Rapid HIV testing and counseling for residents in battered women’s shelters

Over one million Americans live with the human immunodeficiency virus (HIV), and roughly 20 percent of those living with HIV are unaware of their status. One way to decrease this epidemic is community-based rapid testing with high-risk populations. One high-risk population that has received limited attention is victims of intimate partner violence who seek shelter. In an effort to gain foundational information to implement rapid HIV testing and counseling services in domestic violence shelters, the current study conducted a series of focus groups with eighteen residents and ten staff of local shelters from October 15 to December 12, 2012. Participants provided valuable insight into how HIV rapid testing and counseling might be best implemented given the resources and constraints of shelter life. Despite identifying some potential barriers, most believed that the promise of quick results, the convenience and support afforded by the shelter venue, and the timing of the intervention at a point when women are making life changes would render the intervention acceptable to residents. Further insights are discussed in the article

Protocol for the ROSE sustainment (ROSES) study, a sequential multiple assignment randomized trial to determine the minimum necessary intervention to maintain a postpartum depression prevention program in prenatal clinics serving low-income women

Background: More research on sustainment of interventions is needed, especially return on investment (ROI) studies to determine cost-benefit trade-offs for effort required to sustain and how much is gained when effective programs are sustained. The ROSE sustainment (ROSES) study uses a sequential multiple assignment randomized (SMART) design to evaluate the effectiveness and cost-effectiveness of a stepwise approach to sustainment of the ROSE postpartum depression prevention program in 90 outpatient clinics providing prenatal care to pregnant women on public assistance. Postpartum depression (PPD) is common and can have lasting consequences. Outpatient clinics offering prenatal care are an opportune place to provide PPD prevention because most women visit while pregnant. The ROSE (Reach Out, Stay Strong, Essentials for mothers of newborns) program is a group educational intervention to prevent PPD, delivered during pregnancy. ROSE has been found to reduce cases of PPD in community prenatal settings serving low-income pregnant women. Methods: All 90 prenatal clinics will receive enhanced implementation as usual (EIAU; initial training + tools for sustainment). At the first time at which a clinic is determined to be at risk for failure to sustain (i.e., at 3, 6, 9, 12, and 15 months), that clinic will be randomized to receive either (1) no additional implementation support (i.e., EIAU only), or (2) low-intensity coaching and feedback (LICF). If clinics receiving LICF are still at risk at subsequent assessments, they will be randomized to either (1) EIAU + LICF only, or (2) high-intensity coaching and feedback (HICF). Additional follow-up interviews will occur at 18, 24, and 30 months, but no implementation intervention will occur after 18 months. Outcomes include (1) percent sustainment of core program elements at each time point, (2) health impact (PPD rates over time at each clinic) and reach, and (3) ROI (costs and cost-effectiveness) of each sustainment step. Hypothesized mechanisms include sustainment of capacity to deliver core elements and engagement/ownership. Discussion: This study is the first randomized trial evaluating the ROI of a stepped approach to sustainment, a critical unanswered question in implementation science. It will also advance knowledge of implementation mechanisms and clinical care for an at-risk population

Another dodo bird verdict? revisiting the comparative effectiveness of professional and paraprofessional therapists

We examine major criticisms of studies comparing paraprofessionals\u27 and professionals\u27 therapeutic effectiveness. Such analysis does not support the contention that methodological weaknesses of the studies produced systematic biases against professional therapists. Thus, despite common beliefs to the contrary, the finding that formal training does not predict successful therapy appears sound. We discuss the implications of this finding for research, training, and clinical practice. Copyright © 1995 John Wiley & Sons, Ltd

MOSAIC (MOthers' AdvocateS In the Community) for pregnant women and mothers of children under 5 with experience of intimate partner violence: A pilot randomized trial study protocol.

BackgroundPregnancy and motherhood increase the risk for long-term exposure to physical, psychological and sexual intimate partner violence (IPV; sexual or physical violence by current or former partners). Pregnant women and mothers with children under 5 who have experienced IPV exhibit poor physical and mental health and obstetric outcomes. Depression and posttraumatic stress disorder (PTSD) are the two most common mental health consequences of IPV. There is good evidence that women with good social support have better mental health and IPV outcomes.MethodsThis study will develop MOthers' AdvocateS In the Community (MOSAIC) Plus intervention for pregnant women and mothers with children under the age of 5. MOSAIC uses trained mentor mothers and has been found to reduce subsequent IPV. This study will blend the original MOSAIC intervention with principles of interpersonal psychotherapy (IPT) to address symptoms of depression, PTSD, and prevent subsequent risk of IPV. We will conduct a pilot randomized trial of the MOSAIC Plus intervention compared to the traditional MOSAIC intervention to determine its feasibility and acceptability. Study samples include focus groups (n = 36), open trial (n = 15), and a randomized pilot trial including 40 pregnant women and mothers with children under 5 who report current/recent of IPV and elevated symptoms of maternal depression and/or PTSD. The study's primary outcome will be changes in maternal depressive and PTSD symptoms. Secondary outcomes will include reduction in subsequent IPV, improvement in functioning, changes in social support and effectiveness in obtaining resources.DiscussionThis is a formative study evaluating the feasibility and acceptability of a mentor mother intervention for pregnant women and mothers with children under 5. Promising results of this study will be used for a larger, fully-powered randomized trial evaluating the effectiveness of a mentor mother intervention in preventing subsequent IPV and reducing depressive and PTSD symptoms in this population

Individual and Relationship Characteristics of Adolescent Girls with Histories of Physical Dating Violence

The objective of this article is to examine the individual and relational characteristics of adolescent girls with a history of physical DV, as well as to utilize partner-specific, temporal data to explore links between these factors and recent or ongoing DV experiences. Participants were 109 high school girls (ages 14-17) identified as having a history of DV through a school-based screening procedure. Details regarding the timing of DV and links with specific dating partners were gathered using Timeline Followback (TLFB) interview methodology. At study entry, 30% endorsed clinical levels of depression symptoms and 89% reported delinquent behaviors. Forty-four percent reported vaginal intercourse in their lifetime and of those, 35% reported not using a condom at last sex. During the 90 days prior to study entry, 69% of youth reported having a romantic relationship and 58% of those youth reported physical/sexual violence. Data revealed that more physical/sexual violence was associated with longer relationship length, Wald χ2(2) = 1,142.63, p \u3c .001. Furthermore, depressive symptoms, not delinquency, contributed significantly to recent DV experiences, even when relationship length was controlled. Our findings suggest that prevention programs for this population should teach participants how to quickly recognize unhealthy relationship characteristics, as violence severity increases with relationship length. Programs for adolescent girls should also address depressive symptoms, which are linked to DV severity when other risks are taken into account. Finally, the TLFB calendar method appears useful for gathering the temporal and partner-specific data needed to understand the complexity of dating relationships and violence experiences in this population