A rural shelter in Ontario adapting to address the changing needs of women who have experienced intimate partner violence: A qualitative case study

Introduction: Intimate partner violence is a significant public health problem, with shelters offering the predominant communitybased solution. Shelters in Canada are mandated to provide a safe place, protection planning, advocacy and counseling among other services. Recently it has been noted the role of the shelter was shifting from an inpatient to outpatient model with a focus on increased integration of health and social services. This changing role of the shelter is amplified within the rural context where resources and cultural norms may be limited or incompatible with help-seeking behaviors. Women\u27s shelters located in rural settings provide services within a specific cultural context that can be at odds with the needs of women who have experienced abuse, because cultural values such as rural pride, lack of anonymity, and lack of services may inhibit access to health and social services. Methods: The purpose of this in-depth qualitative case study was to examine and explore how one rural Canadian women\u27s shelter role was changing and how the shelter was adapting to achieve the changing role. The theoretical framework utilized was a feminist intersectional lens. Qualitative interviews (averaging 60 minutes) were conducted with shelter service providers (n = 6) and women staying in the shelter or utilizing shelter services (n = 4). Throughout semi-structured interviews, data-trustworthy steps were taken including member-checking and paraphrasing to ensure data were an accurate representation of participants\u27 experiences. Inductive content analysis of all interviews and field notes was conducted independently by two researchers. Results: Analysis revealed the shelter\u27s role was changing to include filling gaps, case management, and system navigation. To achieve the changing role, relationship building, community mobilization (both education and empowerment), and redesigning delivery were implemented as adaptation strategies. Together both the changing role of the shelter and the adaptation strategies being implemented were found to be working toward a larger goal of transformation of cultural and structural norms related to violence against women. Conclusions: This study uniquely identified the specific changes to the role of one rural Canadian shelter and the adaptations strategies utilized to adapt to the changing needs of women. The changing role of the shelter and the adaptation strategies being utilized have significant implications for the health of women given the increased use of healthcare services for women who have experienced violence. Specifically, the changing role of the shelter has the potential to decrease healthcare service use while increasing the potential fit of services. Further research is required to assess the impact of the changing role of the shelter on the healthcare needs and outcomes for women who have experienced intimate partner violence

Criticai discourse analysis of policies impacting the intersection of health and experiences of intimate partner violence for rural women in Ontario, Canada

Introduction: Intimate partner violence (IPV) impacts approximately one quarter of Canadian women, and services provided to support women are heavily influenced by policy. Policy sets the stage and tone for action in all sectors. To date, there have been no critical discourse analyses examining how provincial, hospital, and women\u27s shelter policies intersect and impact women in rural communities. Methods: A critical discourse analysis using a case study of one rural community in south-western Ontario was undertaken by a multisectoral team of researchers using a critical, feminist, intersectional lens. The selected policies were (1) Domestic Violence Action Plan for Ontario (ODVAP), (2) the rural women\u27s shelter policy, and (3) the hospital policy. Results: The internal analysis of the policies revealed that ODVAP Rural and Remote Health rrh. org. au focused on societal solutions to violence requiring cross-sectoral cooperation with a focus on marginalized populations, whereas the rural shelter policy focused on creating a philosophical orientation to underpin their work with clients. There was no formal hospital policy related to the provision of services for women who have experienced violence. The policies revealed a disconnect between the stated goals and the specifics concerning how the policies would come together to achieve these goals. Obstacles such as having no clear link for how ODVAP and the shelter policy would work together, idealization of training but a lack of specificity on what training would be useful, and the requirement of affirmative action on the part of women to engage with services functioned as a means to maintain the status quo, that is, working in a siloed approach to care. Conclusions: Integrative systems are important for women who have experienced IPV given the wide range of health, social, and economic consequences of violence. Policy alignment is important for women who have experienced or are experiencing IPV, particularly in rural contexts where services are fraught with additional barriers

Examining the impact of trauma-informed cognitive behavioral therapy on perinatal mental health outcomes among survivors of intimate partner violence (the PATH study): Protocol for a feasibility study

Background: Intimate partner violence (IPV) is a pervasive public health problem, impacting the health and quality of life of survivors worldwide. The trauma of IPV is associated with a high incidence of mental illness, namely depressive and anxiety disorders, and posttraumatic stress disorder (PTSD). Moreover, literature endorses cognitive behavioral therapy (CBT) interventions as a gold standard for those with symptomatology consistent with anxiety disorders, mood disorders, and PTSD. However, efficacy has not been evaluated among a population of pregnant survivors of IPV. Objective: We present the protocol that will be used to explore the efficacy of trauma-informed cognitive behavioral therapy on maternal and child health outcomes for pregnant women with PTSD, depression, or anxiety symptomatology resulting from IPV. A secondary aim will be to test the validity and feasibility of study methodology to support the successful implementation of a full-scale randomized controlled trial. Methods: The Promoting Attachment Through Healing (PATH) study will use a mixed-methods approach grounded in an intersectional feminist framework to explore the effectiveness of trauma-informed CBT for pregnant survivors of IPV. Study participants will be recruited through the hospital-based Perinatal Mental Health Clinic (London, Ontario, Canada). A feasibility sample of 20 pregnant women (cohort 1) will be selected to engage in an eight-session antenatal CBT intervention facilitated by the program\u27s perinatal clinical nurse specialist, with evaluation at baseline, at two months postpartum (intervention and online questionnaire), and at six and twelve months postpartum (online questionnaire only). Concurrently, we will conduct a retrospective audit of 100 medical charts (cohort 2; 50 charts of perinatal women who received CBT and 50 charts of women who did not receive perinatal CBT) from the past five years. The efficacy of the intervention will be based on a reduction of mental illness symptomatology, improved maternal-infant attachment, maternal coping, and maternal quality of life. Additionally, the feasibility of the protocol and acceptability of the intervention from the women\u27s perspective will be examined. Inductive content analysis of all qualitative data will be used to determine common themes. Additionally, descriptive statistics, including measures of central tendency and dispersion, will be computed for all continuous variables. Alternatively, frequency tables will be constructed for all categorical variables. Results: The work reported here is in the proposal phase. Once the protocol is implemented, we will report the results in a follow-up paper. Participant recruitment for cohort 1 has started and we have finished data collection for cohort 2. It is anticipated that the results will be available by the end of 2018. Conclusions: Findings will assess the acceptability of the study methodology and protocol for a full-scale randomized controlled trial. Furthermore, if CBT is proven effective for pregnant survivors of IPV, this intervention could be readily adopted by health care and social support services, thereby contributing to an improved standard of care for this unique population

Experiences of At-Risk Women in Accessing Breastfeeding Social Support During the Covid-19 Pandemic

Background: With strict public health measures implemented in March 2020 due to the COVID-19 pandemic, many breastfeeding parents, who are within an at-risk population, have experienced limited formal and/or informal breastfeeding social support. In the Canadian context, the experiences of these women is unknown. Research Aim: To explore the experiences of at-risk postpartum breastfeeding women in accessing formal and informal breastfeeding social support during the COVID-19 pandemic. Methods: This was a prospective, longitudinal interpretive description study using mixed methods. Data were gathered using an online survey and one 52–112-min semi-structured interview at 12-weeks postpartum. At-risk breastfeeding participants were those who lack social support and had at least one of the following: age \u3c 25 years; experiencing or had experienced intimate partner violence; or of low income. We sought participants’ experiences of accessing breastfeeding social support during the first few months of the COVID-19 pandemic/lockdown. Seven participants completed the survey and the interview. Results: Participants identified that the COVID-19 pandemic created barriers to accessing formal and informal breastfeeding social support, which stemmed from public health restrictions and difficulties communicating online with families and healthcare providers. Additionally, participants identified that the COVID-19 pandemic/lockdowns facilitated feelings of connectedness, protection, and resiliency. Conclusion: We provide preliminary insight into the experiences of trying to access breastfeeding social support during the COVID-19 pandemic. Future researchers should seek to prioritize improved communication and resources in supporting breastfeeding during COVID-19 and future pandemics/lockdowns

Changes in care-a systematic scoping review of transitions for children with medical complexities

Background: Children with medical complexity (CMC) and their parents are affected physically and mentally during transitions in care. Coordinated models of care show promise in improving health outcomes. Objective: The purpose of this scoping review was to examine research related to CMC and their parents and transitions in care. The aim was 3-fold: (1) to examine the extent, range, and nature of research activity related to the impact of transitions on physical and mental health for CMC and their parents; (2) to summarize and disseminate research findings for key knowledge users; and (3) to identify research gaps in the existing literature to inform future studies. Methods: Twenty-three sources were identified through database searches and five articles met the inclusion criteria of CMC (multi-organ involvement or technology-dependent) (or parents of CMC) transitioning from hospital to alternate levels of care where outcome measures were physical or mental health-related. Results: Numerical analysis revealed substantial variation in methodological approaches and outcome measures. Content analysis revealed two themes for parents of CMC during this transition: (1) emotional distress, and (2) high expectations; and three themes for CMC: (1) improved health, (2) changes in emotion, and (3) disrupted relationships. Conclusion: The findings from this scoping review reveal for parents, transitions in care are fraught with emotional distress and high expectations; and for CMC there are improvements in quality of life and emotional health post-hospital to home transitions when collaborative models of care are available. This review serves as an early attempt to summarize the literature and demonstrate a need for further research

Impacts of COVID-19 on the Coping Behaviours of Canadian Women Experiencing Intimate Partner Violence

Background: Strict public health measures central to slowing the spread of COVID-19 have, unintentionally, exacerbated risks for women experiencing intimate partner violence (IPV) while impeding their usual coping strategies. The goal of this study was to understand how coping was influenced by COVID-19 for women who have experienced IPV and identify changes in coping strategies and gaps that need to be addressed to support coping. Methods: A qualitatively driven, sequential, cross-sectional design, where quantitative data informed and was embedded within qualitative data collection, was used to explore the experiences of IPV (CAS-R-SF scale) and coping (Brief-COPE scale) specific to IPV of 95 Canadian women. A subset of 19 women was invited to complete an interview exploring coping strategies identified within the survey to contextualize and validate these findings. Results: Survey data subjected to quantitative content analysis identified ten themes, all of which were explored in semi-structured interviews. Thematic interview findings included (1) influence of COVID-19 on coping, (2) coping during COVID-19, and (3) needed coping strategies. Conclusion: COVID-19 had important impacts on the experiences and coping strategies of women who experience IPV. To better support this population in pandemic circumstances, in-person services should be prioritized with an emphasis on accessible and empathetic care. Public health measures in response to COVID-19, and the eventuality of future pandemics, should aim to be gender- and violence-informed

Quark masses in Higgs production with a jet veto

We study the impact of finite mass effects due to top and bottom loops in the jet-veto distribution for Higgs production. We discuss the appearance of non-factorizing logarithms in the region p t,veto ≳ m b . We study their numerical impact and argue that these terms can be treated as a finite remainder. We therefore detail our prescription for resumming the jet-vetoed cross section and for assessing its uncertainty in the presence of finite mass effects. Resummation for the jet-veto, including mass effects, has been implemented in the public code JetVHeto

Heavy-quark mass effects in Higgs boson production at the LHC

We study the impact of heavy-quark masses in Higgs boson production through gluon fusion at the LHC. We extend previous computations of the fully differential cross section and of the transverse momentum spectrum of the Higgs boson by taking into account the finite top- and bottom-quark masses up to O(alpha_S^3). We also discuss the issues arising when the heavy-quark mass is much smaller than the Higgs mass. Our results are implemented in updated versions of the HNNLO and HRes numerical programs.Comment: Minor modifications, results unchanged. Discussion on uncertainties added. Version published on JHE

Parental attributions of control for child behaviour and their relation to discipline practices in parents of children with and without developmental delays

Children with developmental delays (DD) are at risk for developing behavior problems. Research suggests that parents’ causal attributions for child behavior are related to parenting. This study investigated this association in parents of children with DD compared to parents of typically developing (TD) children. It specifically focused on attributions of child control by separating these from attributions of responsibility, blame and intent, and from attributions of parent control and responsibility. Fifty-one parents of children with DD and 69 parents of TD children completed two questionnaires. The Written Analogue Questionnaire measured causal attributions. The Parenting Scale measured dysfunctional discipline practices. Parents of children with DD viewed the child’s role in problematic behavior more positively while also viewing misbehavior as more fixed than parents of TD children. Parents of TD children who viewed their child as more in control over misbehavior used less dysfunctional discipline, but this association was not found for parents of children with DD. The results advance understanding of how parents perceive behavior problems in children with DD and the important role these perceptions play in parental behavior management strategies. More importantly, these perceptions relate to discipline practices differently for parents of children with DD compared to parents of TD children, highlighting that parent interventions should be adapted to the specific needs of parents of children with DD