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The Role of Children's Hospitals In Family Violence Prevention

Monday, October 22, 2012: 4:00 PM
Versailles Ballroom (Hilton Riverside)
Kimberly A. Randell, MD, MSc1, Donna O'Malley, PhD, RN1, Karen Seaver Hill2, Nancy Hanson2 and M. Denise Dowd, MD, MPH1, (1)Division of Emergency and Urgent Care Services, The Children's Mercy Hospital, Kansas City, MO, (2)Children's Hospital Association, Alexandria, VA

Purpose Childhood exposure to family violence results in alterations in development which place children at risk for a lifetime of negative outcomes in multiple domains. The new ecobiodevelopmental foundation for pediatrics provides a comprehensive approach to pediatric health care that by design must include family violence prevention. The purpose of this study was to determine the perceived role of children’s hospitals in family violence prevention, current hospital-based approaches and needs when addressing family violence and potential usefulness of a Delphi instrument which would provide comprehensive guidelines and standardized assessment measures for family violence prevention programs.

Methods Data were gathered by individual phone interviews of non-clinical administrative and clinical staff identified by random sampling of the Children’s Hospital Association’s (formerly the National Association of Children’s Hospitals and Related Institutions) member institutions, as well as purposive sampling of pediatric experts in family violence. Interviewers took detailed notes, which were analyzed using a grounded theory approach.

Results Data saturation was achieved with 43 interviews. Participants had varied roles (administrative, clinical, research, advocacy) and education (nursing, physician, social work, business administration, etc.). There was consensus that children’s hospitals play a key role in addressing family violence internally (e.g. staff training, screening and identification, treatment) and externally (e.g. public education, advocacy, community collaboration), with the exception of participants from specialty children’s hospitals who questioned the role of their institutions in this issue. Between institutions there was wide variance in the components and depth of family violence programs, family violence-related decision-making loci, the level of institutional support for such programs and program assessment. Key barriers to addressing family violence included lack of funding and time, misconceptions (e.g. addressing family violence offends families) and provider discomfort. Participants with clinical job roles also emphasized the shortage of trained staff and family violence not being a priority in their institutions. Most participants felt their institution should do more to address family violence, with wide variation in what this would entail. There was near-uniform agreement that a comprehensive family violence Delphi instrument would be a useful tool in the children’s hospital setting. Participants felt such an instrument would standardize program assessment at the institutional level, provide benchmarks when comparing programs, provide concrete steps for improvement, and prompt discussion about the issue with individuals not currently invested in it.

Conclusion Children’s hospitals are perceived as playing a key role in family violence prevention, although considerable variation exists in how the issue is addressed. No clear guidelines for program components or standardized program assessment measures currently exist. A Delphi instrument would provide comprehensive guidelines and standards for family violence prevention in the children’s hospital setting and may enable children’s hospitals to more effectively integrate family violence prevention programs into routine clinical care and institutional culture.