Screen Mothers, Help Kids: An Innovative Community-Based Partnership Helps Amplify the Voices of Children

Photograph of a Screening
Figure 1 Photograph by Community Health Network. CCO.

Submitted by: Ashley Simons-Rudolph, Katharine Atwood, and Ben Harris

Highlights

Children are often the unheard voices of domestic violence.
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Screening mothers for the impact of domestic violence on their kids is one way to connect kids with appropriate DV services in the community.

Ninety percent of children who are exposed to domestic violence (DV) witness it firsthand, yet their exposure is often undetected (Huecker & Smock, 2020). Routine screening for the impacts of domestic violence (DV) within social services and child health appointments provide opportunities to identify children in need of DV-related services. Yet, ethically screening children directly and in age-appropriate ways can be difficult.

Through annual domestic violence screening, our project helps service providers better identify families experiencing DV. Children in the home can be referred to existing community-based services including immediate shelter, legal advocacy, case management, and safety planning. With three community partners, a non-profit contract research organization developed an easy-to-use DV screening.

We can combine a parental screen for DV with assessments of  developmental delays in children to make active referrals to a community-based agency.

The Screener

Creating the screener was a multi-stage process. The Pacific Institute for Research and Evaluation (PIRE) conducted a needs assessment informed by a Community Advisory Board of survivors of interpersonal violence. Key stakeholders and clients from the Home of the Innocents (HOTI) provided context of the lived experience of people in their community living with intimate partner violence. The Screener (Appendix A.) was developed with a team from three community non-profits located in Louisville, Kentucky: (1) Center for Women and Families that provides support and shelter to families experiencing dv, 2) Family Health Centers which include five offices serving the medical needs of low-income families, and (3) HOTI which provides transitional housing and independent living supports to young women ages 18-24 and their children.

How Did A Community Psychology Perspective Inform Your Work?

We utilized theoretical perspectives from Community Psychology to ensure that potential clients/patients, community-based organizations, and researchers were on a level playing field when constructing the screening process and screener itself. Forming a strong community-based network builds capacity for DV and future efforts.

There are three steps to the screener:

Step 1: The screener begins with E-HITS, a five question DV screening for which we received permission from the developer (Sherin et al, 1998). Prior work in the Louisville Community showed us that E-HITS casts a wide net from which we can assess the likelihood of current violence. If the patient/client scored negative, meaning a total score of less than 9 and/or a score lower than 2 on Questions 1 and 5, the screening ends. If the patient/client scored positive, the screener continued to Step 2.

Step 2: The screener continues with a single harm question, developed by the full team as described above. The question: Does the mother have concerns for her child’s physical/emotional well-being due to violence in the household? We know that impacts of DV in the home often impact children, if not resulting in violence directed towards them, from impacts of the stressful home environment. This question serves to alert the patient/client to this possibility in a non-confrontational way and provide information to the provider as to the readiness of the client/patient to seek help on their own. In many cases, the mother is aware and will affirm the need for a referral. In this case, the screening ends and an active referral is made. In some cases, the mother cannot or will not recognize the potential risk to the child. In rare cases, the impact of the domestic violence is nil. To ascertain a direction of referral in these discordant cases, the provider would proceed to Step 3.

Step 3: Some of the providers involved in our study were already using the CDC’s Milestone Checklist (CDC, 2021) This developmental screener asks between 5 and 13 questions depending on the age of the child. Mothers screened are asked to answer for their oldest child living in the home. For children ages 6 and older, providers use the Columbia Impairment Scale (Bird et al., 1993) which asks 13 questions. Scoring for both screeners is explained in the attachment.

What Does This Mean For?

Research and Evaluation: Although it is early in the project, the Screener is being implemented by a subset of our clinical partners with success.

Practice: Community-based organizations can use a common tool to address an issue (here, DV) and increase active referrals. Funding and research assistance may be needed to bring stakeholders together initially, but the work is sustainable after tools are developed and relationships are cemented.

Social Action: Committed social service providers are busy and often overwhelmed. They care deeply for their clients/patients but don’t always know how make active referrals to other community-based organizations. Activists and community health promoters can serve as “connectors” with up-to-date information about what is going on in other agencies and possible ways that agencies can work together.

References

Bird, H. R., Shaffer, D., Fisher, P., & Gould, M. S. (1993). The Columbia Impairment Scale (CIS): pilot findings on a measure of global impairment for children and adolescents. International Journal of Methods in Psychiatric Research.

Huecker, M. R., & Smock, W. (2018). Florida Domestic Violence.

Sherin, K. M., Sinacore, J. M., Li, X. Q., Zitter, R. E., & Shakil, A. (1998). HITS: a short domestic violence screening tool for use in a family practice setting. FAMILY MEDICINE-KANSAS CITY-, 30, 508-512.

United States Centers for Disease Control (CDC) (2021). CDC’s Developmental Milestones. https://www.cdc.gov/ncbddd/actearly/milestones/index.html accessed 9/1/2021

This communitypsycyhology.com article was made possible by Grant # 90EV0465-01-00 from the Department of Health and Human Services, Administration for Children and Families. Its contents are solely the responsibility of the Pacific Institute for Research and Evaluation and do not necessarily represent the official views of the Department of Health and Human Services, Administration for Children and Families.

Appendix A. Sample IPV Protocol

Referral/s Made:  Yes ☐   No ☐ If yes, where:

Section 1: E-HITS

Please circle how often your partner did each of these things in the past 12 months.

1. Has your partner ever physically hurt you in the past 12 months? positive if score ≥ 2

1. Never

2. Rarely

3. Sometimes

4. Often

5. Frequently

 

2. Has your partner ever insulted you in the past 12 months?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Frequently

3. Has your partner ever threatened to harm you in the past 12 months?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Frequently

 

4. Has your partner ever screamed or cursed at you in the past 12 months?

1. Never

2. Rarely

3. Sometimes

4. Often

5. Frequently

5. Has your partner ever forced you to have sexual activities in the past 12 months? positive if score ≥ 2

1. Never

2. Rarely

3. Sometimes

4. Often

5. Frequently

Patient Screens Positive if: Total Score ≥8 OR Question 1 or Question 5 Scores > 2  

If positive, move to Section 2.

Section 2: Child Concerns Question

Does the mother have concerns for her child’s physical/emotional well-being due to violence in the household? Positive if “YES” Yes ☐     No ☐
Mother answered “no,” but providers has concerns about this child.

Please ask mother about her oldest child that is being seen in the appointment.

Yes ☐     No ☐

If yes to either question, move to Section 3a or 3b as appropriate.

Section 3a: CDC Milestone Checklist (ages 0-5)

Positive if 2 or more are “yes”

2 months
1. Doesn’t respond to loud sounds Yes ☐ No ☐
2. Doesn’t watch things as they move Yes ☐ No ☐
3. Doesn’t smile at people Yes ☐ No ☐
4. Doesn’t bring hands to mouth Yes ☐ No ☐
5. Can’t hold head up when pushing up when on tummy Yes ☐ No ☐

3-4 months
1. Doesn’t watch things as they move Yes ☐ No ☐
2. Doesn’t smile at people Yes ☐ No ☐
3. Can’t hold head steady Yes ☐ No ☐
4. Doesn’t coo or make sounds Yes ☐ No ☐
5. Doesn’t bring things to mouth Yes ☐ No ☐
6. Doesn’t push down with legs when feet are placed on a hard surface Yes ☐ No ☐
7. Has trouble moving one or both eyes in all directions Yes ☐ No ☐

5-6 months
1. Doesn’t try to get things that are in reach Yes ☐ No ☐
2. Shows no affection for caregivers Yes ☐ No ☐
3. Doesn’t respond to sounds around him Yes ☐ No ☐
4. Has difficulty getting things to mouth Yes ☐ No ☐
5. Doesn’t make vowel sounds (“ah”, “eh”, “oh”) Yes ☐ No ☐
6. Doesn’t roll over in either direction Yes ☐ No ☐
7. Doesn’t laugh or make squealing sounds Yes ☐ No ☐
8. Seems very stiff, with tight muscles Yes ☐ No ☐
9. Seems very floppy, like a rag doll Yes ☐ No ☐

7-9 Months
1. Doesn’t bear weight on legs with support Yes ☐ No ☐
2. Doesn’t sit with help Yes ☐ No ☐
3. Doesn’t babble (“mama”, “baba”, “dada”) Yes ☐ No ☐
4. Doesn’t play any games involving back-and-forth play Yes ☐ No ☐
5. Doesn’t respond to own name Yes ☐ No ☐
6. Doesn’t seem to recognize familiar people Yes ☐ No ☐
7. Doesn’t look where you point Yes ☐ No ☐
8. Doesn’t transfer toys from one hand to the other Yes ☐ No ☐

10-12 Months
1. Doesn’t crawl Yes ☐ No ☐
2. Can’t stand when supported Yes ☐ No ☐
3. Doesn’t search for things that she sees you hide. Yes ☐ No ☐
4. Doesn’t say single words like “mama” or “dada” Yes ☐ No ☐
5. Doesn’t learn gestures like waving or shaking head Yes ☐ No ☐
6. Doesn’t point to things Yes ☐ No ☐
7. Loses skills he once had Yes ☐ No ☐

13-18 Months
1. Doesn’t point to show things to others Yes ☐ No ☐
2. Can’t walk Yes ☐ No ☐
3. Doesn’t know what familiar things are for Yes ☐ No ☐
4. Doesn’t copy others Yes ☐ No ☐
5. Doesn’t gain new words Yes ☐ No ☐
6. Doesn’t have at least 6 words Yes ☐ No ☐
7. Doesn’t notice or mind when a caregiver leaves or returns Yes ☐ No ☐
8. Loses skills he once had Yes ☐ No ☐

19 Months – 2 Years
1. Doesn’t use 2-word phrases (for example, “drink milk”) Yes ☐ No ☐
2. Doesn’t know what to do with common things, like a brush, phone, fork, spoon Yes ☐ No ☐
3. Doesn’t copy actions and words Yes ☐ No ☐
4. Doesn’t follow simple instructions Yes ☐ No ☐
5. Doesn’t walk steadily Yes ☐ No ☐
6. Loses skills she once had Yes ☐ No ☐
7. Doesn’t use 2-word phrases (for example, “drink milk”) Yes ☐ No ☐

2 to 3 Years

1. Falls down a lot or has trouble with stairs Yes ☐     No ☐
2. Drools or has very unclear speech Yes ☐     No ☐
3. Can’t work simple toys (such as peg boards, simple puzzles, turning handle) Yes ☐     No ☐
4. Doesn’t speak in sentences Yes ☐     No ☐
5. Doesn’t understand simple instructions Yes ☐     No ☐
6. Doesn’t play pretend or make-believe Yes ☐     No ☐
7. Doesn’t want to play with other children or with toys Yes ☐     No ☐
8. Doesn’t make eye contact Yes ☐     No ☐
9.  Loses skills he once had Yes ☐     No ☐

3 Years to 4 years

1.  Can’t jump in place Yes ☐     No ☐
2. Has trouble scribbling Yes ☐     No ☐
3. Shows no interest in interactive games or make-believe Yes ☐     No ☐
4.  Ignores other children or doesn’t respond to people outside the family Yes ☐     No ☐
5. Resists dressing, sleeping, and using the toilet Yes ☐     No ☐
6. Can’t retell a favorite story Yes ☐     No ☐
7. Doesn’t follow 3-part commands Yes ☐     No ☐
8. Doesn’t understand “same” and “different” Yes ☐     No ☐
9. Doesn’t use “me” and “you” correctly Yes ☐     No ☐
10. Speaks unclearly Yes ☐     No ☐
11. Loses skills he once had Yes ☐     No ☐

4 Years to < 6 Years

1. Doesn’t show a wide range of emotions Yes ☐     No ☐
2. Shows extreme behavior (unusually fearful, aggressive, shy or sad) Yes ☐     No ☐
3. Unusually withdrawn and not active Yes ☐     No ☐
4. Is easily distracted, has trouble focusing on one activity for more than 5 minutes Yes ☐     No ☐
5. Doesn’t respond to people, or responds only superficially Yes ☐     No ☐
6. Can’t tell what’s real and what’s make-believe Yes ☐     No ☐
7. Doesn’t play a variety of games and activities Yes ☐     No ☐
8. Can’t give first and last name Yes ☐     No ☐
9. Doesn’t use plurals or past tense properly Yes ☐     No ☐
10. Doesn’t talk about daily activities or experiences Yes ☐     No ☐
11. Doesn’t draw pictures Yes ☐     No ☐
12. Can’t brush teeth, wash and dry hands, or get undressed without help Yes ☐     No ☐
13. Loses skills he once had Yes ☐     No ☐

Section 3b: Columbia Impairment Scale (ages 6+)

Please ask mother about her oldest child that is being seen in the appointment. Positive if Positive if total score ≥ 15 or any individual item score is ≥ 3 for any age.

In general, how much of a problem do you think [she/he] has with: No Problem ……….… Some Problem ……….… Very Bad Total Score
0 1 2 3 4
1 getting into trouble 0 1 2 3 4 n/a
2 getting along with (you/[her/his] mother/mother figure). 0 1 2 3 4 n/a
3 getting along with (you/[her/his] father/father figure). 0 1 2 3 4 n/a
4 feeling unhappy or sad? 0 1 2 3 4 n/a
How much of a problem would you say [she/he] has:
5 with [her/his] behavior at school? (or at [her/his] job)? 0 1 2 3 4 n/a
6 with having fun? 0 1 2 3 4 n/a
7 getting along with adults other than (you and/or [her/his] mother/father)? 0 1 2 3 4 n/a
How much of a problem does [she/he] have:
8 with feeling nervous or afraid? 0 1 2 3 4 n/a
9 getting along with her/his] [sister(s)/brother(s)]? 0 1 2 3 4 n/a
10 getting along with other kids [her/his] age? 0 1 2 3 4 n/a
How much of a problem would you say [she/he] has:
11 getting involved in activities like sports or hobbies? 0 1 2 3 4 n/a
12 with [her/his]school work (doing [her/his] job)? 0 1 2 3 4 n/a
13 with [her/his] behavior at home? 0 1 2 3 4 n/a
TOTAL SCORE /52
Positive if Total Score is ≥ 15 or Any Individual Item Score is ≥ 3
Total Score /52

 

For more information about this project, please contact Dr. Katherine Atwood,  Lead Evaluator

The “Expansion of screening, referral and trauma-informed services to meet the needs of children exposed to domestic violence and mothers who are victims of domestic violence (DV) residing in Jefferson County, Kentucky” Project is one of the 26 grantees participating in the Specialized Services for Abused Parents and Children (SSAPC) program funded by the Family and Youth Services Bureau (FYSB).
The capacity building projects serve as leaders for improving responses to children, youth and parents experiencing domestic violence. The program’s goals include:
• Improving systems and responses to abused parents and their children exposed to domestic violence
• Coordinating or providing new or enhanced residential and non-residential services for children exposed to violence
• Enhancing evidence-informed and practice-informed services, strategies, advocacy and interventions for children & youth exposed to domestic violence
Learn more about this project and SSAPC demonstration initiative here: https://promising.futureswithoutviolence.org/advancing-the-field/communities-in-action/specialized-services-for-abused-parents-and-children-grantees/

Download a .pdf of this page here.

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