The Role of Relationship in Addressing Intimate Partner Violence in Home Visitation

Background/Purpose

Women who are pregnant or have recently given birth are at increased risk for intimate partner violence (IPV) (Bacchus, Bullock, & Sharps, 2014).  A recent Cochrane review finds that there is insufficient evidence that current interventions prevent or reduce violence against pregnant women (Jahanfar, Howard, & Medley, 2014).  Early childhood home visitation programs are likely to encounter IPV among their clients and are an opportunity for prevention and early intervention (Levenson, 2015).  However, little is known about how these programs encounter and address IPV that affects their participants and their staff.  This paper uses interviews with administrators in a statewide network of home visiting programs in a large Midwestern state to explore their perspectives on how home visiting programs encounter and address IPV.

Methods                                                                                   

In-depth, semi-structured, qualitative interviews approximately 90-120 minutes in length were conducted with 34 program administrators and supervisors in a Midwestern, statewide network of home visiting programs.  Interviews were transcribed and coded thematically.  Qualitative data obtained from free response and open ended questions was analyzed for common themes using qualitative description (Sandelowski, 2000, 2010).  The data analysis process was aimed at summarizing the information obtained as well as identifying the most frequently occurring themes.  The qualitative responses were analyzed by three researchers independently and then as a group in order to achieve consensus.

Results

Respondents emphasized relationships between the home visitor and others as key to how home visiting programs addressed interpersonal violence, and three primary types of relationship emerged: 1) The home visitor’s alliance and helping relationship with women who participated in home visitation.  Respondents emphasized meeting participants where they are without leaving them there, performing concurrent assessment over time (as IPV was rarely disclosed at the start of the home visiting relationship), and being willing to set aside the home visiting curriculum as needed to engage in crisis work regarding IPV. 2) The relationships between home visitors and IPV professionals.  Respondents valued being able to “go in the back door” and link participants to specific IPV agencies and professionals so that participants received highly personalized attention when IPV was identified.  3) The home visitor’s relationship with herself and her supervisor as it emerged through reflective supervision.  Respondents recognized that dealing with IPV created an emotional burden for home visitors and that reflective supervision was a way for visitors to separate from the work, avoid being judgmental or reactive, and put enough “gas in their tank” to be able to continue working with participants experiencing IPV.

Conclusions/Implications

Interviews with administrators and supervisors who oversee home visits revealed that as the relationship between home visitors and participants developed, participants were more likely to disclose their experience of IPV.  In response to this disclosure, respondents identified the need to understand the dynamics of IPV and how to respond to crisis situations, to have a relationship-based network of IPV resources and referrals, and to follow up with a supervisor to process IPV disclosures as they occurred.  Relationships across multiple levels are key to addressing IPV in home visitation.