Secondary aims and outcomes
The BRAVE intervention has the following secondary aims and outcomes:
Aim 1 - to assess gains and sustainability in knowledge on DVA among mental health professionals.
Aim 2 - to assess the feasibility, sustainability and acceptance of the intervention among CMH teams and,
Aim 3 - to assess the (possible) referral pathway to DVA services and the implementation of the Meldcode.
We will assess Aim 1 using a structured questionnaire – The BRAVE Survey - developed specifically by the study team, to assess CMH teams knowledge and attitudes regarding DVA.
Aim 1 - the BRAVE survey
The BRAVE survey was informed by the PREMIS [
37] and PROTECT questionnaires [
38].
All members of the included teams will receive this survey. The survey has a total of 53 questions divided into 5 sections: (1) Respondent profile, (2) Previous Courses on DVA (3) Skills in management of DVA, (4) Knowledge on DVA and (5) Opinions on DVA. Section 1; “Respondent profile” consists of 7 questions, of which 3 are multiple choice and 4 questions an individual can fill in. Participants are asked about their professional background (work experience, current profession, educational level) and general information (date, age, gender); section 2; “Previous courses attended on DVA” consists of a multiple choice question about previous courses on DVA. If participants check yes they are asked 4 questions about duration of this course and when this course was completed. Section 3; “Skills in management of DVA” consists out of 7 multiple choice statements. Participants can check the box on the Likert scales, ranging from 1 (not skilled) to 5 (very skilled), the extent to which they feel skilled to handle/judge a particular described situation regarding DVA. Section 4; “Knowledge on DVA” consists of a total of 14 multiple choice statements. For the first three questions, participants need to check the box on Likert scales, ranging from 1 (nothing) to 5 (a lot). These questions are followed by 10 multiple choice questions with statements about DVA where participants can choose between true (1) and not true (2). The last question in this section asks the participants to combine the correct described statement with the right stage of the process of discontinuing a relationship with a perpetrator. Section 5; “Opinions on DVA” consists of 16 statements on DVA where participants can choose whether they agree on a Likert scale ranging from 1 (do not agree) to 5 (agree).
To be able to compare the scores of the survey, sections 3 (Skills), 4 (Knowledge) and 5 (Opinions) will be calculated separately per participant and will then be aggregated at a team level. Qualitative answers will be given a score and, post-hoc assigned to answering categories. Statistical comparisons will be made between intervention and control teams.
This questionnaire will be assessed at baseline, after 6 months of the intervention and after 12 months of the intervention.
We will assess Aim 2 by conducting semi structured in-depth interviews with members of CMH teams, policy makers, patients and DVA practitioners about the feasibility, sustainability and acceptance of the intervention.
Aim 2 Semi-structured in depth interviews
We will obtain outcomes regarding opinions on feasibility, sustainability and acceptance of the intervention using a semi-structured in depth interview with a purposive sample of professionals in the intervention - and control group, team-leaders, managers, patients in the intervention group, patients in the control group, patients who have experienced DVA and patients who didn’t experience DVA. The interview for clinicians will mostly focus on their opinions and personal definition of the following themes:
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DVA
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actions (not) taken
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referral pathways between CMH services and DVA services
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impact of the intervention on care provision and care professionals (including personal safety)
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impact of the intervention on client relationship
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impact of the intervention on client wellbeing (including personal safety)
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level of implementation of the intervention in daily practice
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feasibility of implementation of the intervention
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sustainability of the intervention
In the policy makers of the included mental health institution and team managers the in depth interview will focus on their opinions and personal definition of the following themes:
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DVA
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the intervention
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referral pathways between CMH and DVA services
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level of collaboration between CMH and DVA services
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impact of the intervention on care provision and operational capability
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cost-effectiveness of the intervention
The in depth interview with psychiatric patients will focus on their opinions and personal definition of the following themes:
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DVA
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disclosure of DVA
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available help for DVA
We will gather data until saturation of the theoretical framework (what is the feasibility, sustainability and acceptance of the intervention as well as how was the intervention implemented). Interviews will be recorded and transcribed as preparation for analysis. We will analyze the data with a mix of content and framework analysis. After the frameworks are identified, the data will be structured, labelled and coded.
We will assess aim 3 using the detected cases from the primary outcome. We will then search electronic patient files of the detected cases to identify cases of DVA referred to professional DVA services per included CMH team.
Aim 3 Evaluation of the referral pathway to professional services on DVA of detected cases
Detected cases are extracted from the electronic patient’s files using the method described in the section ‘Primary outcome’ of this article. Of all detected cases of DVA the following information, will be extracted from the electronic patient file, when available: 1) the time from disclosure of DVA to referral, 2) details on any consultation with VT and/or colleagues, including the possible reason for consultation and advice given; 3) if the patient was involved in the decision to engage with VT and/or colleagues and their opinion about the given advice; 4) how the severity of the DVA case was assessed and which sources were used for the assessments; 5) details on the referral process, Including the reasons for the formal request for advice/ informal advice from VT, reasons for the ultimate decision to refer/not to refer, details of the referral site, the care provided at the referred institution, and outcomes for the patient with regards to the (ending of) violence. In doing so, we aim to assess the qualitative characteristics of the referral pathway in the intervention and control teams.