The author(s) shown below used Federal funds provided by the U.S. 

Department of Justice and prepared the following final report: 

Document Title: Increasing Victim Safety and System 

Accountability: Evaluating a Collaborative 

Intervention Between Health Care and Criminal 

Justice, Executive Summary 

Author(s): Texas Women's University

Document No.: 201944 

Date Received: September 2003 

Award Number: 2000-WT-VX-0020

This report has not been published by the U.S. Department of Justice. 

To provide better customer service, NCJRS has made this Federallyfunded grant final report available electronically in addition to 

traditional paper copies.

 

Opinions or points of view expressed are those 

of the author(s) and do not necessarily reflect 

the official position or policies of the U.S. 

Department of Justice.
Increasing Victim Safety and System Accountability: 

Evaluating a Collaborative Intervention Between Health Care and Criminal Justice 

EXECUTIVE SUMMARY 

“Sam beat me during each pregnancy. He threw away the vitamins, tore up the 

prescriptions and would not let me return to the clinic. I was too scared to go to the 

emergency room. I thought the nurse or doctor would ask why I stayed. I thought the 

violence would end when Sam got a better job. When he poinied a gun at me during the 

last pregnancy, I went to my sister’s house and applied for a protection 0rde.r. ’’ 

“Juan made me and the two youngest children stand on the corner and beg each day 

while he sat in a car across the street. At night we were locked in a room and made to 

sleep on a cement floor. He kept a machete at his side and I was reminded duily that he 

would kill me and the children ifwe tried to leave. When Juan beat me so blidly I 

miscarried the baby, he took me to the emergency room and told me he would never get 

my papers ifI reported the abuse. Two years later, when a w,indow was broken during a 

violent episode, neighbors called the police, Juan was arrested, and I was advised to 

apply for aprotection order. ’’ 

Research Goals & Obiectives 

Violence against women largely involves intimate partners, such as husbands, boyfriends, 

and dates. An estimated two million women are physically or sexually assaulted each year in the 

U.S. Most women surveyed who report rape or physical assault since the age of 18, identify the 

perpetrator as a current or former spouse, cohabiting partner, or date. Frequently, the abuse is 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
2 

severe, may occur during pregnancy, and can result in long-term health problems. 

Approximately 3,000 U.S. women are murdered each year by an intimate partner. Stopping 

abuse and increasing women’s safety are primary goals for our health and justice systems. 

Abused women often turn to the justice system for protection, seeking a protection order 

against the abuser. Victims prefer protection orders rather filing assault charges. Several studies 

demonstrate that intimate partner violence decreases after a woman receives a protection order. 

The justice system seeks to increase efficiency in issuing protection orders, and to maximize the 

number of protection orders received by applicants. 

This research sought to increase victim safety, and simultaneously increase the efficiency 

of the protection order process by offering an advocacy-case management intervention. The 

intervention was performed by registered nurses as part of a collaborative partnership between 

justice and health care. The intervention was offered to 75 women qualifying for a protection 

order against a sexual intimate. An additional 75 similar women were followed as a control 

group. All 150 women were recruited into the study and interviewed over a 28 day period during 

January and February 2001 by a team of six investigators. All participants signed informed 

consent. 

Research Design & Methodolow 

A two group experimental design with an intervention, using random assignment to 

control group (usual district attorney procedures) or experimental group (Advocacy Case 

Management Intervention) was used. Interviews were repeated at three, six, twelve, and 18 

months. The research setting is a special family violence unit of a large urban District Attorney’s 

Office that serves an ethnically diverse population of three million citizens. The study subjects 

are women that qualified for a civil protection order against a sexual intimate. All female 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
3 

applicants that qualified for a protection order against a sexual intimate, and who spoke English 

or Spanish, were invited into the study by one of the six investigators until 150 women were 

entered into the study. The women are: 33% African American, 27%’white, and 34% Hispanic. 

One woman committed suicide six weeks into the study. All remaining 149 women completed 

the three, six, 12 and 18 month follow-up interviews. Each follow-up interview used several 

instruments to measure safety-seeking behaviors, as well as the type and severity of violence, 

and health status. 

An Advocacv-Case Management Intervention 

To accomplish the project objectives of: 1) increasing victim’s safety and 2) increasing 

system processing of protection orders, an advocacy-case management intervention was offered 

to the 75 women randomized to the intervention group. The remaining 75 women received the 

standard services of the district attorney’s office. The advocacy case-management intervention 

has two parts. 

1. Telephone Contacts 

The first part consists of six telephone contacts with the victim. The first phone call 

occurs within 48 to 72 hours of the protection order application by the victim. The victim is recontacted at one, two, three, five and eight weeks thereafter. The focus of each call is on victim 

safety. The advocate reviews 15 safety-seeking actions: 

1. Hiding money 

2. Hiding extra house and car keys 

3. Hiding a bag with extra clothing 

4. Establishing a secret code with family and friends 

5. Asking neighbors to call the police if violence begins 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
4 

During 

6. Removing weapons 

Having available: 

7. Social security numbers for the woman, perpetrator, &: children 

8. Rent and utility receipts 

9. Birth certificates for the woman and children 

10. An identification or driver’s license 

1 1. Bank account numbers 

12. Insurance policies and numbers (medical, auto, life, house) 

13. A marriage license 

14. Valuable jewelry 

1 5. Important phone numbers 

ach phone call, the advocate offers si ggestio s for adopting each safety beha rior. For 

example, women are given information on making extra keys, obtaining copies of birth 

certificates or a marriage license, and applying for a driver’s license. The importance of 

possessing documents, such as rent and utility receipts, social security numbers, and birth 

certificates, are discussed. Women are offered suggestions on where to hide money and 

important documents, such as in an empty tampon container, with sanitary products, or with a 

trusted friend, neighbor, or relative. The women are coached in how to develop a secret code to 

use with family and friends to signal the need for assistance, as well as identify a neighbor who 

could be asked to call the police if an altercation is heard or seen. If weapons are in the house, 

women are offered strategies for weapon removal and disposal with law enforcement officials. 

The advocate also offers educational information and tailors referral sources to the woman’s 

unique situation. 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
5 

During each of the six planned advocacy phone contacts, the victim is offered a status 

update on any missing information from her protection order application. The advocacy advises 

the woman on securing needed pieces of information, such as divorce or paternity decrees, 

medical records, or certified birth certificates. The advocate supports, encourages, and 

compliments the woman’s efforts toward completion of her protection order file. The telephone 

calls ranged in duration from three minutes to twenty-five minutes, with a mean of nine minutes 

per call. The telephone calls stopped eight weeks after application for the protection order. 

2. Application Status 

The second part of the advocacy case-management intervention is the advocate checking 

the progress of protection orders for women in the intervention group. Appropriate offices are 

called to ascertain if essential papers have been received and how many attempts have been 

made to serve legal papers to the abuser. For example, the advocate would telephone the serving 

precinct to inquire if an officer had served the protection order papers to the abuser. By having a 

person that understands the justice system and the process of filing protection orders make 

telephone calls until the protection order is received, we projected a quicker processing of 

protection orders, as well as more protection orders received by the intervention group women. 

RESEARCH RESULTS & CONCLUSIONS 

0 Victim Safety Increases Quickly for Intervention Women 

Adoption of safety behaviors quickly increased for women in the intervention group. 

Exhibit A graphs the rapid increase in safety-seeking behaviors along with the mean number of 

safety behaviors adopted at each phone call. Within the first 7 days of the intervention period, the 

mean number of safety behaviors performed increased by more than two, from 10 behaviors at 

the time of application for the civil protection order to 12 behaviors at one week. As some of the 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
6 

safety behaviors were not applicable to all women, such as having a marriage license, only the 

percentages of applicable behaviors were tracked. During the first week of the intervention, the 

percentage of applicable safety behaviors practiced increased from 69% to 84%. Many of the 

safety behaviors required great effort and major risk taking. For example, the seemingly simple 

act of making an extra key requires the steps of obtaining the key (many abusers keep house and 

car keys on a ring attached to a belt worn at all times), locating and securing transportation to a 

key duplication site (for several women this meant identifying a trusted person from which to 

request transportation or learning and completing lengthy bus transfers from their homes), and 

returning the key to its original location without the abuser’s knowledge (women reported 

securing and copying the key while the abuser slept), 

Despite these difficulties, the women were eager to share stories of their success, for 

example, telling a neighbor about the abuse and asking the person to phone the police if they 

lower their lutchen window shade (which always remained up). Women devised creative codes 

to use with family and friends to alert them to potential violence (Le,, transposed birth date, 

asking about a deceased relative, requesting a food item to which they had an allergy). Removing 

weapons and hiding a bag with extra clothing can be dangerous. However, more than 70% of the 

intervention women reported adopted these behaviors. Since the average length of the telephone 

intervention calls was 9 minutes and since six calls were made, the time required to complete the 

intervention was 54 minutes (6 calls @ 9min/call=54minutes). Less than one hour of time was 

required to quickly and significantly increase the number of safety behaviors practiced. Not only 

did the women rapidly adopt safety behaviors, but the women continued to practice the safety 

behaviors for eighteen months after the intervention ended. Women in the intervention group 

practiced significantly (pC.01) more safety behaviors at 3 months, 6 months, 12 months, and 18 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
7 

months compared to the control women. In addition, women in the intervention group practiced 

significantly (p<.Ol) more safety behaviors at 3 months, 6 months, 12 months, and 18 months 

compared to the behaviors practiced at the time of the initial interview. In contrast, women in the 

control group 2lso increased their safety behaviors slightly at follow.up interviews but the 

increase was never significant at p<.Ol. 

Number of protection orders received did not increase for intervention group 

The number of protection orders received by the intervention women was not 

significantly higher than women receiving standard protection order processing. Exhibit B 

presents the number of women receiving a protection order by intervention versus control group. 

Some 56% of the intervention women (n=42) received a protection order compared to 52% 

(n=39) of the women in the control group. This difference of three women was not significantly 

higher. The reasons women did not receive a protection order were not significantly different 

between groups. Exactly the same number of women in both groups did not receive a protection 

order due to the inability of the system to serve the perpetrator. Similarly, the same number of 

women in each group dropped the protection order. Although not statistically different, none of 

the women in the intervention group failed to show in court; whereas three women in the control 

group did not receive the protection order due to failure to show in court. The intervention did 

not increase the number of protection orders received. 

0 Processing time for protection orders did not decrease for intervention group 

Exhibit C presents the number of days from application to receipt of the protection order 

for intervention, compared to control, women. There was no significant difference in the number 

of days required to process a protection order for the intervention group women compared to the 

control group women. The mean number of days for receipt of the protection order was 24 days 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
8 

for both groups of women. Similarly, there were no significant differences between the numbers 

of days required for any step in the protection order process. Having an advocate telephone to 

check the status of the protection order made no difference in number of days required to 

complete the process. 

0 Violence decreased & health status improved for all women 

Exhibit D presents the violence and health scores for intervention and control women 

reported at the initial, 3-, 6-, 12-, and 18-month followed interviews. Frequency and severity of 

violence, both threats of abuse and actual physical assault, as well as stalking and risk factors of 

femicide significantly decreased for women in the intervention and control groups over time. 

Similarly, health status and physical functioning significantly improved for both groups of 

women over time. 

IMPLICATIONS FOR VICTIM SAFETY & JUSTICE SYSTEM EFFICIENCY 

VICTIM SAFETY 

Abused women offered a safety intervention at the time of applying for a protection order 

quickly adopt safety behaviors and continued to practice those safety behaviors for eighteen 

months. Abused women that did not receive the intervention did not adopt significantly more 

safety behaviors. The intervention required less than one hour of professional time and was 

totally delivered over the telephone. The effectiveness of the safety intervention is large at three 

months and remains substantial for eighteen months. The average length of time required to offer 

the intervention was only 54 minutes (e.g., six nine-minute phone calls), less than one hour of 

professional time. The low intensity of this intervention makes it feasible to be integrated into a 

variety of justice, health, and social service agencies in both urban and rural settings. 

Additionally, the cost of the intervention is minimal, perhaps as little as $50 to $100 per woman, 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
9 

and the averted trauma and associated suffering and costs potentially enormous. We recommend 

the replication of this intervention with populations of women in rural settings as well as with 

Asian and Native American women. Finally, as the effectiveness of the intervention stabilized at 

six months, supplemental phone calls may be warranted in further testing. 

All women in the study, irrespective of intervention or control group, reported 

significantly lower levels of violence and hgher health functioning at the three, six, twelve and 

1 8-month interviews. Coming into contact with the justice system, whether or not an intervention 

was received, served to decrease violence and increase health functioning. Public documentation 

of the abuse through an order of protection application may well function to give women some 

degree of control in their lives. Definitely an application for an order of protection can 

communicate to an abuser that the woman has taken public action. This finding emphasizes the 

importance of justice system contact with abused women. A decision to contact the justice 

system may indicate to the abuser that official agencies know about the abuse and may act to 

deter any future violence against the woman, especially if the perpetrator fears jail or losing 

prestige in a community. 

JUSTICE SYSTEM EFFICIENCY 

Abused women offered an intervention to assist with their protection order processing, 

received no more protection orders and in no shorter time than the women that received standard 

processing. Twelve percent of the women in both the intervention and control group did not 

receive the protection order because the perpetrator could not be served. The inability to serve 

the perpetrator lies beyond the scope of the intervention tested in this study. However, the major 

reason that both intervention and control women did not receive the protection order was the 

woman choosing to drop the order of protection. 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
10 

More than one-fourth of the women (28%) decided not to complete the protection order 

process and subsequently dropped the protection order against the intimate partner. The drop rate 

was the same for both control and intervention group women. When asked why they dropped the 

protection order, most of the women stated they had returned to live with the abusive partner. 

Leaving an abusive partner and then returning to the abusive partner has been discussed at length 

in the literature as have issues of “attachment” to the abuser. Leaving the abuser is a “process” 

that can take years. Women in this study chose to leave their abusive partners when they applied 

for the protection order and signed an affidavit that domestic violence had occurred and there 

was high risk for further intimate partner violence. When a woman then chooses to drop the 

protection order, the district attorney’s office requests that she return to the office and sign a 

release form that she no longer wants to continue the protection order process. Among the 

women in this study who dropped the protection order, significantly more women were in 

current relationships, whereas protection order recipients considered the perpetrator a former 

partner. Furthermore, at intake and 3 months later, women in current relationships, irrespective 

of subsequent protection order receipt or drop, reported significantly (p<.005) more physical 

assaults compared to women in former relationships. Clearly, relationship status is a significant 

correlate of abused women’s receipt or dropping of a protection order as well as her level of 

assault experienced. We recommend relationship status be assessed by the health and justice 

systems and the implications for protection order receipt discussed with women. We also 

recommend an intervention focused on explaining to women the concept of “attachment” and 

associated danger when a decision is made to return to live with the abuser or continue in the 

relationship. 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
11 

Almost one-quarter of the women (23.8%) who dropped the protection order cited that 

the process of obtaining the protection order was "too much of a hassle," and "inconvenient". In 

order to obtain a protection order, the applicants in this study had to be willing to participate in 

the following process: (a) arrive at DA's office with proper photo identification; (b) complete 

paperwork, interview with caseworker, take photographs, and sign affidavit (this step takes 

approximately 2 to 3 hours); (c) may need to return to DA's office at a later date with additional 

required paperwork and/or witnesses to the violence; (d) wait approximately 6 weeks for court 

date; and (e) appear in court in front of a judge where abuser may contest the protection order. 

During this process, the woman is told to stay away from her abusive partner. Several women 

reported employers telling them that they would lose their jobs if absent from work. These 

women decided to drop the process. Our advocacy intervention did not assist in sustaining and 

enabling the women to continue in the lengthy process of receiving a protection order. We 

recommend the justice system better inform the public as to the information required for a 

protection order and the time required. We also recommend community outreach efforts by the 

justice system with general information on civil protection orders. In addition, worksite 

awareness programs as to how employers might support and assist employees applying for a 

protection order are urgently needed. Public service announcements and information circulars in 

public buildings (Le., restrooms, libraries, civic centers, and churches) could better inform the 

public as to the process of applying for and receiving protection orders. 

SUMMARY 

Safety for the victims of intimate partner violence is of utmost importance to the justice 

and health systems. This research clearly demonstrates that a simple, 54 minute telephone 

intervention, can significantly increase the safety behaviors practiced by abused women. Justice 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
12 

and health system personnel should receive comprehensive training about the safety needs of 

abused women and how to include a safety plan in every encounter. Finally, steps must be taken 

in the justice system to simplify the process the victim must go through to obtain a protection 

order. 

EXHIBITS 

A. Graph of safety behaviors performed by time of intervention phone call 

B. Receipt of protection order status for 75 intervention women compared to 75 control 

group women. 

C. Number of days from application to receipt of a protection order for 75 intervention 

women compared to 75 control group women. 

D. Violence & health scores at intake, 3 months, 6 months, 12 months, and 18 months by 

treatment group (intervention and control). 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
13 

Exhibit A. Adjusted number of safety behaviors performed by time of intervention phone call 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
14 

Exhibit B. Receipt of protection order status for 75 intervention women compared to 75 

control group women. 

Intervention Control Total 

Received Protection Order 42 56.0 39 52.0 81 54.0 

Did Not Receive Protection Order 

Women Dropped 20 26.7 20 2,6.7 40 26.7 

N YO N_ 94 N % 

Perpetrator never Served 9 12.0 9 12.0 18 12.0 

Case dismissed by DA: 4 5.3 7 9.3 11 7.3 

Incomplete (3) (3 ) 

PO contested &judge dismissed (1) (1) 

Woman no show (3 ) 

The 42 protective orders, or 56%, received by the intervention group were not significantly 

higher (n’ (1)=0.242, p=.623) than the 39 protective orders, or 52%, received by the control 

group. 

The reasons the women did not receive a protection order were not significantly different (112 

(1)=0.242, p=.623) between the intervention and control groups. 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
15 

Exhibit C. Number of days from application to receipt of protection order (PO). 

Number of Days from Intake Intervention Control 

B - M __ SD N M - SD 

Days to PO Secretary 72 1.5 2.'7 70 1.4 2.6 

Days Application Typed 

Days to PO Prosecutor 

Days Back from PO Prosecutor 

Days File Copied 

Days Filed in Court 

Days Service Papers Received 

Days Serve Papers to Constable 

Days Perpetrator Served 

Days from Intake Woman Received 

71 4.7 

71 4.7 

71 4.9 

68 7.2 

68 7.3 

66 11.9 

66 12.2 

51 16.0 

3.3 70 5.2 

3.3 70 5.2 

3.3 69 5.5 

3.1 69 7.6 

3.1 69 7.7 

5 :4 68 11.2 

5.5 68 11.7 

8.5 53 15.0 

PO 41 24.5 9.1 39 24.7 

F(8,70)=1.735, p=.106 

3.5 

3.5 

3.5 

3.3 

3.2 

3.3 

3.2 

5.5 

8.5 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.
16 

Exhibit D. Violence and Health Scores for intervention and control groups at Intake, 3-, 6-, 12-, 

and 18-Months for Intervention (n=75) and Control (n= 75) Group Women 

Group Initial 3-MOS 6-MOS 12-MOS 18-MOS 

Measure 

M(SD) 

Intervention Group 

Violence Scores 

SAVAWS: 

Threats 44.5 (14.2) 

Actual 49.1 (18.9) 

Stalking 6.9 (4.1) 

Danger 6.8 (3.2) 

Work Harassment 3.9 (1 .8) 

Health Scores 

SF-12: 

Physical Health 48.5 (12) 

Mental Health 29.2 (1 2.1) 

22.4 (8.5) 21.1 (6.1) 23.3 (9) 22.1 (6.7) 

28.7 (6.2) 27.2 (1.2) 29.2 (8.5) 28.5 (5.7) 

2.1 (3.3) 1.3 (2.7) 1.9 (2.9) 2.0 (3.1) 

1.9 (2.3) 1.3 (1.7) 1.6 (2.4) 1.5 (2) 

1.8 (1) 1.2 (0.4) 1.5 (0.9) 1.3 (0.7) 

49.9 (10.4) 51.5 (9.6) 513 (9.3) 50.2 (10.6) 

39.5 (12) 43.8 (11.7) 44.8 (12.6) 46.1 (1 1.6) 

Control Group* 

Violence Scores 

SAVAWS: 

Threats 47.5 (13.1) 22.1 (7.5) 22.2 (8.5) 22.7 (8.6) 22.5 (9.2) 

Actual 48.6 (16.3) 28.1 (4.7) 28.8 (6.2) 28.7 (6.7) 29.0 (9.0) 

Stalking 7.8 (3.8) 3.1 (3.5) 2.0 (3.0) 2.3 (3.1) 1.8 (2.8) 

Danger 7.3 (2.6) 1.7 (2.2) 1.5 (2.2) 1.5 (1.9) 1.4 (2.3) 

Work Harassment 4.1 (1.9) 2.4 (1.7) 1.5 (1.4) 1.5 (1.1) 1.3 (0.8) 

Health Scores 

SF-12: 

Physical Health 47.0 (12.9) 50.8 (10.2) 48.5 (11.1) 50.4 (10.2) 49.1 (10.8) 

Mental Health 28.8 (10.6) 40.4 (13.9 42.9 (13.7) 44.1 (13.4) 44.3 (12.9) 

*n=74 for control group at 3,6, 12, and 18 months 

This document is a research report submitted to the U.S. Department of Justice.

This report has not been published by the Department. Opinions or points of view

expressed are those of the author(s) and do not necessarily reflect the official

position or policies of the U.S. Department of Justice.