- Copyright © 2002 by the American Academy of Pediatrics
Results of a late-1990s AAP Periodic Survey of Fellows identified members’ needs in the areas of violence prevention and management. The Academy has worked over the last few years to respond to those needs and has received three major grants to address them.
AAP Periodic Survey #38, initiated by the AAP Task Force on Violence, was mailed to 1,629 active U.S. members between October 1997 and March 1998, with a response rate of 62%.
In general, results indicated that injury from violence is a problem confronting large numbers of pediatric practices. In the 12 months prior to the survey, for example, more than half of pediatricians who provide direct patient care reported treating injuries from child abuse, and more than one-third treated injuries from community or domestic violence.
Most pediatricians said they have an important role to play in the treatment, prevention and screening of violent injuries. However, while many pediatricians recognize injuries from domestic abuse and community violence in their practices, they feel particularly ill-prepared to respond to these types of violence compared to child abuse. (See table.)
Few pediatricians (less than one in five) said there is sufficient time in health maintenance visits to address child abuse, community violence or domestic violence issues, and seven out of 10 pediatricians recognized that they spend too little time on these issues.
Grants to address violence
Two of the new AAP initiatives focus on prevention.
A three-year project funded by the U.S. Department of Justice’s Office of Juvenile Justice and Delinquency Prevention will permit the Academy to develop and evaluate a Violence Intervention and Prevention Program (VIPP) for clinical practice. The VIPP will provide pediatricians with anticipatory guidance, screening, counseling, and referral protocols and materials for use in the context of routine health care maintenance.
This clinical tool will help pediatricians contribute to the broad efforts to reduce violence-related injuries much like the TIPP (The Injury Prevention Program) protocol addresses risks for unintentional injuries. The protocol will allow health care professionals to offer sound, scientifically based education, guidance and services to children and their families.
The project will begin with a thorough review of violence prevention resources and then will incorporate expert, pediatrician and parent viewpoints to develop and pilot test a prototype VIPP for the Academy. The project will be overseen by principal investigator Howard Spivak, M.D., FAAP, and project director Robert Sege, M.D., FAAP, and will include representatives from a number of AAP committees and sections and AAP staff.
At the same time, a randomized, controlled trial of a concise, practical and evidence-based office intervention for violence prevention will be undertaken by Pediatric Research in Office Settings (PROS), the Academy’s practice-based research network, in conjunction with investigators at Wake Forest University School of Medicine (WFUSM). This $2.25 million study, called Safety Check, will involve more than 200 pediatric providers and 5,000 patients throughout the country.
The study, funded by the National Institute of Child Health and Human Development and the Agency for Healthcare Research and Quality (AHRQ), will involve two groups of practitioners. One of the study groups will receive training and tested educational materials to incorporate violence prevention into standard practice, and the other will receive educational materials on a topic unrelated to violence but important to the provision of services for healthy child development. Shari Barkin, M.D., FAAP, principal investigator, will lead a team of investigators in the Department of Pediatrics and Public Health Sciences at WFUSM, together with co-investigators from PROS and expert consultants from around the country. PROS is seeking practitioners to participate in the study.
The PROS network also is launching a study to examine the management of child abuse in pediatric practice. Although the literature indicates that the number of U.S. children who are abused each year continues to increase, very little research has examined how practitioners manage these children or how management could be enhanced to prevent tragic outcomes for abuse victims. The Child Abuse Recognition Experience Study is a four-year national study funded by AHRQ to look at the management of 16,000 childhood injuries seen in practice settings.
The study, called PROS Cares, is headed by Emalee Flaherty, M.D., FAAP, of Northwestern University and Children’s Memorial Hospital in Chicago. The study seeks to: 1) identify factors that affect identification of abuse; 2) identify factors that affect management of suspicious injuries; and 3) assess the validity of practitioner management of childhood injuries.
Four hundred PROS primary-care practitioners each will gather information about 40 consecutive injury visits. The study will build on the preliminary work done by Dr. Flaherty through the Chicago-based Pediatric Practice Research Group. Recruitment for this study is beginning, and PROS seeks practitioners interested in participating.
External core funding for PROS is provided by the Health Resources and Services Administration Maternal and Child Health Bureau and AHRQ.
For more information on AAP Periodic Survey #38, visit www.aap.org/research/surv2.htm or contact Karen O’Connor at (800) 433-9016, ext. 7630, or e-mail .
Practitioners seeking more information about joining either PROS study should contact PROS Central at (800) 433-9016, ext. 7623, e-mail, or complete the accompanying coupon and fax it to (847) 228-9651.