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Annals of Family Medicine 2:161-169 (2004)
© 2004 Annals of Family Medicine, Inc.
doi: 10.1370/afm.113
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Review

Screening Children for Family Violence: A Review of the Evidence for the US Preventive Services Task Force

Peggy Nygren, MA1, Heidi D. Nelson, MD, MPH1,2 and Jonathan Klein, MD, MPH3

1 The Oregon Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Ore
2 Medical Service, Veterans Affairs Medical Center, Portland, Ore
3 Department of Pediatrics, University of Rochester, Rochester, NY

CORRESPONDING AUTHOR: Heidi D. Nelson, MD, MPH, Oregon Health & Science University, Mail Code BICC 504, 3181 SW Sam Jackson Park Road, Portland, OR 97201, nelsonh{at}ohsu.edu.

ABSTRACT

BACKGROUND We wanted to evaluate the benefits and harms of screening children in primary health care settings for abuse and neglect resulting from family violence by examining the evidence on the performance of screening instruments and the effectiveness of interventions.

METHODS We searched for relevant studies in MEDLINE, PsycINFO, CINAHL, ERIC, Cochrane Controlled Trials Register, and reference lists. English language abstracts with original data about family violence against children focusing on screening and interventions initiated or based in health care settings were included. We extracted selected information about study design, patient populations and settings, methods of assessment or intervention, and outcome measures, and applied a set of criteria to evaluate study quality.

RESULTS All instruments designed to screen for child abuse and neglect were directed to parents, particularly pregnant women. These instruments had fairly high sensitivity but low specificity when administered in high-risk study populations and have not been widely tested in other populations. Randomized controlled trials of frequent nurse home visitation programs beginning during pregnancy that address behavioral and psychological factors indicated improved abuse measures and outcomes. No studies were identified about interventions in older children or harms associated with screening and intervention.

CONCLUSIONS No trials of the effectiveness of screening in a health care setting have been published. Clinician referrals to nurse home visitation during pregnancy and in early childhood may reduce abuse in selected populations. There are no studies about harms of screening and interventions.

Key Words: Domestic violence/prevention and control • child abuse • child neglect • review, academic • evidence-based medicine




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TRACK Comments:

Read all TRACK Comments

Looking Forward in Dealing With Child Abuse
Randell C Alexander
Annals of Family Medicine, 1 Apr 2004 [Full text]
Screening Children for Violence
Emalee G. Flaherty
Annals of Family Medicine, 4 Apr 2004 [Full text]
Evidenced Based Screening for Child Abuse and Family Violence: Experienced Based Caution
Andrew Sirotnak,MD
Annals of Family Medicine, 4 May 2004 [Full text]
Authors Respond to Comments on Screening Children for Family Violence: Clarifying the Scope of the Systematic Review
Peggy M Nygren, et al.
Annals of Family Medicine, 21 Jun 2004 [Full text]
Competing Priorities
Brian K. Crownover
Annals of Family Medicine, 27 Jun 2004 [Full text]

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