Young adult women ages 18-29 years attending family planning clinics report higher rates of intimate partner violence and sexual assault (IPV/SA) as compared to their same-age peers;however, standard-of-care family planning counseling does not currently include specified protocols to screen for or intervene to reduce IPV/SA. The proposed study will pilot test, via a 2-armed randomized-controlled trial, a brief (10 minute) intervention to reduce risk for IPV/SA among young adult women attending urban, publicly-funded family planning clinics. The proposed intervention and research design are the result of extensive collaboration among the investigative team, the Family Violence Prevention Fund, the Violence and Sexual Assault Prevention and Family Planning Programs of the Massachusetts Department of Public Health, and Action for Boston Community Development (ABCD, a large community-based health agency with extensive networks of family planning clinics). Created for integration into routine family planning clinical care, this brief intervention for female family planning clients to be delivered by family planning counselors (non-licensed community-based health educators) consists of: 1) Enhanced Screening to increase client awareness of IPV/SA and facilitate IPV/SA disclosure, 2) Harm Reduction Counseling to assist clients in developing harm reduction and safety planning strategies to reduce risk of future IPV/SA, and 3) Supported Referral to educate clients regarding local professional IPV/SA victim resources and reduce barriers to utilization of these resources. Based on receipt of this intervention, we hypothesize that all participants will report a) increased recognition of IPV/SA, b) increased harm reduction behaviors regarding IPV/SA victimization, and c) increased knowledge of, and self-efficacy to utilize, IPV/SA-related resources as compared to participants attending control family planning clinics (i.e., receiving standard-of-care family planning services). Among participants reporting IPV/SA victimization, we additionally hypothesize that intervention participants will report d) increased utilization of IPV/SA-related resources and e) reduced recent experiences of physical and sexual victimization as compared to participants reporting IPV/SA victimization and attending control family planning clinics. The evaluation design for this pilot intervention, developed in partnership with ABCD with additional project partner input, involves random assignment of four comparable, large publicly-funded family planning clinics in Greater Boston, to either intervention or control conditions. Participants from each condition will be assessed at baseline and 16-20 week follow-up in order to explore intervention effects on IPV/SA-related knowledge, harm reduction behaviors, and service utilization, as well as on recent IPV/SA victimization. Study procedures will involve female family planning clients ages 18-29 (N=1000) from all clinic sites being recruited at reception by research staff for study participation. Follow-up data collection will coincide with scheduled clinic visits to increase the likelihood of continued participation;use of extensive tracking information and escalating incentives will also be used to maximize retention at follow-up. Data at each time point will be collected via a 20-minute audio computer-assisted self-interview in English or Spanish. Regression analyses adjusted for baseline scores will be conducted to assess intervention effects. All project partners will actively participate in interpretation of results, dissemination of findings, and development of a larger scale intervention based on these pilot data results.
The proposed community-based participatory study will pilot test, via a 2-armed randomized-controlled trial, a brief intervention to reduce risk for IPV/SA among young adult women attending urban, publicly-funded family planning clinics. The intervention to be delivered by family planning counselors (non-licensed community-based health educators) consists of: 1) Enhanced Screening to increase client awareness of IPV/SA and facilitate IPV/SA disclosure, 2) Harm Reduction Counseling to assist clients in developing harm reduction and safety planning strategies to reduce risk of future IPV/SA, and 3) Supported Referral to educate clients regarding local professional IPV/SA victim resources and reduce barriers to utilization of these resources. The evaluation design involves random assignment of four comparable, large publicly-funded family planning clinics in Greater Boston, to either intervention or control conditions, with clients ages 18-29 (N=1000) to be assessed at baseline and 16-20 week follow-up to explore intervention effects on IPV/SA-related knowledge, harm reduction behaviors, service utilization, and recent IPV/SA victimization.
