Addressing Intimate Partner Violence Among Women Veterans
Condition: Intimate Partner Violence
Study type: Interventional

Summary: 
      Up to 20% of women Veterans (WV) using VHA primary care experience past-year intimate partner
      violence (IPV), which contributes to numerous physical and mental health conditions,
      including suicidality. Despite national recommendations to screen WVs for IPV, there is low
      adoption of IPV screening programs in primary care. In response, VHA is spreading IPV
      screening programs in Women's Health Model 1 and Model 2 primary care clinics, where the
      majority of WV VHA primary care patients receive care. The systematic and effective
      implementation of IPV screening programs within primary care clinics is expected to enhance
      care for WVs as well as improve access to, and timeliness of, IPV-related care. Given the
      high prevalence of IPV among WVs and its significant negative health effects, successful
      implementation of IPV screening programs is expected to reduce morbidity among WV VHA
      patients. This stepped wedge hybrid II implementation/effectiveness study will assess efforts
      to implement routine IPV screening for WV VHA patients.
    

Detailed description: 
      Background: Intimate partner violence (IPV) is common among women Veterans (WVs), with nearly
      20% of WVs treated in Veterans Health Administration (VHA) primary care clinics experiencing
      past-year IPV. VHA's Women's Health Services (WHS), the IPV Assistance Program, and the
      Offices of Primary Care and Mental Health and Suicide Prevention developed recommendations
      for implementing IPV screening programs in primary care. More than two-thirds of WV primary
      care patients receive care in "Model 1" (i.e., mixed-gender primary care) and "Model 2"
      (i.e., separate but shared space) clinics, but uptake of screening is low in these clinics.
      WHS therefore plans to use Blended Facilitation (BF) to roll out IPV screening programs in
      Model 1 and Model 2 primary care clinics. Given the high number of these clinics throughout
      VHA, it is unclear whether resource-intensive BF is feasible and whether a less intensive
      strategy (i.e., toolkit + Implementation as Usual [IAU]) can be effective. Research is also
      needed on the clinical effectiveness of IPV screening programs.

      Significance/Impact: Given the high prevalence of IPV among WVs and its significant health
      effects, successful implementation of IPV screening programs is expected to improve
      healthcare services and reduce morbidity among WV VHA patients, an HSR&D priority area.

      Innovation: This study will be the most comprehensive evaluation of both the implementation
      impact and clinical effectiveness of IPV screening programs globally. It is innovative in its
      inclusion of four strong VHA operations partners dedicated to successful implementation of
      IPV screening programs. This project capitalizes on a time-sensitive opportunity to advance
      IPV screening programs and implementation science.

      Specific Aims: This objective of this proposal is to comprehensively evaluate two strategies
      for implementing IPV screening programs through achieving three specific aims.

        1. Evaluate the degree of reach, adoption, implementation fidelity, and maintenance
           achieved using two implementation strategies for IPV screening programs.

        2. Evaluate the clinical effectiveness of IPV screening programs, as evidenced by
           disclosure rates and post-screening psychosocial service use.

        3. Identify multi-level barriers to and facilitators of IPV screening program
           implementation and sustainment.

      Methodology: The investigators propose a cluster randomized, stepped wedge, Hybrid Type II
      program evaluation design to compare the impact of two implementation strategies (BF +
      toolkit vs. toolkit + IAU) and the clinical effectiveness of IPV screening programs. This
      study will use a mixed methods approach to collect quantitative (clinical records data) and
      qualitative (key informant interviews) implementation outcomes (Aims 1 and 3), as well as
      quantitative (clinical records data) clinical effectiveness outcomes (Aim 2). The
      investigators will supplement these data collection methods with surveys to assess
      implementation strategies survey to be completed pre-BF, post-BF, and in the maintenance
      phase. The integrated-Promoting Action on Research Implementation in Health Services
      (i-PARIHS) framework will guide the qualitative data collection and analysis. Summative data
      will be analyzed using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM)
      Framework.

      Next Steps/Implementation: This study's four VHA operations partners are eager to use the
      study results to inform future implementation strategies and clinical practices to spread IPV
      screening programs to all VHA primary care clinics and other clinical settings so that this
      vital intervention is accessible to all WV VHA patients.
    

Intervention name(s): Blended Facilitation; Implementation as usual; Toolkit
Intervention type(s): Other; Other; Other
Intervention description(s): Blended facilitation consists of an External Facilitator and Internal Facilitator to support adoption of intimate partner violence screening practices for WVs treated in primary care.; Implementation as usual refers to traditional, site-initiated support for screening practices to detect intimate partner violence among WVs treated in primary care.; All study arms will feature a toolkit meant to guide sites' adoption of intimate partner violence screening among WVs treated in primary care.
Allocation: Randomized
Intervention model: Crossover Assignment
Intervention model description: Hybrid type II implementation-effectiveness design; stepped wedge
Masking: None (Open Label)
Primary purpose: Screening
Keywords: intimate partner violence; women Veterans; screening; primary care