Intimate Partner Violence

Question 1

What is the CDC’s definition of IPV?

Answer 1

• Physical or sexual violence, use of physical force, or threat of such violence
• psychological or emotional abuse or coercive tactics after prior physical violence between persons who are spouses or non-marital partners (or former)

Question 2

What is the definition of Child abuse and neglect?

Answer 2

The Child Abuse and prevention treatment act (CAPTA) dictates minimum standards that must be incorporated into state statutes
- Neglect
- Physical abuse
- Sexual abuse
- Emotional abuse

Question 3

Neglect

Answer 3

Failure to provide for a child’s basic educational, physical, emotional and medical needs

Question 4

Physical abuse

Answer 4

Physical injury due to punching, beating, kicking, biting, burning, shaking, or otherwise harming a child; even if the parent or caretaker did not intend harm, such acts are considered abuse when done purposefully

Question 5

Sexual Abuse

Answer 5

Includes fondling child’s genitals, incest, penetration, rape, sodomy, indecent exposure, and exploitation through prostitution or production of pornographic materials

Question 6

Emotional abuse

Answer 6

Any pattern of behavior that harms a child’s emotional development or sense of self-worth includes belittling, rejection, threats, and withholding love and support

Question 7

What is the definition of Adolescent Violence?

Answer 7

Physical, sexual or psychological/ emotional violence wothin a dating relationship that includes stalking
- may occur in person or electronically
- may occur with present or former partner

Question 8

What about reporting elder abuse and neglect?

Answer 8

Mandatory reporting of abused elderly & other vulnerable patients
- You only need to have a suspicion that it is occurring to report it to the authorities
- You do not need to have proof

Question 9

What is the definition of elder abuse and neglect?

Answer 9

Physical abuse: violent acts that result or could result in injury, pain, impairment, or disease
Physical neglect is the failure of a family or caregiver to provide basic goods and services such as food, shelter, health care, and medications.
Psychological abuse: behaviors that result in mental anguish
Psychological neglect: failure to provide basic social stimulation
Financial abuse: Intentional misuse of an elderly person’s financial and material resources
Financial neglect: failure to use elderly person’s assets to provide needed services

Question 10

What are the health affects of violence?

Answer 10

Injury
- neurologic
- gastrointestinal
- gynecologic
- chronic pain
Depression
Suicide
Sxs of PTSD
substance abuse

Question 11

What are the effects of child abuse?

Answer 11

• Physical injury–> long-term injury or death
• ex: shaken baby syndrome
• mental retardation
  blindness
• LT effects substance abuse & continuing cycle of violence

Question 12

What are the risk factors that contribute to child mistreatment?

Answer 12

Disabilities that increase the caregiver’s burden
Social isolation of families
Lack of understanding about child’s needs and development
History of domestic abuse
Poverty and SES disadvantage
Family disorganization, dissolution, and violence
Substance abuse in the family
Young, single, nonbiological parents
Parental thoughts & emotions supporting maltreatment behaviors
Parental stress and distress & mental health conditions
Community violence

Question 13

What are some health effects of elder abuse?

Answer 13

Physical injury, bleeding from trauma–> circulatory issues & death
Infections–> sepsis & death
Assault or stress leading up to it can cause cardiac complications
STIs if sexually abused
Often coupled with neglect
Family may be responsible intentionally or not
Criminal neglect
Family caring for patients may struggle with their care/ health–> caregiver strain.
Self-neglect- may raise questions about the right to live autonomously ** this is also reportable **

Question 14

What does routine screening for IPV look like?

Answer 14

*Asking every woman * if she has been abused by an intimate partner or ex-partner

Question 15

Factors involved in screening for IPV

Answer 15

How to screen
Abuse Assessment screen
History
PE
Documentation

Question 16

Abuse Assessment Screen

Answer 16

When you argue, are you ever afraid of your partner?
Does your partner try to hurt you emotionally?
Does your partner try to control you?
Has your partner ever physically hurt you?
Did your partner ever physically hurt you when you were pregnant?
Has your partner ever forced you to have sex?

Question 17

How to assess Elder/ vulnerable person abuse & neglect?

Answer 17

• In cognitively challenged individuals this is complicated
• Physical findings are inconsistent with history provided by caregiver
• Problems may exist at multiple levels- physically and cognitively

Question 18

What are some questions to ask for elder abuse?

Answer 18

Has anyone:
* ever touched you inappropriately?
* Made you do things that you don’t want to?
* Taken things without asking?
* Physically hurt you?
* Scolded or threatened you?
* Failed to help you take care of yourself?
Have you signed documents your did not understand?
Are you afraid of anyone at home?
Are you alone a lot?

Question 19

What should you keep in mind if have a past hx of traumatic injuries?

Answer 19

Assess and document prior abuse
MMSE is important for elder, IPV and head/ neurologic sxs
**Violence survivors: **check for problems associated with attention to suicidality, PTSD, substance abuse and anxiety

Question 20

What PE screening is important for child abuse & neglect?

Answer 20

PMHx is most important part of the exam
* Prior hospitalizations
* Do they take meds that may cause easy bruising?
* Hx of repeated visits to hospital?
* Do they delay seeking care for other than minor injury?
If child is verbal hx should be obtained away from caretaker

Question 21

What is important for child’s physical exam?

Answer 21

Visual inspection- head to toe
* injuries maybe hidden under clothes
* bruising on buttocks, hands, feet & abdomen is rare in normal life
* bruising in the shape of an object is highly specific for abuse
* bruising in non mobile children should be further investigated for fractures & intracranial injuries

Question 22

What are important components of physical exam for IPV & Elder abuse?

Answer 22

Complete head to toe visual inspection
* especially if receiving care for abuse
* Health evaluations should include baseline lab tests
CMP, CBC w/ diff, LFTs, coagulation panel & urinalysis

Question 23

What are the specific documentation requirements?

Answer 23

Detailed non-biased notes
Injury maps
Photographic documentation
Cultural aspects of care
Available resources

Question 24

How do we use photographic documentation to support description of abuse?

Answer 24

Place picture & description here

Question 25

How to assess for the risk of homicide?

Answer 25

Danger assessment DA
19 item yes/ no questionnaire
Begins with a calendar to enable visualization of violence frequency & severity
The more yes answers to items on the assessment the higher the risk of homicide

Question 26

What about if the patient says no during the DA but there are other IPV indicators?

Answer 26

Suspect IPV and be alert to other conditions associated with IPV
GYN problems STIs, pelvic pain, and complaints of sexual dysfunction
Chronic irritable bowel syndrome back pain, depression, sxs of PTSD, sleeping problems, panic attacks or nerves

Question 27

What about other IPV indicators?

Answer 27

When these issues occur and persist, a thorough and repeated assessment for domestic violence is required.
WEB is an additional tool that can be used in conjunction with AAS. In addition to this we can ask gentle, indirect questions:
Ex: “I am concerned about your health conditions. Is there any chance that stress at home is contributing to these problems?”