Improving detection of violence among pregnant adolescents.
OBJECTIVE
The purpose of this study was to determine whether a systematic assessment protocol could increase reporting of violence among pregnant adolescents compared with a routine prenatal assessment. This study also sought to examine issues related to violence assessment among maternity care coordinators.


METHODS
The Maternity Care Coordination (MCC) program in a health department prenatal clinic in North Carolina routinely screened all clients for violence at their first visit. This assessment was not standardized. In 1994, the MCC program implemented a systematic violence assessment protocol for all adolescents (n = 117). The protocol assessed violence at three points during pregnancy by asking one direct question: "Have you been hit, slapped, kicked, or hurt during this pregnancy?" To examine the effectiveness of the system, we retrospectively reviewed the 1993 MCC records in which the coordinators routinely screened clients for violence (n = 129). To examine issues related to screening, we conducted in-depth interviews with the maternity care coordinators.


RESULTS
The routine pre-intervention assessment indicated that 5.4% of adolescents 12-19 years of age reported prenatal violence. The systematic assessment protocol resulted in a significant increase in reported violence from 5.4% to 16.2% (odds ratio = 2.9, 95% confidence interval = 1.6, 5.6, adjusted for race). Maternity care coordinators identified five factors related to increased reporting using the standardized protocol: (a) written protocol and data collection form; (b) asking direct, specific questions; (c) not labeling the victim; (d) not naming the perpetrator; and (e) conducting multiple assessments.


CONCLUSIONS
Multiple, direct, systematic assessments throughout prenatal care resulted in increased reporting of prenatal violence among adolescents compared to single, routine, nonstructured assessments.
Covington
D L
DL
Research Department, Coastal Area Health Education Center, Wilmington, NC 28402-9025, USA.
Dalton
V K
VK
Diehl
S J
SJ
Wright
B D
BD
Piner
M H
MH
D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002985:Clinical Protocols / Q000592:standards; D015331:Cohort Studies; D016001:Confidence Intervals; D017579:Domestic Violence / Q000517:prevention & control* / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D008429:Maternal Welfare / Q000706:statistics & numerical data; D008487:Medical History Taking / Q000379:methods / Q000592:standards*; D009657:North Carolina; D016017:Odds Ratio; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000523:psychology / Q000706:statistics & numerical data; D011295:Prenatal Care / Q000379:methods / Q000592:standards; D012189:Retrospective Studies; D012650:Self Disclosure