Domestic Violence Enhanced Home Vistation Program - DOVE
Keisha S. Walker, MSN, RN, Kimberly Hill, MS, Etasha Crowder, BSN, RN
Phyllis Sharps, PhD, RN, FAAN
Children witnessing their mothers' experiences with intimate partner violence (IPV) are known to have serious long-term physical health, mental health and behavioral consequences. Half of all child witnesses to IPV are less than six years old (Campbell & Lewandoski, 1997; Kilpatrick & Williams, 1997). Little is known about appropriate interventions for infants/toddlers and their abused mothers. The Domestic Violence Enhanced Home Visitation Program- DOVE, a five year research project funded by the National Institute of Nursing Research (NINR), is a multistate study rigorously testing the effectiveness of a structured IPV intervention (DOVE) with 360 mothers and infants in three different settings using three different designs.
The DOVE study is being conducted as a collaborative effort between Johns Hopkins University, the Baltimore City Health Department, the University of Missouri, and the Missouri Department of Health and Senior Services. Research team members are: Drs. Phyllis Sharps, Jacquelyn Campbell, and Linda Rose from Johns Hopkins University, School of Nursing and Linda Bullock from the University of Missouri-Columbia, Sinclair School of Nursing. There are two experimental designs: 1) random assignment to DOVE or Usual Care in urban Baltimore City Health Department, and 2) in Missouri, eleven health departments are randomly assigned by department as follows: six to the DOVE intervention and five to Usual Care. In urban Baltimore and rural Missouri, 160 families at each site will receive either DOVE or Usual Care. In the third setting, Kansas City, Missiouri, a cohort design with a matched control analysis will be implemented. Twenty families will receive DOVE enhanced Nurse Family Partnership (NFP-DOVE), based on David Olds's home visitation model, and the outcomes will be compared to a group of 20 families selected from the national Nurse Family Partnership database. Families will be matched on key demographic variables.
Health department home visitor teams are provided training by the DOVE research team on screening and assisting women who have experienced IPV. Public health nurses deliver the DOVE intervention. The DOVE intervention is delivered during three prenatal and three postpartum visits for a total of six visits. A mixed-methods design is being used to collect quantative and qualitative data. Mothers and infants/toddlers are assessed at baseline, birth, 3, 6, 12, 18, and 24 months postpartum. Data is collected utilizing quantitative measurement tools. Maternal outcome measures include history of IPV, level of danger, adopted safety behaviors, resources used, mental health (depression, PTSD), parenting skills (knowledge, attitudes, and practices), and parenting stress (high risk parenting, attachment, and perceived adaptability of the infant/toddler). The infant/toddler dependent measures are physical and mental health development including physical injury. A sub-set of the sample, 30 clients, are recruited to participate in the qualitative component of the study. Purposive sampling is being utilized. Mothers are interviewed at baseline, 3, 6, 12, and 24 months postpartum. The goal is to learn in-depth from the perspectives of these women about the patterns of abuse and the effects of these patterns.
Analyses will include mixed linear models, ANCOVA, MANOVA procedures, and logistic regression. Constant comparative techniques will also be employed for the qualitative data. Outcomes will provide intervention efficacy data and information about the patterns of IPV, maternal health, and infant/toddler development in homes where there is IPV. This innovative intervention to reduce maternal and infant/toddler exposure to IPV has the potential to improve the health of women who experience IPV during pregnancy and the children exposed to this violence.
Subject recruitment began in December, 2006 and will be ongoing for two years. To date, a total of 31 participants have been enrolled in the Baltimore and Missouri study sites; 14 women are enrolled in DOVE and 17 women are enrolled in the Usual Care (comparison) group. Twenty-five participants have consented to the longitudinal qualitative study. Eight qualitative interviews have been completed across both study sites.