Development of a Problem-Solving Intervention to Address Intimate Partner Violence and Behavioral Health Sequelae

Lead Principal Investigator:  VA PI: Dr. Paul King; UB PI: Ghazala Saleem, EdD, MS, OTR/L

Funding Agency: VA Health Services Research and Development Service Award

Awarded: March 2024

Abstract: Intimate partner violence (IPV) is a major health concern among women Veterans, with prevalence estimates far exceeding those documented among civilian women. IPV is a known risk factor for adverse health outcomes, including but not limited to pain, PTSD and depression and particularly in the case of chronic IPV, repeated mild traumatic brain injuries (mTBIs). Research has shown that repeated mTBIs can lead to long-term disruptions in neurobehavioral functioning. While recent work has focused on identifying suitable interventions for mTBI, many of these studies have targeted improvement of cognitive as opposed to psychological and behavioral outcomes. Further, these interventions are often delivered in specialty treatment settings, thus limiting their accessibility. Scalable interventions that are capable of addressing the psychological and environmental safety needs of women Veterans who have experienced IPV-related mTBI are critically needed.

Our recent work has emphasized adaptation and testing of brief, problem-solving interventions to improve Veterans’ neurobehavioral outcomes following mTBI. Problem-solving is an evidence-based, transdiagnostic approach successfully adapted to treatment length and target in multiple health care settings.¹ Members of our team have successfully adapted versions of problem-solving for use with primary care patients (Problem-Solving Training for Primary Care; PST-PC²) as well as combat Veterans who have reported mTBI history (Problem-Solving Training for Concussion; PST-Concussion³). National program evaluation data (n = 519) have shown that PST-PC is effective in reducing depression (ES = .74) and general psychological distress (ES = .61) and further, is well-received by Veterans.⁴ Data from our recent open pilot trial suggest that further adaptations for mTBI are also feasible and acceptable to Veterans (King et al, under review). While outcome data are presently limited (n = 7), available data show promise that an mTBI-specific version (PST-Concussion) may also be effective in reducing psychological distress (ES = 1.8). Tailoring PST-Concussion to concurrently address IPV-related mTBI, a) information needs (e.g., identifying IPV-related mTBI and symptoms); b) current neurobehavioral complaints (e.g., difficulty with attention, memory); c) psychological distress associated with trauma and d) violence safety planning may offer a viable avenue to address the critical gap in IPV-care in a stepped, trauma-informed and culturally appropriate manner. We propose to:

Aim 1. Conduct an expert consensus study to adapt PST-Concussion for use with women Veterans who have experienced IPV-related mTBIs.

Aim 2. Gather subject matter expert feedback on recruitment techniques and viable referral pathways to engage women Veterans in treatment for IPV-related mTBIs.