APA Recommends that docs start screening patients for violence.

["Portia Davis" <portia@xxxxxxxxxxxxx>]

Doctors to screen kids for violence

By Kristen Go
Denver Post Staff Writer

Mar. 7 - The next time you and your child visit a pediatrician, don't be
surprised if the doctor asks about spanking, how often your child sees
violence on television or if there has been violence in your home.

On Monday, the American Academy of Pediatrics recommended that doctors ask
those questions to help them recognize violence in the home or possible
indicators that a child might ultimately become violent.

It is the first time a medical organization has recommended that physicians
look at violence prevention during routine visits to the doctor.

"We've always known that violence has been a major health problem for
children, but it seems to be getting even more concerning every year," said
Dr. Jack Swanson, a member of the American Academy of Pediatrics who was on
the committee that made the recommendation.

The 53,000-member academy is the nation's largest organization for
pediatricians.

The academy said homicide and suicide have become the second- and
third-leading causes of death in teenagers. In 1995, children younger than
17 made 517,000 hospital emergency department visits for assault-related
incidents.

After doctors ask the questions, they may choose to follow up at later
visits or refer their patients to other agencies for follow-up help aimed at
preventing violence.

The last time the academy's recommendations - which also include guidelines
for care such as vision and hearing screening - were revised was in 1995.
Violenceprevention screening is not the only new recommendation this year.
However, Dr. Eric Cox, a member of the American Academy of Pediatrics, said
violence prevention is the most topical subject, especially since there have
been several high profile school shootings.

Cox said the organization began looking at pediatricians' role in the
prevention of violence in the home in the early 1990s.

The recommendation includes asking about a family's mental history, domestic
violence, gun ownership and beliefs on discipline. Studies have shown that
those questions could indicate potential violence in the home.

A recent report from the Massachusetts Department of Youth Services said
children who witness domestic violence are more likely to become sexual
perpetrators, commit an assault and attempt suicide.

The American Academy of Pediatrics also reports that family members are more
likely to cause violent injury or death than strangers.

Dr. Andrew Sirotnak, director of Kempe Child Protection Team at Children's
Hospital in Denver, said violence-prevention screening is definitely needed.

"Violence is a national problem, and it hasn't gone away," he said. "As
physicians, we should say, "Are we doing a good job (of prevention)?'- " Dr.
Howard Spivak of the New England Medical Center in Boston helped develop
some of the screening tools. He said there isn't a lot of research on the
scientific correlations between the factors identified by the screening
questions and actual commission of violent acts. However, he said, the
screening guidelines were based on up-todate research.

The screening tools address what doctors can look for at different stages of
a child's development.

"We're not going to reduce violence in this country if we just (remain)
reactive," Spivak said.

Dr. Patti Rosquist, a consultant in child abuse for Denver Health and
Hospitals, said she believes the new recommendations and guidelines will
help keep children safe. She said she was not involved in the
decision-making process.

Some of the screening tools may be seen as controversial, Rosquist said.

"A lot of people have strong feelings about handgun ownership and parents'
disciplinary practices," she said. "As a physician, I have to pay attention
to the research that shows there are risk factors to child violence.
Unfortunately, some of those risk factors include some of these
controversial topics." Dr. Paul Melinkovich, president of the academy's
Colorado chapter, also believes the recommendation will be helpful.

"We're learning more and more that this is an important area of screening,"
he said. "Unfortunately, when you're really busy seeing a whole bunch of
kids, you don't get around for screening everything."

Sally Holloway, executive director of the Denver Child Advocacy Center, said
she's glad that pediatricians are recognizing how much violence children are
exposed to. The Denver Child Advocacy Center helps families deal with child
abuse.

"We have got to wise up about the whole subject matter as a society," she
said. "It'll take a long time to get down to the grassroots level, but if
you never stand up and say, "This is the right thing to do for kids,' it'll
never happen."

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WHAT DOCTORS SHOULD LOOK FOR

The American Academy of Pediatrics has devised some screening tools to help
signal potential violence in the home. The tools were designed after
reviewing the most up-to-date research. Below is a list of the areas doctors
should focus on.

- History of mental illness, previous domestic violence or substance abuse
in parents or other family members.

- Family stresses such as unemployment, divorce or death.

- Disciplinary attitudes and practices of the parents or caregivers.

- Exposure to violence in the home, school or community.

- Degree of exposure to media violence.

- Access to firearms in family's or neighbor's home, or the community. -
Gang involvement or exposure in family, school or neighborhood.

- Presence of signs of poor selfesteem or depression.

- Issues such as poor school performance and physical, emotional or
developmental disabilities.

http://www.denverpost.com/news/violence/viol0307.htm

Portia Davis, Executive Director
The Ross County Network For Children
http://www.geocities.com/Heartland/Village/3648/