Assessment of Survivor and Provider Perception of Trauma and Violence Informed Care Among Black Women (ASAP-TVIC in Black Women)

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Rates of intimate partner violence (IPV) homicides are three-fold higher among Black women and IPV-related deaths rob Black women of at least a decade of life relative to White women. Lifetime IPV prevalence is also higher among Black (50%) than White (35%) women. This persistent and disproportionate impact of IPV for Black women strongly suggests the need for an intersectionality framework to inform IPV intervention and prevention services for Black women delivered by health care providers. The American College of Obstetrics & Gynecology (ACOG) recommends routine IPV screening and supports implementation of `trauma-informed care with close attention to avoiding stigmatization and prioritizing resilience'. As a Tennessee-based HBCU, Meharry Medical College is ideally positioned to heed ACOG's call to action. We propose the use of an intersectionality framework to inform the adaptation, implementation and evaluation of clinic-based trauma and violence informed care (TVIC) intervention. Meharry is home to an evidence-based trauma-informed care intervention for HIV care; this intervention will inform our IPV focused intervention's development. To support women's health equity and actualize ACOG recommendations, we propose the adaptation, implementation, and rigorous evaluation of an innovative TVIC intervention. By using an intersectionality framework in the adaptation of our TVIC intervention, we seek to ensure its relevance for Black women. Our primary goal is the adaptation, implementation and evaluation of a TVIC intervention designed for Black women in Central Tennessee. In this 5-year RCMI project, we propose 3 aims. Aim 1) Engage a stakeholder committee of patients, providers, and experts (COPE) to adapt a trauma & violence informed care (TVIC) intervention for Black women and their healthcare providers at Meharry. [Years 1-2]. Aim 2) Implement and prospectively evaluate the adapted TVIC intervention at the healthcare provider-level, measuring changes in Meharry healthcare provider's self-efficacy for TVIC implementation and alignment with TIC knowledge, attitudes, and practices. [Years 2-3] Aim 3) Implement the adapted TVIC intervention at the patient-level to provide trauma- informed IPV screening, brief interventions, and referrals to treatment (SBIRT), and rigorously evaluate this TVIC intervention's impact on the primary outcome of patient-perceived usefulness of intervention and reported linkage to IPV services, and the secondary outcome of changes at the clinic-level relative to climate and culture, through a non-randomized pragmatic trial design. [Year 4-5]. Meharry's mission of `advancing health equity through innovative research' and `compassionate health services' make this HBCU an ideal setting for this innovative and impactful research. This research has the potential to transform the care Black women who experience IPV receive with the goal of addressing the disproportionate impact IPV has for Black women. Early detection of IPV via universal screening coupled with IPV-related trauma-informed care can reduce the range of IPV-associated mental and physical health consequences and medical costs, estimated at $2.1 trillion USD.