Thousands of children and adolescents worldwide are exposed to various acts related to violence and trauma on a daily basis. These incidents cross all socioeconomic, religious, ethnic, cultural, and geographic borders and pose a serious threat to the physical, emotional, and social health and well-being of the youths who witness such acts, according to a joint report issued by the World Health Organization and UNICEF (accessed March 18, 2009). Exposure to these events can have grave adverse effects on quality of life and may put these youths at risk for various forms of violence, such as domestic violence or intimate partner violence (Journal of Applied Biobehavioral Research. 2005; 10:27-38).
The injuries a youth might suffer as a result of being exposed to acts of violence and trauma are preventable, especially when health-care providers are cognizant of the possible or actual detrimental impact these acts can inflict on the health of their young patients. All health-care providers practicing in office- or community-based settings are in a key position to screen, recognize, and assess these problems. Therefore, it is imperative that they do so because some children and adolescents may not freely disclose their experiences with violence or trauma. In a large-scale study by Sally H. Adams, RN, PhD, and colleagues, reported in the Journal of Adolescent Health, clinicians appeared to spend insufficient amounts of time discussing violence and other health topics with adolescents during their routine medical care or physical exams (published online ahead of print December 8, 2008).
In efforts to open up the lines of communication, health-care providers can ask direct questions using age-appropriate language:
- Ask an adolescent, “Have you recently been involved in a violent incident, encounter, confrontation, or relationship at home? At school? In the community?”
- Ask a younger child, “Have you recently seen someone being hit or hurt at home? At school? In the community?”
- Ask the parent(s)/guardian(s)/primary caregiver(s) of a toddler, “Have you recently noticed that your toddler is despondent or sad at home? Outside the home in familiar surroundings? In the community?”
- Ask the parent(s)/guardian(s)/primary caregiver(s) of an infant, “Have you recently noticed that your infant is more inconsolable at home? Outside the home in familiar surroundings? In the community?”
The answers to these questions may serve as a warning sign that the clinician should further pursue screening, assessing, and treating, possibly with the help of instruments such as the Trauma Symptom Checklist for Children (accessed March 18, 2009) and Responsibility for Violence Questionnaire (2004) by Shavers et al. (For additional information, contact Dr. Shavers at: [email protected])
To best elicit information and provide assistance, clinicians should have an understanding of the ethnic and cultural attitudes, feelings, values, beliefs, and behaviors that could influence the youth’s reaction to violent or traumatic events. Also, it is useful for the clinician to know the relevant policies and laws for reporting suspected or actual cases of victimization. In addition, health-care providers can help their young patients by making available information on community and other resources that promote safety, support, and advocacy for children and adolescents.