner partnerships can help DV coordinated community response teams (CCRTs) develop accessible and sustainable dashboards to visualize data and advance community transparency. As calls for drastic changes in policing are realized, prioritization of finite resources will become critical. Data‐driven decision‐making by CCRTs provides an opportunity to work within resource constraints without compromising the safety of DV victims.

Child Sexual Assault Nurse Examinations and Prosecutorial Decisions to Accept or Reject Cases of Child Sexual Abuse

Prosecution of child sexual abuse (CSA) cases provides safety for communities and justice for victims. Prosecutorial decisions are multifactorial and include the presence of a structured coordinated community response to outcries and access to skilled healthcare providers. This study examines the impact forensic nurse sexual assault examinations (SAEs) have on prosecution in a population of children seen at a child advocacy center (CAC). The authors examined case data from 553 cases of reported CSA, seen by a forensic nurse in a CAC. Statistical analysis focused on prosecution decisions with and without SAE, with and without physical findings. Logistic regression determined prosecution occurred more often when SAE had been conducted (p = 0.026, OR = 1.732, 95% CI [1.068, 2.808]), regardless of examination findings. The limitations include a single location for data and the multifactorial reasons for prosecution of cases. The multifactorial elements contributing to prosecutorial decisions are diverse. The formalized approaches in CACs historically show increased prosecution. Teasing out the impact of an SAE in a CAC may be reflective of positive CAC approaches. Regardless, a statistically significant finding of association uniquely with the SAE, with or without findings, implies more studies are needed to support the role of the forensic nurse in successful prosecutions of CSA cases.

Evaluation of Two Approaches for Responding to Allegations of Family Maltreatment in the U.S. Army: Coordinated Community Response Impacts and Costs.

The U.S. Air Force (USAF) conducted a program of research to develop and disseminate reliable and valid criteria for partner and child maltreatment (comprising abuse [physical, emotional/psychological, and sexual] and neglect). These criteria are now used in all branches of the U.S. military. The U.S. Army was the first service outside the USAF to adopt the criteria sets and computerized decision support tool but maintained the original committee composition (the "Case Review Committee" [CRC]) instead of adopting the entire assessment, allegation determination, and treatment planning process (the "Field-tested Assessment, Intervention-planning, and Response" [FAIR] system). The Army commissioned this study to compare the CRC and FAIR processes by testing (1) intra-committee process (i.e., three facets of committee functioning-fidelity to regulations, cohesion and team process, outsized influence of unit representatives); (2) coordinated community response to maltreatment (i.e., perceptions of fairness to alleged offenders and victims, impact on unit representatives, and (3) collaboration between the Family Advocacy Program (FAP, the military's maltreatment response agency) and outside agencies; and (4) the time expended and cost. New York University's Institutional Review Board approved the study protocol, and the Army's Human Research Protection Office provided permission to collect data. The ten Army garrisons with the most annual maltreatment cases participated. Committee members, FAP social workers, unit commanders, and independent observers completed assessments of individual meetings and of their overall impression of the processes. A test of whether the means significantly differed between phases was then performed separately for each outcome, and 95% CIs of the unstandardized mean difference between phases were estimated. Independent observers rated FAIR meetings as significantly more faithful to regulations. Unit representatives (i.e., commanders and/or first sergeants) perceived the committee to function better during FAIR (although other committee members and independent observers did not perceive differences). Unit representatives not only rated FAIR as significantly more fair to both alleged offenders and victims (ratings from other committee members did not differ), but also were more likely to attend FAIR meetings and, when they did, rated their ability to serve soldiers and families higher during FAIR. However, FAP social workers rated their relationships with units as being better during CRC, and outside agencies rated their relationship with FAP as significantly better during CRC. Costs to the Army were nearly identical in the two committee structures. Results indicated that the CRC and FAIR processes cost almost identical amounts to run and that the FAIR system was superior in ways most likely to impact service members: (1) independent observers judged its meetings to be more faithful to Army and DoD Instructions; (2) unit representatives were more likely to attend and believed the FAIR system to be fairer (to both alleged offenders and victims) and better functioning. Care should be taken, however, in nurturing relationships between FAP and (1) unit representatives and (2) outside agencies, which may have weakened during FAIR.

Muslim women’s service utilization for intimate partner violence: Front line service providers’ perceptions of what constitutes a culturally informed response

We explored Muslim women’s involvement in social services in response to intimate partner violence [IPV] from the perspective of frontline service providers. Participants identified several barriers embedded in current services including the absence of individualized support which offers women a continuum of options based on their needs and preferences. Furthermore, lack of sensitivity and appropriate response to abuse experiences based on women’s culture leads to further marginalization of women in services, which decreases service utilization. Participants suggested a strong collaboration among mainstream services, and Muslim centered services providing coordinated community response to IPV. Given women’s collectivist culture, involvement of women’s collective such as family member, and cultural community leaders upon women’s discretion was also recommended. Finally, participants recommended cultural diversity of service providers, while providing an ongoing education on culturally informed practices for all frontline workers. Our results support the development of survivor-defined and culturally informed services in addressing varied needs. To do so, we recommend building a bridge between Muslim communities and formal services, which help with the development of high quality services, and also facilitate women’s access to and use of formal support for IPV.

Nonprofit Hospitals' Response to the Opioid Epidemic in Urban Communities: A Content Analysis of Hospitals' Community Health Needs Assessments and Implementation Strategies.

Addressing the opioid epidemic requires a coordinated community response; yet, the role that nonprofit hospitals play in these efforts has not been systematically examined. To explore hospital-initiated strategies to address opioid use in urban communities most affected by the opioid epidemic. We conducted content analysis of publicly available community health needs assessments (CHNAs) and accompanying implementation strategies of 140 nonprofit hospitals. We employed a qualitative approach using open coding methods to explore the extent to which hospitals identified opioid use as a community health need and engaged in interventions to address opioid use in their communities. We also conducted bivariate analysis to compare organizational and community characteristics of hospitals that did and did not engage in strategies to address opioid use. One hundred forty nonprofit hospitals in urban areas with high opioid death rates across 25 states. Almost 70% of CHNAs identified opioid use as a community health need, and 63% of implementation strategies included at least 1 hospital-initiated activity to address this need. More than 90% of these implementation strategies involved providing additional capacity for and access to treatment. Bivariate analysis showed that hospitals that engaged in activities to address opioid use did not differ meaningfully from hospitals that did not engage in such activities, with 2 exceptions. Hospitals that relied on consultants to prepare the CHNA were more likely to engage in activities to address opioid use as were hospitals located in Medicaid expansion states. Nonprofit hospitals are taking action to address the opioid epidemic in their communities, most commonly by providing additional treatment capacity for patients with opioid use. While an important contribution, hospitals need incentives to develop a more comprehensive response to the opioid epidemic that extends beyond medical care to include the social and economic determinants of this crisis.

CHALLENGES AND BARRIERS FOR SERVICE PROVIDERS IN RURAL SETTINGS: AN ELDER-ABUSE NEEDS ASSESSMENT

There has been concern about the increasing prevalence of elder abuse in the rural settings. This trend has called for more coordinated efforts to address elder abuse in the rural community. The current literature regarding elder abuse suggest there is more to learn about systematic obstacles service providers face. The framework applied in this study include elements of Bronfenbrenner’s Bioecological model, showing a multilevel application to the obstacles agencies encounter when supporting else abuse victims. Little research has been conducted on the providers who work with elders in the rural context. In this study, based on the needs assessment of Iowa, we have examined the perceived barriers service providers face. Our sample included 222 providers across Iowa who took an online survey. The survey was initially sent to members of the Coordinated Community Response team of Iowa. Our findings indicated that service providers revealed multilevel challenges (i.e., individual vs. organization level) in working with elder abuse cases. Service providers’ perceived effectiveness training was negatively associated with the quality of training they evaluated (β=.24, p<.05). The data also showed us that a large portion of agencies offered no training and education on elder abuse. Common themes described by the providers as barriers to addressing abuse was lack of education, social isolation, low awareness and ageism. These results highlight that training for elder abuse in the rural setting needs multilevel systematic efforts.

From Health to Financial Problems: Multiproblems Among Victims of Partner and Non-Partner Physical Violence, and Matched Nonvictims.

Previous research suggests that victims of partner physical violence (PPV) often face multiple distinct problems, but comparative population-based studies focusing on the prevalence of multiple problems are lacking. Aim of the present study is to gain insight in the prevalence of multiple problems among individuals victimized by PPV in the past 12 months, compared with matched nonvictims and victims of non-partner physical violence (non-PPV). For this purpose, data were extracted from two population-based surveys conducted in 2018 and 2019 on potentially traumatic events in the Netherlands. We focused on problems identified in previous studies on PPV and non-PPV and related problems, varying from physical health, mental health, financial and legal problems, to lack of social support and being exposed to other potentially traumatic and stressful life events (LFEs). In total, 49 respondents were victimized by PPV and 89 by non-PPV in the past 12 months. They were compared with pairwise matched groups not affected by any traumatic or stressful LFEs in this period (nPPV victims comparison group = 245, nnon-PPV comparison group = 445). Results showed that PPV victims significantly more often faced all 12 distinct problems than matched nonvictims (2.31 ≤ odds ratio [OR] ≤ 15.48) and non-PPV victims (2.12 ≤ OR ≤ 4.52). PPV victims more often had any problem than non-PPV victims (OR = 8.19), but no significant differences were found between PPV and non-PPV victims with regard to mental health problems. Findings stress the necessity of a multidisciplinary coordinated community response to help PPV victims.

Domestic Violence Legislation in Greece: Analysis of Penal Mediation

This article presents an analysis of the penal mediation clause within Greece’s domestic violence legislation (Law 3500/2006) in the context of contemporary criminal justice theories. An overview of Law 3500/2006 will be presented, along with highlights of recent changes leading to Law 4531/2018 ratified as part of the Istanbul Convention and Law 4604/2019 designed to enhance gender equality. The penal mediation component of the Law will be discussed in depth and theories related to application of coordinated community response, restorative justice, and power and control will be highlighted. Current debates that lack clarity and scientific evidence, and could possibly lead to dismantling a “good” legal provision, will be presented. Greece’s penal mediation provision has the potential to be a best practice. However, lacking a proper evaluation, this information could be prematurely lost. Last, an action plan for scientific evaluation and legal clarification of the penal mediation clause will be presented.

The Challenges of Working With Men Who Perpetrate Partner Violence: Perspectives and Observations of Experts Who Work With Batterer Intervention Programs.

Batterer intervention programs (BIPs) constitute the primary treatment for perpetrators of intimate partner violence (IPV). Systematic evaluations of BIPs, however, have yielded modest results in terms of these programs' ability to reduce perpetration. Descriptive studies, which can provide information on the contexts and process associated with BIPs, can provide insights into the underlying mechanisms that might promote change among BIP clients, and as such are important to improving efficacy measures for BIPs. To date, however, limited research exists on what challenges BIPs encounter in working with clients, and how those challenges present barriers to behavioral change among perpetrators at the intervention level. As part of a 2-year ethnographic study, we conducted 36 individual semistructured interviews with professionals working with BIPs. We identified six themes related to challenges to promoting behavioral change among men who perpetrate violence: (a) social acceptance of IPV, (b) hypermasculine attitudes, (c) emotional problems, (d) childhood exposure to violence, (e) co-morbid mental health issues, and (f) denial, minimization, and blame. Our results have implications for thinking about some of the contextual factors that may impede BIPs ability to produce desired outcomes and for identifying areas in which programs can be tailored to improve the overall client experience. Our results also point to the need for a more coordinated community response to IPV, and in particular to helping provide resources that support BIPs sustained, safe, and as effective as possible work.