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

I ti t P t Vi l Child & Intimate Partner Violence, Children & 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:

D i i t PTSD ADHD

• Depression, anxiety, PTSD, ADHD
• Bullying in school

h l f l

• School failure
• 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

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• 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

H t i th i k f d l i th

• Have twice the risk of developing asthma
• 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

H ii H l h S P i d Hawaii Healthy Start Program was associated with changes in rates of mothers’ IPV i i i i d i d i h 3 victimization and perpetration during the 3 years of program & long‐term follow‐up

Bair‐Merritt, et al Arch Ped Adol Med 2010

14.0

12.5 11.5

0.0 12.0 ternal IPV

• n year

8.9 8.2

8.0 10 acts of mat r one pers

4.7 5.4 5.1 3.9 3 0

4.0 6.0 umber of a mization pe

3.9 3.2 3.0 3.0

2.0 4 Mean n victim 0.0 1 2 3 4 5 6 7 8 9 10 Child age in year Control Treatment

12.0

8.5 9.2

10.0 ernal IPV

• n year

7.7 6 2

6.0 8.0 acts of mate r one perso

3.6 3.1 2 8 6.2 3 5

4.0 6 umber of a tration per

2.4 2.8 2.2 3.5 2.7 1.3

2.0 Mean nu perpe 0.0 1 2 3 4 5 6 7 8 9 10 Child age in year Control Treatment

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?

d di d i –Standardized screening –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

l h b d h d Health Bureau; Robert Wood Johnson Foundation; 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