Article Figures & Data
Figures
- Figure 1.
Analytic framework and key questions.
Tables
Author, Year No. Population and Settings Instruments Results Quality Rating and Limitations Self-administered questionnaires Stevens - Simon, 200144 262 Adolescents (13–19 y) in a maternity program at the University of Colorado Hospital In Denver (32% African American, 22% Hispanic, 92% Medicaid recipients, 94% unmarried) Kempe Family Stress Inventory (KFI) At 1 and 2 years, the KFI was the only significant predictor of maltreatment using multiple outcome measures (RR 8.41, 95% CI, 5.77–10; RR 5.19, 95% CI, 1.99–13.60) Good-fair Differential loss to follow-up CCAPR, 199645,46 287 Pregnant women at hospital obstetric clinics in 6 counties in Oahu (Hawaii Healthy Start) (mean age 23 y, 65% poor, 89% multicultural, 40% poor maternal mental health, 45% domestic violence in the home, 30% parental substance use, 28% no high school diploma) 2 step screening: 15 item Hawaii Risk Indicators Screening Tool (medical record or interview)
KFI
89% sensitivity and 28% specificity with high scores on the Child Abuse Potential (CAP) inventory Fair No abuse outcomes, high attrition Katzev, 199747 2,870 At-risk pregnant women from 12 counties in Oregon (Healthy Families) (72% single parents, 68% with story of child abuse or neglect, 57% less than high school education, 37% history of substance abuse, 29% 17 y or younger) 2 step screening: 15 item Hawaii Risk Indicators Screening Tool (medical record or interview)
If positive then, KFI
1,350 were given the KFI. Score was highly correlated with maltreatment rates (per 1000 children): 7 for low-risk scores, 18 moderate, 45 high, and 172 severe. Korfmacher52 reports sensitivity 97%, specificity 21% for scores in high-severe risk range Fair-poor Many confirmed reports were made by home visitors to high-risk homes Clinical staff-administered questionnaires Brayden, 199348 1,089 Pregnant women receiving prenatal care at Metropolitan Nashville General Hospital, Tennessee (<23 y, 60% single, 68% white, 25% unemployed) Maternal History Interview-2, open-ended questions, and subscales including parenting skills, personality, discipline philosophy, life stress, and others; high risk based on percentile scoring on subscales; 314 identified as high risk The Maternal History Inteview-2 predicted child abuse, but not neglect or sexual abuse. High-risk group 6.6% with child abuse reports compared with 2.3% in low-risk group in first 36 months (RR 3.02, 95% CI, 1.02–8.90) Poor Participation was low; requires trained interviewers Anderson, 199349 185 Abusive and nonabusive mothers recruited from a national sample of female nurses contacted through advertising and a mailing list Parenting Profile Assessment, 21-item nurse interview for the primary care setting; 38 (21%) scored as high risk 75% sensitivity, 86% specificity for self-reported abuse. Most sensitive to high stress and poor marital relationships Poor Only self-reports of abuse by mothers, no actual abuse measured or verified; small sample with only 15 self-reported abusers Clinician observation Leventhal, 199650 114 cases 114 controls Children at the Primary Care Center at Yale New Haven Hospital referred to the hospital’s child abuse committee from the postpartum ward by clinicians Clinician judgment of potential child abuse or neglect based on a number of criteria including parental substance use, income, social support, previous child abuse or neglect, and parenting behavior After controlling for baseline variables, 1.8-fold increase in the rate of subsequent hospitalizations of the high-risk children compared with others (P <.05) Poor Risk criteria not fully defined or standardized Author, Year No. and Study Type Population Child’s Age When Intervention Ended (Mo) Risk Assessment Significant Decrease in Abuse Measures Other Significant Effects* Quality Rating RCT = randomized controlled trial; X = significant relationship; 0 = studied but not significant; NA = not studied; HIV = human immunodeficiency virus; HRIS = Hawaii Risk Indicator Scale; KFI = Kempe Family Stress Inventory; CPS = Child Protective Services. *Other outcomes include injury, poisoning, hospitalizations, child development level, and others. Olds 198657 199454 199555 199756 RCT Pregnant women, first births (many teenagers, unmarried, low social class) small, semirural county in New York State 24 85% had 1 or more factors: age <19 y, single-parent status, low income Good Eckenrode, 200058 follow-up 2 y 400 X (P = .07) X 3 y 400 0 X 4 y 56 0 X 15 y 324 X X Kitzman, 199763 1,139 RCT Pregnant, low-income, minority women, most teenagers; public obstetric clinic in Memphis 24 First birth with at least 2 factors: unmarried, 12 y of education, unemployment status NA X Fair Black, 199461 43 RCT Drug using pregnant women (majority single, African American, multiparus, low education, low income, history of incarceration, urban) 18 Admitted using cocaine or heroin during pregnancy NA X Fair Barth, 199159 191 RCT Pregnant women in California with low income; 90% scored above mean on Child Abuse Potential Inventory (CAP) 6 Two or more positive responses to a list of criteria 0 NA Fair Marcenko, 199460 225 RCT Pregnant low-income minority women in Philadelphia 6 A history of at least 1 factor: substance abuse, homelessness, domestic violence, psychiatric illness, incarceration, HIV infection, lack of social support 0 X Fair Brooten, 198664 79 RCT Low birth weight infants 18 Weight <2,200 g 0 X Fair Siegel, 198062 331 RCT Pregnant women; mostly minority, low education, not married; North Carolina 12 None 0 0 Fair Cerny, 200167 142 Cohort Pregnant women at risk for child abuse or neglect; Tripler Army Medical Center 12 One or more positive responses to a list of criteria. 0 X Fair-poor Katzev, 199947 6,921 Cohort First-birth pregnant women; Oregon 36 HRIS, if high score, then KFI X X Fair-poor Brayden, 199348 1,082 RCT Pregnant women; Philadelphia 24 Risk factors: frequent moves, previous removal of children by CPS, abusive behavior, and high scores on the Life Stress Scale and Nurture Scale X NA Poor Dawson, 198966 172 Quasi- experimental Low-income pregnant women; Denver 24 None Increased reports NA Poor Flynn, 199968 137 Cohort Pregnant minority women; mostly teenagers; Newark 36 Based on clinical judgment 0 X Poor Gray, 197965 150 RCT Pregnant women; Denver 36 Based on clinical judgment Increased reports X Poor
Supplemental Appendixes
Appendix 1: Search strategies; Appendix 2: Study quality rating criteria; Appendix 3: Detailed results; Appendix 4: Screening instruments
Files in this Data Supplement:
- Supplemental data: Appendix 1 - PDF file, 1 page, .87 MB.
- Supplemental data: Appendix 2 - PDF file, 2 pages, .87 MB.
- Supplemental data: Appendix 3 - PDF file, 4 pages, 1.12 MB.
- Supplemental data: Appendix 4 - PDF file, 1 page, .87 MB.
The Article in Brief
Nygren and colleagues conducted a systematic review of relevant studies on screening children for family violence. They found that despite the prevalence of child abuse and neglect and its impact on health, there are few studies providing data on its detection and management to guide physicians. These findings provided evidence for the U.S. Preventive Services Task Force recommendation statement on Screening for Family and Intimate Partner Violence.
