Children’s Exposure to Intimate Partner Violence among DCF Referred Families: Results - PowerPoint Presentation

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Children’s Exposure to Intimate Partner Violence among DCF Referred Families: Results from a Comprehensive Chart Review

CT Injury Prevention Center

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Chart Review

Study Aim 1.To examine the scope of IPV exposure among DCF referred familiesStudy Aim 2.

To examine associations between IPV characteristics and (a) co-occurring maltreatment, (b) familial characteristics, and

(c)

new reports of abuse/neglect

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Methods

Selected reports/allegations referred to as

index reports/allegations

Selections discarded if (a) repeat case, (b) sealed case, or (c) institutional allegation

Data extracted from entire history of case

–

all reports prior to ‘index report’ and 12 months following ‘index report’

Data extractors reviewed electronic and paper records, spending ~4 hours per case

Note – while the term ‘intimate partner violence (IPV) is used here, data are inclusive of incidents between cohabitating individuals who were not intimate partnersOffline, information collected was reviewed and coded for Maltreatment Severity (0-4) based on a standardized coding protocol

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Family Characteristics

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Child Demographics

141 children named victim as part of index report (238 across full case history)

0 to 17

y.o

. children (

M

= 7.2

yrs

; half < 6 y.o.)46.8% FemaleRace/ethnicity differences across regions, but consistent with full population referred to DCF during study time periodHartford: Non-Hispanic White (14%), Non-Hispanic Black (44%), Hispanic/Latino (32%), Other (10%)Willimantic: Non-Hispanic White (81%), Non-Hispanic Black (1%), Hispanic/Latino (12%), Other 6%)24% cases had children removed from the home at one point during case history

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Caregiver/Family Demographics

Mother age at index from 18 to 52 (Ave ~32)

Father age

at index from 14 to 62 (Ave ~35)

# children in home from 1 to 8 (Ave ~2)Employment: 47% mothers, 54% fathersMarital status ~30%DCF contact as minor: 32% mothers, 17%

fathers

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Index Reports

Total # allegation types per family

from 1 to 3 (Ave ~1.3; 36% > 1 type)

Allegations Types

(consistent with Child Maltreatment 2015)Physical Neglect (77%)Emotional Neglect (35%)Physical Abuse (14%)Medical Neglect (5%)Emotional Abuse (4%)

Sexual Abuse (3%)

FAR

assignment (34%)

76% of cases had prior reports31% of cases had a new report of abuse/neglect within 12 mo. of the index report, with 19% substantiated 7

Findings & Recommendations

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#1 Improve methods for documentation and extraction of IPV exposure information from charts

26% of index reports had IPV indicated in either CAN code, Safety Assessment, or Risk Assessment

Exhaustive review of narrative and investigation documents revealed IPV in 43%

A protocol for flagging cases with IPV would allow for easier identification, improved continuity of care, and a more accurate estimate of number of families where IPV is presenting risk

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#2 Develop and enhance tools to guide assessment of IPV presence and severity to increase risk assessment accuracy

Child Maltreatment Severity Ratings

Yale-Vermont Adversity in Childhood Scale (Y-VACS; Kaufman &

Hudziak

, 2014)

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#2 Develop and enhance tools to guide assessment of IPV presence and severity to increase risk assessment accuracy

53%

psychological IPV rated moderate to severe

34

%

physical

IPV

rated moderate to severeMore than half of cases with only allegations of neglect had IPV severity rated moderate to severe 11

#2 Develop and enhance tools to guide assessment of IPV presence and severity to increase risk assessment accuracy

IPV Severity is predictive of psychological and physical abuse, neglect, loss, caregiver substance abuse, familial suicide, caregiver criminality, and sexual assault

Psych.

Abuse

Physical Abuse

Sexual Abuse

Neglect

Loss

CG Substance AbuseFamilial SuicideCG CriminalityPsychological IPV.28*.15.17.33*.22*.28*.32*

.35*

Physical

IPV

.28*

.31*

.05

.22*

.24*

.23*

.22*

.41*

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#2 Develop and enhance tools to guide assessment of IPV presence and severity to increase risk assessment accuracy

IPV

presence/severity

was predictive of new reports of abuse/neglect within 12 months of index report

Cases with moderate to severe IPV across case file were 2.5 times more likely to have a new report of abuse/neglect

Subgroups

Based on Adversity Severity: A Latent Profile Analysis

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#2 Develop and enhance tools to guide assessment of IPV presence and severity to increase risk assessment accuracy

Risk assessment scores for index reports were not associated with any measure of IPV (i.e., CAN codes, chart review, IPV exposure severity codes)

R

isk assessment questions may not be sufficiently capturing risk associated with IPV

Given risk conferred by IPV exposure, should it be considered a rule-out for FAR?Currently, data suggests there are more FAR cases than investigated cases with indicators of current IPV (62% vs. 33% as determined by case review)14

#3 Improve use of multiple data sources and valid methods for IPV screening and assessment

Documentation of IPV Screening (74%)

IPV discussed in interviews with

M

other (73%)Father (43%)Child interviews (49%)Both mother and child (43%)All interviews (26%)About a third of child victims had disclosed IPV at one point in case history, and these children had significantly greater severity ratings on psychological and physical abuse

While several sources are utilized and reviewed during intake procedures, questions that address IPV specifically are often limited

Youth receiving public mental health services

(Grasso et al., 2010)

Chart review of DCF foster care cases (Grasso et al., 2009)15

#3 Improve use of multiple data sources and valid methods for IPV screening and assessment

Structured, evidence-based assessments can…

Standardize decision-making and reduce variability

Reduce bias and ensure the right questions are asked

In one study, >50% of questions from a diagnostic interview were neglected when interviewers took an unstructured approachMore efficiently use staff time and effortReplace subjectivity with objective criteria that can increase confidence in decision-making

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#4 Enhance training around IPV and co-occurring forms of maltreatment and continue to support workers’ efforts to screen, assess, consult with IPV specialists, and provide safety planning when appropriate

Utilization of IPV specialists was low, with only 3 cases receiving consultation at the index report; albeit the program was in its early stages

Only 12 cases had a documented IPV safety plan, which is less than half of cases with IPV indicated in index CAN codes and only 28% of cases with evidence of current IPV per case review

It

is essential to continue to educate staff regarding IPV screening and assessment, how information about IPV should be used in risk assessment and decision-making, and what resources are available for families impacted by IPV

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Future Directions

Suggestions?

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