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The Need for Pandora's Box
Every year in America, more than
three million children are reported victims of child abuse and neglect. An estimated
three to four million children witness violence in the home. Over eight million children
under the age of 17 live with a parent who is dependent on alcohol and/or in need of
treatment for illicit drug use. What does this mean for health care
providers? Sensitive family issues, including parental substance abuse, child-witnessed domestic violence, child abuse and neglect, and adolescent substance abuse, are central to pediatric morbidity and mortality. For example, children of substance abusers have a higher incidence of: - Depression They are also likely to manifest their stress through physical illnesses – and access medical attention at much higher rates than their peers – such as: - Sleep disturbances Medical professionals in a variety of fields can play a key role in the early detection, and even the prevention, of these sensitive family issues. However, according to the AAP, “only 45% [of pediatricians] routinely screen their patients for alcohol use, and that many pediatricians feel inadequately trained in this area.” (Pediatrics Vol. 108 No. 1). Another barrier, according to a recent
study by the Center for Substance Abuse, is physician discomfort with the subject matter
(CASA, 2000). On a different sensitive family issue, nearly 83% of women favored
their child’s pediatrician asking about domestic violence during well visits –
but only 17% recall ever being asked (Pediatrics Online 2001; Vol. 108:e43). The medical community is coming to
realize the importance of medical professionals in early intervention on behalf of these
families and is creating initiatives to address some of the above issues. For
instance, the AAP recently updated their policy statement on alcohol use and abuse as a
pediatric concern (July 2001). They have recommended that a comprehensive substance
abuse curriculum be integrated into every pediatrician’s training that prepares them
to screen, identify, and refer patients successfully. Another statement outlines
spousal abuse as a pediatric concern (June 1998). The challenge now lies for health care
programs to adopt, or expand upon, a curricula that teaches students and residents both
the information and skills they will need to competently and comfortably assist these
families. Pandora’s Box serves as a tool to help achieve this goal. |
