Domestic Violence and Children
Health professionals who care for children need to be alert to the possibility that children in their practice are living in homes where one or more of their caregivers are experiencing intimate-partner violence. Children who live in homes characterized by domestic violence are 15 times more likely to be victims of abuse or neglect themselves. Even if they are not directly victimized, they frequently experience severe psychological sequelae from being witnesses to it.
Domestic violence has been defined as coercive or abusive behavior, perpetrated by someone involved in an intimate or dating relationship, aimed at controlling the partner's behavior. The violence may consist of physical injury, psychological abuse, sexual assault, enforced isolation, or other actions such as stalking, intimidation, or threats.
Thirty to 60 percent of children who witness domestic violence are found to be the victims of abuse or neglect; in households where 50 or more episodes of domestic violence have been documented, 100% of the children have been found to be abuse victims. Other studies have demonstrated that home interventions to stop or prevent child abuse are completely ineffective if domestic violence is also taking place in the home.
Witnessing domestic violence may be as traumatic as experiencing it: 85% of children exposed to domestic violence but not directly abused develop moderate to severe symptoms of Post-Traumatic Stress Disorder, including sleep disturbances, hypervigilance, distractibility and poor concentration. Older children often develop tremendous guilt at not being able to defend the victimized parents, and may attempt to intervene, placing themselves at risk of serious injury or death.
The role of the pediatrician or child health provider in responding to domestic violence is legally unclear, since the adult victim is usually not the patient of the children's provider. However, the American Academy of Pediatrics and other child advocacy organizations have advocated that pediatricians implement some sort of screening for domestic violence in their practices, in view of its substantial impact on children. Further, the pediatric office is often the only interaction a victim has with health care professionals.
Most authorities currently recommend that pediatricians include a set of simple questions to be asked privately of all mothers of new patients, and at least once every year or two thereafter for mothers of established patients.
Examples of screening questions include:
- Have you ever been hurt or threatened by your spouse or partner?
- Do you ever feel afraid of your partner?
- Has your child ever witnessed a violent incident in your home or neighborhood?
The provider should have a prepared response if a parent responds affirmatively to the screening questions. That response should include one or more of the following steps:
- The parent should be provided with information about domestic violence (available from the local domestic violence crisis or resource center), and should be encouraged to contact that center as soon as possible.
- The provider should express his/her concern for the parent's safety. If she is not willing to discuss the situation, the provider should indicate he/she will be available in the future should she change her mind.
- The provider (or if available the clinic or hospital social worker) should attempt to assess the level of risk in the home. If the situation appears to be imminently dangerous (for instance, if there are firearms in the home or if the parent expresses fear that she or the children are in immediate danger), the parent should be discouraged from going home. Options include arranging transportation directly to the local crisis or resource center, or possibly admitting the child(ren) to the hospital until the situation can be stabilized.
- In nearly all instances, a report to Child Protective Services should be made, even if there is no overt evidence of child abuse or neglect. Many states, including Texas, accept reports of domestic violence for investigation, due to the extremely high risk it poses to involved children.
