Social Work - Research Publications

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    An online healthy relationship tool and safety decision aid for women experiencing intimate partner violence (I-DECIDE): a randomised controlled trial
    Hegarty, K ; Tarzia, L ; Valpied, J ; Murray, E ; Humphreys, C ; Taft, A ; Novy, K ; Gold, L ; Glass, N (ELSEVIER SCI LTD, 2019-06)
    BACKGROUND: Evidence for online interventions to help women experiencing intimate partner violence is scarce. We assessed whether an online interactive healthy relationship tool and safety decision aid (I-DECIDE) would increase women's self-efficacy and improve depressive symptoms compared with an intimate partner violence information website. METHODS: In this two-group pragmatic randomised controlled trial, we enrolled women who had screened positive for any form of intimate partner violence or fear of a partner in the 6 months before recruitment. Women aged 16-50 years currently residing in Australia, who had safe access to a computer and an internet connection, and who answered positively to one of the screening questions in English were eligible for inclusion. Participants were randomly assigned (1:1) by computer to receive either the intervention or control website. The intervention website consisted of modules on healthy relationships, abuse and safety, and relationship priority setting, and a tailored action plan. The control website was a static intimate partner violence information website. As the initial portion of the website containing the baseline questions was identical for both groups, there was no way for women to tell which group they had been allocated to, and the research team were also masked to participant allocation until after analysis of the 12-month data. Data were collected at baseline, immediately after completion of the website, at 6 months, and 12 months. Primary outcomes were mean general self-efficacy score (immediately after website completion, and at 6 months and 12 months) and mean depression score (at 6 months and 12 months). Data analyses were done according to intention-to-treat principles, accounting for missing data, and adjusted for outcome baseline scores. This trial was registered with the Australian New Zealand Clinical Trials Registry, ACTRN 12614001306606. FINDINGS: Between Jan 16, and Aug 28, 2015, 584 patients registered for the study and were assessed for eligibility. 422 eligible participants were randomly allocated to the intervention group (227 patients) or control group (195 patients). 179 (79%) participants in the intervention group and 156 (80%) participants in the control group completed 12-month follow-up. Mean self-efficacy at 6 months and 12 months was lower for participants in the intervention group than for participants in the control group, although this did not meet the prespecified mean difference (6 months: 27·5 [SD 5·1] vs 28·1 [4·4], imputed mean difference 1·3 [95% CI 0·3 to 2·3]; 12 months: 27·8 [SD 5·4] vs 29·0 [5·0], imputed mean difference 1·6 [95% CI 0·5 to 2·7]). We found no difference between groups in depressive symptoms at 6 months or 12 months (6 months: 22·5 [SD 17·1] vs 24·2 [17·2], imputed mean difference -0·3 [95% CI -3·5 to 3·0]; 12 months: 21·9 [SD 19·3] vs 21·5 [19·3], imputed mean difference -1·9 [95% CI -5·6 to 1·7]). Qualitative findings indicated that participants found the intervention supportive and a motivation for action. INTERPRETATION: Our findings highlight the need for further research, development, and refinement of online interventions for women experiencing intimate partner violence, particularly into the duration needed for interventions. Although we detected no meaningful differences between groups, our qualitative results indicated that some women find an online tool a helpful source of motivation and support. FUNDING: Australian Research Council.
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    Safe at home? Housing decisions for women leaving family violence
    Diemer, K ; Humphreys, C ; Crinall, K (WILEY, 2017-03)
    Abstract Internationally, domestic violence policy has shifted towards supporting women to stay at home with the perpetrator of violence excluded. However, the practical realities indicate that this is a complex arena in which the rhetoric of rights for “women and children to stay in their own home” needs to be underpinned by additional support to provide safety and protection for those choosing this option. The current study examines decision making about accommodation options and the role of civil protection orders among 138 women accessing domestic violence support services in Victoria Australia. It shines a light on the intersection between justice responses and the housing needs of women and their children leaving a violent relationship. Our findings reveal that for this sample of women, staying in their own home left them more open to breaches of intervention orders than those who re‐located. In spite of the frequency of breaching, a majority of women believed that they were safer with the protective order in place. We conclude that supporting women to “stay at home” with the perpetrator removed may be a pathway to safety for only a minority of women particularly if support from police and courts is not proactive and reliable.
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    Interventions to improve supervised contact visits between children in out of home care and their parents: a systematic review
    Bullen, T ; Taplin, S ; McArthur, M ; Humphreys, C ; Kertesz, M (WILEY, 2017-05)
    Abstract Although the importance of contact between children in care and their parents, when safe, is accepted, there is limited research about supervised face‐to‐face contact. There is no literature that has systematically critiqued how supervised contact can be best delivered. The aim of this systematic review was to evaluate the evidence for interventions aimed at improving the quality of contact visits between parents and their children who are in out‐of‐home care. Twelve studies were included in this review. Each study was graded and assigned scores according to the presence or absence of each of seven criteria. The studies demonstrated key similarities in the types of interventions provided, although delivery varied across group, individual and educational interventions. Parents reported improved capacity to manage their emotions and parents' satisfaction with the programmes was high. Although there was a lack of large scale, methodologically rigorous studies with long‐term follow‐up, some promising findings were identified: the literature indicates individual family support and group programmes have the potential to improve parent–child relationships and the quality of contact visits. This review suggests that future studies build on current evidence by addressing their methodological limitations and evaluating interventions that can be tailored to meet the needs of individual families.
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    The Perceptions of Australian Workers about Caring for Sexually Exploited Children in Residential Care
    McKibbin, G ; Humphreys, C (WILEY, 2019-11)
    Child sexual exploitation (CSE) is a problem for children and young people living in out‐of‐home care (looked after children). As part of a broader action research project aiming to prevent both harmful sexual behaviour carried out by children and young people and CSE in out‐of‐home care, four focus groups were undertaken with 17 workers at three Victorian residential houses in 2017. The findings reported in this paper were generated through the research question: What do workers perceive as the key challenges in caring for children and young people vulnerable to CSE in out‐of‐home care? Three major themes were identified: (i) children and young people going missing from home; (ii) children and young people not identifying as victims; and (iii) frontline police response unhelpful when children and young people missing. The design of prevention and response strategies to combat CSE must take into account the challenges identified by workers to ensure the best possible sexual abuse prevention outcomes for children and young people living in residential care. ‘What do workers perceive as the key challenges in caring for children and young people vulnerable to CSE in out‐of‐home care?' Key Practitioner Messages Children and young people need to be educated about the tactics used by perpetrators so that they can recognise if they are being groomed or exploited. Residential staff need to be upskilled about how to respond to children and young people at the point that they are leaving the house for the purpose of CSE. Workers need to be empowered to make decisions about the day‐to‐day welfare of the children and young people in their care. Multiagency collaboration is vital in preventing and responding to CSE, and efforts should be upscaled across all local government areas.
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    More present than absent: Men who use domestic violence and their fathering
    Humphreys, C ; Diemer, K ; Bornemisza, A ; Spiteri-Staines, A ; Kaspiew, R ; Horsfall, B (WILEY, 2019-05)
    Abstract An earlier article referred to the “absent presence” of the perpetrator in the lives of children and their mothers who have lived with domestic violence. It identified the ways in which the shadow of the perpetrator continued and was evidenced in the “symptoms of abuse” that both women and children experienced in spite of his absence. The current article argues that fathers who use violence are actually more present than absent in the lives of children (and women), even following separation. A mixed method approach surveyed men in Men's Behaviour Change Programs (N = 101), and interviewed women who had experienced violence (N = 50). The studies reported that the majority of men in both the quantitative men's study (80%) and the qualitative women's study (77%) had substantial contact with children. The women's interviews highlight the problematic fathering that many of their children experienced, both before and after separation. They reported very high levels of child abuse and poor attitudes to both women and children. The article concludes that the family violence and child welfare systems are poorly configured to address fathers who use violence and continue to hold substantial parenting roles, including following separation.
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    Child protection and fathering where there is domestic violence: Contradictions and consequences
    Smith, J ; Humphreys, C (WILEY, 2019-02)
    Abstract Children live in different contexts of protection and vulnerability when exposed to domestic violence. The negative impacts for many children are consistent and widely acknowledged. However, the implication that this requires men who use violence to address their fathering has been slower to emerge. This article draws from 69 in‐depth qualitative interviews with men, women, and workers across four men's behaviour change programmes in rural Victoria, Australia. Particular attention is given to men's attitudes to their fathering and the formal and informal consequences they experienced as a result of their violence and its impact on their fathering. Although most men came to recognize that their violence impacted their children, they failed to make the connection that the involvement of statutory child protection services in their lives was a direct consequence of their abusive behaviour. This article explores this disconnection by fathers who use violence, their attitude to the involvement of statutory child protection services, and identifies the implications for social work practitioners in addressing this issue.
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    Supporting foster and kinship carers to promote the mental health of children
    Fergeus, J ; Humphreys, C ; Harvey, C ; Herrman, H (WILEY, 2019-02)
    Abstract The majority of children and young people removed from the care of their parents by the state of Victoria, Australia, reside in foster or kinship care. These children have experienced a broad range of adverse conditions and are up to 4 times more likely to experience problems with mental health than their mainstream peers. This paper draws on the perspectives of foster and kinship carers, describing the disconnection between their role as mental health advocates and their interest in early intervention in a field which is dominated by crisis and the historic marginalisation of foster and kinship carers. Thirty‐one foster and kinship carers across greater metropolitan Melbourne, Australia, contributed to this study through interviews and focus groups. Participants demonstrated a practical understanding of mental health and an ability to identify a range of conditions that have an adverse impact on the mental health of children and young people in their care. The paper concludes that there is a lack of systemic support and even a range of barriers that affect the capacity of foster and kinship carers to promote the mental health and well‐being of the children and young people in their care.
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    Enhanced maternal and child health nurse care for women experiencing intimate partner/family violence: protocol for MOVE, a cluster randomised trial of screening and referral in primary health care
    Taft, AJ ; Small, R ; Humphreys, C ; Hegarty, K ; Walter, R ; Adams, C ; Agius, P (BMC, 2012-09-20)
    BACKGROUND: Intimate partner violence (IPV) can result in significant harm to women and families and is especially prevalent when women are pregnant or recent mothers. Maternal and child health nurses (MCHN) in Victoria, Australia are community-based nurse/midwives who see over 95% of all mothers with newborns. MCHN are in an ideal position to identify and support women experiencing IPV, or refer them to specialist family violence services. Evidence for IPV screening in primary health care is inconclusive to date. The Victorian government recently required nurses to screen all mothers when babies are four weeks old, offering an opportunity to examine the effectiveness of MCHN IPV screening practices. This protocol describes the development and design of MOVE, a study to examine IPV screening effectiveness and the sustainability of screening practice. METHODS/DESIGN: MOVE is a cluster randomised trial of a good practice model of MCHN IPV screening involving eight maternal and child health nurse teams in Melbourne, Victoria. Normalisation Process Theory (NPT) was incorporated into the design, implementation and evaluation of the MOVE trial to enhance and evaluate sustainability. Using NPT, the development stage combined participatory action research with intervention nurse teams and a systematic review of nurse IPV studies to develop an intervention model incorporating consensus guidelines, clinical pathway and strategies for individual nurses, their teams and family violence services. Following twelve months' implementation, primary outcomes assessed include IPV inquiry, IPV disclosure by women and referral using data from MCHN routine data collection and a survey to all women giving birth in the previous eight months. IPV will be measured using the Composite Abuse Scale. Process and impact evaluation data (online surveys and key stakeholders interviews) will highlight NPT concepts to enhance sustainability of IPV identification and referral. Data will be collected again in two years. DISCUSSION: MOVE will be the first randomised trial to determine IPV screening effectiveness in a community based nurse setting and the first to examine sustainability of an IPV screening intervention. It will further inform the debate about the effectiveness of IPV screening and describe IPV prevalence in a community based post-partum and early infant population. TRIAL REGISTRATION: ACTRN12609000424202.
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    Reconnecting mothers and children after violence (RECOVER): a feasibility study protocol of child-parent psychotherapy in Australia
    Hooker, L ; Toone, E ; Raykar, V ; Humphreys, C ; Morris, A ; Westrupp, E ; Taft, A (BMJ PUBLISHING GROUP, 2019-05)
    INTRODUCTION: Intimate partner violence detrimentally affects the social and emotional well-being of children and mothers. These two populations are impacted both individually and within the context of their relationship with one another. Child mental health, maternal mental health and the mother-child relationship may be impaired as a consequence. Early intervention to prevent or arrest impaired mother-child attachment and child development is needed. Dyadic or relational mental health interventions that include mothers with their children, such as child-parent psychotherapy, are effective in improving the mental health of both children and mothers and also strengthening their relationship. While child-parent psychotherapy has been trialled overseas in several populations, Australian research on relational interventions for children and women recovering from violence is limited. This study aims to assess the acceptability and feasibility of implementing child-parent psychotherapy in Australian families. METHODS AND ANALYSIS: Using a mixed methods, prepost design this feasibility study will examine the acceptability of the intervention to women with preschool aged children (3-5 years, n=15 dyads) and providers, and identify process issues including recruitment, retention and barriers to implementation and sustainability. In addition, intervention efficacy will be assessed using maternal and child health outcomes and functioning, and mother-child attachment measures. Young children's mental health needs are underserviced in Australia. More research is needed to fully understand parenting in the context of intimate partner violence and what works to help women and children recover. If the intervention is found to be feasible, findings will inform future trials and expansion of child-parent psychotherapy in Australia. ETHICS AND DISSEMINATION: Ethics approval obtained from clinical sites and the La Trobe University Human Research Ethics Committee (ID: HEC17-108). Results will be disseminated through conference proceedings and academic publications.
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    Is a clinician's personal history of domestic violence associated with their clinical care of patients: a cross-sectional study
    McLindon, E ; Humphreys, C ; Hegarty, K (BMJ PUBLISHING GROUP, 2019-08)
    OBJECTIVE: To investigate whether domestic violence (DV) impacts on health professionals' clinical care of DV survivor patients. DESIGN, SETTING: Descriptive, cross-sectional study at an Australian tertiary maternity hospital. PARTICIPANTS: 471 participating female health professionals (45.0% response rate). OUTCOME MEASURES: Using logistic and linear regression, we examined whether health professionals' exposure to lifetime DV was associated with their clinical care on specific measures of training, attitudes, identification and intervention. RESULTS: DV survivor health professionals report greater preparedness to intervene with survivor patients in a way that is consistent with ideal clinical care. This indicates that personal DV experience is not a barrier, and may be a facilitator, to clinical care of survivor patients. CONCLUSIONS: Health professionals are at the front line of identifying and responding to patients who have experienced DV. These findings provide evidence that survivor health professionals may be a strength to the healthcare organisations in which they work since among the participants in this study, they appear to be doing more of the work seen as better clinical care of survivor patients. We discuss the need for greater workplace supports aimed at promoting safety and recovery from violence and strengthening clinical practice with patients.