1. ABUSE Child, Domestic Violence, and Elder Mistreatment Updated 10/06 All Clinical Staff

2. 10/06All Clinical Staff Objectives: At the completion of this SLP, the learner will be able to : Recognize the national and Maryland statistics on Child, Elder, and Spousal abuse. Define what constitutes child, elder, and spousal abuse. Identify signs and symptoms indicating potential abuse. List staff responsibilities in managing suspected cases of abuse, with reference to hospital policy and procedure. Identify community resources that could be of assistance to potential abuse victims. Identify State requirements for reporting abuse.

3. Child Abuse and neglect

4. 10/06All Clinical Staff Incidence of Child Abuse There are an estimated 3 million cases of suspected child abuse or neglect each year. 2,000 or more children die yearly as a result of abuse or neglect. Only 50-60% of the children identified as harmed by abuse or neglect in 2004 were investigated by Child Protective Services. Child abuse occurs in all ethnic groups and transcends all socioeconomic levels and religious affiliations.

5. 10/06All Clinical Staff Contributing Factors of Child Abuse and Neglect Family Factors: marital conflict extended family contact domestic violence financial stress crisis in the abuser’s life Environmental Factors: cultural attitudes economic pressures isolation from the community

6. 10/06All Clinical Staff Contributing Factors of Child Abuse and Neglect Parent Factors: Parents abused as children low self esteem child rearing skills unrealistic expectations immaturity and dependency lack of trust and empathy substance abuse Child Factors Age Behavior level of isolation

7. 10/06All Clinical Staff CHILD ABUSE:Physical Indicators multiple injuries in various stages of healing unexplained injuries, especially located in parts of the body not usually affected by normal childhood activity (eyes, mouth, neck, cheeks, lower back, genital area, buttocks, abdomen) repeated injuries, especially those where the shape of an object has left a visible mark (electrical cord, belt buckle, circular burns-such as a cigarette burn)

8. Domestic Violence

9. 10/06All Clinical Staff What Is Domestic Violence? Domestic violence is control by one partner over another in a dating, marital or live-in relationship. The means of control include: physical, sexual, emotional and economic abuse, threats and isolation.

10. 10/06All Clinical Staff Who Is Affected by Domestic Violence? Domestic violence occurs in every culture, country and age group. It affects people from all socioeconomic, educational and religious backgrounds and takes place in same sex as well as heterosexual relationships

11. 10/06All Clinical Staff Early Signs of Abuse Quick whirlwind romance Jealousy at any perceived attention to or from others Hypersensitivity to perceived slights Pressures you into doing things you aren’t comfortable with “If you really love me, you’ll do this for me”

12. 10/06All Clinical Staff How common is domestic abuse? According to a National Violence Against Women Survey, 22% of women are physically assaulted by a partner or date during their lifetime. Nearly 25% of women have been raped and/or physically assaulted by an intimate partner during their lives.

13. 10/06All Clinical Staff What can you do if you are being abused? Talk with someone you trust: a friend or relative, a neighbor, coworker or religious or spiritual advisor. Tell your physician, nurse, psychiatrist or therapist about the abuse. Call the National Domestic Violence Hotline [1-800-799-SAFE (7233)], your state domestic

14. 10/06All Clinical Staff Recommended Questions for healthcare workers Are you in a relationship in which you have been physically hurt or threatened? Has your partner ever destroyed things you care about? Do you have guns in the house?

15. 10/06All Clinical Staff Management of Domestic Violence Follow hospital policy #242 Provide information about local organizations for assistance Believe her Tell her she is not alone Do not pass judgment National Domestic Violence Hotline 1-800-799-SAFE

16. Elder Mistreatment and Abuse

17. 10/06All Clinical Staff Types of Elder Mistreatment Physical Abuse – acts of violence that may result in pain, injury, impairment, or disease Physical Abuse – acts of violence that may result in pain, injury, impairment, or disease Physical Neglect – failure of the caregiver to provide the goods or services that are necessary for optimal functioning or to avoid harm Physical Neglect – failure of the caregiver to provide the goods or services that are necessary for optimal functioning or to avoid harm

18. 10/06All Clinical Staff Types of Elder Mistreatment Psychological (Emotional) Abuse – Willful infliction of mental anguish or the provocation of fear of violence; diminishes the identity, dignity, and self-worth of the person Psychological (Emotional) Abuse – Willful infliction of mental anguish or the provocation of fear of violence; diminishes the identity, dignity, and self-worth of the person Psychological Neglect – Failure to provide a dependent older adult with social stimulation Psychological Neglect – Failure to provide a dependent older adult with social stimulation

19. 10/06All Clinical Staff Types of Elder Mistreatment Financial / Material Abuse – Misuse of the older person’s income or resources for the financial or personal gain of a caretaker or advisor Financial / Material Abuse – Misuse of the older person’s income or resources for the financial or personal gain of a caretaker or advisor Financial / Material neglect – Failure to use available funds and resources necessary to sustain or restore the health and well-being of the older adult Financial / Material neglect – Failure to use available funds and resources necessary to sustain or restore the health and well-being of the older adult

20. 10/06All Clinical Staff Types of Elder Mistreatment Violation of Personal Rights – Ignoring the older person’s rights and capability to make decisions for himself / herself Violation of Personal Rights – Ignoring the older person’s rights and capability to make decisions for himself / herself Self-abuse or Self-neglect - It characterized as the behaviors of an elderly person that threaten his/her own health or safety. Self-abuse or Self-neglect - It characterized as the behaviors of an elderly person that threaten his/her own health or safety.

21. 10/06All Clinical Staff Indicators of Elder Mistreatment Physical Unexplained injuries Inconsistent explanations Welts, lacerations, fractures, burns, rope marks Psychological Excessive weight gain or loss Insomnia or excessive sleeping Signs of infantile behavior Expressions of ambivalent feelings toward caregivers or family members

22. 10/06All Clinical Staff Interventions Coordinate with Social Worker on your unit Coordinate with Social Worker on your unit If patient is willing to accept voluntary services: If patient is willing to accept voluntary services: Educate the patient Educate the patient Implement a safety plan Implement a safety plan Provide assistance that will alleviate causes of mistreatment Provide assistance that will alleviate causes of mistreatment Refer patient to appropriate services: social work, counseling, legal assistance, and advocacy Refer patient to appropriate services: social work, counseling, legal assistance, and advocacy

23. 10/06All Clinical Staff State Requirements Maryland Law requires that each health practitioner must report suspected abuse or neglect of a child or vulnerable adult A “vulnerable adult” is a person 18 or older who lacks the physical or mental capacity to provide for his or her daily needs. When reporting, you are protected from liability when acting in good faith

24. Please Take Post Test