This 4-year randomized controlled trial will design, implement, and test the efficacy of nurse case management and group education for African- American, Hispanic, and White abused women attending inner city primary care clinics. These clinics are part of a county-wide system that maintains a computerized information system of inpatient and outpatient encounters. The theoretically-based intervention will build on empirically tested components designed to: increase safety planning behaviors; increase self-efficacy for safety behaviors; decrease frequency and severity of abuse; improve physical emotional and social well-being; decrease unscheduled medical care utilization; and increase work productivity. An additional objective is to evaluate the impact of the interventions on the health and functional status and medical utilization of abused women's children. Consecutive sampling of women 18-44 years of age presenting for medical care will be screened for domestic violence until a sample of 400 abused women is obtained. Participants will be randomized to one of 4 treatment cells in a factorial design: referral card, referral card + group education, referral card + case management, referral card + group education + case management. Nurse case management will include education on safety planning, crisis management, supportive care, anticipatory guidance, and referrals. Group education will consist of sessions conducted by local legal, social, and educational agencies for abused women. The factorial study design will allow testing the main effects of group education and nurse case management and the interaction of group education and case management on safety behaviors, health outcomes in the women and their children, and medical care utilization. Measures will be collected at baseline and every 6 months for 3 years after randomization. An economic evaluation of the program will be conducted using cost benefit analyses of the four alternative treatments from both societal and health care system perspectives.
