Testing a Violence Prevention Program for Women Using a Multistep Research Approach

Purpose/Background: The relationship between PTSD, anger, and the perpetration of violence has been established in existing research. Violence prevention interventions have focused mainly on men, and as a result, there are no effective interventions to address trauma related anger and violence among women. Using the steps of intervention research and building upon a prior feasibility study, this paper describes the theory, intervention, research process and outcomes associated with Beyond Violence (BV), a prevention program for women who are convicted of violent offenses. The overarching research question is: Is BV an efficacious intervention for this population of women? The research question specific to this study: Is BV an effective alternative to the existing treatment as usual (TAU) in terms of decreasing symptoms associated with PTSD, depression, anxiety and anger?

 Methods: Inclusion criteria for these incarcerated women were: conviction for a violent offense; within 2 years of release; no serious mental health disorder; and presence of a substance use disorder (SUD) at intake. A randomized design was planned, with a total of 48 women assigned to the ‘treatment as usual’ (i.e. Assault Offender Programming, a program designed for men) or the experimental condition (BV). Both conditions used a group modality led by professionals that met twice a week; TAU had 44 sessions and BV had 20 sessions. Standardized measures (STAXI; PHQ; K6, PTS-SS, etc.) were administered at pre- and post intervention; focus groups at midway and post. Paired t-tests were conducted to examine pre-post change; repeated measures ANOVA was used to test between-group differences over time.

 Results: Mean age was 33 (SD=8.7), with an average prison stay of 3.5 years (SD=3.7). Over half (52%) were women of color. Groups appeared equivalent except for higher rates of SUD in BV (100% vs. 78% in TAU). Women averaged 35 of 44 (80%) sessions in TAU and 18 of 20 (90%) in BV, with fewer women completing TAU. Short-term outcomes revealed positive changes on measures of depression, PTSD and anxiety across groups. Trait anger, commonly associated with aggressive behavior, significantly decreased (17.5 to 14.2, d= 0.99) for both groups. Between group differences were found on a subscale of anger expression, with women in TAU experiencing a greater decline (F=2.88; p<.05), suggesting those in TAU may express their anger outwardly (i.e. slamming doors) less often.

 Conclusion/Implications: The study identified few outcome differences between groups, suggesting that BV was similarly effective to TAU. Viewed as a ‘noninferiority trial’ – a type of comparative effectiveness trial that assesses whether similar outcomes can be achieved with a lower-dose intervention, the economy of the 20-session BV compared to the 44-session TAU is compelling. This reduction in time and staff resources was attractive to a department committed to cutting costs of prison-based treatment. Moreover, the gender-specific and trauma informed BV intervention was well received by staff and participants. Next steps include assessing long-term outcomes associated with community re-entry. Implications for social work research and practice include insights about the difficulties of conducting interventions, particularly randomized control trials, within a prison setting.