1998-1999 indexDistributed May 27, 1999
Pediatric emergency rooms a place to identify adult abuse victims
In a recent study by Brown University researchers, more than half of 157 women who sought emergency care for children aged 3 or younger were themselves victims of domestic abuse. The findings underscore the importance of intervention in that setting.
PROVIDENCE, R.I. -- Mothers seeking care for their young children in pediatric emergency departments are often victims of domestic violence. That finding underscores the importance of using pediatric emergency sites to identify adult victims of domestic violence and offer services, according to a new study by Brown University researchers.
Of 157 women who sought emergency care for a child 3 or younger in the study, 52 percent reported a history of adult physical abuse and 21 percent reported adult sexual abuse. Yet most of the women - 79 percent - had never been screened for domestic violence by any health care provider. The findings were published in the May issue of Pediatrics.
Providing routine screening to mothers in pediatric emergency departments may prove beneficial to the health and well-being of pediatric patients and help physicians and nurses learn to identify adult victims, says lead study author Susan J. Duffy, M.D., assistant professor in the Brown University School of Medicine. Violence to mothers places children at risk for both abuse and for the psychological trauma of witnessing violence.
Researchers surveyed mothers at Hasbro Children's Hospital Pediatric Emergency Department in Providence in 1996. Only mothers of infants and toddlers - those unlikely to understand the context of the discussions - were asked to participate. Women were also excluded if older children or partners were present or if their child was critically ill.
Mothers who reported abuse often said the abuser was a close relative who had regular contact with their children. Intimate partners perpetrated 67 percent of physical abuse and 55 percent of sexual abuse. Seventy-three percent of the perpetrators of physical abuse in the last year, and 10 percent of the perpetrators of sexual abuse, had regular contact with the victims' children.
However researchers did not find any relationship between the types of medical complaints that brought the children to the emergency room and the mother's history of physical or sexual abuse. Most of the children accompanying the women to the emergency department were evaluated for illness rather than injury.
Mothers may select emergency departments for their child's medical care for the same reason they prefer emergency departments for themselves, researchers say: anonymity. Emergency departments provide unscheduled evaluations and treatments 24 hours a day by health professionals who rarely have ongoing relationships with the patients.
Few studies have looked at the prevalence of domestic violence against the mothers who bring their children to the pediatric emergency room, said Duffy. But the findings parallel those previously reported in adult emergency department surveys in which the participants were the patients themselves instead of the mother of the patient.
Part of the explanation for the findings lies in the demographics of those served by emergency departments, said Duffy. The population consists mainly of impoverished young mothers - a group that is at known risk for domestic abuse. The mean age of the women in the study was 27, most of whom earned less than $25,000 a year and had 3.5 children.
The true prevalence of family violence will be known only when women are questioned routinely and directly in a variety of confidential settings, said Duffy. The effectiveness of screenings also needs to be validated by outcome studies of victims who have access to services, she said.
The study at Hasbro Children's Hospital was one of three performed concurrently at local hospitals in 1996. Personnel at Rhode Island Hospital and Women & Infants Hospital in Providence also administered the survey with similar findings, said Duffy. Support for the project came from the Rhode Island Rape Crisis Center, the Rhode Island Coalition Against Domestic Violence, the Echoing Green Foundation, and the R.I. Department of Health Violence Against Women Prevention Project.######