Care must be taken in documenting IPV disclosure because the abusive parent often has access to the child’s chart and/or receives insurance statements. Dr. Randell offered several tips:
Use limited, coded documentation in the chart.
• Do not use IPV-related billing codes or mention the terms “domestic violence” or “IPV.”
• Do not use the word shelter or include notes about safety plans.
• Do not screen in the presence of verbal children, or children aged 3 years and older.
Children may inadvertently tell the abuser that mom has been talking to someone, she explained. “And it’s also probably bad for kids to hear mom denying [IPV] because it reinforces that this is a behavior that we keep secret and don’t talk about.”
Posters, pamphlets, and other environmental cues are an important layer for helping families who are experiencing IPV, largely because these items provide women with the opportunity to access resources without having to disclose IPV.
In focus groups at Children’s Mercy, mothers who had experienced or were experiencing IPV said they wanted information “not only on what IPV looks like … but about how it impacts kids, about resources, and about safety planning,” Dr. Randell said. “And they wanted things that are hopeful ... They don’t want to be labeled [as victims].”
There are several validated screening instruments for IPV (such as the Partner Violence Screen and the Woman Abuse Screening Tool), but the tools have significantly variable sensitivities and specificities and have not been studied in pediatric settings. General psychosocial screening tools used in pediatrics, such as the Pediatric Symptom Checklist and the Strengths and Difficulties Questionnaire, may provide clues of possible trauma, including IPV, she noted.
Among the resources recommended by Dr. Randell:
• The Harvard Center for the Developing Child (www.developingchild.harvard.edu).
• Futures Without Violence (www.futureswithoutviolence.org).
• AAP’s policy statement on IPV: pediatrics.aappublications.org/content/125/5/1094).