Abuse, Neglect &

Domestic Violence 2008

Objectives:

1. Define abuse & neglect

2. Discuss assessment findings of abuse & neglect

3. Discuss Ohio law & reporting suspected abuse/neglect.

4. Outline MMH plan for reporting suspected abuse 

Abuse is defined as mistreatment of a person and comes in many forms, and may be defined by several categories.

• Physical abuse—inflicting physical pain or injury, or depriving an individual of a basic need.

• Emotional abuse—inflicting mental pain, anguish or distress through verbal or nonverbal acts, including threatening physical harm.  

• Sexual abuse—non-consensual sexual contact of any kind.

• Exploitation—illegal taking, misuse, or concealment of funds, property, or the assets of a vulnerable individual. 

• Neglect—refusal or failure by those responsible to provide food, shelter, health care or protection. 

• Abandonment—the desertion of a vulnerable person by anyone who has assumed the responsibility for care or custody of that person.

Domestic abuse or battering is also known as  intimate partner violence & may occur in heterosexual or same-sex relationships. The perpetrator may be male or female as can the victim. Unfortunately, many of the signs may not be obvious. One study estimated that 76% of women who’d been a victim of intimate partner violence in the previous year had sought treatment in the emergency department for something other than an injury received from abuse.

There is also a growing problem with child abuse & elder abuse. In homes where women are abused, it is likely that the children are abused as well. 

Children who have been abused may display: 

• Poor self-image

• Inability to trust others

• Aggressive or disruptive behaviors

• Risky behavior (i.e. promiscuity, drug or alcohol abuse)

• Passive behavior

• Fear of entering new relationships or activities

• Poor school performance

Children may be victims of neglect, sexual or emotional abuse. In all kinds of child abuse the victim & family can benefit from the comprehensive evaluation and care of a child & adolescent psychologist. 

Elderly people may be subject to many types of abuse and are vulnerable to neglect, physical, sexual or financial abuse. Many elder patients subject themselves to self-neglect. This can be a result of hopelessness, depression, and social isolation from family or friends.

Abuse potential is important to remember when thinking about mental health issues & care for the elderly. 

The elderly are vulnerable to financial abuse, not only from family or friends, but by ruthless people who have scams that target the elderly. This may occur because they are trusting & believe what they are being told and because many desire to help others. Abusive behavior includes pressuring someone to redistribute assets, mismanaging the patient’s money for personal gain, as well as many other forms of financial abuse.

Ohio Abuse Reporting Laws

Ohio Abuse Reporting Laws state that child abuse/neglect is a mandatory report in Ohio to Child Protection Services. Children are defined as under 18 years of age or mentally retarded or developmentally disabled or physically impaired persons under 21 years. (OH Statute 2151.421). 

Domestic violence in any form is NOT a mandatory report in Ohio unless there is a gunshot wound, stab wound, 2nd or 3rd degree burn or serious physical harm. Serious physical harm is defined as an injury that carries a substantial risk of death; involves some permanent incapacity or some temporary, substantial incapacity; involves some permanent disfigurement or some temporary serious disfigurement; involves acute pain of such duration as to result in substantial suffering or which involves any degree of prolonged or intractable pain; mental illness or condition of such gravity as would require hospitalization or prolonged psychiatric treatment. (ORC 2921.22, ORC 2901.01)

What does MMH policy say?

(Policy1, Patient Care Policies &

Procedures, #57, Suspected Client/Patient Abuse/Neglect/Violence)

 1. Suspected client/patient  abuse/neglect of any kind should be reported to your immediate supervisor or manager (if they are present). If your supervisor/manager is not present, then notify the nursing supervisor.

2. The supervisor/manager will initiate the Evaluation Guidelines found in Meditech “FORMS1”.

3. Social services will be notified & a further investigation will be done.

4. The supervisor/manager will do further investigation & notify the Vice President of Patient Services when appropriate & collaborate with the physician as well.

5. Next, the proper authorities will be notified:

• Elder abuse/neglect---Adult       Protective Services 373-0244

• Child abuse/neglect---Washington County Children’s Services

   373-3485

• Domestic abuse---Outside Marietta-Wash. Co. Sheriff’s Dept.

   373-2833

o Inside Marietta---Marietta City Police-373-4141

• Social Services---374-1492

6. The evaluation guide should be placed in the patient’s chart.

7. Photographs obtained with CONSENT for obvious injury and placed in the patient’s medical record. (See photo release policy). 

What can you do to help identify victims?

As health care providers, we are not always in a position to help in abuse or neglect situations, unless patients are willing to discuss their problems. We are in a position that we can ask patients about abuse situations that may make them more comfortable with sharing their problems.

The following are screening questions that may be used when you are interviewing a patient alone.  

 "Do you ever feel unsafe at home?"

"Are you in a relationship in which you have been physically hurt or felt threatened?"

"Have you ever been or are you currently concerned about harming your partner or someone close to you?" 

Additional questions should be used to further assess the extent to which the individual may be subjected to various forms of abuse. These additional questions are best tailored to each individual. Such questions may include: 

"Have you ever felt afraid of your partner or ex-partner?

"Has a partner or ex-partner currently or ever:

• Pushed, grabbed, slapped, choked or kicked you?

• Forced you to have sex or made you do sexual things you didn't want to?

• Threatened to hurt you, your children or someone close to you?

• Stalked, followed or monitored you? 

Patients need to know that it’s OK to talk about these issues, so they are more likely to offer information if we as health care providers take the initiative and ask about current or past events. 

These questions may be tailored to reflect concern for child or elder abuse as well. 

Health care providers need to be aware of the problems associated with abuse and begin to screen all patients for abuse or neglect. Only when we screen on a routine basis can we effectively treat patients who are in danger of physical or emotional abuse.