Asking caregivers about intimate partner victimization at pediatric visits

IPV: intimate partner violence; CDC: Centers for Disease Control and Prevention.

* Signs, symptoms, and adverse effects of IPV are described in related UpToDate content on childhood exposure to IPV.

¶ The CDC provides a summary of screening instruments.

Δ Other causes of toxic stress include:

• Physical abuse
• Bullying/severe teasing
• Sexual abuse
• Medical care trauma
• Animal attack
• Motor vehicle accident
• Removal from the home by Child Protective Services
• Witness to violence in the home or in the community
• Incarceration of a caregiver
• Loss of a parent due to death, divorce, deportation, deployment
• Racism, sexism, discrimination

A patient information handout related to toxic stress is available through the Community & Family Services Division of the Spokane Health District. Additional resources related to toxic stress are available through the American Academy of Pediatrics (Pediatric Approach to Trauma, Treatment, and Resilience) and the CDC Violence Prevention website (ACES and Toxic Stress).

◊ Assessment of safety and lethality is a difficult and uncertain process and cannot predict if an IPV perpetrator will harm or kill their partner. The Danger Assessment-5 is a brief risk assessment that identifies women who are at a high risk for homicide or severe injury by an intimate partner. If the patient answers "yes" to any question, let them know that they have highly predictive risk factor(s) for serious assault/homicide. Refer to UpToDate content on intervention and management of intimate partner violence for additional details.

§ Examples of indications to contact law enforcement/security include:

• Perpetrator has threatened to kill the caregiver/patient and has a weapon
• The caregiver/patient has injuries and the perpetrator is on site
• The clinician is concerned for the safety of the patient, patient's caregiver, clinic staff, or self