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Examining Cases of Child Physical Abuse Evaluations to Identify Opportunities to Improve Intimate Partner Violence
Kelsey Gregory1, Amanda Fingarson1, Mary Clyde Pierce1
1Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA.
Insights
Social work screening for intimate partner violence (IPV) identified more cases in families evaluated for child physical abuse (PA) than standard pediatric emergency department (PED) triage screening. This highlights the importance of specialized screening in high-risk situations.
Area of Science:
- Pediatrics
- Public Health
- Social Work
Background:
- Child maltreatment and intimate partner violence (IPV) are strongly associated.
- Universal IPV screening is recommended in pediatric settings, but its effectiveness in child physical abuse (PA) evaluations is understudied.
- Existing screening protocols in children's hospitals may not fully capture IPV in families undergoing PA evaluations.
Purpose of the Study:
- To compare the disclosure rates of IPV between universal screening during pediatric emergency department (PED) triage and specialized screening by social workers.
- To evaluate the efficacy of different IPV screening methods in families with children undergoing PA evaluations.
- To identify optimal screening strategies for detecting IPV in high-risk pediatric populations.
Main Methods:
- Retrospective chart review of 329 caregivers of children evaluated for PA in an urban tertiary PED.
- Comparison of caregiver IPV disclosures from "triage screening" versus "social work screening".
- Data included screening responses, interview settings, child injury details, and reported IPV experiences.
Main Results:
- Social work screening yielded significantly higher positive IPV disclosures (14.0%) compared to triage screening (4.3%, p < .001).
- Non-IPV violence concerns were noted in 35.7% of positive triage screens, but not in social work screens.
- Social work screening proved more effective in identifying IPV in this high-risk group.
Conclusions:
- Social work screening is more effective than universal triage screening for identifying IPV in families undergoing child PA evaluations.
- Specialized IPV screening by social workers is crucial in high-risk pediatric settings, irrespective of initial universal screening results.
- Findings can inform the development of improved IPV screening protocols for vulnerable populations.
Abstract:
The association between child maltreatment and intimate partner violence (IPV) is well supported. Universal IPV screening has been recommended by the American Academy of Pediatrics and the United States Preventative Task Force, and many children's hospitals have established screening protocols. However, the yield and best screening method in families undergoing a child physical abuse (PA) evaluation have not been fully explored. To determine if there is a discrepancy in IPV disclosures between universal IPV screening completed during pediatric emergency department (PED) triage ("triage screening") and IPV screening by a social worker ("social work screening") in families of children who were evaluated for PA. Caregivers of children who presented to an urban tertiary PED and underwent an evaluation for PA via a child abuse pediatrics consult. A retrospective chart review was completed. Data collection included: caregiver responses to both triage screening and social work screening, interview setting details and participants, the child's injuries, and details of the family's reported IPV experiences. Our study (N = 329) revealed that social work screening produced significantly more positive IPV disclosures than triage screening (14.0% vs. 4.3%, p < .001). Additionally, non-IPV violence concerns were identified in 35.7% (n = 5) of the positive triage screens, whereas social work screens had none. These results highlight the benefits of IPV screening by social work in high-risk scenarios, such as child PA evaluations, regardless of universal IPV screening results. Exploring differences between the two screening methods can inform decisions about screening protocols to improve IPV identification in high-risk populations.
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