Lewis Natalia V, Feder Gene S, Howarth Emma, Szilassy Eszter, McTavish Jill R, MacMillan Harriet L, Wathen Nadine
Centre for Academic Primary Care, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Centre for Primary Care and Public Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
BMJ Open. 2018 Apr 28;8(4):e019761. doi: 10.1136/bmjopen-2017-019761.
To synthesise evidence on the acceptable identification and initial response to children's exposure to intimate partner violence (IPV) from the perspectives of providers and recipients of healthcare and social services.
We conducted a thematic synthesis of qualitative research, appraised the included studies with the modified Critical Appraisal Skills Programme checklist and undertook a sensitivity analysis of the studies scored above 15.
We searched eight electronic databases, checked references and citations and contacted authors of the included studies.
We included qualitative studies with children, parents and providers of healthcare or social services about their experiences of identification or initial responses to children's exposure to IPV. Papers that have not been peer-reviewed were excluded as well as non-English papers.
Searches identified 2039 records; 11 studies met inclusion criteria. Integrated perspectives of 42 children, 212 mothers and 251 professionals showed that sufficient training and support for professionals, good patient-professional relationship and supportive environment for patient/clients need to be in place before enquiry/disclosure of children's exposure to IPV should occur. Providers and recipients of care favour a phased enquiry about IPV initiated by healthcare professionals, which focuses on 'safety at home' and is integrated into the context of the consultation or visit. Participants agreed that an acceptable initial response prioritises child safety and includes emotional support, education about IPV and signposting to IPV services. Participants had conflicting perspectives on what constitutes acceptable engagement with children and management of safety. Sensitivity analysis produced similar results.
Healthcare and social service professionals should receive sufficient training and ongoing individual and system-level support to provide acceptable identification of and initial response to children's exposure to IPV. Ideal identification and responses should use a phased approach to enquiry and the WHO Listen, Inquire about needs and concerns, Validate, Enhance safety and Support principles integrated into a trauma-informed and violence-informed model of care.
从医疗保健和社会服务提供者及接受者的角度，综合关于儿童遭受亲密伴侣暴力（IPV）的可接受识别方法及初步应对措施的证据。
我们对定性研究进行了主题综合分析，使用修改后的批判性评估技能计划清单对纳入研究进行评估，并对得分高于15分的研究进行了敏感性分析。
我们检索了八个电子数据库，检查了参考文献和引用情况，并联系了纳入研究的作者。
我们纳入了关于儿童、父母以及医疗保健或社会服务提供者对儿童遭受IPV的识别或初步应对经历的定性研究。未经过同行评审的论文以及非英文论文被排除。
检索共识别出2039条记录；11项研究符合纳入标准。42名儿童、212名母亲和251名专业人员的综合观点表明，在询问/披露儿童遭受IPV的情况之前，需要为专业人员提供充分的培训和支持，建立良好的医患关系，并为患者/服务对象提供支持性环境。护理提供者和接受者赞成由医疗保健专业人员分阶段询问IPV情况，重点关注“家庭安全”，并将其纳入咨询或就诊背景中。参与者一致认为，可接受的初步应对措施应优先考虑儿童安全，包括情感支持、关于IPV的教育以及指向IPV服务的指引。参与者对于与儿童的可接受接触方式及安全管理存在相互冲突的观点。敏感性分析得出了类似结果。
医疗保健和社会服务专业人员应接受充分培训，并获得持续的个人层面和系统层面的支持，以便对儿童遭受IPV的情况进行可接受的识别并做出初步应对。理想的识别和应对措施应采用分阶段询问方法，并将世界卫生组织的倾听、询问需求和关切、确认、加强安全和支持原则融入以创伤知情和暴力知情为基础的护理模式。
