Semester

Fall

Date of Graduation

2010

Document Type

Dissertation

Degree Type

PhD

College

School of Medicine

Department

Community Practice

Committee Chair

Jeff Coben.

Abstract

Each year in the United States, 4.8 million physical assaults and rapes are committed against 1.5 million women by an intimate partner. An estimated 3.3 to 10 million children are exposed to some form of intimate partner violence (IPV) in their own homes annually. Although mandatory reporting laws regarding child abuse and/or neglect are implemented in all 50 U.S. states, the extent to which these laws are appropriate for IPV between adults and children exposed to IPV is undetermined. A comprehensive examination of the perspectives of those required to report abuse is critical, as their roles as mandated reporters often pose legal, practical, moral and ethical questions. Even so, the perspective of the mandated reporter is often overlooked. Very few studies have examined the perspective of the mandated reporter with regard to reporting of IPV and children exposed to IPV. Even less research has been dedicated to mandated reporters who work outside of clinical settings, such as public health nurses, who engage in home visitation with clients. The main objective of this project was to enhance our understanding of mandatory reporting issues with regard to IPV and children's exposure to IPV within the context of home visitation programs. In the first study, a secondary analysis of qualitative data was employed to examine community stakeholders', clients', and home visiting nurses' perspectives of mandatory reporting of IPV and children's exposure to IPV within the context of the Nurse-Family Partnership (NFP) home visitation program. Findings demonstrated that issues surrounding reporting in these instances are salient and warrant further investigation with the population of home visitors, as nurses in the focus groups revealed wide variability and uncertainty with regard to their reporting obligations. In the second study and third studies, a web-based survey was administered to NFP nurses in order to quantify the emergent themes found in the qualitative study. The results of the second study revealed that nurse home visitors generally support mandated reporting of IPV, yet exhibited varied attitudes with regard to the impacts of reporting. Furthermore, many nurses revealed uncertainty with regard to reporting duties when managing clients experiencing IPV. The third study assessed home visitors' perceptions of mandated reporting of children's exposure to IPV. Results of this study demonstrated that the majority of our sample believed reporting IPV perpetrated in the presence of a child can help the battered woman and protect her children, but can also result in negative repercussions on the nurse-client relationship, such as limiting the disclosure of abuse to the home visitation provider. Furthermore, nurses were more likely to endorse reporting of children's exposure to IPV when the child was at greatest risk for being physically injured as a result of the IPV between adults. The results of these three studies highlight the need for comprehensive guidelines for providers managing clients and children exposed to IPV that routinely interact with abused women and their children, but may not provide medical treatment, as a substantial proportion of home visitors were uncertain about their obligations to report IPV towards women or perpetrated in the presence of a child. This research demonstrates the importance of examining the perspective of the mandated reporter with regard to managing IPV in home visitation settings. Our findings support and enhance previous research about mandated reporting and demonstrate the need for training, education, and intervention in order for health care providers to appropriately support women and children exposed to IPV.

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