Improving Universal Pediatric Domestic Safety Screening Using Feedback from Focus Groups of Adolescents and Parents

Background: Millions of children, adolescents, and adults are exposed to intimate partner violence (IPV) each year. IPV exposure is associated with negative mental and physical health outcomes. Federal agencies and medical societies have amplified the need for IPV screening in healthcare settings. In 2016, our pediatric hospital implemented a domestic safety screening (DSS) tool. Little is known about patients’ and parents’ attitudes towards DSS, particularly in pediatric facilities.

Methods: Our objectives were to elicit feedback on 1) the wording of screening questions; 2) who should be screened and at what age; 3) privacy concerns and; 4) preferred screening formats. Adolescents and parents were recruited for focus groups (FGs) between October 2019 and November 2020. One qualitative researcher moderated the FGs. Enrolled participants were asked questions about DSS. Data were collected until thematic saturation was reached. Data were coded and themes identified and refined in an iterative manner.

Results: Seven FGs (2 FGs of adolescents ≥13 yrs, 2 FGs of parents/caregivers of adolescents ≥12 yrs, and 3 FGs with mothers of children ≤12 yrs) were conducted with 58 participants. Overall, participants supported the use of DSS. Participants across FGs found the questions on the current DSS tool (Figure 1) to be vague and ambiguous and recommended using more direct and straightforward language, providing context and/or examples whenever possible. Participants suggested using words, such as “harmed” or “hurting” rather than “violence” and “abuse.” Participants across all FGs approved of directing DSS questions toward children as young as 5 or 6 years old, depending on cognitive ability and maturity. FG participants in all groups agreed that a written questionnaire or tablet with questions should be provided to the patient and parent/caregiver for completion if healthcare professionals suspect that whomever is accompanying the patient may be an abuser. Across FG, participants said verbal DSS screenings were preferred over providing universal education about IPV, indicating that there is no substitute for one-on-one communication about such an important topic. Further, it was suggested that patients and parent/caregivers could benefit from having multiple ways to disclose. Other frequently offered recommendations for improvement are shown in Table 1.

Conclusion: FG participants supported DSS and recommend IPV screening using direct language to children as young as 5 years old, but the use of written or tablet screeners should be considered. Participants also made concrete recommendations about the language of screening questions.