Identifying children at risk of abuse

Children whose mothers suffer domestic abuse are much more likely to be abused themselves. An article in BMC Medicine today shows that active screening significantly helps physicians to identify families that experience domestic abuse, and thus to protect children.

The American Academy of Pediatrics (AAP) notes that, “child abuse occurs in one third to three quarters of families that experience domestic violence”. Identifying these women, and taking steps to intervene, may be one of the most effective ways to prevent child abuse.

Dr Richard Wahl and his colleagues asked all families who visited the University of Arizona Pediatric clinic over a two-year period to fill in a child safety questionnaire. This questionnaire explicitly asked parents questions about their experiences of domestic violence, such as “Have you ever been in a relationship with someone who has hit you, kicked you, slapped you, punched you or threatened to hurt you?”

A total of 7070 questionnaires were completed, and 138 people revealed that they were currently exposed to domestic violence. This is equivalent to two percent of those screened. The researchers then compared the number of cases of domestic violence identified prior to the implementation of active screening, with those identified when the questionnaires were in use.

“Using the child safety questionnaire significantly increased the odds of detecting current domestic violence, with 73% of the cases identified being attributable to the use of the questionnaire,” write the study’s authors. They continue: “An estimated 40+ cases per year of current domestic violence would probably have been missed in our clinic without active screening. With the implementation of active screening for domestic violence, those parents were assessed and referred to social service agencies while still in our clinic.”

The researchers note that the initiation of active screening dramatically increased the need for clinical social services support. Once the staff at the clinic had begun to ask questions about domestic violence, they received requests for assistance on an almost daily basis.

“The pediatric clinics may be the ideal environment in which to screen for domestic violence,” said the researchers. As the AAP notes, “abused women are often reluctant to seek care for their own injuries but usually continue seeking routine care for their children.”