Developing Comprehensive Screening and Treatment for Intimate Partner Violence Perpetration

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Background: Intimate partner violence (IPV) is a major public health concern with significant negative consequences for those who experience it and wide-ranging impact on children, families, and the healthcare system. However, IPV is an especially prevalent health issue for Veterans, who are at increased risk of both experiencing and perpetrating IPV. More than one out of three women Veterans experience IPV and up to 60% of Veteran men report IPV perpetration. Although VHA currently recommends routine screening of IPV experiences among women Veterans, no guidelines or instruments currently exist for IPV perpetration screening. Moreover, effective intervention development for IPV perpetration is in its infancy with no evidence- based individual treatment available for IPV perpetration. In order to improve Veterans' health and reduce rates of IPV, effective and acceptable screening and treatment for IPV perpetration must exist. Significance/Impact: IPV perpetration detection, followed by behavioral intervention, are urgently needed for IPV cessation and improved health of Veterans with these common presenting problems. Yet there has been little progress to develop tools and procedures for IPV perpetration, and no guidelines on best practices for IPV perpetration screening or treatment exist. The findings of the proposed research will improve the health and functioning of Veterans and their families, enhance much needed healthcare response for this population, and inform VHA national efforts for IPV response among Veterans. Innovation: This project is innovative in its focus on IPV perpetration. With the majority of IPV research focusing on IPV victimization, there is currently a significant gap in knowledge related to IPV perpetration, including limited tools and procedures with which to address perpetration of IPV among Veterans. Enhancing services for those who experience IPV is essential, but insufficient. In order to reduce and prevent IPV, a comprehensive healthcare response necessitates implementing validated screening to detect IPV perpetration among Veterans and developing intervention protocols to address IPV perpetration. Completion of the CDA research aims will provide VHA with the data and tools necessary to inform IPV efforts, practices, and policy. Aims: The primary objective of this research is to decrease IPV among Veterans. To do so, we must have effective and acceptable tools and protocols. Aim 1: Evaluate the psychometric properties and cut-scores of a previously developed IPV screening tool. Aim 2: Identify an effective IPV perpetration intervention process and essential treatment components and develop an intervention manual. Aim 3: Conduct a pilot study of the IPV perpetration manualized intervention in a sample of Veterans. Methodology: For Aim 1, we will calculate the sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios of the screening instrument in comparison to the reference standard in a sample of [male] Veterans (n=113). To achieve Aim 2, we will a) engage in a consensus process with IPV experts to select intervention components from four pre-existing treatment models; b) solicit Veterans’ feedback through focus group discussions (n=4 focus groups); and c) refine the intervention, develop intervention manual, and present manual to stakeholders. For Aim 3, we will use a pre-post design to assess feasibility, safety, acceptability, and satisfaction (primary outcomes) and patient- and partner-reported changes on indicators of psychosocial health (secondary outcomes) among Veterans (n=20). Next Steps/Implementation: Research proposed in this CDA will provide the necessary groundwork for developing and implementing screening and intervention for IPV perpetration among Veterans, a critical need in VA care. Completion of these aims will inform an IIR proposal, to further evaluate and implement VHA's IPV perpetration response. Specifically, I will use findings from the CDA to refine the manualized IPV perpetration intervention, which I will then test in a larger Hybrid Type 1 effectiveness-implementation trial.