Cincinnati--Should children be in the room when mom's physician asks
questions about partner violence? Therese Zink, MD, MPH, assistant
clinical professor of Family Medicine at the University of Cincinnati
College of Medicine, researched this question and published her
findings in the February issue of The Journal of Family Practice.
meeting with 29 different family physicians, pediatricians, child
psychologists, social workers, and domestic violence agency directors
for interviews and focus group discussions about family violence, Zink
concludes that routine screening for intimate partner violence by
physicians may give a child a better chance at maturing into a healthy
adult by interrupting the cycle of violence. "The benefits of screening
are two-fold," says Zink. "If domestic violence is recognized and
addressed by the physician, the mother is given the opportunity to
alert a professional about the violence and, if action is taken, the
children are less likely to be in abusive relationships down the road."
Zink also suggests that physicians need further research to understand
appropriate questions and methods of screening for intimate partner
violence in front of children.
In Zink's study, experts agreed
that researchers need to help physicians identify the method of
screening that best preserves the safety of both the victim-parent and
the children. "Health care providers should receive domestic violence
intervention training to ensure that both the mother and children are
protected during the screening process," says Zink.
American Academy of Pediatrics recommends screening for domestic
violence and abuse at the child's well visit, and advises that if the
child is old enough to talk, screening of patients is to be done when
the mother is away from both the suspected abuser and the children,
some of the experts Zink interviewed disagreed with this
recommendation. "Most thought that general questions in the child's
presence were appropriate with in-depth questioning of the victim in
private," says Zink. The experts who advocate general screening in
front of children believe the children already know what is taking
place within their family. These experts explain it is important for
the kids to know there are other ways to live and help is available.
All study participants agreed that women should not be interviewed in
the abusive husband's presence.
According to Zink, the experts
also addressed the issue of physicians documenting the suspicion of
domestic violence in the child's medical chart. "This raises questions
about confidentiality since the perpetrator, if a legal guardian, has
access to those medical records. Screening and documentation must be
done in a confidential manner that ensures the mother's safety," says
Zink. For example, one must consider the possibility of the child
telling the abuser about the conversation mom had with the doctor. She
adds, "Failure to consider this may have life-threatening consequences
for her and the children."
"Physicians need more education and
training on how to recognize the symptoms of children who are exposed
to violence between adults and how to document it," continues Zink.
"Children who hear and see violence between their parents display a
variety of behavioral, physical, cognitive, and emotional problems and
symptoms," she adds.
Since children who witness violence are at
greater risk for becoming perpetrators or victims, routine screening by
physicians is important. "Failure to screen means the family continues
to live with violence and abuse without intervention," adds Zink. "Once
health care professionals have confirmed the domestic abuse the health
care giver needs to give the patient information about local crisis
centers, hotline phone numbers, and begin the development of a safety
plan," says Zink. Future research could examine the advantages and
disadvantages of face-to-face interviewing compared to questionnaires,
the development of screening questions to be used with the children
present, and legal guidelines to clarify what type of notation about
the mother's victimization is appropriate in a child's chart.
acknowledging the need for future research, Zink gives the following
recommendations for current domestic violence screening practice:
- The AMA-formatted questions should be used in the presence of children younger than two or three years old.
- Physicians should educate patients about intimate partner violence and distribute resource materials and crisis phone numbers.
- Physicians should ask the mother's permission before screening questions are asked in front of children older than two or three.
- Because of an established link between spousal abuse and child abuse, whenever one is present, the other should be considered.