Bimodal intervention shows promise for intimate partner violence survivors

Black women involved in the legal system disproportionately experience intimate partner violence (IPV) but currently have few options for tailored interventions that consider intersectionality, according to a Penn State College of Education researcher.

Brandy Henry, assistant professor of education (rehabilitation and human services), co-authored a study that found that Black women who are survivors of IPV, particularly those with co-occurring substance use disorders (SUDs) and who are also involved in the criminal legal system, could benefit from a culturally sensitive intervention that combines in-person counseling and a self-paced computerized tool.

"The goal is to tailor an intervention that would address the stresses Black women face that create barriers to accessing services for substance use and interpersonal violence," Henry said.

In their paper published in Women's Health Reports, the researchers conducted a subgroup analysis of Black women using data from a randomized controlled trial that evaluated the feasibility and efficacy of two IPV screening and prevention programs for women who use drugs or engage in binge drinking and were under community supervision in New York City.

Participants in the original study were randomized into two IPV prevention conditions—computerized or case manager Women Initiating New Goals of Safety (WINGS). WINGS, which was developed in 2016, is an evidence-based, single-session Screening Brief Intervention and Referral to Treatment and Service (SBIRT) tool that is designed to address IPV among women who use drugs or engage in heavy drinking (WWUD). In the study, the researchers examine the effects of the original study's two conditions on linkage to IPV services and secondary outcomes, specifically among Black participants who experienced physical, sexual and psychological IPV.

"It's already known we need more services, particularly services that address intersectional problems for marginalized communities," said Henry. "The remaining question was, given that (IPV victims) are disproportionately women of color, are there differential effects of intervention by race? We wanted to know, was the goal of culturally tailoring services effective?"

The computerized WINGS intervention provided a self-paced assessment that allowed women involved in the legal system who use drugs to identify and disclose IPV; provide feedback on their risks for IPV; develop self-efficacy to protect themselves from IPV; raise awareness of drug-related triggers for IPV; develop safety plans considering substance-related risks for IPV; and enhance social supports and linkages to IPV services. A culturally appropriate female narrator guided participants through the tool. The case manager version of WINGS provided the same core components delivered by a trained case manager.

In the parent study, which included women of all races, both WINGS conditions saw significant improvements in all outcomes over the three-month follow-up period, with no differences across study arms. Similar to the parent study, in the sub-analysis, the researchers' findings showed that both modalities of WINGS could be helpful in identifying and addressing IPV victimization among Black women in community supervision programs who use drugs or engage in binge drinking. Unlike the parent study, in this sub-analysis, there were differences in results across the study arms: The case manager approach worked well for increasing receipt of IPV services, whereas the computerized arm was helpful in strengthening social support.

For the case manager arm, Henry said, social support may have fallen short due to a cultural mismatch between the service providers and the people they were serving. On the other hand, the computerized intervention was delivered via taped sessions by women of color, which may have helped with forging a sense of affinity. Nonetheless, Henry added, the live counseling sessions were more effective at connecting women with support services such as childcare and transportation—possibly because in-person engagement, coaching and support helps with tailoring those services.

"These findings suggest that different WINGS modalities may work better for different activities and point to the need for hybrid formats that optimize the use of different modalities," Henry said.

According to Henry, research has shown that there is a correlation between experiencing IPV and substance abuse. Many women cope with IPV by using substances, which creates a barrier to seeking help since services for substance and IPV are often not integrated. Some IPV services may not accept people with active substance dependence, she added, while substance abuse services may not help IPV victims. Additionally, many evidence-based interventions are tested on samples that don't include Back women.

"(WINGS) was trying to address this gap and create an integrated package of services that are tailored to this group of people," said Henry.

An additional complication for women of color experiencing IPV, Henry said, is that they are disproportionately surveilled by police and child protective services. For women who are using drugs and have children, they could be automatically referred to child protective services even if they are in treatment.

"How can we think about delivering services in a way that's disconnected from policing and punishment? How can we work with systems to change systems to divert women out of this carceral response into community-driven and community-delivered services?"

One way this population could be helped without being exposed to state surveillance, Henry said, is through mobile-delivered interventions such as the computerized arm of WINGS. A silver lining of the COVID-19 pandemic, she added, is that it has accelerated policy changes that facilitate the delivery of mobile services.

"Intersectionality is the way the cultural response plays out in this population," she said. "How can we shift that perspective and help deliver services to the people who most need them?"