The Future of Children, Princeton - Brookings: Providing research and analysis to promote effective policies and programs for children.

While it is important to assure an adult victim of domestic violence that any information revealed in the health care setting will be confidential, it is also necessary to inform her of the health care provider's legal obligation to report child abuse. As mandated reporters of suspected child abuse in every state, medical professionals reported 11% of all child abuse cases in 1996. The majority (56%) of these cases were substantiated by child protection agencies.²² Child abuse reporting can bring the immediate involvement of social services and/or law enforcement, result in the removal of a child from his or her parents, and put battered women at risk for further injury and/or death due to retaliation from their abusers. Therefore, it is imperative to assure a woman that her safety and the safety of her children are the priority. (See the article by Findlater and Kelly in this journal issue for further information about the child protective services system and domestic violence.)

Once child abuse is reported, individual health care providers often have very little control over events. The consequences of a report depend on the interaction among a health care institution, child protection agencies, law enforcement and the legal system, and community services for abused women and children. Health care providers can and do work to develop and foster these collaborations.

A few hospital-based family violence programs across the country use a team approach to assist both child and mother at the point of first identification of child abuse in a pediatric setting. For example, AWAKE (Advocacy for Women and Kids in Emergencies), a program based at Children's Hospital in Boston, has as its premise the belief that protecting battered mothers is important to the hospital's mission of protecting abused children. AWAKE seeks to provide comprehensive services to abused children and mothers. Abused women who accept AWAKE's services are paired with an advocate who collaborates with hospital staff and outside agencies to devise a safety plan and, whenever possible, to keep mothers and children together. Services provided include housing guidance, such as shelter referrals, court advocacy, referrals for medical and legal care, and individual counseling and support groups for women. AWAKE also provides consultation and education to hospital staff and the community. AWAKE provides opportunities for abused women, in seeking medical attention for their children, to access services for themselves that they might not have sought otherwise. ^23,24

Another innovative hospital-based program serving both battered mothers and abused children is the Family Violence Program at San Diego Children's Hospital. Initiated by the hospital's Center for Child Protection in 1991, the program provides advocacy support for mothers and mental health services for both mothers and children. A 1995 study of the program found that the percentage of women participants reporting physical assault decreased from 88% at intake to 10% at six-month follow-up, and that 85% of the participating mothers were living with their children.²⁵