Abuse and Neglect

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To describe groups of people who are vulnerable to abuse and neglect

  • Anybody who has traditionally held a place in which they did not have "power"
  • Example: children, women, the eldery
  • Definition of abuse: Mistreatment by an individual known to the victim in a caretaker role

To describe what the physician should do to identify the person who has been abused - child, adult, senior

  • Most importantly, one must always be alert to the possibility of abuse
  • Listen to the person
  • Interview the person alone if possible
  • Interview all caregivers separately
  • Use open-ended questions, specific questions only to clarify issues
  • Do not display judgement towards caregivers
  • For women, physicians should always do a routine abuse screening
  • Good procedures for targetting woman abuse will catch problems early and avoid complications later (HEWA has a good screening tool)
  • Identify and try to eliminate the barriers to disclosure, such as communications problems (especially cultural), overmedication/sedation, fear
  • To identify, always look for primary effects such as bruising and cuts, or secondary effects such as STDs or fear.

To describe some of the complications of abuse and/or neglect in people of all ages

Generalized

  • Social withdrawal
  • Low self-esteem

Children

  • Peer rejection (especially in children)
  • Academic delays
  • Developmental delays

Women

  • Family problems
  • Escalations of abuse
  • Financial or social hardships

To describe where to go to obtain treatment services for the person who has been abused or neglected

  • Children's Aid Society (CAS)
  • The police
  • A women's shelter
  • Churches (especially for elderly)
  • Health Care Services
  • Community Care Access Centres (especially for elderly)
  • Committee on Abuse and Neglect of the Elderly
  • Project Senior (Multidisciplinary action team)
  • Public Guardian and Trustee

To demonstrate knowledge of reporting requirements regarding abuse and neglect for a physician in Ontario (CAS & CPSO)

  • All provinces mandate that physicians suspecting child abuse must report to child welfare agencies
  • The report should be immediate
  • Physicians are immune from libel litigation
  • Child welfare needs a report in writing describing your findings and concerns
  • Reports must be timely, in writing, and contain a factual account as well as the general impressions
  • There is no reporting requirement for elderly abuse

Stay CALM

  • Be Compassionate (don't judge)
  • Have an Agenda
  • Know the Law
  • Have a Mentor (CAS; child abuse team)

Resources