Approximately one in four children is exposed to caregiver intimate partner violence (IPV) in their lifetime. As children grow and develop in this type of environment, they face a higher risk of adverse physical, psychological and psychosocial effects.
Pediatricians are in a unique position to identify IPV occurring in the home, to evaluate and treat children exposed to IPV, and to connect families with local and national resources.
An updated AAP clinical report from the Council on Child Abuse and Neglect and Council on Injury, Violence and Poison Prevention provides guidance to the pediatrician on how best to support and advocate for IPV survivors and their children.
The report, Intimate Partner Violence: Role of the Pediatrician, is available at https://doi.org/10.1542/peds.2023-062509 and will be published in the July issue of Pediatrics.
New directions
IPV is defined as physical violence, sexual violence, stalking and/or psychological aggression (including coercive tactics) by a current or former intimate partner (e.g., spouse, boyfriend or girlfriend, dating partner or ongoing sexual partner). It also includes other aspects of intimidation and control, including financial (e.g., ruining credit, taking money) and immigration-related abuse (e.g., threatening to reveal a partner’s status).
In addition to guidance to help recognize and respond to IPV in the pediatric setting, three key aspects of the updated report are new and noteworthy for pediatricians.
Endorsement of a universal education approach to identify IPV
A universal education approach prioritizes social connection and resource provision over simply trying to elicit a disclosure of IPV through a traditional screening model.
Parents and caregivers routinely are provided with brief education and resources on IPV across a variety of health care settings. Conversations about IPV are normalized, and an environment is established in which a parent or caregiver has the opportunity to disclose IPV only if he/she feels safe and comfortable doing so.
Confidentiality, Universal Education and Empowerment, and Support (CUES) is one approach that allows a caregiver to access resources without having to disclose IPV to the pediatrician. The CUES model has been shown to be feasible and acceptable in various settings, including school- and college-based health centers, family planning clinics and emergency departments.
Discussion of IPV and intersecting structural oppressions
The updated report summarizes previously discussed challenges in the assessment of IPV, including barriers for the pediatrician and the caregiver. New to this update is a discussion on the unique barriers experienced by IPV survivors from marginalized communities.
Although there is much to learn about how implicit and explicit biases impact the experiences of survivors, it is clear that policies and practices rooted in racism and fear have significant impact on IPV disclosure, accessing of resources and treatment, and interactions with the legal system.
Also highlighted is the need for pediatricians to engage with culturally specific agencies and programs, many of which serve marginalized groups of survivors, to maximize opportunities for impact.
Systems-level processes within health care to address IPV
The updated report includes more detail on successfully and safely leveraging the electronic health record for IPV identification, referrals and systems-level improvement. Information on documentation, including considerations in light of the 21st Century Cures Act, is mentioned.
General guidance
- Consider incorporating the universal education approach in practice or screening with a validated tool to identify IPV.
- Adhere to developmental screening guidelines for children at risk of or exposed to IPV.
- Intervene in a sensitive and skilled manner that validates the lived experiences of IPV survivors and maximizes safety for the child and caregiver.
- Remain aware of local IPV laws.
- Advocate for and support local and national multidisciplinary efforts to recognize, treat and prevent IPV.
- Identify opportunities to improve IPV education in residency training programs and continuing medical education programs.
Dr. Thackeray is a lead author of the clinical report.
Resources
- The clinical report offers resources, including screening instruments
- AAP resources on intimate partner violence, https://bit.ly/3WJAfWI, and trauma-informed care, https://bit.ly/45EDeDX
- CUES: Confidentiality, Universal Education, Empowerment and Support
- Information for parents from HealthyChildren.org on intimate partner violence
