Research paper

Journal of Social Service Research, 37:481–489, 2011 Copyright c© Taylor & Francis Group, LLC ISSN: 0148-8376 print / 1540-7314 online DOI: 10.1080/01488376.2011.587747

Intimate Partner Violence Survivors’ Unmet Social Service Needs

Melissa E. Dichter Karin V. Rhodes

ABSTRACT. Women who have experienced intimate partner violence (IPV) victimization are at risk for physical and mental health problems, as well as social and economic challenges. In this cross-sectional study, 173 adult, English-speaking women who had experienced police response to IPV completed a self-report questionnaire about their use of, interest in, and need for various social services and whether or not each type of service helped (or would help) them to feel safer. More than three quarters of the participants reported a current need for health and economic support services. There was less interest in traditional IPV resources: law enforcement and domestic violence counseling or shelter. Expanding services to meet survivors’ needs for health care and economic independence may facilitate long-term safety. Recommendations for further research in this area are provided.

KEYWORDS. Intimate partner violence, domestic violence, service needs

INTRODUCTION AND BACKGROUND

More than one in four women experiences physical or sexual violence, or stalking, from an intimate partner in her lifetime (Tjaden & Thoennes, 2000). Intimate partner violence (IPV) victimization can lead to a variety of both short- and long-term medical, financial, and psychosocial problems, and victims may have a variety of related social service needs. This article presents the self-identified health and so- cial service needs of female IPV survivors who had come to the attention of police as a result of IPV. Although the majority of IPV incidents are not reported to the police (Tjaden & Thoennes,

Melissa E. Dichter, MSW, PhD, Health Services Research Fellow, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, PA.

Karin V. Rhodes, MS, MD, Director, Division of Health Policy Research, University of Pennsylvania, Department of Emergency Medicine and School of Social Policy & Practice, Philadelphia, PA.

Address correspondence to: Melissa E. Dichter, MSW, PhD, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104 (E-mail: mdichter@sp2.upenn.edu, Melissa.Dichter@va.gov).

2000), those that are tend to be the more severe incidents (Bonomi, Holt, Martin, & Thompson, 2006; Davies, Block, & Campbell, 2007), and police intervention provides the opportunity for referral to other needed social services.

Impacts of IPV

In addition to the sequela of direct injury, studies have found a history of IPV victimiza- tion to be associated with short- and long-term physical health, mental health, and financial and social problems. IPV may lead to problems with the respiratory and gastrointestinal tracts as well as a host of gynecological and chronic

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pain syndromes, sleep loss and sleep disorders, and complications in pregnancy (Bonomi et al., 2009; Drossman, Talley, Lesserman, Olden, & Barreiro, 1995; Janssen et al., 2003; Walker, Shannon, & Logan, in press). IPV victimization has also been found to be strongly associated with mental health symptoms and disorders including anxiety, posttraumatic stress symp- toms, depression, and suicidal ideation or attempts (Abbott, Johnson, Koziol-McLain, & Lowenstein, 1996; Afifi et al., 2009; Bonomi et al., 2009; Coker et al., 2002; Golding, 1999; Woods, Hall, Campbell, & Angott, 2008). Women who have experienced IPV victimiza- tion are also more likely than nonvictimized women to have symptoms of substance abuse problems (Bonomi et al., 2009; Coker et al., 2002; Martin, Beaumont, & Kupper, 2003). Although substance use may contribute to women’s vulnerability to victimization, several studies report that women use substances to cope with the victimization and its aftermath (El-Bassel, Gilbert, Wu, Go, & Hill, 2005; Salomon, Bassuk, & Huntington, 2002; Ward, 2003; Zubretsky & Digirolamo, 1996).

IPV victimization can also affect women’s fi- nancial and social well-being. Abusive partners may interfere with a woman’s ability to work by forbidding her from leaving the house or com- municating with others, or by inhibiting her abil- ity to do so—for example, by taking away her access to necessary resources such as transporta- tion or by interfering with her daily function- ing by, for example, interfering with her ability to sleep (Adams, Sullivan, Bybee, & Greeson, 2008; Brewster, 2003; Moe & Bell, 2004; Riger, Raja, & Camacho, 2002). Victims may be iso- lated from friends, family, and other sources of social support. Leaving an abusive partner can also mean loss of economic resources including the partner’s financial contributions to support housing, food, child care, and other necessities (M. A. Anderson et al., 2003; Riger et al., 2002).

Resources and Services

Police are often the first responders in IPV cases and have been positioned as the entry point into gaining services from the criminal legal sys- tem (CLS). Individuals victimized by violence

may turn to the CLS for protection, with the expectation that the offender will be held ac- countable for his or her actions. However, the survivor’s safety may or may not be protected in the process. Indeed, the focus of CLS inter- vention is on the offender and not necessarily on the needs of the victim, who may have ser- vice needs that extend beyond CLS intervention. Furthermore, many survivors of IPV do not seek or receive intervention from the CLS, although they may have a variety of needs resulting from IPV.

Social services specifically designed to serve individuals victimized by IPV include emer- gency shelter, advocacy, and counseling. Shel- ters are designed to help survivors escape vio- lence, and in addition to temporary housing, they may provide advocacy and short-term counsel- ing services (Schechter, 1982; Vapnar, 1980). Counseling typically focuses on addressing the impacts of violence and helping survivors re- cover from trauma and build self-esteem and self-efficacy. Such programs may be helpful for healing and restructuring one’s life free from violence. Outside of the shelter, however, women are not necessarily protected from vi- olence (Bennett, Riger, Schewe, Howard, & Wasco, 2004; Bybee & Sullivan, 2005).

Leaving the relationship does not guarantee safety; however, resources that facilitate inde- pendence may help women escape violent situ- ations (K. L. Anderson, 2007). Postmus, Sev- erson, Berry, and Yoo (2009) recently found that “tangible interventions, such as day care, housing, education, food bank, and job training” were helpful to women leaving abusive relation- ships (p. 862). These economic supports could be protective against further violence by help- ing women establish independence and physical distance from their partners (Bybee & Sullivan, 2005; Goodman, Dutton, Vankos, & Weinfurt, 2005; Perez & Johnson, 2008). Lack of such resources, on the other hand, is potentially detri- mental to safety. In a study of women in domestic violence shelters in Pennsylvania, Harding and Helweg-Larsen (2009) found that half of the par- ticipants said that they had previously left and then returned to violent partners because they did not have a place to live or stay. Bybee and Sullivan (2005) also note that lack of financial

IPV Survivors’ Unmet Service Needs 483

resources is a barrier to leaving and, therefore, may contribute to risk for reassault. These find- ings are not new—the early literature from more than 30 years ago also indicated that women were “entrapped” in relationships with violent partners due to lack of economic resources to es- tablish independence (e.g., employment; Gelles, 1976). However, few studies have specifically asked survivors about unmet needs and desire for social services and resources that they think will make them safer.

Recent literature has identified the types of services that women who had experienced in- terpersonal violence need (Eisenman et al., 2009), have sought (Nuris, Macy, Nwabuzor, & Holt, 2011), and have used and found help- ful (Postmus et al., 2009). Eisenman and col- leagues (2009) conducted in-person interviews with pregnant and postpartum Latina women in Los Angeles who had experienced recent IPV. Almost half reported needing social services such as housing, child care, or drug/alcohol treat- ment; 40% identified a need for legal services, and close to 30% wanted employment-related services. Nuris and colleagues (2011) surveyed women who had sought a police intervention or a civil order of protection for IPV and found that 38% had sought domestic violence services (in- cluding shelter or housing, support groups, advo- cacy, or counseling), 66% had sought legal help for criminal or civil matters, 32% sought eco- nomic support (welfare, food stamps, Social Se- curity, or food bank), and 9% sought substance abuse services. In interviews with women who had experienced IPV, Postmus and colleagues (2009) found that close to 65% of the women had received counseling services in response to the violence, more than half had used cash support (welfare), close to half had used legal services to pursue a divorce or order of protection, close to 40% had used a domestic violence shelter, and just over one quarter had received job train- ing or employment counseling. The participants rated economic support services, such as subsi- dized day care, subsidized housing, welfare, and unemployment compensation as most helpful, in addition to religious or spiritual counseling, educational support services, and employment training or counseling.

Study Purpose

The purpose of the present study was to ex- plore the health and social service needs of women who had a police-reported incident of IPV. In particular, the study aims were to iden- tify the full range of service use, interest in fu- ture service use, need for services, and whether or not the services would contribute to survivors’ feelings of safety. The overall goal is to inform resource allocation and targeted intervention ef- forts for women who seek help for IPV. This study adds to this literature by: a) focusing on the subset of women who have come to the atten- tion of the police, which provides an entry point for referral; b) identifying both service use and perceived need to gain a better understanding of unmet needs; and c) identifying a survivor’s perspective on the services’ contribution to her sense of safety.

METHODS

Setting and Sample

The study took place in a large city on the East coast of the United States. Participants were adult (aged 18 to 64 years), English-speaking women who had experienced police response to an incident of partner violence with a male partner.

Measures

Data were collected through a self-report questionnaire. Participants were asked to pro- vide demographic information (age, race, level of education, whether or not they were em- ployed, and whether or not they had children) as well as information about their relationship status (whether or not they were still in the rela- tionship to which they were referring in the sur- vey and whether or not they were living with the partner at the time of data collection) and about violence experienced from the partner during or after the relationship.

Violence victimization was measured with questions from the physical assault, psycho- logical aggression, sexual coercion, and injury

484 M. E. Dichter and K. V. Rhodes

subscales of the Short Form of the Revised Con- flict Tactics Scales (Straus & Douglas, 2004). These scales contain eight items, two for each form of violence, and participants were asked whether they had experienced each of these forms of violence.

The research team developed a list of services and programs based on review of prior litera- ture and input from staff of agencies providing services to IPV survivors. The service/program categories included: medical health care, men- tal/behavioral health care, economic support, le- gal services, domestic violence services, and parenting services. For each service or program, the participant was asked: a) if she had ever used, or was currently using, that service/program; b) if she would be interested in using, or continuing to use, that service or program for herself; c) if she thought that the service or program would meet her current needs; and d) if she thought that the service or program would help her feel safer.

Procedures

The study protocol was reviewed and ap- proved by the Institutional Review Board of the University of Pennsylvania. Participants were recruited through two venues: a hospital emer- gency department (screened for IPV and, if eligi- ble, invited to participate) and community-based agencies that provide services to women expe- riencing IPV (recruited through flyers and in- formation provided by counselors). Eligible and interested women were invited to complete the questionnaire at the time of their visit at the hos- pital or the agency, or to schedule an individ- ual appointment with a member of the research team. Participation was voluntary and anony- mous, and questionnaires were administered in- dividually and in a private space at the agency from which the participant was recruited. The researcher conducted the informed consent pro- cess with the participant before beginning the questionnaire.

RESULTS

Sample Description

One-hundred seventy-three women com- pleted the questionnaire. Demographic, relation-

TABLE 1. Sample Description (N = 173)

N a %

Age 18–25 64 37.4 26–35 47 27.5 36–45 33 19.3 46+ 27 15.8

Race Black/African American 132 78.6 White/Caucasian 25 14.9 Mixed/Other 11 6.5

Level of Education Did not finish high school 43 26.9 Completed high school or GED 51 31.9 Some college 50 31.3 Completed college 16 10.0

Employed (Full or Part Time) Yes 56 35.0 No 104 65.0

Children Yes 141 81.5 No 32 18.5

Relationship Status Current 66 38.6 Former 105 61.4

Living with Partner Yes 46 26.6 No 127 73.4

Psychological Violenceb

Yes 164 97.0 No 5 3.0

Physical Violenceb

Yes 144 86.7 No 22 13.3

Sexual Violenceb

Yes 100 59.5 No 68 40.5

Injuryb

Yes 141 84.9 No 25 15.1

aDue to missing data, some variables do not add to 173; the percent- age is of those with nonmissing data. bRefers to victimization by the current/recent partner.

ship, and violence characteristics of the sample are presented in Table 1. The participants ranged in age from 18 to 57 years old, with a mean age of 32.05 years. Almost two thirds (64.9%) of the participants were younger than 36 years old. The majority (78.6%) of the participants self- identified as Black or African American. More than a quarter of the participants had not finished high school; only 10% had completed college. Most (81.5%) of the participants had children.

Participants were asked to provide informa- tion about a current or recent relationship with

IPV Survivors’ Unmet Service Needs 485

TABLE 2. Service Use, Interest, Need∗

Used Interested Current Need Help to Feel Safer

Health Care (Medical) Medical Care 97.6 87.8 89.9 76.9

Mental/Behavioral Health Care Mental Health Care 62.2 71.4 70.7 63.0 Stress Management 35.9 77.6 75.9 62.5 Anger Management 29.7 57.3 59.4 53.5 Alcohol/Drug Counseling 14.2 19.3 19.7 20.9

Economic Support Financial Assistance 61.0 76.6 76.1 64.0 Housing Assistance 49.4 75.3 75.2 67.2 Employment Assistance 54.2 69.7 70.4 52.6

Legal Services Law Enforcement 92.8 56.7 47.0 62.3 Legal Assistance 42.2 57.9 56.0 52.3

Domestic Violence Services Domestic Violence Counseling 38.6 57.9 62.5 56.6 Domestic Violence Shelter 24.8 29.9 28.7 38.0

Parenting Servicesa

Child Care 52.0 58.9 57.1 47.0 Parenting Education/Support 30.2 50.0 47.4 37.5

∗Proportion of all participants who said “yes.” aOf those who have children.

a male partner. Just over a quarter of the partici- pants were living together with the partner at the time of data collection. The majority (61.4%) of the participants were no longer in a relation- ship with that partner at the time of data col- lection. Nearly all of the participants reported having experienced psychological violence from the partner. Most (86.7%) reported physical vio- lence victimization; more than half (59.5%) re- ported sexual violence victimization, and nearly 85% reported injury due to physical or sexual violence victimization.

Service Use, Interest, Need

Findings related to service use, interest, and need are presented in Table 2. Nearly all par- ticipants (97.6%) had used medical care, and such services received high endorsement for in- terest (87.8%), meeting a current need (89.9%), and helping the participant to feel safer (76.9%). More than half of all participants (62.6%) said that they had used general mental health care and that this service helped them feel safer (63.0%); more than two thirds (71.4%) said that they were interested in mental health care and/or that hav-

ing such a service meets or would meet a cur- rent need (70.7%). Stress and anger management programs were less frequently used (35.9% and 29.7%, respectively) but received endorsement from more than half of all participants for inter- est and need. More than three quarters of partic- ipants said that they needed or were interested in using (or continuing to use) a stress man- agement program. Drug or alcohol counseling received far less support, but still, nearly one in five women said that they would be interested in participating in such a program.

Economic support programs, including direct financial (cash) assistance, housing assistance, and employment assistance, received high en- dorsement, with more than half of all partici- pants (and in the case of financial and housing assistance, more than three quarters) reporting that they have a need for, and are interested in, using such programs. Both law enforcement and legal assistance services were endorsed by close to or more than half of all participants.

Slightly more people were interested in using, and felt a current need for, domestic violence shelter services than had actually used such services. Still, the level of interest and

486 M. E. Dichter and K. V. Rhodes

need for domestic violence shelter services was lower than that of any other service except for alcohol or drug counseling. Domestic violence counseling received more support than domestic violence shelter services. More than half of all participants were interested in using domestic violence counseling services. Participants who had children were interested in, and felt a current need for, child care services; more than half said they needed such services and more than 40% said that child care services would help them to feel safer. Half of all participants with children were interested in parenting education or sup- port programs, and more than a third said that such programs would help them to feel safer.

For all services or programs, with the excep- tion of law enforcement, the proportion of par- ticipants expressing interest in use was highest among the subset of participants who had used that service or program. There was particularly strong disparity between need and use of stress management, anger management, and housing assistance programs (a difference of 40 percent- age points for stress management and more than 25 percentage points for anger management and housing assistance), reflecting particular areas of unmet needs.

DISCUSSION

Limitations

As in most cross-sectional studies collecting data from nonrepresentative samples, this study has a number of important limitations. In particu- lar, the participants were predominantly African American and from a single urban community, all with a history of police calls for IPV with a male partner. Police-involved victims are more likely to have more severe experiences of IPV than women whose cases do not come to the at- tention of police (Bonomi et al., 2006); they may also have higher rates of severe IPV and perhaps higher levels of unmet need for a variety of so- cial services. Participants were recruited from an emergency department and from community- based services. Therefore, the results may not be generalizable to women who do not seek help in either health care or social service settings, to

women in rural populations, or to women who experience IPV from a female partner. However, within the context of urban IPV, this population’s needs appear to be reflective of other qualitative and quantitative studies of the barriers to safety faced by abused women.

Implications

This study found high levels of expressed in- terest in and need for financial assistance, em- ployment assistance, and housing, with propor- tions of participants who had used such services higher than those found in previous studies (e.g., Nuris et al., 2011; Postmus et al., 2009). Eco- nomic support, including employment and hous- ing programs, can help women establish inde- pendence from their partners. A large majority of participants in this study expressed interest in and need for employment serves that would help them to be gainfully employed—women want and need job training, skills development, and access to jobs. It is also critical to have employ- ment policies and practices that support women who have experienced violence not only to ob- tain, but also to maintain, employment. Employ- ment policies that, for example, provide leave for dealing with the consequences of violence, or al- low an employee to transfer to another location to escape from violence, can facilitate a victim’s future safety. A large majority (more than three quarters) of the women in this study expressed interest in and need for housing assistance—not just shelter but the ability to move into a place where they could be safe. Housing subsidies, rent assistance, and tenant or homeowner ad- vocacy could assist women in gaining freedom from violence (Menard, 2001).

A large majority of the study participants also indicated interest in and need for medical and mental health care, especially stress man- agement programs. Health care may be viewed as a standard necessary service to meet a va- riety of needs, and use of such services may feel less stigma-associated than use of domes- tic violence services. Health care can also be an entry point for identifying IPV and referring sur- vivors to other necessary services. Studies have found that a majority of women who have ex- perienced IPV victimization are supportive of

IPV Survivors’ Unmet Service Needs 487

health care provider screening for IPV and be- lieve that such screening would help women to get needed help for IPV (Gielen et al., 2000). Overall, it seems that women who have experi- enced police response to IPV have a favorable view of utilizing health care services for both their physical and psychological health care and believe these services can increase their safety.

These high endorsements for economic sup- port and mental and medical health care contrast with relatively low interest in the services that are particularly designated as the traditional re- sponse to IPV and victim care: law enforcement, domestic violence counseling, and domestic vi- olence shelter. The lower levels of endorsement of these traditional IPV resources may reflect negative perceptions of these services (e.g., that they are not helpful) or perceived stigma at- tached to using these services. Additionally or alternatively, these critical services may act as a temporary “Band-Aid” for acute circumstances but are not viewed as useful for long-term protec- tion. Without means for gaining independence from the partner, some women will not be able to safely escape the violence. However, the po- lice may potentially serve as an entry point into other services as many female IPV victims, and all of the participants in this study, have interac- tions with police.

Services beyond counseling and shelter can be administered and facilitated through domestic violence programs, which may provide support for a wide variety of needed social services, such as transportation, financial support, skills educa- tion, substance abuse treatment, child care, job training, medical care, legal service, housing, and parenting needs. These programs, however, are often severely underfunded, and therefore, demand for services typically exceeds supply. Based on a one-day (September 17, 2008) cen- sus of domestic violence programs across the country, nearly 9,000 requests for IPV services were unmet due to lack of resources (primarily insufficient funding or staff) within the programs (National Network to End Domestic Violence [NNEDV], 2009). We may, therefore, need to in- crease support for domestic violence programs so that they can begin to meet the demand for both traditional and nontraditional IPV services.

Some women who have survived IPV may have a need for social services but are not inter- ested in seeking those services from a domestic violence program. It may be appropriate, then, to target funding to meet the needs of IPV survivors through other social service programs that may serve IPV survivors but that are not specifically designated for this population. Additionally, po- lice and hospital personnel who may encounter IPV survivors may be able to help refer indi- viduals to the services they need, beyond the traditional victim services.

The findings from this study indicate that sur- vivors of IPV have a variety of social service needs, many of which are not classically con- sidered or funded as domestic violence services. When we think of domestic violence services, we need to think more broadly than shelter, counseling, and advocacy. Coordinated commu- nity response programs, which have been in use for more than 20 years (Pence & Shep- ard, 1999), are focused primarily on the CLS (offender accountability) and shelter programs. The results from this study would support Pennington-Zoellner’s (2009) recommendations for expanding the community coordination model to include a broader array of social service support for IPV survivors.

This study found high levels of unmet health and social service needs among police- involved victims of IPV and demonstrated the perceived relevance of such services for vic- tims’ sense of safety. Current domestic vio- lence crisis services, including shelters, ad- vocacy programs, and policing, are necessary for temporary refuge from trauma, but with- out adequate resources to provide or connect clients with broader health and social services, these services may not be sufficient for help- ing women escape and recover from abusive sit- uations. A broader range of social, economic, and health care services may have relevance for long-term safety and recovery. Future re- search in this area could expand to other pop- ulations, including those who have not sought medical, legal, or social support, and could in- vestigate mechanisms of broadening support ser- vices to meet the needs of this vulnerable popu- lation.

488 M. E. Dichter and K. V. Rhodes

ACKNOWLEDGMENTS

This work was supported by the Centers for Disease Control and Prevention, National Cen- ter for Injury Prevention and Control (grant #: 1R49CE001226-01). The authors thank Richard J. Gelles, PhD, for contributions to the design of this project and feedback on this article, and thank the staff of the agencies from which par- ticipants were recruited, and, most importantly, the participants themselves. The contents of this article do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.

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