Abuse: Child elderly and intimate partner.

Question 1

After completing this module, the learner should be able to:

Answer 1

1. Define types and possible signs of child abuse
2. Define types and possible signs of elder abuse
3. Define types and possible signs of intimate partner violence
4. Describe what providers should do - and what they should not do - if abuse is suspected

Question 2

A child is:

Answer 2

Someone who is less than 18 years old, or
The age defined by the Child Protection Act of the state in which the child resides (except in the
case of sexual abuse)

Question 3

The U.S. Centers for Disease Control and Prevention (CDC) defines two categories of child maltreatment
(abuse and neglect):

1. Define Acts of commission (child abuse):
2. Define. Acts of omission (child neglect):

Answer 3

1. Acts of commission (child abuse):
   o Physical abuse
   o Sexual abuse
   o Emotional abuse
2. Acts of omission (child neglect):
   o Failure to provide, such as physical, emotional, medical, or educational neglect
   o Failure to supervise, such as inadequate supervision and exposure to violent environments

Question 4

Define types of child abuse
physical abuse
sexual abuse.

Answer 4

1. Physical Abuse
Physical abuse is any action that causes physical harm to a child, even if the harm is not intentional, as in
over-punishment. It includes:
Kicking
Punching
Hitting
Biting
Burning
Shaking

2. Sexual Abuse
Sexual abuse is inappropriate sexual behavior with a child. It includes:
Fondling a child's genitals
Making the child fondle the adult's genitals
Intercourse
Incest
Rape
Sexual exploitation

Question 5

To be considered child abuse

To be considered sexual assault.

Answer 5

To be considered child abuse, these acts have to be committed by a person responsible for the care of a
child (such as a parent, baby-sitter, or daycare provider), or someone related to the child.

If a stranger
commits these acts, it would be considered sexual assault.

Question 6

Define Emotional/Psychological Abuse and give examples.

Answer 6

Emotional abuse is an act, by parents or caregivers, that could cause behavioral, cognitive (affecting the
thinking process), emotional, or mental disorders. Examples of this type of abuse include:

Bizarre forms of punishment such as locking a child in a dark closet, basement, or attic
Constant criticism, threats, or rejection
Withholding love, support, or guidance
Emotional abuse is generally present with most other forms of abuse and is often hard to prove.

Question 7

Define abandonment.

Answer 7

Abandonment
Abandonment of a child is when:
A parent’s identity or whereabouts are unknown
The child has been left alone in circumstances where the child suffers serious harm
The parent has failed to maintain contact with the child or provide reasonable support for a
specified period of time

Question 8

neglect.

Physical neglect.
Medical neglect.
Emotional neglect
educational neglect.

Answer 8

Neglect is the failure to provide for a child’s basic physical, medical, educational, or emotional needs.
It is important to note that allowances must be made for cultural values, poverty, and other factors that
might be part of the reason for neglect. For example, people living in poverty may not be able to afford
the medication the child needs.

Physical neglect includes the failure to provide food, not allowing a runaway to come home, or
inadequate supervision so that the child is endangered.
Medical neglect includes failure to provide or withholding medical treatment or other lifesustaining
treatments including water and nutrition, when the treatment would most likely
result in correction of a medical condition. This does not include cases where there is no chance
of recovery from illness, such as a child with terminal cancer or a newborn with a condition that
is incompatible with life.
Emotional neglect includes not responding to the emotional needs of a child, exposing a child to
domestic violence, allowing a child to use drugs and/or alcohol, and the failure to provide the
necessary psychological care.
Educational neglect includes failure to educate a child or attend to special educational needs.

Question 9

Physical neglect

Answer 9

Physical neglect includes the failure to provide food, not allowing a runaway to come home, or
inadequate supervision so that the child is endangered.

Question 10

Medical neglect

Answer 10

Medical neglect includes failure to provide or withholding medical treatment or other lifesustaining
treatments including water and nutrition, when the treatment would most likely
result in correction of a medical condition. This does not include cases where there is no chance
of recovery from illness, such as a child with terminal cancer or a newborn with a condition that
is incompatible with life.

Question 11

Emotional neglect

Answer 11

Emotional neglect includes not responding to the emotional needs of a child, exposing a child to
domestic violence, allowing a child to use drugs and/or alcohol, and the failure to provide the
necessary psychological care.

Question 12

Educational neglect

Answer 12

Educational neglect includes failure to educate a child or attend to special educational needs.

Question 13

Substance Abuse

Answer 13

Many states consider substance abuse a form of child abuse and neglect. It may include the following
circumstances:
Prenatal exposure of a child due to the mother’s use of an illegal drug or other substance
Manufacture of methamphetamine in the presence of a child
Selling, distributing, or giving illegal drugs or alcohol to a child
Use of a controlled substance by a caregiver that impairs the caregiver’s ability to adequately
care for the child

Question 14

Signs of child abuse
physical
emotional
sexual..

Answer 14

SIGNS OF CHILD ABUSE
Child abuse is often hard to recognize unless it is very obvious. Knowing the signs of different types of
abuse can help you recognize possible cases.

Question 15

Signs of physical abuse include:

Answer 15

Injuries inconsistent with the explanation of the injury (for example, an infant who is not yet
walking or crawling with a broken leg, or injuries on both sides of the body because of a fall,
since injuries due to a fall are usually found on one side only)
Injuries in several stages of healing, such as old bruises and new bruises
Evidence of old fractures
Injuries such as rope burns, scalding, and cigarette burns

Question 16

Signs of sexual abuse include:

Answer 16

Provocative behavior or knowledge of sexual matters inconsistent with child’s age
Suicidal gestures
Behavior problems
Diagnosis of sexually transmitted disease in a child

Question 17

Signs of emotional/psychological abuse include:

Answer 17

Signs of emotional/psychological abuse include:
Poor development of basic skills
Anxiety or insecurity
Withdrawal
Destructive behavior
Aggression or angry outbursts

Question 18

Signs of neglect include:

Answer 18

Malnutrition
Failure to keep medical appointments or prescribed treatment
Child not dressed for the weather
Child not taking medicine as prescribed

Question 19

Be mindful that factors such as poverty may appear as neglect.

Answer 19

Be mindful that factors such as poverty may appear as neglect.

Question 20

REPORTING CHILD ABUSE

Answer 20

In all states, it is MANDATORY that healthcare professionals report suspected cases of child abuse.
Your facility may have its own policies about who files the actual report. As a healthcare worker, you
should become familiar with your facility’s policies in this regard.

Question 21

What to do If a child tells you he or she was abused, or if you suspect abuse:

Answer 21

1. Notify the appropriate state agency as per your facility’s policy (your facility will have a hotline
   number to call), and they will get the details from the child.
2. DO NOT interview the child; studies show that the testimony of children is less accurate when they
   are asked to repeat it.
3. DO NOT allow the child to leave with the caregiver until the state agency is contacted and you have
   their permission to allow the child to leave with the parent/caregiver.

Each state has its own statutes defining:
The procedure for reporting suspected cases of child abuse to Child Protective Services
Who must file the report
Other factors such as criminal punishment for abuse

Question 22

Define elderly abuse.

Answer 22

Elder abuse is:
The physical, emotional, or financial mistreatment, neglect, or exploitation of a person age 60 or
older by another person,
or
The self-neglect of an individual in this age range

According to the National Center on Elder Abuse, each state defines elder abuse according to its unique
statutes and regulations, and definitions vary from state to state.

Question 23

Elder abuse can occur in these settings:

Domestic elderly abuse and institutional elderly abuse.

Answer 23

1. Domestic elder abuse. This is abuse of an older person by someone who has a special
   relationship with the elder, such as an intimate partner, spouse, sibling, child, friend, or
   caregiver. The abuse occurs in the older person’s home or in the home of the caregiver.
2. Institutional elder abuse. This is abuse of an older person that occurs in a residential facility for
   older persons such as a nursing home, foster home, group home, or boarding house. In
   institutions, the persons who are the abusers have been hired to provide care and protection for
   elders.

Question 24

TYPES OF ELDER ABUSE

Answer 24

Physical abuse, sexual abuse, emotional or psychological abuse,, neglect, abandonment, financial or material exploitation., Self-neglect.

Question 25

Physical abuse and its signs.

Answer 25

Physical abuse is intentional physical pain or injury inflicted on an elder by a person who is responsible
for his or her care. Examples include:
Slapping
Bruising
Use of unreasonable physical restraint
Deprivation of food or water
Over-medicating or under-medicating

Signs of physical abuse include:
Elder’s report of being hurt
Injury inconsistent with the story of how it was received
Injuries in various stages of healing
Observed actions of caretaker, such as hitting, slapping, or burning
Caretaker’s refusal to allow anyone to see an elder alone

Question 26

Define sexual abuse and its signs.

Answer 26

2. Sexual Abuse
   Sexual abuse (a type of physical abuse) is any nonconsensual sexual contact or sexual act with any
   person incapable of giving consent. This includes, but is not limited to:
   Unwanted touching
   Sexually explicit photographing
   All types of sexual assault or battery, such as rape, sodomy, or coerced nudity

Signs of sexual abuse include:
Elder’s report of being sexually abused
Torn, stained or bloody underclothing
Bruises or other injuries around breasts or genitals
Unexplained vaginal or rectal bleeding
Unexplained sexually transmitted disease (STDs) such as gonorrhea or syphilis

Question 27

Define emotional or psychological abuse and its signs.

Answer 27

Emotional or psychological abuse is the infliction of mental or emotional suffering (anguish, pain, or
distress) through verbal or nonverbal acts by a person who is in a position of trust. Examples include:
Verbal assault
Humiliation
Intimidation or threats
Isolation from family and/or friends

Signs of psychological abuse include:
Elder report of psychological abuse
Elder being very agitated and upset
Elder being withdrawn and uncommunicative or nonresponsive
Unusual behavior often attributed to dementia (hitting, biting)

Question 28

Define neglect and its signs.

Answer 28

4. Neglect
   Neglect is the failure of a caretaker to provide adequate food, clothing, shelter, psychological care,
   physical care, medical care, or supervision to avoid physical harm, mental anguish, or mental illness to
   the elder.

Examples include:
Failure to assist with personal hygiene or the provision of clothes
Failure to protect an elder from health and safety hazards

Signs of neglect include:
Dehydration, malnutrition, untreated bed sores, and poor personal hygiene
Unattended or untreated health problems
Unsafe living conditions
Unsanitary appearance such as dirty clothes
Elder report of being mistreated

Question 29

Abandonment

Answer 29

Abandonment is the desertion by an individual who has assumed responsibility for providing care for an
elder or by a person with physical custody of an elder. This includes:

The desertion of an elder at a clinical facility, shopping mall, or other public location
Elder report of being abandoned

Question 30

Financial or Material Exploitation

Answer 30

Financial or material exploitation is the theft or improper use of an elder’s money or property, without
his or her consent, for someone else’s benefit.

Examples include:
Forcing or tricking the elder into selling his or her home
Forging a signature on pension checks, wills, or financial documents
Misusing “power of attorney”
Not allowing the older person to buy needed items such as clothes
Using the elder’s ATM without permission or taking over bank accounts without permission
Making changes to the elder’s will without approval
Providing substandard care despite an elder’s ability to pay
Unexplained disappearance of funds or valuable possessions
Elder report of financial exploitation

Question 31

Self-Neglect

Answer 31

Self-neglect (also known as self-abuse) is the behavior of an elderly person that threatens his or her own
health or safety, such as not providing himself/herself with enough food or water, clothing, shelter,
safety, personal hygiene, and/or medication.

Self-neglect usually occurs when an elder lives alone.
This excludes any competent older people who make a conscious and voluntary decision to engage in
acts that threaten their health or safety and who understand the consequences of those decisions.

Signs of self-neglect include:
Grossly inadequate housing or homelessness
Lack of the necessary medical aids
Hazardous, unsafe, or unclean living conditions
Dehydration, malnutrition, poor personal hygiene, improperly treated medical conditions

Question 32

REPORTING ELDER ABUSE

what to do If abuse is suspected or an elder tells you he or she was abused:

Answer 32

Healthcare professionals in all states are required by law to report any suspected cases of elder abuse.

Your facility may direct the procedure for reporting. All calls are confidential and must be made to your
state’s hotline.

The investigation will be carried out by the state’s Adult Protective Services.

If abuse is suspected or an elder tells you he or she was abused:
Document all findings, including any statements the victim and caretaker make
DO NOT allow the elder to leave without permission from the state Adult Protective Services

Your community should also have an Area Agency on Aging that provides services for the elderly. If a
caretaker expresses any concerns or clearly needs help, you can either call or refer the person to this
agency.

Question 33

INTIMATE PARTNER VIOLENCE

Answer 33

Intimate Partner Violence is a pattern of threatening or violent behavior used to establish power and
control over an intimate partner. It involves emotional, financial, physical, sexual, or social abuse.
Intimate Partner Violence is also known as:
Domestic violence
Domestic abuse
Intimate partner abuse

Question 34

Intimate Partner Violence happens in all types of intimate relationships:

Answer 34

Between married couples
Between unmarried couples
Between same-sex couples
Between couples living together or apart
In a relationship where Intimate Partner Violence exists, one person is forced to change his or her
behavior because of abuse or the perceived threat of abuse.

Question 35

TYPES OF INTIMATE PARTNER VIOLENCE

Answer 35

• Physical abuse
• sexual abuse,
• psychological abuse
• financial abuse
• emotional abuse.

Question 36

Physical Abuse

Answer 36

Physical abuse is the infliction of pain or physical injury by the victim’s partner. A physical abuser may:
Hit, push, kick, slap, hold down, or throw things at the victim
Harm a victim’s children, pets, or property
Commit battery (a threat of violence accompanied by the ability to carry out the threat)

Question 37

Sexual Abuse

Answer 37

Sexual abuse is violence by the victim’s partner in which sex is used to hurt, degrade, dominate,
humiliate, or gain power over the victim. It is an act of aggression.
The abuse may involve force, coercion, bribes, threats, or corruption, and may include prostitution or
money. Abusers may brag or boast to the victim about sexual activities with another person, or compare
the victim’s sex actions to those of other persons.
A victim of sexual abuse may:
Be treated as a sex object
Be called sexual names
Be forced into sexual activities by the abuser
Develop an inability to trust, which leads to secrecy and nondisclosure

Question 38

Psychological Abuse

Answer 38

Psychological abuse includes:
Intimidation
Degradation
Coercion
False accusations
Humiliation
Ridicule
Threats of physical harm

Question 39

Financial Abuse

Answer 39

Financial abuse of an intimate partner is the misuse or exertion of control over money, access to money,
or possessions. It includes stealing and lying about money.

A financial abuser may:
Remove large sums of money from the victim’s bank account
Deny the victim the ability to pay bills or buy necessities
Deprive the victim of money or access to money
Deny the victim job freedom

Question 40

Emotional Abuse

Answer 40

Emotional abuse is behavior that causes feelings of unworthiness. An emotional abuser may withhold affection from the victim, or use jealousy, passion, or anger to justify actions.

Victims of emotional abuse may be:
Put down by their partner
Told no one else will want them if the partner leaves
Ignored or isolated

Emotional abuse is cruel and destructive. It is almost always present in situations where other forms of
Intimate Partner Violence occur

Question 41

THE CYCLE OF INTIMATE PARTNER VIOLENCE

Answer 41

The cycle of abuse is common in many cases of Intimate Partner Violence. It results in the abused person
living in fear with the belief that there is no escape.

The three phases of the cycle of Intimate Partner Violence are:

1. Tension-building phase
2. Crisis phase
3. Honeymoon phase

Question 42

Phase 1: Tension-Building Phase

Answer 42

The tension-building phase is characterized by stress.

The abuser shows signs of increasing irritation with the victim, often finding fault with
everything he or she does.
The victim becomes fearful and tries to find ways to appease the abuser.

Question 43

Phase 2: Crisis Phase

Answer 43

The crisis phase is characterized by violence.
The abuser’s anger reaches a critical point and is released in the form of verbal or physical
violence.

The abuser may shout and scream at the victim, threaten him or her, and damage the victim’s property.

Physical assaults such as punching, kicking, or slapping hard enough to bruise, break bones, and draw blood may also occur.

The police or neighbors may be called, or the violence may be unknown to people outside.

The victim may be made to feel that he or she provoked the escalation from phase 1 to phase 2.

Question 44

Phase 3: Honeymoon Phase

Answer 44

The honeymoon phase is characterized by a return to calmer behavior.

The abuser is sorry and promises to get help and never do this again.
The abuser may offer affection to the victim.

Question 45

IDENTIFYING INTIMATE PARTNER VIOLENCE

When a patient denies Intimate Partner Violence, the following signs may alert healthcare workers to
suspect abuse:

Answer 45

Victims of Intimate Partner Violence often have obvious physical injuries. Others may have vague
complaints and deny abuse.

When a patient denies Intimate Partner Violence, the following signs may alert healthcare workers to suspect abuse:

A pattern of missed appointments
Delays in seeking treatment
Frequent medical visits for vague complaints with lack of evidence of physical causes
Injuries in several stages of healing, such as old bruises, and evidence of old fractures
Injuries during pregnancy (because pregnancy is a high-risk situation for abuse)
Injuries inconsistent with the explanation of the injury

Examples of situations in which the explanation of the injuries are inconsistent with the injuries:
Someone states that the injuries are caused by a fall, and yet the bruises and cuts, on the hands
and arms, are consistent with self-defense injuries.
Someone states that the injuries are caused by a fall, and yet the injuries are found on both
sides of the body (usually, in a fall, injuries are on one side only).

Question 46

REPORTING INTIMATE PARTNER VIOLENCE

If you suspect Intimate Partner Violence:

Answer 46

Provide privacy and the opportunity for the person to talk. Privacy also means privacy from
partner, family members, or acquaintances.
Assure the person of confidentiality.
Be nonjudgmental and caring.
Ask if the partner has ever harmed or threatened to harm the person or his or her children.
Let the person know that there are options. Reinforce the idea that victims do not cause nor
deserve the abuse.
DO NOT ask the person why he or she does not leave the abuser.
DO NOT change your course of action because the person does not admit to abuse.

Question 47

As a healthcare worker, your responsibilities include:

Answer 47

Screening patients for signs of abuse
Documenting all findings including the victim’s statements
Ensuring domestic violence information is available in waiting areas and restrooms
Knowing the options and inform the person about options
Making referrals, as indicated

Question 48

Use the acronym RADAR as a guide:

Options for victims include:

Answer 48

R = Routinely screen patients
A = Ask direct questions so the person can answer "yes" or "no"
D = Document your findings
A = Assess the person's safety
R = Review options and referrals

Options for victims include:
Pressing charges to have the abuser arrested
Obtaining an injunction or restraining order against abuser (the purpose of the restraining order is to prevent the abuser from communication or associating with the victim)
Going to a safe house or shelter for protection and accommodations
Going back home
Getting help when ready

BE CAUTIOUS about giving victims a phone number to call for help. The abuser may find it and respond
abusively. Instead:
Help victims memorize the number.
Tell them how to find the numbers for help.
Tell them the names of organizations or websites they can look up when it is safe.
If an abuser seeks help, follow the hospital policy on Intimate Partner Violence and refer him or her to
treatment centers for help. There is also help for substance abuse.