Recognize the Signs Intimate Partner Violence & Child Abuse

1. Recognize the Signs Intimate Partner Violence & Child Abuse What the Family Physician Can Do NJAFP Scientific Assembly Ping-Hsin Chen, PhD Abbie Jacobs, MD Sue Rovi, PhD UMDNJ - New Jersey Medical School, Department of Family Medicine NYMC Family Medicine Residency, Hoboken University Medical Center

2. Learning Objectives • Define Intimate Partner Violence (IPV), and Child Abuse and Neglect • Demonstrate knowledge of the dynamics and risk factors in abuse • Recognize the signs and symptoms of adults and children affected by abuse • Discuss the role of Family Physicians in addressing the health and safety of victims and their families

3. Incidence and Prevalence • 7.7 million IPV victimizations each year • 35.6% women experience IPV during their lifetime • For men, the lifetime prevalence is 15.9% • In clinical settings, the rate of IPV in the past year among women: • 33.6% for physical abuse • 44% for psychological abuse • 26% for sexual abuse

4. Definition of IPV Physical, sexual or psychological harm by a current or former partner or spouse. - Physical: pushing, grabbing, slapping, use of a weapon, restraints, or one’s own body strength. - Sexual: A verbal or physical act, and may or may not result in the completion of a sexual act. - Psychological: Coercive tactics, threats, and harm such as isolation, humiliation, denial of resources, and stalking.

5. Dynamics of IPV Developed by Domestic Violence Intervention Project. Duluth:MN.

6. Case #1 Karen Smith presents with a complaint of chronic pelvic pain and insomnia. You remember learning that IPV can cause health problems and are concerned that she is a victim of IPV.

7. Health Consequences of IPV (1)

8. Health Consequences of IPV (2)

9. Individual Risk Factorsof IPV

10. Relationship and Community Factors of IPV

11. Case #2 Mary Jones is 35 yr old and comes to your office for her annual check-up. She screens positive for depression. You recall USPSTF also recommends screening for IPV and you wonder what should be your next step.

12. Current Recommendations for IPV Screening • In 2013, USPSTF recommended: Screen women of childbearing age for IPV and provide or refer women who screen positive to intervention services. (B recommendation) • In 2011, the IOM recommended that women’s preventive services include: Screening and counseling for all women and adolescent girls for interpersonal and domestic violence in a culturally sensitive and supportive manner. USPSTF. http://www.uspreventiveservicestaskforce.org/uspstf/uspsipv.htm. IOM. http://www.iom.edu/Reports/2011/Clinical-Preventive-Services-for-Women-Closing-the-Gaps.aspx

13. Use your “RADAR” • Routinely screen every patient • Ask directly, kindly, nonjudgmentally in a private setting • Document findings • Assess patient’s safety • Review options and provide referrals Massachusetts Medical Society, 1992

14. Screening Tools for IPV

15. Documenting IPV • Ask permission to document. • Use IPV documentation forms, including body maps and photos of injuries. • Include quote marks of what the patient says, avoid prejudicial terms, e.g, ‘alleged’. • Document options discussed, referrals, follow-up. • Ensure confidentiality of all documentation.

16. Assessing patient’s safety • Evaluate immediate danger (e.g., weapons in the home) • Likelihood of perpetrator harming self or others • Check safety of children

17. Reporting of IPV in NJ New Jersey requires a police report if injuries are the result of a weapon (e.g., a gun or knife, not fists) Otherwise, respect the autonomy of adult victims If you think a child is in danger, report or if possible, ask the non-offending parent to report

18. Advocacy - Empowerment • Victim is decision maker • Aim is to increase safety, access services, reduce abuse, improve health • Assist victims in developing sense of control • FPs can provide information cards and referrals to community resources

19. Case #3 Mary brings her daughter Julie in for her 14 year old check-up. You notice that Julie is more withdrawn than previously. Mary mentions that Julie’s behavior has changed. What are the consequences to a child exposed to abuse?

20. Cycle of Violence • The co-occurrence of IPV and child abuse is 60%. • Children exposed to IPV are 3.8 times more likely to be IPV perpetrators 3.5 times more likely to be IPV victims in their adulthood.

21. Child Abuse and NeglectNJ Definitions • ABUSE is the physical, sexual or emotional harm or risk of harm to a child under the age of 18 caused by a parent or other person who acts as a caregiver for the child. • NEGLECT occurs when a parent or caregiver fails to provide proper supervision for a child or adequate food, clothing, shelter, education or medical care although financially able or assisted to do so. New Jersey Department of Children and Families, http://www.nj.gov/dcf/reporting/defining/

22. Child Abuse and NeglectUS and NJ, 2011 • In the US, an estimated 681,000 children were found to be victims of maltreatment by CPS; and there were over 1500 child deaths. • Most cases (4/5) are from neglect • In NJ, there were 8,752 substantiated victims of child abuse and neglect and 25 deaths. USDHSS: Child Maltreatment 2011 at http://www.acf.hhs.gov/sites/default/files/cb/cm11.pdf NJ DCF http://www.nj.gov/dcf/reporting/fatalities/

23. Risk Factors • For Victimization: • Younger than 4 yrs • Special needs • disabilities • chronic illness • Behaviors problems

24. Child Abuse and NeglectIndicators (1) Physical Abuse Indicators: New Jersey Department of Children and Families. http://www.nj.gov/dcf/reporting/indicators/

25. Child Abuse and NeglectIndicators (2) Physical Neglect Indicators:

26. Child Abuse and NeglectIndicators (3) Sexual Abuse Indicators:

27. Child Abuse and NeglectIndicators (4) Emotional maltreatment Indicators:

28. Reporting Child Abuse/Neglect in New Jersey (1) Any person having reasonable cause to believe that a child has been subjected to abuse or acts of abuse should immediately report this information to the Child Abuse Hotline (State Central Registry): 1-877 NJ ABUSE (1-877-652-2873). If the child is in immediate danger, call 911 as well.

29. Reporting Child Abuse/Neglect in New Jersey (2) • Who, what, when, where, how? • Reporter immune from criminal or civil liability • Proof not required and can report anonymously • Failure to report suspected abuse or neglect = disorderly person • Division of Child Protection and Permanency* (DCP&P)investigates within 24 hours * Formerly  the Division of Youth and Family Services (DYFS)

30. Preparing Your Practice • Develop Collaborative Relationships with Agencies (DV, Law Enforcement) • Training and Education for MDs and staff • Create a safe office environment • Protocols for screening, confidentiality • Referrals and Resources available