Development and Evaluation of an Intervention to Address Intimate Partner Violence (IPV)

Background: The self-reported prevalence of intimate partner violence (IPV) in families served by the Nurse-Family Partnership (NFP) program is higher than IPV in the general population. The presence of IPV attenuates the program’s effectiveness in preventing child maltreatment. However, the home visiting context provides a unique opportunity to deliver services to women exposed to IPV given the development of a therapeutic nurse-client relationship and opportunities to assess the quality of interpersonal relationships.

Purpose: To describe the process for developing and evaluating an IPV intervention to identify and respond to current or past IPV among young, low-income pregnant women and first-time mothers enrolled in the NFP.

Methods:An exploratory multiple case study was conducted in 4 NFP agencies to identify core components of the IPV intervention. Problem, practice and needs analyses were conducted through eight focus groups with 27 nurses and multiple interviews with NFP clients exposed to IPV (n=20) and community stakeholders (n=22). The principles of conventional content analysis and constant comparison guided all coding and data synthesis. The effectiveness of the intervention is currently being evaluated in a 15-site RCT. Also, a process evaluation is being conducted to document strategies for the implementation of the IPV intervention into practice at the clinical and organizational levels.

Results: An IPV intervention was developed that uses novel approaches for identifying and responding to IPV disclosures; assessing a client’s level of risk associated with IPV and then delivering a tailored intervention based on a client’s level of readiness to address safety in her relationship. The intervention includes a comprehensive program of nurse education, supervisory guidelines, coaching, organizational guidelines and a clinical pathway that guides nurses through the intervention and includes facilitators and instructions for each component. In the process evaluation, nurses identify that the intervention is resulting in an increased number of IPV disclosures from clients earlier in the program and providing clear direction on how to increase client awareness of IPV impact on maternal-child health, utilize active system navigation, enhance client self-efficacy and adopt new safety strategies.

Discussion: The use of qualitative methods formatively resulted in the development of an IPV intervention grounded within the context of the NFP. This process led to a more informed understanding of intervention strategies that could be helpful to women, enhancing the relevance of the intervention for NFP clients and reinforcing its credibility and applicability for nurse home visitors.