(92) Intimate Partner Violence Support in Perinatal Substance Use: Patient and Provider Insights

Background & Introduction: High rates of intimate partner violence (IPV) victimization are reported among pregnant and postpartum women with substance use disorders (SUD) (Martin et al., 2003). IPV victimization among women with drug and alcohol use is significantly associated with psychiatric conditions and physical health issues (Schneider et al., 2009). Unfortunately, IPV interventions are rarely in place in perinatal substance use recovery centers (Macy & Goodbourn, 2012). Experts generally agree on the benefits of integrating services for IPV, but there are limited evidence-based models (Mootz et al., 2022; Rothman et al., 2018). To address this gap in knowledge, this study aims to identify and compare characteristics of intimate partner violence support considered important to patients and providers of perinatal substance use recovery centers.

Methods: Interviews were conducted with staff, providers, and patients of 3 perinatal substance use recovery services in the Northeastern United States from June 2023 to October 2024. Participants were recruited in-person from outpatient and inpatient clinical settings or contacted through email or phone. Participants filled out a screening questionnaire to assess if they met study criteria and were given a document containing information about the study and their rights to review. Patients who were eligible for the study and consented to participate completed a demographic survey and participated in a 30-to-60-minute interview. Interviews occurred virtually or in-person. Virtual and in-person recordings were captured and automatically transcribed through Microsoft Teams software. To ensure transcription accuracy, a researcher listened to each interview and manually corrected errors. We conducted an inductive thematic analysis of the data. First, we examined transcripts from providers and patients for keywords and concepts from direct quotations. After, we clustered keywords and concepts into potential meaning patterns to generate codes. Codes were organized based on similarity to generate themes. Codes and themes were compared between patients and providers to characterize differences and similarities of opinions about intimate partner violence support for pregnant and postpartum women in recovery.

Results: We conducted 24 interviews with 12 provider and staff participants and 12 patient participants. Provider and staff participants included 6 nurses, 2 social workers, 2 physicians, 1 administrator, and 1 peer advocate. Time working on the service among providers and staff ranged from 1 month to 6 years. Time receiving care among patients ranged from 1 week to 2 years. All patient and provider participants identified as female. Most provider participants (10/12) and patients (10/12) identified as White.

Three overlapping themes arose from patient and providers which included support characteristics, barriers to care, and patient-provider relationships. Regarding support characteristics, both patients and providers favorably viewed warm hand-offs to professionals and community resources, utilization of peer support, universal IPV education and support, technology-based resources (i.e., mobile apps, text communication, telehealth), and practicing discretion when discussing IPV. While providers saw providing only informational resources as a limitation, patients found informational resources like posters and brochures helpful because visual cues indicated that the space was a supportive environment to discuss IPV. Patients and providers similarly shared that barriers to care included checklist screening that could yield untruthful answers, resources requiring patient effort, and resources that could be easily found by perpetrators. While providers emphasized that self-stigma or shame contributed to patients not utilizing IPV resources, patients emphasized fear, trauma, and mental health issues as the reasons. In discussing patient-provider relationships, both groups valued trust, rapport-building, and conversational approaches to asking about IPV. Patients uniquely emphasized consistency, persistence, and patience as favorable characteristics of providers.

Themes unique to providers regarding providing IPV support included self-efficacy, education, and personal wellness. Providers emphasized feeling unprepared, confined to their role which did not include providing IPV support, and self-conscious about using wrong or offensive language. Providers mentioned a lack of formal IPV training in their education and expressed a desire for IPV training specifically in the realms of telemedicine, community resources, legal implications, and substance use. Lastly, providers described engaging in IPV-related work in the clinical setting as rewarding and impactful but also expressed feelings of burnout associated with the work.

Themes unique to patients included understandings about IPV and facilitators of help-seeking. Patients frequently used the term “control” when describing IPV and discussed how substance use can lead to IPV and vice versa. Facilitators of help-seeking included having children, a safe shelter, a supportive clinical environment, and isolation from partners during clinical IPV discussions.

Conclusion & Discussion: Our findings highlight that both patients and providers in SUD recovery clinics acknowledge the relevance and importance of addressing IPV. Providers and patients emphasize wanting safe, universally accessible approaches to providing IPV information and resources while also respecting patient privacy and autonomy. Based on patient and provider insights, IPV support integration in perinatal substance use treatment should thus involve a caring clinical environment, active and discretional support measures, robust IPV education among staff, and strong understandings between patient and providers about their expectations for their relationship with each other. Most importantly, our study supports the notion that IPV training and partnership with community IPV victims' advocacy should be considered integral parts of all clinics and centers that provide recovery services. Strengths of our study include stakeholder involvement and an interview-based design which allowed for more elaboration from study participants. Limitations include the small number of sites in one geographic area of the country and lack of racial and ethnic diversity which limits the generalizability of our findings.

References:

1. Macy, R. J., & Goodbourn, M. (2012). Promoting successful collaborations between domestic violence and substance abuse treatment service sectors: a review of the literature. Trauma Violence Abuse, 13(4), 234-251. https://doi.org/10.1177/1524838012455874
2. Martin, S. L., Beaumont, J. L., & Kupper, L. L. (2003). Substance use before and during pregnancy: links to intimate partner violence. Am J Drug Alcohol Abuse, 29(3), 599-617. https://doi.org/10.1081/ada-120023461
3. Mootz, J. J., Fennig, M., & Wainberg, M. L. (2022). Barriers and facilitators of implementing integrated interventions for alcohol misuse and intimate partner violence: A qualitative examination with diverse experts. J Subst Abuse Treat, 137, 108694. https://doi.org/10.1016/j.jsat.2021.108694
4. Rothman, E. F., Stone, R., & Bagley, S. M. (2018). Rhode Island Domestic Violence Shelter Policies, Practices, and Experiences Pertaining to Survivors With Opioid Use Disorder: Results of a Qualitative Study. Subst Abuse, 12, 1178221818812895. https://doi.org/10.1177/1178221818812895
5. Schneider, R., Burnette, M. L., Ilgen, M. A., & Timko, C. (2009). Prevalence and correlates of intimate partner violence victimization among men and women entering substance use disorder treatment. Violence Vict, 24(6), 744-756. https://doi.org/10.1891/0886-6708.24.6.744