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Beebe R, Fish MC, Grasso D, Bernstein B, DiVietro S, Stover CS. Reducing Family Violence Through Child Welfare Intervention: A Propensity Score-Matched Study of Fathers for Change. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11666-11691. [PMID: 37470201 DOI: 10.1177/08862605231186121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Intimate partner violence (IPV) is prevalent, costly, and detrimental to children's health and development. It often co-occurs with child abuse and neglect. Most children referred to child protective services (CPS) have witnessed IPV and are at increased risk for subsequent exposure, as well as repeat maltreatment. For CPS referred children, there is often a missed opportunity to interrupt family violence and prevent future occurrences. Fathers for Change (F4C) is a family level intervention designed to reduce IPV by improving emotion regulation and reflective functioning in fathers. To date, no study has examined whether F4C is associated with reduced recidivism in families referred to CPS. Using propensity score matching (PSM) to simulate an experimental design, the current study tests the hypothesis that families with fathers who completed F4C will have significantly lower rates of new CPS reports over a 12-month period compared to a PSM sample of families of fathers not referred to F4C. Data were extracted from a state CPS electronic case records system on all accepted child maltreatment reports received between January 1, 2015, and April 30, 2020. PSM was successful in balancing potential confounders (e.g., race, number of prior maltreatment reports, risk level, date of report), resulting in a comparison group approximate to one that could be achieved via a randomized control trial. Logistic regression analyses of 1:1 PSM pairs revealed that control fathers were 2.4 times more likely to have a repeat maltreatment report during the 12-month follow-up period than F4C fathers. These findings suggest that F4C may provide an effective approach for reducing risk of repeat maltreatment among CPS referred children with identified IPV exposure.
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Affiliation(s)
- Rebecca Beebe
- Connecticut Children's Medical Center, Hartford, USA
- University of Connecticut School of Medicine, Farmington, USA
| | - Meghan C Fish
- Connecticut Children's Medical Center, Hartford, USA
| | - Damion Grasso
- University of Connecticut School of Medicine, Farmington, USA
| | | | - Susan DiVietro
- Connecticut Children's Medical Center, Hartford, USA
- University of Connecticut School of Medicine, Farmington, USA
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2
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Wang Y, Ma Z, Xu T, Ma Y, Jin L. Exposure to adverse childhood experiences and diabetes: Mediational role of short sleep duration. Prev Med 2023; 174:107643. [PMID: 37494972 DOI: 10.1016/j.ypmed.2023.107643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/25/2023] [Accepted: 07/19/2023] [Indexed: 07/28/2023]
Abstract
Adverse childhood experiences (ACEs) are associated with an increased risk of diabetes in adulthood. However, the potential mediational role of sleep duration in this association is unclear. A total of 116, 014 participants in the United States, from the Behavioral Risk Factor Surveillance System (BRFSS) survey in 2020 were involved in the study. The effects of ACE status, different ACEs, and ACE scores on short sleep duration were examined using binary logistic regression analysis, and the association of ACE status, different types of ACEs, and ACE scores with diabetes and the mediating role of short sleep duration were observed. Path analysis was used to investigate short sleep duration as pathways between different types of ACEs and diabetes in adulthood. For the different types of ACEs, alcohol abuse in the household (OR = 1.13, 95%CI 1.08; 1.18), witnessing domestic violence (OR = 1.17, 95%CI 1.11; 1.23), emotional abuse (OR = 1.11, 95%CI 1.06; 1.16), physical abuse (OR = 1.22, 95%CI 1.17; 1.28), sexual abuse (OR = 1.25, 95%CI 1.18; 1.32) and short sleep duration (OR = 1.26, 95%CI 1.21; 1.32) independently increased the odds of diabetes. There was also an indirect relationship between alcohol abuse in the household, witnessing domestic violence, physical abuse, sexual abuse, and diabetes via short sleep duration. Short sleep duration plays a partial mediating role between ACEs and diabetes, including alcohol abuse in the household, witnessing domestic violence, physical and sexual abuse.
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Affiliation(s)
- Yanfang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Zhaoyu Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Liaoning, Shenyang, China.
| | - Tong Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
| | - Yanan Ma
- Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Liaoning, Shenyang, China.
| | - Lina Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Jilin, Changchun, China.
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3
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Pickling-Barrionuevo R, Hernández-Vásquez A, Torres-Guillén AL, Mendoza-Correa I, Bendezu-Quispe G. Intimate partner violence against Peruvian women and adequate regulation of emotions and behaviors of their children between 24 and 59 months of age: A cross-sectional study at the national level. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4317-4337. [PMID: 35899778 DOI: 10.1177/08862605221114154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Determine the association between intimate partner violence against Peruvian women and adequate regulation of the emotions and behaviors of children between 24 and 59 months old. METHODS This cross-sectional study analyzed secondary data obtained from the ENDES-2019. The dependent variable was the regulation of emotions and behaviors in 24 to 59-month-old children. The independent variable was partner violence (physical, sexual, verbal or psychological) against mothers at some point in their life. Prevalence ratios (PR) were calculated and adjusted with their 95% confidence interval (CI) to evaluate the association between intimate partner violence and adequate regulation of emotions and behaviors. RESULTS Data from 8,473, 15 to 49-year-old mothers and their children aged 24 to 59 months were analyzed. Intimate partner violence was reported by 57.1% of the women, and 31.6% of the children showed adequate regulation of emotions and behaviors. The probability of children of mothers who were victims of intimate partner violence adequately regulating their emotions and behaviors was low (aPR = 0.81, 95% CI: 0.75-0.88), with an aPR = 0.82 (95% CI: 0.76-0.89) and an aPR = 0.84 (95% CI: 0.76-0.93) for those with mothers suffering psychological or physical violence, respectively, with no differences in children of mothers suffering sexual violence by their partner. CONCLUSIONS Six out of 10 Peruvian women have suffered partner violence at some point in their life, and only three out of 10 children between 24 and 59 months old adequately regulate their emotions and behaviors. Children of mothers suffering physical and verbal or psychological violence by their partners were less likely to regulate their emotions and behaviors adequately.
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Affiliation(s)
| | - Akram Hernández-Vásquez
- Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Lima, Peru
| | | | | | - Guido Bendezu-Quispe
- Universidad Privada Norbert Wiener, Centro de Investigación Epidemiológica en Salud Global, Lima, Peru
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Ramos de Oliveira CV, Sudfeld CR, Muhihi A, McCoy DC, Fawzi WW, Masanja H, Yousafzai AK. Association of Exposure to Intimate Partner Violence With Maternal Depressive Symptoms and Early Childhood Socioemotional Development Among Mothers and Children in Rural Tanzania. JAMA Netw Open 2022; 5:e2248836. [PMID: 36580331 PMCID: PMC9857043 DOI: 10.1001/jamanetworkopen.2022.48836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Approximately 1 in 4 women experience intimate partner violence (IPV) or nonpartner sexual violence during their lifetime. Mothers exposed to IPV are more likely to experience depressive symptoms and to discipline their children harshly, which may affect their children's socioemotional development; however, there is limited evidence on these outcomes. OBJECTIVE To examine the association between IPV, maternal depressive symptoms, harsh child discipline, and child stimulation with child socioemotional development. DESIGN, SETTING, AND PARTICIPANTS This study used cross-sectional follow-up data collected from February 19 to October 10, 2014, from a birth cohort of children aged 18 to 36 months who were enrolled in a randomized, double-blind, placebo-controlled trial of neonatal vitamin A supplementation in the Morogoro region of Tanzania. Data analysis occurred between September 10, 2019, and January 20, 2020. EXPOSURES Lifetime experience of IPV was assessed using an abbreviated module of the Tanzania Demographic and Health Survey, maternal depressive symptoms were assessed with the Patient Health Questionnaire, and data on harsh child discipline and maternal stimulation of their children were collected using modules of the United Nations Children's Fund Multiple Indicator Cluster Survey. MAIN OUTCOMES AND MEASURES Child socioemotional development was measured by the Caregiver-Reported Early Childhood Development Instruments. RESULTS A total of 981 mother-child dyads were included in the analytic sample; 388 children (39.6%) were between ages 18 and 24 (mean [SD] age, 27.06 [6.08]) months, and 515 (52.5%) were male children. A negative association was observed between maternal report of physical IPV only (mean difference, -0.022; 95% CI, -0.045 to -0.006) and physical and sexual IPV (mean difference, -0.045; 95% CI, -0.077 to -0.013) with child socioemotional scores, but neither was statistically significant after including depressive symptoms in the model, which is consistent with mediation. Furthermore, a negative association was observed between maternal mild to severe depressive symptoms and child socioemotional development, including adjustment for IPV (mean difference, -0.073; 95% CI, -0.103 to -0.043). Harsh disciplinary practices and stimulation were not associated with child socioemotional development after adjusting for IPV, maternal depressive symptoms, and other factors. CONCLUSIONS AND RELEVANCE The findings of this study suggest that maternal depressive symptoms may explain the negative association between IPV and child socioemotional development.
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Affiliation(s)
- Clariana Vitória Ramos de Oliveira
- School of Nursing, University of Nevada, Las Vegas
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Christopher Robert Sudfeld
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Alfa Muhihi
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Aisha K. Yousafzai
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Creech SK, Pearson R, Saenz JJ, Braciszewski JM, Riggs SA, Taft CT. Pilot trial of Strength at Home Parents, a trauma-informed parenting support treatment for veterans. COUPLE & FAMILY PSYCHOLOGY 2022; 11:205-216. [PMID: 36185500 PMCID: PMC9524484 DOI: 10.1037/cfp0000232] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PTSD is associated with compromised parenting which is not adequately addressed in available evidence-based PTSD treatments. Strength at Home - Parents (SAHP) is a trauma-informed parenting intervention which aims to improve parenting behaviors and overall parent-child functioning. Here we report pilot data obtained in a sample of veterans (N=21) with PTSD and parent-child functioning difficulties. Results support feasibility of study methods, and intervention acceptability, credibility and satisfaction. Movement on primary outcome measures suggested improved overall family functioning, a decrease in the use of dysfunctional parenting practices, an increase in positive parenting practices and a trend towards a reduction in parenting stress. Results should be interpreted with caution because of the small sample size and attrition at follow-up. Limitations withstanding, findings support further study of the intervention, which would provide insights into whether an efficacy trial is indicated.
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Affiliation(s)
- Suzannah K Creech
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, Waco, TX; and the Dell Medical School of the University of Texas, Department of Psychiatry and Behavioral Sciences, Austin, TX
| | - Rahel Pearson
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, Waco, TX; and the Dell Medical School of the University of Texas, Department of Psychiatry and Behavioral Sciences, Austin, TX
| | - Jeremy J Saenz
- VHA VISN 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, Waco, TX; and the Dell Medical School of the University of Texas, Department of Psychiatry and Behavioral Sciences, Austin, TX
| | | | - Shelley A Riggs
- University of North Texas, Denton, TX; and Sam Houston State University, Huntsville, TX
| | - Casey T Taft
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; and Boston University School of Medicine, Boston, MA
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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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7
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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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8
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Prevalence of children witnessed violence in a pediatric emergency department. Eur J Pediatr 2022; 181:2695-2703. [PMID: 35441247 PMCID: PMC9018099 DOI: 10.1007/s00431-022-04474-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 03/03/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
Abstract
UNLABELLED Witnessed violence is a form of child abuse with detrimental effects on child wellbeing and development, whose recognition relies on the assessment of their mother exposure to intimate partner violence (IPV). The aim of this study was to assess the frequency of witnessed violence in a population of children attending a pediatric emergency department (ED) in Italy, by searching for IPV in their mother, and to define the characteristics of the mother-child dyads. An observational cross-sectional study was conducted from February 2020 to January 2021. Participating mothers were provided a questionnaire, which included the Woman Abuse Screening Tool (WAST) and additional questions about their baseline data and health. Descriptive analysis was reported as frequency and percentage for the categorical variables and median and interquartile range (IQR) for quantitative variables. Mothers and children screened positive and negative for IPV and witnessed violence, respectively, were compared by the chi-square test or the exact Fisher test for categorical variables, and by the Wilcoxon-Mann-Whitney test for continuous variables. Out of 212 participating mothers, ninety-three (43.9%) displayed a positive WAST. Mothers tested positive were mainly Italian (71%, p 0.003), had a lower level of education (median age at school dropout 19, p 0.0002), and a higher frequency of unemployment (p 0.001) and poor personal health status (8.6%, p 0.001). The children of mothers tested positive showed a higher occurrence of abnormal psychological-emotional state (38.7%, p 0.002) and sleep disturbances (26.9%, p 0.04). CONCLUSION IPV was common in a population of mothers seeking care for their children in a pediatric ED. WHAT IS KNOWN • Witnessed violence is a form of child abuse, usually inferred by their mothers' exposure to IPV. The latter is suffered by one in three women worldwide. WHAT IS NEW • This study shows a 43.9% prevalence of IPV among mothers attending an Italian pediatric ED. • Positive mother-child dyads displayed a higher frequency of poor mothers' health status and children's abnormal emotional state and sleep disturbances.
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Rebbe R, Lyons VH, Webster D, Putnam-Hornstein E. Domestic Violence Alleged in California Child Maltreatment Reports During the COVID-19 Pandemic. JOURNAL OF FAMILY VIOLENCE 2022; 37:1041-1048. [PMID: 34866773 PMCID: PMC8629594 DOI: 10.1007/s10896-021-00344-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 05/07/2023]
Abstract
During the COVID-19 pandemic, reports to child abuse and neglect hotlines have dropped significantly across the United States. Yet, during this same period, calls to domestic violence hotlines have increased. The purpose of this study was to examine if there have been measurable changes in domestic violence-related reports to child abuse and neglect hotlines. Using administrative child protection records from California, we plotted counts and proportions of child maltreatment reports with and without domestic violence allegations before and through the onset of school closures associated with the COVID-19 pandemic. We used an interrupted time series analysis to evaluate whether or not there was a change in domestic violence allegations in child protection reports corresponding to the COVID-19 pandemic. We document that during the first two quarters of 2020 there was a 14.3% drop in the overall number of child protection reports. Despite a decline in maltreatment reporting overall, there was a 25% increase in the proportion of reports with allegations of domestic violence. Our findings suggest both the count and composition of reports to child protection agencies were affected by the COVID-19 pandemic. The current analyses also showcase the seasonality of CPS reports generally, and reports with DV allegations, specifically.
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Affiliation(s)
- Rebecca Rebbe
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Vivian H. Lyons
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI USA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA USA
| | - Daniel Webster
- School of Social Welfare, University of California, Berkeley, CA USA
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Muñeton-Castaño YF, Hull JH, Graham RJ. Tele-mental health intervention for caregivers of children on home ventilation: A randomized control trial. Child Care Health Dev 2022; 48:80-87. [PMID: 34355408 DOI: 10.1111/cch.12905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/07/2021] [Accepted: 07/25/2021] [Indexed: 11/27/2022]
Abstract
AIM This study aims to evaluate a Tele-P cognitive behavioural intervention (CBT) to promote the emotional functioning (i.e. reduce anxiety, depression and social isolation) and improve the quality of life (QoL) of caregivers of children who are ventilator dependent at home. BACKGROUND There is an urgent need for support of parents with technology-dependent children. Research shows that the parents of children whose chronic illness require assisted-technology experience significant emotional stress, potential gaps in social isolation, and social isolation leading to lower quaility of life, unhealthy family functioning, and negative psychological consequences. RESULTS Participation in a Tele-P intervention significantly reduced caregivers' anxiety, depression and fatigue, and reduction was sustained in a 4 week follow-up period. There was no significant change in social isolation. CONCLUSION Findings demonstrate preliminary efficacy of an innovative Tele-P intervention on outcomes of anxiety, depression and fatigue in an at-risk group of caregivers. Although the intervention did not improve self-reported social isolation, using technology in combination with established psychological support is an efficient way to better equip our mental health intervention systems to serve vulnerable populations.
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Affiliation(s)
- Yudy F Muñeton-Castaño
- Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - John H Hull
- Department of Psychology, Bethany College, Bethany, West Virginia, USA
| | - Robert J Graham
- Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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Gartland D, Conway LJ, Giallo R, Mensah FK, Cook F, Hegarty K, Herrman H, Nicholson J, Reilly S, Hiscock H, Sciberras E, Brown SJ. Intimate partner violence and child outcomes at age 10: a pregnancy cohort. Arch Dis Child 2021; 106:1066-1074. [PMID: 33883191 DOI: 10.1136/archdischild-2020-320321] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 02/05/2021] [Accepted: 02/17/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Assess the mental health, physical health, cognitive and language development of 10-year old children in families where mothers have reported intimate partner violence (IPV) compared with children with no reported IPV exposure. DESIGN Prospective pregnancy cohort. Maternal report of IPV (Composite Abuse Scale) at 1, 4 and 10 years. Maternal and direct assessment of child mental health (probable psychiatric diagnosis, anxiety and emotional/behavioural difficulties), cognition (IQ and executive function), language (general, pragmatic and receptive) and physical health at 10 years. SETTING A subsample of 615 mother-child dyads drawn from a pregnancy cohort of 1507 nulliparous women recruited from six public hospitals in Melbourne, Australia. RESULTS Any IPV exposure from infancy to age 10 was associated with poorer child outcomes at age 10. Specifically, twice the odds of a probable psychiatric diagnosis, emotional/behavioural difficulties, impaired language skills (general and pragmatic), and having consulted a health professional about asthma or sleep problems. IPV exposure at age 10 associated with two to three times higher odds of all mental health outcomes, elevated blood pressure and sleep problems. Early life exposure alone (at 1 and/or 4 years) associated with three times higher odds of a general language problem and asthma at age 10. CONCLUSION The high prevalence of IPV and increased risk of poorer health and development among children exposed highlights the burden of ill health carried by children in families experiencing IPV. Fewer difficulties where exposure was limited to the early years builds the case for better identification, understanding and resourcing of effective early intervention.
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Affiliation(s)
- Deirdre Gartland
- Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia .,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Laura J Conway
- Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Rebecca Giallo
- Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
| | - Fiona K Mensah
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Fallon Cook
- Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kelsey Hegarty
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia.,Centre of Family Violence Prevention, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Helen Herrman
- Orygen and Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jan Nicholson
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.,School of Early Childhood and Inclusive Education, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Sheena Reilly
- Menzies Health Institute, Griffith University, Brisbane, Queensland, Australia
| | - Harriet Hiscock
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Health Services Research Group, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Emma Sciberras
- School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Stephanie J Brown
- Intergenerational Health Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
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12
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Expert Perspectives on Intimate Partner Violence Power and Control in Pediatric Healthcare Settings. Acad Pediatr 2021; 21:548-556. [PMID: 32097782 DOI: 10.1016/j.acap.2020.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Childhood exposure to intimate partner violence (IPV) is a pervasive public health epidemic with profound impact on child health. While past work has demonstrated how abusive partners exert control over IPV survivors in a variety of settings (eg workplace, courts, home), scant research has examined how IPV power and control behaviors manifest themselves in pediatric healthcare settings. In this study, we explore the perspectives of pediatric IPV experts about: (1) behaviors used by abusive partners to control IPV survivors in pediatric healthcare settings; (2) how controlling behaviors impact healthcare access and quality; and (3) recommendations for the pediatric healthcare team. METHODS Individual semi-structured interviews were conducted with pediatric IPV experts recruited through snowball sampling. Interviews were individually coded by two research team members and analyzed using thematic analysis. RESULTS Twenty-eight pediatric IPV experts participated. Participants described several types of controlling behaviors including limiting healthcare access, dominating conversations during medical visits, controlling medical decision making, and manipulating perceptions of the healthcare team. Participants acknowledged the challenges of recognizing controlling behaviors and provided several recommendations to addressing behaviors such as leveraging the expertise of multidisciplinary teams. CONCLUSIONS Participants described how abusive partners may attempt to control or discredit their partners in pediatric healthcare settings, using subtle behaviors that may be easily missed by the healthcare team. These results set the stage for further research and clinical practice innovation including triangulating the findings with IPV survivors, examining how frequently these behaviors occur, and developing multidisciplinary IPV training for the pediatric healthcare team.
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Conway LJ, Cook F, Cahir P, Brown S, Reilly S, Gartland D, Mensah F, Giallo R. Children's language abilities at age 10 and exposure to intimate partner violence in early childhood: Results of an Australian prospective pregnancy cohort study. CHILD ABUSE & NEGLECT 2021; 111:104794. [PMID: 33160647 DOI: 10.1016/j.chiabu.2020.104794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/15/2020] [Accepted: 10/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Approximately one in four children in Australia have mothers who experience intimate partner violence (IPV). These children are at risk of poor mental health. Less is known about their language outcomes, despite evidence that childhood adversity threatens neurodevelopment, and the home environment effects language development. OBJECTIVE This study aimed to examine the relationship between early childhood IPV exposure and language outcomes (receptive vocabulary, general language, pragmatic language) at age 10, including the influence of maternal depressive symptoms. PARTICIPANTS AND SETTING Participants were 615 mothers and their first-born child participating in a prospective, community-based pregnancy cohort study in Melbourne. METHODS Mothers reported their experience of IPV and depressive symptoms in the first and fourth year postpartum. At 10 years postpartum, children's receptive vocabulary was directly assessed and mothers reported on their child's general and pragmatic language skills. RESULTS Exposure to IPV was related to scores indicating poorer abilities in receptive vocabulary (d=-0.26, p = .009), general language (d = 0.23, p = .047) and pragmatic language skills (d = 0.41, p < .001) at age 10. After adjusting for maternal depressive symptoms, evidence remained for the relationship with pragmatic language (d=-0.32, p = .006), and a trend for receptive vocabulary (d=-0.20, p = .052). CONCLUSIONS At a community-level, children whose mothers experienced IPV during the child's first four years had poorer language skills in middle childhood than children whose mothers did not experience IPV. This is important because poor child language skills are associated with adverse outcomes across the lifespan including academic under-achievement and mental health problems. Clinical implications are discussed.
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Affiliation(s)
- Laura J Conway
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia.
| | - Fallon Cook
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - Petrea Cahir
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - Stephanie Brown
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Sheena Reilly
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD 4222, Australia
| | - Deirdre Gartland
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - Fiona Mensah
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia
| | - Rebecca Giallo
- Murdoch Children's Research Institute, 50 Flemington Rd, Parkville, VIC 3052, Australia; Department of Paediatrics, University of Melbourne, 50 Flemington Rd, Parkville, VIC 3052, Australia; La Trobe University, Bundoora, Australia
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14
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Kieselbach B, Kress H, MacMillan H, Perneger T. Prevalence of childhood exposure to intimate partner violence and associations with mental distress in Cambodia, Malawi and Nigeria: A cross-sectional study. CHILD ABUSE & NEGLECT 2021; 111:104807. [PMID: 33243451 PMCID: PMC7885728 DOI: 10.1016/j.chiabu.2020.104807] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 10/02/2020] [Accepted: 11/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Research from high-income countries shows that witnessing intimate partner violence (IPV) between caregivers is experienced by up to a third of all children and is related to poor mental health outcomes. Much less is known about the burden of witnessing IPV in low- and middle-income countries. OBJECTIVES This study seeks to explore the magnitude of witnessing IPV between caregivers, its association with other types of violence and the relationship between witnessing IPV in the past and current mental distress. PARTICIPANTS AND SETTING Representative data from the Violence against Children Surveys (VACS) from Cambodia (N = 2373), Malawi (N = 2147) and Nigeria (N = 4098) are employed. METHODS Logistic regression was applied to assess the association between witnessing IPV in childhood and mental distress in adulthood. RESULTS Between 22.4 % and 34.3 % of participants witnessed IPV between their caregivers during childhood. Respondents who witnessed IPV had higher odds of mental distress, compared to those who did not witness IPV in Cambodia (OR 2.73 [2.02, 3.72] for females, OR 2.38 [1.67, 3.41] for males) and Malawi (OR 2.48 [1.43, 4.28] for females, OR 1.66 [1.11, 2.48] for males). In Nigeria only male respondents who witnessed IPV had higher odds of mental distress (OR 2.12 [1.60, 2.80]), but females had no significant association (OR 0.91 [0.68, 1.20]). CONCLUSIONS The findings highlight the association of negative mental health consequences faced by children living in households with intimate partner violence for selected low- and middle-income countries. Children's exposure to IPV should be considered when providing support to survivors of IPV. Special considerations should be made to provide culturally and resource-appropriate support.
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Affiliation(s)
- Berit Kieselbach
- Institute of Global Health, University of Geneva, Geneva, Switzerland.
| | - Howard Kress
- Centers of Disease Control and Prevention, Division of Violence Prevention, Atlanta, GA, United States
| | - Harriet MacMillan
- Departments of Psychiatry and Behavioural Neurosciences, and of Pediatrics, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Thomas Perneger
- Division of Clinical Epidemiology, Geneva University Hospitals, and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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15
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van Minde MRC, Remmerswaal M, Raat H, Steegers EAP, de Kroon MLA. Innovative postnatal risk assessment in preventive child health Care: A study protocol. J Adv Nurs 2020; 76:3654-3661. [PMID: 32996632 DOI: 10.1111/jan.14547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/07/2020] [Accepted: 07/23/2020] [Indexed: 11/30/2022]
Abstract
AIM To introduce the rationale and design of a postnatal risk assessment study, which will be embedded in Preventive Child Health Care. This study will evaluate: (a) the predictive value of an innovative postnatal risk assessment, meant to assess the risk of growth and developmental problems in young children; and (b) its effectiveness in combination with tailored care pathways. DESIGN This study concerns a historically controlled study design and is designed as part of the Healthy Pregnancy 4 All-2 program. We hypothesize that child growth and developmental problems will be reduced in the intervention cohort due to the postnatal risk assessment and corresponding care pathways. METHODS The study was approved in August 2016. Children and their parents, visiting well-baby clinics during regular visits, will participate in the intervention (N = 2,650). Additional data of a historical control group (N = 2,650) in the same neighbourhoods will be collected. The intervention, consisting of the risk assessment and its corresponding care pathways, will be executed in the period between birth and 2 months of (corrected) age. The predictive value of the risk assessment and its effectiveness in combination with its corresponding care pathways will be assessed by Preventive Child Health Care nurses and physicians in four Preventive Child Health Care organisations in three municipalities with adverse perinatal outcomes. A total risk score above a predefined threshold, which is based on a weighted risk score, determines structured multidisciplinary consultation. DISCUSSION The successful implementation of this innovative postnatal risk assessment including corresponding care pathways has potential for further integration of risk assessment and a family-centred approach in the work process of Preventive Child Health Care nurses and physicians. IMPACT This study introduces a systematic approach in postnatal health care which may improve growth and developmental outcomes of children and even future generations.
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Affiliation(s)
- Minke R C van Minde
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marianne Remmerswaal
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marlou L A de Kroon
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Erasmus University Medical Centre, Rotterdam, The Netherlands.,University Medical Center Groningen, Department of Health Sciences, University of Groningen, Groningen, The Netherlands
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16
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Randell KA, Ragavan MI. Intimate Partner Violence: Identification and Response in Pediatric Health Care Settings. Clin Pediatr (Phila) 2020; 59:109-115. [PMID: 31585503 DOI: 10.1177/0009922819879464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Carlson J, Voith L, Brown JC, Holmes M. Viewing Children's Exposure to Intimate Partner Violence Through a Developmental, Social-Ecological, and Survivor Lens: The Current State of the Field, Challenges, and Future Directions. Violence Against Women 2019; 25:6-28. [PMID: 30803426 DOI: 10.1177/1077801218816187] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although some children exposed to intimate partner violence (IPV) demonstrate resilience, the population-level health consequences of exposure across the lifespan and the related social and economic costs of such exposure are enormous. Using a developmental and social-ecological perspective, this article summarizes the literature examining the effects of IPV exposure on children, reviews key underlying mechanisms, and suggests the use of a public health prevention approach. It presents a discussion of next steps and identification of key challenges. One of the authors, a survivor of child exposure to IPV, presents a vignette that augments key sections and highlights children's resilience.
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Affiliation(s)
| | - Laura Voith
- 2 Case Western Reserve University, Cleveland, OH, USA
| | | | - Megan Holmes
- 2 Case Western Reserve University, Cleveland, OH, USA
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18
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Riley M. Health needs of a hidden group: child residents of domestic abuse refuges. Br J Gen Pract 2019; 69:138. [PMID: 30819746 PMCID: PMC6400632 DOI: 10.3399/bjgp19x701597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Mark Riley
- Academic Department of Military General Practice, Birmingham
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19
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Schols MWA, Serie CMB, Broers NJ, de Ruiter C. Factor analysis and predictive validity of the Early Risks of Physical Abuse and Neglect Scale (ERPANS): A prospective study in Dutch public youth healthcare. CHILD ABUSE & NEGLECT 2019; 88:71-83. [PMID: 30447504 DOI: 10.1016/j.chiabu.2018.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 06/09/2023]
Abstract
Early detection of child abuse risk factors in families of new-born babies is an important task of the public youth health care system in the Netherlands. The Early Risks of Physical Abuse and Neglect Scale (ERPANS) was originally developed in Belgium as an observation scale for public child healthcare nurses. The present longitudinal study is an independent prospective validation of the ERPANS in a Dutch community sample (N = 1257) of families with a new-born. Results showed a commonality of underlying subsets of items belonging to the 'Disturbed parent-child relationship' and 'Psychological problems' factors, but the factor 'Communication problems' of the original ERPANS could not be replicated. We found that parental psychological problems were a significant predictor of family problems, including involvement of child protection authorities, at an average follow-up of 22 months. Parents who reported feeling unloved by their own parents were at higher risk of reports of serious concern to child protection authorities at 22 months after birth. These findings support the utility of at least a subset of the ERPANS items as a screening tool for child abuse risk in preventive public youth health care for new-born babies. Our research adds to a growing body of evidence which points to the importance of parental mental health problems and adverse childhood experiences as precursors to child abuse risk.
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Affiliation(s)
| | - Colinda M B Serie
- Maastricht University, Netherlands and Catholic University Leuven, Belgium
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20
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Barnett W, Halligan S, Heron J, Fraser A, Koen N, Zar HJ, Donald KA, Stein DJ. Maltreatment in childhood and intimate partner violence: A latent class growth analysis in a South African pregnancy cohort. CHILD ABUSE & NEGLECT 2018; 86:336-348. [PMID: 30241702 PMCID: PMC6297167 DOI: 10.1016/j.chiabu.2018.08.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 08/21/2018] [Accepted: 08/29/2018] [Indexed: 05/22/2023]
Abstract
Intimate partner violence (IPV) is a significant global problem, prevalent in low and middle-income countries (LMICs). IPV is particularly problematic during the perinatal and early postnatal period, where it is linked with negative maternal and child health outcomes. There has been little examination of profiles of IPV and early life adversity in LMIC contexts. We aimed to characterize longitudinal IPV and to investigate maternal maltreatment in childhood as a predictor of IPV exposure during pregnancy and postnatally in a low resource setting. This study was nested in the Drakenstein Child Health Study, a longitudinal birth cohort. Maternal IPV (emotional, physical and sexual) was measured at six timepoints from pregnancy to two years postpartum (n = 832); sociodemographic variables and maternal maltreatment in childhood were measured antenatally at 28-32 weeks' gestation. Associations between maternal maltreatment in childhood and IPV latent class membership (to identify patterns of maternal IPV exposure) were estimated using multinomial and logistic regression. We observed high levels of maternal maltreatment during childhood (34%) and IPV during pregnancy (33%). In latent class analysis separating by IPV sub-type, two latent classes of no/low and moderate sexual IPV and three classes of low, moderate, and high emotional and physical IPV (separately) were detected. In combined latent class analysis, including all IPV sub-types together, a low, moderate and high exposure class emerged as well as a high antenatal/decreasing postnatal class. Moderate and high classes for all IPV sub-types and combined analysis showed stable intensity profiles. Maternal childhood sexual abuse, physical abuse and neglect, and emotional abuse predicted membership in high IPV classes, across all domains of IPV (aORs between 1.99 and 5.86). Maternal maltreatment in childhood was associated with increased probability of experiencing high or moderate intensity IPV during and around pregnancy; emotional neglect was associated with decreasing IPV class for combined model. Intervening early to disrupt this cycle of abuse is critical to two generations.
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Affiliation(s)
- Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Medical Research Council Unit on Child & Adolescent Health, University of Cape Town, South Africa.
| | - Sarah Halligan
- Department of Psychology, Bath University, United Kingdom
| | - Jon Heron
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom; MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
| | - Nastassja Koen
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Medical Research Council Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Kirsty A Donald
- Division of Developmental Paediatrics, Department of Paediatrics & Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa; South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
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21
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Dababnah S, Rizo CF, Campion K, Downton KD, Nichols HM. The Relationship Between Children's Exposure to Intimate Partner Violence and Intellectual and Developmental Disabilities: A Systematic Review of the Literature. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2018; 123:529-544. [PMID: 30421974 DOI: 10.1352/1944-7558-123.6.529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Children exposed to intimate partner violence (IPV) can experience negative social, emotional, behavioral, and academic outcomes. A growing body of research has examined the relationship between intellectual and developmental disabilities (IDD) and IPV exposure. We systematically reviewed the literature for research exploring this relationship and found a limited number of studies meeting inclusion criteria ( N = 11). Over half (64%) identified a significant relationship between IPV and IDD, although the cross-sectional methodologies of the majority of studies (82%) prevented the ability to ascertain directionality. Further, the studies defined and measured IPV and IDD in various ways. Some studies were limited by poor external validity and small sample sizes. More research is needed to understand the intersection between IPV exposure and IDD.
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Affiliation(s)
- Sarah Dababnah
- Sarah Dababnah, University of Maryland, Baltimore; Cynthia Fraga Rizo, University of North Carolina at Chapel Hill; and Karen Campion, Katherine D. Downton, and Helen M. Nichols, University of Maryland, Baltimore
| | - Cynthia Fraga Rizo
- Sarah Dababnah, University of Maryland, Baltimore; Cynthia Fraga Rizo, University of North Carolina at Chapel Hill; and Karen Campion, Katherine D. Downton, and Helen M. Nichols, University of Maryland, Baltimore
| | - Karen Campion
- Sarah Dababnah, University of Maryland, Baltimore; Cynthia Fraga Rizo, University of North Carolina at Chapel Hill; and Karen Campion, Katherine D. Downton, and Helen M. Nichols, University of Maryland, Baltimore
| | - Katherine D Downton
- Sarah Dababnah, University of Maryland, Baltimore; Cynthia Fraga Rizo, University of North Carolina at Chapel Hill; and Karen Campion, Katherine D. Downton, and Helen M. Nichols, University of Maryland, Baltimore
| | - Helen M Nichols
- Sarah Dababnah, University of Maryland, Baltimore; Cynthia Fraga Rizo, University of North Carolina at Chapel Hill; and Karen Campion, Katherine D. Downton, and Helen M. Nichols, University of Maryland, Baltimore
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22
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Lamela D, Jongenelen I, Pinto R, Levendosky A. Typologies of intimate partner violence-maternal parenting and children's externalizing problems: The moderating effect of the exposure to other forms of family violence. CHILD ABUSE & NEGLECT 2018; 81:60-73. [PMID: 29723700 DOI: 10.1016/j.chiabu.2018.04.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 04/22/2018] [Accepted: 04/24/2018] [Indexed: 06/08/2023]
Abstract
Typologies of IPV and parenting practices in mothers who experienced police-reported IPV remain surprisingly unexplored, in addition to how those typologies are linked with children's externalizing problems. Using data from 162 Portuguese mother-child dyads with a police or child protection services referral of IPV, this study aimed to: (a) identify IPV-parenting typologies; (b) test the associations between typologies and children's externalizing problems, and (c) examine the moderating effect of children's exposure to other forms of family violence in those associations. Using a person-centered approach, two IPV-parenting typologies were found: a spillover typology, with high levels of physical, psychological, and sexual violence and high levels of harsh and inconsistent parenting practices; and a compartmentalized typology, with high levels of physical, psychological, and sexual violence and lower ineffective parenting practices. Results also showed that externalizing symptoms (reported by mothers and teachers) were significantly lower in children of mothers in the compartmentalized typology compared to those in the spillover typology. Children's direct exposure to other forms of family violence moderated this association. Findings suggested that children with a high exposure to other forms of family violence showed the highest levels of externalizing problems when their mothers were classified into the spillover typology, and they exhibited the lowest levels of externalizing problems when their mothers were classified in the compartmentalized typology.
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23
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van Minde MRC, Hulst SM, Raat H, Steegers EAP, de Kroon MLA. Postnatal screening and care for non-medical risk factors by preventive child healthcare in deprived and non-deprived neighbourhoods. BMC Health Serv Res 2018; 18:432. [PMID: 29884178 PMCID: PMC5994004 DOI: 10.1186/s12913-018-3243-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Children born in families with non-medical risk factors, such as deprivation, have higher odds of preterm birth (< 37 weeks of gestation) or being born small for gestational age (birth weight < 10th percentile). In addition, growing up they are at risk for growth and developmental problems. Preventive Child Healthcare (PCHC) monitors growth and development of babies and children. Early identification of children at risk could result in early interventions to prevent growth and developmental problems in later life. Therefore, we aimed to assess current practices in postnatal risk screening and care for non-medical risk factors and the collaboration with other healthcare professionals, in both deprived and non-deprived neighbourhoods in the Netherlands. Methods Eight out of ten invited PCHC organisations, from different areas in the Netherlands, consented to participate in this study. A questionnaire was designed and digitally distributed to professionals working at these organisations, where 370 physicians and nurses were employed. Data was collected between June and September 2016. Descriptive statistics, chi square tests and t-tests were applied. Results Eighty-nine questionnaires were eligible for analyses. Twenty percent of the respondents were working in a deprived neighbourhood and 70.8% of the respondents were employed as nurse. Most of them performed screening for non-medical risk factors in at least 50% of their consultations. PCHC professionals working in deprived neighbourhoods encountered significantly more often families with non-medical risk factors and experienced significantly more communication problems than their colleagues working in non-deprived neighbourhoods. 48.2% of the respondents were satisfied with the current form of postnatal risk screening in their organisation, whereas 41.2% felt a need for a structured postnatal risk assessment. Intensified collaboration is preferred with district-teams, general practitioners and midwifes, concerning clients with non-medical risk factors. Conclusion This study shows that postnatal screening for non-medical risk factors is part of current PCHC practice, regardless the neighbourhood status they are deployed. PCHC professionals consider screening for non-medical risk factors as their responsibility. Consequently, they felt a need for a structured postnatal risk assessment and for an intensified collaboration with other healthcare professionals. Electronic supplementary material The online version of this article (10.1186/s12913-018-3243-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M R C van Minde
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands. .,Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.
| | - S M Hulst
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - E A P Steegers
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - M L A de Kroon
- Department of Obstetrics & Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands
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Rizo CF, O'Brien J, Macy R, Ermentrout D, Lanier P. Reporting Maltreatment to Child Protective Services in the Context of Intimate Partner Violence Research. Violence Against Women 2018. [PMID: 29521193 DOI: 10.1177/1077801218761604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Given the overlap between intimate partner violence (IPV) and child maltreatment, IPV-exposed child participants in research might disclose instances of child maltreatment. Such disclosures might require researchers to report the maltreatment to child protective services (CPS). However, the literature provides minimal guidance on how to navigate the complex challenges and ethical dilemmas around reporting in the context of research. To help address this gap and stimulate discussion regarding protocols and policies for reporting child maltreatment, this article presents a CPS reporting protocol developed as part of a community-engaged research project evaluating a parenting intervention for system-involved mothers experiencing IPV.
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Affiliation(s)
| | | | - Rebecca Macy
- 1 The University of North Carolina at Chapel Hill, USA
| | | | - Paul Lanier
- 1 The University of North Carolina at Chapel Hill, USA
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25
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Immediate and Late Response to Intimate Partner Violence Intervention in the Pediatric Emergency Department: A Case Report. Pediatr Emerg Care 2018; 34:e41-e43. [PMID: 27749804 DOI: 10.1097/pec.0000000000000908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Childhood exposure to intimate partner violence (IPV) results in numerous, lifelong, negative health outcomes, underscoring the American Academy of Pediatrics' recommendation for IPV screening and intervention in the pediatric health care setting. We report a case in which a mother denied IPV during routine IPV screening in a pediatric emergency department (ED). However, subsequent discussion with health care providers during the ED visit revealed IPV. The mother declined to meet with an IPV advocate because the abuser was texting repeatedly to ask about the duration of the ED visit. However, the onsite social worker met with the mother to provide supportive counseling and complete safety assessment and planning. The mother returned to the abusive home after ED discharge because 3 of her 4 children were with the abuser at that time. Four months later, the mother returned to the ED with her children to see the IPV advocate. After speaking with the advocate, the mother and children went to safe shelter directly from the ED. This case underscores the importance of providing caregivers with multiple opportunities to disclose IPV, the need for health care providers to remain alert to indications that IPV may be occurring, and the role of the entire health care team in addressing IPV. This case also demonstrates that although IPV interventions may not immediately result in leaving an abusive relationship, the unseen benefits of such education and support can ultimately improve safety.
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Oh DL, Jerman P, Silvério Marques S, Koita K, Purewal Boparai SK, Burke Harris N, Bucci M. Systematic review of pediatric health outcomes associated with childhood adversity. BMC Pediatr 2018; 18:83. [PMID: 29475430 PMCID: PMC5824569 DOI: 10.1186/s12887-018-1037-7] [Citation(s) in RCA: 206] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 01/30/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Early detection of and intervention in childhood adversity has powerful potential to improve the health and well-being of children. A systematic review was conducted to better understand the pediatric health outcomes associated with childhood adversity. METHODS PubMed, PsycArticles, and CINAHL were searched for relevant articles. Longitudinal studies examining various adverse childhood experiences and biological health outcomes occurring prior to age 20 were selected. Mental and behavioral health outcomes were excluded, as were physical health outcomes that were a direct result of adversity (i.e. abusive head trauma). Data were extracted and risk of bias was assessed by 2 independent reviewers. RESULTS After identifying 15940 records, 35 studies were included in this review. Selected studies indicated that exposure to childhood adversity was associated with delays in cognitive development, asthma, infection, somatic complaints, and sleep disruption. Studies on household dysfunction reported an effect on weight during early childhood, and studies on maltreatment reported an effect on weight during adolescence. Maternal mental health issues were associated with elevated cortisol levels, and maltreatment was associated with blunted cortisol levels in childhood. Furthermore, exposure to childhood adversity was associated with alterations of immune and inflammatory response and stress-related accelerated telomere erosion. CONCLUSION Childhood adversity affects brain development and multiple body systems, and the physiologic manifestations can be detectable in childhood. A history of childhood adversity should be considered in the differential diagnosis of developmental delay, asthma, recurrent infections requiring hospitalization, somatic complaints, and sleep disruption. The variability in children's response to adversity suggests complex underlying mechanisms and poses a challenge in the development of uniform diagnostic guidelines. More large longitudinal studies are needed to better understand how adversity, its timing and severity, and the presence of individual genetic, epigenetic, and protective factors affects children's health and development.
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Affiliation(s)
- Debora Lee Oh
- Center for Youth Wellness, 3450 Third Street, Bldg 2, Ste 201, San Francisco, CA 94124 USA
| | - Petra Jerman
- Center for Youth Wellness, 3450 Third Street, Bldg 2, Ste 201, San Francisco, CA 94124 USA
| | - Sara Silvério Marques
- Center for Youth Wellness, 3450 Third Street, Bldg 2, Ste 201, San Francisco, CA 94124 USA
| | - Kadiatou Koita
- Center for Youth Wellness, 3450 Third Street, Bldg 2, Ste 201, San Francisco, CA 94124 USA
| | - Sukhdip Kaur Purewal Boparai
- Center for Youth Wellness, 3450 Third Street, Bldg 2, Ste 201, San Francisco, CA 94124 USA
- Human Impact Partners, Oakland, California, USA
| | - Nadine Burke Harris
- Center for Youth Wellness, 3450 Third Street, Bldg 2, Ste 201, San Francisco, CA 94124 USA
| | - Monica Bucci
- Center for Youth Wellness, 3450 Third Street, Bldg 2, Ste 201, San Francisco, CA 94124 USA
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Ragavan MI, Fikre T, Millner U, Bair-Merritt M. The impact of domestic violence exposure on South Asian children in the United States: Perspectives of domestic violence agency staff. CHILD ABUSE & NEGLECT 2018; 76:250-260. [PMID: 29161645 DOI: 10.1016/j.chiabu.2017.11.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 11/08/2017] [Accepted: 11/13/2017] [Indexed: 06/07/2023]
Abstract
The South Asian community is the fastest growing ethnic group in the United States, and past research suggests that South Asian domestic violence (DV) survivors may require culturally-specific resources. Similarly, South Asian children in the US exposed to DV may have unique responses and needs, but this has not been explored to date. The objective of this study was to examine the specific needs of South Asian children exposed to DV from the vantage point of staff from South Asian DV agencies across the United States. Thirty interviews were conducted, with data coded and consolidated into larger themes using thematic analysis. Participants described several factors important to understanding the impact of DV on South Asian children including the role of the extended family, identifying with two cultures, fear about what the South Asian community will think, gender differences, and the importance of projecting an image of perfection. Participants also discussed development of culturally-tailored resources. This study suggests the importance of framing South Asian children's experiences within the context of interweaving South Asian and American cultural values, with careful attention paid to how potential culture clashes between parents and children may impact the way children process trauma. Further work should triangulate these themes with children, parents, and extended family, as well as collaborate with South Asian DV agencies to design child-focused programs.
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Affiliation(s)
- Maya I Ragavan
- Division of General Pediatrics, Department of Pediatrics, Boston Medical Center, 88 E. Newton St, Boston, MA 02118, United States.
| | - Tsion Fikre
- Boston University, 635 Commonwealth Avenue, Boston, MA 02215, United States.
| | - Uma Millner
- Boston University Center for Psychiatric Rehabilitation, 940 Commonwealth Ave. West, Boston, MA 02215, United States.
| | - Megan Bair-Merritt
- Division of General Pediatrics, Department of Pediatrics, Boston Medical Center, 88 E. Newton St, Boston, MA 02118, United States.
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Gilbert AL, Balio C, Bauer NS. Making the Legal and Ethical Case for Universal Screening for Postpartum Mood and Anxiety Disorders in Pediatric Primary Care. Curr Probl Pediatr Adolesc Health Care 2017; 47:267-277. [PMID: 28916453 DOI: 10.1016/j.cppeds.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Postpartum depression (PPD), part of a larger spectrum of perinatal mood and anxiety disorders, affects up to 15% of women following the birth of an infant. Fathers may also be affected. PPD not only affects caregivers, but also impacts infants through mechanisms such as inadequate caregiver-infant interactions and non-adherence to safety practices. The negative impact on infants may extend across the life course through adulthood. This article seeks to move the needle toward universal screening for PPD using validated tools in pediatric primary care settings for new caregivers by making the legal and ethical case for this course of action in a manner that is both compelling and accessible for clinicians. Toward this end, we summarize current literature as it applies to provider responsibilities, liabilities and perspectives; and caregiver autonomy, confidentiality, and privacy. We then assess utility by balancing the benefits and burdens of this approach to practices, providers, and caregivers; and take the analysis one step further by looking across multiple populations to assess distributive justice. We conclude that there is a strong ethical case for universal screening for PPD in pediatric primary care settings using validated tools when informed consent can be obtained and appropriate follow-up services are available and accessible. Clinical considerations, practical resources, and areas ripe for future research are also addressed.
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Affiliation(s)
- Amy Lewis Gilbert
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN
| | - Casey Balio
- Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN
| | - Nerissa S Bauer
- Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN; Regenstrief Institute, Inc., Indianapolis, IN
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Chaudhury S, Brown FL, Kirk CM, Mukunzi S, Nyirandagijimana B, Mukandanga J, Ukundineza C, Godfrey K, Ng LC, Brennan RT, Betancourt TS. Exploring the potential of a family-based prevention intervention to reduce alcohol use and violence within HIV-affected families in Rwanda. AIDS Care 2017; 28 Suppl 2:118-29. [PMID: 27392007 PMCID: PMC4964967 DOI: 10.1080/09540121.2016.1176686] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
HIV-affected families report higher rates of harmful alcohol use, intimate partner violence (IPV) and family conflict, which can have detrimental effects on children. Few evidence-based interventions exist to address these complex issues in Sub-Saharan Africa. This mixed methods study explores the potential of a family-based intervention to reduce IPV, family conflict and problems related to alcohol use to promote child mental health and family functioning within HIV-affected families in post-genocide Rwanda. A family home-visiting, evidence-based intervention designed to identify and enhance resilience and communication in families to promote mental health in children was adapted and developed for use in this context for families affected by caregiver HIV in Rwanda. The intervention was adapted and developed through a series of pilot study phases prior to being tested in open and randomized controlled trials (RCTs) in Rwanda for families affected by caregiver HIV. Quantitative and qualitative data from the RCT are explored here using a mixed methods approach to integrate findings. Reductions in alcohol use and IPV among caregivers are supported by qualitative reports of improved family functioning, lower levels of violence and problem drinking as well as improved child mental health, among the intervention group. This mixed methods analysis supports the potential of family-based interventions to reduce adverse caregiver behaviors as a major mechanism for improving child well-being. Further studies to examine these mechanisms in well-powered trials are needed to extend the evidence-base on the promise of family-based intervention for use in low- and middle-income countries.
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Affiliation(s)
- Sumona Chaudhury
- a Department of Epidemiology , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Felicity L Brown
- b Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Catherine M Kirk
- b Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | | | | | | | | | | | - Lauren C Ng
- e ScD, Division of Global Psychiatry, Massachusetts General Hospital , Boston , MA , USA
| | - Robert T Brennan
- b Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
| | - Theresa S Betancourt
- b Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , MA , USA
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30
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Waelput AJM, Sijpkens MK, Lagendijk J, van Minde MRC, Raat H, Ernst-Smelt HE, de Kroon MLA, Rosman AN, Been JV, Bertens LCM, Steegers EAP. Geographical differences in perinatal health and child welfare in the Netherlands: rationale for the healthy pregnancy 4 all-2 program. BMC Pregnancy Childbirth 2017; 17:254. [PMID: 28764640 PMCID: PMC5540512 DOI: 10.1186/s12884-017-1425-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 07/18/2017] [Indexed: 03/01/2023] Open
Abstract
Background Geographical inequalities in perinatal health and child welfare require attention. To improve the identification, and care, of mothers and young children at risk of adverse health outcomes, the HP4All-2 program was developed. The program consists of three studies, focusing on creating a continuum for risk selection and tailored care pathways from preconception and antenatal care towards 1) postpartum care, 2) early childhood care, as well as 3) interconception care. The program has been implemented in ten municipalities in the Netherlands, aiming to target communities with a relatively disadvantageous position with regard to perinatal and child health outcomes. To delineate the position of the ten participating municipalities, we present municipal and regional differences in the prevalence of perinatal mortality, perinatal morbidity, children living in deprived neighbourhoods, and children living in families on welfare. Methods Data on all singleton births in the Netherlands between 2009 and 2014 were analysed for the prevalence of perinatal mortality and morbidity. In addition, national data on children living in deprived neighbourhoods and children living in families on welfare between 2009 and 2012 were analysed. The prevalence of these outcomes were calculated and ranked for 62 geographical areas, the 50 largest municipalities and the 12 provinces, to determine the position of the municipalities that participate in HP4All-2. Results Considerable geographical differences were present for all four outcomes. The municipalities that participate in HP4All-2 are among the 25 municipalities with the highest prevalence of perinatal mortality, perinatal morbidity, children living in deprived neighbourhoods, or children in families on welfare. Conclusion This study illustrates geographical differences in perinatal health and/or child welfare outcomes and demonstrates that the HP4All-2 program targets municipalities with a relative unfavourable position. By targeting these municipalities, the program is expected to contribute most to improving the care for young children and their mothers at risk, and hence to reducing their risks and health inequalities. Electronic supplementary material The online version of this article (doi:10.1186/s12884-017-1425-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adja J M Waelput
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.
| | - Meertien K Sijpkens
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Jacqueline Lagendijk
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Minke R C van Minde
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Public Health, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Hiske E Ernst-Smelt
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Marlou L A de Kroon
- Department of Public Health, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Ageeth N Rosman
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Jasper V Been
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands.,Department of Paediatrics, Division of Neonatology, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Loes C M Bertens
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus Medical Centre Rotterdam, Postbus 2040, 3000 CA, Rotterdam, the Netherlands
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Franchek-Roa KM, Tiwari A, Connor ALO, Campbell J. Impact of Childhood Exposure to Intimate Partner Violence and Other Adversities. Soa Chongsonyon Chongsin Uihak 2017. [DOI: 10.5765/jkacap.2017.28.3.156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Affiliation(s)
| | - Agnes Tiwari
- Li Ka Shing Faculty of Medicine, The University of Hong Kong School of Nursing, Hong Kong, China
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32
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de Groot R, Palermo T, Handa S, Ragno LP, Peterman A. Cash Transfers and Child Nutrition: Pathways and Impacts. DEVELOPMENT POLICY REVIEW : THE JOURNAL OF THE OVERSEAS DEVELOPMENT INSTITUTE 2017; 35:621-643. [PMID: 31363343 PMCID: PMC6667168 DOI: 10.1111/dpr.12255] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Childhood malnutrition remains a significant global problem, with an estimated 162 million children under the age of five suffering from stunted growth. This article examines the extent to which cash transfer programmes can improve child nutrition. It adopts a framework that captures and explains the pathways and determinants of child nutrition. The framework is then used to organize and discuss relevant evidence from the impact evaluation literature, focusing on impact pathways and new and emerging findings from sub-Saharan Africa to identify critical elements that determine child nutrition outcomes as well as knowledge gaps requiring further research, such as children's dietary diversity, caregiver behaviours and stress.
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Affiliation(s)
- Richard de Groot
- UNICEF Office of Research - Innocenti, Piazza SS Annunziata, 12, 50122, Florence, Italy
| | - Tia Palermo
- UNICEF Office of Research - Innocenti, Piazza SS Annunziata, 12, 50122, Florence, Italy
| | - Sudhanshu Handa
- UNICEF Office of Research - Innocenti, Piazza SS Annunziata, 12, 50122, Florence, Italy
- department of Public Policy, University of North Carolina at Chapel Hill, North Carolina, USA
| | | | - Amber Peterman
- UNICEF Office of Research - Innocenti, Piazza SS Annunziata, 12, 50122, Florence, Italy
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Bauer NS, Ofner S, Pottenger A, Carroll AE, Downs SM. Follow-up of Mothers with Suspected Postpartum Depression from Pediatrics Clinics. Front Pediatr 2017; 5:212. [PMID: 29043246 PMCID: PMC5632353 DOI: 10.3389/fped.2017.00212] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 09/20/2017] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Pediatric providers are increasingly screening for postpartum depression (PD), yet, it is unknown how often mothers comply with recommendations to seek treatment. The objectives were to describe the rate at which mothers with suspected PD seek treatment and explore factors that predict help-seeking behavior. DESIGN AND METHODS Mothers were recruited from four pediatric clinics after identification using the Child Health Improvement through Computer Automation (CHICA) system. Mothers with a positive screen were invited to participate in a telephone interview between January 2012 and December 2014. Mothers reported if they sought treatment or called a community resource. RESULTS 73 of 133 eligible mothers participated (55% response rate). Fifty women recalled a recommendation to seek help. Only 43.8% (32/73) made a follow-up appointment with an adult provider and even fewer kept the appointment. CONCLUSION A majority of mothers suspected of having PD recalled a referral for further intervention; yet, less than half took action. Further investigation of barriers of help-seeking behavior is warranted.
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Affiliation(s)
- Nerissa S Bauer
- Section of Children's Health Services Research, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
| | - Susan Ofner
- Biostatistics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Amy Pottenger
- Section of Children's Health Services Research, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Aaron E Carroll
- Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States.,Section of Pediatric and Adolescent Comparative Effectiveness Research, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Stephen M Downs
- Section of Children's Health Services Research, Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Center for Health Services Research, Regenstrief Institute, Indianapolis, IN, United States
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34
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Ragavan M, Karpel H, Bogetz A, Lucha S, Bruce J. Health Education for Women and Children: A Community-Engaged Mutual Learning Curriculum for Health Trainees. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2016; 12:10492. [PMID: 30984834 PMCID: PMC6440431 DOI: 10.15766/mep_2374-8265.10492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/29/2016] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Intimate partner violence (IPV) affects the physical and psychological health of survivors and their children; however, to our knowledge, no comprehensive health curriculum exists for this population. As a partnership between a transitional housing program (THP) and an academic medical center, we developed a health education curriculum for female IPV survivors using the principles of community-based participatory research (CBPR). METHODS After partnering with a community-based organization, and recruiting participants (IPV survivors), the curriculum is then taught by health trainees. The materials needed to facilitate the 10 workshops are provided and include: a facilitator's guide; workshop materials, including PowerPoint slides and handouts; a training guide for a community partner to teach facilitators about IPV; a sample focus group guide for curricular evaluation that aligns with CBPR methodologies; a sample time line for curricular implementation; and CBPR resources. RESULTS The curriculum was implemented for two 9-month periods between September 2014 and June 2016. During the first session, 80% of women attended at least one workshop and during the second session, 65% of women did the same. Participants and staff at the THP found the curriculum engaging and requested that it be implemented yearly. DISCUSSION The community-academic partnership offered prehealth and health trainees the opportunity to learn effective methods of delivering health education and to understand some of the challenges associated with surviving IPV. Such education can be provided to trainees at any stage and across multiple specialties (e.g., medical, nursing, public health, or social work). There is potential to replicate this mutual learning curriculum in a wide variety of other settings serving mothers and children.
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Affiliation(s)
- Maya Ragavan
- Recent Graduate, Stanford University School of Medicine
| | | | - Alyssa Bogetz
- Instructor and Education Program Developer, Department of Pediatrics, Stanford University School of Medicine
| | - Sarah Lucha
- Crisis Intervention Training Manager, San Jose Police Department; Former Manager of Self-Sufficiency Services, Next Door Solutions to Domestic Violence
| | - Janine Bruce
- Instructor, Research Associate, and Program Director, Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine
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Neonates and Infants Discharged Home Dependent on Medical Technology: Characteristics and Outcomes. Adv Neonatal Care 2016; 16:379-389. [PMID: 27275531 DOI: 10.1097/anc.0000000000000314] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Preterm neonates and neonates with complex conditions admitted to a neonatal intensive care unit (NICU) may require medical technology (eg, supplemental oxygen, feeding tubes) for their continued survival at hospital discharge. Medical technology introduces another layer of complexity for parents, including specialized education about neonatal assessment and operation of technology. The transition home presents a challenge for parents and has been linked with greater healthcare utilization. PURPOSE To determine incidence, characteristics, and healthcare utilization outcomes (emergency room visits, rehospitalizations) of technology-dependent neonates and infants following initial discharge from the hospital. METHODS This descriptive, correlational study used retrospective medical record review to examine technology-dependent neonates (N = 71) upon discharge home. Study variables included demographic characteristics, hospital length of stay, and type of medical technology used. Analysis of neonates (n = 22) with 1-year postdischarge data was conducted to identify relationships with healthcare utilization. Descriptive and regression analyses were performed. FINDINGS Approximately 40% of the technology-dependent neonates were between 23 and 26 weeks' gestation, with birth weight of less than 1000 g. Technologies used most frequently were supplemental oxygen (66%) and feeding tubes (46.5%). The mean total hospital length of stay for technology-dependent versus nontechnology-dependent neonates was 108.6 and 25.7 days, respectively. Technology-dependent neonates who were female, with a gastrostomy tube, or with longer initial hospital length of stay were at greater risk for rehospitalization. IMPLICATIONS FOR PRACTICE Assessment and support of families, particularly mothers of technology-dependent neonates following initial hospital discharge, are vital. IMPLICATIONS FOR RESEARCH Longitudinal studies to determine factors affecting long-term outcomes of technology-dependent infants are needed.
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36
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Ragavan M, Bruce J, Lucha S, Jayaraman T, Stein H, Chamberlain L. The Health of Women and Children After Surviving Intimate Partner Violence. Violence Against Women 2016; 23:1205-1227. [PMID: 27411720 DOI: 10.1177/1077801216656833] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Few studies have explored the perspectives of survivors of intimate partner violence (IPV) regarding their health and their children's health, their experiences accessing and utilizing health care, and health initiatives that would best serve their families' needs. We facilitated focus groups with female IPV survivors and adolescents who witnessed IPV. Women described their health and their children's health as poor and reported challenges with health care utilization, whereas teenagers generally perceived their health as typical for their age. Participants requested health education workshops, community resources, and social support. This study lays the foundation for further research and the development of health initiatives.
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Affiliation(s)
- Maya Ragavan
- 1 Stanford University School of Medicine, Palo Alto, CA, USA
| | - Janine Bruce
- 1 Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sarah Lucha
- 2 Next Door Solutions to Domestic Violence, San Jose, CA, USA
| | | | - Harise Stein
- 1 Stanford University School of Medicine, Palo Alto, CA, USA
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Impact of Intimate Partner Violence on Primary Health Care Use for Children: Evidences from Rio de Janeiro, Brazil. Matern Child Health J 2016; 20:2065-73. [PMID: 27324046 DOI: 10.1007/s10995-016-2036-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives To assess whether severe physical intimate partner violence (PIPV) after childbirth affects the number of pediatric visits in Primary Health Care (PHC) units during this period. Methods Cross-sectional study including 927 mothers of infants under 6 months, users of 27 PHC units in Rio de Janeiro, Brazil. PIPV from childbirth to the date of interview was measured using the Revised Conflict Tactics Scales (CTS2). The number of pediatric visits in the first 6 months of life was the outcome measure of interest. Poisson and multinomial regression models were used for data analysis to control for confounders. Results Children of mothers who experienced severe PIPV had a reduced number of pediatric visits than those not reporting it. This finding was identified only among children who had health problems: relative to five or more baseline pediatric visits, the chance of 3-4 and 1-2 visits increased three- and five-fold, respectively, when severe PIPV was present. Conclusions The maternal experience of severe PIPV reduces the number of pediatric visits in PHC services among the most vulnerable children. This is a hindrance to adequate health promotion, prevention and care, required for the healthy growth and development of children. Early violence detection by pediatricians and other health professionals could be a step in the right direction.
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38
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Cao Y, Li L, Zhao X, Zhang Y, Guo X, Zhang Y, Luo X. Effects of Exposure to Domestic Physical Violence on Children's Behavior: A Chinese Community-based Sample. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2016; 9:127-135. [PMID: 27516817 PMCID: PMC4976775 DOI: 10.1007/s40653-016-0092-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Domestic physical violence (DPV) is common in China due to its long history of slavery and feudalism. This study aimed to examine the effects of exposure to DPV on children's behavior in a Chinese community. Ninety-three 12- to 16-year-old adolescents exposed to DPV were compared to 54 adolescents with no exposure to DPV. We found that DPV exposure was associated with adverse behaviors in children, especially among boys. Children witnessing DPV alone had similar behavioral scores as the abused children. We recommend that both abused and DPV witness-only adolescents in Chinese communities need treatment to mitigate the effects on maladjusted behaviors. The intervention programs for children who witness domestic violence are also important.
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Affiliation(s)
- Yuping Cao
- Mental Health Institute, Second Xiangya Hospital, Central South University
| | - Longfei Li
- Mental Health Institute, Second Xiangya Hospital, Central South University and Jining Mental Hospital of Shandong Province
| | - Xingfu Zhao
- Mental Health Institute, Second Xiangya Hospital, Central South University and Wuxi Mental Health Center
| | - Yu Zhang
- Mental Health Institute, Second Xiangya Hospital, Central South University
| | | | - Yalin Zhang
- Mental Health Institute, Second Xiangya Hospital, Central South University
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Anand V, Carroll AE, Biondich PG, Dugan TM, Downs SM. Pediatric decision support using adapted Arden Syntax. Artif Intell Med 2015; 92:15-23. [PMID: 26547523 DOI: 10.1016/j.artmed.2015.09.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 09/17/2015] [Accepted: 09/19/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric guidelines based care is often overlooked because of the constraints of a typical office visit and the sheer number of guidelines that may exist for a patient's visit. In response to this problem, in 2004 we developed a pediatric computer based clinical decision support system using Arden Syntax medical logic modules (MLM). METHODS The Child Health Improvement through Computer Automation system (CHICA) screens patient families in the waiting room and alerts the physician in the exam room. Here we describe adaptation of Arden Syntax to support production and consumption of patient specific tailored documents for every clinical encounter in CHICA and describe the experiments that demonstrate the effectiveness of this system. RESULTS As of this writing CHICA has served over 44,000 patients at 7 pediatric clinics in our healthcare system in the last decade and its MLMs have been fired 6182,700 times in "produce" and 5334,021 times in "consume" mode. It has run continuously for over 10 years and has been used by 755 physicians, residents, fellows, nurse practitioners, nurses and clinical staff. There are 429 MLMs implemented in CHICA, using the Arden Syntax standard. Studies of CHICA's effectiveness include several published randomized controlled trials. CONCLUSIONS Our results show that the Arden Syntax standard provided us with an effective way to represent pediatric guidelines for use in routine care. We only required minor modifications to the standard to support our clinical workflow. Additionally, Arden Syntax implementation in CHICA facilitated the study of many pediatric guidelines in real clinical environments.
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Affiliation(s)
- Vibha Anand
- Children's Hospital and Pediatric Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Aaron E Carroll
- Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Riley Child Development Center, 705 Riley Hospital Drive, Room 5837, Indianapolis, IN 46202, USA; Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN 46202-3012, USA
| | - Paul G Biondich
- Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN 46202-3012, USA; Children's Health Services Research, Indiana University, 410 West 10th Street, Suite 1000, Indianapolis, IN 46202-3012, USA
| | - Tamara M Dugan
- Children's Health Services Research, Indiana University, 410 West 10th Street, Suite 1000, Indianapolis, IN 46202-3012, USA
| | - Stephen M Downs
- Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN 46202-3012, USA; Children's Health Services Research, Indiana University, 410 West 10th Street, Suite 1000, Indianapolis, IN 46202-3012, USA
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Abstract
Mothers caring for technology-dependent children at home often suffer clinically significant and unrecognized depressive symptoms. The study aim was to determine factors related to elevated depressive symptoms and provide information to target interventions that assists mothers in self-management of their mental health. Secondary data analysis from a descriptive, correlational study of 75 mothers was performed. Hierarchical multiple regression analysis results indicate that younger, unpartnered mothers with lower normalization efforts and personal resourcefulness, and less care hours, had increased depressive symptoms. The importance of personal resourcefulness and the potential for a resourcefulness training intervention to reduce depressive symptoms are discussed.
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Affiliation(s)
- Valerie Boebel Toly
- a Case Western Reserve University , Frances Payne Bolton School of Nursing , Cleveland, Ohio, USA
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