Adolescents and ipv

1. Adolescents and ipv Dawn Stueven Fadden RN, BAN

2. Research by Amar & Gennaro (2005) Dating Violence In College Women • Results included: • 48% (n=412) of respondents had experienced IPV in their history • 39% (n=160) of these experienced multiple types of violence • Multiple types of violence correlated with a higher incidence of physical injuries and higher rates of mental health symptoms • Victims of violence were most likely to confide in friends; confiding in others was far less likely • Barriers to communicating with health care providers may include fear of retaliation, embarrassment, scorn from the provider, and misunderstanding from the staff.

3. Research by Renker (2006) Adolescent Perinatal Violence Assessment • Evaluated reasons why adolescents might be hesitant to report IPV, even when asked • Screened adolescents with a known history of IPV during or just before a recent pregnancy • Results included: • Adolescents have complex reasons for revealing or keeping private their experiences with interpersonal violence • Involved identified categories of power/powerlessness, hope/fear, trust/mistrust, and action/inertia. • Adolescents are simultaneously negotiating the developmental tasks of adolescence and pregnancy while living in a world of violence

4. Research by Samargia, Saewyc, & Elliot (2006) Adolescent Barriers to Mental Health Care • Study sought to identify adolescent-stated barriers to needed mental health care and the demographics that describe such a group • Barriers included: • Structural Barriers • No transportation, no way to pay, no one to come along • Non-structural barriers • Thought the problem would go away, didn’t want others to know, hard to find the time • Demographic data showed that teens from two parent households were more likely to forego needed mental health care • These teens may be more hidden from the social service system, as two parent households are likely to have more economic and human resources

5. Research by Teagle & Brindis (1998) Adolescent Motivators/Barriers to Accessing Prenatal Care • Research compared provider responses to adolescent responses to questions concerning access to prenatal care • Overall, adolescents reported system-related barriers rather than personal barriers, while providers predicted the opposite • 99% of adolescent responders were primarily motivated to access prenatal care due to concerns about the baby’s health • 33% of providers felt that this was the primary concern • The primary answer from providers was the patient’s concern that they weren’t feeling well

6. EBP implications • Providers should continue to screen routinely for IPV, should work to decrease embarrassment for the patient, and decrease the likelihood that a patient will feel scorn or misunderstanding from the provider. • Understanding abused adolescents’ concerns for interacting with health care providers is essential to form a working relationship for health promotion and disease/trauma prevention. • School and community-based interventions can facilitate youth access to mental health services. • Providers need education in order to bridge the communication gap with adolescent patients, and work to develop better service delivery strategies.

7. References • Amar, A.F., & Gennaro, S. (2006). Dating violence in college women: Associated physical injury, healthcare usage, and mental health symptoms. Nursing Research, 54(4), 235-242. • Renker, P.R. (2006). Perinatal violence assessment: teenagers’ rationale for denying violence when asked. Journal of Obstetric, Gynecologic, and Neonatal Nursing,35(1), 56-67. • Samargia, L.A., Saewyc, E.M., & Elliot, B.A. (2006). Foregone mental health care and self-reported access barriers among adolescents. Journal of School Nursing,22(1), 17-24. • Teagle, S.E., & Brindis, C.D. (1998). Perceptions and motivators and barriers to public prenatal care among first-time and follow-up adolescent patients and their providers. Maternal and Child Health Journal,2(1), 15-24.

8. Pregnancy and IPV Myra Berry, RN, BSN

9. Research by Bacchus et. al (2002)Women’s Perceptions and Experiences of Routine Enquiry for Domestic Violence in a Maternity Service • Results include: • 99% (n=718) acceptable to be asked about IPV • 10 reported domestic violence in current pregnancy • 6 reported domestic violence in the last 12 months • Assessing for IPV is acceptable if done professionally. Effectiveness is affected by lack of time, confidentiality, and training. Data collected by semi-structured interviews conducted during the postpartum period and up to 14 months. • Positive feelings include relief and being able to express their feelings, empowerment by discussing the issue, and recognition versus denial to the problem. • Negative feelings include appropriateness of the timing of the interview.

10. Research by Yost et. al. (2005)A Prospective Observational Study of Domestic Violence During Pregnancy • With a survey method, assessing whether there are any associated adverse pregnancy outcomes. • HITS Questionnaire (Hurt her, insulted her, threatened her, or screamed at her). • 6% (n=16,041) responded “yes” to one or more questions. • 0.6% (n=94) declined to answer. • Pregnancy outcomes with those who declined the questionnaire include: premature birth and low birth weight. • Findings of this study of the individuals who declined the participate in the questionnaire are considered to be the most fragile of the groups.

11. Research by Silverman et. al. (2005)Intimate partner violence victimization prior to and during pregnancy among women residing in 26 united states: associations with maternal and neonatal health • Between 2000-2003 data was collected from 118,579 women by information produced by the Centers for Disease Control. • 5.8% reported IPV prior to or during pregnancy. • 4.7% reported abuse prior to pregnancy • 3.7% reported abuse during pregnancy • Demographics of those at highest risk (pre-pregnancy) include <24, Native American, <high school education, little or no prenatal care in first trimester, and those who smoke and use alcohol. • Four common experiences during pregnancy associated with IPV: Preterm labor, vaginal bleeding, severe nausea, vomiting or dehydration, and kidney or UTI

12. Research by Janssen et. al. (2003)Intimate partner violence and adverse pregnancy outcomes: a population-based study • Between 1-1-1999 and 12-31-2000 in British Columbia, 4,750 women were screened for IPV. • 1.2% (n=56) reported abuse • 1.5% (n=69) reported fear • 1.9% (n=88) reported both • Associations between abuse and both antepartum hemorrhage and neonatal death were elevated. • Associations between those abused and intrauterine growth restriction elevated. (According to the study, this was identified for the first time in research).

13. EBP Implications • If questioned appropriately by the provider, it can be a positive experience. If done insensitively, it can do more harm than good. • Certain demographic backgrounds stand at a higher risk of IPV. Recognition of these groups and intervention is needed to improve maternal and neonatal health outcomes. • Screen all women of past and current IPV and to promote provider awareness for implementation of IPV screening. • Further research is needed in order to evaluate the progress of identifying this type of phenomenon