Health care system responses to children exposed to domestic violence.

The health care system has only recently adopted protocols and training to enable practitioners to identify and respond to victims of domestic violence. Currently, most hospitals have domestic violence protocols in place, although training in the use of protocols is less routine. However, because the provision of health care focuses on the treatment of the individual, the well-being of the children of adult domestic violence victims has received little attention in adult health care settings. Pediatricians do not routinely receive training in domestic violence identification and do not see responding to battered mothers as within the purview of their practice. Innovative programs in children's hospitals in Boston, Massachusetts, and San Diego, California, recognize that the safety of children is integrally tied to the safety of their mothers. These programs identify abused children whose mothers are the victims of domestic violence and provide advocacy and support that allow mothers and children to remain together in most instances. Little is known about the health impacts of teen dating violence, and opportunities for screening exist in the settings where teens receive health care. Likewise, prenatal visits provide regularized opportunities for domestic violence screening. Integrating the health care needs of mothers and children from violent households will require continued and expanded training, collaboration with community institutions, and improvements in insurance reimbursements to cover the costs of needed services.