Maternal domestic violence screening in an office-based pediatric practice

Background. Maternal domestic violence (MDV) screening by pediatricians is not well-studied. Objectives. To determine the practicality and dynamics of routine MDV scree ning in a private pediatric office and to determine the rate of MDV in Uppe r Cape Cod, Massachusetts. Setting. A 3-pediatrician, private pediatric office in Falmouth, Massachuse tts. Participants. Mothers of children aged 1 month to 10 years scheduled to und ergo a well-child visit between February 7 and July 7, 2000. Intervention. Completion of an 11-item questionnaire related to violence. Results. Seven hundred sixty-six families were scheduled for well visits. F ive hundred ninety-two eligible mothers presented to the office. Five hundr ed fifty-three completed questionnaires were returned (71.2%). The rate of MDV was 2.5% in current relationships (95% confidence interval [CI]: 1.4-4. 3), 14.7% in past relationships (95% CI: 11.9-18.0), and 16.5% overall (95% CI: 13.5-19.9). Increased incidence of MDV was associated with the following variables: 1) harm to a child (odds ratio [OR]: 57.3, 95% CI: 7.3-1232.4), 2) being in a relationship other than a first marriage (OR: 4.6, 95% CI: 2.7-7.8), 3) hav ing been previously asked about MDV (OR: 3.5, 95% CI: 2.1-6.1), 4) having 4 or more children (OR: 3.1, 95% CI: 1.6-6.1), 5) Women, Infants, and Childr en's program eligibility (OR: 3.0, 95% CI: 1.8-5.0), 6) having public insur ance (ie, Medicaid or Children's Medical Security Plan) (OR: 2.2, 95% CI: 1 .3-3.7), 7) a history of failure to present for a scheduled well-child visi t (no-show; OR: 2.0, 95% CI: 1.0-4.2) and 8) anonymous questionnaire comple tion (OR: 1.7, 95% CI: 1.0-2.9). Thirty-two and one-half percent (32/91, 95% CI: 25.6-46.0) of mothers with a history of MDV recall having previously been asked about this by a health professional, compared with 16.9% overall (93/551, 95% CI: 13.9-20.3). Eig hty-two and eight tenths (82.8) percent (457/552, 95% CI: 79.3-85.8) of mot hers favored pediatricians asking about MDV. Discussion. This information was gathered within the context of normal work hours in a busy office. No additional staff were required. Hence, routine MDV screening appears feasible. The results suggest that a documented history of child abuse in a family ma kes it very likely that the mother has also been abused. However, child abu se among abused mothers is probably underreported. Furthermore, because most mothers favor domestic violence screening, concer ns about lack of acceptance of maternal screening at pediatric visits seem to be unfounded. Screening may actually increase satisfaction with care. In addition, families who do not show up for appointments are at higher ris k. Therefore, screening only at well visits will miss an important group. Conclusions. Maternal domestic violence screening at well-child visits is p ractical in a private pediatric office setting. Current rates of screening are low; however, most mothers favor such screening. Furthermore, MDV scree ning should also be offered on a catch-up basis for those who miss well-chi ld visits, as is currently recommended for immunizations.