A Delphi Approach to Reach Consensus on Primary Care Guidelines Regarding Youth Violence Prevention Edward De Vos Howard Spivak Elizabeth Hatmaker Flanigan and Robert D Sege Pediatrics 2006 118 1109 1115 DOI 10 1542 peds 2005 2209 This information is current as of November 14 2006 The online version of this article along with updated information and services is located on the World Wide Web at http www pediatrics org cgi content full 118 4 e1109 PEDIATRICS is the official journal of the American Academy of Pediatrics A monthly publication it has been published continuously since 1948 PEDIATRICS is owned published and trademarked by the American Academy of Pediatrics 141 Northwest Point Boulevard Elk Grove Village Illinois 60007 Copyright 2006 by the American Academy of Pediatrics All rights reserved Print ISSN 0031 4005 Online ISSN 1098 4275 Downloaded from www pediatrics org at Vanderbilt University Eskind Biomedical Library on November 14 2006 ARTICLE A Delphi Approach to Reach Consensus on Primary Care Guidelines Regarding Youth Violence Prevention Edward De Vos EdDa Howard Spivak MDa Elizabeth Hatmaker Flanigan MSb Robert D Sege MD PhDa aPediatric and Adolescent Health Research Center Floating Hospital for Children at Tufts New England Medical Center Boston Massachusetts bAmerican Academy of Pediatrics Elk Grove Village Illinois The authors have indicated they have no nancial relationships relevant to this article to disclose ABSTRACT OBJECTIVE Anticipatory guidance is a cornerstone of modern pediatric practice In recognition of its importance for child well being injury prevention counseling is a standard element of that guidance Over the last 20 years there has been growing recognition that intentional injury or violence is one of the leading causes of morbidity and mortality among youth The US Surgeon General identified youth violence as a major public health issue and a top priority Yet only recently has the scope of injury prevention counseling been expanded to include violence Pediatric health care providers agree that youth violence prevention counseling should be provided yet the number of topics available the already lengthy list of other anticipatory guidance topics to be covered developmental considerations and the evidence base make the selection of an agreed on set a considerable challenge The purpose of this study was to systematically identify and prioritize specific counseling topics in violence prevention that could be integrated into anticipatory guidance best practice DESIGN A modified electronic Delphi process was used to gain consensus among 50 national multidisciplinary violence prevention experts Participants were unaware of other participants identities METHODS The process consisted of 4 serial rounds of inquiry beginning with a broad www pediatrics org cgi doi 10 1542 peds 2005 2209 doi 10 1542 peds 2005 2209 Key Words anticipatory guidance child development Delphi technique pediatrics violence prevention Abbreviations AAP American Academy of Pediatrics TFOV Task Force on Violence VIPP Violence Intervention and Prevention Program Accepted for publication Apr 28 2006 Address correspondence to Edward De Vos EdD Pediatric and Adolescent Health Research Center Tufts New England Medical Center 750 Washington St NEMC Box 531 Boston MA 02111 E mail edevos tuftsnemc org PEDIATRICS ISSN Numbers Print 0031 4005 Online 1098 4275 Copyright 2006 by the American Academy of Pediatrics open ended format for the generation of anticipatory guidance and screening topics across 5 age groups infant toddler school age adolescent and all ages Each subsequent round narrowed the list of topics toward the development of a manageable set of essential topics for screening and counseling about positive youth development and violence prevention RESULTS Forty seven unique topics were identified spanning birth to age 21 years Topics cover 4 broad categories building blocks physical safety parent centered child centered and community connection Participants placed topics into their developmentally appropriate visit based schedule and made suggestions for an PEDIATRICS Volume 118 Number 4 October 2006 Downloaded from www pediatrics org at Vanderbilt University Eskind Biomedical Library on November 14 2006 e1109 appropriate topic reinforcement schedule The resulting schedule provides topics for introduction and reinforcement at each visit CONCLUSIONS The Delphi technique proved a useful ap proach for accessing expert opinion for analyzing and synthesizing results for achieving consensus and for setting priorities among the numerous anticipatory guidance and assessment topics relevant for raising resilient violence free youth T HE AMERICAN ACADEMY of Pediatrics AAP logo proclaims the commitment dedicated to the health of all children Increasingly the greatest threats to child health are part of what has been called the new morbidity 1 More than a decade ago the AAP s Committee on Psychosocial Aspects of Child and Family Health approved a policy statement advocating better preparation of pediatricians to address the behavioral and psychosocial factors that threatened child health with increasing prevalence 1 More recently the AAP s commitment has been reaffirmed 2 In recognition of the newer morbidities such as violence suicide substance abuse and school problems the committee concluded These are the morbidities that place our patients at risk In other words after infancy children in the United States are more likely to die from injuries or violence and suicide than from infectious disease 2 Increasingly pediatricians are called on to address these new morbidities effectively and efficiently not only through diagnosis treatment and referral but through prevention as well Preventive care is a cornerstone of pediatric practice but the new morbidities require new approaches from physicians To effectively address these new morbidities pediatricians will need a model that encompasses expanded areas of competence in child behavior development and family function 2 Violence ranks highly among the clear threats to child health The World Health Organization operationally defined violence as the intentional use of physical force or power threatened or actual against oneself another person or against a group or community that either results in or has a high likelihood of resulting in injury death psychological harm maldevelopment or deprivation 3 Numerous statistics speak to the severity and