Maternal and child health nurse screening and care for mothers experiencing domestic violence (MOVE): a cluster randomised trial

Abstract

BackgroundMothers 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.MethodsCluster 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).ResultsNo 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.ConclusionA 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.Trial registrationAustralian New Zealand Clinical Trials Registry, ACTRN12609000424202, 10/03/2009

Nurse and midwifery education and intimate partner violence: a scoping review

“…Recent research shows that outcomes, such as safety planning with women may be sustained when using comprehensive, system‐level interventions based on implementation theory (Taft et al . ). Although no additional training was included in this study, authors acknowledged the importance of ongoing education and reflective practice to improve and maintain nursing skills (Hooker et al .…”

“…, Taft et al . ). A lack of IPV education for healthcare practitioners has been identified as a major barrier to adequate recognition and care for women experiencing IPV (Sprague et al .…”

‘It is a difficult topic’ – a qualitative study of midwives´ experiences with routine antenatal enquiry for intimate partner violence

“…This was in spite of a thorough implementation, training and access to guidance throughout the period [8]. Taft et al found similar screening numbers among maternal and child health nurses in Australia [37]. …”

Differences in help‐seeking behaviours and perceived helpfulness of services between abused and non‐abused women: A cross‐sectional survey of Australian postpartum women

“…To examine the help‐seeking patterns in abused and non‐abused postpartum women, we analysed data from the MOVE (Improving Maternal and Child Health Care for Vulnerable Mothers) trial. MOVE was a cluster randomised control trial which aimed to enhance the identification and support of postpartum women who may have experienced partner violence (Taft et al, ). The trial was set in eight Victorian MCH services within local government, in metropolitan Melbourne, Victoria, Australia.…”