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CME: Dating Violence Among Adolescent ED Visits

CME: Dating Violence Among Adolescent ED Visits
Author Information (click to view)

Vijay Singh, MD, MPH, MS

Clinical Lecturer, Departments of Emergency & Family Medicine
University of Michigan Medical School

Vijay Singh, MD, MPH, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

Figure 2 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

  1. Recognize the importance of screening for intimate partner violence among adolescent emergency department patients.
  2. Describe the findings—and their implications for health service—of a study in which patients aged 14 to 20 who sought emergency department care were screened for intimate partner violence.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwmay1.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

 

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

 

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 

 

 

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

Christopher Cole- Senior Editor
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

Vijay Singh, MD, MPH, MS
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Vijay Singh, MD, MPH, MS (click to view)

Vijay Singh, MD, MPH, MS

Clinical Lecturer, Departments of Emergency & Family Medicine
University of Michigan Medical School

Vijay Singh, MD, MPH, has indicated to Physician’s Weekly that he has or has had no financial interests to report.

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In a recent study, nearly one of six adolescents who seek ED care report recent dating violence and several factors were associated with dating violence. There is a need to develop screening and intervention programs to address this problem.
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Adolescent and young adult dating violence, which encompasses both victimization and aggression, is a significant public health concern. Some studies estimate that as many as 10% of high school students have experienced dating victimization and nearly 20% have reported physical violence toward a dating partner. “While intimate partner violence (IPV) has been recognized as a significant problem among adults, little is known about this violence and aggression in adolescent and young adult populations,” says Vijay Singh, MD, MPH, MS.

The Joint Commission mandates that clinicians screen patients for IPV in all healthcare settings, including the ED. The United States Preventive Service Task Force also recently recommended that asymptomatic women aged 14 to 46 be screened for IPV and provided intervention services. “Despite these initiatives, only 30% of adolescents report ever being asked by a healthcare provider about dating violence,” says Dr. Singh. “Simply treating injuries and not assessing for dating violence means we can miss opportunities to prevent these problems in the future and break the cycle of violence.”

It is important to examine dating victimization and aggression among both sexes because dating violence is common in both men and women, according to Dr. Singh. “Assessment of both dating victimization and aggression is lacking in the literature,” he says. “Dating violence is different from adult IPV in that relationship roles are not yet set. Many adolescent couples aren’t living together and there is a tendency for them to change partners more often than adults.” Patterns that begin in adolescence can carry over to adulthood, including IPV.

Dating-Violence-ED-Callout

Assessing Trends of Adolescent Violence

In the Annals of Emergency Medicine, Dr. Singh and colleagues had a study published in which they screened 4,089 males and females aged 14 to 20 who sought ED care. Dating victimization was defined as violent acts received by a young adult, whereas dating aggression referred to violent acts perpetrated by youths. These acts included throwing objects at someone; kicking, hitting, or punching; slapping or pulling hair; and pushing and shoving.

According to the results, more than 15% of the sample reported past-year dating violence (Table 1). “Almost one in five females and one in eight males reported past-year dating violence,” Dr. Singh says. This prevalence was higher than what has been seen previously in school-based samples. Of female patients involved in the study, nearly 11% reported any dating victimization and about 15% reported any dating aggression. For males, about 12% reported any dating victimization and nearly 5% reported any dating aggression. Among those with dating violence, nearly one in three patients reported both dating victimization and dating aggression.

Several themes also emerged with regard to demographics, associated behaviors, and ED health service use for any dating violence, any dating victimization, and any dating aggression (Table 2). “Patients who misused alcohol, used illicit drugs, and/or had depression were more likely to commit dating violence, regardless of the patient’s gender,” says Dr. Singh. African-American race was another factor associated with dating violence for both males and females. In addition, females who reported dating violence were more likely to be on public assistance, have lower academic grades, and to have visited an ED in the prior year for an intentional injury.

Important Implications for ED Health Service

Understanding ED health service use patterns may enhance the identification of dating violence. “Our data highlight the fact that many adolescents have already experienced violence in their dating lives,” says Dr. Singh. “These patterns may begin in adolescence, and there is a real chance that they can carry over into adulthood. Screening and interventions for youths with a history of dating violence may help reduce the risk of IPV later in life.”

The fact that dating violence among adolescents was strongly associated with alcohol misuse, illicit drug use, and depression is important, says Dr. Singh. “If adolescents present to the ED with any of these factors, clinicians should consider asking about dating violence,” he says. “We can take a targeted approach if we understand the factors and health problems associated with dating violence.”

In the future, Dr. Singh recommends that dating violence interventions assess mental health and substance use problems, and intervene on these co- occurring problems. “We need studies to explore new and efficient ways to screen young adults for dating violence in the ED so that we can decrease the burden of this growing health problem,” he says. “When developing interventions, we should consider both male and female youths as potential victims and/ or aggressors.”

Readings & Resources (click to view)

Singh V, Walton MA, Whiteside LK, et al. Dating violence among male and female youth seeking emergency department care. Ann Emerg Med. 2014 Jun 29 [Epub ahead of print]. Available at: http://www.annemergmed.com/article/S0196-0644(14)00486-7/fulltext.

Moyer VA. Screening for intimate partner violence and abuse of elderly and vulnerable adults: a US Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;158:478-486.

Cutter-Wilson E, Richmond T. Understanding teen dating violence: practical screening and intervention strategies for pediatric and adolescent healthcare providers. Curr Opin Pediatr. 2011;23:379-383.

Walton M, Cunningham R, Goldstein AL, et al. Rates and correlates of violent behaviors among adolescents treated in an urban emergency department. J Adolesc Health. 2009;45:77-83.

Erickson MJ, Gittelman MA, Dowd D. Risk factors for dating violence among adolescent females presenting to the pediatric emergency department. J Trauma. 2010;69:S227-S232.

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