Kimberly A. Randell

Mothers' Motivations for Intimate Partner Violence Help-Seeking

The purpose of this study was to determine motivators for intimate partner violence (IPV) help-seeking among mothers. This qualitative study used English and Spanish-speaking focus groups and a grounded theory approach. Sixty-two mothers participated in eight groups. Motivators for IPV help-seeking fell into two broad categories, internal and external motivators. Although participants cited numerous motivators for IPV help-seeking, recognizing the negative effects of IPV on their children, labeling the partner’s behavior as abusive and the intervention of others were particularly important. For many participants, the effects of IPV on their children were the most important motivator. Few women made the decision to seek help without the encouragement of others. Unique to the Spanish-speaking participants was the influence of immigration status and limitations to disclosure created by using significant others as translators. Exploration of incorporating these motivators into IPV intervention efforts is warranted.

Association of Parental Adverse Childhood Experiences and Current Child Adversity

Association of Parental Adverse Childhood Experiences and Current Child Adversity Prompted by a growing body of evidence demonstrating the significant lifelong effect of adverse childhood experiences (ACEs) and toxic stress, health care professionals have begun to address these issues more directly.1-3 The parental history of ACE may serve as a marker of risk for child adversity, thus offering opportunities for early intervention to prevent ACE or ameliorate the negative outcomes associated with ACE. However, associations between parental ACE and child adversity are not well described. Previous studies primarily examine associations between maternal childhood maltreatment and child behavioral health. This study examined associations between parental ACE and child current adversity.

Factors Associated With Interest in Same-Day Contraception Initiation Among Females in the Pediatric Emergency Department

PURPOSE The purposes were to describe interest in hormonal contraception initiation among female adolescent in the emergency department (ED) and to assess for associations with factors known to increase pregnancy risk such as violence victimization. METHODS We used a computerized survey to assess sexual and dating practices, pregnancy history/likelihood, contraception use (including long-acting reversible contraception [LARC]) and concerns, contraception initiation interest, violence victimization, medical utilization, and demographics among sexually experienced females aged 14-19 years in our ED. The primary outcome was interest in contraception initiation. We compared responses between subgroups using the chi-square test. RESULTS A total of 168 adolescents participated (82% of approached; mean age 16.6 years; 41% white; 48% black; 21% commercial insurance). Interest in contraception initiation was high: 60% overall and 70% among those not using hormonal contraception (n = 96). Among those using non-LARC contraception (n = 59), 29% were interested in LARC initiation. Contraception/LARC interest was positively associated with lack of recent well care (p < .06) and concerns about cost (p < .01), privacy (p = .03), and where to obtain contraception (p < .01). Nearly all planned on avoiding pregnancy, although many (23%) used no contraception at last intercourse. One third (36%) reported violence victimization. Most (70%) reported ≥1 concern about contraception (most commonly cost). CONCLUSIONS Many reported behaviors and exposures, including violence victimization, that increase their risk for pregnancy and most expressed interest in same-day initiation of hormonal contraception, including LARC. These findings may inform novel strategies for increased adolescent access to contraception and pregnancy prevention through use of nontraditional sites such as EDs.

Two Year Old With Water Bead Ingestion.

Abstract Foreign body ingestion is a common pediatric complaint. Two case reports describe intestinal obstruction in children from an ingestion of a single superabsorbent water ball, requiring surgical removal. We describe nonsurgical management of an asymptomatic child who ingested approximately 100 superabsorbent water beads. Because of the risk for subsequent intestinal obstruction, the patient was admitted for whole bowel irrigation. This case report is the first describing use of whole bowel irrigation in the management of an asymptomatic patient with multiple water beads ingestion.

Educational interventions for intimate partner violence: guidance from survivors.

Objective Previous research suggests that health care providers’ assumptions about the content and marketing of intimate partner violence (IPV) materials are not always correct and may do harm. This study sought to determine what mothers with histories of IPV identify as important information to communicate about IPV and how it should be presented in a pediatric emergency department. Methods This qualitative study used English- and Spanish-speaking focus groups for data collection and a grounded theory approach for data analysis. Initial focus groups elicited opinions on content, appearance, and location of IPV material. After data analysis, IPV posters were developed. Follow-up focus groups provided feedback on the posters. Results Ninety-nine mothers with histories of IPV participated in 8 initial and 4 follow-up focus groups. Women felt information should be presented in a positive, hopeful manner. Key information desired was signs of IPV, effects of childhood IPV exposure, and available resources. Spanish-speaking groups desired that information that helps was available regardless of immigration status. Women cautioned that information regarding the effects of childhood IPV exposure should be presented in a nonjudgmental manner to minimize feelings of anger and guilt in mothers. Participants endorsed the distribution of IPV materials in many formats and locations but also worried that women might suffer retribution if perpetrators see IPV material. Conclusions Passive educational interventions for IPV should present information about the signs of IPV, resources, and effects on children in a positive, hopeful manner. Materials directed toward Spanish-speaking victims should address the issue of immigration status.

Children outcomes and intimate partner violence research

1for taking a rigorous approach to assess universal screening for intimate partner violence (IPV) in health-care settings. As paediatricians, we have a unique perspective on their findings and potential implications. 40% of women experiencing IPV live with children who are subsequently exposed to chronic and unpredictable violence in the home. It is well documented that IPV-exposed children are at an increased risk for adverse physical and mental health outcomes, child maltreatment, and academic failure. 2,3 Unfortunately, many studies of IPV interventions fail to address these paediatric outcomes. Although Hegarty and colleagues noted a clinically signifi cant reduction in maternal depressive symptoms in the intervention group, they did not discuss the implications of this fi nding for children. Current data suggest that the adverse outcomes of childhood IPV exposure are compounded by coexisting maternal depression. 4

Intimate Partner Violence Programs in a Children's Hospital: Comprehensive Assessment Utilizing a Delphi Instrument.

OBJECTIVE The purpose of this study was to conduct a baseline assessment of intimate partner violence (IPV) practices in a pediatric hospital system. METHODS The Delphi Instrument for Hospital-based Domestic Violence Programs was used to assess the structure and components of the hospital systems IPV practices. Through key stakeholder interviews, we also assessed IPV practices in individual patient care areas. Qualitative analysis of interview data used a grounded theory approach. RESULTS The hospital scored 17 of 100 points on the Delphi instrument assessment. Key areas of weakness identified by the Delphi instrument and interviews included lack of coordinated provider training and evaluation of IPV-related processes and no standards for IPV screening, safety assessment, and documentation. Most interviewees supported addressing IPV; all identified barriers to IPV screening at individual provider and institutional levels. Institutional barriers included lack of a standardized response to IPV disclosure, need for individualized screening protocols for different patient care settings, lack of standardized provider training, concerns about overextending social work resources, and lack of resources for hospital staff experiencing vicarious trauma. Individual barriers included concern that screening may harm physician-patient-family relationships and the perception that physicians are unwilling to address psychosocial issues. CONCLUSIONS The Delphi Instrument for Hospital-based Domestic Violence Programs identified weaknesses and key areas for improvement in IPV practices. Deficiencies revealed by the Delphi instrument were affirmed by individual interview results. Institutional and individual provider level barriers must be addressed to optimize IPV practices in a pediatric hospital system.

A 19-month-old boy with recurrent respiratory distress.

We present a 19-month-old boy with a history of asthma who presented to the pediatric emergency department with noisy breathing and tachypnea partially responsive to albuterol. He was discharged to routine care at home. His parents brought him back the next day for persistent respiratory distress despite routine home albuterol. A check of electrolytes showed a low bicarbonate level.