Abused Women With Children Who Are First-Time Users of a Shelter or Applicants for a Protection Order

Abstract

Worldwide, two models of care are offered most often to abused women—safe shelter and justice services. No evidence exists on the differential effectiveness of the services. To provide evidence, 300 abused women, 150 first-time users of a shelter and 150 first-time applicants for a protection order, signed informed consent to participate in a 7-year study. Safety, abuse, and functioning of the women and their children were measured. Compared with women seeking justice services, women in shelters reported more abuse and depression and less support. The baseline characteristics of these 300 women are presented with implications for practice and policy.

Keywords

children protection orders shelters

Introduction

Violence against women is a global epidemic, with intimate partner violence (IPV) resulting in deaths, injuries, miscarriages, mental health disorders, and contributing to chronic diseases and permanent dysfunctions (Campbell, 2002). In the United States, an estimated one third of women (35.6% or about 42.4 million) experience rape, physical violence, and/or stalking by an intimate partner at some point in their lifetime (Black et al., 2011). Each year, an estimated 4.8 million women in the United States are victims of physical assault by an intimate partner (Centers for Disease Control and Prevention [CDC], National Center for Injury Prevention and Control, 2011). According to the most recent World Health Organization (WHO) report, prevalence rates for violence against women are even higher for countries outside the United States (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006; Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). Strong evidence suggests a dose–response effect; as the frequency and severity of violence increases, the impact on the health of victims becomes more severe (Campbell, 2002; Cox et al., 2006).

When women are victimized, so are their children. The children of abused women who witness partner violence or whose mothers are victimized by violence have even greater problems with social skills, learning, depression, and aggression (Hurt, Malmund, Brodsky, & Giannetta, 2001; McFarlane, Groff, O’Brien, & Watson, 2003), with boys more negatively affected than girls (Silverstein, Augustyn, Cabral, & Zuckerman, 2006). As most abused women have children and children are usually negatively affected by the abuse experienced by their mothers, it is essential to examine the joint impact of violence and violence interventions on mothers and children.

The WHO guidelines for policy and clinical practice for partner violence call for evidence-based interventions that are culturally sensitive and effective for low-, medium-, and high-resource countries (WHO, 2013). Safe shelter and protection orders are interventions commonly offered globally to abused women and their children; however, evidence on their effectiveness is lacking. Only a few longitudinal studies were found and no studies were identified that followed abused women with children using shelter or justice services for the first time. First-time users of services are a unique population of abused women who may provide a unique opportunity to interrupt the abuse and prevent the long-term cycle of violence and associated negative consequences to women and children.

Clearly, to promote the safety and well-being of abused women and their children, longitudinal data are required. Therefore, to examine how effective safe shelters and protection orders are to interrupt abuse and improve functioning of abused women with children, a 7-year study is underway. This research presents the characteristics of the 300 abused women with children, 150 of whom sought safe shelter and 150 who applied for a protection order, who are participating in the 7-year study.

Shelter Services

Shelters for abused women began as a grassroots movement to provide emergency housing to abused women and their children. Globally, shelters range from a few beds in a small home to large complexes providing 24-hr crisis hotlines, group and individual counseling, and job training and programs for children (Lyon, Lane, & Menard, 2008). The National Network to End Domestic Violence (NNEDV; 2007) estimates that 1,949 shelters exist in the United States, serving several thousand women and children on any given day, with a median length of stay of 21 days. As shelters have increased in structural size and program offerings, so have the operating budgets, with funders asking what evidence exists for shelter effectiveness? Are women and children safer following a shelter stay? What is the dose–response effect of a shelter stay? Stated another way, is a longer shelter stay and exposure to more services, and at a greater cost, associated with enhanced safety and quality of life? What are the physical and emotional needs of women and children entering a shelter? What programs are needed for women and children entering a shelter that will best address needs and promote safety and functioning? What is the evidence on which to base program and policy decisions?

The scant research from shelters on long-term effectiveness indicates advocacy, consisting of home visits to offer guided referral and solution-based decision making; following a shelter stay women displayed improved functioning, increase in use of community resources, and reduced likelihood of further reports of abuse for up to 18 months after which time there is no difference between women who received the counseling and women in the control group who did not receive the advocacy (Bybee & Sullivan, 2002; Sullivan, 2000). Most research on shelter effectiveness uses testimonials of women following a shelter stay (Bennett, Riger, Schewe, Howard, & Wasco, 2004; Berk, Newton, & Berk, 1986). One study by Campbell, Sullivan, and Davidson (1995) reports an impressive decrease in depression following a shelter stay with 83% of women reporting symptoms of depression while in the shelter, decreasing to only 50% at 10 weeks and remaining at 50% 6 months post shelter stay.

None of the studies differentiated first-time users of a shelter from repeat residents, although some 85% of shelter residents are repeat residents (Lyon, 2008). No research was identified that measured the demographic, abuse severity, safety practices, mental and physical health functioning, and economic solvency characteristics of abused women entering shelters for the first time that could provide evidence for programs and policy to break the cycle of abuse and repeated use of shelters.

Justice Services

Justice services for abused women are usually perpetrator arrest by law enforcement or orders of protection granted by courts. What evidence exists for justice intervention effectiveness? Although considerably more research exists on justice interventions compared with shelter effectiveness, the research has not been able to answer the question of effectiveness for women’s safety definitively, mainly because it is not ethically permissible to randomly arrest or not arrest, or grant or deny protective orders, to compare results.

All States in the United States have statutes authorizing civil protection orders to provide victims protection from abusive partners (Klein, 2009). Regarding effectiveness in stopping further abuse, before-and-after studies suggest that protective orders may deter certain abusers. If the abusers are also arrested at the time of the order issuance, the physical abuse diminishes further; if the abuser has children, future abuse is diminished less (Carlson, Harris, & Holden, 1999). Differences exist among women who receive a protective order and those who do not. Specifically, women who obtain a protective order are more likely to be employed, depressed, and report physical injury and sexual coercion, suggesting a link between severity of abuse and obtaining a protective order (Wolf, Holt, Kernic, & Rivara, 2000) as well as associations with obtaining a protection order and certain socio-demographic characteristics, such as employment (Logan, Shannon, Walker, & Faragher, 2006).

Several studies that compared women who maintain orders of protection and women who drop them, or did not return for permanent orders, found that order retention made no difference in re-abuse rates (Harrell & Smith, 1996; McFarlane, Malecha, Watson, et al., 2004). However, based on a review of 15 empirical studies of outcomes following protection orders, Benitez, McNiel, and Binder (2010) concluded that there is evidence that receiving a protection order reduces the victim’s risk for further violence. Many women who apply for an order of protection do not qualify for the order. Gist and colleagues (2001) report that 28% of women did not qualify for the order, and the non-qualifying women reported significant differences in history of partner victimization with the abuse being less physical and more threatening and stalking. Unlike arrest, which frequently involves a third party to contact law enforcement to begin the process, the abused woman must initiate the application for a protection order and follow through with a court appearance. Accessibility barriers to receiving a protection order include narrow eligibility requirements, a time-consuming and costly bureaucratic process that requires a court appearance, and an often less-than-adequate response by the criminal justice system in the serving and enforcement of orders (Logan et al., 2006). Despite the obstacles, many women apply, qualify, and receive the protection order. What are the characteristics of women who qualify and receive the order compared with women who qualify and do not receive the order? No research was identified that measured the demographic, abuse severity, safety practices, mental and physical health functioning, and economic solvency characteristics of abused women qualifying for a protection order for the first time. To break the cycle of abuse, information is needed on first-time qualifying applicants for a protection order.

Research Purpose

To promote the safety of abused women and children worldwide, evidence is needed on the effectiveness of shelters and justice interventions, such as protection orders as well as the characteristics of the women who use such services. Because of the documented impact of violence against women on children, information is urgently needed on abused women with children who access services, especially women with children who use services for the first time, thereby providing an opportunity to stop violence and promote safety for the mother and child. We identified no studies that described or compared the demographic, safety, abuse, mental health, and functioning characteristics of abused women with children who are “first-time” users of a shelter or protection order applicants. Similarly, we identified no studies that followed first-time users of services forward in time. We believe this to be the first study of its type.

Although the primary purpose of this project is to investigate the impact of abuse on mothers and their children following a shelter or justice intervention (i.e., protection order) over a 7-year period, the purpose of this article is to describe the demographic, safety, abuse, mental health, and functioning characteristics of abused women with children who enter a shelter for the first time compared with abused women who apply and qualify for a protection order for the first time. We believe “first-time users” of the shelter and justice systems provide a unique opportunity to discover differentiating characteristics that can offer evidence for policy and programs to better protect the well-being of abused women and their children. Findings and implications from this article will not only add substantially to the empirical body of research on abused women and their children but will also serve as a guide for other researchers studying this important topic. This study addresses the characteristics of the mothers. Information on the functioning of the children is presented elsewhere (Binder, McFarlane, Nava, Gilroy, & Maddoux, 2013).

Research Questions

Based on the existing body of literature, specific research questions for this article include the following:

Research Question 1: What are the demographic, safety, abuse, mental health, and functioning characteristics of abused women with children (aged 18 months to 16 years), who are “first-time users” of a shelter compared with “first-time qualifying applicants” for a protection order?

Research Question 2: What are the demographic, safety, abuse, mental health, and functioning characteristics of abused women with children (aged 18 months to 16 years), who are “first-time users” of a shelter and stay 21 days or less compared with women staying longer than 21 days?

Research Question 3: What are the demographic, safety, abuse, mental health, and functioning characteristics of abused women with children (aged 18 months to 16 years), who are “first-time” qualifying applicants for a protection order and who receive the order compared with women who qualify but do not receive the order?

Method

This study is part of a 7-year prospective study funded by the Houston Endowment. The project was approved prospectively by the Texas Woman’s University institutional review board. The purpose of the 7-year prospective study is to investigate the treatment efficacy of the two models most often offered to abused women worldwide: safe shelter and justice services. We will examine the efficacy of these two models of care and support for abused women, and investigate the long-term effects that the abuse has on the women’s functioning. Unlike previous studies on abused women, this study plans to examine in addition the effects that the abuse of the woman has on her children over a 7-year span. For the purposes of this article, we are examining differences across outcome measures between abused women who seek assistance through safe shelter for the first time and those who seek support through justice services, specifically those applying and qualifying for a protection order for the first time.

Characteristics of women who qualified and received the protection order are compared with women who qualified and did not receive the order of protection. Likewise, characteristics of women who entered a shelter for the first time and stayed 21 days or less, the national median for a shelter stay (NNEDV, 2007), are compared with women who stayed 21 days or longer. See McFarlane, Nava, Gilroy, Paulson, and Maddoux (2012) for a full review of the aims, scope, and methodology of the 7-year prospective study, which uses a community-based participatory approach to multi-year study to ensure stakeholder participation and rapid application of findings to shelters and the justice system.

Procedures

In line with the scope of the 7-year prospective study, participants were recruited through shelters and the District Attorney’s (DA) office. As women reached out to use either of the services, research assistants provided them with an overview of the study, evaluated each woman as to “first-time” use of services, and obtained informed consent. (Specifics of inclusion criteria, exclusionary procedures, data collection periods, enrollment scripts, and process of randomly choosing one child are provided elsewhere [McFarlane et al., 2012].) If women consented to participate, the research assistant would interview the woman to get demographic and outcome measurements. Interviews took approximately 45 min to complete.

Participants

A total of 300 women agreed to participate in this study. Half of the total sample were recruited from the DA’s office (n = 150), and the remaining half were recruited from shelters (n = 150). Means and standard deviations for continuous demographic variables for the full sample are outlined in Table 1. Women who participated in this study ranged from 18 to 52 years (M = 30.65, SD = 7.64), with the age of the randomly chosen child ranging from 1.5 to 16.42 years (M = 6.88, SD = 4.23). Participants reported an average of 3.64 (SD = 1.60) people living in their household, and that there was an average of 1.93 (SD = 1.09) children living in the home. Some 55% of the women reported employment, with an average wage of US$10.96 an hour. The length of the relationship with the abuser ranged greatly, from 0 to 300 months (25 years; M = 83.59, SD = 62.86).

Table 1.

Frequencies and Percentages of Categorical Demographics of Full Sample.

	n	%
Ethnicity
White	32	10.7
Black	78	26.0
Asian	4	1.3
American Indian/Native Alaskan	1	0.3
Spanish or Hispanic	170	56.7
Bi-/multi-racial	15	5.0
Currently in an intimate relationship
No	251	83.7
Yes	49	16.3
Currently in relationship with abuser
No	190	63.3
Yes	110	36.7
Graduate from high school or GED?
No	101	33.7
Yes	199	66.3

Frequencies and percentages of categorical demographics for the full sample are shown in Table 2. The greatest percentage of the sample identified Spanish or Hispanic as their ethnic background (n = 137, 45.7%), followed by Black (n = 78, 26.0%), and White (n = 32, 10.7%). A large majority of the sample reported that they are not currently in a romantic relationship (n = 251, 83.7%). In addition, a majority of the sample reported that they are not currently in a relationship with the abuser (n = 190, 63.3%). Most participants reported that they had completed secondary education or equivalent (66.3%) and more than half of the women reported some college education (50.7%); however, a very small percentage of the sample reported completing 4 or more years of college (n = 18, 6.0%). With regard to the randomly selected child, there were relatively equal percentages of boys and girls (50.7% and 49.3%, respectively).

Table 2.

Means and Standard Deviations of Continuous Demographics for Full Sample and Groups.

	Full sample			Protection order women			Shelter women
	n	M	SD	n	M	SD	n	M	SD	F	p	η²
Age	300	30.65	7.64	150	30.71	7.88	150	30.59	7.41	0.02	.898	.000
Number of people in household	298	3.64	1.60	148	4.14	1.78	150	3.16	1.24	30.34	<.001	.093
Length of relationship	297	83.59	62.86	147	85.15	64.86	150	82.06	61.02	0.18	.673	.001
Hours worked per week	164	34.7	12.50	108	37.11	10.97	56	30.04	13.99	12.65	<.001	.072
Dollars per hour	160	11.37	5.71	104	12.32	6.08	56	9.61	4.51	8.58	.004	.052
Number of children 1.5-16 Years	300	1.93	1.09	150	1.93	0.99	150	1.93	1.19	0	1.000	.000

Note. Means in boldface indicate significantly higher than comparison group, p < .05.

Instruments

Safety and community resource use

The Safety Behavior Checklist (McFarlane & Parker, 1994) is a 7-item safety survey to assess the present use of safety behaviors and chart future adoption. The Safety Behavior Checklist was initially published in 1994 by the March of Dimes as part of a comprehensive protocol on the care of abused women (McFarlane & Parker, 1994) and subsequently updated (McFarlane, Parker, & Cross, 2001, 2007). Content validity was established by a group of nurse researchers in the field of violence against women and has since been used to evaluate safety behavior adoptions (McFarlane, Malecha, Gist, et al., 2002, 2004; McFarlane, Malecha, Watson, et al., 2004; McFarlane, Parker, Soeken, Silva, & Reel, 1998). Sample questions include asking the woman whether her copies of important documents, such as social security numbers and birth certificates, are stored together in a safe place and whether she had money hidden and a code word that family, friends, and children know means that they need to call the police. Scoring of the checklist proceeds as follows: As not all 7 items on the checklist are applicable to every participant (e.g., a woman with a child <5 years of age would be “not applicable” for teaching the child to dial 911), the scoring of the checklist is “adjusted” for purposes of interpretation and comparison. The adjusted total score falls within a 0 to 7 range of behaviors performed. The following equation expresses the relationship of the number of applicable behaviors performed to the “adjusted” total number of behaviors: $a / b = x / 7$ where a is the number of behaviors performed, b is the total number of applicable behaviors, and x is the adjusted total. An “adjusted” total number of behaviors performed is calculated each time the Safety Behavior Checklist is completed. Time to complete the Safety Behavior Checklist is approximately 2 min.

The Community Agency Use, Frequency of Use, Helpfulness, and Difficulty Form (McFarlane & Parker, 1994) is designed to assess the use of nine different types of community agencies commonly used by abused women to deal with abuse, including battered women’s counseling, shelter/emergency housing, police/sheriff/law enforcement, DA’s office for protection orders, legal services, faith community, social services, and health care (McFarlane & Parker, 1994). A score of 0 to 9 is generated depending on the number of agencies used. If the woman indicates use of an agency, she is asked about the frequency of use and how helpful (1 = very, 2 = somewhat, 3 = not effective, and 4 = made things worse) the agency was in assisting her to deal with the violence (a lower score is associated with more helpfulness). A second set of questions asks whether the woman had tried to access any of the agencies and, if yes, whether she experienced any difficulties in contacting the agency. Sum scores were created for Community Agency Use, Frequency of Use, Helpfulness, and Difficulty. Difficulty was scored “1” if the woman reported difficulty and “0” if the woman reported no difficulty. Time to complete this form is approximately 6 min.

Abuse and danger measures

The Severity of Violence Against Women Scale (SVAWS; Marshall, 1992) is a 47-item instrument designed to measure threats of physical violence (19 items) and physical assault (28 items). Examples of behaviors that amount to threats of abuse or physical violence are threats to destroy property, hurt the woman, or harm other family members. Examples of behaviors that represent physical violence are kicking, beating up, and forced sex. Included are nine factors or subscales that have been demonstrated as valid through factor analytic techniques: Symbolic Violence and Mild, Moderate, and Serious Threats (Threats of Violence Dimension) and Mild, Minor, Moderate, Serious, and Sexual Violence (Actual Violence Dimension). For each item, the woman responds using a 4-point scale to indicate how often the behavior occurred (1 = never, 2 = once, 3 = 2 to 3 times, and 4 = 4 or more times). The possible range of scores is 19 to 76 for the threats of abuse and 28 to 112 for physical assault. Initial internal consistency reliability estimates ranged from .92 to .96 for a sample of 707 female college students and from .89 to .96 for a scale of 208 community women (Marshall, 1992). Subsequent reliability for abused women has ranged from .89 to .91 for threats of abuse and .91 to .94 for assault, respectively (Coker, Smith, McKeown, & King, 2000; Gist et al., 2001). Time to complete the SVAWS is approximately 5 min.

The Danger Assessment Scale (DAS; Campbell, 1986) is a 19-item questionnaire with a yes/no response format designed to assist women in determining their potential risk for becoming a femicide victim. All items refer to risk factors that have been associated with murder in situations involving abuse. Examples of risk factors include the abuser’s possession of a gun, use of drugs, and threats to kill the woman. Convergent construct validity of the instrument has been supported by correlations in the moderately strong range, with instruments measuring severity and/or frequency of abuse (Campbell, 1995). Validity in terms of differentiating groups is supported by the different means in seven groups of abused women studied that accurately reflect the differing degrees of severity of abuse one would expect in different populations. For example, the lowest scores were in the non-abused sample, with the highest scores in the hospital emergency room group. Samples of abused women from the community had scores in the intermediate range (Campbell, 1995). Initial reliability of the instrument was .71 and ranged from .60 to .86 in five subsequent studies (Campbell, 1995). Weighted scoring results in four ranges of danger: less than 8 = variable danger, 8 to 13 = increased danger, 14 to 17 = severe danger, and 18 or more = extreme danger. Time to complete the DAS is approximately 5 min.

Mental functioning

The Post-Traumatic Stress Disorder (PTSD) Scale is a 7-item symptom scale that screens PTSD. This instrument is a subset of items from the National Institute of Mental Health Diagnostic Interview Schedule for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric Association, 1994; Breslau, Peterson, Kessler, & Schultz, 1999). A score of 4 or greater defines a positive case of PTSD with a sensitivity of 80%, specificity of 97%, positive predictive value of 71%, and negative predictive value of 98%. Time to complete this screen is approximately 2 min.

The Brief Symptom Inventory (BSI; Derogatis & Lazarus, 2001) is an 18-item shorter version of the BSI-53 and measures three global indices of psychological distress: depression, anxiety, and somatization. Internal consistency reliability ranges from .74 to .89 on the subscales. Test–retest reliability over 2 weeks ranges from .68 to .91. A principal components analysis has been performed to determine dimensional analysis. Factors identified in the analysis include depression, somatization, and anxiety. Higher scores indicate more symptoms. Time to complete the BSI is approximately 3 min.

The General Self-Efficacy Scale (GSE; Schwarzer & Jerusalem, 1995) is a 10-item instrument created to assess a general sense of perceived self-efficacy with the aim of predicting coping and adaptation after stressful life events. Responses to each item are made on a 4-point scale (1 = not at all true, 2 = hardly true, 3 = moderately true, and 4 = exactly true). The possible range of scores is 10 to 40. Criterion-related validity is documented in numerous correlation studies where positive coefficients were found with favorable emotions, and negative coefficients were found with depression, anxiety, and somatization. In samples from 23 countries, Cronbach’s alphas ranged from .76 to .90, with the majority in the high .80s (Schwarzer & Jerusalem, 1995). Time to complete the GSE is approximately 2 min.

Social support and marginalization

The Norbeck Social Support Questionnaire (Norbeck, Lindsey, & Carrieri, 1981, 1983) is a 6-item instrument that measures multiple components of social support, including functional properties of social support (e.g., emotional and tangible support) and network properties (e.g., stability of relationships, frequency of contact), as well as the amount of support from specific sources (e.g., relatives, friends). Respondents are asked to list first names or initials for each significant person in their lives who provides personal support to them. Then they indicate the kind of relationship for each person on this network list, followed by the use of a 5-point rating scale to describe the amount of support available from each person (Norbeck et al., 1981, 1983). The instrument was revised to the present form in 1995. For the purposes of this study, respondents are asked for the initials of their three primary sources of support. An extra question follows the Norbeck standard questions that ask whether the abused woman has shared the violence with this individual. Time to complete this measure is approximately 5 min.

The Koci Marginality Index (KMI; Koci, 2004) is a 5-item, abbreviated version of the KMI-95 items and KMI-70 items that uses a 5-point Likert-type scale to assess women’s marginality, the perception of living on the periphery of the social center. Sample questions include asking how difficult it is for the woman to meet new people and her likelihood of speaking to people before they speak to her. Higher scores indicate higher marginality. In previous research, the internal consistency (Cronbach’s α coefficient) of the KMI-70 was .96 (n = 244, Koci, 2004). Time to complete this measure is approximately 2 min.

Data Analysis

Data were confidentially encoded and entered into a secure database in the research office. To test for differences across continuous demographic and outcome variables, a series of one-way ANOVA tests was conducted. For these F tests, partial eta squared (η²) is used as the standardized measure of effect size. Partial η² can be interpreted as ~.01, a small effect; ~.06, a medium effect; and any value >.14, a large effect (Cohen, 1988). Due to skewness of the data for some outcome measures, all parametric ANOVAs were confirmed using non-parametric Mann–Whitney U tests. Cross-tabulations with Pearson’s chi-square were conducted to test for differences in the level of pain severity/interference. Cramer’s V is the standardized measure of effect size for Pearson’s chi-square. Cramer’s V can be interpreted as .01 to .05, no or negligible effect; .06 to .10, a weak effect; .11 to .15, a moderate effect; .15 to .25, a strong effect; and .25 and greater, a very strong effect (Cohen, 1988).

Results

Differences in Categorical Demographics Between Shelter and Protection Order Women

To test for differences on categorical demographic variables across groups (e.g., shelter vs. protection order), a series of cross-tabulations with Pearson’s chi-square was conducted. Table 1 shows ethnicity of the total group, relationship status, and graduation from high school. There was a significant relationship between group and whether or not one graduated high school, χ²(1) = 5.39, p = .020, Cramer’s V = .134. Of those who had graduated high school, a greater proportion were in the protection order group (n = 109, 72.7%) compared with the shelter group (n = 90, 60.0%). There were no other significant relationships between group and other categorical demographic variables of relationship status, ethnicity, and primary language; all tests were not statistically significant.

Differences in Continuous Demographics Between Shelter and Protection Order Women

To test for differences in continuous differences across groups, a series of one-way ANOVAs was conducted (see Table 2). There was a significant relationship between group and number of people living in the household, F(1, 296) = 30.24, p < .001, η² = .093. Women qualifying for a protection order had more people living in their households compared with women in the shelter group. There was a significant relationship between group and number of hours worked per week, F(1, 296) = 12.65, p < .001, η² = .072. Women in the protection order group worked more hours per week compared with women in the shelter group. There was a significant relationship between dollars earned per hour and group, F(1, 296) = 8.58, p = .004, η² = .052. Women in the protection order group made significantly more per hour compared with women in the shelter group. There were no other statistically significant relationships between continuous demographics and group.

Differences in Community Agency Use Between Shelter and Protection Order Women

Cross-tabulations with Pearson’s chi-square were conducted to test the differences in community agency factors, see Table 3. There was a significant relationship between group and community agency difficulty, χ²(3) = 11.30, p = .010, Cramer’s V = .194. Among women who had high levels of difficulty accessing community agency resources, a greater proportion were in the shelter group compared with those in the protection order group.

Table 3.

Frequencies and Percentages of Community Agency Factors by Group.

	Protection order women		Shelter women
	n	%	n	%	χ²	p
Community agencies used					3.92	.270
None	24	16.0	31	20.7
One used	52	34.7	42	28.0
Two used	41	27.3	34	22.7
Three or more used	33	22.0	43	28.7
Community agency helpfulness					0.06	.725
None used	24	16.1	31	20.7
Low helpfulness	56	37.6	51	34.0
Medium helpfulness	36	24.2	38	25.3
High helpfulness	33	22.1	30	20.0
Community agency difficulty					11.3	.010
None tried to use	22	14.7	30	20.0
No difficulty	62	41.3^a	49	32.7^b
Low difficulty	54	36.0	42	28.0
High difficulty	12	8.0^a	29	19.3^b

Note. Proportions with varying superscripts differed significantly, p < .05.

Differences in Outcome Measures Between Shelter and Protection Order Women

To test for differences in outcome measures by group, a series of ANOVAs was conducted (see Table 4). There was a significant relationship between group and marginalization, F(1, 299) = 4.48, p = .035, η² = .015. Women in the shelter group had higher marginalization scores compared with women in the protection order group. There was also a significant relationship between group and physical abuse, F(1, 299) = 4.47, p = .035, η² = .015. Women in the shelter group had higher physical abuse scores compared with women in the protection order group. Similarly, a significant relationship existed between group and sexual abuse, F(1, 295) = 6.07, p = .014, η² = .020. Women in the shelter group had higher sexual abuse scores compared with women in the protection order group. There was also a significant relationship between group and BSI Depression scores, F (1, 299) = 8.03, p = .005, η² = .026. Those in the shelter group had higher depression scores compared with those in the protection order group.

Table 4.

Means and Standard Deviations of Outcomes by Group, PO Status, and Days at Shelter.

	Protection order women			Shelter women						Protection order received women			Protection order not received women						Shelter stay <21 days			Shelter stay 21+ days
	n	M	SD	n	M	SD	F	p	η²	n	M	SD	n	M	SD	F	p	η²	n	M	SD	n	M	SD	F	p	η²
Safety behaviors	150	3.58	1.62	150	3.32	1.72	1.92	.167	.006	86	2.90	1.56	64	3.23	1.43	1.78	.185	.008	74	3.19	1.78	76	3.44	1.67	0.74	.390	.005
Self-efficacy	150	30.78	5.71	150	31.19	6.51	0.33	.566	.001	86	31.21	6.05	64	30.02	5.19	1.42	.287	.008	74	30.26	7.28	76	32.09	5.57	3.02	.085	.020
Marginalization	150	12.72	5.16	150	14.03	5.58	4.48	.035	.015	86	12.80	4.86	64	12.61	5.58	0.05	.822	.002	74	14.00	6.05	76	14.07	5.13	0.01	.943	.000
Threats of abuse	150	41.27	12.42	150	42.32	14.19	0.47	.494	.002	86	42.64	13.02	64	39.42	11.41	2.49	.117	.017	74	42.28	14.54	76	42.36	13.92	0.00	.976	.000
Physical abuse	150	34.83	12.71	150	38.20	14.80	4.47	.035	.015	86	36.47	13.05	64	32.64	12.00	3.37	.068	.022	74	37.68	15.34	76	38.71	14.35	0.18	.670	.001
Sexual abuse	150	7.81	3.36	145	8.85	3.84	6.07	.014	.020	86	8.05	3.56	64	7.5	3.08	0.97	.327	.007	72	8.72	3.88	73	8.97	3.83	0.15	.696	.001
Danger	150	14.87	7.22	150	15.93	7.74	1.51	.221	.005	86	15.10	7.13	64	14.56	7.39	0.21	.651	.001	74	15.66	8.02	76	16.20	7.49	0.18	.673	.001
PTSD	150	5.04	1.85	150	5.22	1.81	0.73	.395	.002	86	4.95	1.91	64	5.16	1.78	0.44	.509	.003	74	5.16	1.92	76	5.28	1.71	0.15	.701	.001
BSI Global	150	25.27	16.71	150	28.01	17.09	1.98	.160	.007	86	25.33	17.20	64	25.19	16.17	0.00	.960	.000	74	28.51	18.62	76	27.53	15.56	0.12	.725	.001
BSI Anxiety	150	11.01	7.07	150	10.45	7.13	0.46	.500	.002	86	10.94	7.18	64	11.09	6.98	0.02	.897	.000	74	10.49	7.65	76	10.42	6.63	0.00	.955	.000
BSI Somatization	150	5.78	5.75	150	6.93	6.13	2.83	.094	.009	86	6.30	6.23	64	5.08	4.98	1.67	.198	.011	74	7.14	6.22	76	6.74	6.06	0.16	.692	.001
BSI Depression	150	8.48	6.32	150	10.63	6.79	8.03	.005	.026	86	8.08	6.15	64	9.02	6.56	0.80	.372	.005	74	10.89	7.28	76	10.34	6.32	0.22	.639	.001
Social supports	150	2.81	0.55	150	2.21	1.05	38.32	<.001	.114	86	2.85	0.50	64	2.77	0.61	0.85	.360	.006	74	2.12	1.15	76	2.30	0.95	1.11	.294	.007
Global social support	147	68.05	13.66	134	54.98	19.69	42.40	<.001	.132	85	67.96	13.50	62	68.16	14.00	0.01	.932	.000	62	56.61	19.05	72	53.57	20.25	0.80	.374	.006

Note. Means in boldface are significantly higher than the comparison group, p < .05. PTSD = post-traumatic stress disorder; BSI = Brief Symptom Inventory.

There was also a significant relationship between group and number of social supports, F (1, 299) = 38.32, p < .001, η² = .114. Women in the protection order group had a higher number of total social supports compared with those in the shelter group. Last, there was a significant relationship between group and global social support, F (1, 280) = 42.40, p < .001, η² = .132. Women in the protection order group had a higher social support score compared with women in the shelter group. There were no other significant relationships between the outcome measures (e.g., agency use, agency helpfulness, safety behaviors, self-efficacy, mental health, threats, risk for murder, PTSD symptoms, BSI Total Score, and BSI Somatization) and group.

Differences in Receipt or Non-Receipt of a Protection Order and Length of Shelter Stay

To test for differences within group by receipt or non-receipt of a protection order and stay at a shelter of less than or more than 21 days, one-way ANOVAs were completed and are presented in Table 4 for protection order and shelter women, respectively. No significant differences emerged between women qualifying and receiving compared with women not receiving the protection order. In addition, no statistically significant differences exist between women staying at a shelter for less than 21 days and women staying longer than 21 days.

Taken together, these findings reveal that the 300 women in this sample experienced similar agency use, helpfulness and difficulty, safety behaviors, self-efficacy, threats, physical and sexual abuse, danger for murder, PTSD, depression and anxiety symptoms, and levels of social support, regardless of days at a shelter, and whether or not they received a protection order. We identified no significant differentiating characteristics with which to forecast women who were going to receive the protection order compared with women who were not recipients, or women staying at a shelter for less than or more than 21 days.

Two marginal outcomes merit further thought. A trend toward significance was noted for higher physical abuse reported among women who received the protection order and higher self-efficacy among women staying at the shelter for longer than the median of 21 days.

Discussion

Abused women with children who enter a shelter for the first time report major demographic differences in terms of education and economic sustainability. Shelter women are much less likely to have completed high school or college, considerably less likely to be employed, and, if employed, they work fewer hours and earn appreciably lesser money compared with women qualifying for a protection order. Shelter women report greater difficulty in accessing needed community agencies, higher marginalization, more frequent and severe physical and sexual abuse, and higher levels of depression. Compared with women qualifying for a protection order for the first time, women entering a shelter for the first time identified fewer persons offering social support and an appreciably lower social support score. In sum, women entering shelters for the first time report less social support, more difficulty accessing community resources, and in general have fewer resources of education, employment, and income than women qualifying for a protection order for the first time.

When comparing abused women by receipt or non-receipt of a protection order, no significant differences emerged with the exception of a tendency toward a significant finding (p =.06) regarding more physical abuse reported by women who received the protection order. Similarly, comparisons across length of stay at a safe shelter yielded no significant differences with the exception of a tendency toward a significant finding (p = .08) noted for more self-efficacy reported by women who stayed at the shelter longer than the median of 21 days. Given that this is based on baseline data from a 7-year prospective study, the lack of statistical significance will actually be of benefit in further longitudinal analyses as it suggests that all women in this sample are functioning at statistically similar levels; therefore, any differences within the group of shelter women or protection order women that begin to emerge over the course of the 7-year study will more likely be the result of the intervention (i.e., shelter or justice services) rather than preexisting differences.

The abused women in this study entering shelters for the first time were appreciably less resourced compared with women qualifying for a protection order for the first time. Sheltered women reported lower levels of employment and a lower hourly wage compared with women applying for a protection order. Shelter women experienced significantly more difficulty in obtaining needed community services and far greater abuse, marginalization, depression, and lack of social support compared with women applying for a protection order. However, there was no significant difference in danger levels and potential for lethality among women in safe shelter compared with abused women applying for a protection order and living in the community. Clearly, both groups of women reaching out for services of shelter and protection orders for the first time have significant needs for safety and improved functioning.

Limitations

Our methodology has limitations that may underrepresent victimization and functioning outcomes of abused women with children who access justice services for a protection order or seek safe shelter for the first time. First, we only sampled from shelters designated for abused women; therefore, abused women who access a shelter for homeless persons would have been missed. In like fashion, abused women who seek orders of protection from a private lawyer or legal service other than the county DA’s office would have been missed. Our participants were limited to English and Spanish speakers. Second, participants may have underreported or minimized victimization or functioning status. Third, the questions may miss some episodes of victimization and incorrectly classify others. The researchers acknowledge that recall bias was operant in all questions. The researchers tried to minimize recall bias with the use of calendars. Despite these limitations, the researchers feel this study provides the most detailed and comprehensive data available on abused mothers with children who use justice and safe shelter services for the first outcome and their associated safety, abuse, and functioning status.

Program and Policy Implications

Our findings indicate the lack of potential economic self-sufficiency, especially for sheltered women. Most sheltered women were unemployed and reported significant depression and marginalization, which could thwart obtaining and maintaining employment. Depending on budget and staff, shelters tend to focus on safety planning, counseling, and acquisition of community resources (e.g., housing, employment, and food) for safe transition to independent living.

Although literature on programs offered by shelters is scarce, Lyon and associates (2008) completed a comprehensive study of 215 shelters across eight states and reported that the most common services were support groups (97%), crisis counseling (96%), individual counseling (92%), parenting classes (55%), counseling for kids (54%), and child care (50%). Advocacy was offered for housing (95%), civil court (82%), criminal court (81%), health care (81%), and Temporary Aid to Needy Families (TANF). There was no mention of economic skill building classes or job training. This research indicates a strong need for economic and social network skill building. The marginalization, depression, and low social support among the shelter women place them at high risk of not obtaining or, if obtained, maintaining employment. Without economic sufficiency, abused women are at high risk of further abuse and are in higher danger for themselves and their children. We found no published reports on economic skill building programs offered in shelters or associated with abused women accessing justice services.

To address the Millennium Development Goals 2015 of gender equity and empowerment of women (United Nations [UN], 2009), economic solvency of abused women is essential to stop the abuse and enable the women to move forward toward a non-violent future. Research validates the connection of poverty, marginalization, and low education to increased risk of violence (UN, 2006). International summits forward the benefits of economic interventions such as microcredit and associated improvements in women’s well-being and improved mental health (Microcredit Summit Campaign, 2011).

This research found abused women using a shelter for the first time to be significantly economically depressed compared with abused women accessing justice services through a protection order for the first time. Shelters provide a window of opportunity for abused women to be offered safe housing and resource development. Programs of economic skill building with community partnerships for employment opportunities hold promise to improve abused women’s economic solvency and thereby promote transition to safety and well-being.

Impressive was the lack of differences between shelter and protection order women regarding threats of abuse, danger for murder, and mental health measures of anxiety, PTSD, and somatization. Both groups are at similar risk of severe danger and associated poor mental health and compromised functioning. Both groups experienced difficulty in accessing community resources. Yet, only the shelter group was in safe housing and offered on-site counseling and advocacy. This research indicates that women applying for a protection order, whether or not the order is received, and returning to their residence in the community need the same intensive and accessible safety planning, advocacy, and counseling offered to sheltered women. Community justice centers (Townsend, Hunt, & Rhodes, 2000) and similar one-stop centers that use a collaborative agency participatory model to aggregate services for abused women hold promise for interrupting violence against women and preventing further abuse.

In conclusion, abused women accessing shelters or justice services of a protection order for the first time are in equally high danger of further violence and report high levels of mental health disorders; however, sheltered women are significantly more marginalized, depressed, and economically challenged. Immediate resources for mental health, especially symptoms of depression, are indicated for first-time users of a shelter. Attention to economic skill building as well as essential safety, advocacy, and guided referral at point of first contact, whether at a shelter or through justice services, are evidenced by the results of this study.

Footnotes

Acknowledgements

We acknowledge the 300 women and children who allowed us to record their pain and recovery and who took emotional risks each time we met. As one woman said, “I want to talk but it hurts to remember.” We thank each woman who chose to remember and dedicate the findings of this research to their courage and determination.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The Houston Endowment in Houston, TX funded the research of this report.

Author Biographies

Judith McFarlane is the Parry Chair in health promotion and disease prevention at Texas Woman’s University where she conducts research on the health effects of violence against women and children and the effectiveness of interventions to prevent further violence. In 2010, she was funded with US$2.6 million by the Houston Endowment to complete a 7-year study on abused women with children who use shelters or justice services for the first time. The health and functioning of the women and children will be described to inform global policy and practice standards for the care of abused women and their children.

John Maddoux is a statistical analyst with the Office of Research and Sponsored Programs at Texas Woman’s University in Denton, Texas.

Angeles Nava is a bi-lingual grant project manager with the 7-year study on abused women with children who use shelters or justice services for the first time and was responsible for logistic management of the study, data retrieval, analysis, synthesis, and dissemination.

Heidi Gilroy is a bi-lingual grant project manager with the 7-year study on abused women with children who use shelters or justice services for the first time and was responsible for logistic management of the study, data retrieval, analysis, synthesis, and dissemination.

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