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Schalk D, Fernandes C. How Health Professionals Identify and Respond to Perpetrators of Domestic and Family Violence in a Hospital Setting: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241246783. [PMID: 38656268 DOI: 10.1177/15248380241246783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
There is heightened awareness that a whole-of-systems approach to perpetrator responses is key to addressing domestic and family violence (DFV). This paper reports on the findings from a scoping review which mapped the international literature on how health professionals identify and respond to perpetrators of DFV within a hospital setting. A comprehensive scoping review methodology was used. The search, spanning January 2010 to January 2022, yielded 12,380 publications from four databases. Eligibility for inclusion included peer-reviewed literature with any reference to inpatient hospital health professionals identifying or responding to perpetrators of DFV. Fourteen articles were included in the final review. The review presents the literature categorized by levels of prevention, from primary, secondary, through to tertiary preventive interventions. An additional category "other practices" is added to capture practices which did not fit into existing levels. Despite glimpses into how health professionals can identify, and respond to perpetrators of DFV, the current knowledge base is sparse. The review did not identify any mandated or formal procedures for identifying and/screening or responding to perpetration of abuse in hospitals. Rather, responses to perpetrators are inconsistent and rely on the motivation, skill, and self-efficacy of health professionals rather than an embedded practice that is driven and informed by hospital policy or procedures. The literature paints a picture of missed opportunities for meaningful work with perpetrators of DFV in a hospital setting and highlights a disjuncture between policy and practice.
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Affiliation(s)
- Danielle Schalk
- Fiona Stanley Hospital, South Metropolitan Health Service, Perth, Australia
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Scott SE, Jenkins G, Mickievicz E, Saladino J, Rick AM, Levenson R, Chang JC, Randell KA, Duplessis V, Miller E, Ragavan M. Creating Healing-Centered Spaces for Intimate Partner Violence Survivors in the Postpartum Unit: Examining Current Practices and Desired Resources Among Health Care Providers and Postpartum People. J Womens Health (Larchmt) 2024; 33:204-217. [PMID: 37971822 PMCID: PMC10880269 DOI: 10.1089/jwh.2023.0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: Intimate partner violence (IPV) has negative health impacts for pregnant people and their infants. Although inpatient postpartum units offer an opportunity to provide support and resources for IPV survivors and their families, to our knowledge, such interventions exist. The goal of this study is to explore (1) how IPV is currently discussed with postpartum people in the postpartum unit; (2) what content should be included and how an IPV intervention should be delivered; (3) how best to support survivors who disclose IPV; and (4) implementation barriers and facilitators. Materials and Methods: We used individual, semistructured interviews with postpartum people and health care providers (HCPs). Interview transcripts were coded and analyzed using an inductive-deductive thematic analysis. Results: While HCPs reported using a variety of practices to support survivors, postpartum people reported that they did not recall receiving resources or education related to IPV while in the inpatient postpartum unit. While HCPs identified a need for screening and disclosure-driven resource provision, postpartum people identified a need for universal IPV resource provision in the postpartum unit to postpartum people and their partners. Participants identified several barriers (i.e., staff capacity, education already provided in the postpartum unit, and COVID-19 pandemic) and facilitators (i.e., continuity of care, various HCPs) to supporting survivors in the postpartum unit. Conclusion: The inpatient postpartum unit is a promising setting to implement an intervention to support IPV survivors and their infants. Future research and intervention development should focus on facilitating universal education and promoting resource provision to IPV survivors.
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Affiliation(s)
- Sarah E Scott
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Genelle Jenkins
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Erin Mickievicz
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jackie Saladino
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne-Marie Rick
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Judy C Chang
- Department of Obstetrics, Gynecology & Reproductive Sciences, and Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kimberly A Randell
- Division of Emergency Medicine, Children's Mercy, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | | | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Maya Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Xyrakis N, Aquilina B, McNiece E, Tran T, Waddell C, Suomi A, Pasalich D. Interparental Coercive Control and Child and Family Outcomes: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:22-40. [PMID: 36573654 DOI: 10.1177/15248380221139243] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Coercive control (CC) is a core facet of intimate partner violence (IPV) and involves asserting power, dominance, and control over another person. Although the adverse impacts of childhood exposure to interparental IPV have been well documented, the outcomes of childhood exposure to interparental CC have not been systematically examined. This study aimed to address this gap by reviewing available empirical evidence on interparental CC and child and family outcomes. Articles were identified by searching electronic databases using keywords relating to CC, children and parents, and child wellbeing outcomes. The final review included 51 studies that reported on adverse outcomes pertaining to parenting and family relationships (k = 29), child internalizing and externalizing problems (k = 7), social-emotional development (k = 5), and physical/health development (k = 17). Specifically, studies reported that CC was associated with increased parental psychopathology, poorer family functioning, harsher parenting and higher levels of child abuse, strained parent-child relationships, children used as tools and co-victims of CC, increased risk of child internalizing and externalizing problems, limited socializing opportunities, increased bullying, poorer perinatal outcomes, limited access to healthcare, and increased risk of child mortality. Evidence identified CC as a unique contributor to adverse child wellbeing outcomes, independent of exposure to IPV more broadly. Results indicated that the impacts of childhood exposure to CC are complex, far reaching, and, in some cases, devastating. The limitations of the findings, as well as implications for practice, policy, and research are discussed.
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Affiliation(s)
- Nakiya Xyrakis
- Australian National University, Canberra, ACT, Australia
| | | | - Ella McNiece
- Australian National University, Canberra, ACT, Australia
| | - Thomas Tran
- Australian National University, Canberra, ACT, Australia
| | - Connor Waddell
- Australian National University, Canberra, ACT, Australia
| | - Aino Suomi
- Australian National University, Canberra, ACT, Australia
| | - Dave Pasalich
- Australian National University, Canberra, ACT, Australia
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Ragavan MI, Murray A. Supporting Intimate Partner Violence Survivors and Their Children in Pediatric Healthcare Settings. Pediatr Clin North Am 2023; 70:1069-1086. [PMID: 37865431 DOI: 10.1016/j.pcl.2023.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Intimate partner violence (IPV) is a pervasive public health epidemic that influences child health and thriving. In this article, we discuss how pediatric healthcare providers and systems can create healing-centered spaces to support IPV survivors and their children. We review the use of universal education and resource provision to share information about IPV during all clinical encounters as a healing-centered alternative to screening. We also review how to support survivors who may share experiences of IPV, focused on validation, affirmation, and connection to resources. Clinicians are provided key action items to implement in their clinical settings.
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Affiliation(s)
- Maya I Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh and UPMC Children's Hospital of Pittsburgh, 3414 Fifth Avenue, Pittsburgh, PA 15213, USA.
| | - Ashlee Murray
- Division of Pediatric Emergency Medicine, Children's Hospital of Pennsylvania, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Lamar CE, Jain D, Schmitz KH. Perils of Auto-Population of Newborn EHR With Maternal Intimate Partner Violence History. Pediatrics 2023; 152:e2022060189. [PMID: 37712123 DOI: 10.1542/peds.2022-060189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 09/16/2023] Open
Abstract
In 2020, the 21st Century Cures Act was enacted, mandating that patients have access to their electronic health record. This has the potential to benefit both patients and clinicians by increasing communication, transparency, and patient autonomy. However, with the onset of the act, a number of unintended consequences of the act have been identified. Presently, we discuss a case where documentation of intimate partner violence and the safety plan documented in a mother's electronic health record automatically populated her newborn's admission note. This confidential information inadvertently became accessible to the perpetrator: the infant's father.
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Affiliation(s)
- Casey E Lamar
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Deepak Jain
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kristine H Schmitz
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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Ragavan MI, Risser L, Duplessis V, DeGue S, Villaveces A, Hurley TP, Chang J, Miller E, Randell KA. The Impact of the COVID-19 Pandemic on the Needs and Lived Experiences of Intimate Partner Violence Survivors in the United States: Advocate Perspectives. Violence Against Women 2022; 28:3114-3134. [PMID: 34859721 PMCID: PMC9163202 DOI: 10.1177/10778012211054869] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We explored the challenges and lived experiences of intimate partner violence (IPV) survivors during the COVID-19 pandemic by interviewing 53 U.S.-based IPV advocates between June and November 2020. Advocates described how the COVID-19 pandemic limited survivors' abilities to meet their basic needs. The pandemic was also described as being used by abusive partners to perpetrate control and has created unique safety and harm reduction challenges. IPV survivors experienced compounding challenges due to structural inequities. IPV must be considered by local, state, and federal governments when developing disaster planning policies and practices, including in the context of pandemics.
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Affiliation(s)
- Maya I Ragavan
- Division of General Academic Pediatrics, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Risser
- Division of Adolescent and Young Adult Medicine, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Sarah DeGue
- Division of Violence Prevention, National Center for Injury Prevention and Control, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrés Villaveces
- Division of Violence Prevention, National Center for Injury Prevention and Control, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tammy P Hurley
- Child Welfare, Trauma, and Resilience Initiatives, 3192American Academy of Pediatrics, Itasca, IL, USA
| | - Judy Chang
- Department of Obstetrics, Gynecology & Reproductive Sciences, and Internal Medicine, Magee-Women's Hospital, Pittsburgh, PA, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Kimberly A Randell
- Division of Pediatric Emergency Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
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Randell KA, Ragavan MI, Query LA, Sundaram M, Bair-Merritt M, Miller E, Dowd MD. Intimate Partner Violence and the Pediatric Electronic Health Record: A Qualitative Study. Acad Pediatr 2022; 22:824-832. [PMID: 34455099 PMCID: PMC8882201 DOI: 10.1016/j.acap.2021.08.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 08/17/2021] [Accepted: 08/21/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore expert perspectives on risks associated with the pediatric electronic health record (EHR) for intimate partner violence (IPV) survivors and their children and to identify strategies that may mitigate these risks. METHODS We conducted semistructured interviews with multidisciplinary pediatric IPV experts (nursing, physicians, social workers, hospital security, IPV advocates) recruited via snowball sampling. We coded interview transcripts using thematic analysis, then consolidated codes into themes. RESULTS Twenty-eight participants completed interviews. Participants identified the primary source of risk as an abuser's potential access to a child's EHR by legal and illegal means. They noted that abuser's access to multiple pediatric EHR components (eg, online health portals, clinical notes, contact information) may result in escalated violence, stalking, and manipulation of IPV survivors. Suggested risk mitigation strategies included limited and coded documentation, limiting EHR access, and discussing documentation with the IPV survivor. Challenges to using these strategies included healthcare providers' usual practice of detailed documentation and that information documented may confer both risk and benefit concurrently. Reported potential benefits of the pediatric EHR for IPV survivors included ensuring continuity of care, decreasing need to repeatedly talk about trauma histories, and communication of safety plans. CONCLUSIONS Our findings suggest the pediatric EHR may confer both risks and benefits for IPV survivors and their children. Further work is needed to develop best practices to address IPV risks related to the pediatric EHR, to ensure consistent use of these practices, and to include these practices as standard functionalities of the pediatric EHR.
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Affiliation(s)
- Kimberly A. Randell
- Division of Emergency Medicine, Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City MO 64110, USA,University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Maya I. Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh/Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Lindsey A. Query
- Division of Emergency Medicine, Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City MO 64110, USA,University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Mangai Sundaram
- University of California Berkley, 110 Sproul Hall #5800, Berkeley CA 94720
| | - Megan Bair-Merritt
- Division of General Academic Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh/Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - M. Denise Dowd
- Division of Emergency Medicine, Children’s Mercy Kansas City, 2401 Gillham Rd, Kansas City MO 64110, USA,University of Missouri-Kansas City School of Medicine, Kansas City, MO
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Child Protective Services Reports in the Context of Intimate Partner Violence: A Delphi Process Examining Best Practices. Acad Pediatr 2022; 22:833-841. [PMID: 35259548 PMCID: PMC9922527 DOI: 10.1016/j.acap.2022.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/24/2022] [Accepted: 02/26/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Child protective services (CPS) reporting for families experiencing intimate partner violence (IPV) is complex. The goal of this study was to develop expert-driven best practices for pediatric providers filing CPS reports in the context of IPV. METHODS We conducted a Delphi study with experts in IPV and child abuse and neglect (CAN) through 3 rounds of surveys. In Round 1, participants selected clinical scenarios for which they would file, as well as best practices when CPS reporting is indicating. In Round 2, participants described how strongly they agreed that a provider should file for each clinical scenario and how important each best practice was on a 5-point Likert scale. Finally, in Round 3 participants reviewed Round 1 and 2 results, then reported their final determination by selecting yes or no for each option. Consensus was achieved in Round 3 if >80% of participants agreed. In each round, participants could provide further detail via free-text answers. RESULTS Twenty-three (40%) of the invited experts participated. Consensus was not achieved for children directly witnessing IPV or experiencing health symptoms due to IPV exposure. Participants were in consensus regarding need for CPS reporting when CAN was present and that reporting should not occur for exposure to IPV only. Best practices included supporting IPV survivors, developing healthcare-based IPV advocacy programs, and optimizing the child welfare system. CONCLUSION This study provides expert-driven recommendations for filing CPS reports in the context of IPV and highlights the inherent complexity of filing and the need for further guidelines.
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Risser L, Berger RP, Renov V, Aboiye F, Duplessis V, Henderson C, Randell KA, Miller E, Ragavan MI. Supporting Children Experiencing Family Violence During the COVID-19 Pandemic: IPV and CPS Provider Perspectives. Acad Pediatr 2022; 22:842-849. [PMID: 35342034 PMCID: PMC8949658 DOI: 10.1016/j.acap.2022.03.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/06/2022] [Accepted: 03/19/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Children experiencing family violence (child abuse and neglect and exposure to intimate partner violence) are at a particularly elevated risk for compounding challenges during the COVID-19 pandemic. In this study, we interviewed intimate partner violence (IPV) advocates, child protective services (CPS) caseworkers, and IPV and CPS administrators on the needs of children experiencing family violence during the pandemic. METHODS We conducted semistructured interviews with IPV advocates, CPS caseworkers, and IPV and CPS administrators. Recruitment occurred through emails to national and state listservs, networks of the study team, and word of mouth. Interviews were completed through Zoom, took 45 to 60 minutes and were audio recorded. We used a mixed deductive-inductive content analysis approach. RESULTS Fifty-nine IPV advocates, 35 IPV administrators, 21 CPS workers and 16 CPS administrators participated in this study. Four themes emerged from this work. Participants discussed the role of social isolation, school closures, and distance learning on children experiencing family violence. They also noted child custody and visitation challenges, particularly in the context of abusive partners using custody to control IPV survivors and limitations to virtual visitation more broadly. Compounding challenges were described for children from marginalized communities due to structural-level inequities. Collaboration was discussed by participants from both IPV and CPS sectors. CONCLUSION This study is one of the first to describe the way the COVID-19 pandemic has impacted children experiencing family violence. Future studies should triangulate these results with children, families, and other child-serving providers.
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Affiliation(s)
- Lauren Risser
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh (L Risser, C Henderson, and E Miller), Pittsburgh, Pa
| | - Rachel P. Berger
- Division of Child Advocacy, UPMC Children's Hospital of Pittsburgh (RP Berger), Pittsburgh Pa
| | - Veronica Renov
- Pediatric Emergency Medicine, UPMC Children's Hospital of Pittsburgh (V Renov), Pittsburgh, Pa
| | - Fatimah Aboiye
- Child Welfare, Trauma, and Resilience Initiatives, American Academy of Pediatrics (F Aboiye), Itasca, Ill
| | | | - Cynterria Henderson
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh (L Risser, C Henderson, and E Miller), Pittsburgh, Pa
| | - Kimberly A. Randell
- Division of Emergency Medicine (KA Randell), Kansas City, Mo,University of Missouri-Kansas City School of Medicine (KA Randell), University of Kansas School of Medicine, Salina
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh (L Risser, C Henderson, and E Miller), Pittsburgh, Pa
| | - Maya I. Ragavan
- Division of General Academic Pediatrics, University of Pittsburgh (M Ragavan), Pittsburgh, PA,Address correspondence to Maya I. Ragavan, MD, MPH, MS, University of Pittsburgh, 3414 Fifth Ave, Pittsburgh PA 15213
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