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A Process Analysis of
Maryland Abuse
Intervention ProgramsChristopher M. Murphy
University of Maryland, Baltimore County
Tara N. Richards
University of Baltimore
Background
Brief History of Abuse Intervention Programs
Collaborative outgrowth of the battered
women’s movement in late 1970’s
Early programs – consciousness raising men’s
groups; voluntary participants
1980’s and 90’s – rapid expansion due to
changes in policing and prosecution (court-
mandated participants)
Background
1990’s – 2000’s
Development of various intervention models
Outcome research showed small effects,
but with many study limitations
BackgroundUnique History in Maryland
Integration with comprehensive domestic violence agencies
Maryland Certification Guidelines (1996)
Goal to develop research-based standards
With recent tracking of family violence convictions, the Governor’s Office of Crime Control and Prevention requested a study of AIP program effectiveness
Before being able to evaluate whether Maryland AIPs are effective, we wanted to better understand program practices
Project Framework
Process evaluation identifies the conceptual
model(s) of influence and change; key
features of program design; program
implementation; and relevant challenges
Can identify areas for program / practice
enhancement
Provides a foundation for subsequent
evaluation of program effects and impact
Project Objectives
1. To develop logic models of Maryland AIPs
by
a) describing the interventions used
b) identifying change targets that
practitioners believe contribute to long-term
cessation of partner violence
Project Objectives
2. To identify promising practices used by Maryland AIPs by:
a) Uncovering staff perspectives on program elements and practices that are important and effective in ending IPV
b) Conducting a systematic analysis of common and unique AIP program practices and comparing them to available research on behavior change and offender rehabilitation
Project Objectives
3) To identify challenges and barriers to effective
practice by:
a) Uncovering program staff perspectives on the
challenges they face in conducting this work
b) Elucidating the working relationships of Maryland
AIPs with local legal systems, referral sources, and
service providers
Project Objectives
4) To identify ways in which the Maryland AIP
Guidelines can facilitate and promote best practices
by:
a) Identifying program staff awareness of the Guideline
b) Uncovering program staff perspectives on helpful
and facilitative aspects of the Guidelines; and
c) Uncovering program staff perspectives on the
challenges posed by compliance with the Guidelines
and suggested changes
Key Topics Examined
AIP’s …
(1) philosophies and goals
(2) processes and content
(3) relationships with referral and monitoring
organizations
(4) familiarity and compliance with state guidelines
Participating Programs
All 32 Certified Maryland AIPs were invited to
participate
20 programs (63% of those invited) volunteered and
enrolled
Participating programs serve 19 (of the 24) counties
in Maryland
Methods
Reviewed program materials submitted with their
last self-certification application
Conducted 1-hour structured telephone interviews
with 38 AIP directors and staff
Reviewed 5 de-identified case files for each
program
Findings: Program Models
All programs use group as the primary modality
Very few programs adhere strictly to one specific model; most use an integrative approach
The most commonly endorsed approaches (% of interview respondents who mentioned it) were:
Duluth / power and control (34%)
Motivational / Stages of change (18%)
Cognitive – behavioral (13%)
STOP (11%)
Emerge (11%)
Findings: Convergent Perspectives
Providers agree that the cessation of violence and other forms of abuse is the main objective
Many providers articulated the importance of:
strategies to address resistance, reduce minimization and blaming, and enhance accountability and change motivation
collaborative relationships with AIP participants
positive group interactions (including role modeling) to promote change
Findings: Convergent Perspectives
Many providers indicated that they provide
interventions or education to help participants:
identify and understand different forms of abuse
(emotional / psychological abuse; expressions of power
and control
take responsibility for one’s abusive actions
understand and accept the effects of abuse on others
recognize and manage personal triggers and high-risk
situations
Findings: Divergent Perspectives
Providers expressed divergent perspectives (and/or experience conflicts in their practice)on ways to achieve those goals, including:
Social change / consciousness raising versus therapeutic approaches
The value of structured program materials
Some use little or no materials or home / practice assignments
Some very enthusiastic about their structured program content
Major Findings: Divergent Perspectives
Differences in emphasis on key change targets
Commonly mentioned were:
Learning about healthy relationships
Communication / relationship skills
Active listening; assertiveness; empathy
Ability to identify, express, and regulate emotions
Findings: Divergent Perspectives
Less commonly mentioned change strategies:
Gender role attitudes and conceptions of masculinity
Identifying and managing stress
Decision-making and problem solving
Family origins of violence (e.g., witnessed abuse)
Parenting / co-parenting
Findings: Case-Specific Needs
Although most providers assess client needs, most have significant limitations in their capacity to address individual problems that may influence response to AIP
substance use disorders
serious mental health concerns (e.g., psychotic and mood disorders)
traumatic stress reactions
life complications such as unemployment and housing instability
Findings: Coordination and Evaluation
AIP coordination with referring sources is highly
variable
Some have exemplary monitoring of referrals and
compliance
Others have challenges in this area
Providers expressed the need for more evaluation of
program effects
Relatively little current capacity for evaluation
Barriers and Challenges
Interviews identified challenges with:
Funding (84%)
Reliance on client fees when many are poor or unemployed
Outdated or insufficient program materials
Staffing (55%)
Reliance on part-time staff or limited time commitment from full-time staff
Limited training and credentialing options
Inadequate space (18%)
Reliance on other organizations for group space
Key Conclusions
AIPs provide crucial opportunities to disrupt cycles of violence, reduce trauma, and enhance safety for survivors and communities
Maryland AIPs could benefit from greater access to training, enhanced processes to disseminate promising and best practices, and development, testing, and sharing of intervention resources
The level of financial and infrastructure support for Maryland AIPs is woefully inadequate to promote full implementation of best practices
An Examination of
Maryland Abuser
Intervention Programs’
(AIPs) Impact on Domestic
Violence RecidivismTara N. Richards
University of Baltimore
Christopher M. Murphy
University of Maryland, Baltimore County
Data collection assistance from Adam LaMotte, Alisha Sillaman, Ana Maldano, Katherine Kafonek, and Stephanie Dolamore
Purpose
Provide systematic evaluation of MD AIP
participation and completion
Examine impact of participation on
recidivism
Participating Programs
Agencies who participated in the Process
Analysis were located in “DV tag
counties” were invited to participate
Proposed subset of 3-5 programs
7 programs volunteered, all 7 were
enrolled
Methods
AIP data collection for cohort of 2014-2015 clients
Completed during summer 2017 (n=1692)
Recidivism data collection
Proposed using data from MSAC
Currently collecting data from MD Case search
MD AIP Outcomes (n=1692)
44.1% Successful discharge (Completers)
23.6% Failed to appear after intake (No-Shows)
24.1% Unsuccessful discharge (Dropouts)
5.9% Deemed inappropriate for AIP
1.7% Client sought treatment elsewhere
0.4% Incarcerated
0.1% Deceased
Working sample for this analysis includes completers, dropouts, and no-shows (n=1,553)
MD AIP Participant Sample: Demographic
Variables (n=1,553)
Variables M/% SD Minimum Maximum
Age at Intake 34.81 10.76 18 86
Gender
Male
Female
89.8%
10.2%
Race
Non-White
White
78.3%
21.7%
HS Diploma/GED 68.5%
Employed at Intake 48.3%
Married to Victim 16.7%
Children with Victim Partner 48.5%
Living with Victim Partner at time of
IPV incident
38.8%
Living with Victim Partner at Intake 26.8%
MD AIP Participant Sample: Psychosocial
Variables (n=1,553)
Variables M/%
On Probation 73.9%
Past Substance Abuse 75.4%
Substance Abuse at Time of IPV Incident 31.7%
Current Substance Abuse at Intake 41.6%
Past or Current Mental Health Problem 30.8%
Past History of Homicidal Ideation,
Threats, or Attempts
9.3%
Past History of Suicide Attempts 4.6%
Past History of Suicidal Ideation 15.9%
Exposure to IPV in Family of Origin 22.6%
MD AIP Participant Sample: Treatment-
Related Variables (n=1,553)
Variables M/% SD Minimum Maximum
Group Counseling Only 86.7%
Individual Counseling Only 2.4%
Group and Individual Counseling 10.9%
Total Number of IPV Tx Sessions
Attended
14.19 12.08 0 76
Treatment Completers 48.0%
Treatment Dropouts 26.2%
Treatment No-Shows 25.8%
Bivariate Differences in Treatment Completion
(n=1,553)Variables Completers
(C)
Dropouts
(DO)
No-Shows
(NS)
F-test Tukey’s b
Post Hoc
TestsAge at Intake 35.85 34.58 33.08 8.69*** C>NS
Male 0.84 0.94 0.96 25.37*** NS>C, DO
Non-White 0.73 0.80 0.86 13.55*** All sig.
HS Diploma/GED 0.74 0.65 0.61 10.12*** C>DO, NS
Employed at Intake 0.58 0.42 0.34 32.45*** All sig.
Children with Victim
Partner
0.46 0.47 0.62 8.57*** NS>C, DO
On Probation 0.74 0.79 0.68 4.98** C, DO>NS
Past Substance Abuse 0.72 0.81 0.77 5.26** DO>C
Substance Abuse at
Time of IPV Incident
0.28 0.36 0.39 5.39** NS>C
Current Substance
Abuse
0.38 0.48 0.43 5.11** DO>C
Past or Current Mental
Health Problem
0.26 0.35 0.44 12.23*** All sig.
Note. The reference category for the dependent variable is “Completers.” *p<.05. **p<.01. ***p<.001
Multinomial Regression Predicting Batterer
Intervention Treatment Attrition (n=1,553)Variables No-Shows Dropouts
B SE OR (95% CI) B SE OR (95% CI)
Age at Intake -0.02 0.01 0.99 (0.97-1.01) -0.01 0.01 0.99 (0.97-1.00)
Male 1.29*** 0.39 3.63 (1.70-7.80) 1.45*** 0.30 4.26 (2.45-8.01)
Non-White -0.04 0.16 0.96 (0.69-1.30) -0.07 0.12 0.94 (0.74-1.17)
HS Diploma/GED -0.58** 0.17 0.56 (0.40-0.77) -0.34** 0.12 0.71 (0.56-0.89)
Employed at
Intake-0.88** 0.24 0.41 (0.26-0.66) -0.41* 0.16 0.67 (0.50-0.93)
Children with
Victim Partner-0.02 0.22 0.98 (0.64-1.49) -0.10 0.16 0.90 (0.66-1.21)
On Probation -0.69** 0.25 0.50 (0.31-0.83) -0.09 0.19 0.92 (0.63-1.33)
Current
Substance Abuse-0.09 0.22 0.91 (0.51-1.40) 0.32* 0.16 1.38 (0.77-1.59)
Past or Current
Mental Health
Problem
0.60** 0.23 1.81 (1.18-2.90) 0.32 0.17 1.38 (0.98-1.93)
Note. The reference category for the dependent variable is “Completers.” *p<.05. **p<.01. ***p<.001
Implications: Education and Employment
Findings highlight the complex needs of AIP clients.
Less than two-thirds of the total sample had a high school
diploma/GED and less than half were employed.
Like many AIPs nationwide, MD AIPs operate on a fee-for-service
basis so clients must pay for treatment.
For unemployed or underemployed clients, payment may be a barrier
to treatment engagement or retention.
Education and employment indicators must be viewed as
significant “red flags” for treatment engagement.
AIP clients would likely benefit from employment assistance and
connection to GED preparation courses and/or exams.
Implications: Probation Supervision
The multivariate findings clarified the relationship between
probation and treatment attrition: treatment no-shows, but not
treatment drop-outs, were significantly less likely to be on probation
relative to treatment completers once we controlled for other
variables.
Probation agents may serve as important collaborators with BIP
providers regarding offender supervision and accountability at
referral/intake.
Probation supervision was not a protective factor against early
treatment disengagement (i.e., dropout).
Review probation contract language: Are AIP clients under
probation supervision required to “engage in” OR “complete” AIP.
Implications: Mental Health and Substance Use
Treatment no-shows were significantly more likely to report a mental
health problem than completers.
Dropouts were significantly more likely to report a substance use
problem than completers.
This data did not include individuals whose mental health or substance abuse condition was serious enough for the BIP to decline to treat them.
Findings highlight the need for routine screening for mental health and
substance abuse and intensive case management where possible.
If clients with mental health problems that are not severe enough for the BIP to refer them to other treatment can be engaged early in the BIP, they are no more likely to drop out of treatment than those without a mental health issue.
Prior research suggests that BIPs may successfully impact clients’ substance use problems even if the BIP does not specifically target substance use reduction (Bennett; 2008; Lila, Gracia, & Catala-Minana; 2017).
What’s Next?
Recidivism data collection for treatment sample is almost complete.
Recidivism data collection for control group sample is underway.
May: Recidivism data analysis will be completed.
June: Final report will be developed.
Inclusive of (1) Attrition analysis, (2) Risk-profiles for AIP participants who
reoffend, and (3)Comparative analysis of reoffending for treatment
group (AIP clients) versus control group (DV tag offender not in AIP).
