Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. e473-e480 (doi:10.1542/peds.2007-1671)
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ARTICLE

Impact of Intimate Partner Violence on Children's Well-Child Care and Medical Home

Megan H. Bair-Merritt, MD, MSCEa, Sarah Shea Crowne, BAa, Lori Burrell, MAa, Debra Caldera, MPHb, Tina L. Cheng, MD, MPHa and Anne K. Duggan, ScDa

a Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
b Alaska State Department of Health and Social Services, Anchorage, Alaska

OBJECTIVES. Intimate partner violence has been linked to poor child health. A continuous relationship with a primary care pediatric provider can help to detect intimate partner violence and connect families with needed services. The objectives of this study were to determine the relationship between intimate partner violence and (1) maternal report of a regular site for well-child care, (2) maternal report of a primary pediatric provider, (3) well-child visits in the first year of life, (4) up-to-date immunizations at 2 years of age, (5) maternal report of medical neglect, and (6) maternal report of the pediatric provider–caregiver relationship.

METHODS. This retrospective cohort study evaluated data from 209 at-risk families participating in the evaluation of the Healthy Families Alaska program. Research staff interviewed mothers near the time of an index child's birth and again at the child's second birthday. Medical charts were abstracted for information on well-child visits and immunizations.

RESULTS. Mothers who disclosed intimate partner violence at the initial interview (n = 62) were significantly less likely to report a regular site for well-child care or a primary pediatric provider. In multivariable models, children of mothers who disclosed intimate partner violence tended to be less likely to have the recommended 5 well-child visits within the first year of life and were significantly less likely to be fully immunized at 2 years of age. Differences in medical neglect were not statistically significant. Of mothers who reported a specific primary pediatric provider, those with intimate partner violence histories trusted this provider less and tended to rate less favorably pediatric provider–caregiver communication and the overall quality of the pediatric provider–caregiver relationship.

CONCLUSIONS. Future research should explore effective ways to link intimate partner violence–exposed children with a medical home and a primary pediatric provider and to improve relationships between pediatric providers and caregivers who face violence at home.

Key Words: intimate partner violence • medical home • health service use • immunizations • pediatric provider-caregiver relationship

Abbreviations: AAP—American Academy of Pediatrics • IPV—intimate partner violence • HFAK—Healthy Families Alaska • OCS—Office of Children's Services • CTS2—Conflict Tactics Scale 2

Accepted Jul 21, 2007.