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RIViR Paper #2. Current Approaches:
Introduction
The purpose of this paper is to describe healthy relationship programs’ current approaches to addressing intimate partner violence (IPV) and teen dating violence (TDV). 1 Having a report-out of programs’ actual approaches to addressing IPV and TDV will help lay the foundation for other activities in the Responding to Intimate Violence in Relationship Programs (RIViR) project, including developing a proposed framework for understanding how healthy relationship programs influence IPV and TDV, proposing parameters for IPV and TDV assessment tools and surrounding protocols, and field testing these tools and protocols in healthy relationship programs.
How Are IPV and TDV Relevant to
Healthy Relationship Programs?
Analyses of healthy relationship program study data conducted for the RIViR project suggest that healthy relationship programs can expect that a substantial proportion of their current or prospective participants experience IPV. For example, RIViR analyses showed that the prevalence of physical partner violence in adult healthy relationship program target populations ranged from 11% in a 3-month period among a married couple target population to 42% in a 6-month period among a justice-involved target population.
The federal Administration for Children and Families (ACF) has administered roughly $75- $100 million in grants per year since 2006 2 to hundreds of programs designed to foster and support healthy relationships and marriage. Healthy relationship programs typically offer relationship education classes for couples or individuals, accompanied by other services such as parenting and co-parenting education, financial literacy, case management, or mentoring. In more recent years, many programs have added job training and workforce development as well. Some programs focus on youth populations, while others serve individual adults or adult couples.
(^1) For purposes of reporting research findings as succinctly as possible in this research paper, we use the acronyms “IPV” and “TDV” to refer to intimate partner violence and teen dating violence. However, relying on these or other acronyms in program documents designed for 2 ongoing staff or participant use should be carefully considered, since they can cause confusion or seem to minimize survivors’ experiences. Funding for federal programs to promote healthy relationships and marriage was authorized by the Deficit Reduction Act of 2005 and re- authorized under the Claims Resolution Act of 2010.
Current Approaches to Addressing Intimate Partner Violence
in Healthy Relationship Programs
April 2016 OPRE Report # 2016 - 41 Authors: Kate Krieger, Tasseli McKay, Lexie Grove, & Anupa Bir
Project Overview
The purpose of the Responding to Intimate Violence in Relationship programs (RIViR) project is to understand how to best identify and address intimate partner violence (IPV) in the context of healthy relationship programming. The project takes a comprehensive approach by considering: actions to be taken prior to IPV identification; strategies and tools to identify IPV at initial assessment and throughout the program; and recommended protocols for when individuals disclose IPV, such as linking individuals to appropriate resources and referrals. The project focuses on research evidence and supplements this information with expert input where evidence is lacking, so that technical assistance providers and practitioners can understand the current knowledge base as they develop specific guidance and program approaches. The project will develop a series of papers for research and practice audiences and other stakeholders on five core topics: Paper #1. Prevalence and Experiences: IPV prevalence and experiences among healthy relationship program target populations Paper #2. Current Approaches: Current approaches to addressing IPV in healthy relationship programs Paper #3. Frameworks: Proposed frameworks for understanding how healthy relationship programs can influence IPV Paper #4. State of the Evidence: Evidence on recognizing and addressing IPV in healthy relationship programs and key research gaps Paper #5. Screeners and Protocols Assessment: An assessment of whether different approaches to IPV disclosure opportunities reliably identify IPV and result in appropriate assistance to victims. The project team partners with a range of IPV advocates and healthy relationship program practitioners, to ensure the project is relevant to healthy relationship program contexts and safely and appropriately addresses IPV. All papers are vetted with these experts, and will be released beginning in 2016.
IPV can be defined as physical, sexual, or psychological harm, or reproductive coercion by a spouse, partner, or former partner.^3 The term “teen dating violence (TDV)” refers to similar abuses when they occur in youth dating experiences, 4 typically among middle and high school aged youth.^5 , 6^ (A glossary of key terms used in this paper appears as Appendix A .) IPV is widespread in the U.S., and women are disproportionately impacted: Recent data show that 31.5% of U.S. women and 27.5% of U.S. men had experienced IPV within their lifetimes^7 and 42% of female and 14% of male IPV victims report physical injury. 8 TDV is also a pervasive issue: Two thirds of adolescents who have dated also report experiencing abuse from a dating partner. 9
IPV is particularly relevant to healthy relationship programs because four major ACF-funded studies examining healthy relationship programs found that IPV experiences were common among the target populations served by these programs.^10 While these programs may have potential to prevent abuse or help individuals experiencing it, there is also need for more research on whether such programs could lead to increased IPV/TDV for some participants if not adequately identified and addressed by programs. 11 Research evidence related to healthy relationship program implementation in the context of participants’ potential IPV and TDV experiences is the subject of RIViR Paper #3.
Why Look at Healthy Relationship Program
Approaches to IPV and TDV?
Menard and Oliver (2005) argue that healthy relationship programs must be prepared to address IPV and TDV for a myriad of reasons: The likelihood that some participants are experiencing IPV/TDV, the need to ensure that participants are not inadvertently encouraged by the program to stay in unhealthy relationships, and because being free of abuse is foundational to a healthy relationship. In other words, “It’s not healthy if it’s not safe.”^12 Some healthy relationship programs directly speak to IPV-- for example, providing information on what constitutes IPV and TDV and how to identify it– while others do not. Whether programs include such content or not, participants might disclose abuse (i.e., discuss it with a program staff member) at a number of points during the course of a
(^4) While we use the term “teen dating violence” throughout this paper, particularly with regard to healthy relationship programs for youth, it is
5 important to point out that dating violence is not limited to teens, but may occur in the context of adult dating relationships. Centers for Disease Control and Prevention: National Center for Injury Prevention and Control (2014). Understanding Teen Dating Violence. 6 Retrieved from:^ http://www.cdc.gov/violenceprevention/pdf/teen-dating-violence-factsheet-a.pdf Teen dating violence is also referred to as Adolescent Relationship Abuse (ARA), to emphasize the fact that abuse between teens does not 7 always occur in the context of “dating”.^ Appendix A: Glossary^ provides definitions of other relevant terms. Breiding, M. J., Smith, S. G., Basile, K. C., Walters, M. L., Chen, J., & Merrick, M. T. (2014). Prevalence and characteristics of sexual violence, stalking, and intimate partner violence victimization-national intimate partner and sexual violence survey, United States, 2011. Morbidity 8 and mortality weekly report. Surveillance summaries (Washington, DC: 2002), 63, 1-18. Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., & Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers 9 for Disease Control and Prevention. Taylor, B.G. & Mumford, E.A. (2014). A national descriptive portrait of adolescent relationship abuse: Results from the National Survey on 10 Teen Relationships and Intimate Violence (STRiV).^ Journal of Interpersonal Violence,^ DOI 10.1177/ McKay, T., Cohen, J., Grove, L., Bir, A., Cutbush, S., & Kan., M. (2015). “Intimate Partner Violence Experiences in Federal Healthy Relationship 11 Programs.” Prepared for the Administration for Children and Families, U.S. Department of Health and Human Services. Potential healthy relationship program effects on IPV and TDV are the subject of “A Proposed Framework for Understanding How Healthy 12 Relationship Programs Can Influence Intimate Partner^ Violence”, [insert hyperlink once released] Menard, A, & Williams, O. (2005, Updated 2006). “’It’s Not Healthy If It’s Not Safe: Responding to Domestic Violence Issues within Healthy Marriage Programs.” Paper for Presentation at Fall Conference of the Association for Public Policy Analysis and Management.
This paper does not describe best practices for addressing intimate partner violence or teen dating violence in healthy relationship programs. For the most current guidance for grantees on working with a local domestic violence program partner to address intimate partner violence, please refer to Promoting Safety: A Resource Packet for Marriage and Relationship Educators and Program Administrators.
IPV-Related Requirements in Healthy Marriage Program Funding Opportunity Announcements The 2006 funding opportunity announcement for Healthy Marriage and Relationship Education required that applicants describe in their applications how their proposed programs or activities would address IPV, and that they consult with domestic violence programs in developing their procedures. In 2011, the funding opportunity announcement required that applications describe how programs or activities would address IPV and describe consultation with domestic violence organizations, but did not require the development of written protocols. Current ACF healthy relationship grantees, funded in 2015, were required to include evidence of consultation with a local domestic violence program or coalition in their applications and to take a “comprehensive approach to addressing domestic violence.” The funding announcement outlines an example of such an approach, which includes training for staff and a memorandum of understanding with a local domestic violence program.
Many healthy relationship grantees aim to offer basic information about IPV/TDV through their relationship education curricula. In this section, we provide a report-out of the extent to which relationship education curricula include any content related to IPV/TDV. We reviewed 14 healthy relationship program curricula commonly used by ACF grantees (see Table 1 ). Thirteen of the 14 curricula^15 most commonly used by healthy relationship grantees contain components related to IPV/TDV, though often indirectly. For example, five curricula include modules describing the characteristics of healthy versus unhealthy relationships (but not necessarily focused on violence specifically), while seven include instruction and activities designed to train participants to identify warning signs in a relationship that may escalate to violence. None of the curricula reviewed included a focus on gender roles and attitudes as they relate to IPV/TDV. (This is an important gap, given that prior research shows that traditional gender roles are associated with IPV/TDV perpetration. 16 ,17, )
Of the curricula reviewed, eight provide (any) information on how facilitators can help a participant who is experiencing IPV/TDV, six contain (any) guidelines for facilitators on how to discuss abuse in a way that does not endanger participants who experience it, and two explain how to identify forms of IPV/TDV that developers believe would make program participation dangerous for a couple. Two curricula also include information to be used by program staff in deciding whether or not to assess IPV/TDV experiences among potential participants before the start of the program (we include a section on assessment later in this paper). Adult-focused curriculum developers who were interviewed believed that the risks of participating in a relationship education program might be greater for people attending with an abusive partner than for those attending individually. They cited the possibility that violent partners may retaliate against partners who disclose IPV during a program. Additionally, couples-based curricula tend to encourage open communication between couples, and open discussion of relationship problems among couples in which one partner is perpetrating IPV could provoke further abuse. 19 Of the two curricula we reviewed that were geared to individual adults rather than couples, one directly addresses IPV and includes a unit on IPV with several lessons and activities, while the other does not.
(^15) Healthy relationship programs have traditionally been educational, and therefore use curricula, rather than oriented toward counseling or
16 other clinical services. 17 Jewkes, R. (2002). Intimate partner violence: causes and prevention.^ The Lancet, 359 (9315):1423-1429. Santana, M. C., Raj, A., Decker, M. R., La Marche, A., & Silverman, J. G. (2006). Masculine gender roles associated with increased sexual risk 18 and intimate partner violence perpetration among young adult men.^ Journal of Urban Health, 83 (4): 575-585. Reed, E., Silverman, J. G., Raj, A., Decker, M. R., & Miller, E. (2011). Male perpetration of teen dating violence: Associations with neighborhood violence involvement, gender attitudes, and perceived peer and neighborhood norms. Journal of Urban Health, 88 (2): 226- 19 239. The issue of safety in couples-based versus individual-based healthy relationship programs will be discussed further in RIViR papers #3 and #4.
Table 1. Presence of Selected IPV-Related Elements in Commonly Used Relationship Education Curricula
Curriculum Content Instructions for Facilitators
Curricula by Type^ Does curriculum include
a
module describing healthy vs. unhealthy relationships? Does curriculum include instruction and activities designed
to train
participants to identify warning signs
for violence
?
Does curriculum address gender constructs, gender roles, or systemic oppression? Does the curriculum include information about how participants can get help if they
experience IPV/TDV
?
Does cur
riculum include
instructions on
safer ways
to
talk about IPV
/TDV
?
Does curriculum include
an
explanation of
diff
erent
forms of IPV
/TDV
for the
facilitator?
Curricula for Youth-Serving Programs
Love U2: Relationship Smarts Yes Yes No No No No
Connections Yes Yes No No No No
Love Notes Version 2 Yes Yes No Yes No No
Active Relationships for Young Adults No No No Yes Yes No
Curricula for Adult-Serving, Couples-Based Programs
PREP: Within Our Reach No Yes No Yes Yes Yes
PREP: Version 7.0 No No No Yes Yes Yes
Active Relationships: Marriage and Best Practices, Active Choices No Yes No Yes Yes No
Family Wellness – The Strongest Link: The Couple No^ Yes^ No^ Yes^ No^ No
Family Wellness – Survival Skills for Healthy Families Yes Yes No Yes No No
PREPARE/ENRICH No No No No No No
Mastering the Mysteries of Love No No No No Yes No
Curricula for Adult-Serving, Individual- Based Programs
PREP: Within My Reach Yes Yes No Yes Yes No
PICK a Partner Program No Yes No No No No
Note: The RIViR curriculum review did not attempt to assess the quantity, quality, or depth of information provided within each of these topics. This table indicates whether any information on a given topic was included in the curriculum, not whether such information would be considered an adequate treatment of the topic by a domestic violence professional.
Like adult-serving healthy relationship programs, youth- serving programs deliver youth relationship education curricula (not TDV prevention curricula) to their participants. None of the youth-serving grantees used evidence-based TDV prevention curricula, Safe Dates 20 or The Fourth R. 21 The relationship education curricula they did use vary in the extent to which they include information about TDV. Of the four youth curricula reviewed, three provide (any) information on healthy and unhealthy relationships, including warning signs; two include (any) information on what to do if one is experiencing TDV; and two provide (any) resources to guide facilitators in safely responding to TDV or a participant’s disclosure of witnessing IPV against a parent or guardian.
(^20) Foshee, Vangie Ann, Karl E. Bauman, Susan T. Ennett, Chirayath Suchindran, Thad Benefield, and G. Fletcher Linder. 2005. “Assessing the Effects of the Dating Violence Prevention Program ‘Safe Dates’ Using Random Coefficient Regression Modeling.” Prevention Science 6:245– 21 57. Wolfe, David A., Claire Crooks, Peter Jaffe, Debbie Chiodo, Ray Hughes, Wendy Ellis, Larry Stitt, and Allan Donner. 2009. “A School-Based Program to Prevent Adolescent Dating Violence.” Archives of Pediatrics & Adolescent Medicine 163(8):6 92 – 99
“We encounter folks who have grown up in situations where ‘to hit me means you love me.’ We work on busting the norms that violence is normal.” - Curriculum developer
Exhibit 2 shows the number of FY 2011-2014 grantee protocols that included suggested elements related to addressing IPV/TDV in close collaboration with a local domestic violence program. Some grantees provide additional information in their protocols, such as procedures for documenting IPV/TDV, ensuring safety during program implementation, conducting IPV/TDV assessments, responding to abusers, and mandated reporting of child maltreatment.
How Do Healthy Relationship Programs and Domestic Violence Programs
Collaborate?
Healthy relationship programs often partner with local domestic violence programs for support in addressing IPV and TDV. The role of these partners varies, but it often involves co- developing or reviewing a program’s domestic violence protocol, training program staff on recognizing and responding to IPV/TDV, serving participants who are identified as being at risk for or experiencing abuse, providing presentations on IPV/TDV-specific components of the relationship education curriculum, offering ongoing guidance on safely serving participants, and connecting grantees with other resources. 25
Healthy relationship program TA providers suggested that programs were most likely to maintain a consistent investment in partnerships with local domestic violence programs when staff (1) believed that addressing IPV/TDV was of central importance to their programs, and (2) were familiar enough with the field of IPV/TDV intervention to understand that their own internal expertise was not sufficient to address it alone. Grantees generally began program implementation with plans to work with a domestic violence program partner. Some of these partnerships thrived, while others faltered. Interviewees suggested that partnership success hinged on how grantees approached several early decisions:
When to involve a domestic violence program partner. Grantees that collaborated with a local domestic violence program in developing the program design and grant application often had an easier time maintaining the partnership through implementation, as many potential sources of conflict or divergence had already been addressed. Which domestic violence program to involve. Some grantees had working relationships with a local domestic violence program prior to beginning their ACF-funded work; for these programs, the choice of partners was often simple, and the partnership was often characterized as successful. Other grantees approached an individual consultant with experience in IPV/TDV issues or attempted to identify a suitable partner organization in their communities without prior knowledge of their organizational philosophies. Grantees and TA providers noted that the latter two approaches often led to later challenges. Whether to pay the partner domestic violence program. Several interviewees noted that local domestic violence programs operated under extreme budget constraints, and providing funding directly to the domestic violence programs to cover their involvement enabled them to invest in thoroughly understanding and supporting healthy relationship
(^25) No data indicated that domestic violence program staff were co-located at grantee organizations. However, one grantee interviewed indicated that they provide in-house IPV services.
“[Every organization has an initial understanding about IPV]. That said, there are those [organizations] who think that just having an understanding is enough…more mature, more understanding organizations understand there is a lot more that can be done to uncover the issue of IPV before folks get into services. They involve experts to develop relevant protocols and assessment tools.” - TA Provider
“We know that … [domestic violence program staff] will continue to follow people much more carefully and closely than my staff have the capability of doing.” - Grantee
Exhibit 2. Number of Domestic Violence Protocols that Include Suggested Elements Related to Addressing IPV/TDV, N=
program operations, instead of providing generic training or guidance. TA providers also suggested that domestic violence programs resented being asked to provide unfunded services. How to involve the partner domestic violence program in protocol development. Grantees that reported a successful partnership with a domestic violence program involved the program in developing a domestic violence protocol to guide program operations related to IPV and TDV. They characterized a collaborative domestic violence protocol development process as the cornerstone of a strong partnership. Grantees also characterized partners’ work in helping select assessment tools and providing tailored services to participants referred for IPV/TDV issues as highly valuable.
Grantees reported that ongoing investment was critical. They stressed persistence in working through initial differences in philosophy, goals, and approaches, and continuing relationship- building and communication at the leadership and line staff levels. Some TA providers and grantees described these partnerships as the single most important factor enabling a program to effectively address IPV and TDV.
What IPV or TDV-Related Training Do Healthy Relationship Programs Provide
Staff?
Of the 56 grantee protocols that we reviewed, 44 include mandatory training for their healthy relationship program staff on IPV/TDV. Trainings range from one-hour overviews^26 to 40-hour trainings. Trainings are often conducted by a partner domestic violence program and less often by internal staff. Trainings often include an overview of IPV/TDV, verbal and nonverbal signs of abuse, safety and confidentiality procedures, disclosure response, local resources and referrals, and an overview of the grantee’s protocol and policies related to IPV and TDV. While less common, some grantees also provide training on staff self-care, effects of IPV on children, mandated reporting for child abuse, and providing culturally competent responses to IPV. Most grantees who provide training require, at a minimum, that staff are trained on IPV/TDV during new staff orientation. Some grantees hold an annual refresher training on IPV/TDV for all staff, while other grantees hold multiple trainings per year on specific related topics (e.g., the impact of IPV on children).
How Do Healthy Relationship Grantees Identify Participants Who Are
Experiencing IPV/TDV?
Healthy relationship grantees often provide opportunities for participants to disclose IPV/TDV by assessing for IPV/TDV during recruitment and intake, creating safe opportunities for participants to disclose during program activities, and providing universal education on IPV/TDV.^27 This section describes how recent grantees may attempt to identify participants who experience IPV/TDV.
IPV Assessment. Healthy relationship grantees have varying reasons for proactively assessing participants’ abuse experiences, or for not doing so. Adult-serving grantees often conduct assessments in order to better serve participants experiencing IPV, or to identify potential IPV prior to joint participation in couples’ classes. Some adult-serving grantees that offer couples-based services
(^26) The practice of offering no staff training or minimal staff training (e.g. a one-hour overview) would be widely considered inadequate for
27 informing safe service delivery. It is widely recognized that individuals who experience IPV/TDV may or may not wish to disclose it to service providers, and trauma informed assessment practices include giving consideration to whether or not an individual wishes to disclose during a given interaction.
“[Partners] are training staff so that people understand how IPV might arise, responses to those situations, partners to call on, and their particular role. None of this is about healthy marriage and relationship program staffers taking on the role of IPV advocate. They cannot possibly take on that role.” - TA Provider
This section does not describe best practices for IPV/TDV assessment. For the most current guidance for grantees on identifying IPV/TDV in collaboration with a local domestic violence program partner, see the National Healthy Marriage Resource Center resource, Screening and Assessment for Domestic Violence.
“There is no screening or reason why we would say ‘no’ to anyone attending the individual-based program. For our couples program we are always asking questions to understand what drives people to get involved in [services like these], and we follow up from there.” - Grantee
their youth participants for TDV. Adult-serving grantees implementing short interventions, such as single-day classes, feel that they do not have the ability to confidentially and safely screen for IPV, given the brevity of their programs. Some grantees believe that IPV assessment creates a barrier to services, while others do not believe that assessment will actually identify IPV among participants. Some grantees believe that they predominately recruit couples who might be experiencing situational couple violence, and are not experiencing coercive controlling violence. These grantees believe that perpetrators of coercive controlling violence would likely not seek out (or would prevent their partners from seeking out) healthy relationship programming because, by doing so, perpetrators risk exposing the abuse or relinquishing power and control in their relationships.
Creating Safe Opportunities for Disclosure. Regardless of whether they screen for IPV/TDV, many grantees try to foster trust and rapport between facilitators and participants and to create opportunities for disclosure. Staff training often includes instructions on recognizing signs of IPV/TDV and approaching participants to discuss it. Some grantee staff communicate that participants can talk to them confidentially, and make themselves available for private meetings after sessions in which IPV/TDV is discussed.
Universal Education. Some participants may not wish to share their IPV/TDV experiences with healthy relationship program staff, even if they are given multiple opportunities to disclose. To ensure that these participants receive information and resources regardless of their choice to disclose, some grantees provide universal education. This can include providing information about what constitutes IPV/TDV, the consequences of IPV/TDV, the potential risks of participating in relationship education if one is experiencing IPV/TDV, and community resources that may be helpful. Of the 56 grantee protocols reviewed, 31 specifically described some method of universal education, such as including IPV/TDV education as part of the program; displaying posters about IPV/TDV; and distributing brochures or palm cards with information on IPV/TDV and national and local resources.
Disclosure and Confidentiality. Based on interviews with grantee staff, IPV and TDV disclosure most often happens during program implementation, usually after a session involving discussion of abuse or unhealthy relationships. Participants are most likely to disclose to program facilitators, and disclosure most often happens during a private conversation with the facilitator at a break or after class. Sometimes participants, especially adolescent participants, will disclose TDV during a group conversation; in such a situation, interviewees explained that facilitators are instructed to thank the youth for sharing and ask him or her to meet privately after the class. Grantees use several approaches to maintain confidentiality (see text box above, “Approaches Taken by Current Grantees to Protect Confidentiality”).
Barriers to Disclosure. Interviewees identified a number of barriers that affect whether participants choose to disclose IPV and TDV. First, grantee staff believe that individuals might not disclose due to fear of partner retaliation, stigma surrounding abuse, or lack of awareness about what behaviors constitute IPV/TDV. Similarly, some grantees and curriculum developers believe that many participants or couples do not disclose at assessment because they have not yet built trust with program staff. Finally, youth-serving grantees explained that youth may consider various forms of relationship abuse (such as slapping or name-calling) normal due to being exposed to violence at home or being more susceptible to media messages about the acceptability of abuse. No interviewees mentioned concerns about reporting to authorities.
How Do Healthy Relationship Grantees Respond When Participants Experience
IPV/TDV?
Approaches Taken by Current Grantees to Protect Confidentiality Separate male and female participants during screening Privately administer all screenings Provide private places to meet with facilitators Ensure all records are confidentially maintained Suggest participants not bring IPV-related materials home (for programs serving individuals only) Inform participants about mandated reporting laws
“[Teen dating violence] is often culturally acceptable. I’m talking about what is acceptable in that particular high school and in youth culture in general…. Oftentimes a teen realizes they are in a dating violence relationship because of our program…. To them, it’s all new.”- Grantee
Healthy relationship grantees respond differently to youth and adult participants who disclose TDV or IPV, respectively. Youth-based programs tend to take place in public high schools, so healthy relationship protocols for youth programs defer to high school or school district policies. These school-based policies require that adolescents talk to a teacher, counselor, or other mandated reporter when TDV is disclosed. Exhibit 4 shows the number of grantees using various strategies when responding to IPV among adults, according to their protocols. Adult healthy relationship programs train staff in how to respond when a participant discloses IPV, either in assessments or during the course of a program. These response guidelines generally involve the following steps:
Safety assessment. Nearly all grantees state that their first step is to assess the safety of the immediate situation. If the participant is currently experiencing IPV/TDV and does not feel safe, grantee staff ensure the participant is in a safe place at that moment, provide options for immediate safety, such as a women’s shelter or a police escort, and help the participant access these resources. Private consultation. If safety is confirmed, staff usually hold a private conversation to learn more about the situation, particularly the level of severity of the IPV and how the participant feels about continuing in the program. Staff may discuss the advisability of continuing in the program, as well as the willingness of the participant to refer his/her partner to discuss the issue with staff. Provide referrals. The most common way that healthy relationship programs assist those who have disclosed IPV/TDV is to provide referrals to local and national resources, including their local partner domestic violence program and any in-house services. Some grantees also provide warm hand-offs. Few grantees provide referrals for abusers. Safety plans. Several grantees help participants develop safety plans after IPV/TDV disclosure. Recognizing that local domestic violence programs are expert in safety planning, some domestic violence protocols instruct staff to refer participants to their domestic violence program partners for safety planning instead. Post-program follow up. While not common, some grantees explained that if someone has disclosed IPV/TDV, they follow up with him/her after the program is over or after disclosure has occurred to ensure that he or she has received services to address the abuse.
IPV/TDV response at different program points. If disclosure happens prior to the beginning of the program (e.g., during recruitment or intake), grantees often respond by determining program eligibility, recommending participants receive services at a domestic violence program, and providing a list of resources. If disclosure happens during the course of the program, grantee staff generally provide a more in-depth and personally tailored response, including assessing for danger, holding an in-depth private conversation, providing referrals and safety planning, and discussing how to safely exit from the program if the participant desires or if staff or the participant deem participation unsafe. (As described above, many grantees recognize that some participants who experience IPV/TDV will not wish to disclose, and also opt to provide universal IPV/TDV education and resources to all participants.)
Challenges in IPV/TDV response. Interviewees shared a number of challenges related to responding to abuse among program participants. Grantee staff do not feel that they are experts in the area of IPV/TDV; some staff want to “do the right thing” in responding to disclosure, but because their expertise is not in this area, they feel uncomfortable and unsure in responding appropriately to a disclosure, and many do not have the skills necessary to provide survivor-driven responses to IPV and TDV. Also, grantee staff may experience challenges determining if an individual or couple experiencing IPV/TDV can safely continue the program. Because of uncertainty about whether programming could pose safety risks for couples experiencing different forms of violence, some grantees “screen out” couples experiencing any form of violence. Some TA providers stated that program exclusions could create barriers for
Exhibit 4. Number of Grantees Using Various IPV Response Strategies for Adults, N=
concrete skills and protocols necessary for their critical roles in linking those experiencing IPV and TDV to resources.
Finally, programming in this arena could benefit from additional guidelines for addressing IPV and TDV in diverse programs (including programs with youth, individual adults, and adult couples, and programs with varying dosage) that take into account differences in abuse experiences. Future products from this project are intended to inform these efforts.
Suggested Citation
Krieger, K., McKay, T., Grove, L., & Bir, A. (2016). “Addressing Intimate Partner Violence in Healthy Relationship Programs: Current Approaches. (RIViR Paper #2: Current Approaches).” Prepared for Administration for Children & Families, U.S. Department of Health and Human Services.
For More Information about the RIVIR Project, Contact: Seth Chamberlain , ACF Project Officer: Seth.Chamberlain@acf.hhs.gov Samantha Illangasekare , ACF Project Officer: Samantha.Illangasekare@acf.hhs.gov Tasseli McKay , Project Director: tmckay@rti.org Anupa Bir , Principal Investigator: abir@rti.org Monique Clinton-Sherrod , Assoc. Project Director: mclinton@rti.org Office of Planning, Research & Evaluation: http://www.acf.hhs.gov/programs/opre RTI International: 3040 E Cornwallis Rd, Durham, NC 27709
Acknowledgments This brief was guided in its development by Seth Chamberlain and Samantha Illangasekare of ACF’s Office of Research, Planning, and Evaluation; by Charisse Johnson and Millicent Crawford of the Office of Family Assistance; and by Shawndell Dawson and Marylouise Kelley of the Family Violence Prevention and Services program. We are also deeply grateful to our project partners and expert panel for their thoughtful input and guidance:
Jennifer Acker, The Parenting Center Julie Baumgardner, First Things First Jacquelyn Boggess, Center for Family Policy and Practice Kay Bradford, Utah State University Michael Johnson, Penn State University Joe Jones, Center for Urban Families Benjamin Karney, University of California – Los Angeles
Joanne Klevens, Centers for Disease Control and Prevention Lisa Larance, University of Michigan – Ann Arbor Roland Loudenburg, Mountain Plains Evaluation Sandra Martin, University of North Carolina at Chapel Hill Anne Menard, National Resource Center on Domestic Violence Kelly Miller, Idaho Coalition Against Domestic Violence Mary Myrick, Public Strategies
Disclaimer: The views expressed in this publication do not necessarily reflect the views or policies of the Office of Planning, Research and Evaluation, the Administration for Children and Families, or the U.S. Department of Health and Human Services.
Contract #: HHSP23320095651WC
Appendix A. Glossary Terms
- Administration for Children and Families (ACF): The Administration for Children and Families is a division of the Department of Health & Human Services that promotes the economic and social well-being of families, children, individuals and communities with partnerships, funding, guidance, training, and technical assistance.^1
- Ceiling effect: A ceiling effect occurs when a measure possesses an upper limit for responses, causing respondents to score at or near this limit. 2
- Coercive control: Coercive control includes behavior intended to monitor, threaten, or otherwise gain power over an intimate partner. Examples of coercive controlling behavior include limiting access to transportation, money, friends, and family; excessive monitoring of a person’s whereabouts and communication; and making threats to harm oneself or a loved one. 3
- Coercive controlling violence : Also known as intimate terrorism, coercive controlling violence is distinguished by a pattern of emotionally abusive intimidation, coercion, and control coupled with physical violence against a partner. 4
- Dating Matters: Created by the Centers for Disease Control and Prevention (CDC), Dating Matters is a teen dating violence prevention initiative targeting 11-to 14-year- olds in high-risk, urban communities. 5
- Dating violence : Dating violence is violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim. Whether two people are in such a relationship is determined based on the length and type of the relationship as well as the frequency of interaction.^6
- Domestic violence : Domestic violence is a pattern of abusive behavior that is used by an intimate partner to gain or maintain power and control over the other intimate partner. Domestic violence can be physical, sexual, emotional, economic, or psychological actions or threats of actions that influence another person. This includes any behaviors that intimidate, manipulate, humiliate, isolate, frighten, terrorize, coerce, threaten, blame, hurt, injure, or wound someone.^7
- Domestic violence program : Often referred to as “domestic violence agencies” or “domestic violence organizations,” domestic violence programs are community-based service organizations that provide a wide range of direct services for people experiencing IPV. Current ACF-funded healthy relationship grantees partner with local domestic violence programs to guide their IPV-related activities, such as domestic violence protocol development, staff training on IPV, and referring program participants to services.
- Domestic violence protocol : A domestic violence protocol outlines a program’s plan for identifying and responding to intimate partner violence and/or teen dating violence issues, including domestic violence and dating violence. Within the context of healthy
(^1) Definition from Administration for Children and Families website: https://www.acf.hhs.gov/ (^2) Sage (2004). Entry: Ceiling effect. Retrieved from: https://srmo.sagepub.com/view/the-sage-encyclopedia-of-social-science-research-
3 methods/n102.xml 4 CDC (2015). Intimate Partner Violence Surveillance. Retrieved from: http://www.cdc.gov/violenceprevention/pdf/intimatepartnerviolence.pdf Kelly, J. B., & Johnson, M. P. (2008). Differentiation among types of intimate partner violence: Research update and implications for 5 interventions.^ Family Court Review ,^^46 (3), 476-499. 6 CDC. (2015). Dating Matters Initiative. Retrieved from:^ http://www.cdc.gov/violenceprevention/datingmatters/ U.S. Department of Justice, Office on Violence Against Women (http://www.justice.gov/sites/default/files/ovw/legacy/2011/07/08/about- 7 ovw-factsheet.pdf). U.S. Department of Justice, Office on Violence Against Women (http://www.justice.gov/sites/default/files/ovw/legacy/2011/07/08/about- ovw-factsheet.pdf).
- Prevalence : The proportion of a population that has a particular experience (disease, injury, other health condition, or attribute) at a specified point in time or during a specified period. 15
- Psychological abuse: Psychological abuse is verbal and non-verbal communication undertaken with the intent to harm or exert control over another person mentally or emotionally. (Also referred to as emotional abuse or psychological aggression.) 16
- Reference period : A reference period is the time frame for which survey respondents are asked to report on a particular experience, such as IPV.
- Reproductive coercion: Involves one partner attempting to impregnate another against her wishes, controlling pregnancy outcomes, coercing another into unprotected sex, or directly interfering with birth control. 17
- Separation-instigated violence: Separation-instigated violence describes partner violence that is used when a relationship is ending by a partner who has not previously used violence. 18
- Severe physical violence: As defined for purposes of analyzing data on IPV, “severe physical violence” includes the use of a weapon, choking, slamming into a wall, punching, kicking, burning, or beating up.
- Situational couple violence : Situational couple violence, sometimes referred to as “common couple violence,” is violence that is not connected to a general, one-sided pattern of power and control. Situational couple violence involves arguments that escalate to violence but show no relationship-wide evidence of an attempt by one partner to exert control over the other. 19
- Systematic racism: Systematic racism refers to the normalization and incorporation of racialized practices in social, economic, and criminal justice structures. These practices reinforce group inequity and discrimination. (Also known as structural racism.)
- Teen dating violence (TDV): Also referred to as “adolescent relationship abuse,” teen dating violence is physical, sexual, psychological, or emotional harm within a teen relationship, including stalking. 20
- Trauma-informed services : Trauma-informed services are those that are “influenced by an understanding of the impact of interpersonal violence and victimization on an individual’s life and development.” 21
- Verbal relationship aggression : Verbal relationship aggression is the use of verbal communication with the intent to harm another person mentally or emotionally and/or to exert control over another person. 22
(^14) Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and
15 statistical considerations.^ Journal of personality and social psychology ,^^51 (6), 1173. CDC (2015). Terms, Definitions, and Calculations Used in CDC HIV Surveillance Publications. Retrieved from
16 http://www.cdc.gov/hiv/statistics/surveillance/terms.html CDC (2015). Intimate Partner Violence: Definitions. Retrieved from: 17 http://www.cdc.gov/violenceprevention/intimatepartnerviolence/definitions.html. Miller, E. “Reproductive Coercion, Partner Violence and Unintended Pregnancy Among Marginalized, Vulnerable Populations.” Presentation for the National Institute of Child Health and Development. 18 https://www.nichd.nih.gov/about/meetings/2014/Documents/miller_healthequity_061114.pdf Kelly, J. B., & Johnson, M. P. (2008). Differentiation among types of intimate partner violence: Research update and implications for 19 interventions.^ Family Court Review ,^^46 (3), 476-499. Kelly, J. B., & Johnson, M. P. (2008). Differentiation among types of intimate partner violence: Research update and implications for 20 interventions. Family Court Review, 46(3), 476-499. 21 CDC definition:^ http://www.cdc.gov/violenceprevention/intimatepartnerviolence/teen_dating_violence.html Elliott, D.E., Bjelajac, P., Fallot, R.D., Markoff, L.S., Reed, B.G. (2005). Trauma-informed or trauma-denied: Principles and implementation of
22 trauma-informed services for women.^ Journal of Community Psychology, 33 (4): 461–477. CDC (2015). Intimate Partner Violence Surveillance. Retrieved from: http://www.cdc.gov/violenceprevention/pdf/intimatepartnerviolence.pdf
- Violent resistance : When victims of coercive controlling violence or intimate terrorism use violence in attempts to get their partner’s abuse to stop, this is referred to as violent resistance. 23
(^23) Kelly, J. B., & Johnson, M. P. (2008). Differentiation among types of intimate partner violence: Research update and implications for interventions. Family Court Review , 46 (3), 476-499.
The data collection approaches developed to address these questions are described in detail below, along with our analytic approach and limitations.
Data Collection
Grantee Document Review
Our document review involved compiling and systematically reviewing IPV-related materials from healthy relationship grantees and commonly used healthy relationship program curricula. We reviewed:
Grant application text from 60 grantees on their approaches to addressing IPV; An additional document compiled by the ACF TA provider describing 11 grantees’ IPV practices; and 56 grantees’ IPV protocols and/or IPV-related materials.^3
Review of Frequently-Used Curricula
We reviewed IPV-related elements of 14 healthy relationship program curricula commonly used by current ACF grantees (see text box). We examined IPV-related goals, activities, referral information, and instructor guidelines in these curricula.
Healthy Relationship Grantee Interviews
To learn about front-line challenges, barriers, successes, and lessons learned in implementing IPV approaches in healthy relationship programs, we conducted individual, semi-structured phone interviews with the program directors of a subset of nine grantees. This diverse set of grantees was purposively selected in consultation with ACF because they serve different populations and have a variety of strengths and challenges in their approaches to addressing IPV. Grantees in the FY 2011-2015 funding cohort were interviewed in their last year of funding. Our interview guide (included at the end of this document) contained questions in the following domains: IPV approaches and protocols, disclosure and referrals, IPV screening, addressing IPV in programming, staff training, partnerships, and requests for TA.
TA Provider Interviews
We also conducted semi-structured phone interviews with nine healthy relationship program TA providers 4 to gain a bird’s-eye view of how IPV approaches are being integrated into healthy relationship programs, variation across grantees in such approaches, and most common issues that healthy relationship grantees face. We purposively selected TA providers who have worked with multiple healthy relationship grantees and understand the variation of IPV approaches and practices across many grantees, including those with less developed approaches to IPV. Our interview guide (included at the end of this document) contained questions in the following domains: IPV approaches and protocols, disclosure and referrals, IPV screening, addressing IPV in programming, staff training, partnerships, and requests for TA.
Curriculum Developer Interviews
In order to gain a deeper understanding of the ways in which commonly used healthy relationship curricula address IPV, we conducted semi-structured phone interviews with four
(^3) Grantees’ application text related to IPV and descriptions of 11 grantees’ approaches to addressing IPV were collected by ICF International, a healthy relationship program TA provider, and provided to us by ACF. Grantees’ IPV protocols, screening tools, and other IPV-related materials were collected and provided to us by ACF project officers who work with the grantees. 4 One interview was conducted with a group of six TA providers who currently provide TA to healthy relationship grantees. The other three interviews were one-on-one phone interviews with national experts who provide TA on IPV in healthy relationship programs.
Healthy Relationship Program Curricula Included in Document Review Curricula for Youth-Serving Programs Love U2: Relationship Smarts Connections Love Notes Version 2 Active Relationships for Young Adults Curricula for Adult-Serving, Couples-Based Programs PREP: Within Our Reach PREP: For Strong Bonds PREP: Version 7. Active Relationships: Marriage and Best Practices, Active Choices Family Wellness – The Strongest Link: The Couple Family Wellness – Survival Skills for Healthy Families PREPARE/ENRICH Mastering the Mysteries of Love Curricula for Adult-Serving, Individual-Based Programs PREP: Within My Reach PICK a Partner Program
healthy relationship curriculum developers, three of whom had each developed multiple healthy relationship curricula. All four had co-developed at least one youth-based curriculum, and two had co-developed at least one adult-based curriculum. We interviewed curriculum developers representing curricula for both youth- and adult-serving programs and both couples- and individual-based programs. Our interview guide (included at the end of this document) contained questions in the following domains: curriculum logic model and intended outcomes, IPV-related content, IPV-related guidance for program facilitators, and TA requests.
Analytic Approach
Given that our central research goal was to describe healthy relationship grantees approaches to IPV, our analytic methods focused on descriptive analysis and were primarily qualitative.^5 ,
Analysis of Grantee Documents and Curricula
We conducted a systematic data abstraction using two Excel spreadsheet abstraction templates: one to capture information from IPV protocols and related materials, and one to capture information from healthy relationship curricula. The IPV protocol template included data elements related to protocol components and materials, screening, response to IPV disclosure, training, local partners, and strategies for addressing IPV in programs. Data elements included both open-ended (e.g., describe guidelines for staff on how to respond to IPV disclosure) and closed-ended questions (e.g., does the grantee have an IPV protocol?) to generate both qualitative and quantitative data. The curriculum template included data elements on IPV-related goals and objectives, modules, activities, discussions; guidelines for facilitators in responding to IPV disclosure; and evaluation methods related to assessing the impacts of IPV-related content. We used filtering tools to quantify the closed-ended elements (e.g., how many protocols included a definition of IPV?), and we summarized qualitative data from the open-ended elements.
Analysis of Interview Data
All grantee, TA provider, and curriculum developer interviews were transcribed. To analyze data, passages were organized by topic (or “domains”) and type of interviewee (or “data source”). We grouped text by domain (e.g., IPV disclosure, screening, response, training, partnerships, TA), read across domain groupings, and created qualitative descriptive summaries of each domain by interviewee type and adult- or youth-focused programming. Finally, we triangulated across data sources to identify themes that emerged in all data sources and points at which findings varied by data source.
Limitations
This investigation was subject to several limitations. First, our document review cannot be considered fully exhaustive, as we were unable to obtain IPV protocols from all grantees, and we only reviewed 14 healthy relationship curricula. While we likely obtained IPV protocols from all grantees who had them, we cannot confirm that the four grantees from which we did not receive protocols have or do not have IPV protocols.
Additionally, the interviews we conducted were limited in scope. Although we sought to purposively select grantees, TA providers, and curriculum developers in order to represent a range of programs and approaches, we interviewed only a subset of individuals and organizations in each of these categories. Grantees with well-developed approaches may have been overrepresented in both the interviews and the document review, limiting our ability to document challenges and barriers to addressing IPV in healthy relationship programs. To account for this limitation, we asked TA providers to provide us with their perspectives on grantees who might be struggling with their IPV approaches. It is possible that different patterns might have emerged if we had interviewed all 60 grantees, all TA providers who work
(^5) Sandelowski, M. (2000). Focus on research methods-whatever happened to qualitative description?. Research in nursing and health, 23(4),
6 334-340. Sandelowski, M. (2010). What's in a name? Qualitative description revisited. Research in nursing & health, 33(1), 77-84.
