1. From the Child and Family Safety Project to B.R.A.V.E. Teens: Developing a pediatrics-based, comprehensive violence prevention program Terri L. Weaver, Ph.D., Anita Bazile, Ph.D., Patrice L. Pye, Ph.D., Heidi M. Sallee, M.D., Phyllis Terry Friedman, Ph.D., Melissa L. Maglione, M.S., Sarah E. Cruce, B.S., Meagan L. Howell, M.S., Kristen B. Jackson, M.A., Jacquelyn A. Surrell, B.A., and Anna L. Wonderlich-Tierney, M.S. Saint Louis University www.pediatricpsychologypartnership.com Abstract This poster details the design of an interdisciplinary, primary care-based, comprehensive violence prevention strategy. The original project, the Child and Family Safety Project, was established in 2002 with Graduate Psychology Education funding to teach clinical psychology trainees to work with pediatric residents and medical students using a consultative model to provide psychological health services to underserved women and their children affected by Intimate Partner Violence (IPV). The project allowed improved access to care by conducting culturally sensitive IPV assessment and intervention within the standard health care visit. For the past six years, clinical psychology-medical trainees have focused on screening female caregivers presenting with children under the age of 18. Outcomes included evaluations of women’s feedback on the IPV assessment, rates of reported current and past IPV and additional psychosocial concerns that women have for themselves and/or their children. The new project, entitled B.R.A.V.E. Teens (Be Real About Violence Education) was established in 2007 as a downward extension of violence assessment and intervention with a focus on underserved adolescents. The Child and Family Safety Project Disparities are seen in the incidence, prevalence, and burden of IPV among specific population groups. African American women and their children experience disproportionate risk for IPV. Social and environmental risk factors include being young, divorced or separated, earning lower incomes, and living in an urban area. In spite of the magnitude of the problem, IPV is underreported, underidentified, and at-risk populations are underserved. The Child and Family Safety Project focused on reducing issues of health disparity in IPV by eliminating barriers to care for underserved African American women and their children. Goals of the project included enhanced training of clinical psychology, pediatric residents and medical student trainees working in an ambulatory pediatric health care setting. Training enhancement included learning strategies for culturally sensitive identification and remediation of the physical, emotional and behavioral effects of IPV on women and children. In addition, the project aimed to increase the number of ethnic minorities trained. These objectives included: extending psychology training on the established Integrated Clinical Team (ICT) expanding training of medical trainees through pairing with clinical psychology trainees enhancing interdisciplinary graduate psychology education with a hospital based practicum developing interdisciplinary training materials that were exportable via a website and compact disc All goals and objectives were addressed through coursework and experiential learning, and all focused on developing competence with culturally sensitive IPV assessment and intervention. B.R.A.V.E. Teens For the past six years, clinical psychology and pediatric trainees have collaborated successfully to screen and provide IPV safety planning with over 500 unaccompanied adult female caregivers presenting with their children. Our next project focuses on expanding prevention services by focusing directly on adolescents. While recommendations exist for screening adolescents for dating violence within pediatric settings (Family Violence Prevention Fund, 2004), there are no published studies documenting the inclusion of screening and intervention within the healthcare visit. The emerging adult literature lends preliminary support for the proposed intervention, and the success of the existing program (The Child and Family Safety Project) highlights the feasibility of developing and implementing an adolescent-focused program. The project objectives include: extending graduate psychology training through the development of a primary care practicum expanding training of medical trainees by pairing them with clinical psychology trainees developing interdisciplinary exportable materials through an expanded website and compact disc Developing adolescent-appropriate, culturally sensitive screening and intervention materials This project is supported in part by funds from the Division of Medicine and Dentistry (DMD), Bureau of Health Professions (BHPr), Health Resources and Services Administration (HRSA), Department of Health and Human Services (DHHS) under grant number D40HP00051-05-00, entitled Pediatric Psychology Partnership for Dating Violence Prevention. The information and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by the DMD, BHPr, DHHS or the U.S. Government. University Pediatrics University Pediatrics is an ambulatory primary care setting training physicians, medical students, interns, and pediatric residents at Saint Louis University School of Medicine. University Pediatrics is located in St. Louis City, a medically underserved community. University Pediatrics serves: -Average of 6000 patients per year -80% African American -Generally low SES (80% Medicaid) -Substantial percentage of single and teenage mothers -Clinical presentations include poor nutrition, failure to thrive, prematurity, asthma, behavioral and school-related problems. Method Female caregivers attending sick and well child visits at University Pediatrics completed feedback surveys regarding their healthcare visit and were asked about any additional concerns they had for themselves or their children. Female caregivers were screened to assess current and lifetime IPV. All respondents were given resource cards with safety planning information and community resource phone numbers. All male and female adolescents (age 12-18) attending sick and well child visits at University Pediatrics will be assessed for dating violence, including physical and psychological abuse and witnessed violence in the home, and given safety information. Female caregivers will continue to be screened, separately, allowing the healthcare team to provide coordinated safety planning strategies to mothers and their children. These two graphs detail the prevalence of reported current and lifetime IPV reported by female caregivers, reported IPV for others in caregivers’ lives (e.g., friends, other family members) and the relationship with the perpetrator. This Chart illustrates the percentage of trainees who have been trained across both projects. Of note, the graduate psychology education funding provides two-for-one training with generous proportions of medical trainees receiving enhanced training in addition to psychology trainees. This interdisciplinary training project has received tremendous support from our medical colleagues: “This project is vitally important for the further training of future physicians and clinical psychologists to help prevent and treat intimate partner violence in our teenagers and young adults, for their sake, as well as for younger children who might suffer from exposure to violence in their homes and environments.” Timothy Fete, M.D., MPH, Professor in the Department of Pediatrics at Saint Louis University and Director in the Division of General Academic Pediatrics Dr. Heidi Sallee, M.D., Assistant Professor of Medicine in the Department of Pediatrics at Saint Louis University, agrees. “There is no doubt in my mind that this is something we should be doing. Viewing violence effects children’s health.” Future Directions for the Project include: Comparison of the sensitivity and specificity of the screening instrument with established self-report assessments of IPV in order to empirically validate current methods; Examining the concordance between adolescent reports of dating violence and witnessed violence in the home; Increasing the integration of psychological services within primary care practice by emphasizing the inter-relationship among physical health and psychological disorders; Exporting the training strategies used in the current project to other community based sites and other medical and psychology training programs. Increasing the number of minority trainees by using the current project as a means of recruiting prospective students.