If we don't ask, they aren't going to tell: Screening for domestic violence

September 1, 2005

Let all the families you care for know that domestic violence is an issue of concern to pediatricians by screening for it-consistently. Here's how to do that, and how to manage dilemmas that can arise as a result.

The abuse of women is a pediatric issue.

That is the first sentence of a position statement issued by the American Academy of Pediatrics (AAP) in 1998. The AAP statement, "The Role of the Pediatrician in Recognizing and Intervening on Behalf of Abused Women,"1 presented information about the impact of domestic violence on women and children and the obstacles a woman faces in disclosing that she is a victim of domestic violence. Importantly, one of the AAP's recommendations was that pediatricians in office practice "attempt to recognize evidence of family or intimate partner violence."

The AAP statement made a strong case for recognizing domestic violence but it did not offer specific guidelines for screening. Nor did it discuss the critical dilemmas that can arise when a provider implements screening protocols for domestic violence.

What is domestic violence? How common is it?

The term "domestic violence" has been used to describe any act of violence between family members, including child abuse, elder abuse, sibling abuse, and adult partner violence. For purposes of this article, the term refers to acts of violence between adult intimate partners.

There are clinical and legal definitions of domestic violence. The generally agreed-on clinical definition is a pattern of behaviors in partner relationships that incorporates a range of abusive tactics that establish coercive control of one partner over the other. These behaviors may include verbal threats and emotional abuse as well as physical assault. The legal definition of domestic violence is generally more restrictive: specifically, threats or acts of physical or sexual violence, including rape.

It is estimated that 2 to 4 million women are victimized by intimate partner violence each year, with domestic violence occurring in as many as one in four American households.3 The economic costs of violence against women and children are estimated to exceed $200 billion annually.3 The estimates of numbers of children who witness domestic violence each year vary from 3.3 million to 10 million, depending on how "witnessing violence" is defined, the source of the interview, and the age of the child surveyed.4

Four studies deserve mention in making the case for the importance of screening in pediatric settings for domestic violence: