Internet-Based Intervention to Improve Mental Health Outcomes for Abused Women

Intimate partner violence (IPV) is well established as a widespread problem with important
negative physical and mental health, social and cost consequences for victims, their
families and the community. Beyond the physical conditions associated with IPV, research has
consistently demonstrated a strong association between experiencing IPV and increased rates
of anxiety, depression, low-self esteem, substance abuse and suicidality. Increasing abused
women's safety and reducing ongoing exposure to violence is key to minimizing such
consequences.

Building from the empowerment framework, safety planning interventions focus on protecting
women from exposure to repeat violence. However, despite the significant evidence of the
negative outcomes of IPV and the complex individual and community factors that influence
safety, little is known about what interventions improve the safety and mental health
outcomes of abused women. While experimental trials are beginning, to date there has not
been a trial to examine the effectiveness of safety planning, a cornerstone of IPV
interventions, on exposure to repeat violence, safety, and mental health outcomes for women.
An internet-based safety decision aid may assist abused women in weighing risks and benefits
of safety options, assessing danger, and identifying the factors that are most important in
their safety decisions. Further, it provides personalized links with community mental health
and domestic violence resources, which are invaluable in assisting women in planning for
safety, thereby reducing the immediate and long terms risk of negative mental health
consequences of violence.

Women who consent to participate in this study and who have access to a safe computer (e.g.
at home, work, community agency, friend/family) will be randomized to the intervention or
control group. If a woman is randomized into the intervention group, she will complete the
internet-based safety decision aid program. The decision aid program will be located on a
confidential password protected and secured study website and will take approximately 60
minutes to complete. Participants will first be asked demographic and relationship questions
as well as questions about their ability to make decisions about safety in their
relationship. Next, participants will be asked to make a series of comparisons to determine
the importance of specific factors such as: keeping the abuse private, safety of self,
family and children, feelings for partner, resources such as housing and employment and
maintaining norms within family, to safety decisions. Participants will then be asked
questions specific to risk factors for violence and safety seeking behaviors in their
relationship. After completion, the safety decision aid generates results to provide an
individualized safety plan to the participant. Women randomized into the control group will
access the confidential and password protected control website which includes a brief
assessment of risk factors and their history of violence, and will provide a list of local
resources, but not an individualized safety plan. Both intervention and control group
participants will then complete a series of instruments to measure intimate partner
violence, mental health outcomes, and safety seeking behaviors. Each participant will have a
skilled and trained research assistant available by phone or email to assist them in
understanding questions, interpreting the results, developing strategies for safety and
providing referrals for community-based services.

Follow up sessions on the study website will be conducted at 3, 6, and 12 months
post-baseline. Participants will be encouraged by the RA through phone or email contact to
access the password-protected website to complete the internet session and follow-up
assessment questions. Post-baseline questions will be the same as the baseline, but will
focus on outcomes since the previous internet session.

Inclusion Criteria:

- Female

- English or Spanish speaking

- 18-64 years of age

- Report current physical, or sexual intimate partner violence or emotional abuse
within the context of threats of physical or sexual intimate partner violence

- Live in one of the target states (Oregon, Arizona, Missouri, or Maryland)

- Express comfort with and access to a safe computer with internet

Exclusion Criteria:

- Male

- Younger than 18 years of age

- Older than 64 years of age

- Cannot read/speak English/Spanish

- Live outside targeted 4 states

- No access to safe computer with internet

- Uncomfortable with computers

- Does not report past year violence from an intimate partner