Intimate Partner Violence-Related Fractures in the United States: an 8 Year Review Abstract Fractures associated with intimate partner violence (IPV) are devastating injuries that can have lifelong physical and emotional implications. With exception to the facial region, there are very limited epidemiological reports describing the types and location of IPV-related fractures. The objective of this study is to review a national database and describe trends that are associated with IPV-related fractures. An analysis of all adult (18 years and older) was performed using the National Trauma Data Bank from 2007 through 2014. There were 1352 records identified where the patient was diagnosed with an IPVrelated fracture. Women accounted for 83% of the population and the mean age was 37.5 years. Nearly half of the population sustained fractures to the face. Variances among fracture location were observed across age groups. Facial fractures were recorded more in the younger population (18–39 years) when compared to the other age groups (40–59 years and 60+ years), p < 0.001. Alternatively, rib and femur fractures were more commonly seen among survivors aged 60 years and older when compared to the younger age groups, p < 0.001. The ability to identify and respond to survivors of IPV in the healthcare setting is critically important. While facial fractures are particularly common in the presence of IPV, they are not the only type of fractures that may be seen. In many cases healthcare professionals are the first line of defense in identifying suspected IPV cases. The findings of this paper build upon existing literature while also describing IPV-related fractures across the age spectrum.

Distinguishing Subtypes of Mutual Violence in the Context of Self-Defense: Classifying Types of Partner Violent Couples Using a Modified Conflict Tactics Scale Abstract The Revised Conflict Tactics Scale 2 (CTS2; Straus et al. Journal of Family Issues, 17(3), 283–316, 1996) is the most widely used measure for assessing the frequency of intimate partner violence (IPV). However, it has been criticized for not capturing the context in which IPV takes place. This study examined follow-up items to each CTS2 physical assault item asking to clarify how often the act was perpetrated in self-defense. A community sample of couples (N = 180) recruited for men’s recent violence toward women completed the project-modified Conflict Tactics Scale with Self-Defense (CTS2SD). The majority (69.5%) reported that the physical aggression in the past year was bilateral. On the follow-up items, 27% of men’s violent acts and over 22% of women’s violent acts were reportedly committed in self-defense. Men’s and women’s CTS2 physical assault perpetration scores, along with the percentage that were committed in self-defense, were entered into two-step cluster analyses. Cluster analyses revealed three subgroups of bilateral violence: Male Self-defense, Female Self-defense, and Mutual Violence. The Mutual Violent cluster reported the most frequent physical assault, injury, men’s controlling behavior and men’s arrest for domestic violence. Findings suggest that Straus’ (Behavioral Sciences and the Law, 30(5), 538–556, 2012) tripartite conceptualization of Man-only, Woman-only, and Both-violent couples is overly simplistic and fails to capture different types of bilateral aggression.

A Qualitative Evaluation of the Implementation of an Intimate Partner Violence Education Program in Fracture Clinics Abstract We developed an intimate partner violence educational program (EDUCATE) for health care providers which was implemented in seven fracture clinics by local IPV champions. The purpose of the program was to provide health care providers with the knowledge and skills required to comfortably identify and assist women experiencing IPV in the fracture clinic. The program consisted of an introductory video, interactive online modules, and an in-person presentation by a local IPV champion. The study aim was to qualitatively evaluate the feasibility, acceptability, and perceived value of the program. We conducted semi-structured interviews with 10 champions and 23 participants and identified themes using a qualitative descriptive approach. Champions and participants expressed a strong satisfaction with the program. Champions also described several barriers and facilitators to program implementation. Additionally, we identified themes through analysis of interview data from champions (champion training, program delivery, and perceptions about program participants’ receptiveness to the training) and participants (value of the training experience, useful program content, desire for more education, and suggested program improvements). The program showed promising results, as both champions and program participants had overall positive experiences completing the program. Their suggestions for improvement have been used to refine the program, which is now publically available for educational purposes through www.IPVeducate.com.

The Abusive Behaviour by Children- Indices (ABC-I): a Measure to Discriminate between Normative and Abusive Child Behaviour Abstract Child-to-parent abuse (CPA) research struggles to differentiate between disrespectful and abusive behaviour, leading some to conclude that 90% of children abuse their parents and rendering the concept essentially meaningless. The Abusive Behaviour by Children-Indices (ABC-I) was developed with the aim of differentiating abusive and non-abusive youth using a novel scoring procedure created from parents’ norms about abuse. The ABC-I was developed with parents of young people aged 14–25 years (N = 201) using index-development procedures. The structure of the ABC-I was validated with young people aged 14 to 25 (N = 587) using partial least squares-structural equation modelling. Using the parents’ sample, 40 items derived from the literature were reduced to 10 behavioural descriptors. Parents who identified their children as abusive were 89% more likely to have higher ABC-I scores than non-abused parents. The structure of the ABC-I was further reduced to nine items in the youth sample. The ABC-I identified a 12-month CPA incidence rate of 16%. The ABC-I is the first CPA measure to provide an evidence-based threshold for abuse that incorporates both frequency and severity of abuse to improve upon the identification of abuse involving psychological aggression or coercion.

Concordance in the Reporting of Intimate Partner Violence among Male-Male Couples Abstract Intimate partner violence (IPV) among male couples is increasingly recognized as a public health concern. Research on IPV in opposite sex couples indicates frequent underreporting of IPV and high levels of discordance in reporting among dyads. Concordance studies inform refinement methods to measure the experience of IPV among dyads; however the lack of dyadic studies of male couples impedes our understanding of the extent to which IPV is differentially reported in male-male dyads. This study utilized baseline data from a randomized controlled trial of a behavioral intervention to optimize antiretroviral therapy (ART) adherence among 160 sero-discordant male couples in three US cities and provides the first analysis of concordance in reporting IPV among male couples. Low degrees of concordance in the reporting of IPV were identified among male dyads, with a greater proportion of men reporting violence perpetration than experiencing violence. The greater reporting of IPV perpetration may be linked to adherence to concepts of masculinity. The results underscore the unique experiences of IPV among male couples and the need to reexamine current IPV measurement and intervention strategies.

Emotional Reactivity of Partner Violent Men with Personality Disorder during Conflict Abstract This study addresses negative affect, psychophysiological reactivity, and antecedents to psychological aggression within the context of intimate partner violence. One hundred and thirty-nine partner violent men were administered the SCID-II and participated in verbal conflict with their partner in a laboratory setting, during which time observed affect and psychophysiological indices were continuously recorded. Relative to men with antisocial personality disorder (ASPD), men with borderline personality disorder (BPD) exhibited longer periods of anger (p = .03) and lower skin conductance reactivity (p = .04). Relative to men with no diagnosis, men with BPD exhibited less frequent distress (p = .04) and longer periods of anger (p = .02); men with ASPD exhibited shorter periods of anger (p = .03) and greater heart rate reactivity (p = .04). In men with ASPD, psychological aggression was likely to be preceded by partner positive/neutral affect. Treatment and research implications are discussed.

The Role of Accountability in Batterers Intervention Programs and Community Response to Intimate Partner Violence Abstract To describe how stakeholders involved in intimate partner violence prevention and treatment at different levels of the Social Ecological Model view accountability in relationship to the key actors at various levels in the intervention process and their role in addressing future incidence of IPV. We conducted 36 in-depth qualitative interviews with BIP facilitators, IPV advocates, socio-judicial officials, and local and state policy makers. Participants were recruited via snowball sampling and interviews were audiorecorded, transcribed verbatim, and coded in ATLAS.ti. Interviews broadly explored the challenges and best practices in facilitating BIPs, as well as perceptions on the etiology of IPV. The current analysis focuses on participant views related to accountability, and the role that various groups and institutions have in addressing IPV perpetration. Interview participants emphasized a multi-systems level approach to addressing IPV, one that required the responsibility of both programs and judicial systems in establishing IPV as a serious crime, and stressed the need to ensure accountability across all relevant stakeholders engaged in the broader scope of IPV intervention. In order to have a sustainable impact on IPV perpetration, stakeholders across the Social Ecological Model will need to utilize crucial intervention periods using a standardized response to improve outcomes for IPV survivors, perpetrators, families and communities.

Trauma’s Influence on Relationships: Clients’ Perspectives at an Intimate Partner Violence Intervention Program Abstract Although individuals who engage in intimate partner violence (IPV) report high rates of trauma exposure, it is unclear whether they perceive a link between trauma exposures and relationship problems, which traumas are seen as most influential, and whether such perceptions accurately reflect their relationship difficulties. Ninety-four men presenting for IPV intervention services reported their exposure to 22 adverse and potentially traumatic events (APTEs), and were asked whether these events had influenced the way that they think, act, or feel in relationships. APTEs were categorized based on whether or not they appeared to represent PTSD Criterion A traumatic events. Additionally, participants completed self-report measures of IPV use, partner injuries, emotional abuse, relationship problems, emotion regulation difficulties, and PTSD symptoms. Nearly half (43.6%) of the sample reported that one or more APTEs had influenced the way they function in relationships. Of the 92 reports of non-Criterion A APTEs, 42.4% were endorsed as relationship-influencing, whereas only 19.7% of the 310 occurrences of Criterion A APTEs were endorsed as relationship-influencing. The number of relationship-influencing APTEs reported was positively correlated with emotional abuse, relationship problems, emotion regulation difficulties, and PTSD symptoms. In contrast, the number of non-relationship-influencing APTEs reported was only correlated with emotional abuse. Findings from this exploratory study (1) demonstrate the ability of clients receiving IPV services to discern which APTEs have relevance to their relationships; (2) suggest the benefits of considering non-Criterion A APTEs; and (3) indicate the need for trauma- informed IPV intervention services.

The Documentation and Characteristics of Hospitalized IPV Patients Using Electronic Medical Records Data: a Follow-Up Descriptive Study Abstract Intimate partner violence (IPV) is a serious health problem worldwide but is often not identified by health services. The aim of this study was to describe the characteristics of healthcare patients and documentation compared to the baseline study (2008–2012). The sample (N = 798) consisted of visits to a central hospital in Finland that had been marked with the ICD-10 codes for assault (X85–Y09) and physical abuse (T74.1) during the years 2013–2017. The data was analyzed with content analysis. Among the IPV visits (n = 110), partner- or spouse-related perpetrator coding was poor (11%). Victims experienced multiple injuries, and the violence increased with female gender, alcohol, and nighttime. The insufficient use of perpetrator codes underestimates the incidence of IPV and minimizes their usefulness for surveillance.

Adverse Childhood Experiences Among Asian/Pacific Islander Sexual Minority College Students Abstract Adverse childhood experiences (ACEs) remain understudied among people with multiple minority identities. Individuals with multiple minority identities, such as being both a sexual and racial minority, may experience a greater number of ACEs through an intersection of disadvantages. For Asian and Pacific Islanders (APIs), this juxtaposes with previously reported lower rates of ACEs compared to most other racial/ethnic groups. We sought to determine whether ACEs differed among API sexual minorities compared to others. In this study, we examined whether ACEs were more frequent among lesbian, gay, and bisexual (LGB) API college students compared to majority students. We used data from the 2015 College Student Health Survey to estimate the prevalence of ACEs among respondents and compared ACE prevalence between LGB and heterosexual students by race. LGB students reported a higher mean in overall ACE exposure than heterosexual counterparts, regardless of race (2.8 and 1.8 for LGB API vs. heterosexual API, respectively, p < 0.01). The distribution of specific ACEs differed for APIs versus non-APIs, with some significantly higher, and some lower, for APIs than non-APIs. Our findings revealed that significant disparities in ACEs between LGB and heterosexuals exist among APIs, even in the presence of the altered distribution of ACEs when compared to other races. Continued investigation into the unique ACE exposures of sexual minority APIs is needed to eventually inform prevention practices.