The RCMI program in health disparities research at Meharry Medical College

Intimate partner femicide is a leading cause of death for women of childbearing age. Relative to White women, Women of Color (WOC) are disproportionately affected by partner femicide. While all women are at risk of intimate partner violence (IPV), rates of IPV in the past 12 months are 65% higher among WOC (9.4%) compared with White women (5.7%). Women experiencing IPV are at increased risk of HIV or other sexually transmitted infections (STI’s) due to forced intercourse and/or prolonged exposure to stress. IPV is also associated with higher rates of depression, anxiety, and suicidal ideation or actions. Less than 33% of women who are injured by intimate partners receive medical care for their injuries. Despite clear evidence of the higher IPV rates among WOC, little recent research has explored racial differences in access to IPV screening and receipt of health care needed to address the physical and mental health consequences of IPV. Addressing the trauma associated with IPV is crucial to reducing the, often lifelong, consequences of IPV. The American College of Obstetrics and Gynecology (ACOG) recommends routine screening for IPV and endorses trauma-informed care (TIC) as an evidence-based practice that improves IPV and trauma knowledge among medical providers. Best practices for implementing the ACOG recommendations have yet to be implemented or evaluated in minority-serving medical clinics in Tennessee. We propose research to understand potential disparities in IPV screening, detection and receipt of needed physical and mental health care, including ACOG IPV screening recommendations (Aim 1), ACOG TIC approach (Aim 2), and the efficacy of an IPV-adapted trauma-informed care intervention among clinicians and patients attending Meharry Medical College (MMC) primary care clinics (Aim 3). Given MMC’s mission of ‘advancing health equity through innovative research’ and ‘compassionate health services’, Meharry is an ideal setting for this research. To support health equity and actualize ACOG recommendations among women experiencing IPV, we propose an innovative implementation and rigorous evaluation of an IPV-adapted trauma-informed care approach. Specific Aim 1: Examine clinicians’ use of IPV screening to determine racial differences in patients’ self-report of IPV frequency, health status, and help-seeking behaviors in Meharry primary care clinic patients. Specific Aim 2: Adapt and impIement the ACOG recommended trauma-informed care approach, originally evidence-based for HIV, as a culturally appropriate intervention for women who screen as experiencing IPV. Specific Aim 3: Rigorously evaluate the efficacy of an IPV-adapted TIC approach to a) increase receipt of mental health services and reduce symptoms of trauma among women who disclose IPV as Meharry patients, and b) increase clinicians’ knowledge, self-efficacy, and referrals for mental health care for women experiencing IPV. This research innovatively 1) assesses IPV among women attending primary care clinics at Meharry, 2) employs implementation science methods to advance recommendations through stakeholder and community engagement, and 3) tests clinical staff and patient outcomes.