Physical, sexual, Emotional, Neglect, Economic

crisis situation

Perptrator (in crisis situation)

Family member upon whom abuse is perpetrated, Other terms: victim, survivor, or victim/survivor, Survivor: recognizes recovery and healing process

Acts of commission: deliberate and intentional. They include physical sexual, and emotional abuse., Acts of omission: neglect; occurs when a child’s basic physical, emotional, or educational needs are not met or when a child is not protected from harm.

Interpersonal violence is more likely to be done by someone the victim knows., Battering is the most common cause of injury to women in the U.S., Domestic violence is generally physical, physchological, and suxal abuse directed primarily at women by men for THE PURPOSE OF MANTAINING CONTROL AND POWER**, Emotional and psychological abuse is just as devistating as direct physical abuse

The occurrence of one type of abuse is a fairly strong predictor of the occurance of another type., Lufetime secondary effects: anxiety, depression, suicidal ideation, MDD & PTSD

Child is seen as different, Child is seen as fragile, Child reminds parent of someone they dislike, Child does not live up to parent’s fantasy, Child is the result of an unwanted pregnancy, Child whose emotional bonding was interrupted to prematurity or prolonged illness

History of childhood abuse or neglect, Family authoritarianism; harsh punishments, Low self-esteemk, social isolation, and poor coping skills, low frustratation tolerance, Experiencing a crisis (not always), Unrealistic expectation of the child, Severe mental illness or substance use disorder, Poor impulse control or violent temper

25% of women and 10% of men are abused, Teen dating violence: 1in11 females; 1in15 males, Partner stalking: women 10%, men 2%, Nearly half of married couples have instances of abuse, Same-sex relationships: same rate as heterosexual relationships, 1in10 homicided is spousal murder

Women are at greatest danger when they try to leave- up to 2 years after!, 75% of women murdered by their partners were attempting to leave or had left the relationship, On average, survivors of domestic violence leave their abuser SEVEN TIMES before leaving for good

Male perpetrators: may believe in male dominance; need to be in charge, belief that physical aggression lends power, Pathological jealousy, Substance or alcohol use disorder, Resentment toward pregnant or baby, Violence may escalate when the women attempts more independence attempts to leave

Tension-building stage, Attempts to reduce tension by both partners, Acute battering stage, Honymoon stage, Tension builds and cycle continues, Repeat periods of calm and safety diminish over time and repetition

Mistreatment: failure to provide basic needs, failure to protect, Physical or sexual abuse, Financial abuse, Epidemiology: family members are the perpetrators, custodial/care personnel

Poor mental physical health, Disruptive due to a disorder (Alzheimer’s), Dependent on perpetrator, Female, older than 75 years, white, living with a relative while impaired, Elderly parents cared for by children or spouses they abused earlier in life

General assessment: Hx of sexual abuse, family violence, and drug use or abuse, Avoid words like “abuse” or “violence”, Ask how disagreements are settled, how children are disciplined, Avoid assumption about a person’s sexual orientation

Have you ever been emotionally or physically hurt by your parter or someone important to you?, Within the last, have you been hit, slapped, kicked, or physically hurt someone? By whom? How many times?, Within the last year, has anyone forced you to have sexual activity? Who? How many times?, Are you afraid of your partner or anyone else?

Are you in a relationship where you’re being threatened or hurt?, Do you feel safe are home?, I want you to know that I see many women with injuries like yours, and seldom happen accidentally. Usally they come from someone hurting them on purpose.

Tell me about what happened to you., Who takes care of you? (children dependent elders), What happens if you do something wrong?, How do you and your partner resolve disagreements?, What do you do for fun?, Who helps you with your children/parent? (for caregiver), What time do you have for yourself?, For younger children don’t ask open ended questions!

What arrangements do you make when you have to leave your child alone?, How do discipline you child?, When your infant cries for a long time, how do you get him/her to stop?, What about your child’s behavior bothers you the most?

Do not judge or accuse, Do not use the words “abuse” or “violence”, Do not display horror, anger, shock, or disapproval**, Do not force a child or anyone else to remove clothing

Anxiety, Coping mechanisms, Support systems, Homicide potential, Drug and alcohol use

Verbatim statement of who and when, Body map to indicated size, color, shape, areas and types of injuries with explanations (proper 5-6 hrs)

Intense and overwhelming feelings, Strong negative feelings may cloud judgment and interfere with objective assessment and intervention, Common responses of healthcare professionals to violence

Fearfulness,watchfulness, Disheveld, malnourished, Failure to thrive, Multiple injuries but no history of significant trauma

Emotional abuse: Low self-esteem, reported feelings of inadequacy, anxiety and withdrawal, learning difficulties, and poor impulse control., Neglect: Appear undernourished, dirty, and poorly clothed; inadequate medical care such as lack of immunizations and untreated medical or dental conditions, Economic abuse: Failure to provide needs

Unexplained bruises, welts, scratches in various stages of healing., Regular patterns of bruises and welts (shoe print, bite mark etc), Lacerations from rope burns, Bruises on buttocks, genitalia, thighs, side of face, trunk, upper arms

Small round burns from cigarettes, Immersion burns (even boundaries), Patterned burn marks (iron, grill), Fracturs in infants you set than age 1, Fractures: (long bones common for abuse) femur, humerus, posterior ribs, skull, long bones most apparent for children

Leading cause of death as result of physical abuse, Usually occurs in children under 2 yrs old, Injuries are result of brain moving opposit of baby’s head, Presents with respiratory problems, bulging fontenals, retinal hemorrhages, CNS damage, seizures, vomiting, coma, death

Skull fractures subdue all hematomas, Brain hemorrhages or contusions (shaken baby), Alopecia due to hair pulling

Ruptured liver or spleen, Rupturedd blood vessels, Kidney, bladder, pancreatic injury, Jejunal or duodenal injuries

Missing teeth, Perforated ear drum, Epistaxis, nasal fractures, Retinal hemorrhage/detachment, Periorbital hematomas, Other: Munchausen’s by proxy, deprivational syndromes

Vaires from normal to anxious, fearful, depressed, Bruises, lacerations, bite marks, STDs, Vaginal/anal lacerations, edema, petechia, erythema, Dysuria, rectal fissures, Semen, pubic hair on child

Sexualized behaviors (sometimes), Precocious sexual knowledge/ explicit talk or images demonstrations of sexual aggression, Acting out sexual interactions, Masturbation, Sexual promiscuity in older children, PTSD symptoms, Somatic complaints, feelings of guilt

Increased anxiety, fear, depression, Low self-esteem, School issues, Mult. somatic complaints, Signs of PTSD, Antisocial behavior, Promiscuity, Substance abuse, Running away, Self-destructive behavior

Caregiver substance abuse, Abuse in parents, Poor impulse control in caregiver, Caregiver mental illness, Alleged offender with sexual dysfunction, poor coping skills, poor social skills, Social isolated family, Sexual abuse of sibling

Trauumatitezed children’s have a harder time calming down when upset due to biological dysregulation caused by the trauma., PTSD symptoms in trautized children, Anxiety disorders, eating disorders, phobic disorders and OCD, Substance abuse,d expression, suicidal thoguhts, adjustment disorder, conduct disorder, dissociative disorder

Contusions, abrasions, lacerations, Sacrs, burns, Epecially on breast, arms, chest, abdomen, neck, face, genitals

Fractures, sprains (distal bones), Dislocated shoulder, Evidence of old fractures, Evidence of direct kicks/ punches, Vaginal/anal bruising, edema, bleeding

Internal bleeding, Chronic pelvic pain, Hyperactive reflexes, Chronic headaches, Chronic backaches, Parastesias due to old injuries

Anxious, fearful, passive, Poor eye contact, Looks to caregiver for answers, Poor hygiene and inappropriate dress, Underweight or malnourished, Physical needs not met

Contusions, abrasions, burns, scars, Decubitus ulcers, urine burns, Rope marks, Distended, Internal bleeding, Fecal impactions

Fractures, Limited ROM, Contractures, Slurred speech, confusion, Vaginal lacerations, bruises, infections, UTIs

Physical abuse

Sexual abuse

Psychological abuse

Neglect

Financial exploitation

Violation oof rights

Directed toward protecting vulnerable family members, Can also include perpetrator in plans of care, Risk for injury, Risk for violence, Risk for suicide, Outcomes: Reduce or reverse the problem addresses, protection & recovery

Staff ed. in family violence and abuse, Developmet of standard of care to guide clinical practice, Protocol for planning: Patients safety #1 Discuss with patient if possible; child removed to safe place etc, Consider needs of abuser as well if the are motivated

Reporting abuse, Cosidering family’s culture, Counseling-safety plan (for rapid escape), Case management, Promotion of community support, Health teaching and health promotion

Priority is safet of patient and treating of any physical injuries, Parentings classes (Care), Must report to CPS, Play therapy, family therapy or foster care, Confrontations of the perpetrator is not necessarily an outcome- can be done symbolically

Need to intervene regarding feeling guilty later in life if they felt pressure, liked the attention, but know it is wrong- as adult survivors they feel like they gave consent (Cannot give consent as a child), Frequently part of history is psychiatric disorders, Usually treated 1:1 outpatient therapy as opposed to short term therap such as inpatient

Priority is safety of pt and treating of any physical injuries. Dealing with psychological issues comes after safety and physical well being., Do not give unsolicited advice- coercing the pt takes away the responsibility of their own actions and could lead to resentment, Giver the resources event if she does ask for them

YOur job IS NOT to rescue her or convince her to persecute her partner, Follow hospital protocol, Tell her you believe her, Tell her she deserves to be treated with respect, The abuse is not her fault and it is a crime, The frequency and severity of the abuse will escalate

Careful documentation and photographs, Coordinate with law enforcement, Domestic violence laws vary among states and are not always followed, Transport or shelter if desired or needed support groups, Follow up with DV advocate

Priority is safety of patient and treating of any physical injuries, Not all states have mandatory reporting, Careful documentation (legal), Care for the caretaker-family therapy, Help cope with stress and emotions, Help promote self esteem-survivor status, Establish support

A plan for a fast escape when violence occurs, Identified sign of escalation of violence and designate as the time to leave, Include in plan a destination and a way to get there, Have the hotline referral telephone number of a shelter or safe house and a contact person

Cyber stalking, Doxing: publish private personal information on the internet for malicious intent, Swatting: Making a “prank call” to emergency services with the intent of brining and armed police response to a particular address, Internet homicide, Child pornography, Reveng porn

Primary : measures taken to prevent the occurance of abuse, Secndary: Early intervention in abusive situations to minimize their disabling or long-term effect, Tertiary: facilitating healing and rehabilitative process proving support, assisting survivors of violence to achieve their optimal level of safety, health, and well-being