Intimate Partner Violence, Children & I ti t P t Vi l Child - PowerPoint PPT Presentation

Intimate Partner Violence, Children & I ti t P t Vi l Child & Early Childhood Home Visitation (HV) Megan H Bair ‐ Merritt, MD, MSCE Assistant Professor of Pediatrics Department of Pediatrics Department of Pediatrics Johns Hopkins School of Medicine

Three Points to Remember Three Points to Remember 1. Childhood exposure to IPV is common – Over 15 million children exposed each year – Twice as common as asthma 2. IPV exposure is bad for kids’ health – Poor physical & mental health, and child abuse Poor physical & mental health, and child abuse 3. HV can decrease IPV & childhood exposure – Training home visitors about IPV critical Training home visitors about IPV critical Must include this if goal is to improve child health – McDonald R, et al. J Fam Psychol 2006

Childhood IPV exposure is common Childhood IPV exposure is common • 15 million children exposed 15 million children exposed – 7 million to severe IPV • Rates disproportionately high in homes with • Rates disproportionately high in homes with children <5 years old • Data from home visiting (HV) programs ( ) shows up to 50% of women abused • IPV does not always happen at 2am in a different wing of the house

IPV exposure bad for kids’ health IPV exposure bad for kids health • 40 ‐ 60% co ‐ occurrence with child abuse 40 60% co occurrence with child abuse • American Academy of Pediatrics states that intervening on behalf of a battered mother intervening on behalf of a battered mother may be one of the “most effective means of preventing child abuse” preventing child abuse BOTTOM LINE: To decrease child abuse, HV programs must effectively address IPV

IPV exposure bad for kids health IPV exposure bad for kids’ health • Social ‐ emotional health: Social emotional health: – Compared to peers, kids in homes with IPV: • Depression, anxiety, PTSD, ADHD D i i t PTSD ADHD • Bullying in school • School failure h l f l • Teenage substance use Holt et al Child Abuse & Neglect 2008; Kernic MA. Arch Pediatr Adolesc Med 2002; Kitzmann J Consult & Clin Psych 2003; Edleson J Interpers Viol 1999

IPV exposure bad for kids’ health IPV exposure bad for kids health • Health care use: Health care use: – Compared to peers, kids in homes with IPV • Half as likely to be immunized by two years of age Half as likely to be immunized by two years of age • Less likely to receive expected well ‐ child care • Twice as likely to end up in the ER y p • Cost health plans on average 16% more Bair ‐ Merritt MH, et al. Pediatrics 2008; Rivara FP, et al; Pediatrics 2007; Bair ‐ Merritt MH, et al; Arch Ped & Adol Med 2008 Adol Med 2008

IPV exposure bad for kids’ health IPV exposure bad for kids health • Physical health: Physical health: – Compared to peers, kids in homes with IPV • Have twice the risk of developing asthma H t i th i k f d l i th • Increased risk of asthma GOES DOWN when Mom’s engaged with children Mom s engaged with children – HV teaches parenting skills like this Suglia Archives Ped Adol Med 2009

HV decreases IPV & childhood exposure • HV programs seek to decrease child abuse HV programs seek to decrease child abuse and reduce associated risk factors • Recent study: To estimate whether HV in Hawaii Healthy Start Program was associated H ii H l h S P i d with changes in rates of mothers’ IPV victimization and perpetration during the 3 i i i i d i d i h 3 years of program & long ‐ term follow ‐ up Bair ‐ Merritt, et al Arch Ped Adol Med 2010

Mean n umber of a acts of mat ternal IPV victim mization pe r one pers on year 0.0 0 2.0 4.0 4 6.0 8.0 10 0.0 12.0 14.0 0 1 12.5 8.9 2 11.5 4.7 3 5.4 8.2 Control Child age in year 4 5 6 Treatment 3.9 5.1 7 3.9 3.2 8 3.0 3.0 3 0 9 10

Mean nu umber of a acts of mate ernal IPV perpe tration per r one perso on year 0.0 2.0 4.0 6.0 6 8.0 10.0 12.0 0 7.7 1 8.5 9.2 2 3.6 3 6.2 6 2 3.1 Control Child age in year 4 5 6 Treatment 3.5 3 5 2.4 7 2.7 2 8 2.8 8 1.3 2.2 9 10

HV may decrease IPV & childhood exposure • During years of program implementation During years of program implementation, rates of mother’s: – IPV victimization decreased by 14% – IPV victimization decreased by 14% [IRR 0.86 (95% CI, 0.73, 1.01)] – IPV perpetration decreased by 17% IPV perpetration decreased by 17% [IRR 0.83 (95% CI, 0.72, 0.96)]

HV may decrease IPV & childhood exposure • Why may it have worked? • Why may it have worked? – HV ‐ Mom relationship – Encouragement of self ‐ efficacy • But, it could be better , • What is needed? – Standardized screening d di d i – HV training and support

HV may decrease IPV & childhood exposure • Why is this important? Why is this important? – NFP research: presence of IPV limited HV program’s ability to reduce child maltreatment program s ability to reduce child maltreatment • HAVE TO ADDRESS IPV TO ADDRESS CHILD ABUSE – Reducing IPV INDEPENDENTLY benefits child health Eckenrode J et al. JAMA 2000

Three points to remember Three points to remember 1 Childhood exposure to IPV is common 1. Childhood exposure to IPV is common – Over 15 million children exposed each year – Twice as common as asthma Twice as common as asthma 2. IPV exposure is bad for kids’ health – Poor physical & mental health, and child abuse 3. HV may decrease IPV & childhood exposure – Training home visitors about IPV critical – Must include this if goal to improve child health

Acknowledgements Acknowledgements • Co ‐ authors: Jacky Jennings PhD, MPH; Rusan Chen Co authors: Jacky Jennings PhD, MPH; Rusan Chen PhD; Lori Burrell MA; Loretta Fuddy ACSW, MPH; Elizabeth McFarlane PhD; Anne Duggan ScD • I am funded by a K23 Career Development Grant through the National Institute of Child Health and Human Development • HHSP evaluation supported by: Maternal and Child Health Bureau; Robert Wood Johnson Foundation; l h b d h d Annie E Casey Foundation; David and Lucile Packard Foundation; Hawaii State Department of Health; Foundation; Hawaii State Department of Health; and National Institute of Health