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Program Profile: Strength at Home Men’s Program (SAH-M)

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on June 17, 2019

Program Summary

This program is a cognitive-behavioral, trauma-informed group therapy program for active-duty or former military personnel who have engaged in recent physical intimate partner violence (IPV). The program is rated Promising. There were statistically significant reductions in physical and psychological IPV for the SAH-M treatment group, compared with the control group.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals/Target Population
The Strength at Home Men’s Program (SAH-M) is a 12-week, cognitive-behavioral, trauma-informed group therapy program for active-duty or former military personnel who have engaged in recent physical intimate partner violence (IPV). The program addresses social information-processing deficits presumed to increase the risk of IPV.

Program Components
SAH-M addresses the relationship between trauma and IPV in weekly 2-hour, closed-group therapy sessions. Components include psychoeducational material, group exercises and discussion, and practice assignments that focus on recognizing core issues contributing to IPV (i.e., trust, self-esteem, power/control), understanding anger and managing responses to potentially difficult situations, developing cognitive strategies to recognize and correct misinterpretations of others, and communication skills training. Throughout the intervention, feelings of guilt and shame that may cause individuals to deny their abusive behavior are addressed, and they are encouraged to take responsibility for their actions (Creech et al. 2016).

The first two sessions of the intervention provide psychoeducation on IPV and common reactions to trauma, such as substance abuse or depression. These sessions also focus on setting goals, enhancing readiness for change, and building group cohesion and a positive alliance. The third and fourth sessions focus on conflict management skills and include material on the different components of anger such as physiological signs, thoughts, and feelings. Participants are encouraged to learn to take “time outs” to de-escalate situations and learn assertiveness skills.

The fifth and sixth sessions include specific coping strategies, with a focus on identifying and correcting negative thought patterns contributing to anger and IPV, understanding core themes underlying trauma and abusive behavior, and coping with stress more effectively. The seventh through eleventh sessions focus on communication skills, including active listening, giving assertive messages, expressing feelings, avoiding common communication traps, and on discussions of how military training and experiences may have contributed to negative relationship communication behaviors. The twelfth and final session focuses on gains achieved over the course of the intervention and plans for continued change (Taft et al. 2013). The program also includes partner outreach to ensure that any affected partners receive hotline numbers and information about other resources and safety planning (Creech et al. 2017).

Key Personnel
The intervention is delivered by two co-leaders: 1) one doctoral-level male therapist, and 2) one doctoral-level or pre-doctoral-level female therapist.

Program Theory
The trauma-informed, social information-processing model of IPV in military populations hypothesizes that trauma and PTSD symptoms may contribute to biases and deficits in the processing of social information, that can then result in the increased risk of IPV incidences (Creech et al. 2017). The program seeks to educate participants about the influence of trauma and PTSD on intimate relationship problems. In addition, the trauma-informed approach allows therapists to recognize the impacts of trauma on participants while still holding them accountable and responsible for their abusive behavior (Creech et al. 2017).

Evaluation Outcomes

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Study 1
Intimate Partner Violence/Aggression: Physical
Taft and colleagues (2016) found a statistically significant reduction in measures of physical intimate partner violence or aggression for the Strength at Home Men’s Program (SAH-M) intervention group, compared with the control group, at the posttreatment.

Intimate Partner Violence/Aggression: Psychological
There was a statistically significant reduction in measures of psychological intimate partner violence or aggression for the SAH-M intervention group, compared with the control group, at the posttreatment.
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Evaluation Methodology

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Study 1
Taft and colleagues (2016) conducted a randomized controlled trial to evaluate the impact of the Strength at Home Men’s Program (SAH-M) on reducing physical and psychological intimate partner violence (IPV) for a military and veteran population. Participants were recruited from the Boston, Mass., and Providence, R.I., metropolitan areas through clinicians, courts, and self-referrals. Eligibility criteria included the following: 1) the male participant and his partner had to be over 18, 2) the male participant had to be a veteran or service member, 3) the male participant had to provide partner contact consent, and 4) provision of a self-, collateral, or court report of at least one act of male-to-female physical IPV over the previous 6 months or of severe physical IPV over the past 12 months, or an ongoing legal problem related to IPV.

Participants were excluded if they were currently dependent on a substance and not in remission, had an uncontrolled bipolar or psychotic disorder, or had a severe cognitive impairment. Nine participants did not self-report physical IPV; however, they were included due to court involvement or partner IPV reports. Although there was not a trauma requirement for participation, all participants reported at least one trauma on the Traumatic Life Events Questionnaire (Kubany et al. 2000). Over 65 percent of participants reported exposure to military combat, and 42.2 percent reported that this was the most distressing event experienced in their lifetime.

The total sample included 135 male veterans. Participants completed an initial assessment before groups of four to five participants were randomized by blocks using a random number generator to receive SAH-M or enhanced treatment as usual (ETAU). ETAU participants received referrals to mental health treatment within and outside Veterans Affairs, resources for connecting with other IPV services in the community, assessment and monitoring of IPV, and a check-in call between assessments. After 6 months of ETAU, participants could receive the SAH-M intervention. Sixty-seven men were assigned to the intervention group, of which 37 completed the program. Sixty-eight men were assigned to the control group. The intervention group had an average age of 37.5, 57 were white, 19 were married and 16 were dating, and 32 had a formal PTSD diagnosis. The control group had an average age of 38.2, 53 were white, 26 were married and 7 were dating, and 40 had a formal PTSD diagnosis. There were no statistically significant differences between the groups at the baseline.

The researchers used a hierarchical linear model (HLM) to investigate the effect of treatment on changes in IPV over time. Longitudinal analyses were supplemented by cross-sectional analyses at posttreatment and at the 3-month follow up. Subgroup analyses were not conducted.
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There is no cost information available for this program.
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Implementation Information

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Training was delivered in person over 2 days by three Strength at Home Men’s Program (SAH-M) master trainers who were involved in the development of the intervention. Each master trainer was a licensed clinical psychologist with extensive experience working with individuals who engage in intimate partner violence, in treating veterans and military families, and had detailed knowledge of the SAH-M curriculum. The first day of the training focused on the theoretical underpinnings, program evaluation, and general therapeutic approach of SAH-M, with approximately 3 hours of training in the use of motivational-interviewing skills with veterans who may be engaging in IPV (Taft et al. 2016).
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1
Taft, Casey T., Alexandra Macdonald, Suzannah K. Creech, Candice M. Monson, and Christopher M. Murphy. 2016 “A Randomized Controlled Clinical Trial of the Strength at Home Men’s Program for Partner Violence in Military Veterans.” The Journal of Clinical Psychiatry 77(9):1168–1175.
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Additional References

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These sources were used in the development of the program profile:

Bartholomew, Theodore T., Amy S. Badura-Brack, Gary K. Leak, Allison R. Hearley, and Timothy J. Mcdermott. 2017. “Perceived Ability to Cope with Trauma Among U.S. Combat Veterans.” Military Psychology 29(3):165–176.

Berke, Danielle S., Alexandra Macdonald, Gina M. Poole, Galina A. Portnoy, Savannah Mcsheffrey, Suzannah K. Creech, and Casey T. Taft. 2017. “Optimizing Trauma-Informed Intervention for Intimate Partner Violence in Veterans: The Role of Alexithymia.” Behaviour Research and Therapy 97:222–229.

Creech, Suzannah K., Alexandra Macdonald, Justin K. Benzer, Gina M. Poole, Christopher M. Murphy, Casey T. Taft, and Joanne Davila. 2017. “PTSD Symptoms Predict Outcome in Trauma-Informed Treatment of Intimate Partner Aggression.” Journal of Consulting and Clinical Psychology 85(10):966–974.

Kubany, Edward S., Stephen N. Haynes, Mary Beth Leisen, Julie A. Owens, Aaron S. Kaplan, Susan B. Watson, and Katie Burns. 2000. “Development and Preliminary Validation of a Brief Broad-Spectrum Measure of Trauma Exposure: The Traumatic Life Events Questionnaire.” Psychological Assessment 12(2):210–-24.

Taft, Casey T., Christopher M. Murphy, and Suzannah K. Creech. 2016. Trauma-Informed Treatment and Prevention of Intimate Partner Violence. First Edition. Washington, D.C.: American Psychological Association.
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Program Snapshot

Age: 18+

Gender: Male

Race/Ethnicity: Black, Asian/Pacific Islander, Hispanic, White, Other

Geography: Urban

Setting (Delivery): Inpatient/Outpatient

Program Type: Cognitive Behavioral Treatment, Group Therapy, Violence Prevention

Targeted Population: Military Personnel, Families

Current Program Status: Active

Casey T. Taft
VA Boston Healthcare System
150 South Huntington Ave
Boston MA 02130
Phone: 857.364.6261