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Development and training of mental health professionals in providing psychological intervention and support for women survivors of intimate partner violence – A pre–post evaluation study


1 Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), (Institute of National Importance), Bengaluru, Karnataka, India
2 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), (Institute of National Importance), Bengaluru, Karnataka, India

Date of Submission18-Jul-2021
Date of Acceptance14-Mar-2022
Date of Web Publication20-Jun-2022

Correspondence Address:
Mysore Narasimha Vranda,
Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (NIMHANS), (Institute of National Importance), Bengaluru - 560 029, Karnataka
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ipj.ipj_164_21

   Abstract 


Context: Health care providers play a significant role as they are the first contact for seeking help for intimate partner violence (IPV) survivors. Aims: This research aimed toward developing a comprehensive culturally appropriate intervention package for the mental health professionals (MHPs) to provide psychological intervention and support for women survivors of IPV and test the training impact on the level of attitude, knowledge, and preparedness to respond to IPV disclosure among MHPs. Settings and Design: A single group, pre–post intervention study, was conducted at Tertiary Mental Health Hospital in the Southern part of India, Bengaluru. Materials and Methods: A total of 30 MHPs were recruited for the study using purposive sampling. MHP Attitude, Knowledge, Preparedness to Manage IPV (MAP–IPV) questionnaire was used to collect the data. Statistical Analysis Used: Descriptive statistics were used to assess the sociodemographic characteristics of the participants. The pre–post evaluation was analyzed using the independent “t” test by comparing the means scores of the MAP–IPV questionnaire. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) – 20 version of the software. Results: The results revealed a lack of attitude, knowledge preparedness, and available resources materials among MHPs in addressing IPV cases. Pre–post evaluation showed statistically significant improvement in attitude, knowledge, and preparedness to identify and respond to IPV disclosure among MHPs after the intervention program. Conclusion: The comprehensive IPV intervention package effectively brings gain in attitude, knowledge, and preparedness among MHPs in addressing survivors of IPV. Practice guidelines and clear referral pathways following IPV disclosure need to be implemented to support the gains made through the training.

Keywords: Attitude, clinical, health, preparedness, psychological, violence



How to cite this URL:
Vranda MN, Kumar CN, Janardhana N. Development and training of mental health professionals in providing psychological intervention and support for women survivors of intimate partner violence – A pre–post evaluation study. Ind Psychiatry J [Epub ahead of print] [cited 2022 Jul 4]. Available from: https://www.industrialpsychiatry.org/preprintarticle.asp?id=347796




   Introduction Top


Intimate partner violence (IPV) is a major public health issue around the globe and has been associated with adverse health outcomes, including injuries, anxiety, depression, post-traumatic stress disorder (PTSD), and suicide.[1],[2],[3] In India, nearly one-third of women aged 15–49 years have experienced physical violence, and about one in ten have experienced sexual violence. In total, 35% have experienced physical or sexual violence.[4]

Victims/survivors of IPV frequently visit health facilities with IPV-related health issues but rarely disclosure their IPV experiences with health care providers.[5],[6] As a result, in most instances, IPV is not recognized and adequately addressed by health professionals. However, there are several barriers to disclosure and the inquiry, which may be responsible for low rates of detection of IPV by health care professionals. The common reasons for non-disclosure of IPV to health care professionals are lack of privacy, fear of threat, and further violence, re-traumatization, shame, and minimization of violence, especially emotional violence.[7],[8],[9] Several professionals barriers might prevent health care professionals from recognizing IPV, including lack of IPV training, fear of offending women, time constraint, personal discomfort and lack of self-confidence in asking for IPV, lack of skills responding to disclosure of IPV, and negative attitude.[10],[11],[12] Of these, lack of IPV training is a significant barrier preventing health professionals from recognizing IPV.[13],[14],[15]

The World Health Organization (WHO)[16] recommends that IPV training programs address staff attitudes and include safety planning, effective communication, and referral to specialized community resources. Moreover, there is a need for culturally appropriate IPV resource materials for health care professionals to address in clinical settings. A recent scoping review by Sprague et al.[17] reported a lack of IPV educational and training programs and also wide variation in available program content, approaches, and uniformity in methodologies adopted in outcome evaluation of IPV training. There is a need for developing and training mental health professionals (MHPs) in the clinical setting. This research aimed toward developing a comprehensive culturally appropriate intervention package for the MHPs to provide psychological intervention and support for women survivors of IPV and test the training impact on the level of attitude, knowledge, and preparedness to respond to IPV disclosure among MHPs.


   Materials and Methods Top


A single group, pre–post intervention study, was conducted at Tertiary Mental Health Hospital in the Southern part of Bengaluru, India. A purposive sampling technique was used to recruit the participants. Around 30 MHPs working in the multidisciplinary team of Adult Psychiatry, Family Therapy, Neurology Unit, Behavioral Unit, Addiction Medicine, Neurological Rehabilitation Centre were recruited for the research.

Ethical consideration

Informed consent was obtained from the participants. This study received ethical approval from the Institute Ethical Committee – Behavioural Sciences Division.

Materials

  1. Socio-demographic data sheet: The data sheet consisted of background information of the MHPs and training needs specific to handling IPV cases in clinical settings.
  2. MHP Attitude, Knowledge, Preparedness to Manage IPV (MAP–IPV):[18] It assesses the attitude, knowledge, and level of preparedness to address IPV in health setting. It consists of 49 items with 3 domains: attitude and opinion (15 items), knowledge (17 items), and preparedness (17 items). The responses for each item are “strongly disagree,”, “disagree,” “somewhat agree,” “agree,” and “strongly agree” on a five-point Likert scale. The overall actual scores ranged from 158 to 226. A higher score indicates better attitude and opinion, knowledge and preparedness to handle the IPV cases by MHPs in the clinical setting. Through experts' opinion, face validity and consensual validity were established for the scale.


In the follow-up assessment, we also have examined two clinical practices regarding IPV: The number of IPV cases identified during the 3 months of the study and the nature of psychological services offered to prevent or reduce further IPV for the identified cases of MHPs.

Module development and intervention program

The research team developed “Psychosocial First AID Intervention and Support for Women Survivors of IPV” – A guide for MHP based on the review of existing literature reviews. The intervention package was designed to help MHPs offer psychosocial first-aid intervention and support to survivors of IPV in the clinical setting. The intervention package was given to the ten experts to validate its contents and, their opinions and comments were sought to refine the modules. Experts suggested to include information about community resources at the end of the package as an annexure; add modules on self-care strategies to address professional burnouts and ethical issues while dealing with IPV cases. The final intervention package consisted of eight modules covering topics on awareness of gender-based violence (GBV), health impact, overcoming professionals and survivors barriers, guidelines, and techniques of psychosocial assessment, trans-theoretical model, and stages of change framework for understanding how individuals make changes in behavior beginning with recognition of the need for change and simple techniques to handle it, assessment of trauma, and mental health impact, techniques of offering psychosocial interventions, self-care, and addressing professionals burnout, and ethical and legal issues surrounding assessment, intervention, and referral to survivors of IPV.[19]

The intervention package was tested with 30 MHPs to test the feasibility of the modules and improve the MHPs clinical skills to provide psychosocial care and support to IPV survivors in a clinical setting. The training was conducted for four days by adopting participatory methodologies such as role-play, brainstorming, case studies/scenarios, video presentations, and group discussions. The training focused on skills building and empowering the practice to ask about IPV in a clinical setting verbally. The participants were given examples of asking and responding effectively and supportively in disclosure or denial of IPV. Sessions on behavioral skills included offering emotionally supportive statements, safety planning, client education, referral, and documentation skills. Apart from this, case scenarios were given to encourage discussions and critical thinking among the participants. The sessions included discussions on strategies to overcome potential barriers for routine inquiry of IPV and ways to support IPV survivors in prevention or cessation of violence. The final session of the day provided an opportunity for participants to debrief. Each day three to four topics were covered. The topics of sessions are given in [Box 1].



Data analysis

We used the Statistical Package for the Social Sciences (SPSS) version 20 statistical software for all of the statistical analyses. Using descriptive statistics, we first summarised the participants' sociodemographic details. We used paired “t” test to compare mean scores before and after the training program.


   Results Top


The mean age of the participants was 35.5, with SD 5.35. The majority (53.3%) of the MHPs were female, and 46.7% were males. The mean years of experience of MHPs were M = 8.23 with SD = 5.27. Among 30 MHPs, 18 (60%) were psychiatric social workers, 3 (20%) nurses, 4 (13.3%) psychologists, and 2 (6.7%) were psychiatrists. It was revealed that 75% of the MHPs do not routinely screen for IPV experiences with their patients. The number of IPV cases seen by the MHPs ranged from one to ten cases every week with a mean of 2.57 ± 2.20. When it comes to the training needs of the MHPs, 75% of MHPs had not received formal specific training in dealing with women exposed to IPV.

Regarding the MHPs training needs to handle IPV cases, most of them (i.e., 85%) wanted to have resource materials to handle IPV cases covering various therapeutic models, and skills to address IPV issues. They also expressed the need to have Information Education and Communication (IEC) materials in different vernacular languages, which may be displayed at inpatient (IP) and outpatient (OP) care for clients' benefits. The perceived barriers for the screening or responding to IPV reported by MHPS were lack of comfort, concerns related to women's safety, and lack of knowledge and professional skills to respond to IPV disclosure.

Pre and post-intervention differences in MHPs' on MAP-IPV scores

[Table 1] shows the comparison of the effect of pre–post intervention on the domains of the MAP–IPV scale. The results showed a statistically significant gain in attitude (P < 0.001), knowledge (P < 0.001), and preparedness (P < 0.001) to respond and intervene to the disclosure of IPV after the intervention program among the MHPs.
Table 1: Pre–Post Intervention Scores of MHPs on MAP–IPV Scale

Click here to view


MHPs pre–post intervention practices to identify and assist in IPVdisclosures

[Table 2] shows the PHMs' identification of IPV cases before and after the 3 months of intervention. The number of IPV cases identified before (mean 2.57; SD = 2.20) and after the (mean 10.26; SD = 4.16) intervention increased significantly (P < 0.000). The number of cases identified before and after the intervention ranged from 0–10 to 3–20.
Table 2: MHPs' pre- and post-intervention practices to identify and assist in IPV disclosure

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The services offered to the identified cases of IPV by MPHs following the post-intervention were: supportive therapy, information about women's organizations and protection officers, safety planning based on danger assessment, education about legal rights, and legal referrals.

Feedback about quality of content of intervention package and training

About the content of the intervention modules, the majority (70%) of the MHPs were fully satisfied with all aspects of the intervention package and felt topics were relevant to the context of women with IPV in the clinical setting. They also suggested incorporating the information about community resources available for proper referral and brief information on various laws in India to protect women against GBV.

About 85.6% of them reported that the training program improved their awareness of different forms of IPV in the community. They also noted that their knowledge had improved a great deal concerning asking women about IPV, responding to IPV disclosure, awareness of referral networks in the community, and laws to protect women against GBV.


   Discussion Top


In the present study, we developed and evaluated the IPV intervention program and its efficacy in improving MHPs attitude, knowledge, and preparedness to identify and manage IPV cases in clinical settings. The study's findings revealed significant improvements in MHPs' attitude, knowledge, and preparedness to identify and respond to IPV disclosure after the intervention program. The results showed that study participants were not knowledgeable about the cause of violence, IPV risk factors, warning signs, the dynamics of IPV, and lacked professionals skills to respond to IPV disclosure appropriately. Furthermore, the results support earlier research that indicates health care professionals lack of the knowledge and skill to assess and respond to IPV.[20],[21] Findings from a systematic review and meta-analysis revealed that health care providers were much more likely to feel prepared to carry out a routine inquiry if they had undergone a detailed IPV training program.[22] Kim et al.[23] developed a post-rape care model to integrate into existing reproductive health services. The findings revealed improvement in providing quality care services to the survivors of sexual assault after the intervention. Hamberger et al.[24] study revealed that the participants with no prior training showed a significant increase in self-efficacy, change in attitudes and values than those with prior training after a 6-month follow-up. Thompson et al.[25] used a randomized skill-based educational model coupled with environmental cues in identifying and managing domestic violence in primary care. The results revealed improved provider self-efficacy, decreased fear of offense and safety concerns, and increased skills to screen for domestic violence that were documented after the intervention program.

Waalen et al.[26] have reported specific barriers to screen for IPV: such as, lack of training, limited time to screen, fear of offending client, and lack of available effective interventions after identification of IPV among health care workers. In the current study, three-fourth of the MHPs had not undergone any previous training on GBV. Apart from this, lack of resource materials, lack of comport in asking for IPV-related questions, and lack of knowledge and skills to respond to disclosure of IPV are barriers reported by the MHPs. Hence, it is vital to integrate the curriculum into the academic training. There is a need for a whole system approach, including the standard protocol, policies, guidelines to a mandatory screening of IPV, and regular staff training at all levels.

Strength and Limitations

In this study the researchers developed and standardized IPV intervention package for the MHPs in the clinical setting. The research was conducted in one hospital; hence, the generalizability of the result is limited. There is a need to replicate the findings with larger groups.


   Conclusion Top


The IPV training improved MHPs attitude, knowledge, perceived preparedness in identifying and assisting survivors while reducing their perceived barriers. The package is comprehensive and culturally appropriate to the targeted group. The present intervention package may be integrated into all primary care centers, general hospitals, district mental health programmes, one stop centers, Swadhar Grehs, and women crisis centers for early identification and timely intervention for the victims/survivors of IPV.

Financial support and sponsorship

Funded by the National Institute of Mental Health and Neuro Sciences (NIMHANS) - B Extramural Fund, Bengaluru, Karnataka, India.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

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