Mothers' and health care providers' perspectives on screening for intimate partner violence in a pediatric emergency department

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.     

Mitigating the effects of gun violence on children and youth

Countless children and youth are exposed to gun violence each year--at home, at school, in their communities, or through the media. Gun violence can leave lasting emotional scars on these children. This article reviews research regarding the psychological effects of gun violence on children and youth, and offers suggestions for how parents, school administrators, and mental health workers can mitigate these negative effects. Children exposed to gun violence may experience negative short- and long-term psychological effects, including anger, withdrawal, posttraumatic stress, and desensitization to violence. All of these outcomes can feed into a continuing cycle of violence. Certain children may be at higher risk for negative outcomes if they are exposed to gun violence. Groups at risk include children injured in gun violence, those who witness violent acts at close proximity, those exposed to high levels of violence in their communities or schools, and those exposed to violent media. Parents, school administrators, and mental health workers all can play key roles in protecting children from gun violence and helping them overcome the effects of gun-related trauma. The authors recommend a number of strategies that adults can adopt to help children cope with gun violence, such as increasing parental monitoring, targeting services to youth at risk of violent activity, and developing therapeutic interventions to help traumatized young people.     

Exposure to violence and victimization and the use of violence by adolescents in the United States.

Violence by adolescents in the United States is of growing concern. Despite a decrease in the rate of violence and death by firearms, firearm injuries are the second leading cause of death among Americans age 15 to 24 and the third leading cause of death among 10- to 14-year-old children. Although there are many factors associated with the use of violence by youths, exposure to violence and victimization has consistently been a predictor of the use of violence, as well as intentions to use violence, carrying a gun, and having attitudes accepting of the use of violence and aggressive behavior to resolve conflict. Adolescents' families, friends, neighborhoods, schools, and the media provide sources of exposure and victimization related to the use of violence. The cultural transmission of deviant behavior theory establishes a framework for understanding the influence of exposure to violence and victimization from these sources on adolescents' use of violence.     

The impact of violence on children

Existing research on the effects of children's exposure to violence covers a broad range of community, family, and media violence. This research is relevant and useful to an examination of domestic violence in two key ways. First, understanding how exposure to various types of violence affects children and what best enables them to cope can point to important considerations when trying to help children cope with exposure to domestic violence in particular. And second, many families experiencing domestic violence are exposed to other types of violence as well. Exposure to violence on multiple levels can affect the parents' behavior and can compound the effects on children. This article begins with an overview of the extent of children's exposure to various types of violence, and then examines what is known about the effects of this exposure across the developmental continuum. Key protective factors for children exposed to violence are examined. Research indicates that the most important resource protecting children from the negative effects of exposure to violence is a strong relationship with a competent, caring, positive adult, most often a parent. Yet, when parents are themselves witnesses to or victims of violence, they may have difficulty fulfilling this role. In the final section, directions for future research are discussed.