Results Summary
What was the research about?
Intimate partner violence, or IPV, can include physical, sexual, mental, and emotional violence from current or former spouses or partners. IPV can affect people’s mental and physical health. Medical-legal partnerships, or MLPs, are one way to help people who experience IPV. MLPs provide both health and legal services at a clinic or hospital.
In this study, the research team compared two ways to support adults who experienced IPV and had depression and received care at an MLP in a hospital:
- Usual care alone included one meeting with a social worker to create a plan for safety and learn about services in the community.
- Usual care with community health worker, or CHW, support. The CHW was a community member trained to help people assess their physical, emotional, and legal needs. The CHW offered to create a care plan based on those needs and connect people with services. On request, the CHW provided ongoing support for six months. This support could include taking people to clinic visits and calling or texting them to check-in. It could also include advocating for them and supporting them at meetings.
The research team wanted to learn if adding CHW support was better than usual care alone at improving safety, depression, and physical health.
What were the results?
People who received usual care with CHW support and people who received usual care alone didn’t differ in:
- Safety at six months
- Depression symptoms and physical health at nine months
Adults in both groups reported feeling safer and less depressed over time.
Although the research team can’t say for sure, quality of life improved more for:
- Adults with higher levels of IPV if they received usual care with CHW support
- Adults with higher levels of depression if they received usual care alone
Who was in the study?
The study included 231 people who experienced IPV within the past year and had symptoms of depression. Of these, 55 percent were White, 29 percent were Black, 10 percent were biracial, and 6 percent identified their race as other. The average age was 36, and 94 percent were women. The MLP was at a hospital in Rochester, New York.
What did the research team do?
The research team assigned adults by chance to receive usual care alone or with CHW support.
Adults completed surveys at the start of the study and again 6, 9, and 12 months later. The surveys asked about safety, physical health, and symptoms of depression. For data about safety, the research team also looked at restraining orders and the number of calls to 911 from the home.
IPV survivors and their family members and IPV advocates helped plan and conduct the study.
What were the limits of the study?
This study took place in one city. Results may differ in other places.
Future studies could further explore the best support for people with higher levels of IPV or depression.
How can people use the results?
MLPs can use these results when considering how to support people who experience IPV and depression.
Professional Abstract
Objective
To compare the effectiveness of adding support from a community health worker (CHW) to usual care versus usual care alone at a hospital-based medical-legal partnership (MLP) on improving safety, depression, and physical health for adults who experience intimate partner violence (IPV) and depression
Study Design
| Design Element | Description |
|---|---|
| Design | Randomized controlled trial |
| Population | 231 adults who recently experienced IPV and have depressive symptoms |
| Interventions/ Comparators |
|
| Outcomes | Safety at 6 months, which included measures of violence and danger, 911 calls, and court protective orders; depression and physical health at 9 months |
| Timeframe | Up to 1-year follow-up for study outcomes |
This randomized controlled trial compared two approaches to help adults with depressive symptoms who recently experienced IPV. All participants received a referral to care at an MLP, which paired care and support from medical and legal professionals in a hospital-based setting. In addition, researchers assigned participants by chance to one of two groups:
- Usual care at an MLP plus CHW support. The CHW was someone from the community who was trained to use a needs-prioritization system and provide personalized support for people who experience IPV. The CHW offered participants help to prioritize their physical, emotional, and legal needs; develop a care plan based on those needs; and connect with community-based services. The CHW also offered ongoing support for six months, which included advocating for participants across systems, attending meetings, providing occasional transportation to appointments, and calling or texting to check-in.
- Usual care alone at an MLP. Participants in this group were able to meet once with a social worker to help develop a safety plan and receive referrals to community-based resources.
The study included 231 adults who experienced IPV within the previous year and had depressive symptoms. Among participants, 55% were White, 29% were Black, 10% were biracial, and 6% identified their race as other. The average age was 36, and 94% were female. The MLP was at a hospital in Rochester, New York.
Participants completed surveys about safety and depression at baseline and again 6, 9, and 12 months later. Researchers also reviewed court protection orders and number of 911 calls made from the home as additional indicators about safety.
IPV survivors, family members, and IPV advocates provided input throughout the study.
Results
Participants in the two groups did not differ significantly in safety immediately after the intervention at six months or in depressive symptoms or physical health at nine months. Participants in both groups reported improved safety (p=0.002) and depressive symptoms (p=0.002) over time.
In an exploratory analysis for quality of life, participants with a history of higher levels of violence had greater improvement with CHW support, and participants with higher rates of depression had greater improvement with usual care alone.
Limitations
This study took place in a single geographic area at an academic medical center. Results may differ in other areas or settings.
Conclusions and Relevance
In this study, usual care at an MLP plus support from CHWs was not more effective than usual care alone at improving safety and health outcomes for adults who experienced IPV and had depressive symptoms. Hospital-based MLPs can use these results when considering how to support people who experience IPV and depression.
Future Research Needs
Future research could further explore which type of support is best for people who experience more severe IPV or depression.
Final Research Report
View this project's final research report.
Peer-Review Summary
Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.
The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments.
Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:
- Reviewers asked about the large number of study participants who did not engage in the treatments, especially participants in the care-as-usual arm. They asked whether the researchers had any thoughts about why there was so little engagement when participants had completed the consent and baseline assessment process. The researchers explained that their care-as-usual condition followed typical hospital procedures, which were to refer patients to social workers or other community agency so there would be very limited involvement of these individuals in the treatment arm. The researchers acknowledged that because they used intent-to-treat analyses they did not take treatment engagement into consideration but would consider looking more closely at this issue in future papers.
- One reviewer expressed concern about the small number of patient representatives on the study’s advisory board compared to healthcare professionals and researchers. The researchers explained that the Patient Leadership Team of three people was actually part of a larger organization of people who have experienced intimate partner violence but many of those individuals did not feel comfortable being public in the study. The researchers also noted the professional representatives on the larger community advisory board filled multiple roles as patients, representatives of underrepresented groups, and people living mental illness.
- Reviewers noted that the report did not address differences in intimate partner violence when the partners represent sexual minorities. The researchers acknowledged that this is an important way forward for research on intimate partner violence and said they would be writing a paper on this topic in the future.
Conflict of Interest Disclosures
Project Information
Patient / Caregiver Partners
- Elaine Bell, Survivors Advocating for Effective Reform
- Ineabelle Geena Cruz, Survivors Advocating for Effective Reform
Other Stakeholder Partners
- Jaime Saunders, Willow Domestic Violence Center
- Allison O'Malley, RESOLVE of Greater Rochester, Inc.