Transcript Slide 1

Prevalence of Intimate Partner Violence
Among Female Caregivers of
Abused and Non-Abused
Pediatric Emergency Department Patients
Academy on Violence and Abuse
Biennial Scientific Conference
Minneapolis, Minnesota
April 15 -16, 2011
Kathleen M Franchek-Roa MD
John E Bickel LCSW
A Chantal Caviness MD MPH PhD
Michelle A Lyn MD
Background
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Research clearly shows that intimate partner violence (IPV) is
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To adequately assess the safety needs of children other
occurrences of family violence need to be determined,
especially when evaluating high risk families
In addition, studies have found that many caregivers who
have children with alleged CM concerns
have experienced child adversity themselves
 poor health in adulthood is associated with these adverse
experiences
This study was developed to gather information to design a protocol
for assessing IPV victimization in the adult caregivers of children
presenting for abuse evaluations in order to provide appropriate
resources to these high risk families
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a significant risk factor for child maltreatment (CM)
one of the factors contributing to the recidivism rate in CM cases
Background
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Texas Children’s Hospital in Houston, Texas is a tertiarycare teaching hospital
Study participants were recruited from July 2006 to
December 2007
The physicians and staff in the Pediatric Emergency
Department (PED) are well-trained in the evaluation of
children who present with CM concerns
However, there was no routine protocol to identify IPV in
families with CM concerns
Hypotheses
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Hypothesis 1: The frequency of current and lifetime
IPV victimization among female caregivers of suspected
CM cases is higher than among the female caregivers of
children with non-abuse complaints
Hypothesis 2: The frequency of self-reported childhood
maltreatment and IPV exposure among female
caregivers of suspected CM cases is higher than among
the female caregivers of children with non-abuse
complaints
Hypothesis 3: Few women in either group had been
previously assessed for violence in the home by a health
care provider
Design/Methods
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Unmatched case-control study of a convenience sample
Subjects recruited were female caregivers who brought
their child to the PED for CM (CM cohort) and non-CM
concerns (Non-CM cohort)
These female caregivers were asked to complete a
questionnaire that contained questions regarding their
exposure to violence and previous screening by a HCP
Categorical variables were described using frequencies
and compared between the CM and non-CM cohort
using chi-square statistics
IRB-approved Study
Results - Demographic Characteristics
Characteristic
CM Cohort
(N=72)
Non-CM cohort
(N=82)
Median Age of Female Caregiver
31
31
Language (% English)
85%
87%
Median Number of Children
2
2
Median child age in years
7
8
Race/Ethnicity
Hispanic
African-American
Caucasian
Mixed
39%
31%
24%
4%
48%
32%
18%
1%
Education
No HS
HS or Equivalent
Some College
College Degree
Graduate Degree
32%
26%
22%
13%
4%
13%
33%
35%
11%
6%
None
Any
17%
83%
7%
93%
Medical Insurance
Results – Hypothesis 1
Prevalence of IPV between Groups
70
60
*
CM Cohort
Percent
50
40
30
Non-CM
Cohort
20
10
CM Cohort
Non-CM
Cohort
0
Lifetime IPV Victimization
*P-Value = 0.004
Current IPV Victimization
Results – Hypothesis 2
Childhood Abuse Victimization and IPV Exposure
Results – Hypothesis 2
Childhood Abuse Victimization and IPV Exposure
35
30
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Percent
25
20
CM Cohort
15
Non-CM Cohort
10
5
0
Victim of Child Abuse
*P-Value= 0.016
Childhood Exposure to IPV
Results – Hypothesis 2
Childhood Abuse Victimization and IPV Exposure
35
30
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Percent
25
20
CM Cohort
15
Non-CM Cohort
10
5
0
Victim of Child Abuse
*P-Value= 0.016
Childhood Exposure to IPV
Results – Hypothesis 3
Screening by Health Care Provider
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50/143 women (35%) reported that a HCP
had asked about violence in their home
Percent
50
40
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30
CM Cohort
Non-CM Cohort
20
10
0
Screened by HCP for Violence
*P-Value = 0.047
Results – Hypothesis 3
Screening by Health Care Provider
OBGYN Psychiatrist
Other
Primary Care
Social Worker
Pediatrician
Nurse
ED Physician
Limitations
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Type of CM in the CM cohort was not stratified
Convenience sample of self-reported violence
history
IPV survey instrument validation
Conclusions
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Hypothesis 1: The current and lifetime prevalence
of IPV victimization was higher in the CM cohort
than the non-CM cohort
Hypothesis 2: Significantly more women in the CM
cohort than the non-CM cohort reported being
victims of child maltreatment but there was no
difference between the groups with respect to
witnessing IPV as a child
Hypothesis 3: Significantly more women in the CM
cohort than the non-CM cohort had been previously
screened by a HCP for violence in their home
Conclusions
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Our study makes it clear that women
presenting to a PED with CM concerns
should be asked about IPV victimization
because
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Nearly two-thirds of women with child
maltreatment concerns had a history of IPV
victimization
No demographic characteristics predicted which
women would have a positive screen
Practice Implications
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Because of the high prevalence of IPV found
in this study, Texas Children’s Hospital
Emergency Department is educating all
physicians and staff in the identification and
intervention for women with histories of
violence victimization
Further findings from this project will be
forthcoming
Acknowledgements
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Joan Shook MD MBA Professor and Head,
Department of Pediatrics, Section of Emergency
Medicine, Baylor College of Medicine, Houston, Texas
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Faye Blair RN, SANE
Franchelle Applewhite RN, SANE
Nicole Triggs RN, SANE
Thank you