Lecture 9.1 - De-escalation, Addressing Human Trafficking, and Child Maltreatment

Question 1

What is a crisis?

Answer 1

A situation that results in a failure of coping mechanisms

Question 2

What are the priorities during crisis?

Answer 2

1. Safety - no means to harm self/others, proximity to exits
2. Build rapport through respect and using person’s name

Recognize that all behaviour is a form of communication and that our approach changes everything

Question 3

How does an abuse survivor present to the hospital?

Answer 3

1 - through ED triage
2 - Self-referral or external provider referral

Question 4

What is the different between medical and forensic consent?

Answer 4

Medical - obtained from a patient deemed competent and capable of making informed decision. The HCCA allows us to provide life saving medical procedures without consent to incapacitated patients.

Forensic - Must be informed. If intoxicated or incapacitated, a multidisciplinary approach with an ethics team may need to be included.

Question 5

What are the elements of evidence collection for survivors of sexual abuse and/or human trafficking?

Answer 5

Assault Hx

Physical exam

Documentation of injuries and findings

Photography

Physical evidence collection

Question 6

What is meant by high threshold of severity for mandatory reporting of child maltreatment?

Answer 6

The legislation across Canada concentrates understandings of abuse and when protection is needed onto a relatively small proportion of cases where children are harmed in severe ways.
–> Understandings of abuse are reserved for when children are, or are likely to be harmed.

Question 7

What is the issue with mandatory reporting when there is “reasonable grounds” to suspect child maltreatment?

Answer 7

This response closes off dialogue needed to address discriminatory practices of child protection
–> Retributive justice does not address the issue upstream

Question 8

What kind of statements can be useful for validation?

Answer 8

The no wonder response

Question 9

Which areas have the highest reported cases of trafficking?

Answer 9

Metropolitan areas such as Toronto, Ottawa, London, Montreal, Halifax

Question 10

What are the legal exceptions to confidentiality?

Answer 10

Youth under 16 witnessing harm, abuse, neglect, or at risk of sexual exploitation.

Sexual misconduct by a healthcare provider

Elder abuse in LTC setting

Person at imminent risk of harm to self or direct threat to a specific group or person

Reportable communicable disease

Gunshot wound

Question 11

What is meant by coercive control is a crime of liberty?

Answer 11

Coercive control is the subordination and domination of one human being to another.
–> characterized by fear and erodes the sense of self
–> Produced sense of entrapment

Question 12

What three discursive figurations are obstacles to meaningful responses to child neglect and abuse?

Answer 12

The Vulnerable Child

The Responsible Family (Mother)

The Monstrous Perpetrator

Question 13

Which three faulty assumptions underpin the model that prioritizes case-by-case reporting on child neglect and abuse?

Answer 13

1. It is rare and can be addressed on child at a time
2. If you look carefully enough you can see it
3. It can be addressed by identifying perpetrator and holding them accountable within the justice system

Question 14

What is the goal of violence informed care?

Answer 14

To minimize harm or potential for retraumatization, not treat trauma

Question 15

What are the four principles for implementing trauma and violence informed care?

Answer 15

1. Understand trauma and violence and their impacts on peoples’ lives and behaviour
2. Create emotionally and physically safe environments
3. Foster opportunities for choice, collaboration, connection
4. Provide a strengths-based and capacity-building approach to support client coping and resilience

Question 16

What kinds of barriers prevent nurses from engaging in preventative measures against CN&A?

Answer 16

Lack of knowledge about how to identify abuse

Absence of concrete definition of abuse

Lack of time and resources to invest in clients

Organizational constraints and reports not being taken seriously

Question 17

What recommendations for Einboden et al., 2017 make to change our approach to child neglect and maltreatment?

Answer 17

1. Respect children an equals in society
   –> include children in social life, abolish corporeal punishment, acknowledge coercive control in children’s lives, analyze dominant beliefs about children
2. Develop the infrastructure to support parents
   –> Support basic needs, address reproductive labour exploitation, the isolation of women and children, and analyze dominant beliefs about families that hinder just approaches
3. Reform laws and policies
   –> Challenge mandatory reporting, redistribute funding, decentralize decision making power

Question 18

What pattern of behaviours is seen in coercive control?

Answer 18

1. Love-bombing
2. Isolation
3. Restrictions of activities
4. Enforcing trivial demands + eroding boundaries
5. Demonstrate omnipotence and surveillance
6. Alter-perceptions
7. Degrade
8. Threaten
9. Abuse
10. Ongoing

Question 19

What are the four major harms caused by coercive control?

Answer 19

1. Crime of liberty
2. Erodes sense of self
3. Produces sense of entrapment
4. Primary harm is political