A Family Centered Approach to Intimate Partner Violence

项目摘要 照料者之间的亲密伴侣暴力是儿童遭受身体虐待的一个重要风险因素。 IPV影响四分之一的美国妇女，几乎一半的IPV发作期间都有孩子。IPV可以 作为“前哨”事件，可为早期发现和二级预防提供机会， 虐待生活在受影响家庭中的儿童。每年约有12万儿童受到身体虐待， 美国，最小的孩子（<3岁），通常无法提供病史，风险最高。 30%至60%的IPV家庭发生儿童身体虐待。我们已经表明，隐匿性或不明显的伤害是 当患有IPV的幼儿接受虐待评估时，通常通过X射线检测到。然而，大多数孩子 与公认的IPV一起生活的人没有得到评估，也许是因为对受虐待儿童和成人的照顾是 分散到不同的，经常相互竞争的护理系统中。以家庭为中心的护理（FCC），一个过程中， 儿童和照顾者的需要一起考虑，可以改善照顾者与儿童的接触。 评估儿童是否遭受身体虐待，并提供与IPV有关的服务。 拟议研究的目的是开发和评估FCC模型，以提高对 对接触IPV的儿童进行身体虐待，并让IPV受害者照顾自己的需要。一是 对当地利益攸关方（包括IPV受害者）和国家领导人进行定性访谈，并将观察 儿童保护服务机构和医疗服务提供者目前对接触IPV的儿童进行评估的过程， 查明这些评价的障碍和促进因素。利用这些数据，我们将使用一个系统的决策- 制定一个FCC模型，以改善对IPV暴露儿童的医疗评估， 加强其使用的执行战略。一个成功的FCC模式可能会将孩子的医疗访问与 根据初步数据，为受虐待的照顾者提供支持，使其与IPV服务联系起来。最后我们 我们将进行一项试点试验，将我们的FCC模式与通常的做法进行比较，以确定其可接受性， 后续研究其疗效的可行性。我们的中心假设是，FCC模型同时 满足儿童和照顾者的需求将改善照顾者的参与，提高对儿童的认识， 滥用，并降低后续IPV的风险。 我还将接受正规培训，以获得社区参与研究的先进技能和知识， 实施科学的实际应用，临床试验的实施和评估，以及开发 独立研究赠款。我的导师都是临床和社区参与研究的专家， 儿科学、家庭暴力和实施科学，具有指导初级教师的丰富经验。在 除了职业发展方面的指导外，他们还将为拟议的研究提供实践指导。 他们将确保我实现我的长期目标，成为一名独立的调查员， 滥用检测，并确定最佳做法，以加强FCC的IPV。

PROJECT SUMMARY Intimate partner violence (IPV) among caregivers is an important risk factor for the physical abuse of children. IPV affects 1 in 4 American women, with children present during almost half of the episodes of IPV. IPV may serve as a “sentinel” event and can provide an opportunity for both early detection and secondary prevention of abuse in a child who lives in an affected household. Physical abuse affects about 120,000 children annually in the US, with the youngest children (<3 years old), who are usually unable to provide a history, at the highest risk. Physical child abuse occurs in 30-60% of homes with IPV. We have shown that occult or inapparent injuries are often detected by x-rays when young children living with IPV undergo evaluation for abuse. Yet, most children who live with recognized IPV are not evaluated, perhaps because the care of abused children and adults is separated into different, often competing care systems. Family-Centered Care (FCC), a process in which the needs of children and caregivers are considered together, may improve caregiver engagement with the evaluation of children for physical abuse and with IPV-related services. The objective of the proposed research is to develop and evaluate an FCC model to improve evaluations for physical abuse of IPV-exposed children and to engage the IPV victim in attending to her own needs. First, we will conduct qualitative interviews of local stakeholders (including victims of IPV) and national leaders and will observe the current process of evaluating IPV-exposed children by child protective services and by medical providers to identify barriers to and facilitators of these evaluations. Using these data, we will use a systematic decision- making process to develop an FCC model to improve the medical evaluation of IPV-exposed children and an implementation strategy to enhance its use. A successful FCC model might link the child’s medical visit with providing an advocate to connect the abused caregiver with IPV services based on preliminary data. Finally, we will conduct a pilot trial in which we will compare our model of FCC with usual care for its acceptability and the feasibility of subsequent studies of its efficacy. Our central hypothesis is that an FCC model that simultaneously addresses the needs of children and caregivers will improve caregiver engagement, improve recognition of child abuse, and reduce the risk of subsequent IPV. I will also pursue formal training to acquire advanced skills and knowledge in community-engaged research, the practical application of implementation science, the conduct and evaluation of clinical trials, and the development of independent research grants. My mentors are experts in clinical and community-engaged research, child abuse pediatrics, familyviolence, and implementation science with extensive experience mentoring junior faculty. In addition to guidance on career development, they will provide hands-on mentorship for the proposed studies. They will ensure that I achieve my long-term goal of becoming an independent investigator who improves child abuse detection and identifies best practices to strengthen FCC for IPV.