Case Study 2 20 Instructions: Read the scenario below and answer the questions as it relates to the case presented.
A 15 year-old recent immigrant from the Middle East presents with abdominal pain during a regular office visit. During the exam, the patient discloses sexual activity a few weeks prior by her uncle (mother’s brother), who lives in the same community as her immediate family. When told that this may need to be reported, the teen becomes distraught, saying she “could handle” her uncle, and explaining that it was customary in her culture for the family of an affected female child to carry out a vendetta against an abuser, which would force her mother to do something horrible to her own brother. You listen to the patient’s concerns, but are concerned for her physical and emotional well being, and the risk of serious harm from continued abuse.
1. Is this an example of sexual abuse as defined under Pennsylvania law?
2. How can a clinician balance a due respect for the patient’s wishes and right to privacy with the obligation to report suspected sexual abuse?
Questions for case study:
3. What kinds of services or supports could a clinician, faced with this kind of situation, provide to both the teenager and her family?
Commentary: While teens may exaggerate the harms from parental notification, more needs to be learned about this young woman’s family and culture: her concerns should not be minimized or ignored. The physician, by virtue of establishing a doctor-patient relationship with the young woman, owes her respect for her privacy and compliance with her wishes for confidentiality, unless her actions lead to harm to herself or specific others or if, as is the case here, the situation triggers mandatory reporting. This is a difficult decision because the resulting contact with the teen’s mother or uncle against her wishes, may lead the teen to not seek medical care in the future, such as evaluation of physical trauma, evaluation and treatment for STDs, and prenatal care if she becomes pregnant. Nonetheless, this case does meet the definition of sexual abuse even though the extent to which the young woman consented to the sexual activity is unclear. Under PA law, “actual or simulated sexual activity or nudity for the purpose of sexual stimulation or gratification of any individual” with persons younger than 18 years of age is defined as sexual abuse. The physician must report the situation, although the physician should also offer or arrange counseling about safe sex, contraception, options for pregnant teens, and community shelters/resources.
Neglect
• Emotional (e.g., inattention to a child’s emotional needs, failure to provide psychological care, or permitting the child to use alcohol or other drugs) Caregivers may not provide proper care for a variety of reasons, including a lack of knowledge or understanding about the child’s needs, inadequate bonding with the child, or impairment due to substance abuse or to mental illness. 26 Although there are cases of co-occurring maltreatment and poverty, living in poverty, in and of itself, does not mean that a child is being neglected Sometimes cultural values, the standards of care in the community, and poverty may contribute to maltreatment, indicating the family is in need of information or assistance. 26 When a family fails to use information and resources, and the child’s health or safety is at risk, then child welfare intervention may be required. In addition, many states provide an exception to the definition of neglect for parents who choose not to seek medical care for their children due to religious beliefs. What is Neglect Under Pennsylvania CPSL Child Abuse Laws? Child abuse applies under Pennsylvania’s CPSL when intentionally, knowingly or recklessly causing serious physical neglect of a child, defined as any
of the following when committed by a perpetrator that endangers a child’s life or health, threatens a child’s well-being, causes bodily injury or impairs a child’s health, development or functioning: 4 • A repeated, prolonged or egregious failure to supervise a child in a manner that is appropriate considering the child’s developmental age and abilities. • The failure to provide a child with adequate essentials of life, including food, shelter or medical care. What Are The Signs Of Neglect? Neglected children, even when older, may display a variety of physical, emotional, psychosocial, and behavioral problems which may vary depending on the age of the child. Consider the possibility of neglect when the child: 5 • Is frequently absent from school • Begs or steals food or money • Lacks needed medical or dental care, immunizations, or glasses • Is consistently dirty and has severe body odor • Lacks sufficient clothing for the weather • Abuses alcohol or other drugs
Neglect is the most common form of child maltreatment, accounting for about two-thirds of all reports to child protective services nationwide, and neglect is the leading cause of fatalities associated with child abuse. 25 Neglect involves a caregiver’s failure to meet the basic needs of a child, such as food, clothing, shelter, medical care, or supervision. 25 Neglect follows a continuum from mild to severe and often is very difficult to define. Some state definitions include “failure or inability to protect,” which refers to a situation in which a child is exposed to someone who may harm him or her, such as being left with a parent’s drug dealer or a known child molester. In addition, parents might be accused of failing to provide a safe environment by not protecting a child from unsanitary or hazardous living conditions. 26 Neglect may be: 25 • Physical (e.g., failure to provide necessary food, shelter, or supervision) • Medical (e.g., failure to provide necessary medical or mental health treatment) • Educational (e.g., failure to educate a child or attend to special education needs)
12
Powered by FlippingBook