Maternal, Provider, and Stakeholder Perspectives on Addressing Intimate Partner Violence for Nurse Home-Visited Women Jack Stevens, Ph.D.; Philip V. Scribano, D.O., M.S.C.E.; Susan Jack, R.N., Ph.D.; & Harriet MacMillan, M.D., M.Sc., F.R.C.P. (C) on behalf of the NFP IPV Group

Acknowledgments This research was partially supported by grant #5R49CE001170 from the National Center for Injury Prevention and Control, CDC, to the West Virginia University Injury Control Center. Contents are solely the responsibility of the presenters and do not represent official views of the CDC. We thank study participants and research staff at four sites for their assistance: Kane County, IL Fargo, ND Dayton, OH Columbus, OH

Brief summary of the Nurse-Family Partnership (NFP) program Overview of Today’s Presentation Brief summary of the Nurse-Family Partnership (NFP) program Justification for addressing intimate partner violence (IPV) within this program Methods and emerging results from qualitative interviews Implications for designing an IPV intervention within NFP

The Nurse-Family Partnership (NFP) Program Provides home visitation by registered nurses to low-income, first time mothers from pregnancy to child’s second birthday NFP Goals: Maternal well-being Child well-being Self-sufficiency Intervention includes psychoeducation, social support, and referral assistance One of the most widely disseminated home visitation programs www.nursefamilypartnership.org

Not all home visitation programs are alike--wide variation in models Scientific support for Nurse-Family Partnership (NFP) Not all home visitation programs are alike--wide variation in models NFP has long track record of RCTs (Elmira, NY; Memphis, TN; Denver, CO). This prevention program has been shown to produce a wide range of positive maternal and child outcomes.

Justification for the Present Project Much research has been conducted on IPV prevalence, etiology, and consequences; little is known about beneficial IPV interventions. IPV is related to an attenuation of NFP benefits regarding child abuse prevention. Evidence-based model with potential to be successfully modified to achieve desired outcomes.

Overarching Goals of Project Phase I: qualitative evaluation of client, provider (RNs), and stakeholders perceptions to ascertain IPV prevention strategies NFP nurses could use Phase II: develop and test an IPV intervention within NFP

Phase I Methods Design: Qualitative multi-case study conducted with four NFP sites Sample: Purposeful sampling used to recruit 20 NFP clients, 23 NFP nurses, and 22 community stakeholders Data collection: All stakeholders & NFP clients completed one in-depth interview, with a second interview pending. Nurses at each site participated in two focus groups.

Data Analysis All data were transcribed verbatim. Process of conventional content analysis used to interpret data 1. Each transcript coded line by line using NVivo 8.0 2. Codes collapsed into categories 3. Categories synthesized into broader themes Each transcript has been reviewed and summarized by at least two analysts. Dr. Susan Jack oversaw these qualitative data analyses.

Results: Themes from NFP Clients Expressed concerns about existing IPV resources in their communities (e.g., shelters, police) Feared reactions of NFP nurses (e.g., not understanding IPV, possible reports to children’s protective services) Urged nurses to take a balanced approached when assessing for IPV—not too aggressive but not too passive Wanted social support from a wide variety of sources

Results: Themes from NFP Nurses Disclosure of IPV from clients is most likely to occur within trusting, therapeutic relationship over time with nurses. Nurses identified that their roles should include: assessment, identification of IPV, safety planning, education on healthy relationships, support to enhance client self-efficacy, and referrals to community services.

Nurses should receive quality training in: Results: Themes from IPV stakeholders Nurses should receive quality training in: Safety planning for themselves Safety planning for their clients Community resources for IPV Offering nonjudgmental support regarding sensitive topic (e.g., demonstrating patience and understanding without providing ‘counseling’)

Phase I Implications Components that should be part of an NFP IPV intervention 1. Assessment 2. Safety planning 3. Linkage with community resources 4. Non-judgmental support Components similar to evidence-based intervention developed by Sullivan and Bybee (1999)

Next Steps – Phase II Develop an IPV intervention for use with NFP clients Test the intervention through a multi-site RCT