Appropriate Care for Shelter-Based Abused Women

Abstract

We conducted a concept mapping exercise to gain insight into the perspectives held by abused women and professionals with regard to appropriate care in Dutch women’s shelters. Three brainstorming sessions generated 92 statements that were then rated by 56 clients and 51 professionals. A total of 11 clusters were identified. The three most important clusters were “help with finding a safe house if necessary,” “safety and suitable care for the children,” and “a personalized, respectful approach.” The most important statement was “take women seriously and treat them with respect.” The mapping exercise identified key practice-based elements of intervention that should better accommodate the needs of shelter-based abused women. We have used these elements in developing a new intervention for shelter-based abused women in the Netherlands.

Keywords

concept mapping intimate partner violence shelters

Introduction

Intimate partner violence (IPV) can be defined as a pattern of behavior in any relationship that is used to gain or maintain power and control over an intimate partner. It is a type of violence that affects people from all socioeconomic backgrounds and crosses cultural, racial, and educational lines (Heise, Ellsberg, & Gottemoeller, 1999). Most IPV victims are women. Violence against women by a partner or ex-partner is a major public health problem, resulting in injuries and other health consequences both for women (Campbell & Soeken, 1999; McCauley et al., 1995; Plichta & Falik, 2001) and their children (Wolfe, Crooks, Lee, Intyre-Smith, & Jaffe, 2003). Abused women who flee to women’s shelters form a relevant subcategory of IPV victims, as these women report more severe abuse (Saunders, 1994), more frequent injury (Saunders, 1994), and more symptoms of posttraumatic stress disorder (PTSD; Johnson, Zlotnick, & Perez, 2008; Jones, Hughes, & Unterstaller, 2001) than abused women not accommodated in shelters.

Every year, approximately 300,000 women and children in the United States are accommodated in women’s shelters after violence by a partner or ex-partner (National Coalition Against Domestic Violence, 2007). In the Netherlands, 16,000 unique persons (one third of them children) flee to women’s shelters every year (Dutch Federation of Shelters, 2007). The primary purpose of women’s shelters is to provide a safe haven where the abuse can be stopped and further harm can be prevented (Johnson & Zlotnick, 2009; Krishnan, Hilbert, McNeil, & Newman, 2004). Other goals are to improve the quality of life of women staying in shelters, increase their access to resources, and strengthen their self-efficacy and self-esteem (Ben-Porat & Itzhaky, 2008; Goodman & Epstein, 2007). The assistance rendered to abused women by shelter programs include advocacy (legal, housing, and financial guidance; facilitation of access to and use of community resources; safety planning advice; Ramsay et al., 2009), support, social services referrals, resources for the children, and mental health and substance use referrals (Johnson & Zlotnick, 2009; Wolf, 2005).

Despite the importance of women’s shelters, there is very little research on abused women’s perceptions about what shelter services they wish to receive. In a study by Chang et al. (2005), 21 battered women were asked what they wanted from IPV interventions. They were given cards describing various IPV interventions and were asked to sort the cards into three categories (“definitely yes,” “maybe,” and “definitely no”), indicating whether they would want that resource to be available. Participants were then asked to explain their categorizations. The majority supported informational interventions and individual counseling, and emphasized interventions that protected safety, privacy, and autonomy (Chang et al., 2005). Few (2005) interviewed rural battered women (10 African American and 20 White) in domestic violence shelters. She asked them about women’s experiences in the shelters and their ideas about effectiveness of shelter staff and services. Both groups reported that shelter staff did a good job of caring for residents with sincerity and honesty, creating a safe, structured environment and helping to secure resources. Suggestions for improvement were to (a) provide greater visibility of services, (b) include employment training, (c) provide aftercare after shelter exit, (d) consider inspirational resources to nurture spirituality, and (e) diversify shelter staff (Few, 2005).

In the Netherlands, a national-level plan has been drawn up to improve the services to shelter-based abused women (Dutch Federation of Shelters, 2008). One key objective is to develop an evidence-based intervention that draws on practice experience (i.e., on the knowledge and expertise of clients and professionals). Our study contributes to this goal by exploring the perspectives expressed by shelter-based abused women and professionals on appropriate care in women’s shelters. The research questions are twofold: (a) What do women and professionals consider to be appropriate care when abused women enter a shelter and during the first 6 weeks of their stay? (b) What elements should be included in an intervention to better accommodate women’s needs during their stay?

The research was conducted from June 2008 to April 2009 by Impuls, the Netherlands Center for Social Care Research of the Radboud university medical center.

Method

Concept Mapping Method

The concept mapping method (W. M. K. Trochim, 1989) was used in this study because it is well-suited to elucidate complex, diffuse concepts. Concept mapping is an exploratory consensus method for designing conceptual frameworks based on specific elements (W. Trochim & Kane, 2005). Thoughts and ideas are represented in the form of a picture or map, the final content of which is entirely decided by a group of experts (W. M. K. Trochim, 1989). A concept map gives

a pictorial representation of the group’s thinking which displays all of the ideas of the group relative to the topic at hand, shows how these ideas are related to each other and shows which ideas are more relevant, important or appropriate. (W. M. K. Trochim, 1989, p. 2)

This quantitative technique to analyze qualitative data has previously been used in studies on psychiatric care and mental health program evaluation (Johnsen, Biegel, & Shafran, 2000; Wolf, Parkman, & Gawith, 2000).

The method set out by W. M. K. Trochim (1989), as used in our present study, consists of six steps: preparation, generation of statements, structuring of statements, representation of statements as a concept map, interpretation of maps, and utilization.

Participants

Two tasks are undertaken in the preparation stage: (a) the selection of participants and (b) the development of the specific focus for the conceptualization. The participation of a heterogeneous group of relevant people helps to ensure consideration of a wide variety of viewpoints (W. M. K. Trochim, Cook, & Setze, 1994), although not all participants need to take part in every step. To generate a broad sampling of opinion, we identified the following relevant groups: the “clients” (abused women with experience of residing in women’s shelters) and the “professionals” (shelter staff, including social workers, policy advisers, and management).

Twelve Dutch women’s shelter organizations work together with the Impuls Research Center in the Academic Collaborative Centre for Shelters and Public Mental Health. The two groups of intended participants were invited for the concept mapping exercise in an announcement distributed by the collaborative center. Clients were further informed about the study by shelter staff and in posters and leaflets distributed by Impuls researchers. Each partner in the collaborative center delegated a policy adviser and a social worker to participate.

Generation of Statements

Statements were generated in three 1-hr brainstorming sessions with different participant groups: one with 12 clients, one with 12 social workers, and one with 12 other staff members (policy advisers and/or management officials). The sessions were held at a central location in the Netherlands. The purpose and background, the common rules for brainstorming, and the focus of the concept mapping process were explained similarly in all sessions. Participants were then asked to complete the following sentence: “To provide appropriate care for women and their children when they are admitted to a women’s shelter and during their first 6 weeks there, the shelter workers need to . . .” “Appropriate care” was defined as help that is responsive to the problems, needs, and possibilities of abused women and that will benefit the clients. During this brainstorming, each participant was free to suggest whatever she considered relevant. Participants were to make statements that could be understood unambiguously by all members of the session (i.e., simple and containing only one aspect). The statements were recorded without any discussion (Roeg, Van de Goor, & Garretsen, 2005; W. M. K. Trochim et al., 1994). In this way, a total of 377 statements were generated during the three sessions.

Two researchers who were familiar with the concept mapping method and were experts in the field of domestic violence then evaluated the statements for redundancy and clarity. A final list was drafted, consisting of 92 separate, unique statements describing what clients and professionals believe constitutes appropriate assistance after admittance to a women’s shelter and in the first 6 weeks of shelter stay. One client who attended the brainstorm session and one independent professional were asked by email to give feedback on the items: Do the statements accurately reflect the elements put forward during the brainstorming, and are these statements clear and specific enough? The client confirmed that the statements reflected the content of the brainstorm session. The professional verified whether the final list was complete and adequately phrased. Some minor textual changes to improve readability were made, and the final list was determined.

Clients involved in this phase were to be capable of expressing themselves in Dutch and of traveling to the central location; they were also expected to have some detachment from the help offered in shelter facilities so that they could reflect on the work of shelter staff. Women received 15 euros plus travel expenses for taking part.

Structuring of Statements

For the structuring phase, clients were enlisted at five women’s shelter organizations (partners in the Academic Collaborative Centre) dispersed throughout the Netherlands. The structuring activities took place in the five shelters so that women who could not leave for safety reasons were able to participate. Up to 20 clients from each shelter organization were approached for the concept mapping exercise. Clients were to meet the following eligibility criteria: (a) be 18 years or older; (b) understand Dutch, Turkish, or Arabic; and (c) have sought assistance from a women’s shelter during the past 6 months because of IPV by a partner or ex-partner.

At each shelter, 20 women were randomly selected from the total population of eligible shelter users and were invited to take part. In small shelters caring for less than 20 women, all women who met the criteria were asked to participate. A total of 87 women were invited, of whom 64% (n = 56) actually took part in the concept mapping and 36% (n = 31) declined. The main reasons given for declining were “no time” (n = 10; 32%), “no interest” (n = 2; 7%), “other reasons” (n = 4; 13%), or “not known” (n = 15; 48%).

The average age of the 56 clients who took part was 30.9 years (with a range from 18-58). They had originated in 28 different countries. One third had ethnic Dutch backgrounds (n = 19; 33.9%), and 71.4% were accompanied by their children. Clients who declined with reasons did not differ from the participants with respect to ethnicity, presence of children in the shelter, or duration of shelter stay, but they were slightly older (M age = 33, n = 16).

For the concept mapping procedure, each of the 92 statements generated as described above was printed on a small card. Both the client and the staff respondents in the shelters were first asked to cluster the statements and then to prioritize them (W. M. K. Trochim, 1989). In the cluster task, each participant was instructed to individually group the statements “in a way that makes sense to you.” For the rating task, each participant was to individually judge each statement on a 5-point Likert-type scale ranging from least important to most important. Two researchers helped the clients as they performed the concept mapping activities. All the written materials used in the mapping process were translated into Turkish and Arabic. Ten clients made use of the services of professional translators. The concept mapping meeting lasted about 2 hr, and the women received 15 euros for their cooperation.

During this structuring phase, each of the five participating organizations received 15 envelopes with all the materials of the concept mapping exercise plus a homework assignment for completion by staff members. Unlike the clients, the professionals were not approached randomly. They had a mean age of 37.2 years (ranging from 34-40) and had worked in shelters for abused women for an average of 5.1 years. Most (84%; n = 43) were social workers working directly with the clients; 16% (n = 8) were other staff members (see Table 1). Fifty-one complete assignments (of the 75 sent out) were returned by post (68%). The professionals also performed the cluster and rating tasks individually. This routine was chosen to minimize the time spent by shelter staff.

Table 1.

Characteristics of the Participants.

	Participating clients in the shelter				Participating professionals in the shelter
Organization	n	Average age	With children in the shelter	Dutch ethnic background	n	Average age	Average years of experience
BlijfGroep	12	37.9	5	3	10	36.0	4.8
Kadera	12	33.6	7	4	12	39.0	5
Fier Fryslân	12	29.7	10	3	9	34.0	4.8
Kompaan and De Bocht	9	21.4	9	5	10	38.3	6.3
Toevluchtsoord	11	34.3	9	4	10	40.0	5.4
Total	56	30.9	40 (71.4%)	19 (33.9%)	51	37.2	5.1

Data Analysis and Concept Map

We used the computer program Ariadne (Severens, 1995) to support the concept mapping. It processes the results statistically, producing an item matrix that makes the collected data suitable for a multidimensional scaling procedure. After this procedure, we performed a hierarchical cluster analysis (Ward’s method) of the results (The Netherlands Institute of Mental Health, 1994) and represented them graphically in the form of a concept map. A concept map may consist of 3 to 20 clusters. Items located close to one another form a cluster, and the smaller the distance between clusters, the more conceptually alike the clusters are. In other words, the shorter the distance between statements on the map, the more they are considered to have in common; the greater the distance, the less similar they are. Which concept map provides the best solution for the data is decided mainly on the basis of theoretical and content-related considerations (Johnsen et al., 2000; W. M. K. Trochim, 1989). The priority ratings of the items are reflected in the thickness of the clusters; thicker clusters are more important than thinner clusters. In this study, we created a concept map in which client and staff perspectives were combined. Results were discussed with staff during regular meetings of the Academic Collaborative Centre for Shelters and Public Mental Health; there were two meetings with social workers and two with policy advisers. Two brief fact sheets (one for clients and one for shelter staff) were drawn up and sent to shelter facilities to inform interested parties about the results of the concept mapping.

Results

Eleven Clusters

An analysis of the data from all respondents (56 clients and 51 professionals) resulted in a concept map with 11 clusters of appropriate care for abused women in women’s shelters (see Figure 1). The cluster labels are listed below, followed by the number of statements in that cluster and a summary of those statements.

Figure 1.

Conceptual representation: Integrated point and cluster map.

Help with finding a safe house if necessary (13 statements). Professionals must make an assessment of clients’ safety, be supportive, help them obtain appropriate services, provide support and linkage in accessing other organizations (warm transfer), and ensure aftercare after women leave the shelter.

Safety and suitable care for the children (nine statements). It is important that staff accompany women when visiting agencies and other professionals and help them arrange child care.

Personalized, respectful approach (12 statements). Professionals must take women seriously, treat them with respect, listen to them, support and counsel them in their daily life, and help strengthen their ability to cope.

Work according to a systematic plan (11 statements). Professionals must keep client files up to date in consultation with the client and be consistent in applying rules and procedures. They should mediate and intervene if women want to return to their former partner. Aftercare should be available for as long as necessary after shelter exit.

Stopping violence in the family system (15 statements). Professionals must make an assessment of the types and severity of violence within a client’s personal social system and build on to ensure adequate and appropriate care for her and her children. Care should include the family system and possible other social relationships. Women should further be supported in mobilizing, strengthening, and enlisting the aid of their social network.

A transparent and safe shelter environment (four statements). Professionals should talk to women about their wishes and expectations, and should respect and guarantee women’s privacy. They must ask women’s permission before seeking advice from other organizations. They should provide information about women’s rights inside the shelter and in society.

Health and empowerment (12 statements). Professionals should pay attention to the violent situation that the women have escaped and support them in dealing with the mental and physical distress they have suffered. Professionals could deter women from entering a violent relationship again by giving them insight into the spiral of violence (see also Walker, 1979) and helping them improve their ability to fend for themselves.

Help with practical and legal matters (three statements). Professionals ought to help with financial matters as well as legal procedures. They should mediate with other agencies and, if necessary, link women to these agencies. They should also help women find suitable accommodation.

Strengthening individuality and independence (five statements). Professionals should take action when women are most ready to make changes in their lives. During this “window of opportunity” (see also Curnow, 1997), women are often confronted with dilemmas.

Coordination of care; assistance with work and learning activities (seven statements). Professionals should support women in planning and arranging the right care for themselves and their children. Important statements in this cluster concern finding and persevering with learning activities, work, and other daily activities. Professionals can also help women find a babysitter or child care establishment.

Information about cash advances (one statement). Professionals should inform women about possibilities of receiving money in advance via the shelter.

Prioritization of Clusters and Statements

The cluster numbers reflect the 5-point Likert-type scale priority scores of clients and professionals, with Cluster 1 being the most important (average score 4.30) and Cluster 11, the least important (average 2.83; see Figure 2).

Figure 2.

Clients’ and professionals’ cluster priorities.

The two groups (clients and professionals) fully concurred in their priority ratings for Clusters 1 to 7. Both clients and professionals considered help with a safe house to be the most important task of professionals working in women’s shelters. The urgent need for safety was also expressed by both groups in Cluster 2, in combination with made-to-measure care for children. A personal approach and respectful attitude toward women and children were seen by both clients and staff as being of the utmost importance, forming the cornerstone of appropriate care in women’s shelters.

Priority ratings differed for Clusters 8, 10, and 11. Clients attached more importance than professionals to material and practical help, such as assistance with finances and with daily life in general. For example, clients rated help with practical and legal aspects (Cluster 8) at 3.8 (“important” on the 5-point scale), whereas professionals rated it 2.5 (“average”). Clients also rated Clusters 10 and 11, pertaining to coordination of care, assistance with work and learning, and information about cash advances, much higher than professionals did.

Concept Map: Appropriate Care

Respondents sorted the statements in ways that “made sense” to them. What their considerations were can be deduced from the arrangement of the clusters in the concept map titled “Appropriate Care for Shelter-Based Abused Women” (Figure 3).

Figure 3.

Eleven-cluster concept map “appropriate care for shelter-based abused women” according to clients and professionals.

At the center of the map, an imaginary triangle depicts the core of appropriate care for shelter-based abused women: the provision of safety and adequate help to women and their children through professional interventions for all members of the family network and possible other members of the social network in a safe shelter environment. Around the core, three dimensions can be distinguished that relate to women as clients of shelters (top left), as individuals and members of a social network (bottom, center), and as citizens participating in society (top right). Clusters 3, 4, and 6 (top left quadrant) relate to women as shelter clients. These clusters pertain to the attitudes and technical skills of shelter staff and to a safe, transparent shelter environment. In the top right quadrant—women as citizens in society—clusters 8 and 10 are associated with daily life and subsistence levels. Women want help with practical and legal matters and assistance with work and learning. Below, in the center bottom, the figure contains statements that refer to women as individual beings (Clusters 5, 7, and 9). Women need help with empowerment and health; they want to be independent; they want staff to offer appropriate care to help them stop the violence in their personal and social networks and work toward a safe and independent life.

The three dimensions of the concept map appear to correspond to the three functions of care for clients in women’s shelters as identified earlier (Krishnan et al., 2004; Wolf, Jonker, Nicholas, Meertens, & Te Pas, 2006):

an asylum function with an accent on housing accommodation and safety

a balance function with a focus on rest, to allow women to recover their strength and improve their social integration and coping abilities

a transition function, preferably toward an independent, safe living arrangement.

Discussion

We used the concept mapping method to obtain insights into what abused women and shelter staff consider to be appropriate care during the first 6 weeks of a woman’s stay in a shelter. Our aims were to generate practice-based input for a new intervention and to delineate important elements to be incorporated into this intervention. In the brainstorming sessions, 92 clear-cut statements were formulated and, at a later stage, were prioritized and clustered by a sample of clients and professionals. Using the computer program Ariadne, we then grouped the statements into a concept map of 11 clusters.

The most important clusters that emerged were “help with finding a safe house if necessary,” “safety and suitable care for children,” and “a personalized, respectful approach.” The last of these clusters comprised the statements with the highest priority ratings (including “take women seriously and treat them with respect”; “give emotional support, be there”; and “give women space to tell their story”). These statements refer to women’s need to be heard and taken seriously, but also to their need for autonomy, also within the working relationship with staff members. Clients and professionals agreed on the prioritization of the first three clusters. The clusters with the lowest priority were “coordination of care and assistance with work and learning activities” and “information about cash advances.” Significantly, staff members attached substantially less importance to these two clusters than did clients and also gave lower scores to assistance with practical and legal matters.

It is not surprising that clients and staff see the assurance of safety from the abuser (both for women and children) as a key element of intervention, because this is the main reason why women flee to a women’s shelter. In studies by Chang et al. (2005) and Few (2005), abused women likewise emphasized personal safety and a safe, structured environment in shelter facilities. They also expressed the importance of informational interventions, individual counseling, and assistance with resources (Chang et al., 2005; Few, 2005). These elements are also included in our concept map, but with lower scores than in the Few and Chang et al. studies; as noted above, though, clients considered informational interventions and assistance with resources to be much more important than did the professionals. As in other studies, our concept mapping exercise revealed the high significance of the sincerity, honesty, and transparency of shelter staff (Davis & Srinivasan, 1995; Few, 2005; Hague & Mullender, 2006; Haj-Yahia & Cohen, 2009; Tutty, Weaver, & Rothery, 1999).

Before we could integrate the mapping results into the new intervention, we needed to verify whether its clusters and elements were in line with what was already known about evidence-based interventions for shelter-based abused women. Unfortunately, research on effective interventions for abused women in shelters is still very scarce. Ramsay and colleagues’ (2009) systematic review on advocacy interventions to reduce or eliminate violence and promote the physical and psychosocial well-being of women who have experienced IPV indicates that only four studies have recruited women in shelters. In three of these, the intervention was offered to women leaving a shelter; in only one study was the intervention available to women while staying in the shelter. That study, by Constantino (2005), tested the feasibility and effectiveness of an 8-week social support intervention in 24 shelter-based abused women. The intervention also provided information on resources, time to access these, and an environment to chat with counselors and friends (Constantino, 2005). In their meta-analysis, Ramsay et al. (2009) found improved social support directly after the intervention in their analysis. The Ramsay study also found that intensive advocacy increased the likelihood that physical abuse has ceased at 1 to 2 years after the intervention in women who had exited shelters or refuges.

There is debate about what primary outcomes should be in interventions for shelter-based abused women, and even about whether abuse incidence is an appropriate measure for evaluating IPV interventions (Wathen & MacMillan, 2003). Notwithstanding the lack of consensus about primary outcomes, more studies of late are focusing on mental health, re-abuse, and social outcomes (Ramsay et al., 2009), and these are more in line with reported needs of shelter-based abused women (including mental health, safety, and psychological and psychosocial needs; Allen, Bybee, & Sullivan, 2004; Jonker, Sijbrandij, & Wolf, 2012).

Utilization

The results of the concept map can already be used to improve the quality of the services to abused women. Our study identifies five key practice-based elements, developed from bottom up, which we have integrated into the new intervention.

Key Element 1: Stop and prevent violence and provide safe shelter for women and their children. This is of the utmost importance. It also constitutes the societal legitimization of shelter organizations.

Key Element 2: A respectful working relationship forms the cornerstone of tailor-made, appropriate care for abused women in shelters. An important element emerging from our concept map is the relationship between clients and shelter staff members.

Key Element 3: Care should include the family system and/or social relations (it should be system-based). The dynamics of violence in family systems must be tackled to assure lasting safety. Shelter work should preferably be set in the community because shelter-based women are citizens participating in society as well and therefore need to have resources and exchange of information available.

Key Element 4: Care should be integrated and coherent. The concept map shows that women need help focused on mental health, safety, and psychosocial issues.

Key Element 5: Our study reveals the importance of incorporating the three functions of care for abused women (asylum function, balance function, and transition function), as shown in Figure 3, into the professionals’ working methods and the shelter environment. Shelters must explicate which functions they support and how these can be integrated into the working methods. Both clients and staff stress above all the asylum function of women’s shelters. Investment also needs to be made in the transition function, as it involves preserving and strengthening women’s autonomy.

Strengths of our study are the inclusion of two perspectives, those of clients and professionals. A relatively large group of clients in 12 shelter organizations across the Netherlands participated in the study. The concept mapping method helped us give a voice to the clients. Owing to the random selection of clients and the fact that no women were excluded on language grounds, we believe the results are generalizable to the entire population of clients in women’s shelters. In addition, a substantial group of professionals contributed to the study, both social workers and other staff members.

The limitations should also be taken into account in interpreting the results. The group of respondents (clients and professionals) taking part in the brainstorming sessions and the prioritizing and clustering phases were not always the same. Yet, according to W. M. K. Trochim (1989), it is not necessary that all participants take part in every step of the concept mapping exercise. We do feel that the statements were clearly formulated and our approach enabled more people to be involved. Another possible limitation is that the staff members were not randomly selected; the differential selection of professionals may have biased our results.

When women flee to women’s shelters, a personalized combination of the asylum, balance, and transition functions of shelters would be best suited to their needs. Our concept map has revealed what elements are important to the entire group of shelter-based abused women. Shelter workers should assess what every individual woman needs and what care will be appropriate to adequately address them as well as to strengthen her perspectives. That will aid professionals in providing made-to-measure care to abused women.

Footnotes

Acknowledgements

We would like to thank the clients and professionals and all women’s shelters in the Academic Collaborative Centre for Shelters and Public Mental Health for their participation in this research project.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This report is based on research funded by the Academic Collaborative Centre for Shelters and Public Mental Health.

Author Biographies

Irene E. Jonker is a researcher at Impuls, Netherlands Center for Social Care Researchat Radboud university medical center. She has more than 10 years of experience as a researcher with socially vulnerable people. Her research focuses mainly on intimate partner violence (IPV), especially the health and care needs of abused women and which shelter services and interventions are effective for abused women.

Carinda C. J. M. Jansen is currently a lecturer in Social Work at HAN University of applied sciences. Previously, she worked as a researcher at Impuls, Netherlands Center for Social Care Research at Radboud university medical center. She has more than 15 years of experience, both as a researcher and as a social worker, with socially vulnerable people, including abused women and their children.

Milou G. M. Christians is a research associate at Impuls, Netherlands Center for Social Care Research at Radboud university medical center, . She is involved in the development of the Strengths Based Model for shelter services in the Netherlands. She has also been involved in the development of the Consumer Quality Index for Shelter Services.

Judith R. L. M. Wolf is a professor of social care, head of Impuls, Netherlands Center for Social Care Research at Radboud university medical center, and director of the Academic Collaborative Centre for Shelters and Public Mental Health. She has more than 25 years of experience in designing and conducting both academic and applied research on socially vulnerable people, including homeless people and abused women, and on the social and health care services needed by these groups.

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