Interviewing Victims Of Abuse

Question 1

Role of the physician

Answer 1

● Taking a history
● Perform a complete physical or full examination
● Take valid specimens if needed
● Writing a detailed report
● Giving medical opinion
● Giving evidence in court.

Question 2

General medical history

Answer 2

● Past & present health, current medications, previous accidents, previous surgery,
● Family, social, environmental, occupational histories
● Prenatal, natal, immunization, developmental, nutritional
histories

Question 3

Specific history

Answer 3

● Details related to the situation for which the examination is being conducted (e.g., use of force, drugs, damage to clothing, relative position of victim and assailant, circumstances surrounding the abuse, etc.)
● Opinion will be based on the specific history with the physical findings
● Before you begin your interview, you must establish rapport with your patients.

Question 4

Interviewer

Answer 4

● Sensitive and responsive
● Competent
● Skillful

Question 5

Environment

Answer 5

● Safe, private
● Comfortable, quiet, free from distractions

Question 6

Listen to the woman closely, with empathy, and without judging

Answer 6

Listen

Question 7

Assess and respond to her various needs and concerns - emotional, physical, social and practical (e.g. childcare)

Answer 7

Inquire about needs and concerns

Question 8

Show her that you understand and believe her. Assure her that she is not to blame

Answer 8

Validate

Question 9

Discuss a plan to protect herself from further harm if violence occurs again.

Answer 9

Enhance safety

Question 10

Support her by helping her connect to information, services and social support.

Answer 10

Support

Question 11

Child sensitive interview

Answer 11

○ Introductions (developmental screen)
○ Instructions (include promise to tell the truth)
○ Narrative event practice
○ Transition
○ Substantive space
○ Closure

Question 12

There are a lot of strategies that you may use because the narrative ability of a child is influenced by

Answer 12

○ Age
○ Developmental level
○ Family style
○ Level of trauma and neglect
○ Health problems

Question 13

Interviewing

Answer 13

• Victim is asked to explain the assault in her own words
• Use open-ended, non-leading questions
• Avoid “why” questions
• Allow her to complete her account with no interpretations and to clarify later and to be thorough in eliciting embarrassing details
• Address the patient’s questions and concerns in a non judgemental and empathetic manner.
• Use a very calm tone of voice
• Maintain eye-contact
• Do not express shock or disbelief
• Avoid using victim blaming statements.

Question 14

Details you want to ask:

Answer 14

○ How the assault happened
○ Date, time, location of the assault including a
description of the type of surface on which the assault occurred
○ The name and identity and number of assailants.
○ The nature of physical contacts, detailed account of violence inflicted
○ Use of weapons, restraints
○ Use of medications/drugs/alcohol/inhaled substances

Question 15

Investigators and court want to know about the following:

Answer 15

• age of an injury
• how the injury was produced (mechanism)
• amount of force required to produce the injury
• circumstances in w/c the injury was sustained
• consequences of the injury

Question 16

Classification of injuries

Answer 16

● Use standard, universally accepted descriptive terms
○ E.g. laceration, abrasion, bruises, stab wounds, size
wounds (gun shot wounds)

● Assists in identifying the mechanism by which the injury was sustained

● Contributes to a better understanding of the circumstances
in which the injuries may have been sustained

● May allow deductions about the weapon or the object that caused the injury

● Examination of the pattern of injuries may assist in answering questions about whether the injuries were sustained in an accidental, assaultive or self-inflicted manner

Question 17

Examination notes

Answer 17

● Normal and abnormal findings
● Detailed
● The use of abbreviations is NOT recommended ● Legible

Question 18

Documentation (Photographic evidence)

Answer 18

● Make use of the body Diagram and the L- shaped ruler to measure
○ Describe and give detail of the injury
■ “Medial aspect of the thigh, 23 cm above the knee, red-blue bruise measuring 4 x 2 cm”
○ On the body map draw the injury
■ Circle for Hematoma/Bruise
■ Line for Laceration
■ Put an arrow on the injury with a description
○ Take note of the lateralities (left, right, anterolateral, distal, medial, or proximal, etc)

Question 19

Ano-genital examination

Answer 19

Tanner staging

Question 20

Taking valid specimens: “Silent Witnesses”

Answer 20

• traces of contact, scientific evidence
• lab exam

Question 21

Taking valid specimen: chain of custody

Answer 21

• labeling of each specimen, proper recording
• ID of all who handled the specimen
• prevent contamination of specimens

Question 22

If there is a need to take valid specimens, please do so. This is to:

Answer 22

○ Confirm the history
○ Attempt established contact between the individuals
○ Establish contact of the victim and the alleged scene of the incident.
○ Assist the identification of the assailant.

Question 23

Examples of Valid specimens in the identification of the sexually abused:

Answer 23

○ Cultures
○ Gram staining
○ STDs, etc.