Community Health Center Intervention for Intimate Partner Violence<br>

描述（由申请人提供）：本申请涉及广泛的挑战领域（09）：健康差距和具体的挑战主题，09-MD-103*：启动创新干预措施，以防止家庭暴力。亲密伴侣暴力造成的不利的情感和身体健康负担福尔斯不成比例地落在低收入妇女身上，助长了暴力的代际传递和城市少数群体中的健康差距。在卫生保健机构就诊的患者中的高患病率为IPV风险识别、早期干预和预防提供了充足的机会。然而，在呼吁进行常规筛查20年后，仍然没有证据表明IPV筛查可以改善受虐待妇女的结局。这在很大程度上是因为尚未实施切实有效的常规筛查方法，而且鉴于缺乏对IPV识别的适当全系统响应，供应商不愿意发起讨论。我们的建议建立在强有力的初步工作的基础上，发现允许患者自我披露IPV风险作为社会健康调查的一部分，显着增加了IPV的识别。然而，仅凭IPV识别并不能减少家庭暴力。我们的多学科研究团队包括费城公共卫生部（PDPH），以社区为基础的宣传组织，安全家庭研究所，费城健康联合会及其创新的家访宣传计划，以及Brown Partners，一家当地的社会营销公司，专门设计适合文化的健康促进信息。同时，我们提出了一个大规模的示范项目，采用准实验设计，以评估多层次干预对IPV检测和社会工作咨询的影响。干预的四个组成部分是：（1）有效的社会健康筛查程序;（2）提供者培训和社会营销，以提高IPV意识，并提高临床医生对他们解决和转诊IPV能力的信心;（3）由受过专门培训的社会工作者为男性和女性患者提供以IPV为重点的动机咨询;以及（4）以社区为基础的家庭倡导者提供社会支持，并帮助受虐待妇女获得资源。除了示范试验外，还将进行一项试验性治疗研究，招募60名受虐待妇女，以评估干预措施的可接受性、可行性和收集大型随机对照试验所需数据的程序。未来随机对照试验的目标是检验多层次干预措施在改善受虐待妇女结局方面的有效性。与减少差距和经济刺激的目标相一致，该项目建立了以社区为基础的研究基础设施。它将在费城卫生部的四个社区卫生中心进行，为50，000名低收入主要是少数民族患者提供服务，并将创造6个新的全职工作岗位。

DESCRIPTION (provided by applicant): This application addresses broad Challenge area (09): Health Disparities and the Specific Challenge Topic, 09-MD-103*: Initiating Innovative Interventions to Prevent Family Violence. The adverse emotional and physical health burden of intimate partner violence (IPV) falls disproportionately on low income women, contributing to intergenerational transmission of violence and to the health disparities seen in urban minority populations. High prevalence rates among patients seen in health care settings provide abundant opportunity for IPV risk identification, early intervention and prevention. However, after two decades of calls for routine screening, there is still no evidence that IPV screening improves outcomes for abused women. In large part this is because practical effective routine screening methods have not been implemented and providers have been reluctant to initiate the discussion given the lack of adequate system-wide responses to IPV identification. Our proposal builds on strong preliminary work that finds allowing patients to self- disclose IPV risk as part of a social health survey significantly increases identification of IPV. However, IPV identification alone will not reduce family violence. Our multi-disciplinary research team includes the Philadelphia Department of Public Health (PDPH), community-based advocacy organization, Institute for Safe Families, Health Federation of Philadelphia with its innovative home visiting advocacy program, and Brown Partners, a local social marketing firm specializing the design of culturally-appropriate health promotion messages. Together, we propose a large scale demonstration project using a quasi-experimental design to evaluate the impact of a multi- level intervention on IPV detection and social work counseling. The four intervention components are (1) an effective social health screening procedure 2) provider training and social marketing to increase IPV awareness and elevate clinician confidence in their ability to address and refer IPV; (3) IPV- focused motivational counseling for male and female patients by specially trained social workers; and (4) community-based family advocates providing social support and help linking abused women to resources. In addition to the demonstration trial, a pilot treatment study will recruit 60 abused women to assess intervention acceptability, feasibility and procedures for collecting data needed for a large randomized controlled trial. The goal of the future RCT will be to test the effectiveness of the multi-level intervention for improving outcomes for abused women. Consistent with the goals of reducing disparities and economic stimulus, this project builds community-based research infrastructure. It will be conducted in four Philadelphia Health Department community health centers serving 50,000 low income primarily minority patients, and will create 6 new FTE jobs.