Recovering from Intimate Partner Violence Through Strengths and Empowerment (RISE): Tailoring and Evaluating a Patient-Centered Counseling Intervention for Women Veterans

背景 亲密伴侣暴力(IPV)是女性退伍军人的一个主要健康问题。IPV已关联 身体和精神健康状况众多。VHA正在实施IPV筛查 识别经历过过去一年IPV的女性患者的计划。尽管有强有力的证据 筛查增加了对IPV的检测，但关于如何干预以下问题的研究较少 在卫生保健环境中披露IPV，以改善健康结果。现有的医疗保健- 基于基础的干预对健康和福祉的影响微乎其微，可能是因为它们 太简短太笼统了。作为回应，PI通过以下方式从IPV中恢复 优势和赋权(RISE)，基于与IPV相关的保健需求和 退伍军人对女性的偏好。Rise是为初级保健而设计的，是一种 针对1)安全规划的个性化、可变长度、基于模块的干预；2) 关于IPV对健康影响的教育；3)提高应对技能和自我护理；4)加强 社会支持；5)艰难的决策；6)与资源的联系。 目标 这项提议目标是完善和正式评估女性退伍军人的崛起 体验IPV。目标是：1)量身定做和改进Rise，以适应不同的 不同初级保健环境中的服务结构和人员；2)进行形成性 评价RISE与女退伍军人一起开发一款人性化、量身定做的通知工具 实施方案和干预手册；以及3)审查RISE对妇女的影响 退伍军人的个体心理社会结果。 方法 我们将在两个以妇女健康实践为基础的研究中进行拟议的研究 网络站点(马萨诸塞州波士顿和康涅狄格州西黑文)。对于目标1，我们将量身定做和完善Rise 通过利益攸关方咨询委员会、女退伍军人焦点小组(n=24- 32)，并与提供者面谈(n=24)。为了实现目标2，我们将进行形成性开放 上升试验(n=最多20名女性退伍军人)。来自患者的定性和定量结果 供应商将通知用户友好的、量身定制的实现协议的开发 和干预手册。对于目标3，我们将进行杂交1随机临床试验(n=60) 为了研究上升对女性退伍军人心理社会结果的影响(例如， 赋权、自我效能、健康和服务使用)。 对退伍军人医疗保健的预期影响 VHA的卓越蓝图确定了以患者为中心和“推进创新 妇女退伍军人保健“作为关键的战略转型战略。这个项目将会有所帮助 通过评估为女性量身定做的以患者为中心的IPV干预来实现这些目标 退伍军人的需求、偏好和环境。补充现有的VHA势在必行 有效干预下的IPV筛查工作。Rise填补了我们的一个基本的未得到满足的需求 医疗体系，确保经历IPV的女性退伍军人得到 以改善健康和心理社会结果。

Background Intimate partner violence (IPV) is a major health concern for women Veterans. IPV is associated with numerous physical and mental health conditions. VHA is implementing IPV screening programs to identify female patients who experience past-year IPV. Despite strong evidence that screening increases detection of IPV, less is established about how to intervene following IPV disclosure in health care settings, in order to improve health outcomes. Existing healthcare- based interventions result in minimal effects on health and well-being, likely because they are too brief and generic. In response, the PI has developed Recovering from IPV through Strengths and Empowerment (RISE), based on the IPV-related health care needs and preferences of women Veterans. RISE is designed to be delivered in primary care and is an individualized, variable-length, modular-based intervention that addresses 1) safety planning; 2) education on the health effects of IPV; 3) increasing coping skills and self-care; 4) enhancing social support; 5) making difficult decisions; and 6) connecting with resources. Objectives The objective of this proposal is to refine and formally evaluate RISE for women Veterans who experience IPV. The aims are to: 1) tailor and refine RISE to accommodate differences in service structures and personnel in different primary care settings; 2) conduct a formative evaluation of RISE with women Veterans to inform the development of a user-friendly, tailored implementation protocol and intervention manual; and 3) examine the effects of RISE on women Veterans’ individual psychosocial outcomes. Methods We will conduct the proposed research at two Women’s Health Practice-Based Research Network sites (Boston, MA and West Haven, CT). For Aim 1, we will tailor and refine RISE through input from a Stakeholder Advisory Board, focus groups with Women Veterans (n=24- 32), and interviews with providers (n=24). To achieve Aim 2, we will conduct a formative open trial of RISE (n=up to 20 women Veterans). Qualitative and quantitative findings from patients and providers will inform the development of a user-friendly, tailored implementation protocol and intervention manual. For Aim 3, we will conduct a Hybrid 1 randomized clinical trial (n=60) to examine the effects of RISE on women Veterans’ psychosocial outcomes (e.g., empowerment, self-efficacy, health, and service use). Anticipated Impacts on Veteran’s Health Care VHA’s Blueprint for Excellence identifies patient-centeredness and “advancing innovations in women Veterans’ health care” as key strategic transformational strategies. This project will help achieve these aims by evaluating a patient-centered IPV intervention that is tailored to women Veterans’ needs, preferences, and circumstances. It is imperative to complement current VHA IPV screening efforts with an effective intervention. RISE fills an essential unmet need in our healthcare system, ensuring that women Veterans who experience IPV receive care that leads to improved health and psychosocial outcomes.