Post-separation abuse: A concept analysis

Aim: To report an analysis of the concept of post-separation abuse and its impact on the health of children and adult survivors. Design: Concept analysis. Data Sources: A literature search was conducted via PubMed, Cochrane and Embase and identified articles published from 1987 to 2021. Methods: Walker and Avant's (2019) eight stage methodology was used for this concept analysis, including identifying the concept, determining the purpose of analysis, identifying uses of the concept, defining attributes, identifying a model case and contrary case, antecedents and consequences and defining empirical referents. Results: Post-separation abuse can be defined as the ongoing, willful pattern of intimidation of a former intimate partner including legal abuse, economic abuse, threats and endangerment to children, isolation and discrediting and harassment and stalking. An analysis of literature identified essential attributes including fear and intimidation; domination, power and control; intrusion and entrapment; omnipresence; and manipulation of systems. Antecedents to post-separation abuse include patriarchal norms, physical separation, children, spatiality and availability, pre-separation IPV and coercive control and perpetrator characteristics. Consequences include lethality, adverse health consequences, institutional violence and betrayal, such as loss of child custody and economic deprivation. Conclusion: This concept analysis provides a significant contribution to the literature because it advances the science for understanding the phenomenon of post-separation abuse. It will aid in developing risk assessment tools and interventions to improve standards of care for adult and children survivors following separation from an abusive partner. Impact: This concept analysis of post-separation abuse provides a comprehensive insight into the phenomenon and a theoretical foundation to inform instrument development, future research and intervention. Post-separation abuse is a complex, multi-faceted phenomenon that requires differential social, legal and healthcare systems responses to support the health and well-being of survivors and their children.


| INTRODUCTION
Intimate partner violence (IPV) is more prevalent among couples with children, as 60% of couples experiencing IPV have children living in the household (Hamby et al., 2011;McDonald et al., 2006;Rezey, 2020).Separation from an abusive partner is often thought to be the solution to ending violence; yet, abuse and the risk for lethality often escalates following separation (Campbell et al., 2003;Stark & Hester, 2019;Zeoli et al., 2013).Although all genders experience abuse, abuse towards women by their male partners following separation is enabled by patriarchal norms and is more lethal.Women are 10 times more likely to be victims of IPV than men, especially when abuse occurs after separation (Hardesty, 2002).Gender differences in economic power (wage disparities between partners), gendered discourses of parenting that undervalue mothers' unpaid domestic labour, and misogynistic norms that position mothers as obstructive or vindictive make mothers more vulnerable to post-separation abuse (Elizabeth et al., 2012).Most of the international research on post-separation abuse has focused on male perpetration of abuse towards the mothers of their children.For these reasons, we refer throughout this concept analysis to women, mothers and survivors.
Women who are separated and divorced report higher rates of IPV than married women; however, much of this research is cross sectional, and thus impossible to tell if separation occurred before or after the IPV.A 2010 report based on the National Crime Victimization Survey in the United States identified rates of IPV 30 times higher for separated women and nine times higher for divorced women as compared with married women based on 2-year rolling averages of reports of the prior 6 months (Catalano, 2012;Rezey, 2020;Toews & Bermea, 2017).After separation from an abusive partner, up to 90% of women report continued harassment, stalking or abuse (Davies et al., 2009;Hardesty et al., 2012;Mitchell et al., 2021).Yet, patterns of abusive behaviours following separation have not been clearly defined.Post-separation abuse is often missed by quantitative measures (Anderson & Saunders, 2003), especially the more covert types of abuse that arise following separation (Galántai et al., 2019;Lynch et al., 2021;Miller & Smolter, 2011).Few quantitative studies have been conducted that elucidate abusive tactics post-separation that include using children, threats, manipulation of visitation and co-parenting schedules, and withholding child support (Toews & Bermea, 2017) and how these tactics impact the health and wellbeing of children and families (Broughton & Ford-Gilboe, 2017).
A concept analysis of post-separation abuse is needed to develop a clear definition to accurately measure the phenomenon.Post-separation abuse is perpetrated at the individual level but facilitated and perpetuated by factors at the family (power differentials between intimate partners, stigma), community (legal system responses) and societal level (gender and patriarchal norms).IPV, including post-separation abuse, must be understood through the assaults on the personhood, dignity, autonomy, liberty and self-worth of the human being, and not just in terms of the physical bruises it leaves (Scheper-Hughes & Bourgois, 2004;Silverman et al., 2004;Stark & Hester, 2019).Following Walker and Avant's (2019) method of concept analysis, we outline the significance of the concept, followed by identifying its uses, the defining attributes, identifying a model and contrary case, antecedents and consequences, and empirical referents.In addition, we discuss limitations and implications for nursing.

| BACKGROUND AND SIGNIFICANCE OF POST-SEPARATION ABUSE
Systems of care are currently geared towards helping individuals leave abusive relationships, even with the recognition that separation is a well-established risk factor for lethality for women and children (Campbell et al., 2009;Sillito & Salari, 2011).Approximately 1700 women are murdered by intimate partners per year in the US, bereaving an estimated 3300 children annually (Lewandowski et al., 2004;VPC, 2021).Estimating from the Campbell et al. (2003) 12-city intimate partner femicide study, approximately 44% of those women were separated from their partners when killed.Parental IPV, separation and custody disputes are risk factors for child homicides (Jaffe et al., 2012;Lucas et al., 2002;Lyons et al., 2021).
For parents with minor children, legal systems and policies that regulate divorce, separation and custody are the central context influencing the ability to maintain safety following separation from an abusive partner (Broughton & Ford-Gilboe, 2017;Hardesty & Chung, 2006;Jaffe et al., 2008;Saunders, 2007;Wuest et al., 2006).Yet, the family court context in and of itself creates conditions for abusive behaviours to arise following separation and divorce.The majority of high conflict custody cases involve IPV (Jaffe et al., 2008;Jaffe & Crooks, 2004).The divorce and custody literature that guides family court judicial decision-making frames conflict as mutual, which fails to account for the power and control dynamics of abuse.This framework is also damaging as it shifts the focus away from batterers' damaging behaviours and places blame on those experiencing abuse (Feresin et al., 2018).How violence is framed has significant implications for how it is addressed.
Mothers experiencing IPV face barriers to safety post-separation because they must negotiate co-parenting arrangements and family court (Broughton & Ford-Gilboe, 2017;Hardesty & Chung, 2006;Spearman et al., 2022;Stark & Hester, 2019).IPV, child maltreatment and children's exposure to IPV are frequently minimized or underdetected in family court proceedings, which has lasting consequences for survivors (Khaw et al., 2021;Meier, 2020;Saunders, 2015).Understanding specific tactics of post-separation abuse is crucial to designing interventions that acknowledge experiences in negotiating violence, separation and divorce, and the structural contexts that are barriers to safety and health.

| METHODS
We employed Walker and Avant's (2019) eight step procedure of concept analysis, which is a systematic way to promote understanding and to develop a definition that will allow for measurement of the phenomenon.After selecting the concept of post-

| IDENTIFYING AND DEFINING POST-SEPARATION ABUSE
Post-separation abuse can be defined as the ongoing, willful pattern of intimidation of a former intimate partner that includes (1) legal abuse, (2) economic abuse, (3) threats and endangerment to children, (4) isolation and discrediting and (5) harassment and stalking (Breiding et al., 2015;Brownridge, 2006;Dekerseredy et al., 2017;Godfrey & Robinson, 2014;Logan et al., 2008;Miller & Smolter, 2011;Sheridan, 2001;Walker et al., 2004;Zeoli et al., 2013).Post-separation abuse has also been termed 'post-separation violence', 'separation or divorce assault' or 'estrangement violence'.Post-separation abuse is aligned theoretically with descriptions in the literature of intimate partner terrorism (Johnson, 2005) and coercive control (Stark & Hester, 2019), whereby violent and nonviolent tactics are used to wholly dominate an intimate partner and deprive them of free will.This contrasts with what is called situational couple violence, in which violence erupts out of specific arguments or conflicts but without an ongoing motive to dominate one's partner (Hardesty et al., 2012;Johnson, 2005).
Separation is a complex process, often involving iterations of leaving and returning.To operationalize 'post-separation' throughout this concept analysis, we focus on physical or legal separation (moving out, transitioning children between households or invoking some formal, legal mechanism such as filing for a protective order, divorce or custody) as the demarcation for this concept analysis rather than emotional separation described by Dekerseredy et al. (2017).It is the physical or legal separation that explicitly leads to post-separation abuse behaviours.
Economic abuse includes withholding access to resources (child support), medical expenses for children or interfering with the survivor's ability to work (Bell et al., 2007;Brownridge, 2006;Cleak et al., 2018).Interferences with employment can include creating chaos with access schedules to produce childcare hardships, causing conflict at the survivor's place of employment, or involving the employer in litigation.
Threats and endangerment to children includes threats to harm or kidnap children, refusal to return children, physical or sexual abuse of children, medical/psychological neglect or putting children in age inappropriate settings such as leaving unattended with firearms, exposing to hostile gun displays (Azrael & Hemengway, 2000), pornography or illicit drugs (Hayes, 2017).
Isolating and discrediting includes portraying the survivor as an unfit parent, accusing them of parental alienation (Meier, 2020), spreading rumours about their mental health (Gutowski & Goodman, 2020) or extending stalking, harassment and legal abuse to the survivor's support system.The impact of parental alienation allegations in family courts is gendered: mothers accused of parental alienation were more likely to lose custody than fathers (Meier, 2020) and judges implicitly assume mothers are the 'gatekeepers' of fathers' relationships with their children (Austin et al., 2013).
Harassment and stalking are forms of abuse designed to intimidate, create fear and exert power and control over a former partner.Behaviours include violations of protective orders or custody orders, frequent unwanted contact (Logan et al., 2008;Logan & Walker, 2004;Lynch et al., 2021;Walker et al., 2004) or using third parties to harass (Messing et al., 2020).Custody arrangements often legitimize the abusive partners' contact, providing opportunities for harassment (Wuest et al., 2006).Nearly half (42%-50%) of abusive men violate protective orders (Logan et al., 2008).A history of multiple breaches of court orders, stalking and a highly controlling ex-partner are indications of high risk of lethality for women and children (Sachmann & Johnson, 2014).Walker and Avant (2019) describe essential attributes as key characteristics of the concept.Because these occur in a sociolegal context, the historical and cultural environment of gender and patriarchal norms influences the current legal context, which in turn establishes the over-arching context in which post-separation abuse occurs.Post-separation abuse is best viewed as a cumulative pattern of behaviour, rather than incident specific (Katz et al., 2020;Stark & Hester, 2019).The following essential attributes of post-separation abuse were identified: fear and intimidation; domination, power and control; intrusion and entrapment; and omnipresence (Figure 1).

| Fear and intimidation
Intimidation manifests as psychological abuse and includes tactics such as damaging property, gaslighting and non-verbal threats such as hostile gun displays (Brownridge, 2006;Brownridge et al., 2008;Crossman et al., 2016;Hardesty & Ganong, 2006;Miller & Smolter, 2011;Stark & Hester, 2019).As part of creating a climate of fear, abusive expartners weaponize what means most to their former partners, which is often their children (Toews & Bermea, 2017).Threatening behaviour--and an individual's perceived sense of threat based on the pattern of past violence they have experienced--may be largely invisible and not understood by professionals involved in family court litigation (Haselschwerdt et al., 2011;Katz et al., 2020;Rivera et al., 2012;Saunders et al., 2013).This lack of understanding, and climate of fear, hampers the ability of women experiencing IPV to negotiate and obtain safe co-parenting arrangements (Cleak et al., 2018;Toews & Bermea, 2017), entrapping them to further post-separation abuse.

| Domination, power and control
Post-separation abuse is designed to make the former partner feel powerless, and power and control is central to understanding violence towards an intimate partner (Godfrey & Robinson, 2014;Katz et al., 2020;Miller & Smolter, 2011;Stark & Hester, 2019).Domination includes coercive tactics such as technological harassment, stalking and threats, and can be underwritten by a legal system that does not take action to stop these tactics.Abusive former partners are more likely to seek sole physical and legal custody than nonabusive former partners, and are often awarded custody even with documented, substantiated and criminal convictions of IPV against the mother (Bancroft et al., 2002;Meier, 2020;Miller & Smolter, 2011;Silberg & Dallam, 2019).When abusers fight for and obtain custody, what they are often looking for is not more meaningful involvement with their children, but rather acknowledgement of their status and importance (Bancroft et al., 2002;Brown et al., 2019;Silverman et al., 2004;Slote et al., 2005).The cumulative impact of domination, power and control tactics is that mothers experiencing post-separation abuse are rendered powerless to protect their children and powerless to escape ongoing abuse (Gutowski & Goodman, 2020).

| Intrusion and entrapment
Post-separation abuse can be thought of as relentless attacks on a former partner's autonomy that continues throughout post-separation parenting, and results in a state of 'continuous entrapment' (Hardesty, 2002;Katz et al., 2020;Stark & Hester, 2019).Wuest et al. (2006) identified intrusion as the primary barrier to health promotion for women following separation from an abusive partner, which was characterized by continued abuse, harassment, the costs of negotiating support and the cumulative effects of stress and abuse on women and children's health and well-being.Frequent manipulation of access schedules is an additional way perpetrators use children to create intrusion (Toews & Bermea, 2017;Zeoli et al., 2013).Intrusion diverts resources away from children and other priorities (Francia et al., 2019), and limits the ability to negotiate safety, healing and achieve longterm autonomy.

| Omnipresence
Past experiences of violence cast a long shadow, producing a mental state where fear of the perpetrator is always present, leading to the inability to escape in time, place and space (Henze- Pedersen, 2021;Humphreys et al., 2019;Katz et al., 2020).Although a survivor may be separated in physical space, technology allows perpetrators to overcome geographical boundaries (Markwick et al., 2019;Messing et al., 2020).As a result, physical separation from an abusive partner may create neither safety, nor freedom (Katz et al., 2020).Stalking and harassing tactics, even those not reaching criminal levels, communicate that abusers can access and affect them at any time (Zeoli et al., 2013).Government sanctioned parentingtime arrangements create opportunities to force contact, and may prevent the ability to set healthy boundaries (Bendlin & Sheridan, 2019;Toews & Bermea, 2017).Abusers may use subtle behaviours that come across to others as being an 'involved' parent, such as creating additional excuses for contact (Nikupeteri & Laitinen, 2015), but survivors recognize these tactics as intrusion or harassment.

| Manipulations of systems
Abusers manipulate systems to prevent formal help-seeking behaviours, exert power, force contact and financially burden survivors (Miller & Smolter, 2011).This can include litigation strategies used in response to help-seeking behaviours, such as filing for custody in response to a survivor seeking a protection order or reporting violence to police (Miller & Smolter, 2011).'Parental alienation' is used as a tactic to undermine allegations of domestic violence and child maltreatment (Haselschwerdt et al., 2011;Laing, 2017;Lapierre & Côté, 2016;Meier, 2010;Meier, 2017).When there is a custody dispute, judges are less likely to grant protective orders (Rosen & O'Sullivan, 2005), and child protective services (CPS) are less likely to investigate reports of abuse (Black et al., 2021;Saini et al., 2013).Abusers can use aspects of the court process to humiliate and terrorize their former partners, often weaponizing their personal history (Miller & Smolter, 2011), including their mental and physical health.For instance, mothers who seek mental health treatment for depression or anxiety that directly stems from the abuse they experienced risk being perceived as an unfit parent, cast as psychologically unstable (Gutowski & Goodman, 2020;Watson & Ancis, 2013) and having this used against them in court proceedings (Wuest et al., 2006).

| MODEL CASE AND CONTRARY CASE
In Walker and Avant's (2019) method of concept analysis, the model case (Table 1) is presented as a 'real life' example that demonstrates the defining attributes of post-separation abuse.In contrast, a contrary case is a clear example of what the concept certainly is not.We have illustrated both a model case and contrary case, which are amalgamations from qualitative examples in the literature.These illustrations may be helpful to better understand experiences of post-separation abuse.Walker and Avant (2019) describe antecedents as the events that must occur prior to the occurrence of the concept.Antecedents to post-separation abuse include patriarchal norms, pre-separation IPV or coercive control, perpetrator characteristics, physical separation and spatiality or availability (Figure 1).

| Patriarchal norms
Patriarchal norms create the context for post-separation abuse by men towards women through gendered notions of caregiving of children, male entitlement and gender bias in courts (Davies et al., 2009;Meier, 2020).IPV perpetration is strongly associated with men's adherence to familial patriarchal ideology (e.g.men's sense of ownership over wives and children), men's use of pornography, substance use and male peer support that endorsed violence as a means to control (DeKeseredy & Joseph, 2006).

| Pre-separation family context of IPV and coercive control
IPV during the relationship is the strongest predictor of post-separation abuse (Ellis et al., 2021;Galántai et al., 2019).Other family factors that can be considered antecedents for post-separation abuse include marriage or cohabitation, sharing children and separation.Violence that occurred during a relationship continues to influence the perception of the power of the abuser because the survivor knows what the abuser is capable of (Toews & Bermea, 2017).

| Spatiality and availability
Because physical proximity may be limited in the post-separation context, batterers devise tactics that take advantage of their former partner's availability.For example, court mandated periods such as court appearances and custody or visitation exchanges of children offer opportunities where the survivor is mandated to be available in the presence of the abuser.Batterers may also deploy other tactics that circumvent physical barriers such as electronic harassment (Markwick et al., 2019;Messing et al., 2020).

| Perpetrator characteristics
Characteristics of individuals who perpetrate post-separation abuse include narcissism, lack of empathy, jealousy, vulnerability, high dependence (Ellis, 2017) and blame-shifting behaviours (Brownridge, 2006;Hardesty, 2002;Harsey & Freyd, 2020;Sachmann & Johnson, 2014).Perpetrators often have a charming public image, making it difficult for survivors to seek help and be believed and contributes to manipulation of systems (Katz et al., 2020).Additional characteristics of abusive partners include high levels of denigration and disparagement, lack of insight or attention into how their own parenting impacts children and a tendency to place sole blame for problems in the family on the survivor (Bancroft et al., 2002;Katz et al., 2020;Thompson-Walsh et al., 2018;Turhan, 2021).
According to Walker and Avant (2019), consequences are the events and outcomes that occur as a result of the concept.Consequences of post-separation abuse include lethality, health consequences, economic deprivation and institutional violence and betrayal (Figure 1).

| Lethality
The most severe consequence of post-separation abuse is intimate partner homicide.Maternal and child deaths are associated with custody disputes and contact arrangements (Holt, 2015;Kernic et al., 2005).The combination of physical and legal separation created the greatest risk of murder by an intimate partner (Campbell et al., 2007;Ellis, 2017;Wilson & Daly, 1993).In addition, Campbell et al. (2009) found that a partner who was highly controlling increased significantly the risk of homicide for female partners who had left their abusers.The first 3 months and the first year following separation are the most lethal, with the risk declining over time (Campbell et al., 2003;Campbell et al., 2007).

| Health consequences
Ongoing post-separation abuse has devastating health consequences for children and adults who experience violence.Longlasting negative emotional and mental health sequelae for women from post-separation abuse includes PTSD, depression and anxiety (Crosse & Millar, 2017;Ellis et al., 2021;Estefan et al., 2016).Survivors experience adverse physical health consequences relating to both physical injury and somatization of stress, including traumatic brain injury (Valera et al., 2021), chronic pain, gastrointestinal symptoms, reproductive health, neuroendocrine alterations and epigenetic changes (Ford-Gilboe et al., 2011;Ford-Gilboe et al., 2015).A history of stalking is associated with increased severity of post-traumatic stress symptoms, even after controlling for partner abuse (Fleming et al., 2012).Moreover, the sense of powerlessness that is reinforced for IPV survivors who encounter indifference or hostility to their help-seeking behaviours reinforces emotional trauma (Buckley et al., 2011).Denying children access to medications or needed healthcare, especially mental health, is another consequence of post-separation abuse (Silberg & Dallam, 2019;Toews & Bermea, 2017).In addition to IPV exposure, children may experience neglect or physical or sexual abuse (Holt, 2020), with 30%-77% of families experiencing IPV also experiencing child maltreatment (Edleson, 1999;Silberg & Dallam, 2019).

| Economic deprivation
IPV is associated with employment instability, childcare and housing stressors causing material hardship (Bell et al., 2007;Estefan et al., 2016).Economic deprivation can be caused by a batterer's use of court action to exhaust financial resources of their former partner, rendering them bankrupt and financially destitute (Crosse & Millar, 2017;Miller & Smolter, 2011;Toews & Bermea, 2017).In addition to the cost of legal representation, legal abuse can impact economic well-being including increased childcare burdens, lost productivity and transportation difficulties (Gutowski & Goodman, 2020;Miller & Smolter, 2011).IPV survivors who are fearful of abuse often lower demands for child support, which results in trading safety for long-term financial well-being of their children (Hardesty, 2002).Qualitative research has highlighted that many survivors feel that they 'gave up everything' to get out of abusive marriages (Toews & Bermea, 2017).

| Institutional violence and betrayal
Institutional violence may take the form of loss of custody of one's children, lack of investigation and lack of justice (Gutowski & Goodman, 2020).It is precisely when survivors seek out formal sources of help that they come into contact with institutions like family court.However, mothers experiencing IPV often face a catch 22: they risk losing custody to child protective services or being criminalized for failure-to-protect their children, or they risk losing custody to their abuser for being seen as alienating or unwilling to co-parent (Meier, 2020;Saunders & Oglesby, 2016).

| Empirical referents
Empirical referents are the measurement tools that demonstrate the occurrence of concept (Walker & Avant, 2019).The study of IPV has faced persistent definitional and measurement dilemmas (Crossman et al., 2016), and no measurement tool exists that measures the complexity of long-term, ongoing abuse experiences following separation from an abusive partner and co-parent (Cleak et al., 2018).None of the existing measures include aspects of legal abuse, using children or threats to take custody and only the Danger Assessment (Campbell et al., 2009) includes threats of harm to children (Jaffe et al., 2012).Studies reviewed for this concept analysis used instruments including Partner Abuse Scale (Attala et al., 1994), Revised Conflict Tactics Scale (Straus et al., 1996), Abuse Assessment Screen (Parker & McFarlane, 1991) and stalking screening tools such as the NVAWS (Tjaden & Thoennes, 2000).Other empirical referents used in the post-separation context that most closely capture experiences of post-separation abuse include Women's Experience of Battering (WEB) (Smith et al., 1995), HARASS (Sheridan, 2001) and the Danger Assessment (Campbell et al., 2009).

| Implications for nursing
Nurses play an important role in supporting individuals experiencing IPV and their children from ongoing intrusive consequences (Broughton & Ford-Gilboe, 2017;Wuest et al., 2006) and can take action to address post-separation abuse (Table 2).Survivors of IPV are high users of health services and their children have high health and developmental needs (Abdulmohsen Alhalal et al., 2012;Campbell et al., 2018).Adult survivors and their children may be trapped in a web of fear and violence, and the protective parent's opportunities to safeguard children may be limited or nonexistent because of structural barriers such as court orders regulating shared parenting.
Women with children who leave abusive relationships face numerous inhibitors to safety and health, including continued abuse, heightened risk for lethality, desperate need for financial resources and the risk of being separated from their children through the family court system (Abdulmohsen Alhalal et al., 2012).Controlling and threatening, but non-physically violent, behaviours have rarely been viewed as violence by policymakers, law enforcement and the legal system (Crossman et al., 2016;Stark & Hester, 2019).Yet our biology adapts to living in threatening environments, and children are especially sensitive to threats in their environment.Both exposure to IPV and parental separation or divorce are two adverse childhood experiences (ACEs) that are linked in a dose-response relationship to adverse health consequences through the lifespan (Felitti et al., 1998).Mitigation of these harms is needed through ongoing nursing interventions.
Nurses can provide anticipatory guidance for women and children experiencing postseparation abuse, help them with assessing their risk of lethal or near lethal IPV such as with the Danger Assessment (Campbell et al., 2009), safety planning such as myPlan Safety App (Glass et al., 2010;Glass et al., 2017) and identifying resources to help cope.Nurses and other healthcare professionals play an important role in advocating for children to receive needed health and developmental services, including counselling.Nurses and other healthcare providers should document information in the child's medical record; nurses may need to report to Child Protective Services (CPS) on abuse and neglect, including medical neglect.
Little is known about how firearms are used for intimidation in the context of postseparation abuse (Azrael & Hemengway, 2000).Given the increased risk of lethality in the post-separation context, firearm safety is an important consideration.Nurses should ask about and document access to firearms in each parent's home and provide instruction and guidance on safe storage behaviours.Safe storage of firearms has been shown to reduce injuries and fatalities to children, including homicides and suicides (Azad et al., 2020).
Nurses can use a strength-based approach to educate and reassure mothers who are experiencing post-separation abuse about the healing power of safe, supportive and nurturing relationships for children (CDC, 2019).Cultivating positive childhood experiences and parent-child connection can be a powerful source of healing for children and mitigate the harms they are experiencing from ongoing post-separation abuse (Bethell, Gombojav, & Whitaker, 2019;Bethell, Jones, et al., 2019).
Healthcare professionals need to be aware of the ways in which family court judicial decisions can act as a barrier to the health and safety for women and children exposed to IPV in the post-separation context.The criminal legal system has been examined for exacerbating health disparities, but the same attention has not been placed on the civil legal system, despite the family court's role as a determinant of children's health outcomes by regulating the child's environment.Judges have wide discretion in crafting orders and can implement significant guardrails to protect individuals exposed to IPV from further violence and harassment.Supervised visitation and/or exchanges, and other provisions to reduce risk such as refraining from alcohol and other substances during visitation may help keep mothers and children safe from abuse, but given the costs associated may not be available in all jurisdictions and are no panacea (Pond & Morgan, 2008;Spearman et al., 2022).Nurses can advocate for policies and judicial training that is trauma-informed and promotes understanding the complexities and nuances of the ways in which abusers continue to harass their former partners when they share children (Eilers, 2019).

| Limitations
A limitation to this concept analysis is a lack of quantitative data on the incidence, prevalence, severity and health consequences of post-separation abuse.Co-parenting conflict has been studied separately from co-parenting in the context of IPV (Hardesty et al., 2019), or they have been lumped together making it difficult to differentiate post-separation abuse from non-abusive conflict.Given the implications of fear and threat on children's neurodevelopment (McLaughlin et al., 2014), understanding the implications of postseparation abuse on children's health and well-being is an important area for future study.Little empirical data exists on how post-separation abuse may change over time (Hardesty et al., 2017), and chronicity and frequency of exposure to post-separation abuse are factors that need to be explored.Another significant limitation is the lack of attention to diverse populations in the studies reviewed for this concept analysis.This is a significant gap that needs to be addressed to understand the intersectional vulnerabilities in the post-separation context for those with historically marginalized and minoritized identities.Most studies reviewed were from high-income countries, and reflected heterosexual partnerships.Future work should investigate how post-separation abuse varies across legal jurisdictions, across gender and across same sex partnerships.Because of the financial resources required to access the civil legal system in the United States and elsewhere, future work should also address how post-separation abuse varies across socio-economic circumstances.

Author
Identifying factors that predict women's inability to maintain separation from an abusive partner.

Canada
Nursing Quantitative Anderson and Saunders (2003) Leaving an abusive partner: an empirical review of predictors, the process of leaving, and psychological well-being.A concept analysis of post-separation abuse.