Advertisement

Expert Perspectives on Intimate Partner Violence Power and Control in Pediatric Healthcare Settings

Published:February 22, 2020DOI:https://doi.org/10.1016/j.acap.2020.02.021

      Abstract

      Objective

      Childhood exposure to intimate partner violence (IPV) is a pervasive public health epidemic with profound impact on child health. While past work has demonstrated how abusive partners exert control over IPV survivors in a variety of settings (eg workplace, courts, home), scant research has examined how IPV power and control behaviors manifest themselves in pediatric healthcare settings. In this study, we explore the perspectives of pediatric IPV experts about: (1) behaviors used by abusive partners to control IPV survivors in pediatric healthcare settings; (2) how controlling behaviors impact healthcare access and quality; and (3) recommendations for the pediatric healthcare team.

      Methods

      Individual semi-structured interviews were conducted with pediatric IPV experts recruited through snowball sampling. Interviews were individually coded by two research team members and analyzed using thematic analysis.

      Results

      Twenty-eight pediatric IPV experts participated. Participants described several types of controlling behaviors including limiting healthcare access, dominating conversations during medical visits, controlling medical decision making, and manipulating perceptions of the healthcare team. Participants acknowledged the challenges of recognizing controlling behaviors and provided several recommendations to addressing behaviors such as leveraging the expertise of multidisciplinary teams.

      Conclusions

      Participants described how abusive partners may attempt to control or discredit their partners in pediatric healthcare settings, using subtle behaviors that may be easily missed by the healthcare team. These results set the stage for further research and clinical practice innovation including triangulating the findings with IPV survivors, examining how frequently these behaviors occur, and developing multidisciplinary IPV training for the pediatric healthcare team.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hamby SL
        • Finkelhor D
        • Turner H
        • Ormrod R
        Children's Exposure to Intimate Partner Violence and Other Family Violence.
        Juvenile Justice Bulletin. Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice, 2011
        • Holt S
        • Buckley H
        • Whelan S
        The impact of exposure to domestic violence on children and young people: a review of the literature.
        Child Abuse Negl. 2008; 32: 797-810
        • Bair-Merritt MH
        • Blackstone M
        • Feudtner C
        Physical health outcomes of childhood exposure to intimate partner violence: a systematic review.
        Pediatrics. 2006; 117: e278-e290
        • Gilbert AL
        • Bauer NS
        • Carroll AE
        • Downs SM
        Child exposure to parental violence and pscyhological distress associated with delayed milestones.
        Pediatrics. 2013; 132: e1577-e1583
        • Miller E
        • Breslau J
        • Chung WJ
        • et al.
        Adverse childhood experiences and risk of physical violence in adolescent dating relationships.
        J Epidemiol Comm Health. 2011 Nov; 65: 1006-1013
        • Thackeray JD
        • Hibbard R
        • Dowd MD
        • et al.
        Intimate partner violence: the role of the pediatrician.
        Pediatrics. May 2010; 125: 1094-1100
        • Randell KA
        • Ragavan MI
        Intimate partner violence: identification and response in pediatric health care settings.
        Clin Pediatr. 2020; 59: 109-115
        • Miller E
        • McCaw B
        Intimate partner violence.
        N Engl J Med. 2019; 280: 850-857
        • Myhill A
        • Hohl K
        The “Golden Thread”: Coercive control and risk assessment for domestic violence.
        J Interpers Violence. 2019; 34: 4477-4497
        • Beck CJ
        • Raghavan C
        Intimate partner abuse screening in custody mediation: the importance of assessing coercive control.
        Fam Court Rev. 2010; 48: 555-565
      1. Domestic Abuse Intervention Program. Understanding the Power and Control Wheel. Available at: https://www.theduluthmodel.org/wheels/. Accessed November 18, 2019.

        • Hayes BE
        Abusive men's indirect control of their partner during the process of separation.
        J Fam Violence. 2012; 4: 333-344
        • Swanberg JE
        • Logan TK
        • Macke C
        Intimate partner violence, employment, and the workplace: consequences and future directions.
        Trauma Violence Abuse. 2005; 6: 286-312
        • Douglas H
        Legal systems abuse and coercive control.
        Criminol Crim Justice. 2018; 18: 84-99
        • Beeble ML
        • Bybee D
        • Sullivan CM
        Abusive men's use of children to control their partners and ex-partners.
        Euro Psychol. 2007; 12: 54-61
        • McCloskey LA
        • Williams CM
        • Lichter E
        • et al.
        Abuse women disclose partner interference with health care: an unrecognized form of battering.
        JGIM. 2007; 22: 1067-1072
        • Loxton D
        • Powers J
        • Schofield M
        • et al.
        Inadequate cervical cancer screening among mid-aged Australian women who have experienced partner violence.
        Prev Med. 2009; 48: 184-188
        • Bair-Merritt MH
        • Crowne DD
        • Burrell L
        • et al.
        Impact of intimate partner violence on children's well-child care and medical home.
        Pediatrics. 2008; 121: 473-480
        • Bogner A
        • Littig B
        • Menz W
        Interviewing Experts.
        Palgrave Macmillan, New York, NY2009
        • Patton MQ
        Qualitative Research and Evaluation Methods.
        4th ed. Sage, Thousand Oaks, CA2015
        • Dedoose 7.5.16
        Web Application for Managing, Analyzing, and Presenting Qualitative and Mixed Methods Research.
        SocioCultural Research Consultants LLC, Los Angeles, Calif2016
        • Braun V
        • Clarke V
        Using thematic analysis in psychology.
        Qual Res Psychol. 2006; 3: 77-101
        • Guest G
        • Bunce A
        • Johnson L
        How many interviews are enough? An experiment with data saturation and variability.
        Field Methods. 2006; 18: 59-82
        • Abdus S
        • Selden TM
        Adherence with recommended well-child visits has grown, but large gaps persist among various socioeconomic groups.
        Health Aff. 2013; 32
        • Coker TR
        • Chung PJ
        • Cowgill BO
        • et al.
        Low-income parents’ views on the redesign of well-child care.
        Pediatrics. 2015; 124: 194-204
        • Cruz M
        • Cruz PB
        • Weirich C
        • et al.
        Referral patterns and service utilization in a pediatric hospital-wide intimate partner violence program.
        Child Abuse Negl. 2013; 37: 511-519
        • Litzau M
        • Dowd MD
        • Miller MK
        • et al.
        Universal intimate partner violence in the pediatric emergency department and urgent care setting: a retrospective review.
        Pediatr Emerg Care. 2019; (In press)
        • Randell KA
        • Sherman AK
        • Walsh I
        • et al.
        Intimate partner violence educational materials in the acute care setting: acceptability and impact on female caregiver attitudes toward screening.
        Pediatr Emerg Care. 2018; (In press)
        • Substance Abuse and Mental Health Services Administration
        Trauma-Informed Care in Behavioral Health Services.
        Substance Abuse and Mental Health Services Administration, Rockville, MD2014 (Treatment Improvement Protocol (TIP) Series 57. HHS Publication No.(SMA) 13-4801)
        • Marsac ML
        • Kassam-Adams N
        • Hildenbrand AK
        • et al.
        Implementing a trauma-informed approach in pediatric health care networks.
        JAMA Pediatr. 2016; 170: 70-77
        • Raphael JL
        • Zhang Y
        • Liu H
        • Giardino AP
        Parenting stress in US families: Implications for paediatric healthcare utilization.
        Child Care Health Dev. 2009; 36: 216-224
        • Kuo DZ
        • Cohen E
        • Agrawal R
        • et al.
        A national profile of caregiver challenges among more medically complex children with special health care needs.
        Arch Pediatr Adolesc Med. 2011; 165: 1020-1026
        • Ragavan M
        • Thomas K
        • Fulambarker A
        • et al.
        Exploring the needs and lived experiences of racial/ethnic minority domestic violence survivors through community-based participatory research: a systematic review.
        Trauma Violence Abuse. 2018; (In press)
        • Eraz E
        • Adelman M
        • Gregory C
        Intersections of immigration and domestic violence: voices of battered immigrant women.
        Feminist Criminol. 2009; 4: 32-56
        • Ragavan M
        • Bruce J
        • Bair-Merritt M
        • et al.
        Building a novel health curriculum for survivors of intimate partner violence residing at a transitional housing program.
        Violence Against Women. 2018; (In press)