Positive Engagement with Pets Buffers the Impact of Intimate Partner Violence on Callous-Unemotional Traits in Children.

Childhood exposure to intimate partner violence (IPV) is associated with serious psychological outcomes including increased odds of developing callous-unemotional (CU) traits and behaviors. Recent studies suggest that concomitant exposure to animal cruelty (AC) may increase this risk. However, even under these circumstances, bonds with companion animals may still be a protective factor that buffers the deleterious impact of IPV on child adjustment. This cross-sectional study evaluates whether, and to what extent, the association between exposure to IPV and children's CU and empathic-prosocial (EP) traits vary as a function of children's positive engagement with pets and exposure to AC. Participants included 204 children (aged 7-12 years; 57% Latinx) and their maternal caregiver who were recruited from domestic violence agencies in a western US state. We conducted multiple moderation analyses to evaluate each outcome individually (i.e., CU traits, EP traits), adjusting for the effects of child age, gender, and Hispanic ethnicity. Positive engagement with pets significantly moderated the relationship between IPV and CU traits, ∇R = 0.03, F (1, 195) = 7.43, ß = -0.17, t(195) = -2.73, p = .007. Specifically, when high levels of positive engagement with pets is present, IPV is negatively associated with CU traits, whereas the reverse was true at low levels of positive engagement with pets. Evidence of moderation by AC was not supported. Our findings suggest that children who form close relationships with their pets in the context of IPV appear to derive important support from these animals; safeguarding the well-being of these animals may be critical to their long-term emotional health.

Large-Scale Asynchronous Online Interprofessional Learning Experience.

AIMS: As interprofessional education (IPE) grows, more health professions programs have begun promoting it in their accreditation standards. A frequent challenge of large universities is how to include the large set of diverse students in their foundational offerings. A potential way would be to implement an online IPE asynchronous experience with an optional synchronous discussion. The purpose of this study was to: 1) describe implementation of that approach at a large multi-campus university; 2) explore the associations between IPE activities and students' reported level of usefulness; and 3) provide recommendations for online IPE experiences. METHODS: An IPE Module was developed that had 4 sequential online learning activities. After finishing the module, participants completed a self-administered questionnaire that included questions about demographics, retrospective pre and post assessment of key IPE concepts, and rating of the usefulness of the learning based on the module activities. RESULTS: 1,017 participants, representing 8 different health professional programs, completed the survey. The numbers of students were evenly distributed, with dentistry representing the highest number (21%), and most participants were first-year students (71.9%). The learning activities "reading posts/messages of colleagues from other professions" and "watching the video" were reported useful or very useful by 77.4% and 71.4% of participants, respectively. The self-reflection writing activity (67.1%) and the "6-word message" (59.4%) were rated as useful or very useful by over half of participants. DISCUSSION: Most participants reported that the learning activities in the online asynchronous IPE module were useful or very useful in achieving the learning objectives. Thus, an introductory experience based on an online program combining both asynchronous and decentralized optional synchronous instruction might be a viable method of delivering foundational IPE information.

Exposure to intimate partner violence and internalizing symptoms: The moderating effects of positive relationships with pets and animal cruelty exposure.

BACKGROUND: It is estimated that more than half of children living in households where intimate partner violence (IPV) occurs are also exposed to animal cruelty (AC). Although prior research links bonds with pets with higher levels of socioemotional competence among school-age children, exposure to AC may negate the protective effects of pet ownership and/or exacerbate the potentially deleterious effect of IPV on children's mental health. OBJECTIVE: The current study evaluates whether and to what extent the associations between exposure to IPV and several indicators of children's mental health vary as a function of children's positive engagement with pets and exposure to AC. PARTICIPANTS AND SETTING: Participants included 204 children (aged 7-12 years; 47% female; 57% Latinx) and their maternal caregiver who were recruited from domestic violence agencies in a western U.S. state. METHOD: Multiple moderation analysis evaluated whether the association between children's exposure to IPV and internalizing and posttraumatic stress symptoms vary as a function of children's positive engagement with pets and exposure to AC. RESULTS: Analyses revealed several moderation effects for positive engagement with pets (e.g., internalizing problems: [b = -.15, t(195) = -2.66, p = .008]; posttraumatic stress symptoms: [b = -.13, t(195) = -2.24, p = .026]), whereas exposure to AC only moderated the association between IPV and anxious/depressed symptoms (b = .32, t(195) = -2.41, p = .017). CONCLUSIONS: These findings highlight the potential protective effects of positive engagement with pets and importance of screening for exposure to AC when engaging in trauma-informed work with children exposed to IPV.

Preparing Pharmacists for Collaborative/Integrated Health Settings.

Pharmacy practice is changing to accommodate the need for pharmacists to be better team members in newly emerging collaborative care and integrated health systems. Pharmacy schools could lead this change by educating students to be effective participants in these relatively new models of care. Schools are encouraged to follow the approach outlined in the recent guidance published by the Health Professions Accreditors Collaborative (HPAC) for interprofessional practice and education ("the new IPE"). This approach includes articulating an IPE plan, establishing goals, assessing student achievement of the necessary IPE competencies, developing educational plans that are multi-faceted and longitudinal, and modifying the existing assessment/evaluation process to ensure the quality of the IPE effort. These curricular decisions should be based on existing and new research on the effectiveness of IPE on student's attitudes, knowledge, skills, and behavior. A key decision is how to create effective interactions between pharmacy students and those of other professions. Educational emphasis should be directed toward team building skills, not just individual competencies. The pharmacy faculty probably need to enhance their teaching abilities to accommodate this change, such as learning new technology (e.g., simulations, managing online exchanges) and demonstrating a willingness to teach students from other professions.

Intimate Partner Violence Survivors' Reports of Their Children's Exposure to Companion Animal Maltreatment: A Qualitative Study.

Children living in households where intimate partner violence (IPV) is present are at increased risk of being exposed to concomitant maltreatment of companion animals. Recent research suggests that childhood exposure to maltreatment of companion animals is associated with compromised socioemotional well-being in childhood and adulthood. To date, there is a dearth of qualitative research examining how children experience animal maltreatment in the context of IPV. The current qualitative study explored the following research question in an ethnically diverse sample of IPV survivors: How do maternal caregivers convey the ways in which their children experience animal maltreatment in IPV-affected households? Sixty-five women with at least one child (age 7-12 years) were recruited from domestic violence agencies and described their child(ren)'s experiences of animal maltreatment in the home. Template analysis was used to analyze interview data (KALPHA = .90). Three themes emerged related to children's experiences of animal maltreatment: (a) direct exposure to animal maltreatment and related threats, (b) emotional and behavioral responses to animal maltreatment exposure, and (c) animal maltreatment as coercive control of the child. Results suggest that children's exposure to animal maltreatment is multifaceted and may exacerbate children's risk of negative psychosocial outcomes in the context of co-occurring IPV. Intervention programs designed to assist children exposed to IPV should consider the extent of children's awareness of the abuse of their pets and their strong and deleterious reactions to it.

Exploring Empathy and Callous-Unemotional Traits as Predictors of Animal Abuse Perpetrated by Children Exposed to Intimate Partner Violence.

We explored the relation between empathy, callous-unemotional (CU) traits, and animal abuse in a sample of 290 seven- to twelve-year-old children whose mothers were exposed to intimate partner violence (IPV). The sample comprises mostly Latino and White participants, and 55% of the children's mothers were born outside the United States (primarily Mexico). To our knowledge, among studies examining child-perpetrated animal abuse, this study is the first to examine empathy levels and one of only a few to examine CU traits. When comparing Griffith Empathy Measure (empathy) and Inventory of Callous-Unemotional Traits (callous-unemotional [CU] traits) scores with those from studies of White schoolchildren, our sample scored lower on affective empathy, higher on cognitive empathy, and lower for overall CU scores as well as Callous and Unemotional subscales. Of 290 children, 47 (16.2%) harmed an animal at least once according to either mother or child report. There were no significant sex or age differences between Abuse and No Abuse groups. The Abuse group scored significantly higher on affective empathy, CU, and Callousness/Unemotional subscales, and significantly lower on cognitive empathy. However, in regression analyses that controlled for income, only lower cognitive empathy and higher CU significantly predicted having abused an animal. In summary, low cognitive empathy (but not affective empathy) and CU traits may serve as reliable predictors of child animal abuse. However, replication of these results is necessary. A larger sample with a high percentage of Latino children whose mothers were exposed to IPV, along with a non-exposed comparison group, would be ideal.

The relations among animal abuse, psychological disorders, and crime: Implications for forensic assessment.

The confluence of developments in the assessment of animal abuse, the evolution of psychiatric nosology for the diagnosis of conduct disorder, legislative changes involving crimes against non-human animals, and the recent inclusion of crimes against animals in the FBI's National Incident-Based Reporting System, highlights the critical need for examining the forensic dimensions of animal abuse cases. We provide an overview of the research literature on these topics in the hope that forensic evaluators will have an evidence-based framework for assessing cases they encounter that include perpetration of violence against animals.

Flogging tired horses: Who wants whipping and who would walk away if whipping horses were withheld?

Recent studies have cast doubt on the effectiveness of whipping horses during races and this has led to questions concerning its continuing justification. Furthermore, it has been argued that whipping tired horses in racing is the most televised form of violence to animals. The present study used de-identified data from a recent independent Australian poll (n = 1,533) to characterise the 26% of respondents (113 females and 271 males) who support the whipping of racehorses and the 10% of racing enthusiasts in the sample (44 females and 63 males) who would stop watching races and betting on them if whipping were banned. Logistic regression models examining associations between age, gender, and income level of respondents demonstrated that those who support racehorse whipping are significantly more likely to be male. Among racing enthusiasts who would stop watching races and betting on them if whipping were banned, those in the lowest income bracket were over-represented. The more frequently respondents attended races or gambled on them, the more likely they were to agree that horses should be hit with a whip during the normal course of a race. These findings align with previous studies of violence among men and women but may also be attributed to male support of traditional gambling practices. Globally, racing organisations may consider the findings of the present study helpful in their deliberations on the merits of continuing the practice of whipping tired horses in the name of sport. The study might also provide important data for stakeholders who demand that it continues.

A Template Analysis of Intimate Partner Violence Survivors' Experiences of Animal Maltreatment: Implications for Safety Planning and Intervention.

This study explores the intersection of intimate partner violence (IPV) and animal cruelty in an ethnically diverse sample of 103 pet-owning IPV survivors recruited from community-based domestic violence programs. Template analysis revealed five themes: (a) Animal Maltreatment by Partner as a Tactic of Coercive Power and Control, (b) Animal Maltreatment by Partner as Discipline or Punishment of Pet, (c) Animal Maltreatment by Children, (d) Emotional and Psychological Impact of Animal Maltreatment Exposure, and (e) Pets as an Obstacle to Effective Safety Planning. Results demonstrate the potential impact of animal maltreatment exposure on women and child IPV survivors' health and safety.

Intimate Partner Violence and Animal Abuse in an Immigrant-Rich Sample of Mother-Child Dyads Recruited From Domestic Violence Programs.

We examined rates of animal abuse in pet-owning families experiencing intimate partner violence (IPV). We also examined whether higher levels of IPV (as measured by subscales from the Conflict Tactics Scales) predicted increased risk for partner-perpetrated animal abuse. Our sample included 291 mother-child dyads, where the mothers sought services from domestic violence agencies. Nearly half the sample is comprised of Mexican immigrants. Mothers reported that 11.7% of partners threatened to harm a pet and 26.1% actually harmed a pet, the latter of which represents a lower rate than in similar studies. When examining animal abuse by "Hispanic status," follow-up analyses revealed significant omnibus differences between groups, in that non-Hispanic U.S.-born partners (mostly White) displayed higher rates of harming pets (41%) than either U.S.-born or Mexican-born Hispanic groups (27% and 12.5%, respectively). Differences in rates for only threatening (but not harming) pets were not significant, possibly due to a small number of partners ( n = 32) in this group. When examining whether partners' IPV predicted only threatening to harm pets, no IPV subscale variables (Physical Assault, Psychological Aggression, Injury, or Sexual Coercion) were significant after controlling for income, education, and Hispanic status. When examining actual harm to pets, more Psychological Aggression and less Physical Assault significantly predicted slightly higher risk of harm. However, Mexican-born partners had nearly 4 times lower risk of harming a pet. Overall, these results suggest that Hispanic men who are perpetrators of IPV are less likely to harm pets than non-Hispanic perpetrators of IPV, particularly if Mexican-born. Considering that the United States has a significant proportion of Mexican immigrants, it may be worthwhile to explore the topics of IPV and animal abuse within this group.

Concomitant Exposure to Animal Maltreatment and Socioemotional Adjustment among Children Exposed to Intimate Partner Violence: a Mixed Methods Study.

This study uses a mixed-methods approach to examine how patterns of exposure to animal maltreatment (AM) are related to socioemotional adjustment among children (N = 291) recruited from intimate partner violence (IPV) services. First, latent profile analysis (LPA) was used to identify subgroups of children with similar patterns of socioemotional functioning. Next, qualitative data from mothers and children were analyzed to identify thematic patterns in AM exposure among two subgroups of children identified through the LPA: Asymptomatic children and children with Emotional and Behavioral Difficulties (EBD). Seven themes were identified. Overall, EBD children, when compared to Asymptomatic children, were more likely to: a) have been exposed to severe forms of violence against animals, b) have experienced direct victimization by an IPV perpetrator following an effort to protect a pet, and c) express justification and normalization of violence against pets. Implications of our findings for research and clinical practice are discussed.

Evaluation of the Parent-Report Inventory of Callous-Unemotional Traits in a Sample of Children Recruited from Intimate Partner Violence Services: A Multidimensional Rasch Analysis.

OBJECTIVE: Our study applied multidimensional item response theory (MIRT) to compare structural models of the parent-report version of the Inventory of Callous and Unemotional Traits (ICU; English and North American Spanish translations). METHOD: A total of 291 maternal caregivers were recruited from community-based domestic violence services and reported on their children (77.9% ethnic minority; 47% female), who ranged in age from 7 to 12 years (mean = 9.07, standard deviation = 1.64). We compared 9 models that were based on prior psychometric evaluations of the ICU. RESULTS: MIRT analyses indicated that a revised 18-item version comprising 2 factors (callous-unemotional and empathic-prosocial) was more suitable for our sample. Differential item functioning was found for several items across ethnic and language groups, but not for child gender or age. Evidence of construct validity was found. CONCLUSION: We recommend continued research and revisions to the ICU to better assess the presence of callous-unemotional traits in community samples of school-age children.

The role of callous/unemotional traits in mediating the association between animal abuse exposure and behavior problems among children exposed to intimate partner violence.

Children exposed to intimate partner violence are at increased risk for concomitant exposure to maltreatment of companion animals. There is emerging evidence that childhood exposure to maltreatment of companion animals is associated with psychopathology in childhood and adulthood. However, few studies have explored developmental factors that might help to explain pathways from animal maltreatment exposure to children's maladjustment. The present study addresses this gap in the literature by examining relations between children's exposure to animal maltreatment, callous/unemotional traits (i.e., callousness, uncaring traits, and unemotional traits), and externalizing and internalizing behavior problems. A sample of 291 ethnically diverse children (55% Latino or Hispanic) between the ages of 7 and 12 was recruited from community-based domestic violence services. A meditational path model indicated that child exposure to animal maltreatment was associated with callousness (ß=0.14), which in turn was associated with greater internalizing (ß=0.32) and externalizing problems (ß=0.47). The effect of animal maltreatment exposure on externalizing problems was mediated through callousness. Results suggest that callous/unemotional traits are a potential mechanism through which childhood exposure to animal maltreatment influences subsequent behavior problems. Future research is needed to evaluate the extent to which exposure to animal maltreatment affects children's adjustment over time in the context of other co-occurring adverse childhood experiences.

Children exposed to intimate partner violence: Identifying differential effects of family environment on children's trauma and psychopathology symptoms through regression mixture models.

The majority of analytic approaches aimed at understanding the influence of environmental context on children's socioemotional adjustment assume comparable effects of contextual risk and protective factors for all children. Using self-reported data from 289 maternal caregiver-child dyads, we examined the degree to which there are differential effects of severity of intimate partner violence (IPV) exposure, yearly household income, and number of children in the family on posttraumatic stress symptoms (PTS) and psychopathology symptoms (i.e., internalizing and externalizing problems) among school-age children between the ages of 7-12 years. A regression mixture model identified three latent classes that were primarily distinguished by differential effects of IPV exposure severity on PTS and psychopathology symptoms: (1) asymptomatic with low sensitivity to environmental factors (66% of children), (2) maladjusted with moderate sensitivity (24%), and (3) highly maladjusted with high sensitivity (10%). Children with mothers who had higher levels of education were more likely to be in the maladjusted with moderate sensitivity group than the asymptomatic with low sensitivity group. Latino children were less likely to be in both maladjusted groups compared to the asymptomatic group. Overall, the findings suggest differential effects of family environmental factors on PTS and psychopathology symptoms among children exposed to IPV. Implications for research and practice are discussed.

Children's experiences of companion animal maltreatment in households characterized by intimate partner violence.

Cruelty toward companion animals is a well-documented, coercive tactic used by abusive partners to intimidate and control their intimate partners. Experiences of co-occurring violence are common for children living in families with intimate partner violence (IPV) and surveys show that more than half are also exposed to abuse of their pets. Given children's relationships with their pets, witnessing such abuse may be traumatic for them. Yet little is known about the prevalence and significance of this issue for children. The present study examines the experiences of children in families with co-occurring pet abuse and IPV. Using qualitative methods, 58 children ages 7-12 who were exposed to IPV were asked to describe their experiences of threats to and harm of their companion animals. Following the interviews, template analysis was employed to systematically develop codes and themes. Coding reliability was assessed using Randolph's free-marginal multirater kappa (kfree=.90). Five themes emerged from the qualitative data, the most common being children's exposure to pet abuse as a power and control tactic against their mother in the context of IPV. Other themes were animal maltreatment to discipline or punish the pet, animal cruelty by a sibling, children intervening to prevent pet abuse, and children intervening to protect the pet during a violent episode. Results indicate that children's experiences of pet abuse are multifaceted, potentially traumatic, and may involve multiple family members with diverse motives.

Use of antihypertensive medications and diagnostic tests among privately insured adolescents and young adults with primary versus secondary hypertension.

PURPOSE: To compare the use of antihypertensive medications and diagnostic tests among adolescents and young adults with primary versus secondary hypertension. METHODS: We conducted retrospective cohort analysis of claims data for adolescents and young adults (12-21 years of age) with ≥3 years of insurance coverage (≥11 months/year) in a large private managed care plan during 2003-2009 with diagnosis of primary hypertension or secondary hypertension. We examined their use of antihypertensive medications and identified demographic characteristics and the presence of obesity-related comorbidities. For the subset receiving antihypertensive medications, we examined their diagnostic test use (echocardiograms, renal ultrasounds, and electrocardiograms). RESULTS: The study sample included 1,232 adolescents and young adults; 84% had primary hypertension and 16% had secondary hypertension. The overall prevalence rate of hypertension was 2.6%. One quarter (28%) with primary hypertension had one or more antihypertensive medications, whereas 65% with secondary hypertension had one or more antihypertensive medications. Leading prescribers of antihypertensives for subjects with primary hypertension were primary care physicians (80%), whereas antihypertensive medications were equally prescribed by primary care physicians (43%) and sub-specialists (37%) for subjects with secondary hypertension. CONCLUSIONS: The predominant hypertension diagnosis among adolescents and young adults is primary hypertension. Antihypertensive medication use was higher among those with secondary hypertension compared with those with primary hypertension. Further study is needed to determine treatment effectiveness and patient outcomes associated with differential treatment patterns used for adolescents and young adults with primary versus secondary hypertension.

Underlying Rationale and Approach to Treat Hypertension in Adolescents by Physicians of Different Specialty.

OBJECTIVE: To describe the underlying clinical decision-making rationale among general pediatricians, family physicians, pediatric cardiologists and pediatric nephrologists in their approach to an adolescent with hypertension. METHODS: We conducted semi-structured phone interviews with a convenience sample of physicians from the above-mentioned 4 specialties. Each participant was asked to "think aloud" regarding their approach to a hypothetical patient - 12 year old boy with persistent hypertension for 6 months. Standardized open-ended questions about potential factors that could affect physicians' diagnosis and treatment strategies (e.g., patient age) were used. Interviews were audio-recorded; transcribed verbatim; transcripts were independently coded by 2 investigators; emergent themes identified and inter-coder agreement achieved. Thematic analysis was performed based on grounded theory. RESULTS: Nineteen participants included 5 general pediatricians, 5 pediatric cardiologists, 5 pediatric nephrologists and 4 family physicians. Five themes emerged: 1) Accuracy of blood pressure measurement and hypertension diagnosis, 2) Shift in the epidemiology of pediatric hypertension from secondary to primary hypertension, 3) Patient characteristics considered in the decision to initiate workup, 4) Obesity-centered choice of diagnostic tests and lifestyle modifications, and 5) Variable threshold for initiating antihypertensive pharmacotherapy vs. referral to hypertension specialists. CONCLUSIONS: There is variation across primary care and specialty physicians who provide care for children and adolescents with hypertension. Key areas of variability include the willingness to initiate antihypertensive medications, the use of diagnostic tests (e.g., ambulatory blood pressure monitoring), and the perceived need for specialty referral. Further study is needed to assess whether different treatment paradigms result in differential patient outcomes.