In batterer intervention programs, there are conflicting recommendations about best practices for responding to client dropout. Risk management philosophies emphasize the importance of swift and sure sanctions for failure to comply with program attendance requirements. In contrast, change theory emphasizes the importance of providing clients with multiple opportunities to engage in treatment. To clarify the implications of each of these philosophies, the current study examined rates of program dropout, reinstatement, and completion in a consecutive sample of 294 probation-mandated clients referred to a large batterer intervention program. Just over half (53.7%) of men completed intervention on their first attempt. Over the 2-year follow-up study period, 73 clients were reinstated once by the intervention program, 23 clients were reinstated twice, and 5 clients reinstated three (or more) times. Reinstated clients were, in general, more similar to men who failed to complete than those who completed on their first attempt. Although rates of dropout at each reentry point were quite high (56% to 80%), 32 of the 73 (43.7%) reinstated clients eventually completed. There were significant costs associated with providing clients with additional chances to complete the program, with successful reinstatement requiring an average of 7.55 phone calls to clients, 3.82 phone calls to referral agents, one letter, and 0.73 in-person meetings. Results are discussed in terms of practice and policy implications of risk management and change theory approaches to dropout.
Food insecurity affected over 2.3 million Canadians in 2004. To date, the food security literature has not considered the potential impact of economic abuse on food security, but there are three ways in which these two important public health issues may be related: 1) victims of economic abuse are at risk of food insecurity when they are denied access to adequate financial resources; 2) the conditions that give rise to food insecurity may also precipitate intimate partner violence in all its forms; 3) women who leave economically abusive intimate heterosexual relationships are more likely to live in poverty and thus are at risk of food insecurity. This paper presents a case of one woman who, during a qualitative research interview, spontaneously reported economic abuse and heterosexual interpersonal violence. The economic abuse suffered by this participant appears to have affected her food security and that of her children, while her husband's was apparently unaffected. There is an urgent need to better understand the nature of intra-household food distribution in food-insecure households and the impact of economic abuse on its victims' food security. Such an understanding may lead to improved food security measurement tools and social policies to reduce food insecurity.
To describe the characteristics of men and women exposed to physical violence, to identify risk factors for violence exposure and to quantify the attributable healthcare costs of violence.
The Danish national health interview surveys of 2000 and 2005 included data on exposure to defined forms of physical violence over the last 12 months. Respondents who reported exposure to violence during the past year were compared with a reference group of non-exposed respondents, and data were merged with the National Health Registers. We identified risk factors for violence by logistic regression models and used OLS regression for quantification of attributable healthcare costs of violence, including somatic and psychiatric admissions, outpatient contacts, prescriptions and primary health services; and analyzed intimate partner violence separately.
Young age, being divorced and drinking more than the recommended amount of alcohol per week were risk factors for violence both for men and women. Total annual healthcare costs, adjusted for age and deliveries, were 787 euros higher on average for women exposed to violence than for non-exposed women, mainly related to psychiatric treatment. For women, no significant cost differences existed between victims of partner violence and non-victims. The total healthcare costs were not higher for exposed men than for non-exposed men, but male victims of partner violence incurred significantly higher costs.
Primarily due to costs of psychiatric treatment, male and female victims of violence had higher total healthcare costs than non-exposed people. Whether mental health problems increase the risk of violence exposure or violence is a particular risk factor for health problems cannot be assessed by cross-sectional data alone.