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Hooker, L., Small, R., Humphreys, C., Hegarty, K., & Taft, A. (2015). Applying normalization process theory to understand implementation of a family violence screening and care model in maternal and child health nursing practice: a mixed method process evaluation of a randomised controlled trial. Implementation Science, 10(1), 39.

Posted by: admin Posted on: May 24, 2019 ,

Abstract:

Background
In Victoria, Australia, Maternal and Child Health (MCH) services deliver primary health care to familieswith children 0–6 years, focusing on health promotion, parenting support and early intervention. Family violence(FV) has been identified as a major public health concern, with increased prevalence in the child-bearing years.Victorian Government policy recommends routine FV screening of all women attending MCH services. UsingNormalization Process Theory (NPT), we aimed to understand the barriers and facilitators of implementing anenhanced screening model into MCH nurse clinical practice.

Methods
NPT informed the process evaluation of a pragmatic, cluster randomised controlled trial in eightMCH nurse teams in metropolitan Melbourne, Victoria, Australia. Using mixed methods (surveys and interviews),we explored the views of MCH nurses, MCH nurse team leaders, FV liaison workers and FV managers on implementation of the model. Quantitative data were analysed by comparing proportionate group differences and change within trial arm over time between interim and impact nurse surveys. Qualitative data were inductively coded, thematically analysed and mapped to NPT constructs (coherence, cognitive participation, collective action and reflexive monitoring) to enhance our understanding of the outcome evaluation.

Results
MCH nurse participation rates for interim and impact surveys were 79% (127/160) and 71% (114/160),respectively. Twenty-three key stakeholder interviews were completed. FV screening work was meaningful and valued by participants; however, the implementation coincided with a significant (government directed) change in clinical practice which impacted on full engagement with the model (coherence and cognitive participation). The use of MCHnurse-designed FV screening/management tools in focussed women’s health consultations and links with FV services enhanced the participants’ work (collective action). Monitoring of FV work (reflexive monitoring) was limited.

Conclusions
The use of theory-based process evaluation helped identify both what inhibited and enhanced interventioneffectiveness. Successful implementation of an enhancedFV screening model for MCH nurses occurred in the contextof focussed women’s health consultations, with the use of a maternal health and wellbeing checklist and greatercollaboration with FV services. Improving links with these services and the ongoing appraisal of nurse work wouldovercome the barriers identified in this study.

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Researchers: Hooker, L., Small, R., Humphreys, C., Hegarty, K. and Taft, A.

Year: 2015

Taft, A. J., Hooker, L., Humphreys, C., Hegarty, K., Walter, R., Adams, C., Agius, P., & Small, R. (2015). Maternal and child health nurse screening and care for mothers experiencing domestic violence (MOVE): a cluster randomised trial. BMC Medicine, 13(1), 150.

Posted by: admin Posted on: May 24, 2019 ,

Abstract:

Background

Mothers are at risk of domestic violence (DV) and its harmful consequences postpartum. There is no evidence to date for sustainability of DV screening in primary care settings. We aimed to test whether a theory-informed, maternal and child health (MCH) nurse-designed model increased and sustained DV screening, disclosure, safety planning and referrals compared with usual care.

Methods

Cluster randomised controlled trial of 12 month MCH DV screening and care intervention with 24 month follow-up.

The study was set in community-based MCH nurse teams (91 centres, 163 nurses) in north-west Melbourne, Australia.

Eight eligible teams were recruited. Team randomisation occurred at a public meeting using opaque envelopes. Teams were unable to be blinded.

The intervention was informed by Normalisation Process Theory, the nurse-designed good practice model incorporated nurse mentors, strengthened relationships with DV services, nurse safety, a self-completion maternal health screening checklist at three or four month consultations and DV clinical guidelines. Usual care involved government mandated face-to-face DV screening at four weeks postpartum and follow-up as required.

Primary outcomes were MCH team screening, disclosure, safety planning and referral rates from routine government data and a postal survey sent to 10,472 women with babies ≤ 12 months in study areas. Secondary outcomes included DV prevalence (Composite Abuse Scale, CAS) and harm measures (postal survey).

Results

No significant differences were found in routine screening at four months (IG 2,330/6,381 consultations (36.5 %) versus CG 1,792/7,638 consultations (23.5 %), RR = 1.56 CI 0.96–2.52) but data from maternal health checklists (n = 2,771) at three month IG consultations showed average screening rates of 63.1 %. Two years post-intervention, IG safety planning rates had increased from three (RR 2.95, CI 1.11–7.82) to four times those of CG (RR 4.22 CI 1.64–10.9). Referrals remained low in both intervention groups (IGs) and comparison groups (CGs) (<1 %).

2,621/10,472 mothers (25 %) returned surveys. No difference was found between arms in preference or comfort with being asked about DV or feelings about self.

Conclusion

A nurse-designed screening and care model did not increase routine screening or referrals, but achieved significantly increased safety planning over 36 months among postpartum women. Self-completion DV screening was welcomed by nurses and women and contributed to sustainability.

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Researchers: Angela J Taft, Leesa Hooker, Cathy Humphreys, Kelsey L Hegarty, Ruby Walter, Catina Adams, Paul Agius and Rhonda Small

Year: 2015

Healey, L., Humphreys, C. and Howe, K. (2013). Inclusive Domestic Violence Standards: Strategies to improve interventions for women with disabilities? Violence and Victims, 28 (1): 50-68.

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Abstract: Women with disabilities experience violence at greater rates than other women, yet their access to domestic violence services is more limited. This limitation is mirrored in domestic violence sector standards, which often fail to include the specific issues for women with disabilities. This article has a dual focus: to outline a set of internationally transferrable standards for inclusive practice with women with disabilities affected by domestic violence; and report on the results of a documentary analysis of domestic violence service standards, codes of practice, and practice guidelines. It draws on the Building the Evidence (BtE) research and advocacy project in Victoria, Australia in which a matrix tool was developed to identify minimum standards to support the inclusion of women with disabilities in existing domestic violence sector standards. This tool is designed to interrogate domestic violence sector standards for their attention to women with disabilities.

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Researchers: Healey, L., Humphreys, C. and Howe, K.

Year: 2013

Healey, L., Howe, K., Humphreys, C. Jennings, C., & Julian, F. (2008). Building the Evidence: A report on the status of policy and practice in responding to violence against women with disabilities in Victoria. Women’s Health Victoria and Victorian Women with Disabilities Network.

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Abstract

This report presents research completed for the Victorian Women with Disabilities Network Advocacy Information Service (VWDN AIS). The VWDN AIS is a service developed in partnership between Victorian Women with Disabilities Network (VWDN) and Women’s Health Victoria (WHV). The VWDN is the statewide network of women with disabilities which represents key issues of concern to women with disabilities in Victoria. The WHV is the statewide women’s health service, which advocates for women and works with other organisations for better health outcomes for women. VWDN AIS invited the Alfred Felton Research Program at The University of Melbourne and the Domestic Violence Resource Centre Victoria (DVRCV) as strategic partners in this research.2 The purpose of the research was to analyse the extent to which current Victorian family violence policy and practice recognises and provides for women with disabilities who experience violence. Research was conducted from December 2007 to June 2008.

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