Photo by smucon law via Flickr. Leave a Reply Cancel reply Your email address will not be published. Thanks for reading The Crime Report! You have free article s remaining. Subscribe for unlimited access. View Subscription Offers Sign In. Although the emphasis on domestic violence is typically protection against a spouse, and for good reason because this accounts for 1.
In real numbers, that means over , kids were targeted by their parents for violent victimization in just a 4 year period. We must communicate that there is hope. The fact that domestic violence rates have been dropping dramatically is good news.
It means that we as a society are doing something right. We might even think that the victim has somehow caused this event to occur and place some blame on them rather than blame the abuser in the situation. One look at the sentencing patterns for domestic violence compared to non-domestic violence says it all. Women who are aged are at the greatest risk right now and domestic violence accounts for over 18 million visits to a mental health counselor annually. At least 5 million acts of domestic violence occur annually to women aged 18 years and older, with over 3 million involving men.
While most events are minor, for example grabbing, shoving, pushing, slapping, and hitting, serious and sometimes fatal injuries do occur. Approximately 1.
About 1 in 5 women have experienced completed or attempted rape at some point in their lives. Due to underreporting and difficulty sampling, obtaining accurate incidence information on elder abuse and neglect is difficult. Elderly patients may not report due to fear, guilt, ignorance, or shame. Clinicians underreport elder abuse due to poor recognition of the problem, lack of understanding of reporting methods and requirements, and concerns about physician-patient confidentiality.
There may be some pathologic findings in both the victims and perpetrators of domestic violence. Certain medical conditions and lifestyles make family and domestic violence more likely. While the research is not definitive, a number of characteristics are thought to be present in perpetrators of domestic violence. Abusers tend to:.
Domestic violence at home results in emotional damage, which exerts continued effects as the victim matures. The American College of Obstetricians and Gynecologists ACOG recommends all women be assessed for signs and symptoms of domestic violence during regular and prenatal visits.
Providers should offer support and referral information. The danger of domestic violence is particularly acute as both mother and fetus are at risk. Healthcare professionals should be aware of the psychological consequences of domestic abuse during pregnancy. There is more stress, depression, and addiction to alcohol in abused pregnant women. These conditions may harm the fetus.
Gay, lesbian, bisexual, and transgender victims may be reticent to report domestic violence. Part of the challenge may be that support services such as shelters, support groups, and hotlines are not regularly available.
This results in isolated and unsupported victims. Healthcare professionals should strive to be helpful when working with gay, lesbian, bisexual, and transgender patients. Usually, domestic violence is perpetrated by men against women; however, females may exhibit violent behavior against their male partners.
Although women are the most common victims of domestic violence, healthcare professionals should remember that men may also be victims and should be evaluated if there are indications present. Elder domestic violence may be financial or physical. The elderly may be controlled financially.
Elders are often hesitant to report this abuse if it is their only available caregiver. Victims are often dependent, infirm, isolated, or mentally impaired. Healthcare professionals should be aware of the high incidence of abuse in this population.
The most common injuries are fractures, contusions, bruises, and internal bleeding. Unexpected injuries to pre-walking infants should be investigated. The caregiver should explain unusual injuries to the ears, neck, or torso; otherwise, these injuries should be investigated.
They may display inappropriate behavior such as aggression, or maybe shy, withdrawn, and have poor communication skills. Others may be disruptive or hyperactive. School attendance is usually poor.
Approximately one-third of women and one-fifth of men will be victims of abuse. The most common sites of injuries are the head, neck, and face. Clothes may cover injuries to the body, breasts, genitals, rectum, and buttocks. One should be suspicious if the history is not consistent with the injury.
Defensive injuries may be present on the forearms and hands. The patient may have psychological signs and symptoms such as anxiety, depression, and fatigue. Medical complaints may be specific or vague such as headaches, palpitations, chest pain, painful intercourse, or chronic pain. There are a number of historical and physical findings that may help the provider identify individuals at risk.
If the examiner encounters signs or symptoms, she should make every effort to examine the patient in private, explaining confidentiality to the patient. Be sure to ask caring, empathetic questions and listen politely without interruption to answers.
Same-sex partner abuse is common and may be difficult to identify. For men, the incidence is slightly lower. In addition to common findings of abuse, perpetrators may try to control their partners by threatening to make their sexual preferences public. The provider should be aware there are fewer resources available to help victims; further, the perpetrator and victim may have the same friends or support groups.
Male victims are also less likely to seek medical care, so that the incidence may be underreported. These victims may have a history of child abuse. Establishing that injuries are related to domestic abuse is a challenging task.
Life and limb-threatening injuries are the priority. It is important that healthcare professionals first attend to the underlying issue that brought the victim to the emergency department.
Assuming the patient is stable and not in pain, a detailed assessment of victims should occur after disclosure of abuse. Assessing safety is the priority. A list of standard prepared questions can help alleviate the uncertainty in the patient's evaluation. If there are signs of immediate danger, refer to advocate support, shelter, a hotline for victims, or legal authorities.
A detailed history and careful physical exam should be performed. If head trauma is suspected, consider an ophthalmology consultation to obtain indirect ophthalmoscopy. Laboratory studies are often important for forensic evaluation and criminal prosecution. On occasion, certain diseases may mimic findings similar to child abuse. As a consequence, they must be ruled out. If bruises or contusions are present, there is no need to evaluate for a bleeding disorder if the injuries are consistent with an abuse history.
Some tests can be falsely elevated, so a child abuse-specialist pediatrician or hematologist should review or follow-up these tests. The evaluation of the pediatric skeleton can prove challenging for a non-specialist as there are subtle differences from adults, such as cranial sutures and incomplete bone growth.
A fracture can be misinterpreted. If there is a concern for abuse, consider consulting a radiologist. A skeletal survey is indicated in children younger than 2 years with suspected physical abuse. The incidence of occult fractures is as high as 1 in 4 in physically abused children younger than 2 years. The clinician should consider screening all siblings younger than 2 years. The skeletal survey should include 2 views of each extremity; anteroposterior and lateral skull; and lateral chest, spine, abdomen, pelvis, hands, and feet.
A radiologist should review the films for classic metaphyseal lesions and healing fractures, most often involving the posterior ribs. Skeletal fractures will remodel at different rates, which are dependent on the age, location, and nutritional status of the patient.
If abuse or head trauma is suspected, a CT scan of the head should be performed on all children aged six months or younger or children younger than 24 months if intracranial trauma is suspected.
Clinicians should have a low threshold to obtain a CT scan of the head when abuse is suspected, especially in an infant younger than 12 months.
Evaluate for evidence of dehydration, electrolyte abnormalities, infection, substance abuse, improper medication administration, and malnutrition. Domestic and family violence commonly results in the legal prosecution of the perpetrator. Preferably, a team specializing in domestic violence is called in to assist with evidence collection.
Each health facility should have a written procedure for how to package and label specimens and maintain a chain of custody. Law enforcement personnel will often assist with evidence collection and provide specific kits. It is important to avoid destroying evidence. Evidence includes tissue specimens, blood, urine, saliva, and vaginal and rectal specimens.
Saliva from bites can be collected; the bite mark is swabbed with a water-moistened cotton-tipped swab. The priority is the ABCs and appropriate treatment of the presenting complaints. However, once the patient is stabilized, emergency medical services personnel may identify problems associated with violence.
The medical record is often evidence used to convict an abuser. A poorly document chart may result in an abuser going free and assaulting again.
If the patient does not want to go to a shelter, provide telephone numbers for domestic violence or crisis hotlines and support services for potential later use. Provide the patient with instructions but be mindful that written materials may pose a danger once the patient returns home.
Without proper social service and mental health intervention, all forms of abuse can be recurrent and escalating problems, and the prognosis for recovery is poor. Without treatment, domestic and family violence usually recurs and escalates in both frequency and severity. In children, the potential for poor outcomes is particularly high as abuse inflicts lifelong effects.
In addition to dealing with the sequelae of physical injury, the mental consequences may be catastrophic. Studies indicate a significant association between child sexual abuse and increased risk of psychiatric disorders in later life. The potential for the cycle of violence to continued from childhood is very high. There are multiple known and suspected negative health outcomes of family and domestic violence.
There are long-term consequences to broken bones, traumatic brain injuries, and internal injuries. It is important to be aware of federal and state statutes governing domestic and family abuse. Remember that reporting domestic and family violence to law enforcement does not obviate detailed documentation in the medical record. Each state has specific child abuse statutes. Federal legislation provides guidelines for defining acts that constitute child abuse.
The guidelines suggest that child abuse includes an act or failure recent act that presents an imminent risk of serious harm. This includes any recent act or failure to act on the part of a parent or caretaker that results in death, physical or emotional harm, sexual abuse, or exploitation.
The Elder Justice Act provides strategies to decrease the likelihood of elder abuse, neglect, and exploitation. The Act utilizes three significant approaches:. The Violence Against Woman Act makes it a federal crime to cross state lines to stalk, harass, or physically injure a partner; or enter or leave the country violating a protective order.
It is a violation to possess a firearm or ammunition while subject to a protective order or if convicted of a qualifying crime of domestic violence. Domestic violence may be difficult to uncover when the victim is frightened, especially when he or she presents to an emergency department or healthcare practitioner's office. Routine screening should be conducted by all healthcare practitioners including nurses, physicians, physician assistants, dentists, nurse practitioners, and pharmacists.
Interprofessional coordination of screening is a critical component of protecting victims and minimizing negative health outcomes.
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