Developing a Model System of Care for Children Exposed to Domestic Violence:

1. Developing a Model System of Care for Children Exposed to Domestic Violence: Results of a SWOT Analysis Sally Black, RN, PhD Saint Joseph’s University, Institute for Safe Families BACKGROUND METHODS • Best Practices for ETDV: • A mechanism in place for effective, culturally appropriate screening • Screening • Hear their story • Assess readiness • Develop safety plan • Referral • Individual and Family Counseling • Follow-upcommunication between mental health specialists and primary care provider An estimated 3.3 million children nationwide, are exposed to domestic violence (ETDV) each year (Campbell & Lewandowski, 1997). Children exposed have higher rates of substance abuse, cancer, skeletal fractures, heart, lung, and liver diseases (Felitti, et al, 1998). Younger children are at high risk because they spend more time in the home, have not developed internal cues for safety, have small body frames, and parents are still learning parenting skills. Young children are also more likely to visit pediatrician’s offices. Therefore, pediatricians may offer a promising approach to intervening in childhood ETDV. Twenty-four service providers from fourteen different agencies were interviewed to determine symptoms of ETDV and best practices for intervention. Interviews were conducted using semi-structured interview guidelines, lasted 30-60 minutes and were audio taped. Interviews were transcribed into Microsoft Word, exported into Atlas.ti where data were coded for symptoms, strengths, weaknesses, opportunities, threats, and current best practices. Codes were analyzed for themes and relationships. Data were reported using public health foundations as the core structure. RESULTS Table 1: Symptoms of ETDV by age group • Strengths: • Established system of pediatric care in place • People committed to solving the problem • Credibility of the healthcare system • Weaknesses: • Under appreciation of the problem • Not all providers screen for DV • Cases that evade detection • Obstacles to reporting • Limited resources for perpetrators • Limited time, space, and resources • Limited insurance coverage • Lack of follow-up services • Lack of communication between individual and group service providers • Opportunities • Primary Prevention Opportunities:School based programs, dating violence education, summer camp programs, mentors, positive role models and parenting education can help prevent DV. • Secondary Prevention Opportunities: Universal training for pediatric providers, on-site advocates in the primary care office to field referrals, and home based maternal and child health programs, more hotline staff, on-site advocates in the police departments, and programs for kids who are truant • Tertiary Prevention Opportunities: A family centered approach to crisis intervention, shelter services, child therapy, evidence based treatment programs • Threats • Competing priorities • Behavioral change takes time • Safety risks • System ownership(turfism) • Patriarchal attitudes in society CONCLUSIONS • Best practices in the current system of care were thorough, systematic screening, identification, and referral to developmentally appropriate services. The procedures reported are consistent with RADAR for pediatrics. Recommendations are to develop a strategic plan that provides for the safety, stability, and well-being of children and their families, provides accessible, and culturally appropriate support services, is cost efficient, and includes a quality improvement plan. The system most commonly proposed was a ‘one stop shopping’ model. Pediatric primary care offices offer an ideal venue for detection and intervention of ETDV. PURPOSE The purpose of this study was to develop a comprehensive and collaborative intervention for children with ETDV, using pediatric service providers as an entrée into the guarded family system. A SWOT (strengths, weaknesses, opportunities and threats) analysis was performed to help identify symptoms of ETDV, best practices, obstacles, and strengths of the proposed model. OPERATIONAL DEFINITION Exposure to domestic violence (ETDV) was defined as direct ETDV (includes in utero, intervention by the child, intentional or unintentional injury during the incident, direct observation, hearing without seeing, and joining in the incident) and indirect exposure through consequences (includes where the child sees short-term or long-term changes or hears about the incident through conversation) (Holden, 2003). BIBLIOGRAPHY Campbell, J.C. & Lewandowski, L.A. (1997). Mental and physical health effects of intimate partner violence on women and children. The Psychiatric Clinics of North America, 20 (2), 353-374. Felitti, V.J., Anda, R.F., Nordenberg, D.F., Williamson, D.F., Spitz, A.M., Edwards, V., Koss, M.P., Marks, J.S. (1998). Relationship of childhood sexual abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study Am. J. Prev. Med 14: 248-258. Holden, G. W. (2003). Children exposed to domestic violence and child abuse: Terminology and taxonomy Clin. Child Fam. Psychol Rev 6: 151-160.   “There is a need for services that encompass the family so children do not become symptom bearers for family issues.” This project was funded by Department of Health and Human Services Safe and Bright Futures for Children Initiative (SBFCI)