Family Violence & Substance Use Disorders

Family Violence and Substance Use Disorders (Chapters 14 & 59)

Definition: Abusive behavior perpetrated by one individual towards another within an intimate or family relationship.
Role of Dental Professionals: Mandated to advocate for victims by identifying and reporting suspected cases.
High-Risk Groups: Children, the elderly, individuals with cognitive and physical disabilities, Indigenous people, LGBTQ+ individuals, and women. However, anyone can experience FV.
Related Terminology:
- Intimate Partner Violence (IPV)
- Domestic Violence (DV)
- Child abuse/neglect
- Elder abuse/neglect
Manifestations of Family Violence: Can occur in multiple forms, including:
- Physical abuse or exposure to violence.
- Stalking.
- Emotional/psychological abuse or neglect.
- Sexual abuse or violence.
- Neglect or abandonment.
- Medical/dental neglect.
- Financial exploitation.

Physical Neglect: The willful or unwillful failure of a caregiver or parent to provide necessities to individuals under their care. This includes abandonment, as well as medical, dental, and deprivation neglect.
Physical Violence: Nonaccidental injuries inflicted upon family members by parents, caregivers, spouses, or siblings.
Sexual Violence: Nonconsensual or exploitative sexual contact, encompassing sexual intercourse, oral sex, fondling, or pornographic activities, committed by one family member against another.
Emotional Abuse: The causation of mental anguish and despair through ridicule, threats, intimidation, and humiliation. This also includes controlling behavior and isolation.

Child Abuse: Refers to words or actions that cause harm or potential harm to an infant, child, or adolescent.
- In the U.S. context, sex trafficking and prenatal exposure to substance abuse are considered forms of child abuse and neglect.
Child Neglect: The failure to provide a child's basic physical, emotional, educational, and medical needs. This can sometimes involve the spiritual beliefs of parents/guardians impacting care decisions.
Dental Neglect: Specifically defined as the willful failure of a parent or guardian to seek and follow through with dental treatment necessary to ensure a level of oral health essential for adequate function and freedom from pain and infection. This definition extends beyond children to include any adult or elder who requires assistance in meeting these needs.

General Indicators: These are complex and include:
- Physical indicators.
- Behavioral features.
- Social behavior anomalies.
- Emotional well-being concerns.
- Cognitive features.
- (Refer to Table 14-1 in Wilkins' textbook for a comprehensive list).
Common Sites of Children's Injuries:
- Areas like the head, trunk, and inner thighs are common for inflicted or abusive injuries.
- Areas such as the knees, shins, and forehead are common for accidental injuries.

Intraoral Signs of Sexual Abuse:
- Lacerations of the tongue, palates, or oral mucosa.
- Lingual and labial frenal tears.
- Burns within the oral cavity.
- Fractured or displaced teeth.
- Radiographic evidence of fractures, often presenting at varying stages of healing, which can indicate repeated trauma.
Dental Neglect: Both dental prevention neglect (failure to provide preventative care) and dental treatment neglect (failure to pursue necessary treatment) are considered forms of abuse.
- Risk Factors for Dental Neglect: Numerous factors contribute, including low socioeconomic status (SES), low health literacy, parental attitudes towards primary (baby) teeth, refugee populations, and parental dental anxiety, among many others.
Common Parental/Caregiver Characteristics Associated with Neglect:
- Lack of interest in oral health education.
- Indifference towards the child's well-being.
- Substance abuse.
- Repeated missed dental appointments.

General Characteristics:
- A parent or caregiver intentionally fabricates or induces illness or disease in a child.
- It is often difficult to diagnose due to the deceptive nature of the perpetrator.
- The child's disease does not follow a normal history or typical clinical presentation.
- The perpetrator may actively induce symptoms in the child.
- Perpetrators often seek to progress to more invasive medical procedures for the child.
- In approximately 90\% of cases, it is initiated by the mother.
- The perpetrator's motivation is to make the child sick by proxy, often seeking attention or sympathy.
- Perpetrators frequently have a history of child mistreatment.
- Approximately half of perpetrators are employed in healthcare-related fields.
- Most often affects children up to 2 years of age, and usually not older than 6 years.
- While rare, it is a possible form of child abuse.

Nature: A global public health issue and a severe form of child abuse.
Perpetrators: Unlike other forms of family violence, perpetrators are often not family members.
Risk Factors for Victims: Perpetrators often target individuals who:
- Have a history of abuse or neglect.
- Lack a strong support system.
- Are homeless, involved in the foster care system, or are runaways.
- Are undocumented immigrants.
Indicators in Patients: Healthcare providers should watch for:
- A patient who is escorted by a controlling person who may speak for them or insist on remaining in the room.
- It's estimated that almost 88\% of victims have seen a healthcare provider while being trafficked, highlighting the opportunity for intervention.
Call to Action: Healthcare providers must become educated on the numerous indicators and available resources.
- The National Human Trafficking & Resource Center Hotline (https://humantraffickinghotline.org/en) is a crucial resource.

Occurrence: Elder abuse takes place in various settings, including the home, institutions, and community environments.
Types of Abuse: Similar to other forms of Family Violence, including:
- Physical abuse/neglect.
- Psychological abuse/neglect.
- Sexual abuse.
- Financial exploitation.
Impact on Victims: Victims of elder abuse face a higher likelihood of premature death and are at a significantly greater risk of hospitalization.
Demographics: 'Elderly' is typically defined as individuals chronologically aged 65 or older. This demographic comprised 55.8 million or 16.8\% of the U.S. population in 2020, underscoring the scale of this public health problem and the potential for Dental Healthcare Professionals (DHCP) to intervene.
Physical Signs: (Refer to visual aids like those found in Weber & Kelley's