Child Abuse, Elder Abuse & Intimate Partner Violence Intimate Partner Violence

Intentional controlling behavior of physical, sexual or psychological

Child Abuse assaults
Neglect: 60% of abuse cases 28% of couples in a random US survey
Emotional: 5% of abuse cases 4% severe violence
Physical: 20% of abuse cases Pregnancy may double the risk of IPV
Sexual: 10% of abuse cases Thorough history is KEY
Report abuse to protective services Subtle presentation, requires high index of suspicion
1500 children die annually as a result of maltreatment Delay in seeking care, story doesnt make sense, multiple
somatic complaints, substance use, depression/anxiety, etc
5 levels of risk factors & protective factors: When to Screen for IPV
1. Biologic and psychological make-up of the child/victim Delay in seeking care
2. Characteristics of the perpetrator Illogical explanation of injury
3. Family dynamics and environment Multiple somatic complaints
4. Community that family lives in Depression, anxiety, other mental disorders
5. Cultural values and beliefs Pregnancy
Substance use
Clinical Features Recent dx of HIV
Fear, anxiety, nightmares, phobias, depression, anger, hostility, Family hx of IPV
low self-esteem Overbearing partner
More serious: suicidal behavior, PTSD, amnesia PE:
Abnormal sexual behavior, promiscuity Inappropriate behavior
Multiple injuries
Child Sexual Abuse Accommodation Syndrome: Central pattern of injury
Secrecy, helplessness, entrapment and accommodation, Injuries at different stages of healing
delayed/conflicted/conceiving disclosure, retraction HITS questions
Hit, Insulted, Threatened, Screamed at?
Characteristics in victims of trauma: Treatment
Intrusive memories, repetitive behavior, fears related to the Validate the problem this behavior is unacceptable and illegal
trauma, Assess pts safety & review emergency escape plan
Changes in attitudes about people/life/future Document clearly and completely
Provide information and referral
Interview: Be aware of reporting and legal requirements
Build a rapport
Open-ended, non-leading questions 4 pitfalls in caring for IPV victims
Establish need to tell the truth Do not ask what the victim did to bring about the violent episode (they
Introduce the topic of concern are the victim!)
Elicit a free narrative Do not recommend termination of the relationship (controlling)
Pose general or specific questions as appropriate Couple counseling only when perpetrator acknowledges the problem
Use dolls if needed to act out events Avoid using the word Alleged in medical record (implies you dont
Interview the parent believe the pts story)

Treatment: Barriers
Trauma-focused CBT: Providers we do a bad job of detecting!
Psychoeducation Staff is often inadequately trained
Anxiety management Protocols are lacking or insufficient
Exposure Time constraints
Cognitive therapy Its uncomfortable!
Ensure childs safety and well being Patients terminating abuse relationship
Fear
Financial
Elder Abuse Psychological - dependence
Actions by the caregiver causing harm to an older adult or failure to Lack of social support
provide basic needs or protection Lack of options
Self-neglect is MC
May be financial, psychological, physical abuse, or neglect/withholding
Not filling Rxs, lack of clothing/food or hygiene care
10% of people > 65 yo are abused
Question elder alone, determine decision-making capacity
Report abuse to Adult Protective Services

Tx:
Often denial by elder and caregiver
Self-neglect requires in-home help or supervision