Health Assessment: Domestic Violence

Domestic Violence Statistics

20 people/minute are abused by an intimate partner

• 20,000 calls/day are made to domestic violence hotline

• 10 million people are abused annually/ 33% women & 25% men

Half of all female homicide victims are killed by an intimate or former partner

5 children die every day as a result of abuse or neglect

Intimate Partner Violence 4 main categories

Physical Violence

Sexual Violence

Stalking

Psychological Aggression

What is physical violence?

Force resulting in injury or death

What is sexual violence?

Attempted or completed acts without permission

What is Stalking?

Repeated unwanted attention through various methods

What is Psychological Aggression?

Emotional abuse of an aggressive nature

Intimate Partner Violence: Teens (Before 18) Dating Violence

Can be physical, sexual, psychological, or emotion

Youth who experience this are more likely to experience mental health issues and/or participate in unhealthy behaviors

• Cyber abuse can be a means of access

Child Abuse and Neglect

Defined at state and federal levels- The child Abuse Prevention and Treatment Act

• Recently amended to include sex and human trafficking

• Enhance protection for infants with Fetal Alcohol Spectrum Disorder

What is Neglect?

Failure to provide for children’s basic needs

What is Physical Abuse?

Non-accidental injury that leads of harm of a child

What is Sexual Abuse?

Foundling, sexual acts, exploitation, and trafficking

What Emotional Abuse?

Pattern of behavior that harms a child’s sense of self-wroth or development

Older Adult Abuse and Neglect

Involves both intentional and failure to act by a caregiver or trusted person

• Underreported with 60% performed by a family member/est. 1 in 14 are abused

Formed of Older Adult Abuse:

Physical Abuse

Sexual Abuse or abusive sexual contact

Psychological or emotional Abuse

Neglect

Financial abuse or exploitation

What is Physical Abuse in Older adult abuse?

Intentionally assaulted, injured, threatened, or restrained

What is Sexual abuse or abusive sexual contact in older adult abuse?

Any sexual contact against one’s will

What is Psychological or Emotional Abuse in Older Adult Abuse?

Includes verbal and nonverbal behaviors intended to humiliate, isolate, or affirm control

What is Financial abuse or exploitation in Older Adult Abuse?

Unauthorized use and/or improper use of older adult’s funds/ resources

Health Effects of Violence

Immediate effects as well as residual effects of acts of violence leading to complications and more chronic health problems

• Women gynecologic and obstetrical conditions with impact on fetus

  • Preterm, low birth weight, and perinatal death

• More likely to suffer from mental health problems

  • Depression, suicide, PTSD, and substance abuse

• Children who are abused are more likely to experience ongoing poor health as they age

  • Impact on brain development, behavioral learning delays, and higher risk for chronic disease

Barries to Treatment of Intimate Partner Violence: Social Stressors

Poverty level leading to increased difficulties in daily struggles and conflict in relationship

• Past experience with discrimination based on lack of understanding of cultural diversity

Barriers to Treatment of Intimate Partner Violence: Legal Status

Immigration status may prevent individual from seeking care based on fear of deportation

• Violence Against Women Act (AWA) provides legal support

Barriers to Treatment of Intimate Partner Violence: Lack of Access to Culturally Appropriate Care

Traditional roles foster dependency

• Need to bilingual cultural interpreters in clinical practice settings

Documentation: IPV, Child Abuse, or Older Adult Abuse

Provide Detail

• Non-biased progress notes, injury maps, and photographic evidence

Transcribe Verbatim

• Information received from individual

Physical exam

• Thorough documentation using forensic technology terms

Provide digital photographic documentation in the medical record

• Obtain consent

May have to separate

• The patient from the parent, spouse, and/or caregiver- follow protocol

Routine Screening for Intimate Partner Violence

Early detection is the key in terms of prevention of long-term complications

• Health care providers are mandatory reporters

• It is important to normalize questions by asking every patient about IPV- women and men

• Prior hospitalizations, treatment for injuries or delayed treatment may provide clues

• Make sure to describe circumstances match the injury type

How to Assess for IPV: Gathering of Subjective Data

Use of open-ended questions to start the conversation

How to Assess for IPV: Screening Tools

May be a simple question- “Do you feel safe at home?”

• USPTF prefers standardized tools

  • HITS- 4 item questionnarie

  • STat- 3 item questionnarire

IPV Assessment Tools: HITS

How often does your partner:

• Physically hurt you

• Insult or talk down to you

• Threaten you with harm

IPV Assessment Tools: Stat

Have you ever been in a relationship where your partner pushed or slapped you?

Have you even been in a relationship where your partner threatened you with violence?

Have you ever been in a relationship where your partner has thrown, broken, or punched things?

Scream or curse at you?

Assessment of Abuse and Neglect: Child Abuse and Neglect

Use appropriate resources to educate

Medical history is important part of examination

If child is verbal, history should be obtained away from caregivers through open-ended questions or spontaneous statements

Documentation- use words child had used to describe how his or her injury occured

Assessment of Abuse or Neglect: Older Adults

Vulnerable population

Older Adult Abuse suspicion index

• Validated in primary care

• Cognitively intact patients

Objective Data Collection

Be aware of normal range of findings based on developmental age

Visual examination of the entire body is required:

• Abuse may be hidden under clothing

• Atypical bruising pattern or bruise in the shape of an object

• Significant injury observed in non-mobile individual

Use appropriate terminology r/t bruising

• Maintain consistency for accurate interpretation

Include baseline laboratory testing

• CBC with platelet count, basic blood chemistries, serum LFTs, coagulation panel and U/A

Assessing for Risk for Homicide

Danger assessment (DA)

• 19-item yes/no instrument is used extensively by nurses

• Starts with calendar so women/men can more accurately has become over the past year

• Excellent assessment of frequency and severity of violence of health care providers