Contributing factors Several factors can increase the risk that someone will hurt their partner. However, the simple presence of these risk factors does not always mean that IPV will occur. Risk factors for perpetration (hurting a partner) include (CDC, 2021b): ● Having been violent or aggressive in the past. Appropriate intervention for intimate partner violence Reporting requirements Although the reporting of child maltreatment and elder maltreatment by healthcare professionals is required in most states, some states require that all incidents of domestic violence inclusive of intimate partner violence are reportable (Walker, 2017). Risks of reporting It is important to acknowledge some disagreement among advocates on the idea of mandatory reporting in cases of IPV. Some argue that mandatory reporting is more likely to provide assistance for families in need of intervention. Others say that mandatory reporting places the victim of IPV at increased risk. In disclosing suspected IPV to public authorities, mandatory reporting may offer the victim an opportunity to extricate themselves from the relationship. However, a person who has been the victim of IPV may fear that their abuser may become more violent or threaten to kill them, their children, or other family members. (Women against Abuse, 2022). Although about half of the episodes of intimate partner violence result in bodily injury only about a third of those injured seek medical attention (Parish Carrigan et al., 2018). Although our society views children’s rights to privacy as secondary to their safety, this is not the case for adults. Healthcare professionals’ codes of ethics, including that of
● Having witnessed or been a victim of violence as a child. ● Using drugs or alcohol, especially drinking heavily. ● Being unemployed or experiencing other life events that result in high levels of stress.
the American Dental Association (ADA; 2020), generally list patient autonomy as a major principle. Mandatory reporting of IPV is complicated by the victims having to give up their autonomy when a report is filed and not being likely to have given informed consent for pertinent health information to be shared. Also, mandatory reporting most often is made to law enforcement authorities rather than social services agencies. Some victims may be afraid to report IPV because of their immigration status (U.S. Department of Health and Human Services [HHS], 2021). It is suggested that dental offices establish a protocol for such cases. If the victim is alone at the office, a discussion with the dentist and a staff member witness may be possible. If the abusive partner is present in the office or even in the operatory, such a conversation may not be possible. Posting a sign for a woman’s shelter or IPV hotline in the stall of the women’s restroom in the dental office or building is recommended. Tear-off strips with only the phone number can be part of the sign. Because of screening procedures employed by shelters and hotlines, perpetrators who may find and call such phone numbers will be unaware that they have reached a shelter or IPV hotline. Proper documentation, including consented x-rays and photographs, should be included in the patient file. Danger to the abused partner and the children always exists (see Table 1).
Table 1. Dealing with Intimate Partner Violence in the Dental Setting Do
Don’t
• Assure patients of confidentiality to the extent allowed under the state’s mandatory reporting laws. • Listen to the patient. • Respond to the patient’s feelings. • Acknowledge that disclosure is scary for the patient. • Tell the patient that you are glad they told you. • Provide the patient with options and resources. • Document the information in the patient’s chart. • File mandatory reports. • Schedule a follow-up visit. • Discuss the abuse in front of the suspected perpetrator. • Violate confidentiality, unless it falls under the state’s mandatory reporting laws. • Give advice or dictate an appropriate response. • Shame or blame the patient. • Grill the patient for excessive details of the abuse. • Lie about the legal and ethical responsibilities to report suspected abuse. Note . From K. Littel. (2004). Family violence: An intervention model for dental professionals. OVC Bulletin , U.S. Department of Justice. https://ovc. ojp.gov/sites/g/files/xyckuh226/files/media/document/ncj204004.pdf DISABLED PERSONS ABUSE Definition, data, and demographics • Joke about the violence. • Minimize the issue or try to change the subject.
The statutory definition of “disabled persons” varies from state to state; it can include individuals with cognitive, physical, sensory, emotional, mental, or other impairments, including autism, AIDS, or other chronic medical conditions that make daily living difficult or impossible. Because of the differences in definitions, reporting mechanisms, and case disposition, there is little reliable and comparative statistical research available on abuse of people with disabilities. Research has shown, however, that people with developmental disabilities are four to ten times more likely to be victims of crime (CDC, 2020a). Some individuals with disabilities reside in nursing homes along with elderly individuals, whereas others reside in specialized care facilities. Some live at home with family or private caretakers, whereas others live in group homes and work in sheltered facilities. Crimes involving interpersonal violence, including physical and sexual assaults, may occur at home, at the group workplace, in group homes, or in care facilities.
Some government data report on the prevalence of child abuse victims with a reported disability. Categories include individuals with behavioral problems, emotional challenges, learning disabilities, intellectual challenges, physical disabilities, and visual or hearing impairments. According to Grant and colleagues (2022), who were working for the U.S. Department of Justice Office of Victims of Crime, “[C]hildren with disabilities are at least three times more likely to be abused or neglected than their peers without disabilities, and they are more likely to be seriously injured or harmed by maltreatment.” In 2013, almost 13% of child victims had an identified disability. Of those children, the most frequently victimized had behavioral problems (24%), and 19% had emotional disturbances (DoJ, 2018). Almost 95% of people with disabilities who were victims of violent crime were able to identify the perpetrator, and 15% were victimized by an intimate partner (DoJ, 2018).
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