Background Experience of intimate partner violence (IPV) is a major health concern, particularly for women, and research has identified a high rate of IPV experience among women veterans. IPV can lead to a variety of acute and chronic mental and physical health conditions as well as homelessness, unemployment, suicide, and homicide. Through detection and provision of supportive services, healthcare systems can assist patients in seeking safety from future violence and recovering from experience of past IPV. In 2013, the VA approved a plan to implement an IPV program in VA healthcare systems. This program will be the largest national healthcare- based IPV identification and response program in the country. The VA is implementing this program first as a pilot program in six VHA facilities, presenting the first opportunity to gather clinical information about the VHA patient population in need of IPV services on a broad scale. A substantial body of literature reports on studies of IPV screening and patient disclosure in healthcare setting; we know little, however, about patients' post- disclosure experiences and a broad range of health outcomes following a positive screen. Objectives The objectives of this proposed study are to identify the population in need of IPV-related care in VHA, disparities in care or outcomes, and services or supports most helpful in increasing patients' safety and well- being.
The specific aims are to identify: 1) the rate at whic female VHA patients screen positive for past-year IPV, whether they access VHA IPV services, and the demographic and clinical characteristics associated with both outcomes; 2) patient health and safety following disclosure of past-year IPV, and associations with service use and safety-related empowerment; and 3) patients' experiences with violence and service access, and perspectives on impact of interventions on their health and safety. Methods For study Aim 1, we will extract data from the VHA Corporate Data Warehouse for all patients screened for IPV at the six pilot sites. We will compare patients who screen IPV+ to those who screen IPV- based on demographic and clinical characteristics; among patients who screen IPV+, we will similarly compare those who utilize VHA IPV services and those who do not. For study Aim 2, we will enroll patients (N = 160) who screen IPV+ at two sites (Philadelphia, PA, and Portland, OR) to complete a structured interview at baseline (within two weeks of screening) and follow-up (9 months post screening) that measures experience of violence, safety behaviors, service use/help-seeking, empowerment, and health outcomes. We will conduct in-depth qualitative interviews with a subset (N = 50) of the patients enrolled for Aim 2 to understand patient experiences and perspectives regarding service access and changes over time (Aim 3). Anticipated Impact on Veteran's Healthcare Findings from this study will inform IPV programming, including demand for, and impact of, services, and illuminate patients' experiences and perspectives. Findings will be shared with the national VA IPV Assistance Program Steering Committee and will be used to refine the program for a national roll-out. In particular, this study will provide insight into need for expansion or contraction of IPV intervention services and subpopulations of VHA patients that may be in greater need of assistance. Study findings, particularly related to patients' experiences with violence and recovery over time, may also be relevant outside of the VHA system and patient population.

Public Health Relevance

Intimate partner violence (IPV) is a major health concern affecting Veterans and is associated with a variety of acute and chronic medical and mental health conditions and poor quality of life, especially among women. The VA is currently working to implement screening of female VHA patients for past-year experience of IPV and offering supportive services to assist patents in seeking recovery and safety from further IPV. This study will examine clinical data to identify the positive screen rate and uptake of IPV services, as well as demographic and clinical correlates of both outcomes, among female patients at six VA medical centers participating in a pilot of the national IPV program. Additionally, we will interview patients who screen positive for IPV at two VA Medical Centers to identify health and safety outcomes, associations with service utilization, and patients' perspectives on what kinds of services and supports are most helpful following disclosure of IPV victimization to a healthcare provider.

National Institute of Health (NIH)
Veterans Affairs (VA)
Non-HHS Research Projects (I01)
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HSR-2 Determinants of Patient Response to Care (HSR2)
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Philadelphia VA Medical Center
United States
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