Annals of Internal Medicine Tip Sheet for Jan. 22, 2013

Risk assessment and behavioral interventions in pediatric clinics may reduce child abuse and neglect, according to a recent evidence review. Researchers reviewed studies published since 2004 when the U.S. Preventive Services Task Force last published recommendations on child abuse and neglect to determine the effectiveness of primary care relevant interventions on child abuse and neglect outcomes. The researchers also sought to determine adverse effects of interventions. Physicians and other health care providers who care for children and families are uniquely poised to identify children at risk for abuse and neglect during well checks and other visits. If a need is identified, they can initiate interventions to prevent harm. Eleven studies met inclusion criteria and evaluated the effectiveness of child abuse and neglect prevention interventions initiated in primary care settings. According to the studies, these clinic-based interventions reduced physical assault and reports to Child Protective Services (CPS), and resulted in better adherence to medical care and immunization recommendations. According to 10 trials of home visitation interventions, those receiving home visits from a nurse as infants were less likely to die by age 9 than those in the usual care control group. There was some evidence that home visitation resulted in reduced CPS involvement over the long-term, fewer visits to the emergency department or hospital, greater medical and immunization adherence. Adverse effects of interventions were not explicitly evaluated in the trials. Child abuse and neglect affected more than 695,000 children in the U.S. in 2010, 1,537 of whom died. Survivors of abuse face potentially significant health, emotional, and behavioral consequences of abuse. A draft recommendation statement will be posted to www.uspreventiveservicestaskforce.org on January 21 at 5:00 p.m.

Note: For an embargoed PDF, please contact Megan Hanks or Angela Collom. To speak with the author, please contact Tamara Hargens-Bradley at hargenst@ohsu.edu or 503-494-8231. For a copy of the draft recommendation, please contact Ana Fullmer at ana.fullmer@edelman.com or 202-350-6668.

Insufficient evidence to recommend for or against screening elderly or vulnerable adults for abuse and neglect

The U.S. Preventive Services Task Force recommends that physicians screen all women of childbearing age for intimate partner violence (IPV) and refer them to intervention services, if needed. There was insufficient evidence to recommend for or against screening elderly or vulnerable adults (adults with mental or physical disabilities) for abuse and neglect. These recommendations address screening of patients who do not have signs or symptoms of abuse. Patients with such signs and symptoms require evaluation for abuse. The Centers for Disease Control and Prevention estimates that 31 percent of women and 26 percent of men have experienced some form of IPV in their lifetime. While IPV and elderly abuse are common, cases may be underreported. Adequate evidence suggests that screening can identify IPV, but such evidence is lacking for elderly abuse. To inform this updated recommendation, the Task Force reviewed articles published since 2003 to determine the effectiveness of IPV screening and interventions for women in health care settings in reducing IPV and related health outcomes, the diagnostic accuracy of screening tools, and adverse effects of screening and interventions. The evidence shows that women assigned to screening versus usual care can experience moderate improvements in IPV or health outcomes. In addition, more women in the screened group discussed IPV with their clinician (44 percent versus 8 percent). Clinicians may use questionnaire or interview-type tools to screen women for IPV, which were shown to be accurate diagnostic tools. Few studies reported adverse effects of screening and interventions for IPV. The full recommendation statement will be posted to www.uspreventiveservicestaskforce.org on January 21 at 5:00 p.m.

Note: For an embargoed PDF, please contact Megan Hanks or Angela Collom. For an interview with the Task Force, please contact Ana Fullmer at ana.fullmer@edelman.com or 202-350-6668.