Intimate Partner Violence
Conditions
Keywords
Intimate Partner Violence, Sheltered Battered Women, Substance Use
Brief summary
This study developed and assessed an innovative, high-reach, easily implementable, low-cost computer-delivered intervention (Safe and Healthy Experiences; The SHE Program) that addresses known barriers in early identification and intervention with sheltered battered women with IPV (intimate partner violence) and substance use.
Detailed description
Intimate partner violence (IPV) and substance use are significant and interconnected public health problems facing women. For battered women, the presence of substance use increases the risk of revictimization and the risk of more severe abuse. Battered women's shelters provide emergency shelter to approximately 300,000 women and children each year. A prime time to intervene with battered women might be when they enter a shelter and have already initiated a change in their lives. A shelter-based intervention for battered women that addresses substance use problems might reduce the risk of substance use, reduce the risk of future IPV, and improve utilization of substance use treatment and community resources. The objective of this R34 Award was to develop and assess an innovative, easily implementable, low-cost, computer-delivered intervention, the SHE Program (Safe and Healthy Experiences) that addresses known barriers in early identification and intervention for battered sheltered women with substance use issues. SHE is based on motivational interviewing (MI) a well-defined intervention strategy that has yielded particularly promising results in a range of clinical issues and a range of patient populations, including substance using women. MI is consistent with an empowerment model, which is a highly recommended intervention model for victimized women. The R34 had two distinct phases to assess the SHE Program with battered sheltered women with substance use issues. During the Development Phase, the research team conducted focus groups and developed the intervention to meet the needs of our target group, developed the software for the computer-delivered intervention, and conducted an open trial with 10 participants. During the Pilot Study Phase, the investigators conducted a two-group, randomized controlled study with a sample of 50 battered sheltered women who reported substance use difficulties within the last three months, which provides the necessary groundwork to examine the efficacy of the SHE Program in a future, large clinical trial. The SHE Program was found to be feasible, acceptable and efficacious in improving outcomes for our vulnerable target population. The program has the potential to be widely disseminated while maintaining treatment fidelity across battered women shelters and may hold promise for IPV populations with substance use difficulties in other settings.
Interventions
BEHAVIORALSHE Program
The SHE program is specifically tailored, innovative and relevant to diverse, racial, and ethnic sheltered, battered women in a number of ways including the images and content used in the intervention. It is also tailored to participants' alcohol or substance use status, and designed to reach participants across levels of motivation for change. The content of SHE is theory-driven, consistent with the motivational interviewing model of behavior, and consistent with the literature on effective interventions that address IPV and substance use.
Sponsors
National Institute on Drug Abuse (NIDA)
Women and Infants Hospital of Rhode Island
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Women who are 18 or older, residents of a battered women's shelter, who are at risk substance users within the last 3 months as determined by the screener, the NIDA-Modified ASSIST, and endorse IPV within the last 3 months as determined by the screener, the WAST (Woman Abuse Screening Tool)
Exclusion criteria
* Inability to provide informed consent (e.g., due to florid psychosis or other clear cognitive impairment) * Inability to understand English
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Alcohol and Substance Use: Timeline Follow-back (TLFB)-Modified Computer Version | Assessed at baseline, and at 3 and 6 months post shelter | The computer-based TLFB will assess drug use and heavy drinking (4+ standard drinks) days for the past week and the past 90 days. For primary analysis, days using drugs and heavy drinking days will be combined to create a single variable that reflects the total number of days that women used drugs or had 4+ drinks. The primary outcome is substance use (heavy drinking or drug using) days over a 6 month post shelter period. We are assessing the change of this number from baseline to 3 months post shelter, and from baseline 6 months post shelter. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The Treatment Services Review (TSR) | Assessed at baseline, and again at 3 and 6 months later | The Treatment Services Review will be used to assess total times using substance use services (both treatment and self-help utilization) received (including outpatient, day patient, residential treatment, NA, AA) to capture the extent to which women are reaching out to access recovery-related resources. The TSR will assess number of times attending substance use services, divided by the number of days in the reporting period. |
| The Composite Abuse Scale (CAS) | Assessed at baseline, and again at 3 and 6 months after shelter release | The CAS is a widely used self-report of behaviors scale with 4 subscales that measure severe, combined abuse, emotional abuse, physical abuse, and harassment. The CAS has recently been published in the Centers for Disease Control and Prevention compendium of intimate partner violence measures. It consists of 30 items presented in a six point format requiring respondents to answer never, only once, several times, monthly, weekly or daily in a twelve month period. Below we present the CAS victimization scores. Scores range from 0 to 145; higher scores are worse. |
| The Cyber Stalking Scale | Assessed at baseline, and again at 3 and 6 months later | The Cyber Stalking Scale measure is a 6 -item measure and assesses the use of technologies in stalking and harassment. Scores range from 0 to 12. Lower is better (indicated less Cyber Stalking). |
| Safety Behavior Checklist (SBC) | Assessed at baseline, and again at 3 and 6 months after shelter release | Safety Behavior Checklist (SBC) has 15 items that assess the use of strategies suggested to keep victim safe (e.g., hiding money and extra clothing). Scores range from 0 to 15; higher scores are better (indicating more safety behaviors used). |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| SHE Program Participants received a 50 minute intervention on the computer immediately after their baseline assessment and a 15 minute booster session on the computer within 2 weeks after the intervention. There was also a 3 and 6 month follow-up after completion of the SHE program.
SHE Program: The SHE program is specifically tailored, innovative and relevant to diverse, racial, and ethnic sheltered, battered women in a number of ways including the images and content used in the intervention. It is also tailored to participants' alcohol or substance use status, and designed to reach participants across levels of motivation for change. The content of SHE is theory-driven, consistent with the motivational interviewing model of behavior, and consistent with the literature on effective interventions that address IPV and substance use. | 25 |
| Control Condition Control condition consisted of a series of questions regarding television show preferences and viewing a brief series of videos of popular entertainers/shows, with subsequent requests for rating of subjective preference. Participants in this condition completed a baseline assessment as well as a television show booster and a follow-up assessment 3 and 6 months later. | 25 |
| Total | 50 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lost to Follow-up | 3 | 1 |
| Overall Study | Withdrawal by Subject | 1 | 1 |
Baseline characteristics
| Characteristic | SHE Program | Control Condition | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 1 Participants | 0 Participants | 1 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 24 Participants | 25 Participants | 49 Participants |
| Age, Continuous | 35.3 years STANDARD_DEVIATION 11.4 | 35.2 years STANDARD_DEVIATION 11.5 | 35.2 years STANDARD_DEVIATION 11.3 |
| % drug using/heavy drinking days | 0.54 % drug using/heavy drinking days STANDARD_DEVIATION 0.38 | 0.66 % drug using/heavy drinking days STANDARD_DEVIATION 0.38 | 0.59 % drug using/heavy drinking days STANDARD_DEVIATION 0.37 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 5 Participants | 4 Participants | 9 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 20 Participants | 21 Participants | 41 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 10 Participants | 11 Participants | 21 Participants |
| Race (NIH/OMB) More than one race | 1 Participants | 3 Participants | 4 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 5 Participants | 0 Participants | 5 Participants |
| Race (NIH/OMB) White | 9 Participants | 10 Participants | 19 Participants |
| Region of Enrollment United States | 25 participants | 25 participants | 50 participants |
| Sex: Female, Male Female | 25 Participants | 25 Participants | 50 Participants |
| Sex: Female, Male Male | 0 Participants | 0 Participants | 0 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 25 | 0 / 25 |
| other Total, other adverse events | 0 / 25 | 0 / 25 |
| serious Total, serious adverse events | 15 / 25 | 16 / 25 |
Outcome results
Primary
Alcohol and Substance Use: Timeline Follow-back (TLFB)-Modified Computer Version
The computer-based TLFB will assess drug use and heavy drinking (4+ standard drinks) days for the past week and the past 90 days. For primary analysis, days using drugs and heavy drinking days will be combined to create a single variable that reflects the total number of days that women used drugs or had 4+ drinks. The primary outcome is substance use (heavy drinking or drug using) days over a 6 month post shelter period. We are assessing the change of this number from baseline to 3 months post shelter, and from baseline 6 months post shelter.
Time frame: Assessed at baseline, and at 3 and 6 months post shelter
| Arm | Measure | Group | Value (MEDIAN) | Dispersion |
|---|---|---|---|---|
| SHE Program | Alcohol and Substance Use: Timeline Follow-back (TLFB)-Modified Computer Version | Baseline | 0.54 % days of drug use or heavy drinking | Standard Deviation 0.38 |
| SHE Program | Alcohol and Substance Use: Timeline Follow-back (TLFB)-Modified Computer Version | 3 months post-shelter | 0.12 % days of drug use or heavy drinking | Standard Deviation 0.38 |
| SHE Program | Alcohol and Substance Use: Timeline Follow-back (TLFB)-Modified Computer Version | 6 months post-shelter | 0.21 % days of drug use or heavy drinking | Standard Deviation 0.42 |
| Control Condition | Alcohol and Substance Use: Timeline Follow-back (TLFB)-Modified Computer Version | Baseline | 0.66 % days of drug use or heavy drinking | Standard Deviation 0.38 |
| Control Condition | Alcohol and Substance Use: Timeline Follow-back (TLFB)-Modified Computer Version | 3 months post-shelter | 0.29 % days of drug use or heavy drinking | Standard Deviation 0.38 |
| Control Condition | Alcohol and Substance Use: Timeline Follow-back (TLFB)-Modified Computer Version | 6 months post-shelter | 0.16 % days of drug use or heavy drinking | Standard Deviation 0.21 |
p-value: 0.56Wilcoxon (Mann-Whitney)
Comparison: Differences between conditions in the change in % heavy drinking/using days from baseline to 6 monthsp-value: 0.76Wilcoxon (Mann-Whitney)
Secondary
Safety Behavior Checklist (SBC)
Safety Behavior Checklist (SBC) has 15 items that assess the use of strategies suggested to keep victim safe (e.g., hiding money and extra clothing). Scores range from 0 to 15; higher scores are better (indicating more safety behaviors used).
Time frame: Assessed at baseline, and again at 3 and 6 months after shelter release
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| SHE Program | Safety Behavior Checklist (SBC) | 3 months post-shelter | 4.5 score on a scale | Standard Deviation 3.4 |
| SHE Program | Safety Behavior Checklist (SBC) | 6 months post-shelter | 2.8 score on a scale | Standard Deviation 3.8 |
| SHE Program | Safety Behavior Checklist (SBC) | Baseline | 7.3 score on a scale | Standard Deviation 2.7 |
| Control Condition | Safety Behavior Checklist (SBC) | 3 months post-shelter | 5.7 score on a scale | Standard Deviation 4.9 |
| Control Condition | Safety Behavior Checklist (SBC) | 6 months post-shelter | 4.9 score on a scale | Standard Deviation 5.3 |
| Control Condition | Safety Behavior Checklist (SBC) | Baseline | 7.3 score on a scale | Standard Deviation 4 |
p-value: 0.11995% CI: [-3.24, 0.38]Mixed Models Analysis
Secondary
The Composite Abuse Scale (CAS)
The CAS is a widely used self-report of behaviors scale with 4 subscales that measure severe, combined abuse, emotional abuse, physical abuse, and harassment. The CAS has recently been published in the Centers for Disease Control and Prevention compendium of intimate partner violence measures. It consists of 30 items presented in a six point format requiring respondents to answer never, only once, several times, monthly, weekly or daily in a twelve month period. Below we present the CAS victimization scores. Scores range from 0 to 145; higher scores are worse.
Time frame: Assessed at baseline, and again at 3 and 6 months after shelter release
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| SHE Program | The Composite Abuse Scale (CAS) | Baseline | 52.8 score on a scale | Standard Deviation 22.6 |
| SHE Program | The Composite Abuse Scale (CAS) | 3 months post-shelter | 9.4 score on a scale | Standard Deviation 11.5 |
| SHE Program | The Composite Abuse Scale (CAS) | 6 months post-shelter | 14.1 score on a scale | Standard Deviation 23.8 |
| Control Condition | The Composite Abuse Scale (CAS) | Baseline | 74.4 score on a scale | Standard Deviation 40.5 |
| Control Condition | The Composite Abuse Scale (CAS) | 3 months post-shelter | 17.7 score on a scale | Standard Deviation 32.8 |
| Control Condition | The Composite Abuse Scale (CAS) | 6 months post-shelter | 4.9 score on a scale | Standard Deviation 10.6 |
p-value: 0.32595% CI: [-4.5, 13.5]Mixed Models Analysis
Secondary
The Cyber Stalking Scale
The Cyber Stalking Scale measure is a 6 -item measure and assesses the use of technologies in stalking and harassment. Scores range from 0 to 12. Lower is better (indicated less Cyber Stalking).
Time frame: Assessed at baseline, and again at 3 and 6 months later
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| SHE Program | The Cyber Stalking Scale | Baseline | 9.53 score on a scale | Standard Deviation 3.01 |
| SHE Program | The Cyber Stalking Scale | 3 months post-shelter | 4.95 score on a scale | Standard Deviation 4.54 |
| SHE Program | The Cyber Stalking Scale | 6 months post-shelter | 3.89 score on a scale | Standard Deviation 4.27 |
| Control Condition | The Cyber Stalking Scale | 3 months post-shelter | 3.30 score on a scale | Standard Deviation 4.45 |
| Control Condition | The Cyber Stalking Scale | 6 months post-shelter | 2.00 score on a scale | Standard Deviation 3.23 |
| Control Condition | The Cyber Stalking Scale | Baseline | 7.39 score on a scale | Standard Deviation 4.29 |
p-value: 0.19295% CI: [-0.61, 2.98]Mixed Models Analysis
Secondary
The Treatment Services Review (TSR)
The Treatment Services Review will be used to assess total times using substance use services (both treatment and self-help utilization) received (including outpatient, day patient, residential treatment, NA, AA) to capture the extent to which women are reaching out to access recovery-related resources. The TSR will assess number of times attending substance use services, divided by the number of days in the reporting period.
Time frame: Assessed at baseline, and again at 3 and 6 months later
| Arm | Measure | Group | Value (MEDIAN) | Dispersion |
|---|---|---|---|---|
| SHE Program | The Treatment Services Review (TSR) | Baseline | 0.00 times using substance use services/day | Standard Deviation 0.05 |
| SHE Program | The Treatment Services Review (TSR) | 3 months post-shelter | 0.00 times using substance use services/day | Standard Deviation 0.23 |
| SHE Program | The Treatment Services Review (TSR) | 6 months post-shelter | 0.00 times using substance use services/day | Standard Deviation 0.22 |
| Control Condition | The Treatment Services Review (TSR) | Baseline | 0.01 times using substance use services/day | Standard Deviation 0.25 |
| Control Condition | The Treatment Services Review (TSR) | 3 months post-shelter | 0.00 times using substance use services/day | Standard Deviation 0.22 |
| Control Condition | The Treatment Services Review (TSR) | 6 months post-shelter | 0.00 times using substance use services/day | Standard Deviation 0.16 |
p-value: 0.026Wilcoxon (Mann-Whitney)
Comparison: Distributions were badly skewed, and the sample was too small for ZINB or other analyses. Therefore, we analyzed differences between conditions in changes in services/day over time (i.e., from baseline to 6 month post-shelter follow-up) using the Mann-Whitney U.p-value: 0.029Wilcoxon (Mann-Whitney)