The Society for Social Work and Research

2014 Annual Conference

January 15-19, 2014 I Grand Hyatt San Antonio I San Antonio, TX

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

Saturday, January 18, 2014: 4:00 PM
HBG Convention Center, Room 002B River Level (San Antonio, TX)
* noted as presenting author
Sheryl Pimlott Kubiak, PhD, Associate Professor, Michigan State University, East Lansing, MI
Gina Fedock, MSW, PhD Student, Michigan State University, East Lansing, MI
Woo Jong Kim, MSW, Doctoral Student, Michigan State University, East Lansing, MI
Deborah Bybee, PhD, Professor, Michigan State University, East Lansing, MI
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.