Psychological Advocacy Towards Healing (PATH): a randomised controlled trial

Psychological Advocacy Towards Healing (PATH): randomised controlled trial to determine the effectiveness and cost-effectiveness of a psychological intervention delivered by domestic violence advocates.

Background: Domestic violence and abuse (DVA), defined as threatening behaviour or abuse by adults who are intimate partners or family members, is a key public health and clinical priority. The prevalence of DVA in the UK and worldwide is high, and its impact on physical and mental health is detrimental and persistent. There is currently little support within health care settings for women experiencing DVA. Psychological problems in particular may be difficult to manage outside of specialist services, as conventional forms of therapy such as counseling that do not address the violence may be ineffective or even harmful. The aim of this study is to assess the effectiveness and cost-effectiveness of a novel psychological intervention specifically tailored for survivors of DVA and delivered by domestic violence advocates based in third sector organizations.

Methods/Design: This is an open, pragmatic, parallel group, individually randomised controlled trial. Women aged 16 years or older experiencing domestic violence are being enrolled and randomly allocated to receive usual DVA agency advocacy support (control) or usual DVA agency support plus the psychological intervention (intervention). Those in the intervention group will receive eight specialist psychological advocacy (‘SPA’) sessions weekly or fortnightly, with two follow-up sessions, one month and then three months later. This will be in addition to any advocacy support sessions the woman receives. Women in the control group will receive usual DVA agency support but no additional SPA sessions. The aim is to recruit 250 women to reach the target sample size. The primary outcomes are psychological wellbeing and depression severity at one year from baseline, as measured by the CORE-OM and PHQ-9 respectively. Secondary outcome measures include anxiety, post-traumatic stress, severity and frequency of abuse, quality of life and cost-effectiveness of the intervention. A sub-sample of women in both groups will contribute to a nested qualitative study with repeat interviews during the year of follow-up.

Discussion: This study will contribute to the evidence base for management of the psychological needs of women experiencing domestic violence and abuse. The findings will have important implications for healthcare commissioners and providers, as well as third sector specialist domestic violence and abuse agencies providing services to this client group.

Investigators: Gwen Brierley, Roxane Agnew-Davies, Jayne Bailey, Maggie Evans, Morgan Fackrell, Giulia Ferrari, Sandra Hollinghurst, Louise Howard, Emma Howarth, Alice Malpass, Carol Metters, Tim J Peters, Fayeza Saeed, Debbie Sharp, Gene Feder

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