Kristen Berg - Academia.edu (original) (raw)

Papers by Kristen Berg

Obstetrics & Gynecology

Du Bois Review, Dec 19, 2022

Autism

Many of the nearly six million autistic adolescents and adults in the United States require suppo... more Many of the nearly six million autistic adolescents and adults in the United States require support to navigate daily life. Family members often provide the first line of support for autistic youth by providing care and coordinating services. Although considerable research has examined the perspectives of family members caring for young autistic children, comparatively less has focused on those caring for transition-age youth who often struggle to access needed services as they leave child-serving systems of care. This study examined caregiver-reported barriers to service for 174 adolescents and young adults on the spectrum (ages 16–30) and the association between such barriers and unmet service needs. Exploratory factor analysis suggested two service barrier domains: access (e.g., cost) and quality (e.g., providers not trained). Regression models indicated that caregivers whose youth were diagnosed at older ages perceived both greater access and quality barriers. Male caregivers re...

Innovation in Aging

Emerging evidence suggests that older adults benefit from the Medicare Annual Wellness Visit (AWV... more Emerging evidence suggests that older adults benefit from the Medicare Annual Wellness Visit (AWV). Lind and colleagues found that between 2011 and 2016, utilization of the AWV increased from 8.1% to 23.0%. However, compared with non-Hispanic whites, AWV utilization is 11.6% points lower for Hispanic/Latinos and 10.2% lower for non-Hispanic Blacks. AWV differences by primary language have not been previously reported. We examined the rate of AWV utilization for older adults with English vs. Limited English Proficiency (LEP) among patients seen at a large urban health system in northeastern Ohio. Using Bonferroni-corrected chi-square and t-tests, we also evaluated the association between LEP and health risks (e.g., depression, falls, activities of daily living, cognitive status) assessed during the AWV. Using the electronic health record, we identified 41,262 Medicare patients aged 65+ who were eligible for the AWV. Of those identified, 42.8% completed an AWV between 2019 to 2021. Pe...

Children and Youth Services Review, 2020

Each year, more than 6% of all U.S. children are exposed to domestic violence and require interve... more Each year, more than 6% of all U.S. children are exposed to domestic violence and require intervention services from agencies that serve affected families. Previous research has examined detrimental biopsychosocial consequences of domestic violence exposure during childhood and the importance of effective prevention and intervention services for this population. However, less research has explored diverse intervention professionals' own perspectives on the needs of the domestic violence-exposed children they serve. Method: This study employed an inductive approach to thematic analysis to investigate intervention professionals' reflections and advice regarding the service, policy, and research needs as well as overall strategies to better protect children exposed to domestic violence. Results: Respondents articulated four primary themes of (a) building general education and awareness of the effects of domestic violence exposure on children; (b) the need for trauma-informed care; (c) the salience of cultural humility in serving affected families; and (d) essential collaboration across service domains. Respondents discussed these themes in the context of four key systems of care: the clinical or therapy, family, school, and judicial systems. Conclusions: Future research should integrate the voices of affected children and families as well as examine models for effectively implementing these recommendations into practice settings.

Journal of Family Violence, 2022

Autism Research and Treatment

Approximately 50,000 youths with autism spectrum disorders (ASD) exit U.S. high schools yearly to... more Approximately 50,000 youths with autism spectrum disorders (ASD) exit U.S. high schools yearly to enter adult systems of care, many of whom remain dependent on family for day-to-day care and service system navigation. As part of a larger study, 174 family caregivers for adolescents or young adults with ASD were asked what advice they would give service providers about how to improve services for youth with ASD. Reflexive thematic analysis identified a framework of five directives: (1) provide a roadmap to services; (2) improve service access; (3) fill gaps to address unmet needs; (4) educate themselves, their families, and society about autism; and (5) operate from a relationship-building paradigm with families. Education, health, and social service providers, as well as policymakers, can use these directives to better assist youth with ASD and their families in the transition to adulthood.

Children and Youth Services Review

Purpose Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer (BC) with ... more Purpose Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer (BC) with higher recurrence rates and poorer prognoses and most prevalent among non-Hispanic Black women. Studies of multiple health conditions and care processes suggest that neighborhood socioeconomic position is a key driver of health disparities. We examined roles of patients’ neighborhood-level characteristics and race on prevalence, stage at diagnosis, and mortality among patients diagnosed with BC at a large safety-net healthcare system in Northeast Ohio. Methods We used tumor registry to identify BC cases from 2007–2020 and electronic health records and American Community Survey for individual- and area-level factors. We performed multivariable regression analyses to estimate associations between neighborhood-level characteristics, measured by the Area Deprivation Index (ADI), race and comparative TNBC prevalence, stage at diagnosis, and total mortality. Results TNBC was more common among ...

Medical Decision Making

Background Electronic health records (EHRs) provide researchers with abundant sample sizes, detai... more Background Electronic health records (EHRs) provide researchers with abundant sample sizes, detailed clinical data, and other advantages for performing high-quality observational health research on diverse populations. We review and demonstrate strategies for the design and analysis of cohort studies on neighborhood diversity and health, including evaluation of the effects of race, ethnicity, and neighborhood socioeconomic position on disease prevalence and health outcomes, using localized EHR data. Methods Design strategies include integrating and harmonizing EHR data across multiple local health systems and defining the population(s) of interest and cohort extraction procedures for a given analysis based on the goal(s) of the study. Analysis strategies address inferential goals, including the mechanistic study of social risks, statistical adjustment for differences in distributions of social and neighborhood-level characteristics between available EHR data and the underlying local...

Journal of General Internal Medicine

Journal of Family Violence

Over 25% of youth in the United States are estimated to witness intimate partner violence (IPV) a... more Over 25% of youth in the United States are estimated to witness intimate partner violence (IPV) at some point during childhood. Research has synthesized the physical and behavioral health consequences of children’s IPV exposure, but evidence of links between witnessing IPV and children’s physiological functioning has yet to be integrated. The primary aim of this systematic review is to delineate the patterns by which variation in children’s physiological functioning has been measured to associate with IPV exposure. This study was one component of a broader Evidence and Gap Map (EGM) consolidation of how witnessing IPV affects children’s wellbeing. Seven bibliographic databases were systematically searched through August 2020 and, of 381 total EGM-included citations, 23 examined children’s physiological functioning in the context of IPV exposure. Research evidences a directly deleterious effect of IPV exposure for children’s endocrine, nervous, cardiovascular, and immune functioning and a vulnerability effect of physiological dysregulation across other domains of children’s wellbeing. Additional research on how specific aspects of IPV exposure affect children’s physiologies and wellbeing across time is critical. Future inquiry measuring dynamic associations between various physiological responses in the aftermath of witnessing IPV is needed. Further elucidating the physiological context of children’s IPV exposure is important for developing and implementing interventions that maximize children’s opportunities for resilience.

SSRN Electronic Journal, 2021

Background: Dysregulation of immunohematologic function (IHF) promotes cardiovascular disease and... more Background: Dysregulation of immunohematologic function (IHF) promotes cardiovascular disease and impairs protective responses to cancer and infection. A pragmatic method to identify those as risk due to IHF could improve the precision of preventive interventions and provide insight into the heterogeneity of immunologic capacity. We developed and validated a method to distill complete blood cell count data into distinct IHF profiles of prognostic relevance. Methods: We adapted latent profile analysis methods to simultaneously identify distinct groups of patients with respect to 10 immunohematologic indicators and regress time to all-cause mortality on this latent IHF profile. The model was developed using data from 30274 National Health and Nutrition Examination Survey participants and externally validated in 49851 outpatients in the Veterans Heath Administration (VHA) system and 44142 SARS-CoV-2 positive VHA patients.Findings: Ten distinct IHF profiles were identified. Profile 1, with relative mild pan-leukopenia in absence of red cell abnormalities, was associated with the best long term survival in each setting. Profiles 8-10, featuring anemia/anisocytosis especially in the setting of lymphopenia (Profiles 9-10) were associated with adjusted hazard ratio (HR) estimates of 1.76-2.62 for mortality across the three cohorts, compared to Profile 1. Profiles 6-7, featuring relative neutrophilia, were less common but also independently associated with mortality risk, especially after COVID-19 infection (Profile 7 HR [95% CI]: 2.51 [1.63 – 3.86]). The magnitude of adjusted risk conveyed by IHF profiles was greater than individual clinical risk factors (i.e., smoking, diabetes) or prevalent co-morbidities.Interpretation: Distinct immunohematologic endotypes can be identified during routine blood panels which project to mortality risk on par with a decade of life, additive to demographic and clinical factors. Applications that consider immunohematologic dysfunction may improve prevention of common fatal diseases, including COVID-19.Funding Information:This study was funded in part by The National Institute on Aging (R01AG055480;Dalton and Perzynski), the National Cancer Institute (U01CA260513;Zidar and Chan), and the United States Veteran Administration (COVID19-8900-05;Zidar). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veteran Affairs or the National Institutes of Health.Declaration of Interests: No conflict of interest exists between any of the authors and the contents of this paper.Ethics Approval Statement: The study was approved by the Institutional Review Board of the Louis Stokes Cleveland VAMC.

Innovation in Aging, 2018

technology (HIT) shows potential for increasing the value of health care. However, HIT use is low... more technology (HIT) shows potential for increasing the value of health care. However, HIT use is lower among older adults and disadvantaged patients. We evaluated the effectiveness of a program for increasing patient portal use and internet access among underserved patients. We conducted a quasi-experimental study of a community health worker (CHW) and digital literacy program to improve patient portal use by disadvantaged patients seen at one urban primary care clinic. Patients met with a clinicbased CHW who explained patient portal use, gave referrals for a free, health-focused digital literacy training program, and identified connectivity barriers. We evaluated the program using electronic health record data (intervention vs. a control clinic) and daily CHW experience logs. In all, 186 patients met with a CHW. Of these, 2% lacked adequate English proficiency to use the portal, 18% were not interested, 26% already were using the portal and 55% expressed interest and were directed to the training program. Based on data from 6-months pre-and 6 months post-implementation, the CHW program was associated with a threefold increase in the rate of first-time patient portal use and double the rate of portal-based visit scheduling for the intervention vs. control site (p = 0.14). Training barriers included lack of transportation, fear/anxiety of internet, and cost of internet service. Perceived benefits included ready access to lab results and proxy access to family members' health information. These results suggest that a novel clinic-based CHW program and community partnership can promote effective HIT use among disadvantaged populations.

Journal of Evidence-Based Social Work

Journal of Family Violence, 2022

Among children exposed to intimate partner violence (IPV), their appraisals and beliefs about IPV... more Among children exposed to intimate partner violence (IPV), their appraisals and beliefs about IPV have been identified as key cognitive factors that may explain the linkage between IPV exposure and other adjustment outcomes. Grounded in the cognitive-contextual framework, this systematic review summarizes empirical studies examining child IPV exposure, acceptance of IPV, and appraisals of IPV, including perceived threat, self-blame attributions, and coping efficacy. This study is part of a broader evidence and gap map (EGM) that systematically searched seven databases for quantitative studies examining the effects of IPV exposure on all potential child outcomes. Studies were screened and coded for inclusion if they focused on IPV-exposed children 17 years and younger, used a validated or reliable scale to measure child outcomes, and utilized a comparison group. This review examined a subset of 13 studies measuring children's acceptance and/or appraisals of IPV. Findings suggest that children exposed to IPV tend to have stronger beliefs that the use of violence in intimate relationships is acceptable, with important implications for adolescent dating violence. Additionally, children's appraisals of threat and self-blame regarding their parents' IPV acted as a key variable for understanding links between children's IPV exposure and outcomes such as internalizing problems, social anxiety, and self-efficacy. Few studies examined coping efficacy. This review highlights the importance of children's acceptance and appraisals of IPV as an outcome of IPV exposure, and as an intervening factor between IPV exposure and other adjustment outcomes. Implications for intervention and future research are discussed.

Journal of Family Violence, 2022

Intimate partner violence (IPV) exposure continues to be a pervasive problem for children. Althou... more Intimate partner violence (IPV) exposure continues to be a pervasive problem for children. Although the impact of IPV exposure on children’s mental health has been well-documented, the impact of IPV exposure on children’s physical health, as well as families’ engagement with the medical system for their children’s physical health needs (e.g., contact with primary care pediatricians, emergency room visits) remains under-studied. The purpose of this systematic review was to synthesize quantitative studies examining the association between IPV exposure and (a) medical system engagement and (b) physical health outcomes, and to examine methodological factors that may influence findings. A systematic review was conducted using seven electronic bibliographic databases to identify research examining outcomes of IPV-exposed children up to August of 2020. Citations were coded by two independent researchers to determine inclusion and exclusion, and then coded again to identify studies examining medical system engagement and physical health outcomes. A total of 31 citations were included. Consistent results were found across studies in that, compared with non-exposed children, IPV-exposed children were less likely to be up to date on immunizations, had an increased rate of emergency room visits, had more contact with primary care pediatricians, were more likely to have an increased risk of poor lung functioning, obesity, and nutritional deficiencies, and reported more general physical health problems. In addition to further research in this area, this study identifies the need for training healthcare providers to implement consistent IPV screening and provide IPV-exposed children and families with referrals to trauma-informed, community-based interventions.

Journal of Family Violence, 2022

An estimated 15.5 million children in the United States are exposed to intimate partner violence ... more An estimated 15.5 million children in the United States are exposed to intimate partner violence (IPV) in their homes each year. Empirical data suggest that childhood IPV exposure is associated with a plethora of adverse outcomes such as poor behavioral regulation, reduced cognitive functioning, and greater aggressive behavior. Within this body of research, it has been suggested that IPV-exposed children are more likely to both perpetrate and fall victim to bullying than non-exposed children. This systematic review explores the relationship between IPV exposure and bullying perpetration and victimization in the existing literature and includes a discussion of individual- and family-level factors that have been considered in the association between IPV exposure and bullying perpetration and victimization. Building upon findings from a broader Evidence and Gap Map, this systematic literature review identified 14 articles that examined the association between IPV exposure and bullying perpetration and victimization. Of these 14 articles, 12 assessed the relationship between youth IPV exposure and bullying perpetration, and 75.0% of these articles (n = 9) found a significant relationship between IPV exposure and bullying perpetration. Ten of the 14 articles examined youth IPV exposure and bullying victimization, with 70.0% of the articles (n = 7) supporting this association. Individual- and broader family-level characteristics, including gender, race/ethnicity, mental health symptoms, other types of adversities, and parenting were also examined. The article addresses implications for research and practice, including methodological suggestions for future studies and avenues for potential intervention for IPV-exposed children experiencing bullying victimization and perpetration.

Journal of Family Violence, 2022

ABSTRACT Relatively little is known about the associations between childhood exposure to intimate... more ABSTRACT Relatively little is known about the associations between childhood exposure to intimate partner violence (IPV) and adulthood mental health problems. This study used 2,500 Swedish young adults’ retrospective self-reports to determine the prevalence of childhood exposure to IPVand examine the relationships between such exposure and gender, age of exposure and adult mental health problems. Twentyeight percent of participants reported any childhood exposure to IPV. Exposure was more common among women, who were also younger at first exposure and exposed to more severe violence than men. Both exposure and severity of IPV were related to all mental health problems examined. The interaction of IPVexposure and gender, while significant, explained relatively little of the variance in mental health problems.

Obstetrics & Gynecology

Du Bois Review, Dec 19, 2022

Autism

Many of the nearly six million autistic adolescents and adults in the United States require suppo... more Many of the nearly six million autistic adolescents and adults in the United States require support to navigate daily life. Family members often provide the first line of support for autistic youth by providing care and coordinating services. Although considerable research has examined the perspectives of family members caring for young autistic children, comparatively less has focused on those caring for transition-age youth who often struggle to access needed services as they leave child-serving systems of care. This study examined caregiver-reported barriers to service for 174 adolescents and young adults on the spectrum (ages 16–30) and the association between such barriers and unmet service needs. Exploratory factor analysis suggested two service barrier domains: access (e.g., cost) and quality (e.g., providers not trained). Regression models indicated that caregivers whose youth were diagnosed at older ages perceived both greater access and quality barriers. Male caregivers re...

Innovation in Aging

Emerging evidence suggests that older adults benefit from the Medicare Annual Wellness Visit (AWV... more Emerging evidence suggests that older adults benefit from the Medicare Annual Wellness Visit (AWV). Lind and colleagues found that between 2011 and 2016, utilization of the AWV increased from 8.1% to 23.0%. However, compared with non-Hispanic whites, AWV utilization is 11.6% points lower for Hispanic/Latinos and 10.2% lower for non-Hispanic Blacks. AWV differences by primary language have not been previously reported. We examined the rate of AWV utilization for older adults with English vs. Limited English Proficiency (LEP) among patients seen at a large urban health system in northeastern Ohio. Using Bonferroni-corrected chi-square and t-tests, we also evaluated the association between LEP and health risks (e.g., depression, falls, activities of daily living, cognitive status) assessed during the AWV. Using the electronic health record, we identified 41,262 Medicare patients aged 65+ who were eligible for the AWV. Of those identified, 42.8% completed an AWV between 2019 to 2021. Pe...

Children and Youth Services Review, 2020

Each year, more than 6% of all U.S. children are exposed to domestic violence and require interve... more Each year, more than 6% of all U.S. children are exposed to domestic violence and require intervention services from agencies that serve affected families. Previous research has examined detrimental biopsychosocial consequences of domestic violence exposure during childhood and the importance of effective prevention and intervention services for this population. However, less research has explored diverse intervention professionals' own perspectives on the needs of the domestic violence-exposed children they serve. Method: This study employed an inductive approach to thematic analysis to investigate intervention professionals' reflections and advice regarding the service, policy, and research needs as well as overall strategies to better protect children exposed to domestic violence. Results: Respondents articulated four primary themes of (a) building general education and awareness of the effects of domestic violence exposure on children; (b) the need for trauma-informed care; (c) the salience of cultural humility in serving affected families; and (d) essential collaboration across service domains. Respondents discussed these themes in the context of four key systems of care: the clinical or therapy, family, school, and judicial systems. Conclusions: Future research should integrate the voices of affected children and families as well as examine models for effectively implementing these recommendations into practice settings.

Journal of Family Violence, 2022

Autism Research and Treatment

Approximately 50,000 youths with autism spectrum disorders (ASD) exit U.S. high schools yearly to... more Approximately 50,000 youths with autism spectrum disorders (ASD) exit U.S. high schools yearly to enter adult systems of care, many of whom remain dependent on family for day-to-day care and service system navigation. As part of a larger study, 174 family caregivers for adolescents or young adults with ASD were asked what advice they would give service providers about how to improve services for youth with ASD. Reflexive thematic analysis identified a framework of five directives: (1) provide a roadmap to services; (2) improve service access; (3) fill gaps to address unmet needs; (4) educate themselves, their families, and society about autism; and (5) operate from a relationship-building paradigm with families. Education, health, and social service providers, as well as policymakers, can use these directives to better assist youth with ASD and their families in the transition to adulthood.

Children and Youth Services Review

Purpose Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer (BC) with ... more Purpose Triple negative breast cancer (TNBC) is an aggressive subtype of breast cancer (BC) with higher recurrence rates and poorer prognoses and most prevalent among non-Hispanic Black women. Studies of multiple health conditions and care processes suggest that neighborhood socioeconomic position is a key driver of health disparities. We examined roles of patients’ neighborhood-level characteristics and race on prevalence, stage at diagnosis, and mortality among patients diagnosed with BC at a large safety-net healthcare system in Northeast Ohio. Methods We used tumor registry to identify BC cases from 2007–2020 and electronic health records and American Community Survey for individual- and area-level factors. We performed multivariable regression analyses to estimate associations between neighborhood-level characteristics, measured by the Area Deprivation Index (ADI), race and comparative TNBC prevalence, stage at diagnosis, and total mortality. Results TNBC was more common among ...

Medical Decision Making

Background Electronic health records (EHRs) provide researchers with abundant sample sizes, detai... more Background Electronic health records (EHRs) provide researchers with abundant sample sizes, detailed clinical data, and other advantages for performing high-quality observational health research on diverse populations. We review and demonstrate strategies for the design and analysis of cohort studies on neighborhood diversity and health, including evaluation of the effects of race, ethnicity, and neighborhood socioeconomic position on disease prevalence and health outcomes, using localized EHR data. Methods Design strategies include integrating and harmonizing EHR data across multiple local health systems and defining the population(s) of interest and cohort extraction procedures for a given analysis based on the goal(s) of the study. Analysis strategies address inferential goals, including the mechanistic study of social risks, statistical adjustment for differences in distributions of social and neighborhood-level characteristics between available EHR data and the underlying local...

Journal of General Internal Medicine

Journal of Family Violence

Over 25% of youth in the United States are estimated to witness intimate partner violence (IPV) a... more Over 25% of youth in the United States are estimated to witness intimate partner violence (IPV) at some point during childhood. Research has synthesized the physical and behavioral health consequences of children’s IPV exposure, but evidence of links between witnessing IPV and children’s physiological functioning has yet to be integrated. The primary aim of this systematic review is to delineate the patterns by which variation in children’s physiological functioning has been measured to associate with IPV exposure. This study was one component of a broader Evidence and Gap Map (EGM) consolidation of how witnessing IPV affects children’s wellbeing. Seven bibliographic databases were systematically searched through August 2020 and, of 381 total EGM-included citations, 23 examined children’s physiological functioning in the context of IPV exposure. Research evidences a directly deleterious effect of IPV exposure for children’s endocrine, nervous, cardiovascular, and immune functioning and a vulnerability effect of physiological dysregulation across other domains of children’s wellbeing. Additional research on how specific aspects of IPV exposure affect children’s physiologies and wellbeing across time is critical. Future inquiry measuring dynamic associations between various physiological responses in the aftermath of witnessing IPV is needed. Further elucidating the physiological context of children’s IPV exposure is important for developing and implementing interventions that maximize children’s opportunities for resilience.

SSRN Electronic Journal, 2021

Background: Dysregulation of immunohematologic function (IHF) promotes cardiovascular disease and... more Background: Dysregulation of immunohematologic function (IHF) promotes cardiovascular disease and impairs protective responses to cancer and infection. A pragmatic method to identify those as risk due to IHF could improve the precision of preventive interventions and provide insight into the heterogeneity of immunologic capacity. We developed and validated a method to distill complete blood cell count data into distinct IHF profiles of prognostic relevance. Methods: We adapted latent profile analysis methods to simultaneously identify distinct groups of patients with respect to 10 immunohematologic indicators and regress time to all-cause mortality on this latent IHF profile. The model was developed using data from 30274 National Health and Nutrition Examination Survey participants and externally validated in 49851 outpatients in the Veterans Heath Administration (VHA) system and 44142 SARS-CoV-2 positive VHA patients.Findings: Ten distinct IHF profiles were identified. Profile 1, with relative mild pan-leukopenia in absence of red cell abnormalities, was associated with the best long term survival in each setting. Profiles 8-10, featuring anemia/anisocytosis especially in the setting of lymphopenia (Profiles 9-10) were associated with adjusted hazard ratio (HR) estimates of 1.76-2.62 for mortality across the three cohorts, compared to Profile 1. Profiles 6-7, featuring relative neutrophilia, were less common but also independently associated with mortality risk, especially after COVID-19 infection (Profile 7 HR [95% CI]: 2.51 [1.63 – 3.86]). The magnitude of adjusted risk conveyed by IHF profiles was greater than individual clinical risk factors (i.e., smoking, diabetes) or prevalent co-morbidities.Interpretation: Distinct immunohematologic endotypes can be identified during routine blood panels which project to mortality risk on par with a decade of life, additive to demographic and clinical factors. Applications that consider immunohematologic dysfunction may improve prevention of common fatal diseases, including COVID-19.Funding Information:This study was funded in part by The National Institute on Aging (R01AG055480;Dalton and Perzynski), the National Cancer Institute (U01CA260513;Zidar and Chan), and the United States Veteran Administration (COVID19-8900-05;Zidar). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veteran Affairs or the National Institutes of Health.Declaration of Interests: No conflict of interest exists between any of the authors and the contents of this paper.Ethics Approval Statement: The study was approved by the Institutional Review Board of the Louis Stokes Cleveland VAMC.

Innovation in Aging, 2018

technology (HIT) shows potential for increasing the value of health care. However, HIT use is low... more technology (HIT) shows potential for increasing the value of health care. However, HIT use is lower among older adults and disadvantaged patients. We evaluated the effectiveness of a program for increasing patient portal use and internet access among underserved patients. We conducted a quasi-experimental study of a community health worker (CHW) and digital literacy program to improve patient portal use by disadvantaged patients seen at one urban primary care clinic. Patients met with a clinicbased CHW who explained patient portal use, gave referrals for a free, health-focused digital literacy training program, and identified connectivity barriers. We evaluated the program using electronic health record data (intervention vs. a control clinic) and daily CHW experience logs. In all, 186 patients met with a CHW. Of these, 2% lacked adequate English proficiency to use the portal, 18% were not interested, 26% already were using the portal and 55% expressed interest and were directed to the training program. Based on data from 6-months pre-and 6 months post-implementation, the CHW program was associated with a threefold increase in the rate of first-time patient portal use and double the rate of portal-based visit scheduling for the intervention vs. control site (p = 0.14). Training barriers included lack of transportation, fear/anxiety of internet, and cost of internet service. Perceived benefits included ready access to lab results and proxy access to family members' health information. These results suggest that a novel clinic-based CHW program and community partnership can promote effective HIT use among disadvantaged populations.

Journal of Evidence-Based Social Work

Journal of Family Violence, 2022

Among children exposed to intimate partner violence (IPV), their appraisals and beliefs about IPV... more Among children exposed to intimate partner violence (IPV), their appraisals and beliefs about IPV have been identified as key cognitive factors that may explain the linkage between IPV exposure and other adjustment outcomes. Grounded in the cognitive-contextual framework, this systematic review summarizes empirical studies examining child IPV exposure, acceptance of IPV, and appraisals of IPV, including perceived threat, self-blame attributions, and coping efficacy. This study is part of a broader evidence and gap map (EGM) that systematically searched seven databases for quantitative studies examining the effects of IPV exposure on all potential child outcomes. Studies were screened and coded for inclusion if they focused on IPV-exposed children 17 years and younger, used a validated or reliable scale to measure child outcomes, and utilized a comparison group. This review examined a subset of 13 studies measuring children's acceptance and/or appraisals of IPV. Findings suggest that children exposed to IPV tend to have stronger beliefs that the use of violence in intimate relationships is acceptable, with important implications for adolescent dating violence. Additionally, children's appraisals of threat and self-blame regarding their parents' IPV acted as a key variable for understanding links between children's IPV exposure and outcomes such as internalizing problems, social anxiety, and self-efficacy. Few studies examined coping efficacy. This review highlights the importance of children's acceptance and appraisals of IPV as an outcome of IPV exposure, and as an intervening factor between IPV exposure and other adjustment outcomes. Implications for intervention and future research are discussed.

Journal of Family Violence, 2022

Intimate partner violence (IPV) exposure continues to be a pervasive problem for children. Althou... more Intimate partner violence (IPV) exposure continues to be a pervasive problem for children. Although the impact of IPV exposure on children’s mental health has been well-documented, the impact of IPV exposure on children’s physical health, as well as families’ engagement with the medical system for their children’s physical health needs (e.g., contact with primary care pediatricians, emergency room visits) remains under-studied. The purpose of this systematic review was to synthesize quantitative studies examining the association between IPV exposure and (a) medical system engagement and (b) physical health outcomes, and to examine methodological factors that may influence findings. A systematic review was conducted using seven electronic bibliographic databases to identify research examining outcomes of IPV-exposed children up to August of 2020. Citations were coded by two independent researchers to determine inclusion and exclusion, and then coded again to identify studies examining medical system engagement and physical health outcomes. A total of 31 citations were included. Consistent results were found across studies in that, compared with non-exposed children, IPV-exposed children were less likely to be up to date on immunizations, had an increased rate of emergency room visits, had more contact with primary care pediatricians, were more likely to have an increased risk of poor lung functioning, obesity, and nutritional deficiencies, and reported more general physical health problems. In addition to further research in this area, this study identifies the need for training healthcare providers to implement consistent IPV screening and provide IPV-exposed children and families with referrals to trauma-informed, community-based interventions.

Journal of Family Violence, 2022

An estimated 15.5 million children in the United States are exposed to intimate partner violence ... more An estimated 15.5 million children in the United States are exposed to intimate partner violence (IPV) in their homes each year. Empirical data suggest that childhood IPV exposure is associated with a plethora of adverse outcomes such as poor behavioral regulation, reduced cognitive functioning, and greater aggressive behavior. Within this body of research, it has been suggested that IPV-exposed children are more likely to both perpetrate and fall victim to bullying than non-exposed children. This systematic review explores the relationship between IPV exposure and bullying perpetration and victimization in the existing literature and includes a discussion of individual- and family-level factors that have been considered in the association between IPV exposure and bullying perpetration and victimization. Building upon findings from a broader Evidence and Gap Map, this systematic literature review identified 14 articles that examined the association between IPV exposure and bullying perpetration and victimization. Of these 14 articles, 12 assessed the relationship between youth IPV exposure and bullying perpetration, and 75.0% of these articles (n = 9) found a significant relationship between IPV exposure and bullying perpetration. Ten of the 14 articles examined youth IPV exposure and bullying victimization, with 70.0% of the articles (n = 7) supporting this association. Individual- and broader family-level characteristics, including gender, race/ethnicity, mental health symptoms, other types of adversities, and parenting were also examined. The article addresses implications for research and practice, including methodological suggestions for future studies and avenues for potential intervention for IPV-exposed children experiencing bullying victimization and perpetration.

Journal of Family Violence, 2022

ABSTRACT Relatively little is known about the associations between childhood exposure to intimate... more ABSTRACT Relatively little is known about the associations between childhood exposure to intimate partner violence (IPV) and adulthood mental health problems. This study used 2,500 Swedish young adults’ retrospective self-reports to determine the prevalence of childhood exposure to IPVand examine the relationships between such exposure and gender, age of exposure and adult mental health problems. Twentyeight percent of participants reported any childhood exposure to IPV. Exposure was more common among women, who were also younger at first exposure and exposed to more severe violence than men. Both exposure and severity of IPV were related to all mental health problems examined. The interaction of IPVexposure and gender, while significant, explained relatively little of the variance in mental health problems.