Intervention Summary

Community Advocacy Project (CAP)

The Community Advocacy Project (CAP) provides advocacy and individually tailored assistance to women who have been physically and/or emotionally abused by intimate partners as well as to their children, who may have been bystanders in abusive situations. CAP's objectives of eliminating or reducing the risk of future abuse and improving participants' quality of life are premised on the women gaining empowerment and coping skills, obtaining social support, and recognizing and using community resources.

CAP is delivered by trained, supervised paraprofessionals who work as advocates with participating women and their children to help them obtain needed community resources and social support, often after the women leave a shelter-based program. The intervention is composed of five phases:

Assessment. The advocate gathers important information regarding the needs and goals of each participant and her child. The participant, not the advocate, guides the direction and activities of the intervention by identifying issues that are important to her.
Implementation. The advocate and the participant actively work together to generate, mobilize, and access community resources. For women, resources often involve legal assistance, housing, employment, education, transportation, child care, social support, and/or material goods. For children, advocacy often focuses on participation in recreational activities (e.g., joining a Boys and Girls Club, getting on a sports team, going to camp), help with school, and/or material goods.
Monitoring. The advocate checks in with the participant regularly to determine whether her unmet needs have been fulfilled.
Secondary implementation. If the community resources were ineffective in satisfying the participant's original needs, the advocate suggests alternative strategies to generate, mobilize, or access other resources.
Termination. This phase occurs during the last few weeks of the intervention, when the advocate focuses even more intensively on the transfer of skills and knowledge to the participant, ensuring that she no longer needs the advocate at the end of the intervention.

The intervention lasts approximately 10 weeks, and advocates devote 4-6 hours per week to each participant. In one study reviewed for this summary, the intervention was delivered over 16 weeks, not 10.

Descriptive Information

Areas of Interest	Mental health promotion
Outcomes	1: Effectiveness of obtaining resources 2: Abuse by intimate partners 3: Quality of life 4: Social support
Outcome Categories	Education Employment Family/relationships Quality of life Trauma/injuries Physical aggression and violence-related behavior
Ages	18-25 (Young adult) 26-55 (Adult) 55+ (Older adult)
Genders	Female
Races/Ethnicities	American Indian or Alaska Native Asian Black or African American Hispanic or Latino White Race/ethnicity unspecified
Settings	Home Other community settings
Geographic Locations	Urban Suburban
Implementation History	CAP has been implemented in Illinois, Michigan, and Minnesota, as well as outside the United States, in British Columbia, Canada.
NIH Funding/CER Studies	Partially/fully funded by National Institutes of Health: Yes Evaluated in comparative effectiveness research studies: No
Adaptations	No population- or culture-specific adaptations of the intervention were identified by the developer.
Adverse Effects	No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories	Selective Indicated

Quality of Research

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Sullivan, C. M. The provision of advocacy services to women leaving abusive partners. Journal of Interpersonal Violence, 6(1), 41-54.

Study 2

Bybee, D. I., & Sullivan, C. M. The process through which an advocacy intervention resulted in positive change for battered women over time. American Journal of Community Psychology, 30(1), 103-132.

Sullivan, C. M., & Bybee, D. I. Reducing violence using community-based advocacy for women with abusive partners. Journal of Consulting and Clinical Psychology, 67(1), 43-53.

Study 3

Sullivan, C. M., Bybee, D. I., & Allen, N. E. Findings from a community-based program for battered women and their children. Journal of Interpersonal Violence, 17(9), 915-936.

Supplementary Materials

Andrews, F. M., & Withey, S. B. Developing measures of perceived life quality: Results from several national surveys. Social Indicators Research, 1, 1-26.

Straus, M. A. Measuring intrafamily conflict and violence: The Conflict Tactics (CT) scales. Journal of Marriage and the Family, 41(1), 75-88.

Outcomes

Outcome 1: Effectiveness of obtaining resources
Description of Measures	This outcome was measured using the 11-item Effectiveness of Obtaining Resources scale, which assessed the woman's perceived effectiveness in obtaining desired resources, such as material goods and resources, education, transportation, and social support. Response options ranged from 1 (very ineffective) to 4 (very effective). Scale scores were created by calculating the mean of self-reported effectiveness across the domains in which a woman had tried to obtain resources during the 10-week intervention period.
Key Findings	In a pilot study, residents of a shelter program for women with abusive partners were randomized to one of two groups upon leaving the shelter: the intervention group, which received CAP, or the control group, which participated in assessments only. At the end of the 10-week program, women who received CAP were more effective in obtaining the community resources they desired than women in the control group (p < .05). In another study, residents of a shelter program for women with abusive partners were randomized to one of two groups upon leaving the shelter: the intervention group, which received CAP, or the control group, which participated in assessments only. Women who received CAP were more effective in obtaining the community resources they desired than women in the control group at the end of the 10-week program (p < .001) and at the 24-month follow-up (p < .05). Over the 24-month study, the improvement in obtaining resources was greater for women who received CAP as compared with women in the control group (p < .05).
Studies Measuring Outcome	Study 1, Study 2
Study Designs	Experimental
Quality of Research Rating	2.8 (0.0-4.0 scale)

Outcome 2: Abuse by intimate partners
Description of Measures	In one study, abuse by intimate partners was measured with a modified version of the Conflict Tactics Scale (CTS), which assessed the violence the woman experienced from her partner or ex-partner in the previous 10 weeks (at postintervention) or in the previous 6 months (at 12- and 24-month follow-ups). Using a scale ranging from 1 (never) to 6 (more than 4 times a week), respondents indicated how often they had experienced each of various types of violence (e.g., choking, beating up). All women were asked these questions about their original assailants; women who reported being in new relationships were also asked these items in regard to the new partner. Responses were combined to create a 4-point Frequency-Severity Scale of Violence (0 = no violence; 1 = less severe abuse only [tore clothing, pushed, grabbed, shoved, slapped, and threw something at]; 2 = lower frequency [once a month or less] severe abuse [kicked, hit with fist, hit or tried to hit with object, beat up, choked, tied up, raped, and threatened to use or used a gun or knife]; and 3 = high frequency severe abuse [more than once a month]). In another study, abuse by intimate partners was determined from an average of scores on three measures: A 7-item version of the CTS, which was used to assess the physical abuse the woman received from her assailant. Participants responded with "yes" or "no" to each item (e.g., "Has he tied you up physically or restrained you in some way?"). A 22-item version of the Index of Psychological Abuse, which was used to assess the emotional abuse the woman received from her assailant. Using a 4-point Likert-type scale ranging from 1 (never) to 4 (often), participants responded to each item (e.g., "How often has he accused you of having other sexual relationships?"). A 12-item scale that assessed the types of injuries the woman received from her assailant. Participants responded with "yes" or "no" to each item (e.g., "Have you ever experienced internal injuries?"). Mean scores for total physical abuse experienced, total emotional abuse experienced, and total injuries experienced were standardized (i.e., rescaled for a mean of 0 and a standard deviation of 1) and combined to create a single index of the physical and emotional abuse experienced by the women.
Key Findings	In one study, residents of a shelter program for women with abusive partners were randomized to one of two groups upon leaving the shelter: the intervention group, which received CAP, or the control group, which participated in assessments only. Findings included the following: Women who received CAP experienced less physical abuse than women in the control group at the end of the 10-week program (p < .03) and at the 24-month follow-up (p < .05), after controlling for baseline responses. These findings were associated with small (partial eta-squared = .02) and medium (partial eta-squared = .06) effect sizes, respectively. The median time to first reabuse was longer for women who received CAP than it was for women in the control group (9 months vs. 3 months; p < .01). At the end of the 24-month follow-up, the percentage of women who experienced no further abuse from a partner or ex-partner was greater for those who received CAP than it was for women in the control group (24% vs. 11%; p < .01). This finding was associated with a medium effect size (odds ratio = 2.82). In another study, women exiting a domestic violence shelter program or having received services from a community-based family organization or a State social services department were randomized to the intervention group, which received CAP for 16 weeks, or the control group, which participated in assessments only. From pre- to postintervention to the 4-month follow-up, the decline in physical and emotional abuse experienced was greater for women who received CAP than it was for women in the control group (p < .05). This finding was associated with a small effect size (eta-squared = .05).
Studies Measuring Outcome	Study 2, Study 3
Study Designs	Experimental
Quality of Research Rating	3.3 (0.0-4.0 scale)

Outcome 3: Quality of life
Description of Measures	Quality of life was measured with 9 items adapted from an assessment of perceived life quality developed by researchers in another study. Using a 7-point scale ranging from 1 (terrible) to 7 (extremely pleased), respondents indicated how satisfied they were with how their lives were going, such as the way they spent their spare time and how they felt about their level of responsibility. Examples of items include "How do you feel about what you are accomplishing in your life?" and "How do you feel about your emotional and psychological well-being?"
Key Findings	Residents of a shelter program for women with abusive partners were randomized to one of two groups upon leaving the shelter: the intervention group, which received CAP, or the control group, which participated in assessments only. The quality of life reported by women who received CAP was higher than that reported by women in the control group at the end of the 10-week program (p < .01), at the 18-month follow-up (p < .05), and at the 24-month follow-up (p < .05), after controlling for baseline responses.
Studies Measuring Outcome	Study 2
Study Designs	Experimental
Quality of Research Rating	3.3 (0.0-4.0 scale)

Outcome 4: Social support
Description of Measures	Social support was measured with the 9-item Adult's Social Support Questionnaire. Using a 7-point scale ranging from 1 (terrible) to 7 (extremely pleased), respondents indicated how they felt about various types of social support, including emotional support, advice, practical assistance, and companionship. The items were used to indicate amount of support, quality of support, and overall satisfaction with support.
Key Findings	Residents of a shelter program for women with abusive partners were randomized to one of two groups upon leaving the shelter: the intervention group, which received CAP, or the control group, which participated in assessments only. From baseline to the end of the 10-week program, women in both groups reported an increase in social support. However, the increase in social support reported by women who received CAP was greater than that reported by women in the control group at the end of the 10-week program (p < .001) and across the 24-month follow-up period (p < .001), after controlling for baseline responses.
Studies Measuring Outcome	Study 2
Study Designs	Experimental
Quality of Research Rating	2.9 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study	Age	Gender	Race/Ethnicity
Study 1	18-25 (Young adult) 26-55 (Adult)	100% Female	56% White 39% Black or African American 5% Hispanic or Latino
Study 2	18-25 (Young adult) 26-55 (Adult) 55+ (Older adult)	100% Female	45% Black or African American 42% White 7% Hispanic or Latino 4% Race/ethnicity unspecified 2% Asian
Study 3	18-25 (Young adult) 26-55 (Adult)	100% Female	49% White 39% Black or African American 5% Hispanic or Latino 5% Race/ethnicity unspecified 1% American Indian or Alaska Native 1% Asian

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

Reliability of measures
Validity of measures
Intervention fidelity
Missing data and attrition
Potential confounding variables
Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome	Reliability of Measures	Validity of Measures	Fidelity	Missing Data/Attrition	Confounding Variables	Data Analysis	Overall Rating
1: Effectiveness of obtaining resources	2.0	2.0	3.0	3.5	3.0	3.5	2.8
2: Abuse by intimate partners	3.5	3.3	2.8	3.5	3.3	3.5	3.3
3: Quality of life	3.0	3.0	3.0	3.5	3.5	3.5	3.3
4: Social support	2.0	2.0	3.0	3.5	3.5	3.5	2.9

Study Strengths

Some of the measures used in the studies have good psychometric properties. Extensively trained interviewers conducted the participant assessment interviews, which were audiotaped and checked by supervisors. Fidelity of the intervention was assessed through several strategies in all studies. The advocates received extensive training as well as regular supervision and monitoring in weekly sessions, and they also documented their activities and goals on a weekly basis. Postintervention interviews were conducted with advocates and participants to discuss intervention activities. An extensive protocol was implemented to maximize retention of the sample, which resulted in a retention rate of approximately 95% for each of the three studies. Missing data were minimal and were handled with maximization methods to impute missing values. Random assignment was generally successful in producing baseline equivalence between the intervention and control groups, with key variables used as covariates in group comparisons. There were no significant differences between the intervention and control groups regarding the resources they reported needing on their exit from the shelter. One study had a long follow-up period, allowing the researchers to assess changes over time in important variables. A variety of appropriate analyses were conducted.

Study Weaknesses

One of the primary measures, the Effectiveness of Obtaining Resources scale, had limited psychometric properties. None of the studies adequately addressed documentation of individual participants' dosage levels. In one study, analyses were based only on those women who were involved in the intervention for at least 3 weeks; however, five women ended their involvement before this time period, and no comparisons were made between those who left the shelter without participating in the study and those who participated. Two studies had small sample sizes, which precluded extensive analyses of some outcomes.

Readiness for Dissemination

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

Availability of implementation materials
Availability of training and support resources
Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation Materials	Training and Support Resources	Quality Assurance Procedures	Overall Rating
3.5	4.0	4.0	3.8

Dissemination Strengths

The Web-based program implementation materials are easy to access, easy to use, and well organized. The target population for the intervention is well defined, and the techniques needed to work with the population are clearly laid out. The training materials, also found on the program Web site, are well organized, well written, and comprehensive, and they include a train-the-trainer model as well as many other resources. Assorted tools, including a fidelity survey and coding framework with a coding sheet, are available to support quality assurance.

Dissemination Weaknesses

A clear overview of the implementation process or milestones is not provided. Little guidance is provided to assist implementers in deciding whether to use optional materials and, if so, which ones.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description	Cost	Required by Developer
Advocate logbook for weekly activities	$5 each	Yes
The Community Advocacy Project: Advocate Manual (includes weekly progress report forms)	Free	Yes
The Community Advocacy Project: Instructor Manual	Free	Yes
Training handouts	Free	Yes
Training PowerPoint slides	Free	No
Why Does He Do That? Inside the Minds of Angry and Controlling Men (book by Lundy Bancroft)	$8.80 each	No
Safety Planning With Battered Women: Complex Lives/Difficult Choices (book by Jill Davies, Eleanor Lyon, and Diane Monti-Catania)	$59.99 each	No
In Her Shoes: Economic Justice Edition (kit from the Washington State Coalition Against Domestic Violence)	$125 each	No
StarPower (kit from Simulation Training Systems)	$249 each	No
Bafa'Bafa' (kit from Simulation Training Systems)	$289 each	No
The Story of Rachel (DVD from Praxis International)	$49 each	No
40-hour, on-site training	$9,000 for an unlimited number of participants, plus trainer travel expenses, if training is provided by the developer Free, if training is provided by a local qualified trainer	Yes
40-hour, on-site train-the-trainer workshop	$9,000 for an unlimited number of participants, plus trainer travel expenses	No
Online technical assistance and consultation	Cost varies depending on site needs (free for simple inquiries)	No
CAP Fidelity Measure (includes process and outcome measures, CAP Fidelity Coding Sheet, and Fidelity Coding Framework)	Free	No