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ILLINOIS Massage Therapy Education
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What’s Inside
THIS COURSE FULFILLS YOUR DOMESTIC VIOLENCE AND SEXUAL ASSAULT REQUIREMENT Chapter 1: Domestic and Sexual Violence Awareness for Healthcare Professionals (Mandatory) [1 CE hour] This course is intended to share information with all nurses on the concept of domestic and sexual violence when caring for patients who are at risk or have been a target of domestic or sexual violence.
1
THIS COURSE FULFILLS YOUR ETHICS REQUIREMENT Chapter 2: Ethics in Massage Therapy (Mandatory)
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[2 CE hours] Ethical code and professional standards of conduct have important values and concepts in professional massage, also within the boundaries that define therapeutic relationships THIS COURSE FULFILLS YOUR SEXUAL HARASSMENT TRAINING REQUIREMENT Chapter 3: Preventing Sexual Harassment in the Workplace for Illinois Professionals, 2nd edition (Mandatory) [1 CE hour] This course will help Illinois Healthcare professionals identify sexual harassment in the workplace, prevent it, and take appropriate action if it occurs. Chapter 4: Massage Therapy for Sports Injuries [4 CE hours] This course is designed to familiarize massage therapists with the techniques most commonly used to treat sports injuries, the general terminology associated with sports injuries, the most common sports injuries, the anatomy and physiology involved, and the sports each injury is usually associated with. The course also reviews several tips for helping athletes avoid specific injuries. In several instances, learners will discover that massage therapy is contraindicated given the specifics of an athlete’s condition. Chapter 5: Medications & Massage Therapy: Introduction to Pharmacology [4 CE hours] Massage can be a highly effective treatment for many conditions however you can do harm if done incorrectly, also be aware of any medications including non-prescription and herbal supplements, as these can influence or be influenced by the massage.
25
35
49
Final Examination Answer Sheet
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©2024: All Rights Reserved. Materials may not be reproduced without the expressed written permission or consent of Colibri Healthcare, LLC. The materials presented in this course are meant to provide the consumer with general information on the topics covered. The information provided was prepared by professionals with practical knowledge in the areas covered. It is not meant to provide medical, legal or professional services advice. Colibri Healthcare, LLC recommends that you consult a medical, legal or professional services expert licensed in your state. Colibri Healthcare, LLC has made all reasonable efforts to ensure that all content provided in this course is accurate and up to date at the time of printing, but does not represent or warrant that it will apply to your situation or circumstances and assumes no liability from reliance on these materials.
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MASSAGE THERAPY CONTINUING EDUCATION
Book Code: MIL1224
What are the requirements for license renewal? Licenses Expire Frequently Asked Questions
CE Hours Required
Mandatory Subjects
2 hours Ethics 1 hour Sexual Harassment Prevention Training 1 hour Domestic Violence & Sexual Assault Awareness
25 (All hours are allowed through home study)
Licenses expire December 31 of the even-numbered year
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Domestic and Sexual Violence Awareness for Healthcare Professionals (Mandatory)
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Preventing Sexual Harassment in the Workplace for Illinois Professionals, 2nd edition (Mandatory)
1
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Chapter 3:
MIL01SH
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Colibri Healthcare, LLC is approved by the National Certification Board for Therapeutic Massage and Bodywork (Provider #450215-06), and the Illinois Department of Financial and Professional Regulation (Massage CE Sponsor #245.000081). Are my hours reported to the Illinois board? No, the Illinois Department of Financial and Professional Regulation requires licensees to certify at the time of renewal that they have complied with the continuing education requirement. The board performs random audits at which time proof of continuing education must be provided. Is my information secure? Yes! We use SSL encryption, and we never share your information with third-parties. We are also rated A+ by the National Better Business Bureau. What if I still have questions? What are your business hours? No problem, we have several options for you to choose from! Online at EliteLearning.com/Massage-Therapy you will see our robust FAQ section that answers many of your questions, simply click FAQs at the top of the page, e-mail us at office@elitelearning.com, or call us toll free at 1-866-344-0973, Monday - Friday 9:00 am - 6:00 pm EST and Saturday 10:00 am - 4:00 pm EST. Important information for licensees: Always check your state’s board website to determine the number of hours required for renewal, mandatory topics (as these are subject to change), and the amount that may be completed through home-study. Also, make sure that you notify the board of any changes of address. It is important that your most current address is on file. Disclosures Resolution of conflict of interest Colibri Healthcare, LLC implemented mechanisms prior to the planning and implementation of the continuing education activity, to identify and resolve conflicts of interest for all individuals in a position to control content of the course activity. Sponsorship/commercial support and non-endorsement It is the policy of Colibri Healthcare, LLC not to accept commercial support. Furthermore, commercial interests are prohibited from distributing or providing access to this activity to learners.
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Book Code: MIL1224
MASSAGE THERAPY CONTINUING EDUCATION
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MIL1224
If you are only completing individual courses in this book, enter the code that corresponds to the course below online.
Domestic and Sexual Violence Awareness for Healthcare Professionals (Mandatory)
1
$10.00
MIL01DV
2
$20.00
MIL02ET
Ethics in Massage Therapy (Mandatory)
Preventing Sexual Harassment in the Workplace for Illinois Professionals, 2nd edition (Mandatory)
1
$10.00
MIL01SH
4
$40.00
MIL04SI
Massage Therapy for Sports Injuries
4
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MIL04MD
Medications & Massage Therapy: Introduction to Pharmacology
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MASSAGE THERAPY CONTINUING EDUCATION
Book Code: MIL1224
Chapter 1: Domestic and Sexual Violence Awareness for Healthcare Professionals (Mandatory) 1 CE Hour
By: Robyn B. Caldwell, DNP, MSN, FNP-BC, PMHNP Learning outcomes Upon completion of this course, the learner will be able to: Discuss the prevalence of domestic and sexual violence and recent media exposure. Assess how survivors of domestic violence and sexual violence view their health, and assess their impact on the healthcare system. Course overview This course is intended to share information with all nurses on the concept of domestic and sexual violence when professionals perceive and make treatment decisions, ultimately resulting in disparities in health outcomes. These biases, often unconscious and unintentional, can shape behavior and produce differences in medical care along various lines, including race, ethnicity, gender identity, sexual orientation, age, and socioeconomic status. Healthcare disparities stemming from implicit bias can manifest in several ways. For example, a healthcare provider might unconsciously give less attention to a patient or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact Implicit bias in healthcare Implicit bias significantly affects how healthcare
Explain post-traumatic stress disorder (PTSD) as a sequela of domestic violence and sexual violence. Analyze the effects of domestic violence and sexual violence on specific populations. Identify laws that impact domestic violence and sexual violence.
caring for patients who are at risk or have been a target of domestic or sexual violence.
health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases, fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
INTRODUCTION
thorough assessment, awareness of local resources, and knowledge of state and national laws governing practice. Think about a real-world scenario like the following: You are caring for the wife of a prominent physician who presents with multiple bruises in various stages of healing. Based on your observations, you suspect that she may be a victim of abuse. This scenario highlights the critical need for healthcare providers to navigate challenging situations sensitively and respond appropriately. This course will equip you with the knowledge, skills, and strategies to effectively address domestic violence, promote victim safety, and advocate for necessary support services.
Despite reported decreases in domestic violence (DV) rates, its harmful impact on society persists. The COVID-19 pandemic has exacerbated this issue, with projections indicating a global increase of 20 percent, equating to approximately 15 million additional DV cases (Stanley, 2020). Factors contributing to this surge include heightened isolation, increased stress levels, economic anxiety, joblessness, substance use, and limited access to resources. Recognizing domestic violence as a pressing national healthcare concern, it is imperative for healthcare providers to address this issue proactively. Effectively caring for victims of domestic violence necessitates a comprehensive understanding of the topic, including timely recognition,
CASE STUDY
Rachel is a registered healthcare provider who works in a large community hospital’s emergency department (ED). She is assigned to admit and assess a 36-year-old female whose chief complaints are shortness of breath, chest pain, dizziness, and extreme anxiety. The patient is receiving oxygen via nasal cannula. A stat electrocardiogram (ECG) and blood work have been ordered. Her pulse rate is 128 and regular; her respiratory rate is 22; her blood pressure is 150/96.
As Rachel begins her assessment, she realizes that the patient is Allison Michel, the wife of a prominent physician, Dr. Andrew Michel. Dr. Michel is a neurosurgeon and is highly respected by his colleagues. Members of the nursing staff have an extremely favorable opinion of Dr. Michel’s skill as a surgeon and his professional interpersonal communication with members of the nursing staff. One RN said, “He respects healthcare providers and treats us like professional colleagues.”
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Questions 1. What should Rachel do to effectively intervene in this situation? 2. What is important for Rachel to do and not do when attempting to question Mrs. Michel? Discussion 1. When faced with a situation involving suspected domestic violence, healthcare providers play a crucial role in providing support and assistance to victims. It is essential to understand the appropriate actions that should be taken in such circumstances. Let’s discuss what healthcare providers should do when responding to suspected domestic violence: a. Follow state laws and rules governing a healthcare provider’s response to DV. Healthcare providers must be familiar with the specific laws and regulations in their state that govern their obligations and responsibilities in cases of domestic violence. Compliance with these legal requirements ensures that appropriate actions are taken to protect the safety and well-being of the victim. b. Since Rachel is a nurse, she should adhere to the state board of nursing mandates regarding reporting DV. State boards of nursing as well as other healthcare boards often provide specific guidelines on reporting domestic violence cases. Healthcare providers must follow these mandates and promptly report suspected cases of domestic violence to the appropriate authorities, such as law enforcement or child protective services, as required by their state regulations. c. Follow organizational policies and procedures that direct the healthcare provider’s actions in DV. Healthcare organizations typically have policies and procedures in place to guide healthcare providers’ response to domestic violence cases. It is crucial for healthcare providers to familiarize themselves with these organizational guidelines and follow them to ensure a coordinated and effective response. Bottom Line: While it is important to report suspected domestic violence, the appropriate reporting channels may vary depending on the organization and the specific protocols in place. Healthcare providers should follow the designated reporting procedures established by their organization or refer to their state laws and regulations to determine the appropriate reporting authority. 2. When healthcare providers suspect domestic violence and need to question the victim, it is crucial to adopt an appropriate approach that promotes trust, sensitivity, and effective communication. Let’s discuss the options and identify the most suitable approach for Rachel when questioning Mrs. Michel. a. Waiting until her husband is present is not the recommended approach. Waiting for the presence of the alleged perpetrator, in this case, Mrs. Michel’s husband, can potentially compromise the victim’s safety and hinder open communication. Immediate intervention and support are essential to address any potential risks and help the victim. b. Accepting Mrs. Michel’s statements and avoiding further investigation is also not a helpful approach. Accepting the victim’s statements without further investigation might overlook crucial details or underlying issues related to domestic violence. Healthcare providers should be diligent in assessing
Mrs. Michel soon says her chest has stopped hurting and she no longer has trouble breathing. Her ECG shows tachycardia but is otherwise normal, as is her blood work. Her respiratory rate is 14; her heart rate is 100; her blood pressure has decreased to 140/82; her oxygen saturation is 97%. Rachel and the attending ED physician, Dr. Weber, believe Mrs. Michel has had a panic attack. However, there is another worrisome finding. Rachel notes that Mrs. Michel has several bruises over her abdomen and thighs in various stages of healing. There is also a buckle-shaped welt on her back. Rachel is distressed and realizes that she must initiate a screening for possible domestic violence. Mrs. Michel notices that Rachel is looking at her bruises. Mrs. Michel glances up at Rachel and says, “I am so clumsy. I am taking strenuous exercise and yoga classes and always seem to fall. I bump into things too. I have got to be more careful.” At that moment, Dr. Michel’s voice is heard outside the room. Mrs. Michel immediately begins to breathe more rapidly, and her heart monitor shows a swift increase in heart rate. She pulls her hospital gown tightly around her and appears frightened. Dr. Michel enters the room and takes his wife’s hand. “Well, darling, how are you feeling now?” She responds: “Oh, I am fine, I am. I was at that committee meeting for the hospital’s charity ball and suddenly could not breathe, and my chest hurt. This is because I have been drinking too much caffeine lately. I tried to explain that to everyone at the meeting, but they called 911 before I could stop them. I did not want to come here! Furthermore, I am ready to leave right away!” Mrs. Michel attempts to pull her hand away from her husband’s, but he holds her hand tightly. Finally, Dr. Michel smiles and turns to Rachel. “Thank you so much for taking such good care of my wife, but I think it is best to take her home now.” Rachel knows she needs to talk to Mrs. Michel alone. So she casually tells Dr. Michel, “Oh, I just have a few things to finish with Mrs. Michel. Then, perhaps, you could finalize the discharge process and talk to the attending physician about any follow-up care. I will get you as soon as I am through here.” Dr. Michel’s smile now seems forced as he says firmly, “I will wait here with my wife. I am sure she feels better if I am here.” Dr. Weber, the attending ED physician, arrives as Dr. Michel speaks. He asks Mrs. Michel’s permission to discuss the diagnostic findings with her husband. “Oh, of course, you may. However, I would feel better if Andrew knew what was happening, and he could decide what was best for me.” Dr. Michel reluctantly leaves the room with Dr. Weber. After they have gone, Rachel gently asks Mrs. Michel how she got the bruises on her abdomen, thighs, and buttocks. Mrs. Michel begins to cry and says, “Please just let me go home. And please, please, do not tell my husband that you saw those bruises. It would be terrible if he thought anyone would see how clumsy I am. It is my fault I get hurt. I know it is.” Rachel is concerned not only for Mrs. Michel but also for herself. She thinks: “I know I must do a thorough screening for domestic violence. However, I cannot believe Andrew Michel would do this. Everyone admires him so much. But his wife seems so frightened, and those bruises are characteristic of abuse! How will I start an investigation when the possible abuser is so powerful in this hospital? Could I lose my job? I do not know how I am going to handle this!” Rachel is facing a tough challenge. She must conduct an objective, thorough screening for intimate partner violence and deal with a situation involving a physician of prominence and power.
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allow for a comprehensive understanding of her situation. It is essential to approach the conversation with sensitivity, respecting Mrs. Michel’s autonomy and choices while offering support and providing information about available resources. Bottom Line: When caring for and questioning a suspected domestic violence victim like Mrs. Michel, healthcare providers should prioritize maintaining a supportive and objective approach. By being supportive, objective, and actively listening, Rachel can establish trust, encourage open communication, and provide the necessary support and resources to address Mrs. Michel’s situation effectively.
and investigating potential signs and symptoms of abuse to ensure the safety and well-being of the patient. c. Insisting that the victim discloses the truth can further traumatize or discourage them from sharing their experiences. Building trust and creating a safe environment for open communication are vital components in addressing domestic violence effectively. d. Healthcare providers should strive to maintain a supportive and objective stance when communicating with suspected domestic violence victims. Being empathetic, nonjudgmental, and actively listening to Mrs. Michel’s experiences will help establish trust, encourage disclosure, and
DOMESTIC AND SEXUAL VIOLENCE IN THE UNITED STATES
Unnecessary trauma and abuse remain widespread in the United States. Domestic violence—also known as intimate partner violence (IPV)—devastates families, the community, and the nation. Nearly 50% of all women in the United States have experienced at least one form of psychological aggression by an intimate partner (American Psychological Association [APA], 2023). DV impacts the quality of life of abused individuals and the lives around them. In addition, the cost to society is enormous. It is estimated that the lifetime cost of IPV is more than $3.6 trillion (Centers for Disease Control [CDC], 2022). Sexual violence in the United States is common. One in three women and one in four men experience some form of sexual violence that involves physical contact in their lifetime (CDC, 2020a). Sexual violence may start as early as 11 years of age, occurring in one in three rape victims, and may begin earlier. Sexual violence costs, on average, $122,461 in medical costs, criminal justice costs, and lost productivity. Definitions of domestic violence and sexual violence The US Department of Justice (2023) defines domestic violence as “A pattern of abusive behavior in any relationship that one partner uses to gain or maintain power and control over another intimate partner.” Domestic violence can be physical, sexual, emotional, economic, or psychological actions or threats of actions that influence another person. IPV is defined as physical violence, sexual violence, stalking, and psychological aggression (including coercive acts) by a current or former intimate partner (CDC, 2022). The CDC defines sexual violence as a sexual act committed when consent is not obtained or freely given (CDC, 2022). Although these terms are often used interchangeably, they can vary depending upon specific state terminology and by what profession is defining these terms. These definitions and the requirements for reporting domestic violence vary from state to state. Usually, mandatory reporting of known or suspected violence
Do You Live in Connecticut? According to the Connecticut State Department of Children and Families (2020), approximately 20,000 family violence incidents annually result in arrests. The state of Connecticut provided 32,927 court-based advocacies, which was a 1% increase from 2018. Intimate partner violence constitutes most of these incidents. Connecticut Coalition Against Domestic Violence (CCADV) reported in 2019 that 33,141 adults and 4,632 children were treated. In addition, 2,214 victims and their children were housed in shelters with an average length of stay of 46.3 days. The number of hotline calls yielded 33,711 for 2019. According to the Connecticut Alliance to End Sexual Violence (CAESV, 2020), one in two women and one in five men experience sexual violence other than rape in their lifetime. In 2016, sexual violence expenditures totaled $5,762,944 through medical costs or lost wages. In Connecticut, 77% of victims know their perpetrator, a common theme among DV victims (CAESV, 2020). against a vulnerable population is required in the United States. These populations include children, the elderly, and the mentally incompetent. Failure to report suspicion of abuse may lead to hefty fines or possible confinement of the healthcare provider or healthcare provider. Healthcare Consideration: Healthcare providers need to be knowledgeable about the specific definition and reporting requirements of domestic violence based on the state in which they practice, as laws can vary. Understanding these variations is crucial for healthcare professionals to appropriately identify, document, and report cases of domestic violence, ensuring compliance with legal obligations and facilitating the provision of necessary support and protection for survivors. By staying informed about state-specific laws, healthcare providers can effectively contribute to addressing domestic violence and promoting the well-being of affected individuals.
HISTORY OF DOMESTIC AND SEXUAL VIOLENCE
Previously, women were seen as objects or property and had no rights. During ancient times in Mesopotamia, the Code of Hammurabi, a Babylonian code of law dating from 1754 BC, provided guidelines for disciplining females and children. It allowed a husband to execute his wife if caught cheating and drown if she overspent monies. In addition, he could sell the children or force them into slavery to repay his debts (Criminal Justice, 2020).
Domestic and sexual violence has been noted throughout history. However, in today’s world, we experience more violence, including school massacres; the killing of innocent groups, such as children, women, and lesbian, gay, bisexual, transgendered, and queer/questioning people (LGBTQI+); and terrorist attacks across the world in the name of religion. This may increase domestic and sexual violence as social norms change.
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violence instead of supporting reform to help women leave abusive relationships (Criminal Justice, 2020). During the early history of domestic violence, crimes were abundant, and punishments were public. It has been suggested that as crime rates increase, so does the violence toward humans, especially the vulnerable, including women and children. Healthcare Consideration: Social media platforms have emerged as significant channels, empowering numerous individuals affected by domestic violence to share their stories and experiences. Through these platforms, abused individuals find a voice, fostering awareness and generating conversations around domestic violence. The accessibility and reach of social media provide an opportunity to amplify the voices of survivors, break the silence surrounding domestic violence, and promote support and resources for those in need.
In Greece, early laws allowed men to rule as they saw best, which meant they could do anything to their wives. In early Rome, beatings were commonplace, and only women from the upper class could request a divorce. It is written that Constantine the Great, who was later canonized as a saint in the Catholic Church, executed his wife by boiling her alive for the suspicion of adultery (Criminal Justice, 2020). Under English Law, the “rule of thumb” limited the beatings that men could give their wives—they could use a stick no larger in diameter than their thumb to perform the beating. The Constitution did not include women’s rights in the early United States. Women could not own property, vote, or have a say in the political arena. Religious views also contributed to domestic violence against women as people interpreted biblical commands literally, such as women obeying and submitting to their husbands. Even today, courts often require family counseling in cases of domestic
RISK FACTORS FOR DOMESTIC VIOLENCE
● They are fearful or angry. ● They commonly use defensive mechanisms to cope. The one theme that most people agree upon is that anger is not the reason people are abusive. When police are called to a home for a report of domestic violence, the abuser can talk normally without any form of physical violence. If anger were the culprit, the emotion could not be turned off that easily. The Duluth Model: Power and Control Wheel reveals how people who abuse can control and dominate their partner (Domestic Abuse Intervention Programs, 2017). Please see the following link for the Domestic Abuse and Intervention Project Wheel: https://nnedv.org/wp-content/ uploads/2019/07/Library_General_Power_and_Control_ Wheel.pdf Healthcare Consideration: Being aware of the risk factors associated with domestic and sexual violence enables early screening and proactive interventions to support the well- being of individuals experiencing abuse. By recognizing these risk factors, healthcare professionals can take prompt action, providing necessary resources and assistance to those affected. This proactive approach contributes to promoting the overall health and safety of survivors of domestic and sexual violence.
The Centers for Disease Control and Prevention (CDC, 2019) identified risk factors associated with developing violence and domestic violence. The authors looked specifically at factors associated with social learning and developmental perspectives, adult psychopathology, and marital relationship problems. Risk factors for domestic violence or IPV include the following: ● Growing up in a home where a person was maltreated when a child ● Increased marital strain ● Prior history of being physically abused ● Belief in strict gender roles ● Attitudes accepting or justifying IPV ● Depression ● Alcohol and substance abuse Hammond (2020) identified 13 reasons people abuse their partners. Some examples include the following: ● They have a disorder, such as antisocial personality disorder. ● They were abused in their childhood. ● They were exposed to movies, videos, or TV shows that glorify abuse. ● They grew up in a home environment with an abusive/ angry addict. ● They do not understand boundaries. ● They lack empathy.
Table 1: Types of Domestic Violence Form of Violence Behaviors Physical
Hitting; slapping; abandonment; forcing drug/alcohol use; preventing daily activities, such as bathing, eating, or sleeping Making derogatory remarks, forcing sexual acts, forcible rape, forcing someone to watch pornography, and purposely trying to infect someone with a sexually transmitted disease Threatening, ridiculing, isolation, blaming someone for acts, constant surveillance, and acting possessively Providing little or no monies to a person, taking a paycheck away, preventing a partner from working, and overspending credit limits Refusing to use contraceptives to prevent unwanted pregnancies, monitoring someone’s menstrual cycles, and forcing an abortion Denying social media access, sending fearful or threatening texts, sending explicit photos to someone, demanding explicit photos in return, and using technology to monitor a person
Sexual
Emotional
Financial
Reproductive coercion Digital abuse
From Domestic Abuse Intervention Programs, 2017
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Table 2: Types of Sexual Violence Form of Violence Behaviors Sexual assault
Attempted rape, fondling, or unwanted sexual touching, forcing a victim to perform sexual acts or penetration of the body Exposing oneself to a minor; fondling; intercourse, masturbation in the presence of a minor; forcing the minor to masturbate; producing, owning, or sharing pornographic images or movies of children; obscene phone calls, text messages, or digital interaction; sex of any kind with a minor; and sex trafficking or any other sexual conduct that is harmful to a child’s mental, emotional, or physical well- being
Child sexual abuse
Sexual assault of men and boys Intimate partner sexual violence
Sexual assault, specifically against men and boys
Intimate partner rape, marital rape, and spousal rape
Incest
Sexual contact between family members may constitute child sexual abuse, crimes of incest, sexual assault, and rape
Drug-facilitated sexual assault
The use of alcohol or drugs to compromise an individual’s ability to consent to sexual assault
Source: Rape, Abuse, & Incest National Network (RAINN), 2020a.
Stalking Stalking is a pattern of repeated and unwanted attention, harassment, contact, or any other course of conduct directed at a specific person that would cause a reasonable person to feel fear (RAINN, 2020b). Stalking has a high propensity for the development of physical violence and injury. When technology is used to send unwanted emails or pornography, this is classified as cyberstalking. Interestingly, it has been documented that “the less of a relationship between the stalker and target that occurred before the stalking, the more delusional and mentally disturbed the stalker” (New York State Office for the Prevention of Domestic Violence, n.d.). Healthcare Consideration: Domestic violence encompasses various forms beyond physical injuries, and it is essential for healthcare providers to recognize this broader spectrum. While visible signs of abuse may be absent, healthcare providers should consistently screen and evaluate for indicators of emotional, psychological, sexual, or financial abuse, among others. By maintaining a comprehensive approach to assessment, healthcare providers can better identify and address the diverse manifestations of domestic violence, ensuring appropriate support and intervention for all survivors. Weapons of abuse Everytown (2019) reports that over 600 American women are shot to death by an intimate partner per year. Although this number is staggering, it does not consider the many unreported nonfatal gun-related incidents. Many other weapons or perceived weapons can also be used to assault a person. Physical violence using the body (fists, feet, hands) or other weapons (knives, scissors, razors) is the first thought when discussing weapons.
Self-Assessment Quiz Question #1 Megan and her partner Elise have been together for 3 years. Elise’s former partner, Michael, has regularly followed Megan and Elise to various social events. Michael texts Elise frequently, demanding that Elise separate from Megan and return to him. Michael has even begun to wait outside Elise’s workplace and watch her arrive and leave each day. Megan and Elise are frightened and believe that Elise is a victim of domestic violence. Under these circumstances, Elise: a. Is not experiencing domestic violence since its definition does not include violence committed against members of the same gender. b. Is being stalked by Michael, and this behavior is considered part of domestic/sexual violence. c. Knows the definition of domestic violence does not yet include members of the LGBTQ community. d. Knows stalking is considered part of domestic violence, but since Michael is a former partner, this behavior can be reported to authorities but not as domestic violence. Healthcare Consideration: Weapons capable of causing harm extend beyond firearms or knives and can include various objects that may be used to inflict injury on individuals. It is crucial for healthcare providers to broaden their assessment of weapons to encompass any item with the potential to cause harm. By adopting a comprehensive perspective, healthcare providers can more effectively identify potential risks and take necessary precautions to ensure the safety and well-being of individuals in their care.
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HOW ABUSED WOMEN VIEW THEIR HEALTH
may be passed on to others (children) who do not fully understand the abusive situation. As a result, they may seek more medical services, which further burdens the healthcare system. The cost of healthcare services is also increased because of patients seeking care in the emergency room or complaining of vague symptoms, often causing increased unnecessary diagnostic testing, services, and medications. Healthcare Consideration: Understanding the perspective of abused individuals regarding their health is essential for healthcare providers, as it facilitates the implementation of appropriate interventions and facilitates effective follow-up care. By gaining insight into how survivors perceive their health, healthcare providers can tailor interventions to address their specific needs and experiences. This patient-centered approach enhances the effectiveness of healthcare interventions, promotes trust, and fosters a supportive environment for individuals affected by abuse.
When women are abused emotionally or physically, this creates a phenomenon where they view their health as weak or problematic. According to the Office of Women’s Health (2019), violence against women is linked to long-term health problems, such as arthritis, asthma, chronic pain, migraines, immune issues, and irritable bowel syndrome. Violence and abuse can lead to additional psychological suffering and emotional impact that can significantly impact a person’s health (Office of Women’s Health, 2019). Additional comorbidities include anxiety, depression, PTSD, mood disorders, and substance use disorders. This increases the risk of misusing medications or attempting suicide. In addition, many women who experience domestic or sexual violence may use drugs, drinking, smoking, or overeating to cope (Office of Women’s Health, 2019). Abused individuals who perceive poor personal health typically think of themselves as weak, which may prevent them from leaving an abusive situation. These perceptions
PTSD AND DOMESTIC VIOLENCE
Post-traumatic stress disorder (PTSD) is a complex disorder that develops in some individuals after highly traumatic events, such as combat, crime, sexual violence, accidents, or natural disasters (APA, 2022). PTSD associated with domestic violence is considered complex PTSD and may not respond to standard PTSD treatments. The following are factors generally associated with PTSD in victims of domestic violence (APA, 2022): ● Chronic threats ● Personal meaning associated with trauma ● Age ● Duration of trauma ● Feeling guilt or blame for the violence ● Lack of social support ● Inability to stop abuse or violence ● Having an immediate physiological response, such as increased blood pressure or bruising, or a psychological response, such as avoidance PTSD treatments typically have the patient recall the experience and discuss the event to decrease fear associated with the trauma. However, with domestic violence patients, reliving the trauma often re-instills fear, and they may experience the threat of revictimization, thus making this specific treatment inappropriate (APA, 2022).
Healthcare Consideration: Post-traumatic stress disorder (PTSD) can develop in response to both actual and perceived threats, emphasizing the importance of early recognition and intervention to optimize outcomes. When engaging with individuals experiencing PTSD, healthcare providers should approach them with empathy and utilize therapeutic communication techniques. These person- centered approaches foster trust, create a safe space for expression, and enhance the effectiveness of interventions aimed at supporting individuals with PTSD. continued for years, beginning when she was a young child and continuing through her high school years. She is currently seeing a therapist to help her deal with the trauma of sexual violence. Under these circumstances, the therapist is not surprised that Shona is exhibiting all of the following EXCEPT: a. Heart palpitations. b. Abstaining from alcohol. c. Signs of depression. d. Chain smoking. Self-Assessment Quiz Question #2 Shona is a survivor of sexual violence. The abuse
CHILDREN AND SEXUAL VIOLENCE
● Preference for impersonal sex and sexual risk-taking ● Exposure to sexually explicit media ● Adherence to traditional gender role norms ● Prior sexual victimization or perpetration ● Suicidal behaviors
According to the CDC (2022), the risk factors for sexual violence against children include the following: ● Alcohol and drug use ● Delinquency ● Early sexual initiation ● Coercive sexual fantasies Recognition of child abuse According to Boos (2018), trends over time in the United States, Canada, Sweden, Australia, New Zealand, and the United Kingdom suggest that “child maltreatment syndrome or assault, physical abuse deaths, and admissions for injuries related to child abuse have not changed significantly since the mid-1970s despite increased child protection activities” (para. 4). Clinicians must be familiar with characteristics associated with child abuse.
The following are some common symptoms of physical abuse in children:
● Learning disabilities ● Conduct disorders ● Bruises of various ages ● Human bites ● Missing or fractured teeth ● Cigarette burns or hot water scalding ● Fractures ● Head trauma
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Book Code: MIL1224
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The following risk factors in the social environment may lead to child abuse (Boos, 2018): ● Unplanned pregnancy ● Poverty ● Acute or chronic stressors in the home environment (such as job loss) ● Parents with low education levels ● Parents with a negative view of their child’s normal developmental behaviors Clinicians should always assess for the potential or actual presence of child abuse and report any suspicions to the local authorities per the guidance of state laws. Healthcare Consideration: Children represent a particularly vulnerable group within society, making it crucial for healthcare providers to prioritize their safety and well-being. When there is a suspicion of child abuse or neglect, it is essential to follow mandated reporting procedures to ensure proper intervention and protection for the child. Additionally, documenting these suspicions in the health record contributes to a comprehensive record of the child’s care and can assist in future assessments and investigations. By advocating for the rights and safety of children, healthcare providers play a vital role in safeguarding this vulnerable population. ● Substance abuse in the home ● Caregiver with a history of abuse ● Animal cruelty ● Psychiatric illness in the caregiver
Self-Assessment Quiz Question #3 Monique and her husband, Isaiah, have been married for five years and struggle with finances. Isaiah demands that Monique adhere to a strict cultural rule of how she dresses and her role within the home. Monique reflects on Isaiah’s demands and realizes he has been watching pornography and using multiple forms of alcohol. He demands that she engage in acts driven by his desire for coercive “fantasy play,” as he calls it. Given these circumstances, it is apparent that Monique: a. Should ask others for advice. b. Must ask for an increase in her autonomy. c. Is a victim of sexual violence. d. Must monitor Isaiah’s behaviors for abuse. Self-Assessment Quiz Question #4 Monique discusses Isaiah’s behavior with her closest confidant, Kathy, her sister. Kathy sympathizes but says, “It is always something. I know with my husband, the problem is sex. When he wants it, he wants it, and sometimes he even forces himself on me.” In Kathy’s circumstances, she: a. Is experiencing a form of domestic violence. b. Should question if forced sex exists in a marital relationship. c. Is experiencing domestic violence, but Monique is not. d. Should accept the situation since it does not happen too often.
ADOLESCENTS/TEENS AND VIOLENCE
experiences may continue throughout life, including college and adulthood. TDV is commonly associated with socioeconomic status and is more likely to occur in specific populations, such as those who participate in high-risk behaviors. Because of poor self-image or lack of control in complex relationships, TDV is associated with risky health behaviors, such as drug use, alcohol use, marijuana use, and unprotected sex. These risky behaviors, coupled with a poor self-image or coping mechanisms, can lead to unhealthy weight control, unwanted pregnancies, and antisocial behaviors (fighting), leading to legal ramifications and suicide. Teens have voiced that they want to be asked about violence when seeking healthcare from their provider. The Conflict Tactics scale has been used to measure the prevalence of the TDV phenomenon to assess teen violence. The Conflict Tactics scale was first developed in 1972 to examine specific acts and events used in conflict, including acts of physical violence, and is guided by conflict theory (Straus et al., 1996). Although there have been many interpretations of conflict theory, the central premise is that one person or group controls or dictates another person or group. Variables include competition, inequality, revolution, and even war. When thinking about IPV, this seems to help explain the behavior of the abuser seeking power and control over another human being, even if that involves violence to obtain control (Straus et al., 1996). This can be observed in TDV, where the abuser does not want their partner to participate in activities with others. At first, the person may think this is love, as their partner wants to spend only their time with them. However, as time progresses, it is evident that this is controlling behavior.
Adolescent and teen dating violence is intentional physical, sexual, or psychological violence or stalking by current or former partners (Campo-Tena et al., 2023). Violence in this population can also include electronic intimidation through phones and social media. Although there are similarities between adult and teen violence, adolescents and teens have specific issues because of their unique developmental stages. When adolescents are involved in an abusive relationship, anger, and physical aggression are most often utilized to deal with conflict. Healthcare Consideration: Adolescents can experience various disorders that may be attributed to the effects of violence, underscoring the importance of routine assessments for abuse risk and noncoping mechanisms among all age groups, including teenagers. Healthcare providers should prioritize comprehensive evaluations that consider the potential impact of violence on adolescents’ mental health and well-being. By routinely assessing for abuse and noncoping mechanisms, healthcare providers can identify early warning signs, intervene promptly, and provide appropriate support and resources tailored to the unique needs of teenagers affected by violence. Females experienced higher rates of physical and sexual dating violence than males. Additionally, LGBTQI+ individuals also experienced higher rates of physical and sexual dating violence than cisgender individuals (CDC, 2023). These factors merge in many situations to have long- lasting and deadly consequences for young experiencing dating violence (CDC, 2023). Adolescents and teens who experience unhealthy, abusive, or violent relationships are more likely to develop depression and anxiety, engage in substance use, have thoughts of suicide, and engage in lying, theft, bullying, and hitting (CDC, 2023). These
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Book Code: MIL1224
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SPECIAL POPULATIONS
Human trafficking The Centers for Disease Control and Prevention
should be suspicious when the nature of the injury does not fit the story provided as to how the injury occurred. Also, when suspected of trafficking, clinicians should look for a tattoo that brands or demonstrates ownership of the person. However, tattoos are not conclusive of trafficking (Henderson, 2022). Training opportunities and resources for healthcare workers and others are available to assist in understanding the unique needs of human trafficking victims. For example, the C aring for Trafficked Persons handbook, developed by the International Organization of Migration, helps providers understand how to respond better should they have a trafficked patient. The handbook is written in three languages and used in seven countries (Viergever et al., 2015). In addition, the Polaris Project developed a hotline to report known or suspicious trafficking (2019). Finally, local communities devise most health care and legal services for trafficked persons. A classic example is the Response Initiative Guiding Human Trafficking Services, or RIGHTS, group, a policy developed by three counties in Kentucky and Cincinnati, Ohio, that includes guiding principles to enhance healthcare and legal services for this population (Polaris Project, 2019). Pregnancy is a stressor for both partners and even though most women seek medical care during this time, abused women often miss routine follow-ups or may not start pregnancy care until they are in the third trimester. Because of the lack of prenatal care, babies may be born with healthcare issues. In addition, mothers with substance use disorders often continue using it, leading to poor nutritional status and additional health concerns for the baby. The most alarming healthcare concerns during the pregnancy of an abused female include suicide and homicide. Evidence-Based Practice! Research shows a concerning disparity in police response rates, with individuals with disabilities experiencing lower rates of police intervention (77%) compared to those without disabilities (90%) (NCADV, 2018). This highlights the urgent need to address systemic barriers and biases that may hinder the protection and support of individuals with disabilities facing violence. It is crucial for society to advocate for equitable access to justice and enhanced police responsiveness to ensure the safety and well-being of all individuals, irrespective of their disability status. toward authority. In other words, individuals with antisocial personalities violate socially accepted behavior. Understanding that mental health disorders preclude some people from violence, clinicians must routinely assess patients for the potential of being abused or abusing others physically or emotionally. Training for clinicians needs to include knowledge of proper assessment techniques; providing safety for patients; and providing consulting services, such as motivational or support groups, while enhancing patients’ cognitive and emotional skills. Brem and colleagues (2018) reported that physical and mental health issues credited to violence cost over $19.3 million annually.
defines human trafficking as the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for a commercial sex act (CDC, 2020b). The National Human Trafficking Resource Center (Polaris Project, 2019) estimates that one in six endangered runaways reported that they were likely sex trafficking victims. In addition, an estimated 4.8 million (or more) people are trapped in forced sexual exploitation globally. There were 8,248 sex trafficking cases reported in 2019 to the Hotline (Polaris Project, 2019). Monitoring and caring for victims of human trafficking present many problems. Cultural and language barriers, which are often present, may prevent people from seeking help. Additionally, victims may fear retaliation from their trafficker, legal ramifications, or deportation. This population also faces economic challenges, lack of social support, and social stigma, all considered barriers to their healthcare (CDC, 2020b). Trafficked patients experience repetitive physical and psychological injuries. Many display injuries related to weapons and sexual violence and nonspecific symptoms, such as headaches, depression, and stomach complaints (The Official State of Nevada, 2019). Clinicians Pregnant women The prevalence of physical violence during pregnancy is 28%, according to the World Health Organization (Hrelic, 2019). Ninety percent of the abusers are the biological father of the unborn, and the most common site of injury inflicted is to the abdomen or other sites (Hrelic, 2019). The most common site of physical abuse in pregnancy is bruising, especially on the back and arms, in various stages of healing (Hrelic, 2019). Other signs include changes in personality, anxiety about pleasing a partner, missing work or school, wearing clothing incongruent with the weather, and withdrawal from social settings (Hrelic, 2019). impairments, including physical, developmental, and psychological. Disabilities affect 1 in 4 women and 1 in 5 men in the United States, posing a higher risk of violence than the general population (CDC, 2020). Women are more likely to experience rape, and men are at greater risk for sexual coercion, unwanted sexual contact, and noncontact unwanted sexual experiences (CDC, 2020). Individuals with disabilities Disability can mean many types and degrees of People with mental health disorders Mental health and domestic violence are pervasive problems across the United States and have historically been overlooked. Mental healthcare services play an enormous role in recognizing and treating domestic and family violence. There is a reciprocal link between victims and perpetrators of violence with mental health conditions (Fisher et al., 2022). Brem and colleagues (2018) examined antisocial personality traits and the relationship between distress tolerance and domestic violence. Antisocial personality characteristics are documented as thinking only of oneself, disregarding the rights of others (which starts in early childhood), impulsivity, defiance, irritability, possible drug use (such as alcohol), aggressiveness, and hostility
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Book Code: MIL1224
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