Mental Health And Domestic Violence Research Paper Sample

Qualitative studies can also be used to support evidence-based practice. Ethnographic and meta-synthesis studies, in particular, provide in-depth explanation and understanding of phenomena. The former entails observations of persons in their natural setting, while the latter involves consolidating the results of qualitative studies to develop a model or theory that explains the chosen phenomenon (Erwin, Brotherson & Summers, 2011). In mental health care, experiences of trauma such as domestic violence have a deep and long-lasting impact on the functioning of children. An understanding of these experiences through qualitative research informs better approaches to care.

Choosing the Articles

Two articles were chosen to elucidate the impact of trauma and violence and related patient needs. A search of three databases, namely CINAHL, Ovid, and ProQuest, was made using the search terms qualitative, trauma, violence, and mental health. The search was further refined by adding the search terms ethnography, meta-synthesis, phenomenology, grounded theory, and case study. Limits were applied which were journal or scholarly articles, publication dates between 2010 and the present, English language, and American setting. There was no need to limit by journal or publisher because studies done in the American setting can be published in European, Canadian, or Australian journals.
The abstracts of the articles were then reviewed to select one meta-analysis and one single qualitative study. This student is interested in the impact of domestic violence on children’s mental health. In her practice setting which is acute mental health, the primary focus of care is the signs and symptoms and the diagnosis of a mental health problem. For instance, children manifesting with manic and depressive episodes subsequently diagnosed with bipolar disorder based on the symptoms receive pharmacotherapy. On assessment, a history of domestic violence may be noted.
Once stable, children are referred for psychotherapy, family counseling, and/or group therapy. However, not all patients adhere to outpatient therapy or even to their medications. Some fail to attend any session and some do not complete the sessions. As a consequence, there is a high likelihood that the child will once again be admitted for the same problem leading to a cycle of repeated readmissions. Certainly, more can be done to improve care and thereby address trauma and domestic violence as contributory factors to mental health disorders even in the acute care setting.
On this note, the selected meta-synthesis by Greeson et al. (2011) helps in understanding trauma in children. The authors suggested that children may experience multiple types of trauma and not just domestic violence and is referred to as complex trauma or poly-victimization. Their study aimed to characterize the types and prevalence of trauma in children as well as the prevalence of associated mental health problems. More importantly, the authors sought to determine whether demographic characteristics can be used to screen for complex trauma. In addition, the study aimed to ascertain whether there were differences in mental health consequences in children with complex trauma compared to those with other types that would assist in detection as well as treatment and management.
On the other hand, the ethnographic study by Burnette and Cannon (2014) describes the mental health consequences of domestic violence on children. The authors obtained data from women who experienced domestic violence in childhood and are currently experiencing it again as adults. Data on the impact of the phenomenon on their children were obtained as well showing an intergenerational and more holistic picture of the consequences of domestic violence. The aim of the study was to generate data useful in developing strategies to prevent or mitigate domestic violence and its effects.
Thus, the two studies impact pediatric mental health care practice through better screening, detection, and prevention as well as better treatment or management of the mental health problems arising from domestic violence and complex trauma. Based on the knowledge gained, the role of acute mental health care clinicians in relation to other levels of care can easily be determined. For instance, the role of acute care in improving screening for trauma, referral to outpatient therapy, and compliance with such therapy can be explored. The changes needed to enact this role can then be delineated, planned, and implemented.

Comparison of the Two Studies

Burnette and Cannon (2014) employed the ethnography method consisting of semi-structured life history interviews of informants using an interview guide. The participants were American Indian women. An example of the questions asked was “Describe for me how you have been affected by intimate partner violence” (Burnette & Cannon, 2014, p. 3). The interview transcripts were analyzed through pragmatic horizon analysis that bared the meanings of the data. The themes that emerged were further analyzed using NVivo, a software application intended for qualitative data.
On the other hand, Greeson et al. (2011) conducted a meta-synthesis which entailed examining and integrating the histories of trauma and associated emotional and behavioral problems among children who were referred to child welfare systems as described in qualitative studies compiled by the National Center for Child Traumatic Stress. In contrast to ethnography, therefore, the study used a sample of studies and did not involve primary data collection. The studies used in the synthesis obtained data through interviews with informants including the child, parents or caregivers, family members, relatives, or others knowledgeable of the child’s situation. What is known about trauma represented by themes and meanings was subsequently synthesized to answer the research questions.
The purpose of the ethnographic study was to generate a holistic understanding of domestic violence in that it affects not only women as intimate partners but also women as children and as members of a family (Burnette & Cannon, 2014). The latter role touches upon the impact of the phenomenon on the women’s own children. Meanwhile, the purpose of the meta-analysis was to assess children’s experiences of trauma. Based on a synthesis of multiple study findings, the authors attempted to create a profile of poly-victimization separate from that of other types of trauma that will aid in identifying at-risk youth and their needs as well as how best to address these needs (Greeson et al., 2011).
Burnette and Cannon (2014) found that the extensive psychological consequences of domestic violence during the participants’ childhood mirrored their current experiences and also those of their children. Such consequences were post-traumatic stress and depression with suicidal ideation. The study validated the intergenerational cycle wherein the women experienced abuse as children and became victims again in adulthood. Their children who were indirectly exposed to violence and experienced concomitant neglect became either victims or perpetrators in adulthood. The normalization of violence led to this phenomenon running within extended families with relatives and family members doing nothing about it as it had become the norm.
Meanwhile, Greeson et al. (2011) found that around 70.4% of the respondents in the studies experienced two or more traumas that constituted complex trauma, e.g. domestic violence and neglect. Nearly 12% reported 5 types of trauma – physical, emotional, and sexual abuse plus domestic violence and neglect. The authors also found that race, insurance status, and residence in foster care were predictors of complex trauma. Children with complex trauma had a higher likelihood of internalizing disorder, post-traumatic stress, depression, and suicide. Based on this profile, the authors emphasized the need for trauma exposure screening, treatment of trauma using evidence-based approaches, ensuring the availability of trauma resources, and providing continuity at different levels of care.

Level of Evidence and Grade of Recommendation

The National Guidelines Clearinghouse levels of evidence and grades of recommendations do not include qualitative studies. However, the results of the meta-synthesis and ethnographic study best meet the criteria for Level III evidence. This level includes non-experimental descriptive research such as case-control, correlation, and comparative studies (National Guidelines Clearinghouse, 2011). Descriptive studies do not establish cause and effect between variables as the two articles demonstrated. Rather, their outputs were patient profiles and descriptions of the impact of experiences. For the meta-synthesis, it is best categorized as Grade D using the same National Guidelines Clearinghouse tool. This is because it synthesized and drew conclusions from qualitative studies which are also Level III studies. Evidence from the ethnographic study is Grade C because it is based on Level III research.
Despite the studies being of Level III and Grades C or D evidence, they remain useful in improving practice. Underlying practice or policy change is an in-depth understanding of the issue being addressed. The two qualitative studies therefore serve as groundwork in selecting evidence-based recommendations to improve the case of children presenting with mental health disorders potentially arising from experiences of trauma. For instance, the meta-analysis generated a patient profile which will inform screening, care coordination, and a trauma-based approach to treatment (Greeson et al., 2011). The ethnographic study provides the rationale for prevention and successful mitigation of the contributory factors to trauma (Burnette & Cannon, 2014).

Applicability of Findings

The findings are applicable to acute mental health care as this setting also provides care to children who have experienced trauma from domestic violence and other events. Changes are needed in the facility because the prevailing focus is on the acute psychiatric disorder, a diagnosis that is typically multiple and removed from the child’s social context and prior history of trauma. This perspective leads to misdiagnosis and reliance on pharmacotherapy which is oftentimes ineffective as shown by repeat admissions. Practice change requires education to aid the staff in adopting a trauma perspective for the consideration of trauma experiences in the care of the child.

Impact on Policy

Policy change includes incorporating trauma screening and trauma history-taking in the evaluation of children. Recognition of trauma experiences leads to a more accurate interpretation or diagnosis of the child’s symptoms (Greeson et al., 2011) given that, for instance, signs of bipolar disorder intersect with the common responses of children to repeated trauma. Developing a trauma-perspective among the staff leads to an understanding that pharmacotherapy in itself may be ineffective and that for long term health goals to be achieved, the underlying problem has to be addressed. This leads to earlier and more effective referral to other disciplines and resources that can help the child and the family.
The change in perspective further enables the implementation of pre-discharge interventions such as educating the child and his or her parent, guardian, or significant person about trauma, its multiple and long-term effects, and the benefits of utilizing available services and resources. Adopting a trauma perspective upholds the principle of beneficence, non-maleficence, and justice. It leads to a more accurate diagnosis of the patient and reduced use of ineffective medications. It promotes staff understanding of the patient where being understood is a form of support that the latter find important. It also brings about better health outcomes for a vulnerable patient population.
Implementation of the new policies can be supported by information technology. A prompt to use a trauma screening tool integrated into the EMR can be activated if the age entered corresponds to that of a child. The tool can also be constructed to detect a positive trauma or complex trauma history which will then prompt a trauma-history taking tool. In addition, clinical support in the EMR can include the definition of complex trauma, signs and symptoms of trauma in children, and their needs.

Conclusion

As Level III and Grade C or D evidence, the meta-synthesis and ethnographic study are useful in evidence-based practice by improving staff understanding of complex trauma and its manifestations leading to new policies for improved care. The ethnographic study generated primary evidence while the meta-synthesis integrated different qualitative studies on trauma in children for a broader and deeper understanding of the topic. The results of the two selected studies underscore practice improvement through trauma screening and history taking, early referral, and patient and family or caregiver education. Information technology can enhance the implementation of related policies.

References

Burnette, C.E., & Cannon, C. (2014). “It will always continue unless we can change something”: Consequences of intimate partner violence for indigenous women, children, and families. European Journal of Psychotraumatology, 5, 1-8. Retrieved from http://dx.doi.org/10.3402/ejpt.v5.24585.
Erwin, E.J., Brotherson, M.J., & Summers, J.A. (2011). Understanding qualitative metasynthesis: Issues and opportunities in early childhood intervention research. Journal of Early Intervention, 33(3), 186-200. doi: 10.1177/1053815111425493.
Greeson, J.K.P., Ake, G.S., Briggs, E.C., Ko, S.J., Howard, M.L., Pynoos, R.S., Fairbank, J.A. (2011). Complex trauma and mental health in children and adolescents placed in foster care: Findings from the National Child Traumatic Stress Network. Child Welfare, 90(6), 91-108. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22533044
National Guidelines Clearinghouse (2011). Levels of evidence and grades of recommendation. Retrieved from http://hsl.lib.umn.edu/biomed/help/levels-evidence- and-grades-recommendations