Internet-Based Intervention to Improve Mental Health Outcomes for Abused Women
Condition: Domestic Violence
Study type: Interventional

Summary: 
      The purpose for this trial is to test the effectiveness of the first interactive
      internet-based safety decision aid on abused women's exposure to repeat intimate partner
      violence (IPV) and mental health outcomes. An improved safety decision-making process (e.g.,
      knowing the advantages and disadvantages of the relationship, having enough information to
      make a decision) will increase safety-seeking behaviors which in turn will decrease exposure
      to repeat IPV and improve mental health outcomes. Findings from the development and initial
      test of our computerized safety decision aid suggests that it offered abused women privacy to
      consider personalized safety options, informed them about danger in their relationship and
      would be used again if they had access to it through a safe internet site.

      The investigators are conducting a five year experimental trial in four states (Oregon,
      Maryland, Missouri, and Arizona) to address the following aims:

        1. Test the effectiveness of an interactive internet-based safety decision aid on abused
           women's safety seeking behaviors and exposure to violence compared to women assigned to
           control websites. The investigators hypothesize that at three, six, and 12 months
           post-baseline the intervention group will have increased safety seeking behaviors and
           reduced IPV exposure in comparison to the control group.

        2. Test the effectiveness of an interactive internet-based safety decision aid on abused
           women's mental health compared to women assigned to control websites. The investigators
           hypothesize that at three, six, and 12 months post-baseline the intervention group will
           have improved mental health in comparison to the control group.

        3. Test if the effect of an interactive internet-based safety decision aid on abused
           women's mental health and exposure to violence is mediated by the safety decision making
           process and safety-seeking behaviors. The investigators hypothesize that the
           intervention group will have a better decision making process and have greater safety
           seeking behavior over the year in comparison to the control group, and that this better
           decision process and increased safety seeking behavior will mediate improvement in
           mental health and exposure to violence at 12 months post baseline.

      This study will provide much needed new information about safety planning's impact on making
      difficult safety decisions, exposure to violence, and mental health effects.
    

Detailed description: 
      Intimate partner violence (IPV) is well established as a widespread problem with important
      negative physical and mental health, social and cost consequences for victims, their families
      and the community. Beyond the physical conditions associated with IPV, research has
      consistently demonstrated a strong association between experiencing IPV and increased rates
      of anxiety, depression, low-self esteem, substance abuse and suicidality. Increasing abused
      women's safety and reducing ongoing exposure to violence is key to minimizing such
      consequences.

      Building from the empowerment framework, safety planning interventions focus on protecting
      women from exposure to repeat violence. However, despite the significant evidence of the
      negative outcomes of IPV and the complex individual and community factors that influence
      safety, little is known about what interventions improve the safety and mental health
      outcomes of abused women. While experimental trials are beginning, to date there has not been
      a trial to examine the effectiveness of safety planning, a cornerstone of IPV interventions,
      on exposure to repeat violence, safety, and mental health outcomes for women. An
      internet-based safety decision aid may assist abused women in weighing risks and benefits of
      safety options, assessing danger, and identifying the factors that are most important in
      their safety decisions. Further, it provides personalized links with community mental health
      and domestic violence resources, which are invaluable in assisting women in planning for
      safety, thereby reducing the immediate and long terms risk of negative mental health
      consequences of violence.

      Women who consent to participate in this study and who have access to a safe computer (e.g.
      at home, work, community agency, friend/family) will be randomized to the intervention or
      control group. If a woman is randomized into the intervention group, she will complete the
      internet-based safety decision aid program. The decision aid program will be located on a
      confidential password protected and secured study website and will take approximately 60
      minutes to complete. Participants will first be asked demographic and relationship questions
      as well as questions about their ability to make decisions about safety in their
      relationship. Next, participants will be asked to make a series of comparisons to determine
      the importance of specific factors such as: keeping the abuse private, safety of self, family
      and children, feelings for partner, resources such as housing and employment and maintaining
      norms within family, to safety decisions. Participants will then be asked questions specific
      to risk factors for violence and safety seeking behaviors in their relationship. After
      completion, the safety decision aid generates results to provide an individualized safety
      plan to the participant. Women randomized into the control group will access the confidential
      and password protected control website which includes a brief assessment of risk factors and
      their history of violence, and will provide a list of local resources, but not an
      individualized safety plan. Both intervention and control group participants will then
      complete a series of instruments to measure intimate partner violence, mental health
      outcomes, and safety seeking behaviors. Each participant will have a skilled and trained
      research assistant available by phone or email to assist them in understanding questions,
      interpreting the results, developing strategies for safety and providing referrals for
      community-based services.

      Follow up sessions on the study website will be conducted at 3, 6, and 12 months
      post-baseline. Participants will be encouraged by the RA through phone or email contact to
      access the password-protected website to complete the internet session and follow-up
      assessment questions. Post-baseline questions will be the same as the baseline, but will
      focus on outcomes since the previous internet session.
    

Intervention name(s): Internet-based safety decision aid; Usual Care Safety Plan
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Participants will log into the the intervention website at baseline, 3 months, 6 months, and 12 months post baseline and receive:
Setting of priorities for safety; a "sliding bar" allows participants to establish priorities by making pairwise comparisons of importance between factors.
Danger Assessment; asks women to report on well-established risk factors for repeat violence and lethal IPV. A weighted scoring algorithm provides participants with their validated level of danger.
Personalized action plan. Based on a participant's answers to the previous sections, a list of safety strategies with links to resources will be presented to her. The participant is given the option to print her results and the personalized plan.; Participants will log into a control website at baseline, 3 months, 6 months and 12 months post baseline. Website will include the "usual services" provided to IPV survivors looking for safety planning resources on the internet. Participants will receive:
Danger Assessment, will see risk factors associated with lethal violence, but will not receive a score or feedback.
A brief emergency safety plan with links to national and state domestic violence resources as well as a suicide resource.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other
Keywords: Safety Planning