Exploring Risk and Factors Shaping Home Visiting Implementation for Families Impacted by Intimate Partner Violence

• In Event: 3-096 - Stress and Trauma in Home Visiting: Predictors of Family Engagement and Maternal-Child Health Outcomes

Integrative Statement

Background: The adverse effects of intimate partner violence (IPV) on the health and well-being of mothers and young children are significant, and co-occurrence of IPV with other adverse exposures, including child abuse, is common. Home visiting programs are uniquely positioned to provide services to families at risk for IPV. Following rapid dissemination of home visiting across the country, it is critical to explore the factors influencing programmatic capacity for identifying and responding to IPV and understanding the relationship of IPV to child-level outcomes among home visited families.

Methods: This study was part of a mixed-methods evaluation of MIECHV programs in Pennsylvania. Quantitative: Entropy-balanced and propensity score matched retrospective cohort analysis comparing children of Nurse-Family Partnership (NFP) and Parents as Teachers (PAT) enrollees with children of Medicaid eligible women from 2008-2014. IPV in the pregnancy and immediate postpartum period (exposure) and abuse-related injuries (outcome) were identified in medical assistance claims with ICD-9 diagnostic codes. Logistic regression odds of child abuse-related injury within 24 months are presented. Qualitative: In-depth interviews were conducted with key stakeholders from 11 MIECHV-funded home visiting programs across Pennsylvania selected to provide a representative sample. Transcribed interviews were entered into NVivo 10 for analysis. We used a modified grounded theory approach to explore with a priori coding related to how abuse impacts program efficacy and engagement. All data related to this aim was captured and subjected to a thematic analysis through a process of coding, memoing, and group discussion.

Findings: The entropy balanced NFP cohort included 8,736 clients enrolled in 22 NFP programs between 2008-2014 matched to 165,033 comparisons. The propensity score matched PAT cohort included 851 clients enrolled in nine PAT programs matched to 2,929 comparisons. The odds of a healthcare encounter for a child abuse-related injury among clients with IPV were significantly greater than clients without IPV (NFP: 2.31, 95% CI: 1.09, 4.85, p=0.027); PAT: 10.61, 95% CI: 1.32, 85.55, p=0.027). In total, 74 staff and 76 clients participated in interviews. They noted the importance of program-initiated discussion of IPV that attends to client safety and trust. Responses to identified IPV ranged from safety planning, to connecting with community resources, to calling the police. Clients also described other supports the program provided that addressed IPV-related difficulties related to resource navigation. Interviewees described IPV interfering with program engagement ranging from the need to meet outside of the home to dropping out of the program. IPV impacted home visitor engagement through emotional distress and concerns for personal safety.

Conclusions: Families experiencing IPV represent a high-risk subgroup of home visiting clientele with increased risk for adverse child outcomes. Home visitation services are at the frontline of identification and responding to IPV. Ensuring staff training that supports the client and promotes home visitor safety and comfort is essential. Home visitation services must coordinate with community supports, including shelters and low-cost housing, to meet the needs and increasing the safety of families experiencing IPV.

Authors

• Katherine Kellom, Children’s Hospital of Philadelphia
  Presenting Author

• Peter Cronholm, University of Pennsylvania
  Non-Presenting Author

• Heather Griffis, Children’s Hospital of Philadelphia
  Non-Presenting Author

• Jennifer Faerber, Children’s Hospital of Philadelphia
  Non-Presenting Author

• Meredith Matone, Children’s Hospital of Philadelphia
  Non-Presenting Author