parents, unworthy as partners, have low self-control or willpower, or being just plain “crazy.” They are more likely to be blamed for the violence in their lives, further impeding efforts to resolve issues and regain health. Intervention goals for chemically dependent abused patients include sobriety as well as safety. For some, addiction treatment may be a necessary first step, but intervention for the violence should not be neglected. For others, achieving safety may be necessary before participating in an addiction recovery program. Becoming sober may threaten an abuser’s sense of control, and place the survivor at risk for increased violence. Ideally, both issues are treated together. Addiction or intoxication, although maladaptive, may serve as coping strategies for the victimized Sexual assault and IPV According to the National Intimate Partner and Sexual Violence Survey (NISVS), the lifetime incidence of rape is 19.3% for women and 1.7% for men. 42 Patient responses to sexual assault can vary from visible distress to calm composure. Some survivors of recent rape have difficulty trusting hospital personnel and the evidence collection process. Thus, sensitivity and patience are critical when examining or referring a patient to the emergency department. Clinicians trained in empathetic evidence collection such as Sexual Assault Nurse Examiners can be invaluable collaborators. In addition to collecting physical evidence in cases of recent sexual assault, healthcare providers can offer validation, support, and appropriate referrals for sexual assault counseling. Human trafficking Human trafficking is associated with significant physical and psychological harm including the risk for IPV. 43 The abuses suffered by people who are trafficked include many forms of physical violence or abuse (e.g., beating, burning, rape, confinement) as well as many psychologically damaging tactics such as threats to themselves or their family members, blackmail, extortion, lies about the person’s rights, and confiscation of vital identity documents. 43 Healthcare professionals are uniquely positioned to identify and intervene on behalf of trafficking victims. Outside of law enforcement, healthcare settings are among the few places where the lives of human trafficking victims may intersect with the rest of society, if only for brief periods. 44 In a study of 98 sex trafficking survivors, 88% had at least one encounter with a healthcare provider while they were Child-related issues Observing or hearing violence can be traumatic and damaging for children of all ages. Prolonged, severe, and repeated stress adversely affects brain development in young children. Witnessing violence affects children’s abilities to focus and learn in school, form healthy peer relationships, and develop normally. Witnessing violence may exacerbate health problems such as asthma, eating disorders, or behavior problems such as bedwetting.
individual. Sobriety in the absence of safety and resiliency-oriented support may unmask previously undiagnosed mental health issues for marginally functioning abused patients. The success of safety planning can be compromised by ongoing drug use, and the success of addiction recovery can be impeded by continued violence. Therefore, healthcare providers should always carefully assess for IPV where there is evidence of substance abuse, and screen for substance abuse where there is evidence for IPV. In addition, providers should weigh carefully the risks and benefits of prescribing controlled substances for symptom relief in patients with chemical dependence, particularly opioid pain medications. 41 Clinicians should be mindful of asking questions that might sound victim-blaming or judgmental, such as “why were you wearing that?” or “why didn’t you report this to the police?” Instead encourage contact with a local rape crisis center and appropriate therapeutic and community services, even if an assault took place months or years ago. Supportive approaches such as these can be fundamental to the recovery and reintegration process for survivors of sexual assault. Strategies providers can use to assess patients for sexual violence are discussed further at the end of this monograph. being trafficked, with 63 percent of these encounters happening in an emergency department. 45 Some patients meet criteria for human trafficking, even if they don’t identify themselves as trafficking victims. Trafficked people, like IPV patients, often do not accurately perceive their status. They may view their situation, for example captivity, as a requirement for being brought into the country or an expectation they must obey. Adolescents are groomed by traffickers who may call themselves “boyfriends,” “daddies,” or romantic partners. Key tactics of manipulation and entrapment include seduction, gifts, and actions made to look like emotional support. Once the trafficker creates a romantic connection, the victim is coerced into engaging in commercial sex acts. Federal anti-trafficking laws exist and clinicians should be familiar with their general principles. 46 Many children exposed to IPV have a distorted view of the world, one that is not hopeful, welcoming, or safe. They have a foreshortened view of their lives, in which they cannot picture themselves as adults, or see a future for themselves. Adolescents who grew up in violent homes are more likely to be involved with substance abuse and dating violence.
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Book Code: CT24CME
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