Program Profile: Telephone Support Services for Victims of Intimate Partner Violence Recruited from a Midwestern Pediatric Emergency Department

This program provided resources via telephone to women victimized by intimate partner violence (IPV). It provided referrals to community programs, helped participants overcome barriers to obtaining services, and provided social support. The program is rated Ineffective. Results showed no statistically significant differences between the treatment and comparison groups on IPV victimization, feeling vulnerable to someone, depression, and posttraumatic stress disorder.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals/Target Population    

Telephone Support Services (TSS) was designed to reduce intimate partner violence (IPV) victimization and improve health among women who reported IPV in the past year. Assessment of IPV victimization occurred among women who were in the pediatric emergency departments with a child. Because it was delivered by telephone and reduced the travel time involved in providing face-to-face services, the program aimed to minimize the time demands for both interventionists and participants. It was also designed to overcome known barriers for women who have been victimized by IPV but who have not pursued services because of 1) lack of knowledge of community resources, 2) not having someone to confide in, and 3) privacy concerns.

Services Provided        

TSS consisted of five phases (assessment, implementation, monitoring, a second implementation phase, and termination) that relied on motivational interviewing (MI), a nonconfrontational, nonjudgmental style of communication. MI specifies the interventionist should respect the women’s priorities, help them develop their own reasons for seeking change, use reflective listening to demonstrate they are listening to the women’s viewpoint, ask permission to give their input, and then affirm the women’s right to make their own decisions about making choices and seeking additional assistance. The interventionists adhered to MI principles by following the women’s lead throughout conversations and not recommending a specific course of action unless there was a threat of imminent danger.

The program was designed to provide 12 phone calls for a total duration of 6-12 hours over 6 months to each client. During the assessment phase, an interventionist educated the identified victim about a diverse range of community resources and learned which types of services she wished to pursue. In the implementation phase, the interventionist worked with the woman to identify the most appropriate agencies to provide those resources, using a resource manual of 124 agencies across 23 domains (e.g., legal assistance, financial assistance, or day care). During the monitoring phase, the interventionist made follow-up telephone calls to assess progress and provide assistance. In the second implementation phase, the interventionist checked in with the woman to assess any changes in priorities and to provide any additional referrals. During the termination phase, the interventionist worked to identify final relevant resources to equip the woman for the end of the TSS calls.

Key Personnel      

Registered nurses trained in MI served as the interventionists. They were supervised and advised by a clinical psychologist who was also trained in MI.

Study

Stevens and colleagues (2015) conducted a randomized controlled trial that compared the efficacy of Telephone Support Services (TSS) with enhanced usual care (EUC) for female victims of intimate partner violence (IPV). The study was conducted with English-speaking women who self-reported IPV victimization in the past year while in a midwestern pediatric emergency department (ED) between September 2008 and July 2010. The ED used computerized screenings for IPV. If a respondent endorsed IPV, an ED social worker was immediately paged via text to provide standard-of-care assessment and referral assistance.

Women were eligible for the trial if they met the following five criteria: 1) they reported IPV victimization within the past year through the computerized safety screening or through routine conversations with ED staff; 2) they resided in the county where the ED was located; 3) they had at least partial custody of the pediatric ED patient; 4) they were seen in the ED during shifts when a research assistant was available, to explain the study and obtain consent for participation; and 5) they had the opportunity to learn about the study in a private and safe fashion (e.g., it was easy to separate the women from a possible perpetrator while in the ED). The study was described to the women, and consent procedures were followed while still in the ED. Those who agreed to participate were contacted at home and asked to complete a baseline assessment.

A total of 253 women completed the baseline assessment, after which 129 were assigned to the TSS condition, and 124 were assigned to the EUC control condition. Initial phone calls to both groups began with questions about the child’s recent visit to the ED and follow up on any non-IPV injury concerns that the woman had endorsed through the computerized safety screening. At this point, the interventionist who had called the comparison group concluded the call; further calls were made only to seek updated contact information for follow-up assessments. However, the initial call continued for the treatment group, with participants beginning to receive the five advocacy phases of the TSS program. TSS participants completed on average 4.7 calls for a total duration of 81.1 minutes.

The TSS participants were all female, with an average age of 28.8 years. The participants were 46.5 percent white, 45 percent African American, 1.6 percent Hispanic, 1.6 percent Asian American, and 5.4 percent were multiracial or from other racial or ethnic groups. A total of 55 percent of the TSS participants were single, 81 percent had Medicaid or public insurance, and the average age of their child was 5.1 years old. The comparison group participants were also all female, with an average age of 29.5 years. The control participants were 51.6 percent African American, 37.1 percent white, 1.6 percent Hispanic, 0.8 percent Asian American, and 8.9 percent were multiracial or from other racial or ethnic groups. A total of 60.3 percent of the EUC group was single, 80.2 percent had Medicaid or public insurance, and the average age of their child was 6.4 years. There were no statistically significant differences between the two groups on the demographic variables. At baseline, the two groups also did not differ on any clinical variables (e.g., total depression or PTSD score) or abuse variables (e.g., total composite abuse scale, women’s experience with battering, relationship status or cohabitation with the person who perpetrates the abuse) except that those in the TSS group were more likely to have experienced police involvement for IPV victimization by the individual than those in the EUC group.

IPV was measured at baseline, at 3 months (the midpoint of the intervention), and at 6 months (at the end of the intervention) using two measures: 1) the Composite Abuse Scale (Hegarty et al. 2005), which is a 30-item measure that assessed physical, sexual, and emotional IPV victimization, for which scores of 7 or higher denoted IPV exposure; and 2) the Women’s Experience with Battering Scale (Smith et al. 1995), which is a 10-item measure that assessed chronic feelings of vulnerability to a person. Two mental health measures were also used: 1) The Center for Epidemiological Studies Depression Scale (Radloff, 1977), a 20-item scale; and 2) The Posttraumatic Stress Disorder Checklist (Blanchard et al. 1996), a 17-item scale.

The study authors conducted a pre-post design comparing the intervention and control groups on the 6-month variables, using baseline measures for each variable as covariates. T-tests and Chi-Squares were used to detect differences in means. Dosage subgroup analyses were conducted.

Two registered nurses, one with a master’s degree and one with an associate’s degree, served as the interventionists. Each nurse had several years of nursing and clinical research experience and was selected for her nonconfrontational, empathetic interpersonal style. Each completed 32 hours of initial training (16 hours were spent attending a 2-day workshop on MI, and 16 hours were spent becoming familiar with the local community resource manual and role playing with the principal investigator [PI] of the study). The PI was a licensed psychologist who had also completed a 2-day MI training session and had 2 years’ experience providing MI consultation to other health care providers. Additionally, the PI provided approximately 90 minutes of face-to-face consultation with each nurse per month, and responded approximately two to four times per month via pager, telephone, or email to additional requests for information from the nurses (Stevens et al. 2015).

Subgroup Analysis

Analyses of dosage indicated no statistically significant differences in outcomes by program dosage. Specifically, the number of completed phone calls and duration of completed phone calls did not predict 6-month intimate partner violence (IPV) levels after controlling for baseline IPV levels (Stevens et al. 2015).

These sources were used in the development of the program profile:

These sources were used in the development of the program profile: