Engaging Community in Research: DOVE Home Visit Intervention for Abused Pregnant Women

1. Engaging Community in Implementing a Research Protocol:DOVE Home Visit Intervention for Abused PREGNANT WOMEN Phyllis Sharps, PhD, RN, FAAN, Professor Associate Dean Community and Global Programs

2. Session Objectives • Describe approaches to research with communities. • Discuss DOVE approach to community based research. • Discuss lessons learned and strategies for thriving in community based research.

3. Research and Communities Approaches to Research with Communities • Community Based Research • Community Based Participatory Research

4. Community Based Research Research that strives to be: • Community situated • Research topic relevant to community (not researcher) • Carried out in community settings • Collaborative • Community members and research equitable share research agenda • Active and reciprocal roles in design, implementation and dissemination • Action-oriented • Process and Results useful to community to make positive change and promote social equity

5. Characteristics of Community Based Research • Relevance of research identified by community • Resources are shared with community (financial, expertise) • Research process recognizes & uses expertise of community • Research process recognizes & addresses power imbalances • Research values emphasizes empowerment, supportive relationships, social change, learning as ongoing, respect for diversity • Research process & results accessible & understandable to community • Research process & results adapt to context of community • Research leaves a legacy; use of results and future collaborations among partners

6. Community Based Participatory Research Collaborative research project that: • Involves all partners in the research process • Recognizes unique strengths that each brings • Begins with research topic important to community • Aims to combine knowledge with action and achieve social change

7. Characteristics of CBPR • Community residents participates actively in all aspects of research – from concept – to conclusions and dissemination of findings • Build community trust and community capacity with goal of increasing community participation in the research process • CBPR – is essential to public health research that is • Action –oriented • Community driven

8. Community Based Research Research Addressing Professional and Participant Communities

9. Domestic Violence Enhanced Home Visitation Program: (DOVE) NIH/NINR - R01 NR009093

10. Hatching DOVE Research and Practice Interests: • Reducing Infant Mortality Rate among African American women • Depressive symptoms in pregnant and parenting low income women • IPV and perinatal health outcomes

11. Hatching DOVE • Community Based Experiences • Observing impact of violence on pregnancy and maternal and infant outcomes • Working and listening to community – shelter nurse • Research assistant for community projects • Member of interdisciplinary research teams implementing community based projects • All contributed to my keen desire to do research with communities aimed at reducing violence against pregnant women

12. Background for DOVE • IPV violence during pregnancy linked with adverse outcomes for: • Mothers • Infants • More than 3 million children witness IPV of mother each year • More than 50% of these children are under 6 years old

13. Purpose of DOVE DOmesticViolence Enhanced Home Visitation Program • Rigorous test of structured IPV intervention • Empowerment intervention aimed at reducing IPV • Mothers and infants • 2 Sites and Settings • Urban – Baltimore City HD • Urban – Missouri HD • Rural – Missouri HD

14. Design • 3 different designs in 3 different settings • RCT • Mixed methods – quantitative & qualitative • BCHD(women and infants) • Eligible women = R→DOVE vs. UC • MOHD (women and infants) • 12 HDs = R→ 6 HD DOVEvs. 6 UC • NFP(Olds HV model; mothers and infants) DOVE vs. Olds database

15. Schema for DOVE Project Kansas City, Missouri URBAN (Baltimore City Health Dept.) RURAL (Missouri Health Dept.) ò ò ò Selected from NFP National Data 1 NFP (N=40) 12 HD’s (N=160) Referrals ò ò ò RANDOMIZE REFERRAL BCHD  ÷ ø ò DOVE-NFP RANDOMIZE Usual Care (6 HD’s) DOVE (6 HD’s) ÷ ø Usual Care (M&I) DOVE (M&I & DOVE) Data Collection/Follow Up Assessments Baseline, Delivery, 3,6,12,18 24 M post-delivery -

16. Methods Quantitative Study: Measures • IPV • Maternal Mental Health • (stress, depression, PTSD) • Parenting • (stress, stimulation) • Infant Growth & Development • Use of Community Resources

17. Methods Qualitative Study • Patterns of IPV • Urban/Rural influences on patterns of IPV

18. Lessons Learned Developing Partnerships

19. Academic-Community Partnership Johns Hopkins School of Nursing (JHUSON) • Location: Baltimore, Maryland, USA • Mission:To provide leadership to improve health care and advance the profession through education, research, practice, and service. Baltimore City Health Department (BCHD) • Location: Baltimore, Maryland, USA • Mission: Maternal and Infant (M&I)Nursing Program provides home visiting and case management services to pregnant women and infants in Baltimore City in order to improve maternal health, birth and infant outcomes.

20. Partnership Benefits • Established Infrastructures • JHUSON Academic Resources • BCHD-M&I Program Community Resources • Sharing of Resources • DOVE Intervention Nurse=Liaison • Between JHUSON & BCHD-M&I • Implementation of DOVE intervention into existing BCHD-M&I program • Application of evidenced based research into real practice setting – a test of efficacy • Potential Positive Impact on MCH Outcomes

21. Preparing to Launch DOVE • Developing The Town (Home Visitors) and Gown (Research team) Partnership • Both Health Departments: • The Missouri Department of Health and Senior Services (MoDHSS) • Baltimore City Health Department Maternal and Infant Home Visit programs • Extremely supportive of identifying IPV and working with both research teams

22. Developing the Town/Gown Partnership • Examples of activities to develop partnership • Research team members made frequent visits to the DOVE sites and reviews the research protocol with trained HV and new staff • Monthly meeting with BCHD to discuss DOVE protocols • DOVE Nest newsletter sent monthly to all health departments • Conducted professional in service training for health departments • We have conducted 10 different workshops regarding screening for IPV with the home visitors over a four -year period at both sites

23. Issues for the Partnership Challenges of partnering with urban and rural health departments • Home Visitors lack of educational preparation regarding research protocols • Lack of understanding of the importance of screening for IPV • Discomfort with screening for IPV • Rural Settings - distance that has to be traveled by the research team to maintain relationships with the staff • Urban Settings – bureaucratic procedures that hinder recruitment process • Urban Settings – large case loads limit time available for intervening

24. Threat To The Study’s Integrity • After 3 ½ years of recruitment – referrals made at both sites (Baltimore and MO) have not met targeted goals • PIs at both sites hypothesized that: • There may be an issue with women disclosing: • Because of the rural setting of the MO site • Because of the urban setting of Baltimore site • The HVs are not comfortable screening women for IPV • Barriers Study

25. Partnership Limitations • Control • Interdependence of each entity for project results • Communication • Ensuring all team members are up-to-date • Motivation • Team members professional investment in project

26. Clinical Significance • DOVE combines evidenced based protocols • DOVE an be integrated into existing culturally based approaches • DOVE intervention is low cost • DOVE intervention requires training and “buy-in” • Women had many positive comments about DOVE

27. Strategies for Community Based Research • Shared passion – Community & Researcher • Community – Research Team a true team or partnership • Caring and Nurturing is the norm • Committed to success of all members • Mutual benefits • Expected, spelled out, agreed upon • Establishment of trust • Clear expectations – but some give and take • Meeting deadlines – mutual respect not obligations

28. Strategies for Community Based Research Community Connections • Be a part of the community – a real commitment • Community is also a part – a real commitment • Meaningful and important roles and involvement for community members • Do no harm • Share what you learn with the community • Include community in dissemination and presentations • Enhance the community – a legacy for the community

29. Strategies for Community Based Research Have Fun Along the Way !! • Celebrate the achievements of all(new personnel, new grants/awards, publications, presentations, recruitment goals, enrolling in courses) • Celebrate the milestones • Support each other over the rejections and disappointments (cuts/no funding, personnel changes, rejections, slow recruitment, grants, abstracts, manuscripts, slow recruitment)

30. DOVE WEBSITE http://www.son.jhmi.edu/research/dove psharps1@jhu.edu 410-614-5312 Thank You !!!