“Physicians, especially pediatricians, can play a big role in identifying adolescents experiencing intimate partner violence, talking to them about healthy relationships and being able to refer them to appropriate services,” Adhia says. “They can ask their adolescent patients about their relationships and look for signs of mental health problems or problems in school or socially that commonly result from intimate partner violence. Physicians should be prepared to respond appropriately and know about community-based resources that they can refer to if an adolescent discloses intimate partner violence to them.”
Adhia says she hopes that the study will increase awareness about intimate partner violence and its prevalence, as well as the long-lasting mental and physical health consequences. Physicians, in particular, should keep this on their radar when talking to adolescent patients, and know the right resources and services for referrals should these teenagers need help getting out of an abusive relationship, she says.
“Routine office-based intimate partner violence screening for all women of childbearing age is recommended by the US Preventive Services Task Force, so making screening a regular part of doctors’ visits is critical,” Adhis says. “Building trust with patients so that they feel comfortable disclosing and presenting themselves as compassionate and trustworthy is important. They may want to have information readily available and visible in the office so patients know it is a safe place to talk about this issue. It’s also important to respect a patient’s confidentiality and not force a patient to disclose intimate partner violence if they are not ready or do not want to do so.”
Assess for dating violence
Megan Bair-Merritt, MD, MSCE, a pediatrician and researcher at Boston Medical Center and associate professor, Pediatrics, at Boston University School of Medicine, Massachusetts, wrote a companion editorial to Adhia’s study, outlining the need for specific strategies and interventions in cases of intimate partner violence among teenagers.2 She says she hopes the study and editorial will help pediatricians understand the importance of their role in preventing and intervening in intimate partner violence.
“I hope that pediatricians recognize their important role in discussing healthy and unhealthy romantic relationships at each adolescent well-child visit. Pediatricians are a valued and important source of support and information for adolescents and their families,” Bair-Merritt says. “Pediatricians also have a role in advocating for local, state, and federal policies to better support and protect adolescents in violent relationships.”
Finding the time to counsel teenagers can be a challenge, Bair-Merritt notes. “While time is always an issue, I do think it is critical to assess for dating violence at adolescent well visits, given its prevalence and adverse health impact,” she says. “Depending on the practice, social workers and other members of the healthcare team may be able to work together to assess and respond to dating violence.”
There are numerous resources to help clinicians provide counseling to teenagers, including Futures Without Violence, the Centers for Disease Control and Prevention, Love is Respect, and the One Love Foundation.
“Pediatricians often have longitudinal relationships with adolescents, and adolescents view pediatricians as a trusted source of information about romantic relationships. I hope that pediatricians provide early guidance about healthy and unhealthy romantic relationships, ideally starting when children are aged between 9 and 11 years, and have this conversation at each well-child visit,” Bair-Merritt says. “Pediatricians also should routinely ask their adolescents about dating violence—defined widely to include not just physical and sexual violence but also emotional and cyber abuse—and support them, and ensure connection with resources, if there are concerns.”
1. Adhia A, Kernic MA, Hernenway D, Vaviliala MS, Rivara FP. Intimate partner homicide of adolescents. JAMA Pediatrics. 2019;173(6):571-577.
2. Kistin CJ, Rothman EF, Bair-Merritt MH. Deadly adolescent intimate partner violence and the need for youth-specific strategies for effective intervention. JAMA Pediatrics. 2019;173(6):524-525.