Recovering From Intimate Partner Violence Through Strengths and Empowerment (RISE)

Women are the fastest growing group of VHA patients, with their population recently
increasing by 80%. Women Veterans (WV's) are at higher risk for IPV than their non-Veteran
peers, with that 1 in 3 WVs report lifetime IPV, compared to 1 in 4 women in the general U.S.
population. Research reports up to 30% of WVs experience past-year IPV. As a result, WVs are
considered an important population for IPV screening and counseling interventions. In
response, VHA Women's Health Services (WHS) and the IPV Assistance Program of Care Management
and Social Work Services (CMSWS) are implementing IPV screening programs for women and are
seeking an effective intervention to implement into care. Extant brief counseling
interventions for IPV result in minimal effects on patients' health and safety. A recent
review of IPV screening trials highlighted insufficient intensity of post-disclosure
counseling interventions, concluding that existing interventions are too brief, unstructured,
and generic. Such minimal intervention effects of the current standard of care have led
leaders in the field to call for the development and testing of new and more comprehensive
IPV interventions, especially for delivery in conjunction with primary care. The Recovering
from IPV through Strengths and Empowerment (RISE) intervention fills this need.

The PI, a clinical psychologist and health services researcher with expertise in and national
recognition for IPV research and care, has developed an innovative IPV intervention to
respond to this need. Recovering from IPV through Strengths and Empowerment (RISE) is based
on the healthcare needs and preferences of WVs who have experienced IPV. RISE was developed
using rigorous methods, building on the evidence base from the applicant's HSR&D CDA and on
input of VHA primary care and behavioral health experts. RISE is based on empowerment, a
highly relevant intervention model for women who experience IPV. It is an individualized,
variable-length, modular-based intervention addressing key factors:

- safety planning,

- educating about the health effects of IPV,

- improving coping and self-care,

- enhancing social support,

- making difficult decisions, and

- connecting with resources. RISE incorporates aspects of Motivational Interviewing, an
evidence-based approach designed to facilitate behavior change that is widely used in
VHA for numerous health issues.

This timely three-year proposal addresses the critical gap in current IPV care. It will
refine and formally evaluate RISE using established methods for rapid and efficient
effectiveness testing, including a Hybrid 1 randomized clinical trial (RCT) to evaluate RISE
that simultaneously gathers information on barriers to and facilitators of implementation.
The study is guided by the first two phases of the Replicating Effective Programs (REP)
framework, pre-conditions and pre-implementation. These phases emphasize tailoring
interventions with stakeholder input and iterative cycles of pilot testing within routine
practice conditions. Use of the REP framework will maximize the likelihood that RISE-should
its effectiveness be demonstrated-can easily be integrated into routine care in VHA.

The Specific Aims of this study are as follows:

1. Tailor and refine RISE to accommodate differences in service structures and personnel in
different primary care settings through input from a Stakeholder Advisory Board, focus
groups with WVs (four groups; n=24-32), and qualitative interviews with providers
(n=24).

2. Conduct a formative evaluation of RISE with WVs (n=up to 20) to inform the development
of a user-friendly, tailored implementation protocol and intervention manual.

3. Examine the effects of RISE on WVs' (n=60) individual psychosocial outcomes (e.g.,
empowerment, self-efficacy, health symptoms, service use, and quality of life) in an RCT
that compares RISE to an information/referral condition.

3a. Evaluate the feasibility and acceptability of RISE in the context of the RCT.

This study provides the groundwork to examine the effectiveness of RISE. The data will be
used to demonstrate whether the effects of RISE appear promising to support a future-large
scale effectiveness-implementation RCT, including the range of effect sizes that would be
reasonable to expect in a future trial.

This is a multi-site study.

The project will be conducted at two Women's Health Practice-Based Research Network (PBRN)
sites that have adopted IPV screening - the Women's Health Centers (WHC) at VA Boston
Healthcare System and VA Connecticut Healthcare System. The investigators use two sites to
better inform the refinement of RISE and understand variation in implementation
characteristics, since the investigators are focusing on implementation at the early stages
of intervention refinement and evaluation. The sites also differ in provider types within the
clinic, which will allow us to refine and evaluate RISE in ways that accommodate diverse
clinical structures and practices in VHA to maximize flexible delivery.

Inclusion Criteria:

Participants will be eligible to participate if they:

- Self-identify as female

- Are at least 18 years of age

- A patient at VA Boston Healthcare System or VA Connecticut Healthcare System

- Self- reported that they have experienced past-year physical, sexual, or psychological
IPV

- Ability to understand study procedures in English

- Not exhibiting symptoms of mania or psychosis

- Not actively in suicidal crisis warranting imminent hospitalization

Exclusion Criteria:

- Any violation of inclusion criteria