Veterans Affairs Veterans Integrated Services Network 17 Center of Excellence for Research on Returning War Veterans, Waco, Texas; and the Central Texas Veterans Health Care System, Temple.
Dell Medical School of the University of Texas at Austin, Austin.
JAMA Netw Open. 2023 Mar 1;6(3):e232997. doi: 10.1001/jamanetworkopen.2023.2997.
Intimate partner violence (IPV) is a serious and prevalent public health issue that is interconnected with experiences of trauma, mental and physical health difficulties, and health disparities. Strength at Home (SAH) is a group intervention for persons using IPV in their relationships. Although previous studies have provided evidence of SAH's effectiveness in reducing IPV, its patient outcomes as implemented within organized health care have not been examined.
To evaluate patient outcomes from implementation of SAH in the Department of Veterans Affairs (VA) health system.
DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study evaluated patient outcomes from a national implementation and training program conducted between December 11, 2015, and September 24, 2021. Data were collected as part of treatment and submitted by clinicians at 73 VA health care facilities. Patients were 1754 veterans seeking care aimed at addressing and/or preventing their use of aggression in intimate relationships. They completed 1 pretreatment assessment and 1 follow-up assessment in the immediate weeks after group completion.
Strength at Home is a 12-week trauma-informed and cognitive behavioral group intervention to address and prevent the use of IPV in relationships.
Changes in IPV were measured with the Centers for Disease Control and Prevention 2010 National Intimate Partner and Sexual Violence Survey. Changes in posttraumatic stress disorder (PTSD) symptoms were measured with the PTSD Checklist for DSM-5, and alcohol misuse was measured with the Alcohol Use Disorders Identification Test.
The study included 1754 participants (mean [SD] age, 44.3 [13.0] years; 1421 men [81%]), of whom 1088 (62%) were involved with the criminal legal system for IPV charges. Analyses indicate that SAH was associated with reductions in use of physical IPV (odds ratio, 3.28; percentage difference from before to after treatment, -0.17 [95% CI, -0.21 to -0.13]) and psychological IPV (odds ratio, 2.73; percentage difference from before to after treatment, -0.23 [95% CI, -0.27 to -0.19]), coercive control behaviors (odds ratio, 3.19; percentage difference from before to after treatment, -0.18 [95% CI, -0.22 to -0.14), PTSD symptoms (mean change, -4.00; 95% CI, 0.90-7.09; Hedges g = 0.10), and alcohol misuse (mean change, 2.70; 95% CI, 1.54-3.86; Hedges g = 0.24).
In this quality improvement study of the patient outcomes after implementation of SAH, results suggested that the program was associated with reductions in IPV behaviors, PTSD symptoms, and alcohol misuse. Results also suggest that IPV intervention in routine health care at VA health care facilities was successful; extension to other organized health care systems could be warranted.
亲密伴侣暴力（IPV）是一个严重且普遍存在的公共卫生问题，与创伤、身心健康困难和健康差距有关。家庭力量（SAH）是一种针对人际关系中使用 IPV 的人的团体干预措施。尽管先前的研究已经提供了 SAH 有效性的证据，但其在有组织的医疗保健中实施的患者结果尚未得到检查。
评估在退伍军人事务部（VA）医疗系统中实施 SAH 的患者结果。
设计、设置和参与者：这项质量改进研究评估了 2015 年 12 月 11 日至 2021 年 9 月 24 日期间进行的国家实施和培训计划的患者结果。数据是作为治疗的一部分收集的，并由 73 个 VA 医疗保健设施的临床医生提交。患者是 1754 名寻求护理的退伍军人，旨在解决和/或预防他们在亲密关系中使用攻击性。他们在小组完成后的几周内完成了 1 次治疗前评估和 1 次随访评估。
家庭力量是一种为期 12 周的创伤知情和认知行为团体干预措施，旨在解决和预防关系中 IPV 的使用。
使用疾病控制和预防中心 2010 年全国亲密伴侣和性暴力调查衡量 IPV 的变化。使用 PTSD 检查表 DSM-5 衡量 PTSD 症状的变化，使用酒精使用障碍识别测试衡量酒精滥用情况。
该研究包括 1754 名参与者（平均[SD]年龄，44.3[13.0]岁；1421 名男性[81%]），其中 1088 名（62%）因 IPV 指控而涉及刑事法律系统。分析表明，SAH 与身体 IPV 的使用减少有关（优势比，3.28；治疗前后的百分比差异，-0.17 [95%CI，-0.21 至-0.13]）和心理 IPV（优势比，2.73；治疗前后的百分比差异，-0.23 [95%CI，-0.27 至-0.19]），强制性控制行为（优势比，3.19；治疗前后的百分比差异，-0.18 [95%CI，-0.22 至-0.14]），创伤后应激障碍症状（平均变化，-4.00；95%CI，0.90-7.09；Hedges g=0.10）和酒精滥用（平均变化，2.70；95%CI，1.54-3.86；Hedges g=0.24）。
在这项关于实施 SAH 后患者结果的质量改进研究中，结果表明该计划与 IPV 行为、创伤后应激障碍症状和酒精滥用的减少有关。结果还表明，VA 医疗保健设施常规医疗保健中的 IPV 干预是成功的；向其他有组织的医疗保健系统扩展可能是合理的。
