Identification and initial response to children’s exposure to intimate partner violence: a qualitative synthesis of the perspectives of children, mothers and professionals

Abstract

ObjectivesTo synthesise evidence on the acceptable identification and initial response to children’s exposure to intimate partner violence (IPV) from the perspectives of providers and recipients of healthcare and social services.DesignWe conducted a thematic synthesis of qualitative research, appraised the included studies with the modified Critical Appraisal Skills Programme checklist and undertook a sensitivity analysis of the studies scored above 15.Data sourcesWe searched eight electronic databases, checked references and citations and contacted authors of the included studies.Eligibility criteriaWe included qualitative studies with children, parents and providers of healthcare or social services about their experiences of identification or initial responses to children’s exposure to IPV. Papers that have not been peer-reviewed were excluded as well as non-English papers.ResultsSearches identified 2039 records; 11 studies met inclusion criteria. Integrated perspectives of 42 children, 212 mothers and 251 professionals showed that sufficient training and support for professionals, good patient-professional relationship and supportive environment for patient/clients need to be in place before enquiry/disclosure of children’s exposure to IPV should occur. Providers and recipients of care favour a phased enquiry about IPV initiated by healthcare professionals, which focuses on ‘safety at home’ and is integrated into the context of the consultation or visit. Participants agreed that an acceptable initial response prioritises child safety and includes emotional support, education about IPV and signposting to IPV services. Participants had conflicting perspectives on what constitutes acceptable engagement with children and management of safety. Sensitivity analysis produced similar results.ConclusionsHealthcare and social service professionals should receive sufficient training and ongoing individual and system-level support to provide acceptable identification of and initial response to children’s exposure to IPV. Ideal identification and responses should use a phased approach to enquiry and the WHO Listen, Inquire about needs and concerns, Validate, Enhance safety and Support principles integrated into a trauma-informed and violence-informed model of care.

Domestic violence and abuse related emergency room visits in Ontario, Canada

“…Health care professionals, specifically in emergency rooms (ERs), are often victims’ first point of contact with the health care system. This is an opportunity for health care professionals to not only treat the current DVA-related medical condition/injury, but also to provide support in mitigating the risk of its recurrence in the future through safety referral, who can provide emotional support, crisis counselling, and information and assistance with urgent moves [ 7 , 8 ]. Quantifying the number and understanding the demographic characteristics of DVA-related visits made to ERs is a crucial step for estimating how much the burden of this public health issue is and where is it more concentrated [ 9 ].…”

Developing Assessments for Child Exposure to Intimate Partner Violence in Switzerland – a Study of Medico-Legal Reports in Clinical Settings

“…The concurrent accounts by parents, as recorded by the nurses, suggested an important impact on and involvement of young children during the violent events. This important finding warrants further research on how children in this age group are affected and to inform the better identification and assessment of children's needs as recommended by Lewis et al (2017). However, attention to the differential development impact of exposure to IPV on children and young people of different ages and genders is needed to improve the knowledge base and importantly to inform practice.…”

“…Health services are often a primary point of contact with adult and child victims of IPV and WHO guidelines recommend a 'case finding approach' for adult victims (WHO, 2013) although methods of identification of children's needs in cases of IPV in healthcare remain underdeveloped (Lewis et al, 2017). Clinical legal medicine has a unique role to play in this respect, by taking both legal and healthcare aspects of child protection into account.…”

Protocol for developing core outcome sets for evaluation of psychosocial interventions for children and families with experience or at risk of child maltreatment or domestic abuse

“…Widespread recognition that child maltreatment (CM) and domestic violence and abuse (DVA) are common and have serious and long-term adverse health consequences 1 2 has resulted in policies and programmes to ensure that services respond to and safeguard children (and their families) at high risk of or with experience of CM and/or DVA. [3][4][5][6] However, high-quality evidence about how services can effectively intervene is scant. [7][8][9] The value of the current evidence base is limited partly because of the variety of outcomes and measures used in evaluative studies.…”