 |
|
Mothers' and Health Care Providers' Perspectives on Screening for Intimate Partner Violence in a Pediatric Emergency Department
M. Denise Dowd, MD, MPH;
Christopher Kennedy, MD;
Jane F. Knapp, MD;
Jennifer Stallbaumer-Rouyer, MSW
Arch Pediatr Adolesc Med. 2002;156:794-799.
ABSTRACT
| |
Objective To determine the attitudes, feelings, and beliefs of mothers and pediatric
emergency department health care providers toward routine intimate partner
violence screening.
Methods This qualitative project employed focus groups of mothers who brought
their children to a children's hospital emergency department for care, and
physicians and nurses who staffed the same department. We held 6 ethnically
homogeneous mother focus groups (2 white, 2 African American, and 2 Latina)
and 4 provider focus groups (2 predominately female nurse focus groups and
2 physician groups: 1 male and 1 female). Professional moderators conducted
the sessions using a semistructured discussion guide. All groups were audiotaped
and videotaped, and tapes were reviewed for recurring themes.
Results A total of 59 mothers, 21 nurses, and 17 physicians participated. Mothers
identified intimate partner violence as a common problem in their communities,
and most remarked that routine screening for adult intimate partner violence
is an appropriate activity for a pediatric emergency department. However,
many expressed concern that willingness to disclose might be affected by a
fear of being reported to child protective services. They stressed the importance
of addressing the child's health problem first, that screening be done in
an empathetic way, and that immediate assistance be available if needed. Themes
identified in the provider groups included concerns about time constraints,
fear of offending, and concerns that unless immediate intervention was available,
the victim could be placed in jeopardy. Many said they would feel obligated
to notify child protective services on disclosure of intimate partner violence.
Conclusions Intimate partner violence screening protocols in the pediatric emergency
department should take into consideration the beliefs and attitudes of both
those doing the screening and those being screened. Those developing screening
protocols for a pediatric emergency department should consider the following:
(1) that those assigned to screen must demonstrate empathy, warmth, and a
helping attitude; (2) the importance of addressing the child's medical needs
first, and a screening process that is minimally disruptive to the emergency
department; (3) a defined, organized approach to assessing danger to the child,
and how and when it is appropriate to notify child protective services when
a caregiver screens positive for intimate partner violence; and (4) that resources
must be available immediately to a victim who requests them.
INTRODUCTION
INTIMATE PARTNER violence (IPV), commonly called domestic violence,
is a critical but underaddressed health care issue in the United States. An
estimated 2 to 4 million women are physically abused each year, and IPV occurs
in as many as 1 of every 4 households.1 Intimate
partner violence occurs twice as often in households with children.2 There is a direct connection between IPV and child
health and development. The children of abused women are 6 to 15 times more
likely to be abused, with concordance rates between child and maternal abuse
thought to be as high as 77%.3-5
An estimated 3 to 10 million children are exposed to violence occurring between
their parents each year, causing significant social, emotional, behavioral,
and cognitive problems.4-6
Increased recognition of the IPV problem has prompted professional organizations7-9 and regulatory agencies10 to recommend or mandate routine IPV screening in
health care settings. The American Academy of Pediatrics (Elk Grove Village,
Ill) has stressed the importance of the problem, stating that "the abuse of
women is a pediatric issue," and encouraging the screening of mothers in pediatric
settings.7 In particular, the pediatric emergency
department (PED) has been identified as an important place to screen for IPV.3
Despite the importance of the problem, and policy statements encouraging
screening, it is estimated that few screening protocols for PEDs exist, with
one study finding only 4.2% of programs with specific IPV protocols in place.3 Barriers to screening in adult emergency departments
and clinics have been identified, and they include health care providers'
attitudes concerning time constraints, fear of offending, lack of education,
and lack of resources.11-12 A
single survey examined additional possible barriers in a PED and found that
lack of training, lack of experience, and a feeling that responding to IPV
was not in the purview of pediatrics.3
Successful planning, implementation, and evaluation of an IPV screening
and education program should take into account the attitudes and beliefs of
those doing the screening and those being screened. Focus groups are particularly
useful as a first step in developing such an understanding. Additionally,
they serve to provide information for generating hypotheses for later quantitative
studies such as surveys or observational studies.
The goal of this study was to identify the barriers and opportunities
for IPV screening in a PED. Specifically, we sought to explore the attitudes,
beliefs, and feelings toward routine IPV screening of those potentially being
screened, mothers who bring their children to the PED for care, as well as
physicians and nurses who staff the PED.
SUBJECTS AND METHODS
Subjects for the health care provider (HCP) focus groups included full
or part-time physician and nursing staff members of the Children's Mercy Hospital
(Kansas City, Mo) emergency department, a high-volume (57 000 visits
per year) department in an urban Midwestern children's hospital. Nursing students,
medical students, and resident physicians were not included. Two focus groups
of nurses and 2 physician groups were conducted. Emergency nurse practitioners
were included in the physician group because of similarities in their duties.
All participants spoke English, and participation was voluntary. Each group
consisted of 7 to 11 participants. Recruitment of HCP groups was done by e-mail
invitation, wall posters, and word of mouth. Additionally, the primary investigator
(M.D.D.) or study coordinator (J.S.-R.) made announcements about the focus
groups in staff meetings. Each participant was given $50 compensation for
his or her time, and participation in the focus groups was done during nonwork
hours.
Subjects for the mothers group included any woman 18 to 65 years of
age who was the current primary care giver of at least 1 child and had at
some time brought a child to the Children's Mercy Hospital emergency department
for care. For the purpose of this study, "mothers" included foster or adoptive
mothers as well as female family members raising children. Participants spoke
either English or Spanish, and participation was voluntary. Six mother groups
where held (2 African American, 2 white, and 2 Latina); each group was composed
of 9 to 12 participants. Recruitment was accomplished via wall posters in
the emergency department. Along with contact information and place and time
details, the posters stated that the goal of the focus groups was to help
the emergency department staff best plan for a family violence prevention
program. Each participant was given $50 compensation for her time. Written
informed consent was obtained, and the University of Missouri institutional
review board approved the study.
Focus groups were conducted in May 2001 by a research team from Lisboa
Inc, a professional qualitative research group based in Washington, DC. Groups
were conducted according to a semistructured format with the moderator using
a discussion guide composed of open-ended questions. Each focus group lasted
approximately 90 minutes and was videotaped and audiotaped. All groups except
one were conducted in English by the chief moderator. One of the mothers groups,
composed of women whose primary language was Spanish, was conducted in Spanish
by a Spanish-speaking moderator.
All focus groups were held in a nonclinical meeting room on the hospital
property and followed a similar format. The moderator introduced himself or
herself to the participants, described the purpose of the group, and alerted
those in attendance to the presence of the videocamera. Through the use of
the discussion guide, participants were directed to discuss specific topic
areas related to the subject of IPV. For mothers, these topic areas included
(1) knowledge, beliefs, and attitudes toward IPV in general; (2) reactions
to IPV screening in the PED; (3) concerns about IPV screening in the PED;
and (4) ideas on methods and logistics of screening. For providers, a similar
discussion guide was followed and explored, including (1) knowledge, beliefs,
and attitudes toward IPV in general; (2) clinical experiences with IPV; (3)
reactions to IPV screening in the PED, including concerns and logistics; and
(4) current comfort level with knowledge about IPV and attitudes toward learning
more about IPV.
The focus group moderator notes, as well as the audiotapes and videotapes,
were the major sources of information for the study. The tapes were reviewed
first by the chief moderator, who developed structured, topline summaries
of the discussions for the following purposes: (1) to understand participants'
attitudes and feelings about IPV and screening in a PED; (2) to identify common
themes among participants and groups; and (3) to identify areas of disagreement
among the study participants. The primary investigator (M.D.D.) and the study
coordinator (J.S.-R.) reviewed the summaries to uncover possible areas of
interpretative disagreement. No major areas of disagreement between the chief
moderator and the investigators were discovered. In this article, primary
recurring themes with direct illustrative participant quotes are presented.
RESULTS
MOTHERS
A total of 59 women participated in the focus groups: 20 African American,
19 white, and 20 Latina. Results of the focus group discussion are grouped
into 4 topical areas:
1. Recognition of the IPV problem and its effect on
children. Women identified IPV as a significant problem in their community,
and many spontaneously communicated personal experiences with IPV. Participants
identified that exposure to IPV has numerous effects on children, and many
added that they consider exposure to IPV as a form of child abuse or neglect.
The identified effects on children included withdrawn behavior, difficulty
expressing feelings, anger, depression, low self-esteem, and learning to continue
the cycle of violence. "A child grows up in this and doesn't know what to
do if the tension's not there." "They'll repeat what they've seen. They don't
know how to handle it any other way."
2. Support
for IPV screening in the PED. Mothers remarked that they thought the
PED was a good place to ask about IPV. "Battered women want to feel cared
for. So if they know that they are getting excellent care for their
kids . . . why not come here and feel safe for your care for yourself." "You are
bringing your child in and at the same time you have the opportunity to get
some help."
3. Concerns identified. Many women felt that
questions about IPV in the PED might be interpreted as a search for
child abuse, and they feared that disclosure might lead to a report to
child protective services (CPS) (Table 1). "Everything is not
abuse, but sometimes the hospital doesn't look at it that way."
"When I was in an abusive relationship it would have been a problem
because I was always trying to hide it. If someone would have asked me
I would have said `yes, I'm doing fine,' because I would have been
afraid that my kids would have been taken away from me. You believe
you're the only person in world who can protect your kids."
|
|
|
|
Identified Concerns for Routine Screening of Parents for Intimate Partner Violence
in a Pediatric Emergency Setting
|
|
|
Women stated that understanding why the
hospital staff was asking about IPV was very important, and that the reason for asking be
communicated first. "Tell the truth. Domestic violence is on the rise
and the hospital has taken an interest in this and we want to do
whatever is possible to help victims of this." "Let us know you
want to help the situation." "When the conversation begins, it
should start with mention of a service; offering a chance to talk about
and look over the program."
4. Considerations on screening
methods/logistics. Participants mentioned that those doing the
screening should show warmth, understanding, and empathy during the
questioning. "I don't mind being asked sensitive questions if they
show concern when I first come in." "Use a nonaccusatory tone of
voice." "Be supportive, caring, and genuine." "Focus on helping."
Mothers discussed the importance of addressing the child's initial medical
problems prior to asking about IPV. They preferred that the screening questions
be asked after their child had received treatment. "You'd have to wait until
the mother's focus is no longer on the child." "Ask after the child has been
examined. He's going to be okay and you're at your comfort level."
Opinions on whether the screening should be done via a written questionnaire
or face-to-face were mixed. "If you're going to ask questions it should probably
be on paper." "I want to talk to you, not a clipboard." "I don't know who
would later read the questionnaire."
Lastly, mothers emphasized the importance of having services, including
shelter placement, immediately available to victims. One participant, a victim
of IPV, related her experience, underscoring this theme. "The day I opened
my mouth, I had to have a place to go. There's a good chance you'll die if
you talk. You are more scared than ever because you don't know what's going
to happen from then on."
Ethnic subgroup similarities far outweighed differences. The major themes
discussed above were common to all focus groups. One subgroup difference is
worth noting. African American women, in contrast to other subgroups, emphasized
that much of the problem with IPV, as well as other violence, stems from a
decline in spirituality in the family and community.
HEALTH CARE PROVIDERS
A total of 21 registered nurses (19 female and 2 male) and 17 physicians
(10 female and 7 male) took part in the focus groups. This represented 42%
of the department's total registered nursing staff (38% of the department's
female nurses and 100% of the department's male nurses) and 58% of the total
physician staff (53% of the department's female physicians and 70% of the
department's male physicians). Results of the focus group discussions are
grouped into 5 topical areas:
1. Recognition of the problem and its effect on children. Nurses and female physicians felt that IPV is prevalent in the community,
noting that behaviors they witnessed in the PED seemed suggestive of IPV at
home. Male physicians were less certain about the incidence and were less
aware of in-hospital episodes suggestive of IPV. A female nurse stated, "I've
seen situations where I've agonized because I know something is terribly amiss,"
and "You see it in the waiting room, so what do they do at home?" Providers
cited numerous behavioral and emotional correlates of childhood exposure to
IPV. Another quote from a female nurse: "Either they are very submissive because
they're afraid or very aggressive; there's no middle ground." A female physician
said, "It affects their perception of what's real and what should be. Younger
kids think that's the way it is."
2. IPV as a form
of child abuse or neglect. Most female physicians and nurses viewed
exposure to IPV as a form of child abuse, with some indicating that they would
feel obligated to report a child's exposure to IPV to CPS. Some of the male
physicians were reluctant to view IPV exposure as a form of child abuse, suggesting
that it be characterized as neglect. A female physician stated: "I would report
it because there's probably more going on than you'll pick up in the ED [emergency
department]," and "if I feel there is potential for harm [to the child] I
have to let someone know." A male physican stated: "I don't think witnessing
IPV falls under the classic definition of child abuse that we are required
to report." A female nurse stated: "I think you should report it, but I don't
think it would do any good."
3. Attitudes toward
IPV screening and concerns identified. Time constraints were identified
as a major obstacle for all providers. Nurses were sensitive to the problem
of IPV, but said they already had too much to do and too little time to do
it. Physicians more openly questioned the use of emergency department time
and resources for IPV screening. A female nurse stated: "I would need more
time to deal with it. We have huge numbers of people in the emergency department
at any given time." A female physician stated: "There are bigger emergency
issues that need to be taken care of." A male physician stated: "How many
man-hours are wasted in the department every year? Will the cost of doing
the screening outweigh the benefit?" A female physician stated: "You could
really open up a Pandora's box."
Fear of offending caregivers was also a predominant theme among both
nurse and physician groups. Concerns were expressed that caregivers might
be reluctant to report true information because of fear that they would be
reported to CPS. A female physician stated: "These are personally sensitive
issues that people may not want you to ask them while they are here." A male
physician stated: "If you're not careful you're going to offend the hell out
of people." A male physician stated: "I could see a lot of people complain
and say, ‘What does this have to do with my child's illness; why are
you asking me this?'" A female physician stated: "They're afraid you might
report it and take their kids away." A female nurse stated: "The clientele
we have has had bad experiences with social workers and the police. The system
is punitive. We have to approach [screening] with, ‘We're not here to
give you one more bad experience with the Department of Family Services.'"
These concerns are presented in Table 1.
4. Considerations on screening methods
and logistics. Provider groups expressed concern that needed resources
for intervention in IPV, such as shelter placement, might not always be available,
and that they might be doing more harm than good if they uncovered the issue
but did not offer effective services for the caregiver. A female physician
stated: "It's irresponsible for us to initiate screening if we don't have
the staff and resources. Can we appropriately direct them and meet their needs?"
A male nurse stated: "If you ask me to do this, you've got to have something
to give me. When a woman is trying to leave her relationship, that's when
she is most vulnerable. We have to make sure that whatever we give her is
open to her needs." A female nurse stated: "Once you know there's a problem,
you want to have an intervention. We need to have resources."
Timing for screening was important; most thought it best that the
child's medical condition be attended to first. Screening during routine medical
intake, such as during the triage process, was not seen as appropriate. A
female nurse stated: "If you have a kid who is having trouble breathing and
you ask a social question during triage, I don't think that's good." Many
agreed that there should be a dedicated professional or paraprofessional assigned
to do the screening. Other providers mentioned that it might be more cost-effective
to educate parents and guardians via public information materials such as
posters and videos.
5. Comfort level with IPV and
openness to education. Most providers said they are not comfortable
with their current IPV knowledge level, but that they would be open to learning
more. Participants mentioned that credible teachers on the subject would be
victims of IPV, shelter staff, and law enforcement officers. A female nurse
stated: "We need more education. Women from battered shelters or shelter directors
could enlighten us on what we don't know."
COMMENT
We found more similarities in opinions expressed between the providers
and the mothers than was expected. Mothers viewed IPV as a problem prevalent
in the community, and were uniformly supportive of the idea of IPV screening
in a PED; however, they mentioned several concerns. A dominant concern was
that screening might be perceived as a search for child abuse, especially
if it wasn't clear why the question was being asked. Additionally, screening
would be seen as inappropriate if the child's medical needs were not addressed
first and if there was not assistance (eg, shelter placement, orders of protection)
readily available for the IPV victim. Physicians and nurses expressed opinions
that were consistent with the mothers' views. They felt that those being screened
could be offended if the question asked was interpreted as a screen for child
abuse. Similar to the mothers, they felt that the child's medical needs should
come first, and that readily available resources for victims must be in place.
Additionally, providers identified time constraints and lack of education
about IPV as barriers to screening.
This is one of the only studies examining attitudes of mothers and providers
on the idea of screening for IPV in a PED or urgent care setting, so it is
difficult to make comparisons with other studies. However, our findings are
consistent with similar work on IPV screening in other clinical settings.
Time constraints and fear of offending have been previously identified as
physician-related barriers to screening.13
The importance of HCP empathy has been identified in previous focus group
studies with female victims of IPV.14
This study identifies new findings of concern from both mothers and
HCPs regarding the relationship between IPV and child abuse, as well as the
legal and moral mandate to report a positive screen to CPS. Disclosure of
a child witnessing IPV as the sole reason to report to CPS is controversial
and the source of much medical and legal debate. Clearly, there is strong
evidence that IPV committed in the presence of a child may be harmful to that
child, and there is for many, a moral obligation to act on such information.
Legally, there may also be an obligation for a mandated reporter to notify
CPS. Statutory definitions of child abuse and neglect vary widely from state
to state, and several now include the witnessing of acts of IPV in their definitions
of child endangerment or abuse.15 (The current
study took place in an institution that treats children from Kansas and Missouri—states
that do not specifically include witnessing of IPV in their definitions of
child maltreatment.) However, defining child exposure to IPV as neglect or
maltreatment may imply that the victims are neglectful parents, or that they
could have stopped the abuse. Child protection systems do not always have
the capacity to intervene appropriately to ensure the safety of both the child
and the mother in situations involving IPV. Lastly, the practice of routinely
reporting IPV incidents occurring in the presence of children may discourage
victims from seeking help.
As mandated reporters, pediatric HCPs should be familiar with and follow
their local child abuse reporting laws. Most importantly, regardless of legal
obligation, a positive IPV screen should prompt a thorough assessment of risk
to the child. This assessment should include inquires about injury or abuse,
or threats to the child; the current safety of the home; and whether the mother/victim
can adequately protect the child. Answers to these questions will help the
HCP make a decision about imminent risk of harm to the children. If the risk
is not determined to be currently dangerous, the provider can refer the victim
and her children to battered women's services, counseling, or child-focused
services. In the event of a legal mandate or imminent risk, a report should
be made to CPS, and the provider should inform the nonoffending parent of
the obligation to report.
The mixed reaction of mother participants to face-to-face vs written
screening brings up another area of controversy—that of documentation
of IPV in the pediatric setting. Opposition to a notation of a positive IPV
screen in the child's medical record may relate to the batterer potentially
having access to the record. On the other hand, such information may be important
for other providers who work with the family in the future. Evidence is currently
lacking on the consequences or benefits of such written documentation in the
child's medical record. Alternatives include creating a separate record for
the mother/victim, maintaining a section of the child's record that is not
released with the rest of the medical record, and using nonspecific terms
to document IPV.
Because this is a qualitative study, it cannot be generalized to other
settings. Also limiting generalizability, is the fact that participants all
worked in or brought their children to a large inner-city PED. It is likely
that many of the participants in both the mother and the provider groups had
some form of direct experience with the public welfare system or CPS, which
may have significantly shaped their attitudes. Additionally, since the poster
announcing the study mentioned family violence, participants volunteering
for the study might have had experience with, or specific opinions about,
family violence; so a potential for selection bias exists. To maintain privacy,
we did not specifically ask participants about their personal experiences.
Because of the small number of male nurses, we were not able to hold a male-only
nurse group, which did not allow us to compare gender differences across groups.
Another study limitation is that the focus groups did not explore whether
or not it is appropriate to screen in front of children, and if so, at what
age? Previous authors have identified this as a major dilemma for which there
are numerous opinions.16
Despite the limitations of this study, those developing an IPV screening
protocol in a PED, particularly an urban one, should consider the concerns
and themes elicited here. It seems that in this urban PED, there are 4 main
conditions to enhancing the acceptability of a screening program. (1) Screeners
should demonstrate empathy, warmth, and a helping attitude. Critical to the
approach is framing the screening question in a manner that indicates why
it is being asked. (2) Screening methods should recognize the priority of
the child's medical care and be minimally disruptive to the emergency department.
(3) There should be a defined, organized approach to assessing danger to the
child, and how and when it is appropriate to notify CPS when a caregiver screens
positive. (4) Resources must be immediately available to a victim who requests
them.
Future studies that quantify some of the topics raised in the focus
groups would be helpful by testing hypotheses and determining whether the
concerns are generalizable. Research in other demographic settings would also
be useful to understand whether attitudes are typical.
| What This Study Adds
Understanding the concerns and fears of both those being screened and
those doing the screening will enhance the acceptability and effectiveness
of an IPV screening protocol in a PED. To our knowledge, this study is among
the first to qualitatively explore attitudes, beliefs, and feelings of both
mothers and HCPs on the topic of IPV screening in a PED. Those developing
screening protocols in pediatric emergency departments should consider the
following: (1) that the screener must demonstrate empathy, warmth, and a helping
attitude; (2) the importance of addressing the child's medical needs first
and a screening process that is minimally disruptive to the emergency department;
(3) that the disclosure of IPV should not routinely
be viewed as an automatic report to CPS; a thorough assessment of danger to
the child should be performed; and (4) that resources must be available immediately
to a victim who requests them.
|
|
AUTHOR INFORMATION
Accepted for publication October 8, 2001.
This study was funded in part by Public Health Service grant 1 H34 MC
0010601 from the Maternal and Child Health Bureau (Health Resources and Services
Administration), US Department of Health and Human Services, Washington, DC.
Corresponding author: M. Denise Dowd, MD, MPH, Division of Emergency
Medicine, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108
(e-mail: ddowd{at}cmh.edu).
From the Division of Emergency Medicine, Children's Mercy Hospital,
Kansas City, Mo (Drs Dowd, Knapp, and Kennedy, and Ms Stallbaumer-Rouyer),
and the Department of Pediatrics, University of Missouri–Kansas City
(Drs Dowd, Knapp, and Kennedy).
REFERENCES
| |
1. Novella AC, Rosenberg M, Salzman L, Shosky J. From the Surgeon General Report: US Public Health Service. JAMA. 1992;267:3132.
FREE FULL TEXT
2. Fantuzzo J, Boruch R, Beriama A, et al. Domestic violence and children: prevalance and risk in five major US
cities. J Am Acad Child Adolesc Psychiatry. 1997;36:116-122.
FULL TEXT
|
ISI
| PUBMED
3. Wright RJ, Wright RO, Issac N. Response to battered mothers in the pediatric emergency department:
a call for interdisciplinary approach to family violence. Pediatrics. 1997;99:186-192.
FREE FULL TEXT
4. Garbarino J, Kostelny K, Bubrow N. What children can tell us about living in danger. Am Psychol. 1991;46:376-383.
FULL TEXT
| PUBMED
5. Zuckerman B, Augustyn M, Groves BM, Parker S. Silent victims revisited: the special case of domestic violence. Pediatrics. 1995;96:511-513.
FREE FULL TEXT
6. Wolfe DA, Korsch B. Witnessing domestic violence during childhood and adolescence: implication
for pediatric practice. Pediatrics. 1994;94:594-599.
ABSTRACT
7. American Academy of Pediatrics Committee on Child Abuse and Neglect. The role of the pediatrician in recognizing and intervening on behalf
of abused women. Pediatrics. 1998;101:1091-1092.
FREE FULL TEXT
8. American Medical Association. Diagnostic and Treatment Guidelines on Domestic Violence. Chicago, Ill: American Medical Association; 1992.
9. American College of Obstetricians and Gynecologists. The Obstetrician-Gynecologist and Primary-Preventive
Health Care. Washington, DC: American College of Obstetricians & Gynecologists;
1993.
10. Joint Commission on Accreditation of Healthcare Organizations. Accreditation Manual for Hospitals: Standards. Vol 1. Oakbrook Terrace, Ill: Joint Commission on Accreditation of
Healthcare Organizations; 1992:21-22.
11. Gremillion DH, Kanof EP. Overcoming barriers to physcian involvement in identifying and referring
victims of domestic violence. Ann Emerg Med. 1996;27:769-773.
FULL TEXT
|
ISI
| PUBMED
12. McGrath ME, Bettacchi A, Duffy SJ, Peipert JF, Becker BM, St Angelo L. Violence against women: provider barriers to intervention in emergency
departments. Acad Emerg Med. 1997;4:297-300.
ISI
| PUBMED
13. Sugg NK, Inui T. Primary care physician's response to domestic violence: opening Pandora's
box. JAMA. 1992;267:3157-3160.
FREE FULL TEXT
14. Rodriguez MA, Quiroga SS, Bauer HM. Breaking the silence: battered women's perspectives on medical care. Arch Fam Med. 1996;5:153-158.
FREE FULL TEXT
15. National Clearinghouse on Child Abuse and Neglect Information Web site. Child abuse and neglect state statutes elements, No. 41: child witnesses
to domestic violence; 2001. Available at: http://www.calib.com/nccanch/pubs/stats01/childwit/index.cfm. Accessed February 2, 2002.
16. Zink T. Should children be in the room when the mother is screened for partner violence? J Fam Pract. 2000;49:130-136.
ISI
| PUBMED
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Implementation of Universal Screening for Domestic Violence in an Urgent Care Community Health Center
Thurston et al.
Health Promot Pract 2009;10:517-526.
ABSTRACT
Impact of Intimate Partner Violence on Children's Well-Child Care and Medical Home
Bair-Merritt et al.
Pediatrics 2008;121:e473-e480.
ABSTRACT
| FULL TEXT
Mothers' Comfort with Screening Questions about Sensitive Issues, Including Domestic Violence.
Zink et al.
J Am Board Fam Med 2006;19:358-367.
ABSTRACT
| FULL TEXT
Screening for Intimate Partner Violence Using an Audiotape Questionnaire: A Randomized Clinical Trial in a Pediatric Emergency Department
Bair-Merritt et al.
Arch Pediatr Adolesc Med 2006;160:311-316.
ABSTRACT
| FULL TEXT
Evaluation of a Curriculum for Intimate Partner Violence Screening in a Pediatric Emergency Department
Knapp et al.
Pediatrics 2006;117:110-116.
ABSTRACT
| FULL TEXT
Physician Knowledge and Management of Children Exposed to Domestic Violence in Ohio: A Comparison of Pediatricians and Family Physicians
Zink et al.
CLIN PEDIATR 2005;44:211-219.
ABSTRACT
Intimate Partner Violence and Physical Health Consequences: Policy and Practice Implications
Plichta
J Interpers Violence 2004;19:1296-1323.
ABSTRACT
Screening for Domestic Violence in a General Pediatric Clinic: Be Prepared!
Holtrop et al.
Pediatrics 2004;114:1253-1257.
ABSTRACT
| FULL TEXT
What Are Providers' Reporting Requirements for Children Who Witness Domestic Violence?
Zink et al.
CLIN PEDIATR 2004;43:449-460.
ABSTRACT
Screening Women and Elderly Adults for Family and Intimate Partner Violence: A Review of the Evidence for the U.S. Preventive Services Task Force
Nelson et al.
ANN INTERN MED 2004;140:387-396.
ABSTRACT
| FULL TEXT
Screening Children for Family Violence: A Review of the Evidence for the US Preventive Services Task Force
Nygren et al.
Ann Fam Med 2004;2:161-169.
ABSTRACT
| FULL TEXT
How Children Affect the Mother/Victim's Process in Intimate Partner Violence
Zink et al.
Arch Pediatr Adolesc Med 2003;157:587-592.
ABSTRACT
| FULL TEXT
OTHER ARTICLES NOTED (Nov 01 to 18 Oct 02)
Evid. Based Nurs. 2003;6:e1-1.
FULL TEXT
Understanding and Preventing Violence in Children and Adolescents
Rivara
Arch Pediatr Adolesc Med 2002;156:746-747.
FULL TEXT
|
