Use of an Orientation Session May Help Decrease Attrition in a Pediatric Weight Management Program for Low-Income Minority Adolescents

This study examined predictors of attrition from a pediatric weight-control program in a low-income minority community and the potential usefulness of an orientation session to increase length of treatment. Participants were 342 children and adolescents (M age=13.0 years old; 54% female; 89% African American; M BMI=44.2, M BMI z-score=6.0) and their caregivers who attended FitMatters, a multidisciplinary cognitive-behavioral program focused on long-term participation. Those who attended an orientation session stayed in treatment significantly longer, but attrition was not affected by demographic factors, weight status, or psychological functioning. These results indicate that an orientation session that clearly delineates the structure of a program and expected attitudinal and behavioral requirements for the families may help align expectations, as well as more effectively identify families who are ready to make concerted efforts to change the family lifestyle in support of their obese children's efforts.     

Men’s Gendered Constructions of Intimate Partner Violence as Predictors of Court-Mandated Batterer Treatment Drop Out

The purpose of this study was to explore the meaning men make of their violence toward intimate partners and to examine if and how these meanings and constructions of violence predicted who drops out of batterer treatment prior to program completion. We used both qualitative and quantitative data collected from 154 men court-mandated to participate in a batterer intervention program. The qualitative findings indicated that the men in this sample minimized and denied responsibility for the violence they used towards their intimate partners while simultaneously rationalizing and justifying their violent behavior. Such findings provide insight into how denial and minimization and, more broadly, men’s constructions of masculinity might predict their tendency to drop out of batterer treatment. Furthermore, building upon our qualitative findings, logistic regression analysis revealed that men who were lower income, no longer intimately involved with the women they abused, and who reported lower levels of physical violence and higher levels of hostility were more likely to drop out of the batterer treatment program.     

Sexual and nonsexual marital aggression: Legal considerations, epidemiology, and an integrated typology of perpetrators

In this paper, the legal history of marital rape and the current status of “marital rape allowances” to sexual assault statutes are reviewed. The prevalence of marital rape and its comorbidity with nonsexual violence, as well as the physical and psychological sequelae found to be specifically associated with sexual aggression in marriage is reviewed. Our current limited theoretical understanding of the relationship between sexual and nonsexual violence in marriage is extended by integrating marital rape and marital violence batterer typology research. Specifically, we offer a four-type batterer typology integration (i.e., family-only, dysphoric/borderline, generally violent/antisocial, and sexually obsessive batterers) that fully describe husbands that are only nonsexually violent, both physically and sexually violent, or only sexually violent. Theoretical and practical implications of this integration are identified. Future research directions are outlined, and the need for greater clinical attention to the phenomena of sexual violence in marriage is highlighted.     

Engagement in Behavioral Parent Training: Review of the Literature and Implications for Practice

Engagement in behavioral parent training (BPT), including enrollment, attrition, attendance, within-session engagement, and homework completion, has long been a critical issue in the literature. Several estimates of various aspects of engagement have been suggested in the literature, but a systematic review of the available literature has never been accomplished. This review examines engagement data across 262 studies of BPT. Recruitment attrition, program attrition, attendance, and within-session engagement are examined across studies, with particular emphasis on the impact that SES, study purpose (efficacy vs. effectiveness), treatment format (individual vs. group), and age of child may have on those rates. Results of this review suggest that the significant amount of attrition occurs prior to enrollment in BPT, with at least 25 % of those identified as appropriate for BPT not enrolling in such programs. An additional 26 % begin, but drop out before completing treatment. Still the combined dropout rate of at least 51 % leaves at best half of identified parents completing treatment. While SES status had a small effect on attrition, other variables were not found to meaningfully impact engagement. Information on within-session engagement (homework and ratings of participation) was not often reported in studies. Key issues in this literature (e.g., varying definitions of engagement, limited attention to reporting key aspects of engagement) are discussed, and recommendations are made to further improve this important area of research and clinical practice.     

Evaluating batterer counseling programs: A difficult task showing some effects and implications

Over 40 published program evaluations have attempted to address the effectiveness of “batterer programs” in preventing reassaults. Summaries and meta-analysis of these evaluations suggest little or no “program effect.” Methodological shortcomings, however, compromise most of these quasi-experimental evaluations. Three recent experimental studies appear to confirm little or no effect, but implementation problems, intention-to-treat design, and sample attrition limit these results. A longitudinal 4-year follow-up evaluation in four cities poses additional considerations and evidence of at least a moderate program effect. There is a clear deescalation of reassault and other abuse, the vast majority of men do reach sustained nonviolence, and about 20% continuously reassault. The prevailing cognitive–behavioral approach appears appropriate for most of the men, but the following enhancements are warranted: swift and certain court response for violations, intensive programming for high-risk men, and ongoing monitoring of risk. Program effectiveness depends substantially on the intervention system of which the program is a part.     

Attrition During the Pretreatment Stage of a Drug-Free Therapeutic Community

In the treatment of dnig abusers a continuing problem is the high attrition rate. This study focussed on m New South Wales treatment facility, Odyssey House, and aimed to discover some of the variables associated with attrition. A simple of people admitted to the program was divided into two groups, those who left within 30 days and those who did not. Most of the client variables were nonsignificant. The most significant predictor of attrition was the client's status IS a new admission or as a readmission; re-admissions were more likely to stay than newly admitted people. Also significant were the length of previous treatment, suicide attempt history, clients' perceptions of the toughness of the program and the predictions made by the admission team. The study indicated a need for further investigation of program and environmental variables and of interactions among these and client variables.     

Sexual and nonsexual marital aggression: Legal considerations, epidemiology, and an integrated typology of perpetrators

In this paper, the legal history of marital rape and the current status of “marital rape allowances” to sexual assault statutes are reviewed. The prevalence of marital rape and its comorbidity with nonsexual violence, as well as the physical and psychological sequelae found to be specifically associated with sexual aggression in marriage is reviewed. Our current limited theoretical understanding of the relationship between sexual and nonsexual violence in marriage is extended by integrating marital rape and marital violence batterer typology research. Specifically, we offer a four-type batterer typology integration (i.e., family-only, dysphoric/borderline, generally violent/antisocial, and sexually obsessive batterers) that fully describe husbands that are only nonsexually violent, both physically and sexually violent, or only sexually violent. Theoretical and practical implications of this integration are identified. Future research directions are outlined, and the need for greater clinical attention to the phenomena of sexual violence in marriage is highlighted.     

The absence of evidence is not the evidence of absence: The abusive personality as a disordered mental state

Does the perpetration of domestic violence reflect a distinct mental disorder? This essay does not and cannot definitely answer that question. Rather it aims to prompt a discussion of the various indices for surmising a position on this issue. For example, batterer behavior and attitudes are associated with severe psychopathology. Batterers are treated in intervention programs for an unnamed condition. Ultimately, domestic violence is contextualized as abnormal behavior. This paper reviews research in the field of domestic violence to establish a forum for discussion and debate about the potential for an abnormal mental state to describe the psychology of a batterer. This review posits that at minimum, the field of psychiatry should consider a review of batterer characteristics to formally investigate the “abusive personality” as a categorization of a distinct mental disorder.     

Batterer Program Directors' Views on Substance Abuse and Domestic Violence

This article reports on a national survey of batterer intervention program (BIP) directors (N?=?150). The beliefs of these directors on the relationship of substance abuse and domestic violence is reported and discussed. BIP director's opinions are important because they make programmatic and treatment decisions. Most BIP directors believe that for many of their clients, both men and women, perpetrator and victim, violence and substance abuse is related. Treatment and methodological considerations are discussed.     

The Relationship between Characteristics of the Victim,Persuasive Techniques of the Batterer,and Returning to a Battering Relationship

Abstract

In two studies, we examined factors involved in the returning of American women to a battering relationship. In Study 1, several self-reported characteristics of 117 women in a shelter for battered women were found to predict intentions to return to the batterer or number of subsequent admissions to the shelter. In Study 2, 24 battered women identified on questionnaires several techniques commonly used by their batterers to persuade them to stay with or return to them.     

Battered women versus male batterer typologies: Same or different based on evidence-based studies?

Domestic violence research has made great strides in understanding patterns of violence by examining typologies or categories of male batterers. Examining classifications of batterers allows for more targeted interventions and policies that address the particular risks and needs of each batterer subtype. Despite great advancement in our understanding of batterer typologies, little work has been done to examine what these typologies mean for battered women and whether battered women are easily classified into similar typologies useful for service provision. This article reviews the most common and empirically supported batterer typologies and then compares these typologies to Roberts’ [Roberts, A. R. (2007). Domestic violence continuum, forensic assessment, and crisis intervention.] The continuum of the duration and severity of woman battering is adapted from Roberts and Roberts' (2005) Ending Intimate Abuse: Practical Guidance and Survival Strategies, New York: Oxford University Press. The battered-women typology, however, introduces women's degree of independence as a factor important in battered-women classification but often ignored in batterer typologies. Making these comparisons raises several questions regarding the focus of future classificatory and typological research on intrapersonal, interpersonal, and environmental factors. The implications for practice with battered women in different types of violent relationships are discussed.     

Social Construction of Intimate Partner Violence: A Brief Report on Quantitative Grammatical Analysis

This pilot study uses a quantitative linguistic analysis to assess evidence of agency and control, as well as treatment engagement, in letters written by men (N = 46, 37% Latino) participating in a batterer intervention program. At the program’s conclusion, men were asked to imagine their situation in 5 years and write a letter from their “future self” to their “present self.” Letters were scored for grammatical representations of agency and objectification, and temporal complexity. Results showed that the men tended to grant themselves the subject position (conferring agency) and to grant others the object position (deferring or denying agency) by almost equal margins, both rhetorical maneuvers suggesting an objectifying stance toward others. Moreover, they employed several strategies to address temporality, with more complex strategies suggesting greater treatment engagement. Findings suggest that quantitative linguistic analysis is a promising tool for assessing participants’ progress in and engagement with treatment.     

CHALLENGES FACING FEMALE DOCTORAL STUDENTS AND RECENT GRADUATES

Although increasing the numbers of women and minority faculty in academia is a widely held goal, their numbers remain small. The presence of women and minorities decreases disproportionately at each ascending rung of the academic ladder. This investigation identified factors potentially contributing to attrition in White and non-White women at a critical stage in their careers: as doctoral candidates and recent graduates. Two-hundred and twenty-four women in the life sciences, social sciences, and the humanities described their most pressing professional and personal concerns and offered suggestions for changes in their fields and in academia more generally. Independent raters coded responses by thematic content. Differences in responses by field, educational status, and minority status were examined. The most frequently cited concerns involved practical issues such as finding employment, financial stability, and developing professional expertise, revealing wide-spread concerns about a competitive academic climate. Suggestions included modifications in professional conduct, the employment and pay structure, and training.     

Women Court-Ordered for Domestic Violence: Improvements in Depression

A quasi-experimental design was employed to compare depression at intake and completion of a sample of primarily Latina women court-ordered to a batterer intervention program. Data were derived from the intake assessments of 112 women over 24 months. Overwhelmingly, women reported being abused by their current and former partners. Approximately 58% of the women in this sample were depressed at intake. When culturally competent, gender-appropriate treatment is given to court-ordered women, depression symptomatology may decrease to levels of normal functioning. Further research is needed to understand court-ordered women as well as how to meet their unique needs.     

Characteristics of Male Batterers in Treatment

Abstract

This article presents information on the characteristics of a clinical population of male perpetrators of intimate partner violence (IPV) court-ordered for batterers' treatment, and how these characteristics co-varied with treatment attrition. The average demographic profile of male batterers in a midwestern treatment program that met present-day treatment guidelines was similar to that found in other studies. In addition, relationship length and status, alcohol/drug use, self-reports of past treatment and mental health issues, and self-report of witnessing or experiencing violence within the home during childhood was also similar. Batterers' self-reports of their own violent behavior were found to vary by data collection technique, with face-to-face interviews eliciting greater admission of violent behavior than paper-and-pencil questionnaires. However, the only predictors of successful treatment outcome were living arrangement at the time of treatment and racial category. Implications of these findings are discussed, and “local effects” program evaluation approaches are suggested.     

At-Risk Marriages after Compulsory Premarital Testing and Counseling for β-Thalassemia and Sickle Cell Disease in Saudi Arabia, 2005–2006

Results from a screening program for sickle cell disease and β-thalassemia suggest about 90% of couples in Saudi Arabia at risk of having affected children still decide to marry. This study determined the rate of at-risk marriages and identified several factors that may prevent at risk couples from marrying. The marriage status of 934 at-risk couples was determined from original screening program records in the Ministry of Health. Of 934 couples, 824 married (88.2%) and 110 (11.8%) did not. A case–controlled study was conducted on 104 couples who did not marry (cases) and 478 couples who did marry (controls) in order to assess relationships between various cultural and social factors and marriage decisions. In the case-controled study, 28.8% of couples (30/104) who did not marry (cases) knew their disease or carrier status before screening compared to 18% (86/478) of those who married (controls). Reasons couples gave for proceeding with marriage included: wedding plans could not be canceled, and fear of social stigma. Couples who did not marry reported being influenced by prior knowledge of their disease or carrier status and whether they or family members were affected. Approximately half of the cases and controls (n = 270, 46.4%) thought it best to undergo screening before proceeding with the engagement and wedding plans. Most couples received no advice to participate in genetic counseling services. Marriage decisions for the small number who received genetic counseling (n = 168, 27.6%) did not differ significantly from those that received no counseling. Recommendations are made for improving the effectiveness of this screening program.     

VARIATIONS IN HELP-SEEKING, BATTERED WOMEN'S RELATIONSHIP COURSE, EMOTIONAL WELL-BEING, AND EXPERIENCES OF ABUSE OVER TIME

Despite assumptions that leaving the batterer offers the best chance for improvement in battered women's lives, few studies provide conclusive data on this issue. Although many women eventually reunite with partners, also unexamined is the influence of relationship course over time. Five waves of data from 206 low-income, largely Black, help-seeking battered women revealed minimal differences in emotional well-being either initially or over time for women following different relationship trajectories during the course of 1 year. Consistency in relationship status (completely apart, completely together) tended to be associated with sharper drops in violence during the year; abuse tended to decrease most slowly among women who were in and out of their relationship over time. Findings suggest that the act of leaving is not necessarily associated with improvements for victims—how the process of leaving occurs may be more influential. Challenging common assumptions, women remaining with partners may sometimes fare better than women who leave.     

Risk factors for infant attrition and low engagement in experiments and free-play

Forty-three 2-month-old infants participated with their mothers in a laboratory study of factors associated with variations in infants' attrition and levels of attention/engagement in a cognitive-perceptual experiment, and in free-play with their mothers. Increased risk of attrition from the experiment was strongly associated with analgesic medication having been administered during labor and with more restricted maternal perceptions of infants' capacities. Attrition rates and levels of engagement varied independently, showing different patterns of association with explanatory variables. Infants' levels of engagement in the experiment and in free-play were correlated across settings and low levels were associated with a lack of maternal identification with the foetus during early pregnancy and more limited maternal perceptions of their infants' capacities, but were not associated with analgesic medication during labor.     

An Event History Analysis of First-Term Soldier Attrition

The study of attrition has largely focused on identifying demographic or biographic characteristics that predict whether soldiers complete their enlistment term. As a result, much is known about who attrites. Less is known about why soldiers attrite. This research assessed the influence of two psychological factors on U.S. Army soldier attrition: self-reported confidence that one could complete one’s term of service and ambivalence regarding the decision to enlist. The study sample consisted of first-term enlisted soldiers (N = 14,808) who were respondents to Army surveys. Results of fitting three longitudinal models indicated that confidence in being able to complete one’s term of obligation was more predictive of attrition for those reporting greater ambivalence regarding the decision to enlist. This effect was significant throughout a 3-year period. This work adds to our understanding of attrition by highlighting the role of confidence and ambivalence. Implications for strategies to reduce attrition are discussed.