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）是女性退伍军人的主要健康问题。IPV是关联的 身体和精神上都有很多问题VHA正在实施IPV筛查 识别去年经历IPV的女性患者的计划。尽管有确凿证据 筛查增加了IPV的检测，但关于如何干预的研究较少， 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- 基础的干预措施对健康和福祉的影响最小，可能是因为它们 过于简短和笼统。作为回应，PI通过以下方式开发了从IPV中恢复 优势和授权（RISE），基于IPV相关的医疗保健需求， 女性退伍军人的偏好。RISE旨在在初级保健中提供， 个性化、可变长度、基于模块的干预，解决1）安全规划; 2） IPV对健康影响的教育; 3）提高应对技能和自我护理; 4）提高 社会支持; 5）做出困难的决定; 6）与资源联系。 目标 这项提案的目的是完善和正式评估为退伍军人提供的提高收入和社会保障服务， 体验IPV。目标是：1）调整和完善RISE，以适应 在不同的初级保健环境中的服务结构和人员; 2）进行形成性的 与女退伍军人一起评估“提高妇女地位战略”， 实施方案和干预手册;以及3）研究RISE对妇女的影响 退伍军人的个人心理结果。 方法 我们将在两个基于妇女健康实践的研究中进行拟议的研究。 网络站点（Boston，MA和West Haven，CT）。对于目标1，我们将定制和完善RISE 通过利益攸关方咨询委员会的投入，与退伍军人妇女（n=24- 32），并与供应商的访谈（n=24）。为了实现目标2，我们将进行一次形成性的开放式培训， RISE试验（n= 20名女性退伍军人）。患者的定性和定量结果 供应商将告知用户友好的，量身定制的实施协议的开发 干预手册。对于目标3，我们将进行混合1随机临床试验（n=60） 检查RISE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。这个项目将有助于 通过评估以患者为中心的针对女性的IPV干预来实现这些目标 退伍军人的需求，偏好和情况。必须补充当前的VHA IPV筛查工作与有效干预。RISE填补了我们的一个基本的未满足的需求 医疗保健系统，确保经历IPV的女性退伍军人获得护理， 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.