Chapter 7—Key Points
This section discusses definitions and health effects of dysfunction. There are a variety of risk factors that
domestic violence. may increase caregiver maltreatment such as
• Intimate partner violence, child abuse, and elder abuse disabilities, poverty, substance abuse in the family,
are important health problems. Health care professionals and community violence.
must recognize, assess, and report these problems, even • Cultural issues, such as societal stressors,
if abuse or neglect is only suspected. legal status, and lack of access to culturally
• The four types of intimate partner violence include: appropriate care are responsible for the increase in
• Physical violence intimate partner violence (IPV) in nonwhite
• Sexual violence populations.
• Stalking • Documentation of any type of abuse must include
• Psychological aggression detailed, nonbiased progress notes, injury maps, and
• In most states, child abuse and neglect includes these photographs, as appropriate.
four definitions:
• Neglect is the failure to provide for a child’s basic This section presents critical points about subjective and
needs. objective assessments.
• Physical abuse is non-accidental physical injury. • Making routine, universal assessments for intimate
• Sexual abuse includes fondling a child’s genitals, partner violence means asking every person at every
incest, penetration, rape, sodomy, indecent exposure, health care encounter if she has been abused by a
and commercial exploitation through prostitution or current intimate partner or ex-partner.
pornography. • Several abuse assessment tools can be used to screen for
• Emotional abuse is any behavior pattern that harms a intimate partner violence, including HITS, OAS/OVAT,
child’s emotional development or sense of self-worth. STaT, HARK, CTQ-SF, and WAST.
• Teen dating violence is the physical, sexual, • For a person who is a suspected victim of intimate
psychological, or emotional violence within a dating partner violence, assess the risk of homicide using
relationship during the adolescent years. the Danger Assessment or a similar tool.
• Elder abuse is defined by five types of abuse: • If a person denies intimate partner violence but
• Physical abuse other indicators lead you to suspect abuse, be
• Sexual abuse or abusive sexual contact persistent and thorough in the repeated assessment
• Psychological or emotional abuse for domestic violence.
• Neglect • As no validated screening tool is available to assess
• Financial abuse or exploitation for adolescent relationship violence, it is important to
• In addition to obvious physical injuries, the health be aware of the factors that place adolescents at an
effects of violence are significant. The clinician only increased risk for becoming victims.
needs a reasonable suspicion that a child, adolescent, • Assessment of physical abuse or neglect in cognitively
or elder has been maltreated to make a report to the challenged patients is more complicated. Red flags of
appropriate authorities. abuse are physical findings that do not match the
• Abused victims develop more chronic health history.
problems, such as cardiovascular, immune, • For children, when an injury is present or reported,
gastrointestinal, and gynecologic disorders. Abuse an important part of the evaluation is to determine
during pregnancy has serious consequences for both the child’s age and developmental level.
the pregnant mother and the infant. • If a child is verbal, obtain a history away from
• Abuse victims have significantly more depression, caretakers. Use open-ended questions or spontaneous
suicidality, posttraumatic stress disorder (PTSD), and statements.
substance abuse issues. • Be sure to assess the medical history and document
• Forced sex contributes to chronic pelvic pain, prior abuse, including intimate partner violence,
unintended pregnancy, sexually transmitted childhood physical and sexual abuse, and prior rapes.
infections, and urinary tract infections. Cumulative trauma is related to more severe mental
• Adolescents are at risk for adverse health outcomes and physical health problems.
similar to those of adult women. • For a known survivor of abuse, the physical
• Older adults may experience complications from examination includes a complete head-to-toe visual
intentional injury ranging from minor pain and examination. When your examination reveals physical
discomfort to life-threatening injuries. Abuse of older findings, describe them using the correct basic medical
adults often is coupled with neglect. forensic terminology. Describe bruising specifically and
• Children can develop long-term physical, photograph it, if possible. Obtain specimens for baseline
psychological, emotional, social, and cognitive laboratory tests, if needed.
Copyright © 2020 Elsevier Inc. All rights reserved.
This section discusses definitions and health effects of dysfunction. There are a variety of risk factors that
domestic violence. may increase caregiver maltreatment such as
• Intimate partner violence, child abuse, and elder abuse disabilities, poverty, substance abuse in the family,
are important health problems. Health care professionals and community violence.
must recognize, assess, and report these problems, even • Cultural issues, such as societal stressors,
if abuse or neglect is only suspected. legal status, and lack of access to culturally
• The four types of intimate partner violence include: appropriate care are responsible for the increase in
• Physical violence intimate partner violence (IPV) in nonwhite
• Sexual violence populations.
• Stalking • Documentation of any type of abuse must include
• Psychological aggression detailed, nonbiased progress notes, injury maps, and
• In most states, child abuse and neglect includes these photographs, as appropriate.
four definitions:
• Neglect is the failure to provide for a child’s basic This section presents critical points about subjective and
needs. objective assessments.
• Physical abuse is non-accidental physical injury. • Making routine, universal assessments for intimate
• Sexual abuse includes fondling a child’s genitals, partner violence means asking every person at every
incest, penetration, rape, sodomy, indecent exposure, health care encounter if she has been abused by a
and commercial exploitation through prostitution or current intimate partner or ex-partner.
pornography. • Several abuse assessment tools can be used to screen for
• Emotional abuse is any behavior pattern that harms a intimate partner violence, including HITS, OAS/OVAT,
child’s emotional development or sense of self-worth. STaT, HARK, CTQ-SF, and WAST.
• Teen dating violence is the physical, sexual, • For a person who is a suspected victim of intimate
psychological, or emotional violence within a dating partner violence, assess the risk of homicide using
relationship during the adolescent years. the Danger Assessment or a similar tool.
• Elder abuse is defined by five types of abuse: • If a person denies intimate partner violence but
• Physical abuse other indicators lead you to suspect abuse, be
• Sexual abuse or abusive sexual contact persistent and thorough in the repeated assessment
• Psychological or emotional abuse for domestic violence.
• Neglect • As no validated screening tool is available to assess
• Financial abuse or exploitation for adolescent relationship violence, it is important to
• In addition to obvious physical injuries, the health be aware of the factors that place adolescents at an
effects of violence are significant. The clinician only increased risk for becoming victims.
needs a reasonable suspicion that a child, adolescent, • Assessment of physical abuse or neglect in cognitively
or elder has been maltreated to make a report to the challenged patients is more complicated. Red flags of
appropriate authorities. abuse are physical findings that do not match the
• Abused victims develop more chronic health history.
problems, such as cardiovascular, immune, • For children, when an injury is present or reported,
gastrointestinal, and gynecologic disorders. Abuse an important part of the evaluation is to determine
during pregnancy has serious consequences for both the child’s age and developmental level.
the pregnant mother and the infant. • If a child is verbal, obtain a history away from
• Abuse victims have significantly more depression, caretakers. Use open-ended questions or spontaneous
suicidality, posttraumatic stress disorder (PTSD), and statements.
substance abuse issues. • Be sure to assess the medical history and document
• Forced sex contributes to chronic pelvic pain, prior abuse, including intimate partner violence,
unintended pregnancy, sexually transmitted childhood physical and sexual abuse, and prior rapes.
infections, and urinary tract infections. Cumulative trauma is related to more severe mental
• Adolescents are at risk for adverse health outcomes and physical health problems.
similar to those of adult women. • For a known survivor of abuse, the physical
• Older adults may experience complications from examination includes a complete head-to-toe visual
intentional injury ranging from minor pain and examination. When your examination reveals physical
discomfort to life-threatening injuries. Abuse of older findings, describe them using the correct basic medical
adults often is coupled with neglect. forensic terminology. Describe bruising specifically and
• Children can develop long-term physical, photograph it, if possible. Obtain specimens for baseline
psychological, emotional, social, and cognitive laboratory tests, if needed.
Copyright © 2020 Elsevier Inc. All rights reserved.
