or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact 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 Family violence includes child abuse and neglect as well as intimate partner violence (also referred to as domestic violence or spousal abuse). Family violence may also include abuse and neglect of disabled persons (persons with significant physical disabilities or mental or functional impairments), vulnerable adults, and the elderly. Individuals of all age groups can be affected by family violence because multigenerational abuse frequently occurs. In 2009, a Department of Justice (DoJ) study reported that more than 25% of U.S. children had been exposed to family violence in their lifetimes (DoJ, 2017). From 2003 to 2014, more than half of the murders of women in the U.S. were related to intimate partner violence (Petrosky et al., 2017). Approximately one in ten people age 60 and over have experienced some form of abuse, with most of the abuse being perpetrated by family members (National Council on Aging, 2021). In 2015, of violent crime victimizations of people age 65 and older, 44% were committed by someone the victim knew, often a relative or intimate partner (National Center for Victims of Crime, 2017). Approximately 60% to 75% of physical abuse involves injuries to the head, neck, and mouth (Singh & Lehl, 2020). Orofacial injuries resulting from family violence should be easy to identify in the dental setting. Dental professionals also have an advantage over other healthcare professionals because almost two-thirds of all adults in the U.S. have regularly scheduled dental visits at least once a year (Centers for Disease Control and Prevention, [CDC] 2022a). Healthcare providers in the medical field do not have this unique opportunity because victims of family violence often avoid medical appointments. Historically, however, many in the dental profession have been unable or unwilling to properly identify these injuries. Equally disconcerting are cases in which a provider may suspect maltreatment but is uncertain of how to properly intervene. The steps in dealing with
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
abuse or neglect are easy to learn and even easier to incorporate into the dental practice. All members of the dental team should be knowledgeable about the physical and behavioral signs and symptoms of family violence. They should also know how to assess whether symptoms are indicators of trauma as opposed to normal conditions or accidental injuries. Just as important is the knowledge of how to provide appropriate intervention for victims of any age. Although dentists are required to report suspected child abuse and neglect in every state, and to report elder abuse and neglect in most states, there is no universal requirement to report adult victims of intimate partner violence. It is important to note that in 30% to 60% of families experiencing intimate partner violence, child maltreatment also takes place (U.S. Department of Health and Human Services, Administration for Children and Families, n.d.). Members of the dental team must become more aware of the problem of family violence to help prevent abuse and neglect. Clinical protocols can easily be modified to include identification and intervention for cases of suspected abuse and neglect. By applying the knowledge of symptomatology obtained in this basic-level course and providing appropriate intervention, every member of the dental team can help stem the epidemic of family violence. The parallels between the four types of abuse should not be lost on the practitioner. Although an abuser may target different victims, the abuse— be it of a child, an intimate partner, a disabled person, or an elderly individual—follows a pattern, and it is a chain that must be broken. The dental healthcare team is in an excellent position to detect such injury and help prevent future harm.
CHILD ABUSE
Definition, data, and demographics Child abuse is defined by state laws, and its definition varies somewhat from state to state. (See Appendix A for legal definitions of child abuse and neglect in Florida.) Statutes typically define child abuse as nonaccidental physical, sexual, or emotional injuries, or trauma inflicted on a minor child by a parent or other caregiver (FindLaw, 2019; Singh & Lehl, 2020). Therefore, child abuse can take many different forms and can present in different ways in the dental office. It is important to note that child abuse includes injuries inflicted by anyone who cares for a child or has custody of or control over the child. These individuals can include not only parents and guardians, but also teachers, day care workers, and babysitters. They do not include injuries inflicted by strangers. National statistics show that more than 7.8 million children in the U.S. were reported as abused or neglected in 2018 and approximately 678,000 of these children were confirmed victims Contributing factors First and foremost, it is important to remember that people who abuse children may love their children very much . It is just that they do not love their children very well . Abusers are not necessarily motivated by hatred or cruelty, but sometimes by a warped sense of right and wrong in child- rearing.
of maltreatment (Pekarsky, 2022). Very young children are the most vulnerable. Homicide is the second leading cause of death for maltreated children younger than one year of age, with a fatality rate of 2.2 per 1,000 children annually (Brown et al., 2022). Child abuse and neglect know no geographic or class boundaries. Members of the dental team are cautioned against thinking that abuse and neglect occur only in large cities, in certain neighborhoods, or among certain ethnic groups. Across the nation, cases of child abuse and neglect happen in all socioeconomic groups. The victims come from all ethnic groups. Cases of abuse are spread out geographically, with victims in rural as well as urban settings. It has been said repeatedly that abused and neglected children exist in every dental practice. Unfortunately, these children are often not properly identified. Child maltreatment can undoubtedly be considered a breakdown in the parenting skills of the child’s caregivers. Many factors can lead to this failure to parent properly. It is most useful to understand that child abuse and neglect may be among many symptoms of a dysfunctional family (American Academy of Pediatrics, 2022; CDC, 2022b; Brown University,
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