Injuries Suggestive of Physical Abuse in Young Children With Subconjunctival Hemorrhages.

OBJECTIVE: The aim of this study was to compare the demographic characteristics, clinical presentations, medical evaluation, and injuries identified in a cohort of children with and without subconjunctival hemorrhage who were evaluated by a child abuse specialist. METHODS: This was a case-control study that used data from the ExSTRA (Examining Siblings to Recognize Abuse) research network. Subjects with a subconjunctival hemorrhage(s) were designated as cases. Four controls matched for age and participating center were included for each case. Descriptive statistics were used to compare cases and controls. RESULTS: Fifty of the 2890 subjects in the parent study had a subconjunctival hemorrhage(s) and were designated as cases. The cases had a median (interquartile range) age of 5.0 months (2.0-23.6 months). Two hundred controls were matched to the cases. There was no difference in the demographics, clinical characteristics, medical evaluation, or rate of occult injuries identified in cases and controls. Almost one-quarter of children with subconjunctival hemorrhages had no other external sign of trauma but had the same rate of occult injuries as children with bruises. CONCLUSIONS: These data suggest that subconjunctival hemorrhages are relatively rare among children undergoing evaluation by a child abuse specialist, but that they are often an indicator of occult injury. Even in the absence of other external signs of trauma, the presence of subconjunctival hemorrhages should prompt an age-appropriate evaluation for physical abuse.

Child Protective Services Reports in the Context of Intimate Partner Violence: A Delphi Process Examining Best Practices.

OBJECTIVES: Child protective services (CPS) reporting for families experiencing intimate partner violence (IPV) is complex. The goal of this study was to develop expert-driven best practices for pediatric providers filing CPS reports in the context of IPV. METHODS: We conducted a Delphi study with experts in IPV and child abuse and neglect (CAN) through 3 rounds of surveys. In Round 1, participants selected clinical scenarios for which they would file, as well as best practices when CPS reporting is indicating. In Round 2, participants described how strongly they agreed that a provider should file for each clinical scenario and how important each best practice was on a 5-point Likert scale. Finally, in Round 3 participants reviewed Round 1 and 2 results, then reported their final determination by selecting yes or no for each option. Consensus was achieved in Round 3 if >80% of participants agreed. In each round, participants could provide further detail via free-text answers. RESULTS: Twenty-three (40%) of the invited experts participated. Consensus was not achieved for children directly witnessing IPV or experiencing health symptoms due to IPV exposure. Participants were in consensus regarding need for CPS reporting when CAN was present and that reporting should not occur for exposure to IPV only. Best practices included supporting IPV survivors, developing healthcare-based IPV advocacy programs, and optimizing the child welfare system. CONCLUSION: This study provides expert-driven recommendations for filing CPS reports in the context of IPV and highlights the inherent complexity of filing and the need for further guidelines.

Women's perspectives on the context of violence and role of police in their intimate partner violence arrest experiences.

Intimate partner violence (IPV) accounts for up to 50% of all calls to police. In an effort to standardize arrest criteria, mandatory arrest laws were established. It is unclear whether subsequent increased rates of female arrest are due to greater recognition of female IPV perpetrators or of women acting in self-defense. This study aims to understand the context and consequences of IPV-related arrest from perspectives of women arrested in a single metropolitan area. Semi-structured qualitative interviews were conducted with women arrested and court-ordered to attend IPV education groups at a women's shelter in the Northeast United States. Interviews addressed circumstances surrounding arrest, experience with past violence, and reasoning regarding use of partner violence. Two researchers independently coded transcripts and met to iteratively refine the code and review transcripts for themes. Eighteen women were interviewed. Major themes that emerged were as follows: (a) Women's use of violence occurred within the context of their own victimization; (b) the arrest included a complex interplay between subject, partner, and police; (c) women perceived police arrest decisions to be based on a limited understanding of context; and (d) women experienced both positive and negative consequences of arrest. Many relationships did not fall under the traditional victim/perpetrator construct. Rather, women's use of violence evolved, influenced by prior experiences with violence. More appropriate methods must be developed for making arrest decisions, guiding justice system responses, and developing interventions for couples experiencing IPV. Recognition that women's use of partner violence often represented either a retaliatory or self-defensive gesture within the context of prior victimization suggests that victims' interventions should not only focus on empowerment but also provide skills and strategies to avoid temptation to adopt aggression as a primary method of self-protection.