Promoting the Safety of Survivors of Intimate Partner Violence: A Systematic Review of Methodological Rigor and Intervention Effectiveness

Purpose: According to the CDC, 1 in 4 American women will experience severe physical violence by an intimate partner.   Previous victimization has been identified as a key risk factor for future intimate partner violence (IPV).  Given the serious impacts of IPV, there is clear need for interventions that increase the safety of survivors of previous abuse. Additional evidence is needed regarding the types of interventions that are most effective at increasing safety for non-shelter based survivors.  Further, little is known regarding the overall quality of the evidence in this area.  This study fills gaps by addressing the following research questions: 1) What non-shelter interventions have been studied to increase the safety of survivors from future abuse?  2) What is the methodological rigor of studies evaluating these interventions? 3) How does methodological rigor vary by publication date?  4) Which are more effective, counseling or safety planning interventions? 5) Is there a difference in effectiveness by setting or intervention length? 

Methods: A systematic search of seven databases resulted in 1,712 references from peer-reviewed journals.  Titles and abstracts were reviewed for these criteria: 1) study of previously or currently battered women 2) includes at least one outcome concerned with safety from abuse, and 3) the intervention is focused on the survivor rather than the batterer or couple.  This review resulted in 38 remaining articles, which were reviewed for the following exclusion criteria: 1) intervention delivered in a shelter or residential facility, 2) reported only descriptive data, or 3) only qualitative results.  A final sample of 17 studies met these criteria.  Each study was rated for methodological rigor using a modified version of the Methodological Quality Rating Scale. Total scores were used to distinguish studies with higher and lower rigor.  Outcomes were compared across studies based on a rating that combined rigor with statistical significance (Auslander et al, 2012; Miller, 1995). 

Results: Five of nine studies found a significant increase in safety promoting behaviors (SPBs), while seven of thirteen found increases in safety from future abuse (SFA).  Methodological rigor ranged from 5-12, and did not vary by type or setting of intervention.  A trend towards increasing rigor by publication date was identified.  Safety planning interventions showed more promise for increasing SPBs compared to counseling interventions, while no differences were observed for SFA.  Health care based interventions had higher effectiveness compared to legal system or community based interventions.  Interventions lasting more than one session showed more promise at increasing SPBs compared to single session interventions.

Conclusions:  Evidence for the effectiveness of current interventions is mixed.  Health care based safety planning interventions show the most promise in improving safety, possibly because these studies reached women with more variety in the extent of their IPV experiences.  Screening and safety planning protocols in medical settings have the strongest evidence of effectiveness.  Greater attention should be paid to developing and testing interventions for those with the most sever abuse histories.  Methodological quality in this area would be improved through the use of standarized measures and stronger study designs.