ABSTRACT
PURPOSE: 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.
PIP: This study tested the hypothesis that use of a direct, systematic assessment protocol applied throughout the course of prenatal care rather than a one-time, nonstructured, routine assessment would increase the reporting of prenatal violence among adolescents. Data from a retrospective assessment of the records of all 142 adolescents aged 12-19 years enrolled during 1993 (when the assessment was nonstructured) in the Maternity Care Coordination program of a health department prenatal clinic in North Carolina were compared to data from all 130 adolescents enrolled during 1994-95 when the systematic protocol was in place. The 13 adolescents with repeat pregnancies were excluded from analysis. The assessment protocol asked the direct question "Have you been hit, slapped, kicked, or hurt?" at three points during pregnancy. It was found that the standardized assessment protocol resulted in almost twice as many reports of violence at initial assessment, but this result was not statistically significant. However, multiple assessments using the systematic protocol increased reporting of prenatal violence significantly and consistently documented the perpetrator of the violence (68% partners, 14% parents, 9% siblings, and 9% friends). In-depth interviews with the seven maternity care coordinators confirmed that the new intervention tool was useful and effective because it used a written protocol and data collection form; asked direct, specific questions; did not label the victim; did not require the perpetrator's name; and involved multiple assessments.
