Pediatric-Psychology Partnership: Intimate Partner Violence and
Behavioral Health Concerns
Terri L. Weaver, Ph.D., Patrice L. Pye, Ph.D., Anita Bazile, Ph.D., Heidi M. Sallee, M.D., Sarah Cruce, M.S.,
Jason Herndon, B.A., Kristen Jackson, M.S., Jacquelyn Surrell, B.A., Anna Tierney, M. S.
Saint Louis University
Abstract
Pediatric-Psychology Partnership for Abuse Prevention (PPP-AP) is a 6-year-old funded project that uses
culturally competent psychology trainee-pediatric resident and medical trainee pairs to assess for intimate
partner violence (IPV) and intervene with underserved women presenting with their children for ambulatory
pediatric care. To date, IPV screenings and safety planning have been conducted with 1028 predominantly
African-American, low income female caregivers. Rates of current IPV (past year) were 5.4% while rates of
lifetime IPV were nearly 30%. Female caregivers were grouped based on positive or negative (current or
lifetime) IPV and were asked about their behavioral health concerns for themselves and their children.
Women with a positive history of any IPV reported significantly greater concerns for their children’s
internalizing (sad or anxious mood) and externalizing (anger/fighting) symptoms and greater personal health
concerns in the areas of smoking, eating, financial strain, relationship conflict, discipline and parenting.
Additional revealed that total maternal behavioral health concerns was a mediator of the relationship
between IPV history and children’s behavioral health concerns. Implications for using the pediatric clinic as
a violence prevention center will be discussed.
Intimate Partner Violence (IPV):
Implications for Parenting and Parental Resources
•Reported prevalence rates of current IPV across pediatric settings range from 8.4% to 11% (Newman et al.,
2005; McCloskey et al., 2005). Lifetime prevalence rates reported in prior research conducted in primary
care clinics and other specialties vary from 17% to 37% (Kovac et al., 2003; Parkinson, Adams, & Emerling,
2001; McCauley, Kern, & Kolonder, 1995; McCloskey et al., 2005).
•Research has shown that experiencing IPV can have detrimental effects on the lives of mothers and their
children. Broad effects include negative parenting practices (Morrel, Dubowitz, Kerr, & Black, 2003),
diminished children’s (Kitzmann, Gaylord, Holt and Kenny, 2003)and mother’s emotional and behavioral
health (Campbell and Soeken, 1999) and decreased financial stability (Staggs & Riger, 2005).
•The inter-relationship among IPV, parent and child behavioral health has received scant attention.
•The current study examined rates of lifetime and current IPV and the association of IPV with parent and
child-focused concerns within an urban ambulatory pediatric setting.
Ambulatory Pediatric Site
University Pediatrics is an ambulatory primary care setting training physicians, medical students, interns,
and pediatric residents at Saint Louis University School of Medicine.
•University Pediatrics is located in St. Louis City, a medically underserved community.
•University Pediatrics serves:
-Average of 6000 patients per year
-80% African American
-Generally low SES (80% Medicaid)
-Substantial percentage of single and teenage mothers
-Clinical presentations include poor nutrition, failure to thrive, prematurity, asthma, behavioral and
school-related problems.
Method
• Female caregivers attending sick and well child visits at University Pediatrics (N = 1028) completed
feedback surveys regarding their healthcare visit and were asked about any additional concerns they had for
themselves or their children.
• Female caregivers were screened to assess current and lifetime IPV. All respondents were given resource
cards with safety planning information and community resource phone numbers.
Measures
Responses to "I am concerned about my" (N = 1028)
Demographic Characteristics
•40.4% (n = 61/151) of Caucasian participants reported any IPV compared with
29.5% (n = 258/876) participants of color, X2 (1, 1027) = 7.21, p < .01.
•Women 30 years and older were significantly more likely to report any IPV
(35.6%, 173/486) compared with women 29 years or younger (26.7%, 143/536), Χ2
(1, 1022) =9.07, p < .01.
25.0%
20.0%
•36% (n = 187/523) of identified patients 2 years of age or older had female
caregivers with any IPV compared with 26% (n = 131/503) of patients younger than
2 years of age, Χ2 (1, 1026) = 10.86, p < .01.
Rates of IPV: Lifetime and Current
•5.4% (n = 56/1028) reported current (past year) IPV
•Nearly two-thirds experienced current IPV with boyfriends (n = 34/54)
•One-fifth experienced current IPV with husbands/ex-husbands (n = 11/54)
•28.8% (n = 295/1024) reported lifetime IPV
•Over three fifths experienced lifetime IPV with boyfriends (n = 195/292)
•23% experienced lifetime IPV with husbands/ex-husbands (n = 69/292)
•There was a significant association between current and lifetime IPV
•Of those with current IPV, 58% (n = 32/55) reported lifetime IPV compared
with 27.1% ( n = 263/969) with no lifetime histories, X 2 (1, N = 1024) = 22.96, p
< .001
Rates of IPV: Lifetime and Current
Associations with Child and Parent or Adult-Focused Concerns
*
*
15.0%
*
10.0%
*
0.0%
•42.9% (n = 137/319) of those with any IPV reported at least one child-related
behavioral health concern at the pediatric appointment compared with 26.1% of those
with no current or past IPV (n = 184/706), X2 (1, N = 1025) = 28.34, p < .001.
•45.5% (n = 145/319) of those with any IPV reported at least one maternal concern at
the pediatric appointment compared with 25.2% (n = 178/706), X2 (1, N = 1025) =
40.78, p < .001.
•Women with any IPV reported significantly more concerns for their children’s anger
/fighting and sad/anxious mood (see graph)
•Women with any IPV reported significantly more concerns for their smoking, eating,
financial concerns, relationship conflict, difficulty with discipline and parenting than
women with no IPV (see graph).
Test of Mediation: Maternal Behavioral Concerns Mediates Any IPV
and Child Behavioral Health Concerns
Responses to "I am concerned about my child's" (N = 1028)
20.0%
*
18.0%
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
•Any IPVa predicts Child Behavioral Health concerns: F (4, 1014) = 18.02, p < .001, R2 = 6.6%
•Any IPVa predicts Maternal Behavioral Health Concerns: F (4, 1014) = 14.19, p < .001, R2 = 5.3%
*
Financial Strains IPV
Financial Strains No IPV
Smoking Cigarettes IPV
Smoking Cigarettes No IPV
Parenting Concerns IPV
Parenting Concerns No IPV
Discipline IPV
Discipline No IPV
Relationship Conflict IPV
Relationship Conflict No IPV
Eating Issues IPV
Eating Issues No IPV
5.0%
•Screening Questions:
•Any IPVa and Maternal concerns predicts Child Behavioral Health Concerns (24% variance explained)
•In the past year, have you been hit, slapped, kicked or otherwise hurt by someone? If yes, who
•Any IPV reduced to nonsignificance: t = .87, p > .10.
has hurt you?
•Have you been hit, slapped, kicked ore otherwise hurt by someone ever in your lifetime? If
•Maternal Behavioral Health Concerns predicts Child Behavioral Health Concerns: t = 15.3, p < .001
yes, who has hurt you?
a All regressions run controlling for age
•Query related to behavioral health concerns for children:
•Please check all that apply. I am concerned about my child’s:
of parent, age of child and race
Maternal Behavioral
-Smoking Cigarettes
-Eating Habits
-Weight Issues
-Anger/Fighting
Health Concerns
-Sad/Anxious Mood
-Sleeping Habits
-Academic Difficulties
-Other
•Query related to parent and adult focused concerns:
•Please check all that apply. I am concerned about my:
-Smoking Cigarettes
-Eating Habits
-Financial Strains -Relationship Conflict
Child Behavioral
Any IPV
-Difficulties with Discipline
-Parenting
-Other
Health Concerns
Research and Training funded in part by USPHS 1-D40 HP00051-01, awarded to Weaver (PI) Contact: [email protected]
*
*
Cigarette Smoking IPV
Cigarette Smoking No IPV
Eating Issues IPV
Eating Issues No IPV
Weight Issues IPV
Weight Issues No IPV
Anger/Fighting IPV
Anger/Fighting No IPV
Sad/Anxious IPV
Sad/Anxious No IPV
Sleep IPV
Sleep No IPV
Academic Diff IPV
Academic Diff No IPV
4.0%
2.0%
0.0%
Conclusions and Future Directions
 The pediatric visit presents a window of opportunity for assessing for
current and lifetime IPV and for linking exposure to IPV with other
maternal and child behavioral health issues;
 Given the importance of maternal functioning on children’s health,
pediatricians should assess maternal concerns/safety within the pediatric
visit;
 The pediatric visit may be an appropriate venue for interventions
designed to improve maternal and child health;
 Future research needs to replicate the current findings with standardized
measures in order to explore the ways in which maternal behavioral
health concerns (and IPV) may affect children’s health.