By Jillian Gilchrest, MSW
In late September, Futures Without Violence held their National Conference on Health and Domestic Violence in San Francisco, CA. As Director of Health Professional Outreach for the Connecticut Coalition Against Domestic Violence and a member of the clinical care core of The Children’s Center on Family Violence, I was interested to attend one of the breakout sessions on the first day entitled, IPV documentation in the pediatric medical record: Balancing safety and advocacy for the child patient and adult survivor. This particular topic interested me because it is an issue that arises whenever I train pediatricians on the importance of screening a parent for intimate partner violence (IPV).
The breakout session actually left me with more questions than answers. It appears that health professionals across the country are grappling with this topic and Futures Without Violence will release some guidance within the next year. The issues are two-fold. First, because the medical record belongs to the child, both parents have access to that record. If the non-offending parent is screened for IPV during their child’s visit, then there is the potential that the offending parent may gain access to that record. The second issue has to do with automation and having appointment reminders sent by mail or made by phone to the offending parent.
With regard to the first issue of both parents having access to the child’s medical record that may contain a screen of one parent for IPV, the breakout conversation centered around what information healthcare providers should document. The presenters led participants through a discussion of how too much or too little documentation can lead to negative outcomes for the non-offending parent. The healthcare providers in the room shared their sense of responsibility to the child as their patient and conflict with also wanting to protect the non-offending parent. There was no easy answer to the question of what to document in the child’s chart, only that what is documented does have the potential to be used in court proceedings or with child protective services.
As for the second issue, breakout session participants shared examples of when an automatic email, letter, or phone call for a child’s upcoming appointment was sent to an offending parent giving them the opportunity to approach the non-offending parent at that appointment. This discussion led to suggestions for greater training and awareness about IPV and the importance of healthcare practices creating policies to ensure that patient records are routinely updated to reflect current contact information.
It is important to sort through the potential complications of documenting an IPV screen in a pediatric medical record because pediatricians can play such a vital role in connecting a victim of IPV to services and thereby potentially protecting their child patients from further exposure to IPV between their caregivers. I look forward to more guidance from Futures Without Violence in the next year so I can share that information with pediatric healthcare providers in Connecticut.