Yale University School of Medicine, United States of America; Department of Emergency Medicine, Yale University School of Medicine, United States of America.
Yale University School of Medicine, United States of America.
Child Abuse Negl. 2024 Nov;157:107068. doi: 10.1016/j.chiabu.2024.107068. Epub 2024 Sep 26.
BACKGROUND/OBJECTIVES: Intimate partner violence (IPV) and child physical abuse frequently co-occur, yet IPV-exposed children are not routinely evaluated for abuse. Furthermore, IPV survivors often seek care for their children but not for themselves, making pediatric visits an opportunity to address IPV. We developed a trauma- and violence-informed care (TVIC)-based model that 1) evaluated IPV-exposed children and 2) linked survivor-caregivers to an IPV advocate. We aimed to assess the feasibility and acceptability of the model.
Children < 3 who were reported to Child Protective Services (CPS) for exposure to IPV and their survivor-caregiver.
To examine feasibility, we calculated the percentage of 1) eligible children evaluated and 2) caregivers who met with an IPV advocate during the child's visit and followed up with the advocate. To assess acceptability, we conducted qualitative interviews with 30/41 caregivers about their perceptions of the model.
From 7/1/20-6/30/22, 49 (22.7 %) of 216 eligible children were evaluated. Of 41 caregivers, six already were receiving IPV services; Of the remaining 35, 24 (68.6 %) met with an IPV advocate, and 22 (91.7 %) had ≥1 follow-up visit with an advocate. We identified three themes: 1) Motivations for the visit, 2) Engagement with the model, and 3) Benefits. Caregivers attended the visit due to behavioral concerns about the child and a desire to comply with CPS. Engagement occurred as medical providers established rapport and provided support without judgment. Benefits included recognizing the impact of IPV on the child and immediate linkage to advocacy services.
A TVIC-based model is feasible and acceptable and could improve caregivers' engagement with the evaluation of IPV-exposed children for abuse and with IPV services, which have the potential to improve safety and promote well-being.
背景/目的：亲密伴侣暴力（IPV）和儿童身体虐待经常同时发生，但 IPV 暴露的儿童通常不会接受虐待评估。此外，IPV 幸存者经常为他们的孩子寻求医疗，但不为自己寻求医疗，这使得儿科就诊成为解决 IPV 的机会。我们开发了一种基于创伤和暴力知情护理（TVIC）的模型，该模型 1）评估 IPV 暴露的儿童，2）将幸存者照顾者与 IPV 倡导者联系起来。我们旨在评估该模型的可行性和可接受性。
向儿童保护服务（CPS）报告的因 IPV 暴露而小于 3 岁的儿童及其幸存者照顾者。
为了检查可行性，我们计算了以下百分比：1）接受评估的合格儿童的百分比，以及 2）在儿童就诊期间与 IPV 倡导者会面并与倡导者跟进的照顾者的百分比。为了评估可接受性，我们对 30/41 名照顾者进行了定性访谈，了解他们对该模型的看法。
从 2022 年 7 月 1 日至 6 月 30 日，49 名（22.7%）符合条件的 216 名儿童接受了评估。在 41 名照顾者中，有 6 名已经在接受 IPV 服务；在其余的 35 名照顾者中，有 24 名（68.6%）与 IPV 倡导者会面，有 22 名（91.7%）与倡导者进行了至少 1 次后续访问。我们确定了三个主题：1）就诊的动机，2）与模型的互动，以及 3）获益。照顾者就诊的原因是对孩子的行为问题感到担忧，并希望遵守 CPS 的要求。当医疗服务提供者建立融洽关系并提供支持而不评判时，就会发生互动。获益包括认识到 IPV 对孩子的影响，以及立即与倡导服务联系。
基于 TVIC 的模型是可行和可接受的，它可以提高照顾者对 IPV 暴露儿童进行虐待评估以及接受 IPV 服务的参与度，这有可能提高安全性并促进幸福感。
