Developing a screening tool to identify harmful sibling aggression in a primary care setting

Background: Despite the possibility of adversely affecting the mental health of children, sibling aggression, the most common form of family violence, is often dismissed as normal or less harmful than other types of violence. Currently, there is no easily administered screening method for sibling aggression. Purpose: The goal of this project was to develop and test a brief sibling aggression screening tool for use in pediatric primary care. Methods: The project was implemented in four phases: phase I reviewed the literature for adolescent and child aggression screening tools and to create a draft for expert content analysis. Phase II used a focus group of family mental health providers to modify draft items for the screening tool (N = 5). In phase III, the first draft of a screening tool was critiqued by individual pediatric providers (N = 8) for clarity and feasibility of use in pediatric primary care. In phase IV, the screening tool was piloted by one provider in pediatric clinical practice, who used the tool with six children over 3 weeks. Results: All providers in phase II (N = 13) identified sibling aggression as an underassessed area of pediatric care. All providers in phase III found the revised questions to be clearly stated and child friendly; 75% (N = 6) agreed they could incorporate the questions into their current assessment, 25% disagreed citing limited time and resources. Pilot testing with six children demonstrated feasibility for use in pediatric primary care. Implications for practice: Utilization of a brief screening tool to assess for sibling aggression may help providers to identify and therapeutically respond to the most common type of childhood violence.