Abuse Treatment Research Articles

PROTOCOL: Domestic abuse interventions for mothers in or exiting prison: An evidence and gap map.

This is the protocol for a evidence and gap map. The objectives are as follows: to identify existing research and gaps in evidence according to the types of interventions, settings, study design and outcomes; to use the EGM findings to inform subsequent systematic reviews and to identify gaps in evidence to inform future research, policy or practice.

Development and Psychometric Validation of a Scale for Measurement of Tramadol Abuse

There are indications that the practices or behaviour involving tramadol use have not been measured with valid and reliable tools in the past. A scale that can be used to identify tramadol abuse practices in both clinical and non-clinical settings would be useful for possible intervention efforts. The objective of this study was, therefore, to develop and validate a scale to measure tramadol abuse. The scale items were sourced from the literature and outcomes from focus group discussions (FGDs) with 16 longterm tramadol users who were screened with Q-cup urine drug test kit (Q-CUDTK). Six experts and 30 long-term tramadol users were engaged for content and face validations of the items respectively. For construct validation, 180 tramadol users participated. Exploratory factor analysis (EFA) was applied to identify the underlying factor structure of the scale and Cronbach’s alpha was computed for the scale internal consistency. Two items failed to meet the I-CVI (item-content validity index) cut-off point (I-CVIs < 0.83) and were deleted leaving 18 items with the S-CVI (scale-validity index) of 0.93. Three more items were deleted for having factor loadings below 0.50 leaving 15 items. The EFA resulted in the extraction of three factors: frequency of use (7 items), intensity of use (5 items) and pattern of use (3 items) with the reliability coefficients of 0.95, 0.96 and 0.89 respectively. We named this scale ‘Tram-BEHAV’ because it can be used to identify tramadol abuse behaviour for possible intervention. It can also be used for the evaluation of tramadol abuse intervention programmes.

Sexual Abuse and Social Work Intervention from a Feminist Perspective

Sosyal problemleri feminist perspektiften ele almak daha adil ve eşitlikçi toplumların oluşmasında, problemlerin bilinmeyen yönlerinin ve içerdiği güç ilişkilerinin gün yüzüne çıkarılarak mikro ve makro düzeylerde farkındalık oluşturmasında önemli bir adımdır. Bir sorunun feminist düzlemde yeniden okunması, başlangıç noktasının kadınlar olmasını ve ataerkil, baskıcı ve hiyerarşik ilişkilerin yarattığı tüm olumsuzlukların ele alınmasını elzem kılar. Sosyal hizmetin baskı karşıtı, güçlendirici ve özgürleştirici paradigmaları feminist teorinin felsefesi ve argümanları ile paralellik göstermektedir. Bu çalışma karmaşıklığı ve ketumluğu iç içe geçmiş ve birçok toplumda farklı dinamiklerle de olsa benzer şekilde tezahür bulan cinsel istismar sorununu feminist perspektiften ele almayı amaçlamıştır. Çalışma bu kapsamda literatür taraması yoluyla feminist teori, sosyal hizmet ve cinsel istismar arasındaki ilişkiye dikkat çekerek, cinsel istismara maruz bırakılan çocuklar ve aileleri ile gerçekleştirilecek mikro, mezzo ve makro düzeylerdeki sosyal hizmet müdahalelerine ilişkin feminist bakış açısı kazandırmayı ve feminist yaklaşımın uygulamalarda nasıl olabileceğine ilişkin önerilerde bulunmayı ve uygulayıcılara tartışma sunmayı amaçlamıştır.

Evaluating the effectiveness of reformulated extended-release oxycodone with abuse-deterrent properties on reducing non-oral abuse among individuals assessed for substance abuse treatment with the Addiction Severity Index-Multimedia Version (ASI-MV)

Objective Original brand extended-release (ER) oxycodone tablets (OC) for oral use were reformulated (ORF) with abuse-deterrent properties (ADP) against inhalation and injection routes in August 2010. This product transition provided an opportunity to compare “before and after” reformulation abuse trends. Our goal was to assess the change in abuse of brand oxycodone ER from before and after introduction of ORF. Methods Change in self-reported non-oral “OxyContin” abuse in the previous 30 days during two years pre- and four years post-reformulation was assessed among adults evaluated for substance use and treatment planning using the Addiction Severity Index-Multimedia Version (ASI-MV). Comparator opioids were used to provide a frame of reference for changes in abuse due to competing population-level opioid abuse interventions and other factors unrelated to the reformulation. A proportion (PR) and abuse report dispensing ratio (ARDR) are reported because a single measure of abuse has not been identified that can optimally describe opioid abuse or changes in opioid abuse. Results Interrupted time-series analyses indicated an immediate decline in non-oral abuse measures post-reformulation (PR = −52.1%; ARDR = −32.2%). Significant decreases from pre- to post-reformulation in non-oral abuse overall were observed (PR [95% CI] = −30.7% [-46.9%, −9.5%]; ARDR = −29.3% [-37.5%, −20.1%]). Comparator opioids did not demonstrate similar trends over the period. Conclusions Methodology applied in this study suitably assessed the effectiveness of an ADP product. Among individuals assessed for substance use, a differential decline in non-oral abuse of brand ER oxycodone was observed since introduction of ORF.

What are the survivor, family, and professional experiences regarding psychosocial interventions for sexual abuse and violence?

What are the survivor, family, and professional experiences regarding psychosocial interventions for sexual abuse and violence?

Validating the TeenHITSS to Assess Child Abuse in Adolescent Populations.

The purpose of this study is to establish the psychometric properties and diagnostic accuracy of the Teen Hurt-Insult-Threaten-Scream-Sex (TeenHITSS), a 5-item measure used to screen adolescents for family violence in clinical settings. Study participants included 251 adolescent participants (n=197 not at-risk subsample; n=56 at-risk subsample), recruited from ambulatory care clinics, a medical center at-risk referral clinic, and area shelters. Participants completed a cross-sectional survey, including the TeenHITSS and Parent-Child Conflict Tactics Scales (CTSPC) questionnaires. We calculated internal reliability, validity, and sensitivity and specificity for the full sample and both subsamples for each screening instrument. Concurrent validity between the TeenHITSS and CTSPC was strong (r=.71,P<.000). We determined an optimal cutpoint based on sensitivity and specificity for correctly identifying abuse victims as a score of one or greater on the TeenHITSS. The TeenHITSS also proved slightly superior to the CTSPC in differentiating between victims and nonvictims of adolescent abuse (AUC=.79 vs .73, respectively). The TeenHITSS screening tool performed as well as the CTSPC in correctly classifying at-risk and not-at-risk teenagers and offers much greater utility to providers by supplying an actionable cut score. The findings of this study suggest that TeenHITSS is a valid and reliable tool to screen for physical and sexual abuse in children ages 13 years and older in clinical settings and can help health care providers detect adolescent abuse and initiate intervention and prevention of future abuse.

The Effect of a Facility Level Intervention on Disrespect and Abuse during Childbirth: A Controlled Before and After Comparison of Two District Hospital in Abuja, Nigeria

Disrespect and abuse of women by health care workers during pregnancy and childbirth is very common especially in developing countries like Nigeria. This is a deterrent to the utilization of available maternal health-care facilities with resultant high maternal morbidity and mortality. Hence there is a need for interventional strategies to reduce the prevalence. This study examines the effectiveness of an educational intervention on the prevalence of disrespect and abuse in two district hospitals in Nigeria. It employed a quasi-experimental design as a control before and after with a comparison to measure the effect of a single intervention on the prevalence of disrespect and abuse experienced by women during childbirth, using two health facilities. A total of three hundred and seventy four (374) women experiencing childbirth, one hundred and eighty seven from each health facility were randomly selected as research participants for a baseline study while the same total number of women were selected after a 3 days training on respectful maternity care targeted at health workers in only one of the hospitals. The overall prevalence of disrespect and abuse among the women at baseline was 92.33%. The results from the logistic regression analysis conducted at post intervention and the z-score comparison of proportion test indicates a significant reduction in the overall prevalence of disrespect and abuse at the intervention site, from 88.2% to 46% with no significant change in the overall prevalence of disrespect and abuse at the control site. It was concluded that there is a significant relationship between educational intervention and prevalence of disrespect and abuse hence recommendations were made for relevant stakeholders to implement strategies that will improve respectful maternity care.

Engaging domestic abuse practitioners and survivors in a review of outcome tools – reflections on differing priorities

Researchers often develop and decide upon the measurement tools for assessing outcomes related to domestic abuse interventions. However, it is known that clients, service providers and researchers have different ideas about the outcomes that should be measured as markers of success. Evidence from non-domestic abuse sectors indicates that engagement of service providers, clients and researchers contributes to more robust research, policy and practice. We reflect on what we have learnt from the engagement of practitioners and domestic abuse survivors in a review of domestic abuse measurement tools where there were clear differences in priorities between survivors, practitioners and researchers about the ideal measurement tools. The purpose of this reflective article is to support the improvement of future outcome measurement from domestic abuse interventions, while ensuring that domestic abuse survivors do not relive trauma because of measurement.

Reporting and Interpreting Effect Sizes in Applied Health-Related Settings: The Case of Spirituality and Substance Abuse.

Inferential analysis using null hypothesis significance testing (NHST) allows accepting or rejecting a null hypothesis. Nevertheless, rejecting a null hypothesis and concluding there is a statistical effect does not provide a clue as to its practical relevance or magnitude. This process is key to assessing the effect size (ES) of significant results, be it using context (comparing the magnitude of the effect to similar studies or day-to-day effects) or statistical estimators, which also should be sufficiently interpreted. This is especially true in clinical settings, where decision-making affects patients' lives. We carried out a systematic review for the years 2015 to 2020 utilizing Scopus, PubMed, and various ProQuest databases, searching for empirical research articles with inferential results linking spirituality to substance abuse outcomes. Out of the 19 studies selected, 11 (57.9%) reported no ES index, and 9 (47.4%) reported no interpretation of the magnitude or relevance of their findings. The results of this review, although limited to the area of substance abuse and spiritual interventions, are a cautionary tale for other research topics. Gauging and interpreting effect sizes contributes to a better understanding of the subject under scrutiny in any discipline.

GLOBAL ELDER ABUSE: A MEGA-MAP OF SYSTEMATIC REVIEWS

Abstract Elder abuse is an increasingly prevalent public health problem that requires a global political and evidence-based response. To make global evidence on elder abuse easier to locate and analyze, we constructed a mega-map – an interactive map that systematically identifies and overviews existing systematic reviews – on elder abuse prevalence, consequences, risk and protective factors, and interventions. Following Campbell Collaboration methodological guidelines, we conducted a comprehensive database and grey literature search of the global elder abuse literature (n=2,776) to identify systematic reviews that examine one or more of these four abuse domains among adults age 60+ (n=111). We then coded the reviews to identify key characteristics, including the types of abuse, settings, World Health Organization (WHO) geographic regions, and demographic subgroups represented in each review, that can be filtered in the mega-map. We also adapted the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Review and Research Syntheses to appraise the quality of each review. We found that the focus of existing evidence syntheses is most commonly interventions (n=59), followed by prevalence (n=52), risk factors (n=51), consequences (n=31), and protective factors (n=16). The majority of published elder abuse studies have been conducted in the European, Western Pacific, and Region of the Americas WHO geographic regions. Few reviews examine systemic abuse and system-level interventions. Future studies on elder abuse should address these gaps in research on protective factors and systemic aspects of elder abuse, and build evidence about elder abuse in the African, South-East Asian, and Eastern Mediterranean WHO geographic regions.

A DIGITAL ELDER ABUSE INTERVENTION FOR THE EMERGENCY DEPARTMENT

Abstract Elder abuse continues to grow as a national issue with significant gaps in standards for identifying victims. The emergency department provides an opportune setting for affected older adults to report abuse privately, but traditional screening methods may miss certain types of elder abuse when there are no visible signs of abuse. Community resources and reporting methods may not be known or can be stigmatized, therefore creating a challenging scenario for victims of abuse to navigate without fear. The VOICES Elder Abuse Intervention (EAI) is a unique self-administrated tablet-based tool with an automated digital coach that combines major components of screening, educational content, and brief psychoeducational interviewing to empower the older adults and encourage self-identification and self-reporting of abuse. The digital format of the tool allows this EAI to be integrated within an existing elder abuse workflow protocol in the emergency department, rather than replacing it entirely. We will discuss our completed study that included (N=1,002) participants over the age of 60, which suggests that patients find the EAI user-friendly and easy to use. For example, 93% of participants agreed that VOICES was appropriate for learning about abuse, and 94% agreed that using VOICES was very easy to use. Informed by these findings, we plan to adapt and evaluate VOICES EAI for use in other older adult populations and healthcare settings.

SELF-ADMINISTRATED ELDER ABUSE INTERVENTION FOR OLDER ADULTS WITH COGNITIVE IMPAIRMENT

Abstract Many elder abuse interventions and tools designed to screen for abuse exclude older adults with cognitive impairments (CI) due to the challenges associated with screening and whether the older adult with CI can reliably report elder abuse. However, it has been shown that older adults with CI are among the most vulnerable to experiencing elder abuse. VOICES is an innovative, automated tablet-based elder abuse screening and prevention intervention that is self-administered by the older adult in the provider’s waiting room or office. The VOICES Elder Abuse Intervention (EAI) provides screening, educational modules, and brief psychoeducational intervention to enhance and improve identification of elder abuse when there are no visible signs of abuse. The VOICES EAI was already proven successful in terms of feasibility and acceptability in cognitively intact older adults in a busy emergency department setting with (N=1,002). In this study we tested the VOICES EAI with (N=30) participants 60 and above with cognitive impairment at a geriatric center using the Montreal Cognitive Assessment (MoCA) to determine cognitive capacity. Experts in the field of geriatrics and cognitive impairment assisted in grouping participants within three cognitive categories: Mild cognitive impairment (MoCA 23-25), mild dementia (MoCA 16-22) or moderate dementia (MoCA 8-15). Of the (N=30) participants, 29 were able to successfully use the VOICES EAI independently, and most participants were satisfied with the tool. We will discuss the findings of this preliminary study and the implications for future research with older adults with CI.

Strategies to build more effective interventions for elder abuse: a focus group study of nursing and social work professionals in Hong Kong

BackgroundOne in six older adults living in communities experience abuse and neglect. Elder abuse has serious consequences for individuals, families, and society, including mortality, physical and psychological morbidities, and increased care requirements. Timely and effective interventions for elder abuse should therefore be a priority. This study used a qualitative focus group approach to address the following questions: What are the essential elements of elder abuse interventions? What can be done to improve current interventions?MethodThe 32 participants in this focus group study included social workers, medical social workers, and nurses from seven organizations who shared their knowledge and insights. All sessions were conducted online, audio-recorded, and transcribed verbatim. Three researchers with backgrounds in social work and psychology independently coded the transcripts and agreed on the themes emerging from the focus groups.ResultsBased on the experiences of frontline helping professionals in Hong Kong, we highlighted the key factors for effective elder abuse intervention: 1) identification and assessment; 2) essential skills and attitudes; 3) elements of effective interventions; 4) collaborative efforts across disciplines and agencies; and 5) raising awareness among professionals and the public.ConclusionsTraining can equip frontline professionals with the necessary skills to identify elder abuse cases and to assess the risk of abuse. Effective interventions should not only address clients’ safety and need for tangible support but also respect their autonomy and privacy. A client-centered, strength-based approach that involves supportive peers and addresses the complex family relationships involved can be useful. Interventions should also involve cross-discipline and cross-agency collaboration.

“What do mothers know about child sexual abuse?”: A qualitative investigation

The perceptions of mothers about child sexual abuse (CSA) and their levels of knowledge concerning the issue are critical for child abuse intervention and prevention. To date, however very little research has been conducted on this subject in the context of Turkey. Given that gap in the literature this study aims to evaluate the perceptions of Turkish mothers about CSA and recommend means of abuse prevention and intervention, and in doing so improve understanding of the topic. Descriptive phenomenological patterns derived from the qualitative research approach were used to shed light on the CSA perceptions of 15 Turkish mothers with children who were 3–6 years of age. The researchers interviewed the mothers with 11 structured questions and the resulting data were then analyzed with MAXQDA-18. Five main themes related to CSA emerged: defining CSA, as being aware of risk-factors, engaging in protective and preventative behaviour, recognizing cases of CSA and reacting to incidences of CSA. These findings are then discussed in terms of developments in the literature, as well as their implications, and recommendations are considered together with future research directions.

A mixed-methods, exploratory, quasi-experimental evaluation of a radio drama intervention to prevent age-disparate transactional sex in Tanzania.

Age-disparate transactional sex (ADTS) is associated with HIV, unintended pregnancy, school dropout and violence, yet few interventions have successfully prevented it, and none have set ADTS prevention as their primary outcome. This exploratory evaluation aimed to assess indications of change after exposure to the Learning Initiative on Norms, Exploitation and Abuse (LINEA) intervention, a mass-media, gender-transformative social norms intervention aimed at preventing ADTS in Tanzania. In a condensed implementation 331 participants were instructed to listen to the LINEA radio drama over seven weeks, and 60 were randomly allocated to household discussion sessions about content. In-depth interviews (n = 81) from girls aged 12-16 years, and women and men caregivers were collected at baseline (September 2021), midline (November) and endline (December 2021). Surveys were conducted (n = 120) at baseline and endline using the Norms and Attitudes on ADTS Scale (NAATSS) and the Gender Roles and Male Provision Expectations (GRMPE) scale. Interviews were thematically analyzed using a framework approach. Age-stratified linear regression models adjusted for baseline scores were used to measure association between the intervention and endline scale scores. Longitudinal data were available from 59 qualitative (73%) and 95 quantitative participants (79%). Qualitative evidence revealed the drama facilitated family conversations about adolescent challenges, allowing caregivers to advise daughters. Some girls gained confidence to refuse men's gifts, learning that accepting them could necessitate sexual reciprocation. Some caregivers felt increased responsibility for supporting girls in the community to avoid ADTS. Blame for ADTS shifted for some from girls to men, suggesting increased understanding of inequitable power dynamics and reductions in victim blaming. Marginal quantitative evidence revealed that highly exposed girls had improved gender equitable beliefs on the GRMPE (β = -6.26; 95% CI: -12.94, 0.42). Moderately exposed men had increased gender inequitable norms on the NAATSS subscale (β = 0.42 95% CI: 0.05, 0.79), but there was no effect in highly exposed men. Given the small sample results should be interpreted cautiously. Our initial findings indicate high engagement with the LINEA intervention shows promise in shifting knowledge, behaviors, and attitudes, beliefs and social norms driving ADTS in Shinyanga, Tanzania, supporting a robust impact evaluation.

Facilitators and Barriers to Child Sexual Abuse Interventions: A Qualitative Study of Interventions in Iran

Background: Child sexual abuse is a public health problem in most countries. Sensitization, research, and programs for identifying and preventing child sexual abuse have been carried out at the national level with increased political and social awareness and international commitments to decline its consequences. Objectives: This study investigated the facilitators and barriers to community-based interventions for child sexual abuse. Methods: Semi-structured interviews were conducted between September 2021 and March 2022 with 15 purposefully selected experts. The interviews were audio-recorded, transcribed, and analyzed using the content analysis method. Results: Several barriers and facilitators affected child sexual abuse interventions. The barriers included: (1) sociocultural challenges; (2) legal challenges and gaps; and (3) managerial-structural challenges, while the facilitators were: (1) the improvement of the quality of provided services; and (2) facilitative role of the law. Conclusions: Social interventions for child sexual abuse could consider some items to improve implementation, namely as follow: (1) the intersectional cooperation of organizations and beneficiaries to conduct child abuse interventions for children and their families at the local and national levels; (2) the implementation of empowerment activities for the return of children and parents to the community after child sexual abuse; and (3) the revision of the laws and establishment of more deterrent punishments.

Adaptation and evaluation of the digital elder abuse intervention “VOICES” in the primary care-based setting

Adaptation and evaluation of the digital elder abuse intervention “VOICES” in the primary care-based setting

A qualitative evaluation of the “RISE” elder abuse intervention from the perspective of adult protective services caseworkers: addressing a service system gap

ABSTRACT Our understanding of effective elder abuse (EA) response interventions is limited. Adult Protective Services (APS), the primary agency responsible for responding to EA, lacks a coherent, conceptually driven, prolonged intervention phase. Informed by an ecological-systems perspective and adapting evidence-based modalities from other fields, the RISE EA intervention addresses this APS systems gap. Based on a three-year pilot project involving a partnership between RISE and Maine APS, the current study conducted a qualitative evaluation of RISE, from the perspective of APS caseworkers (n = 14) who worked with RISE, to understand RISE strengths and areas for improvement. Findings suggest APS workers perceive that RISE complements the scope and nature of APS, enhances APS caseworker well-being, and reduces repeat APS cases, while further APS/RISE collaboration and clarification on RISE role responsibilities and referral eligibilities are areas of growth. This study provides preliminary evidence for RISE as a community-based EA intervention in partnership with APS.

A multimodal approach to reduce attrition, recidivism, and denial in abuser intervention programs

This study presents findings from a community-based organization (CBO) intimate partner abuser intervention pilot project. The project demonstrated outcomes for high program retention, low recidivism for new domestic-violence arrests, and discernible cognitive change in reductions of denial and increased acceptance of personal responsibility for acts of interpersonal abuse. Thirty-two participants of the cohort (N = 47) finished the 52-week program. Thirty-months post-intake revealed one program completer was arrested for new domestic violence charges. During that same time frame, five of the fifteen non-completers were rearrested for new domestic violence charges. The program used a 52-session multimodal curriculum designed with evidence-based clinical interventions, adult learning strategies, and Risk/Needs/Responsivity (RNR) principles. The CBO received funding from a private Christian foundation to provide the classes free of charge to all participants who were either voluntary (N = 2) or mandated (N = 45). A repeated measurement design evaluated participant’s cognitive changes and acceptance of personal responsibility at intake and 14-weeks after starting the program. Both victim and participant self-assessments of perceived cognitive change were obtained during and after program completion.

Survivor, family and professional experiences of psychosocial interventions for sexual abuse and violence: a qualitative evidence synthesis.

Survivor, family and professional experiences of psychosocial interventions for sexual abuse and violence: a qualitative evidence synthesis.