Implementation of a structured need assessment intervention: Enhancing prevention of violence in intimate partner violence victims

Domestic violence is a serious public health problem with a high prevalence in
all social strata. Compared to other violent crimes, domestic violence is more
repetitive, it can occur on a daily basis and/or it can persist for decades. It
is also more difficult to detect as it mostly occurs in private contexts.
Empirical research shows that some women never leave their violent partner and
that intimate partner violence (IPV) has a negative effect on the mental health
of the victim. A large proportion of women (50-70%) that return to an abusive
partner are revictimized. The failure to understand why women remain in abusive
intimate relationships has fuelled public misperceptions and hampered the
provision of effective services. Contemporary diagnostic procedures mainly
focus on the risk of the abuser and lack to provide a deeper understanding of
the woman*s perception of the situation and her needs.

Through the implementation of the structured need assessment intervention, the
Decision-making In Abusive Relationships Interview (DIARI) in daily clinical
practice, we aim to improve the identification of the needs of victims of
intimate partner violence and consequently enhance the effect of the
intervention. Specific objectives of this project are:

1. To reduce the prevalence of IPV (revictimization) through improving the
results of interventions with victims of IPV.
2. To improve the treatment of abused women through broadening the clinicians*
perspective of the intervention needs of abused women; improving the
understanding of their intervention needs and adjusting the interventions to
these needs.
3. To increase knowledge about the behavior and needs of IPV victims.

The study is a multisite, cluster randomized trial with cross-over; clients are
longitudinally followed up. The study is part of the NWO program 'Violence
Against Psychiatric Patients'. The teams of the participating organizations
will form the clusters and will be randomized for their moment to cross-over to
the experimental condition. Until cross-over, teams form the control group and
will be providing treatment as usual. The clinicians in the experimental
condition receive training and on the job coaching/supervision in using the
DIARI in daily clinical practice to assess intervention needs and organize the
intervention together with the IPV victim around her needs. Clients in the
control condition receive treatment as usual during the intervention. Outcome
measurements in both groups are performed at baseline and after 4, 8, and 12
months.

In the experimental group, the DIARI is applied in daily clinical practice. The
DIARI is used for improved need assessment at intake and during repeated
assessments throughout intervention. It is used in the design of the treatment
plan or to determine most adequate referral.

Burden: The participants of both the control and experimental group are
followed by specially selected and trained, female research assistants with
experience and affinity with the target group. The baseline interviews are
expected to take 1 hour on average, follow-up interviews 0.5-1 hour. iPads are
used for the questionnaires (i.e., self assessments), which enlarge privacy
compared to paper and pencil questionnaires. To avoid that the participant will
encounter different people during the research, the same research assistant
will follow her throughout the study. We aim at obtaining only the necessary
information and keep the time investment of the participant as low as possible.

Risks: The use of the DIARI in the clinical setting is not associated with any
risk for the participants. Another part of the study is the follow up of the
participants on 4 occasions during 12 months. For a large part the participants
are victims of partner violence who together with their partner, or at least
with the knowledge of their partner, have contacted services for support. In
these cases help seeking or participation in the study will not cause any risk.
Another, smaller, part of the victims of intimate partner violence has
contacted services without knowledge of their partner. For these participants
access formal (or informal) support is not without risk because the partner can
take action when they discover the victim contacted external recourses.
Therefore there is limited risk for a part of the participants that we cannot
discard.
Tilburg University has the needed insurances as required by the CCMO, in case
unforeseen events will happen.