Elsevier

Academic Pediatrics

Volume 20, Issue 6, August 2020, Pages 746-752
Academic Pediatrics

Ideas and Innovations
Seeing the Forest in Family Violence Research: Moving to a Family-Centered Approach

https://doi.org/10.1016/j.acap.2020.01.010Get rights and content

Abstract

Victims of family violence are sorted into fragmented systems that fail to address the family as an integrated unit. Each system provides specialized care to each type of victim (child, older adult, adult, animal) and centers on the expertise of the medical and service providers involved. Similarly, researchers commonly study abuse from the frame of the victim, rather than looking at a broader frame—the family. We propose the following 5 steps to create a research paradigm to holistically address the response, recognition, and prevention of family violence.

  • (1)

    Establish common definitions and data elements for family violence. Definitions and data elements should be useable across medical, social, and legal systems of care. Outcomes should be relevant to patients, family members, and providers.

  • (2)

    Measure the efficacy and cost of the current medical-social-legal system that addresses violence.

  • (3)

    Develop actionable screening recommendations for at-risk household contacts when violence is initially identified.

  • (4)

    Develop and test family-centered interventions, especially those that target modifiable risk factors such as substance use or mental illness.

  • (5)

    Target support and prevention strategies for families at highest risk.

By developing an integrated research model to address family violence, and by using that model to support integrated systems of care, we propose a fundamental paradigm shift to improve the lives of families living with and suffering from violence.

Section snippets

Step 1—Establish Uniform Definitions/Priorities

Developing common definitions and common data elements is an essential first step to create an integrated research system. Even defining the field of family violence requires understanding and articulating common phenomena underlying violence regardless of age or relationship. Such common factors include dependency and power, trust, and the particular trauma that arises from victimization by a family or household member. The process for defining these common data elements, especially key risk

Step 2—Measure the Efficacy, Unintended Consequences, and Costs of the Current System

The current fractured system to address violence comes at a significant financial cost to the public and families. However, neither the system's cost nor efficacy is well known. While the impact and economic efficacy of programs like Nurse Family Partnerships25,26 and orders of protection27 have been evaluated, the impact and costs of many widely-used, resource-intensive interventions such as foster care,28 safety planning, and perpetrator incarceration, have not been evaluated. Neither has the

Step 3—Develop Actionable Screening Recommendations

In child abuse pediatrics, the concept of the sentinel injury has been useful to identify children whose risk of physical abuse is high enough to warrant testing for other abusive injuries (eg, with a skeletal survey).29,30 We believe that family violence should be considered such a sentinel event for other household members. While substantial research has demonstrated that different types of violence are likely to co-occur within a home, these data have not yet led to actionable screening

Step 4—Develop and Test Family-Centered Interventions

Implementation and evaluation of novel interventions to reduce family violence and improve family health and well-being will require integration and coordination of the health care, social service, and criminal justice systems, bearing in mind both intended (eg, safety or recurrent violence), and unintended (eg, change in help-seeking behavior due to fear of losing a child or caregiver) outcomes. High-priority interventions for study include: coordinated community responses; in-home visitation;

Family Justice Centers: A Potential Model

Systems that seek to prevent, identify, and/or intervene on family violence need to be re-organized to serve the entire family. Shifting the focus, once safety has been established, from an individual as client or patient to a family or household takes into account other potential victims, long-term sustainable goals, and unintended consequences of interventions. Family Justice Centers (FJCs), multiagency and multidisciplinary collaboratives initially designed for victims of IPV and their

Step 5—Moving Upstream: Family-Centered Prevention

Just as genomics and proteomics provide a more comprehensive evaluation than single gene studies, we believe that a more comprehensive “sociomic” assessment of a family's social risks and strengths is needed to improve family violence research. These efforts have already begun in several settings that seek to use a predictive analytics framework to identify predictors of physical abuse in children. Putnam-Hornstein and colleagues, in several settings, have shown that publicly available data,

Ethical Considerations Related to Protection of Human Research Subjects

Creating integrated systems of research will require balancing the potentially contradictory interests of several family members, all of whom may be considered vulnerable subjects due to age (children), physiologic factors (such as disability), social factors (exposure to trauma), or legal factors (mandated participation in court-ordered services, or the suspicion of having committed a crime). Traditional methods of informed consent depend on an evaluation of risks and benefits by an autonomous

Conclusion

Rather than addressing different diseases of child, older adult, animal, and IPV, we believe that different professionals are all treating a single disease—family violence—using the different lenses, perspectives, and frames of their own experience. By developing a unified, integrated research paradigm, and by using that research paradigm to support unified, integrated systems of care delivery, we propose to re-frame these research communities, and re-focus our efforts to improve the lives of

Acknowledgments

Financial statement: This publication was made possible in part by funds to Gunjan Tiyyagura from CTSA grant number KL2 TR001862 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NIH. Dr Lindberg's effort was supported by a career development grant from the Eunice Kennedy Shriver National Institute of Child

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    The authors have no conflicts of interest to disclose.

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