A qualitative analysis of clinical records from a trauma response program for families exposed to violence Public Deposited

http://ir.library.oregonstate.edu/concern/graduate_thesis_or_dissertations/fx719p92k

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  • This dissertation is a qualitative secondary content analysis of clinical records collected for the Spokane Safe Start Project in Spokane, Washington, a program designed to offset trauma in children exposed to domestic and intimate partner violence (IPV). The Centers for Disease Control and the World Health Organization have identified intimate partner violence (IPV) as a health policy issue. Most studies of intimate partner violence and children exposed to violence have used samples from domestic violence shelters, large phone-based community surveys, or convenience samples such as college students. Currently, studies of families that have experienced intimate partner violence and received services in their homes do not exist. As such, the process and effects of intimate violence in families residing in their homes have not been identified. The purpose of this study was to identify the structural issues, factors affecting service engagement, family characteristics, and factors promoting resiliency in families that experienced intimate partner violence and were served by the Spokane Safe Start Project in Spokane, Washington, a program designed to offset trauma in children exposed to caregiver intimate partner violence. To this end, the four research questions were: 1) What are the underlying structural problems that affected these families? 2) Is family functioning at intake associated with the length of time with the program? 3) Of the families that engaged with Safe Start for at least five face-to-face contacts, what are the caregiver and/or family characteristics that seem to indicate the presence or absence of resilience in the caregivers? This study involved the analysis of the clinical case records of 30 families that received Spokane Safe Services. The primary source of data for this study came from the narrative portions of the electronic ACCESS and written client clinical records. The Spokane Safe Start clinical narratives served as a record of clinician observations, interactions, and service delivery to families greatly affected by intimate partner violence. Using the bio-ecological perspective and family systems theory as the theoretical frameworks to understand intimate partner violence and its effects on children, data analysis and synthesis, I used qualitative content analysis thematic analysis, and data matrices. In essence, this is a multiple case study producing "context-dependent knowledge" that is vital to develop ecologically sound interventions to address intimate partner violence and its effects on families (Flyvbjerg, 2006, p. 221). This study revealed three main findings. Families encountered roadblocks in the form of environmental and individual obstacles. These obstacles included family-of-origin dynamics, severe financial problems, and individual issues such as relationship ambivalence and substance abuse that posed serious limitations to developing resilience. Parent-child interactions were strained and difficult in most families. The majority of children experienced chronic IPV and many had a history of maltreatment as well. Although many parents were concerned about the future wellbeing of their children, they also had difficulty reflecting on their children’s emotional needs and experiences. Evidence of resilience in the case narratives was quite limited. There was evidence, one particular clinician's model of service provision was more successful at engendering resilience than that of the other clinicians. Results were triangulated with the extant literature and previous quantitative studies conducted by Washington State University on the Spokane Safe Start data indicating the results of this study are trustworthy and credible. This study makes an important contribution to the family violence literature and may serve as a resource for policy and program development.  
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