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Appendix F Summary of Evaluation Studies on Training of Health Care Professionals on Intimate Partner Violence 269
270 APPENDIX F Knowledge, Attitudes, and Beliefs Outcome Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Medical students Type: Didactic One group Knowledge Self-report Yes 1 (Ernst et Length: 3 hrs. re IPV (14 items) al., 1998, 2000) Clinical aids: None Medical students Type: Mixed None Two groups Perceived comfort, Self-report No 24 (Haase Length: 9 hrs. (one preparedness, (five et al., 1999) over 6 weeks comparison questioning habits, items, Clinical aids: group) and knowledge of α = 0.70) None resources re IPV
APPENDIX F 271 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report Yes 1 24 Eligible = 148 Ipost > Ipre* Within- (14 items) Pre = 144 (6 items) group com- Post = 141 (98%) parisons were FU = 104 (72%) IFU > Ipre* not based on (5 items) matched groups (e.g., those with IFU < Ipost* complete data (2 items) and on all measure- IFU = Ipost ment waves) (8 items) due to the Institutional Review Boardâs requirement that participants be anonymous. Thus, the com- parisons should be interpreted with caution. Self-report No 24 Eligible = Eligible = Ipost > Cpost* Although the (five Not reported Not reported training was a items, Post = 29 Post = 86 formal elective α = 0.70) course, groups were created by self-report on the posttest rather than known course enrollment. The analysis controlled for gender. Analyses of individual items indicated that group dif- ferences were in knowledge and reported ques- tioning habits rather than comfort and preparedness. continued on next page
272 APPENDIX F Knowledge, Attitudes, and Beliefs Outcome Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Medical students Type: Mixed One group Knowledge Self-report Yes Imm (Jonassen Length: 2-3.5 re IPV (10 items) ately et al., 1999) days traini Clinical aids: Attitudes Self-report Materials on re IPV (26 items) local resources; screening Clinical skills Self-report algorithm and experience (10 items) Medical students Type: Mixed One lecture Two groups Knowledge, Self-report Yes 1 (Short et al., 2000) Length: 4-week (one attitudes, and (37 items, module comparison behavioral α = 0.80, Clinical aids: group) intentions test-retest None about IPV = 0.87) Appropriateness of Self-report intervening (3-item subscale, α = 0.51, test-retest = 0.64) Physician Self-report responsibility (8-item for IPV subscale, α = 0.69, test-retest = 0.82) Victim autonomy Self-report for decisions (3-item subscale, α = 0.54, test-retest = 0.69)
APPENDIX F 273 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report Yes Immedi- 6 Eligible = 205 Ipost > Ipre* Test reliability (10 items) ately after Pre, Post, and IFU > Ipre* was reported as training FU = 144 (70%) adequate. Self-report Ipost > Ipre* (26 items) IFU > Ipre* Results pertain to comparisons Self-report Ipost > Ipre* for two separate (10 items) IFU > Ipre* cohorts. Self-report Yes 1 Eligible = 149 Eligible = 97 Ipost > Ipre* Ipost > Cpost* (37 items, Pre = 124 Pre = 88 α = 0.80, Post = 87 Post = 66 test-retest (70%) (75%) = 0.87) f Self-report Ipost < Ipre Ipost < Cpost (3-item subscale, α = 0.51, test-retest = 0.64) Self-report Ipost > Ipre Ipost > Cpost (8-item subscale, α = 0.69, test-retest = 0.82) Self-report Ipost > Ipre Ipost > Cpost (3-item subscale, α = 0.54, test-retest = 0.69) continued on next page
274 APPENDIX F Knowledge, Attitudes, and Beliefs Outcome Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Self-efficacy for Self-report detecting IPV (6-item subscale, α = 0.72, test-retest = 0.72) Behavioral Self-report intentions to (6-item screen subscale, α = 0.66, test-retest = 0.83) Residents in all Type: Mixed Didactic Two groups Knowledge of Self-report Yes 9-10 specialties Length: 20 min. educational (randomized) IPV (5-item (Coonrod et al., Clinical aids: session on subscale) 2000) Articles and unrelated topic pocket Length: 20 min. information Clinical aids: cards Articles and pocket information cards on topic
APPENDIX F 275 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report Ipost > Ipre* Ipost > Cpost* (6-item subscale, α = 0.72, test-retest = 0.72) Self-report Ipost > Ipre* Ipost > Cpost* (6-item subscale, α = 0.66, test-retest = 0.83) Self-report Yes 9-10 Eligible = 24 Eligible = 22 Ipost > Cpost*Analysis (5-item Pre = 24 Pre = 22 controlled for subscale) Post = 12 Post = 11 pretest score. (50%) (50%) continued on next page
276 APPENDIX F Knowledge, Attitudes, and Beliefs Outcome Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Residents in Type: Didactic One group Beliefs re IPV Self-report Yes Imm internal medicine Length: 105 (including self- (31 items) ately (Knight et al., min. efficacy of victims) traini 2000) Clinical aids: Local resource list; laminated card of screening questions and resource contacts Residents in Type: Mixed One group Knowledge Self-report Yes Imm internal medicine Length: 4 hrs. re IPV (10 items) ately (Kripke et al., Clinical aids: traini 1998) None Attitudes re IPV Self-report (25 items) Perceptions re Self-report skills (10 items)
APPENDIX F 277 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report Yes Immedi- Eligible = 45 Ipost = Ipre Measures (31 items) ately after Pre = 45 used were those ) training Post = 45 (100%) developed by Varvaro et al. (1997), who reported internal consistencies ranging from 0.62 to 0.90, depending on the subscale of interest. Results were affected by residents = complaints about the lengthiness of the survey and their careless responding. Self-report Yes Immedi- 6 Eligible = 55 Ipost > Ipre* The differences (10 items) ately after Pre = 55 IFU > Ipre* would have training Post = 55 (100%) been statisti- Self-report FU = 55 (100%) Ipost > Ipre* cally signifi- (25 items) IFU > Ipre* cant if a one- tailed test had Self-report Ipost > Ipre* been used. (10 items) IFU = Ipre continued on next page
278 APPENDIX F Knowledge, Attitudes, and Beliefs Outcome Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon ED staff and Type: Didactic One group Knowledge of Self-report Yes Imme emergency Length: 90 min. written protocol, (4 items) ately medical Clinical aids: reporting traini technicians Copy of care requirements, and (Allert et al., guidelines; list documentation 1997) of local resources ED nurses Type: Didactic One group Beliefs re IPV Self-report Yes Imme (Bokunewicz & Length: 60 min. (questions ately Copel, 1992) Clinical aids: on a traini None scenario, α = 0.79) ED staff, Type: Mixed Usual or Two groups Knowledge and Self-report Yes 18-24 including Length: 2 days available (group attitudes about (23 items, physicians, Clinical aids: training randomized) IPV α = 0.73) nurses, and Technical social workers assistance if (Campbell et al., requested in press)
APPENDIX F 279 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report Yes Immedi- 3 Eligible = 329 Ipost > Ipre* Total (4 items) ately after Pre = 266 (6 items) number of training Post = 266 (100%) IFU > Ipre* items in the FU = 213 (80%) (6 items) instrument was not specified. The follow-up was done by telephone to a random sample, but the response rate was not reported. It is unclear whether the statistical tests took into account repeated measures. Self-report Yes Immedi- Eligible = 42 Ipost > Ipre* (questions ately after Pre = 18 on a training Post = 18 (100%) scenario, α = 0.79) Self-report Yes 18-24 3 EDs 3 EDs Ipost > Ipre* Ipost > An overall (23 items, Eligible = Eligible = Cpost* response rate α = 0.73) Not reported Not reported for the posttest Pre = Not Pre = Not was 75%, but reported reported no information Post = 330 Post = 319 was provided regarding differential response rates for the two groups. The analyses controlled for gender, state, and pretest standing. continued on next page
280 APPENDIX F Knowledge, Attitudes, and Beliefs Outcome Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Trauma center Type: Didactic One group Knowledge Self-report Yes Imm staff, including Length: Unclear re IPV (18 items) ately residents in Clinical aids: traini surgery and None emergency medicine, medical students, and surgeons (Davis et al., 2000) ED staff, Type: Didactic One group Knowledge of Self-report Yes Imm including Length: 1 hr. IPV (43 items) ately physicians, Clinical aids: traini interns, and nurses Poster (Roberts et al., (protocol); 1997b) pocket cards
APPENDIX F 281 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report Yes Immedi- Eligible = Ipost > Ipre* (18 items) ately after Not reported training Pre = 92 Post = 92 (100%) Self-report Yes Immedi- Physicians Ipost > Ipre* There were (43 items) ately after Eligible = 72 significant training Pre = 31 changes for the Post = 20 (65%) combined Nurses group of Eligible = 91 physicians and Pre = 69 nurses, but Post = 48 (70%) nurses increased more than physicians. Overall, physicians incrased significantly but only in terms of knowl- edge of legal aspects of IPV. continued on next page
282 APPENDIX F Knowledge, Attitudes, and Beliefs Outcome Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon ED staff Attitudes toward Self-report (continued) IPV (10 items) ED, critical care, Type: Usual and Two groups Knowledge, Self-report Yes 12 and perinatal Length: available (one attitudes, and (51 items) hospital staff Clinical aids: comparison behavioral (Short et al., Protocol group) intentions about in press) IPV Understanding of Self-report abusive relationships Beliefs about staff preparation and ability for addressing IPV
APPENDIX F 283 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report Ipost > Ipre After training, (10 items) 35% of physicians believed that there was little a doctor or nurse could do to stop IPV, 50% believed that victims did not want to discuss IPV with a health professional, and 45% did not know that emotional abuse is generally viewed as worse than physical abuse by victims. Self-report Yes 12 12 Eligible = 417 Eligible = 265 IFU2 > Ipre IFU2 > Although exact (51 items) Pre = 200 Pre = 127 CFU2* results were not Post = Post = provided, the authors reported that psychometric Self-report IFU2 > Ipre IFU2 < CFU2 analyses found the scales were internally consistent. IFU2 > Ipre IFU2 > A total of 211 CFU2* individuals had complete data for the outcome continued on next page
284 APPENDIX F Knowledge, Attitudes, and Beliefs Outcome Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon ED, critical care, Victim autonomy Self-report and perinatal for decisions hospital staff (continued) Staff responsibility Self-report to address domestic violence Self-efficacy for Self-report detecting IPV and interacting with victims Self-efficacy for Self-report referral and services Own behaviors re Self-report screening and documentation
APPENDIX F 285 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report IFU2 > Ipre IFU2 > analyses, CFU2* yielding an overall Self-report IFU2 > Ipre IFU2 > CFU2 response rate for the posttest of 65%. The extent to which Self-report IFU2 > Ipre* IFU2 > CFU2 differential attrition occurred between groups was not Self-report IFU2 > Ipre* IFU2 > CFU2 reported. es Analyses controlled for Self-report IFU2 > Ipre* IFU2 > age, gender, CFU2* position, department, exposure to training, and pretest score. continued on next page
286 APPENDIX F Knowledge, Attitudes, and Beliefs Outcome Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon ED house staff Group 1 Usual and Two groups Beliefs about IPV Self-report Yes 0.5 (Varvaro et al., Type: Didactic available (one (12 items, 1997) Length: 1 hr. comparison α = 0.89) Clinical aids: group) None Group 2 Type: Didactic Attitudes re IPV Self-report Length: 1 hr. (self-efficacy in (31 items, Clinical aids: IPV victims) as ranged pocket IPV from 0.62 training manual to 0.90 for subscales)
APPENDIX F 287 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report Yes 0.5 Group 1 Eligible = Ipost = Ipre Ipost = Cpost The lecture- (12 items, Eligible = Not reported only and the α = 0.89) Not reported Pre = 11 lecture plus Pre = 13 Post = 11 manual groups Post = 13 (100%) differed on (100%) specific items Self-report Group 2 Ipost > Ipres regarding (31 items, Eligible = (5 of 12 items) perceived self- as ranged Not reported efficacy at the from 0.62 Pre = 13 posttest, but the to 0.90 for Post = 13 differences did subscales) (100%) not consistently favor one group. No comparisons were made between these two groups and the control group. The ability to detect within- group changes and relative group differ- ences was handicapped by the small sample sizes. continued on next page
288 APPENDIX F Knowledge, Attitudes, and Beliefs Outcome Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Community Type: Mixed One group Knowledge of IPV Self-report Yes Imm health center Length: 3-6 hrs. (13 items, ately staff, including Clinical aids: α = 0.91) traini physicians, mid- IPV screening level practitioners, pocket card; social workers, IPV assessment and psychologists form; stamp to Attitudes (comfort Self-report (Harwell et al., indicate with IPV) (4 items, 1998) screening and α = 0.82) suspected or confirmed abuse; patient card of resources and safety tips; additional tailored follow- up training to some CHCs Nurse-midwives Type: Unclear One group Knowledge re IPV Self-report Yes 6 (Paluzzi et al., Length: 8 hrs. (α = 0.80) 2000) Clinical aids: None Attitudes re IPV Self-report (α = 0.61) Level of comfort Self-report in working with (α = 0.59) victims Perceived cultural Self-report competence (α = 0.96)
APPENDIX F 289 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report Yes Immedi- 3 Eligible = 108 Ipost > Ipre* Analyses were (13 items, ately after Pre = 108 IFU > Ipre* restricted to the α = 0.91) training Post = 108 IFU < Ipre direct care (100%) providers who FU = 23 of received the 66 eligible (35%) training. Self-report Ipost > Ipre* Table 2 is not (4 items, IFU > Ipre clear as to α = 0.82) IFU < Ipost whether results at all waves were only for 23 in the follow-up. Self-report Yes 6 12 Eligible = Ipost > Ipre* (α = 0.80) Not reported IFU > Ipost Pre = 165 Self-report Post = 80 (48%) Ipost > Ipre* (α = 0.61) FU = 23 (14%) IFU > Ipost Self-report Ipost > Ipre* (α = 0.59) IFU > Ipost Self-report Ipost > Ipre* (α = 0.96) IFU > Ipost continued on next page
290 APPENDIX F Knowledge, Attitudes, and Beliefs Outcome Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Primary care Type: Mixed Usual and Two groups Self-efficacy re Self-report Yes 9 team members Length: two available (group detecting IPV (7-item (Thompson et al., half-day training randomized) subscale, 2000) sessions over (e.g., manual) α = 0.73) 12 months Clinical aids: Posters; provider cue cards; routine System support Self-report exam forms; (4-item feedback subscale, α = 0.73) Blaming the victim Self-report (7-item subscale, α = 0.80) Fear of offending Self-report (7-item subscale, α = 0.80) Safety concerns Self-report (8-item subscale, α = 0.91)
APPENDIX F 291 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report Yes 9 21 Two clinics Three clinics Ipost > Ipre* Ipost > Cpost*Total number (7-item Eligible = Eligible = IFU > Ipre* IFU > CFU* of eligible subscale, Not reported Not reported participants in α = 0.73) Pre = 91 Pre = 88 all clinics was Post = Not Post = Not 208 of which reported reported 179 (86%) FU = Not FU = Not responded to reported reported the pretest. At Self-report Ipost > Ipre Ipost > Cpost the posttest and (4-item IFU = Ipre IFU > CFU follow-up, there subscale, were 190 α = 0.73) eligible Ipost > Ipre Ipost > Cpost providers of m Self-report IFU = Ipre IFU > CFU which 79% (7-item responded, and subscale, the correspond- α = 0.80) Ipost > Ipre* Ipost > Cpost ing figures for IFU > Ipre* IFU > CFU* the follow-up Self-report were 171 and (7-item 82%. The subscale, Ipost > Ipre* Ipost > Cpost extent to which α = 0.80) IFU > Ipre* IFU > CFU* the two groups differed with Self-report regard to (8-item attrition was subscale, not reported. α = 0.91) Outcome analyses were adjusted for pretest and clustering.
292 APPENDIX F Outcomes Related to Clinical Intervention Practices Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Residents in Type: Mixed Usual and Two groups, % covering Standardized No 6 internal medicine Length: Two available randomized psychosocial issues patient visit and family 50-min. in patient interview practice (Saunders sessions or et al., 1993) one 2-hr. session Extent to which Standardized Clinical aids: history was taken patient visit None during patient Number of interview participants: 17 Extent of planning Standardized conducted during patient visit patient interview ED staff, Type: Mixed Usual or Two groups % of identified Chart review Yes 12 including Length: 2 days available (group IPV cases with physicians, nurses, Clinical aids: training randomized) more appropriate and social workers Technical interventions (Campbell et al., assistance if in press) requested Patient satisfaction Self-report with care received of patients Commitment by Researcher EDs to detecting ratings and treating IPV victims ED staff Type: Didactic Cohort % of IPV cases Chart review Yes 12 (Fanslow et al., Length: 1 or 4 hrs. where interventions 1998, 1999) Clinical aids: were used (e.g., Protocols; referrals) forms; body map; checklist; contact cards Number of participants: 33 nurses and 11 medical staff
APPENDIX F 293 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Standardized No 6 Post = 15 Post = 20 Ipost = Cpost s patient visit w Standardized Unclear patient visit Standardized Unclear patient visit Chart review Yes 12 18 3 hospitals: 3 hospitals: Ipost = Cpost Pre = 600 Pre = 600 Post = 600 Post = 600 FU = 600 FU = 600 Self-report Ipost > Cpost* of patients Researcher Ipost > Ipre* Ipost > Cpost* ratings IFUt > Ipre* IFUt > CFUt* Chart review Yes 12 Pre = 21 Pre = 26 Ipost > Ipre* Ipost > Cpost*There was a s Post = 34 Post = 13 IFU = CFU difference in the number of interventions at the baseline. continued on next page
294 APPENDIX F Outcomes Related to Clinical Intervention Practices Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Community Type: Mixed Cohort % of all cases with Chart Yes 6 health center Length: 3-6 hrs. a completed safety review staff, including Clinical aids: assessment physicians, mid- IPV screening level practitioners, pocket card; % of all cases Chart social workers, IPV assessment where a body map review and psychologists form; stamp to was completed (Harwell et al., indicate 1998) screening and % of all cases with Chart suspected or referral to review confirmed CHC staff abuse; patient card of % of all cases with Chart resources and referrals to review safety tips; outside agencies additional tailored follow- up training to some CHCs Number of participants: 108 Public health Type: Mixed Cohort % of identified Chart Yes 12 nurses (Shepard Length: 4 hrs. IPV cases who review et al., 1999) Clinical aids: were provided Protocol and information follow-ups Number of % of identified Chart participants: IPV cases who review Unclear were directly referred to services
APPENDIX F 295 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Chart Yes 6 Pre = 251 Ipost > Ipre* review Post = 255 Chart Ipost = Ipre review Chart Ipost > Ipre review Chart Ipost > Ipre* review Chart Yes 12 24 Pre = 31 Ipost > Ipre* Analyses review Post = 23 IFU > Ipre* controlled for FU = 18 age of patients. Chart Ipost > Ipre review IFU > Ipre continued on next page
296 APPENDIX F Outcomes Related to Clinical Intervention Practices Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon ED, critical care, Type: Usual and Two groups % of cases with Chart 15 and perinatal Length: available (one documentation of review hospital staff Clinical aids: comparison relevant social (Short et al., Protocol group) history in press) % of cases with Chart documentation review % of documented Chart referrals for review IPV cases Primary care Type: Mixed Usual and Two groups % of identified Chart Yes 9-10 team members Length: 2 half- available (group IPV cases whose review (Thompson et al., day sessions training randomized) quality of care was 2000) over 12 months (e.g., manual) judged good or Clinical aids: excellent Posters; provider cue cards; routine exam forms; feedback Number of participants: Unclear Prenatal health Type: Didactic No protocol in Two groups % of identified Chart review Yes 3 clinic staff, Length: 90 min. one clinic (one IPV cases who including Clinical aids: comparison received referrals physicians, nurses, Protocol; group) to outside agencies nutritionists, follow-up counselors, and Number of clerical staff participants: (Wist & Unclear McFarlane, 1999)
APPENDIX F 297 Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Chart 15 18 Post, FU1, Post, FU1, IFU3 > A total of 2,531 review 21 FU2, FU3 = FU2, FU3 = CFU3* charts were 24 Not reported Not reported reviewed, but the numbers were not Chart IFU3 > CFU3 reported for review each data collection wave. Chart IFU3 > CFU3* review Chart Yes 9-10 2 clinics 3 clinics Ipost = Ipre Ipost = Cpost review Pre = 27 Pre = 32 Cpost = Cpre Post = 37 Post = 35 Chart review Yes 3 12 Pre = 3 Pre = 0 IFU > Ipre* Post = 9 Post = 0 FU = 17 FU = 0
298 APPENDIX F Screening, Identification, and Detection of Intimate Partner Violence Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Medical students Type: Mixed Earlier cohort Three groups Screening skills Standardized 9 (Jonassen et al., Length: 2-3.5 of third-year (one patient 1999) days medical comparison Clinical aids: students who group) Materials on did not local participate in resources; the clerkship screening algorithm Medical students Type: Mixed One lecture Two groups % correctly Vignettes Yes 1 (Short et al., Length: 4-week (one identifying IPV 2000) module comparison in patient Clinical aids: group) None % correctly Standardized No 1 identifying IPV patient in patient Residents in Type: Didactic Type: Didactic Two groups, No. of days that Self-report No 1 family practice Length: 2 hrs. Length: 2 hrs. randomized resident had of (Bolin & Elliott, Clinical aids: Clinical aids: conversations residents 1996) List of List of contacts with patients (daily contacts; about IPV diary) button Residents in Type: Didactic 1 group % of patients Patient exit Yes 4 day internal medicine Length: 105 reporting that interview (Knight et al., mins. resident had asked (one item) 2000) Clinical aids: about IPV Local resource list; laminated card of screening questions and resource contacts Number of participants: 45
APPENDIX F 299 rtner Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Standardized 9 Eligible = 205 Eligible = 93 Ipost > Cpre* Test reliability patient Post = 205 Post = 93 was reported (100%) (100%) as adequate. Results pertain to two separate cohorts who received the training. Vignettes Yes 1 Eligible = 149 Eligible (97) Ipost < Ipre* Ipost = Cpost The Pre = 124 Pre = 88 standardized Post = 88 Post = 66 patient was (71%) (75%) designed as Standardized No 1 Ipost = Cposttest of patient interview techniques. Self-report No 1 Eligible = Eligible = Ipost > Cpost* of Not reported Not reported residents Post = 6 Post = 5 (daily diary) Patient exit Yes 4 days Pre = 122 Ipost > Ipre* Analyses were interview Post = 116 adjusted for d (one item) patient age, income, and education, along with physician race. continued on next page
300 APPENDIX F Screening, Identification, and Detection of Intimate Partner Violence Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Residents in Type: Mixed One group % of cases seen Chart Yes 6 internal medicine Length: 4 hrs. where patient was review (Kripke et al., Clinical aids: asked about IPV 1998) None Number of % of cases where Chart participants: 55 patient was review identified as IPV victim Residents in Type: Mixed Usual and Two groups % identifying IPV Standardized 4 family practice Length: available (one patient visit (Mandel & Two sessions comparison Marcotte, 1983) over 4 months group) Clinical aids: Checklist on appropriate practices Number of participants: 16
APPENDIX F 301 rtner Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Chart Yes 6 Pre = 693 Ipost > Ipre s review Post = 277 Chart Ipost < Ipre review V Standardized 4 Eligible = Eligible = Ipost = Cpost Due to the patient visit Not reported Not reported small sample Post = 10 Post = 6 sizes, no statistical tests were performed. continued on next page
302 APPENDIX F Screening, Identification, and Detection of Intimate Partner Violence Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Residents in Type: Mixed Usual and Two groups, Time needed to Standardized No 6 internal medicine Length: Two available randomized detect IPV patient visit and family 50-min. in interview practice sessions or one (Saunders et al., 2-hr. session 1993) Clinical aids: None Number of participants: 17
APPENDIX F 303 artner Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Standardized No 6 Eligible = Eligible = Ipost = Cpost Randomization patient visit Not reported Not reported was done by Post = 15 Post = 20 team in one site, and those who did not attend training were placed randomly in rotation sites. The outcome was in the expected direc- tion but was not significant after physician gender, prior professional exposure, and number of IPV victims known were controlled for. continued on next page
304 APPENDIX F Screening, Identification, and Detection of Intimate Partner Violence Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon ED staff, Type: Mixed Usual or Two groups % of women who Self-report Yes 9-12 including Length: 2 days available (groups asked about IPV of physicians, Clinical aids: training randomized) patients nurses, and Technical % of self- social workers assistance if identified IPV Chart (Campbell et al., requested victims review in press) documented as such on medical record ED psychiatric Type: Didactic Protocol only Two groups, % of patients seen Chart No Uncl staff, including Length: 1 hr. (8 staff) randomized by staff where review residents, Clinical aids: history of adult medical students, Protocol spouse abuse was and other staff Number of identified in chart (Currier & participants: 10 Briere, 2000)
APPENDIX F 305 rtner Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report Yes 9-12 18-24 Pre = Not Pre = Not IFU > Ipre* Ipost < Cpost Analyses of reported reported IFU > CFU controlled for patients Post = 330 FU2 = 319 baseline Ipost > Cpost differences. Chart IFU > CFU Although not review statistically significant due to low statistical power, the ratio of self- reported IPV cases by patients to those documented in the medical record increased in the experimental hospitals but decreased in the comparison hospitals. n Chart No Unclear Post = Post = Ipost > Cpost* review 84 patients 78 patients continued on next page
306 APPENDIX F Screening, Identification, and Detection of Intimate Partner Violence Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon ED staff Type: Didactic Cohort % of all cases Chart Yes 1-3 (Fanslow et al., Length: 1 or identified as IPV review 1998, 1999) 4 hrs. victims Clinical aids: Protocols; % of possible Chart forms; body IPV cases that review map; checklist; were confirmed contact cards Number of % of possible Chart participants: IPV cases with review 33 nurses and documentation 11 medical staff ED staff Type: Unclear Cohort % of all cases Chart Yes 12 (McLeer et al., Length: identified as IPV review 1989) Unclear Clinical aids: Protocol Number of participants: Not clear ED physicians Type: Didactic Cohort % of all cases Chart 1 mo (Olson et al., Length: 1 hr. identified as IPV review prior 1996) Clinical aids: Stamped query on patient form Number of participants: Unclear
APPENDIX F 307 rtner Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Chart Yes 1-3 12-15 Pre = 2276 Pre = 1768 Ipost = Ipre Ipost = Cpost The analyses review Post = 2287 Post = 1720 IFU = CFU did not FU = 1598 FU = 1312 incorporate additional Chart Pre = 57 Pre = 54 Ipost > Ipre* Ipost > variables (e.g., review Post = 53 Post = 45 Cpost* patient FU = 17 FU = 30 IFU = CFU characteristics). Chart Pre = 57 Pre = 54 Ipost > Ipre* Ipost > Cpost*Routine review Post = 53 Post = 45 IFU = CFU screening not FU = 17 FU = 17 adopted by ED staff. Chart Yes 12 96 Pre = 359 Ipost > Ipre* At follow-up, review Post = 412 IFU > Ipre the protocol FU2 = 470 IFU < Ipost* was no longer in use nor any other formal assessment procedure. Chart 1 mo. 1 Pre = 1,272 Ipost > Ipre* A significant review prior Stamp-only = IFU > Ipost increase in 1,444 identification Stamp & rates occurred training = 1,356 after introduction of the stamp, but there was no change when education was added. continued on next page
308 APPENDIX F Screening, Identification, and Detection of Intimate Partner Violence Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon ED staff, Type: Unclear Cohort % of self-reported Chart Yes 12 including (workshops IPV victims who review physicians, and case were noted as residents, interns, presentations) such on chart and nurses Length: within 24 hours (Roberts et al., Unclear after presentation 1997a) Clinical aids: None Number of participants: Unclear ED, critical Type: Usual and Two groups % of cases with Chart 15 care, and Length: available (one documentation of review perinatal Clinical aids: comparison definite IPV hospital staff Protocol group) (Short et al., % of cases with Chart in press) documentation of review suspected IPV ED nurses Type: Didactic Cohort % of all cases Chart Yes 4 (Tilden & Length: 4 hrs. identified as IPV review Shepherd, 1987) Clinical aids: Protocol and forms Number of participants: 22
APPENDIX F 309 rtner Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment d Chart Yes 12 Pre = 141 Ipost = Cpost Low attendance review Post = 183 at training and lack of social work referral services at times when victims showed in the emergency room may have contributed to the lack of differences. Chart 15 18 Post = Post = IFU3 > A total of review 21 FU1 = FU1 = CFU3* 2,531 charts 24 FU2 = FU2 = were reviewed, FU3 = FU3 = but the Chart IFU3 > numbers were review CFU3* not reported for each data collection wave. Chart Yes 4 Pre = 447 Ipost > Ipre* review Post = 445 continued on next page
310 APPENDIX F Screening, Identification, and Detection of Intimate Partner Violence Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Maternity care Type: Didactic Cohort % of pregnant Self-report Yes 12 coordinators in Length: adolescents of county health Unclear reporting IPV at adolescent departments Clinical aids: first visit patients (Covington Protocol et al., 1997a) Number of % of pregnant Self-report participants: adolescents of reporting IPV at adolescent any visit patients Maternity care Type: Didactic Cohort % of pregnant Self-report Yes 12 coordinators in Length: adult clients of county health Unclear reporting IPV at pregnant departments Clinical aids: first visit patients (Covington Protocol et al., 1997b) Number of % of pregnant Self-report partcipants: adult clients of Unclear reporting IPV at pregnant any visit patients
APPENDIX F 311 rtner Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Self-report Yes 12 Pre = 129 Ipost > Ipre Analyses of Post = 117 controlled for adolescent differences in patients race/ethnicity between the Self-report Ipost > Ipre* two patient of cohorts. adolescent Although the patients rate of identification at the first visit doubled between baseline and the posttest, this was not a statistically reliable difference due to the small sample size. Self-report Yes 12 Pre = 1,056 Ipost > Ipre* Analyses of Post = 384 controlled for pregnant differences in patients race/ethnicity and age Self-report Ipost > Ipre* between the of two patient pregnant cohorts. The patients baseline review of charts covered a 36- month time span, and no differences were found in identification rates among the three years. continued on next page
312 APPENDIX F Screening, Identification, and Detection of Intimate Partner Violence Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Community Type: Mixed Cohort % of cases Chart Yes 6 health center Length: 3-6 hrs. screened for review staff, including Clinical aids: IPV physicians, IPV screening mid-level pocket card; % of cases Chart practitioners, IPV assessment where review social workers, form; stamp to IPV was and psychologists indicate suspected (Harwell et al., screening and 1998) suspected or % of cases Chart confirmed where review abuse; patient IPV was card of confirmed resources and safety tips; additional tailored follow- up training to some CHCs Number of participants: 108 Public health Type: Mixed Cohort % of cases Chart Yes 12 nurses (Shepard Length: 4 hrs. identified review et al., 1999) Clinical aids: as IPV Protocol Follow-ups Number of participants: 12
APPENDIX F 313 rtner Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Chart Yes 6 Pre = 251 Ipost > Ipre* There was no review Post = 255 significant change in positive Chart Ipost > Ipre* identification review of IPV victims in the chart. Chart Ipost > Ipre review Chart Yes 12 24 Pre = 546 Ipost > Ipre Differences in review Post = 442 IFU1 > Ipre identification FU = 372 rates were not significant when age was controlled (although they were marginally significant). continued on next page
314 APPENDIX F Screening, Identification, and Detection of Intimate Partner Violence Expected Nature of Training Provided Outcomes and Measure Timing Target Comparison Post- Population Intervention Group Study Major Base- test (study citation) Group (if applicable) Design Outcomes Measure line (mon Primary care Type: Mixed Usual and Two groups % asking Provider Yes 9 team members Length: 2 available (group about IPV self-report (Thompson half-day training randomized) (one item) et al., 2000) sessions over (e.g., manual) 12 months % of patients Chart Yes Clinical aids: who were asked review Posters; about IPV provider cue cards; routine % of patients Chart Yes exam forms; who were review feedback victims of IPV Prenatal health Type: Didactic No protocol in Two groups % of patients Chart Yes 3 clinic staff, Length: one clinic (one identified as review including 90 min. comparison IPV physicians, Clinical aids: group) nurses, Protocol; nutritionists, follow-up counselors, and clerical staff (Wist & McFarlane, 1999)
APPENDIX F 315 rtner Results I = Intervention Group easure Sample Size and C = Comparison Group Attrition from Pre = Baseline or Pretest Timing Measurement Post = Posttest FU = Follow-up Post- Follow- Within- Relative Base- test ups Group Group Measure line (months) (months) Intervention Comparison Change Difference Comment Provider Yes 9 2 clinics 3 clinics Ipost > Ipre* Ipost > Differences in self-report Eligible = ? Eligible = ? Cpost* recorded asking (one item) Pre = Pre = IFU > CFU occurred among Post = 91 Post = 88 Ipost > Ipre* Ipost > those who had Chart Yes Pre = 1,590 Pre = 2,205 Cpost* physical review Post = 1,372 Post = 2,020 exams and Same Same screening questionnaire. Chart Yes Ipost > Ipre Ipost > Cpost review Chart Yes 3 15 Pre = 360 Pre = 180 I(post+FU) > IFU > CFU* The percent of review Post = 110 Post = 55 Ipost > charts at the FU2 = 250 FU2 = 125 Cpost* intervention site that contained an abuse screen declined from 95% at the 3- month posttest to 85% at the 15-month follow-up.
