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.

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.

Supporting Practices to Adopt Registry-Based Care (SPARC): protocol for a randomized controlled trial.

BACKGROUND: Diabetes is predicted to increase in incidence by 42% from 1995 to 2025. Although most adults with diabetes seek care from primary care practices, adherence to treatment guidelines in these settings is not optimal. Many practices lack the infrastructure to monitor patient adherence to recommended treatment and are slow to implement changes critical for effective management of patients with chronic conditions. Supporting Practices to Adopt Registry-Based Care (SPARC) will evaluate effectiveness and sustainability of a low-cost intervention designed to support work process change in primary care practices and enhance focus on population-based care through implementation of a diabetes registry. METHODS: SPARC is a two-armed randomized controlled trial (RCT) of 30 primary care practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN). Participating practices (including control groups) will be introduced to population health concepts and tools for work process redesign and registry adoption at a meeting of practice-level implementation champions. Practices randomized to the intervention will be assigned study peer mentors, receive a list of specific milestones, and have access to a physician informaticist. Peer mentors are clinicians who successfully implemented registries in their practices and will help champions in the intervention practices throughout the implementation process. During the first year, peer mentors will contact intervention practices monthly and visit them quarterly. Control group practices will not receive support or guidance for registry implementation. We will use a mixed-methods explanatory sequential design to guide collection of medical record, participant observation, and semistructured interview data in control and intervention practices at baseline, 12 months, and 24 months. We will use grounded theory and a template-guided approach using the Consolidated Framework for Implementation Research to analyze qualitative data on contextual factors related to registry adoption. We will assess intervention effectiveness by comparing changes in patient-level hemoglobin A1c scores from baseline to year 1 between intervention and control practices. DISCUSSION: Findings will enhance our understanding of how to leverage existing practice resources to improve diabetes care in primary care practices by implementing and using a registry. SPARC has the potential to validate the effectiveness of low-cost implementation strategies that target practice change in primary care. TRIAL REGISTRATION: NCT02318108.