Examining Health Advocacy As a Model to Empower Victims of Interpersonal Violence and Improve Health Outcomes

Background and Purpose: Victims of Interpersonal Violence (IPV) are at increased risk of injury and chronic stress related health and mental health conditions. However, most intervention approaches focus on safety planning, resource obtainment and legal issues, without much attention given to the overall health or wellness of a victim. The Technology Enhanced Screening and Supportive Assistance (TESSA) project is piloting a partnership between local clinics and IPV agencies with an intervention referred to as health advocacy. Health advocacy blends the targeted, goal directed approach of Motivational Interviewing with the more clinical, self-reflection components of solution focused therapy. Advocates use tools such as wellness wheels, icon based goal sheets, and goal attainment scaling to promote reflection in areas of safety, stress reduction, and health management. The objective of this study is to determine the effectiveness of these interventions and its ability to replicate in other communities. Research questions include what are the primary healthcare needs of victims of interpersonal violence? What are the best methods to evaluate an intervention such as health advocacy? How does health advocacy improve health outcomes for IPV victims?

Methods: The setting includes clients receiving health advocacy services at local primary care clinics or IPV service provider agencies. Participating clinics are those serving high risk patient populations including the homeless, undocumented immigrants, and high poverty neighborhoods. Participating IPV agencies include a local domestic violence shelter, family justice center, and rape crisis services. Measures include an icon based intake process identifying initial needs in the areas of healthcare, self-care and safety, goal attainment levels captured at baseline, throughout intervention, and at completion of services, along with self-reported scaling.

Results: Early results indicate that the majority of clients (59%) engaged in health advocacy services indicate progress of at least one level on goal attainment scaling, with 35% showing improvement of 2 levels or more. Victims on average identify 4 goals to work on with the majority of participants focusing on areas of healthcare management and navigation.

Conclusions: With victims of IPV experiencing increased risk of poor health outcomes and greater rates of healthcare utilization, there is a clear need to focus efforts in addressing health impacts. If victims experiencing chronic conditions and their symptoms are not satisfactory managed they are less likely to achieve progress in any other area of crisis management. Health advocacy offers a promising strategy to engage survivors in goal setting around health, wellness, and safety, while emphasizing personal autonomy throughout the process.