From Isolation to Connection: The Practices and Promise of Open Domestic Violence Shelters.

Antidomestic violence advocates have begun to question two essential policies that have long defined domestic violence shelters-strict secrecy regarding shelter location and prohibitions on shelter access to all except staff and residents-both of which serve to increase survivors' social isolation and entail coercive rules that resonate painfully with broader oppressive dynamics. In response a growing number of communities have begun experimenting with open shelters, which break from tradition by making their locations public, and allowing visitors. Although this innovation is a sharp departure from tradition, virtually no research exists to explore its philosophical underpinnings, benefits, and challenges. This study addresses this gap. Study Questions: We used a qualitative descriptive approach to explore the experiences and perspectives of open shelter directors. Participants included 14 open shelter directors from 11 states. We conducted semistructured phone interviews with each participant, focusing on their shelter's (a) nature and history; (b) rationale; (c) policies and programs related to secrecy and openness; (d) benefits and challenges; (e) effects on specific survivor subgroups; and (f) practices used to build or strengthen survivors' relationships. Open shelters: (a) promote physical safety using a broad array of measures; (b) adopt a range of policies that promote varying degrees of location disclosure and visitor accessibility; (c) face challenges, such as the need to gain buy-in from multiple constituents; and (d) Improve survivor outcomes, including decreased shame; improved advocacy relationships; increased access to services and community involvement in shelter life; and deepened relationships with network members; in turn increasing prospects for physical and psychological well-being long after survivors' shelter stays are over. Findings suggest a new path for shelters interested in promoting survivor safety and healing in the context of a web of meaningful relationships.

Long-term outcomes of childhood sexual abuse: an umbrella review.

BACKGROUND: Although many meta-analyses have examined the association between childhood sexual abuse and subsequent outcomes, the scope, validity, and quality of this evidence has not been comprehensively assessed. We aimed to systematically review existing meta-analyses on a wide range of long-term psychiatric, psychosocial, and physical health outcomes of childhood sexual abuse, and evaluate the quality of the literature. METHODS: In this umbrella review, we searched four databases (PsycINFO, PubMed, Cumulative Index to Nursing and Allied Health Literature, and Global Health) from inception to Dec 31, 2018, to identify meta-analyses of observational studies that examined the association between childhood sexual abuse (before 18 years of age) and long-term consequences (after 18 years). We compared odds ratios (ORs) across different outcomes. We also examined measures of quality, including heterogeneity between studies and evidence for publication bias. This study is registered with PROSPERO, CRD42016049701. FINDINGS: We identified 19 meta-analyses that included 559 primary studies, covering 28 outcomes in 4 089 547 participants. Childhood sexual abuse was associated with 26 of 28 specific outcomes: specifically, six of eight adult psychiatric diagnoses (ORs ranged from 2·2 [95% CI 1·8-2·8] to 3·3 [2·2-4·8]), all studied negative psychosocial outcomes (ORs ranged from 1·2 [1·1-1·4] to 3·4 [2·3-4·8]), and all physical health conditions (ORs ranged from 1·4 [1·3-1·6] to 1·9 [1·4-2·8]). Strongest psychiatric associations with childhood sexual abuse were reported for conversion disorder (OR 3·3 [95% CI 2·2-4·8]), borderline personality disorder (2·9 [2·5-3·3]), anxiety (2·7 [2·5-2·8]), and depression (2·7 [2·4-3·0]). The systematic reviews for two psychiatric outcomes (post-traumatic stress disorder and schizophrenia) and one psychosocial outcome (substance misuse) met high quality standards. Quality was low for meta-analyses on borderline personality disorder and anxiety, and moderate for conversion disorder. Assuming causality, population attributable risk fractions for outcomes ranged from 1·7% (95% CI 0·7-3·3) for unprotected sexual intercourse to 14·4% (8·8-19·9) for conversion disorder. INTERPRETATION: Although childhood sexual abuse was associated with a wide range of psychosocial and health outcomes, systematic reviews on only two psychiatric disorders (post-traumatic stress disorder and schizophrenia) and one psychosocial outcome (substance misuse) were of a high quality. Whether services should prioritise interventions that mitigate developing certain psychiatric disorders following childhood abuse requires further review. Higher-quality meta-analyses for specific outcomes and more empirical studies on the developmental pathways from childhood sexual abuse to later outcomes are necessary. FUNDING: Wellcome Trust.