Abuse (D2L) PDF

PARA1043: Victims of Abuse N. SPARROW PARA1043 OCT 2024   Child Abuse Which Groups are Most  Elder Abuse Susceptible?  Intimate Partner Violence   Physical Abuse  Any intentional act which causes trauma o...

PARA1043: Victims of Abuse N. SPARROW PARA1043 OCT 2024   Child Abuse Which Groups are Most  Elder Abuse Susceptible?  Intimate Partner Violence   Physical Abuse  Any intentional act which causes trauma or bodily injury  Sexual Abuse  Any non-consensual or exploitive sexual behaviour/ activity imposed upon an individual without consent.  Emotional/Psychological Abuse Types of  Regular and deliberate use of words and non-physical actions to hurt, manipulate, demean, confuse, frighten or Abuse? otherwise control another individual  Neglect  Failure to provide for or meet a dependent’s basic physical, emotional, educational and/or medical needs.  Financial Abuse  Using an individual’s finances to exploit or control that individual Physical Abuse  Sometimes referred to as Non-Accidental Injury  Hitting (with hands or objects)  Slapping or punching  Kicking Physical Abuse  Shaking  Throwing  Burning or scalding  Biting or scratching  Breaking bones  Drowning  Poisoning or causing a child to become unwell  Manufacturing illnesses  Accidental vs Non-Accidental?  Consider age and ability  ANY physical injury in a non-mobile child is Physical cause for concern Abuse:  Toddlers/Pre-Schoolers/Early School Age – covered in bruises and injuries! Children  Consider story/mechanism and placement of injuries  Accidental injuries become less frequent in older children  Exception: Sport-related injuries Torn Frenulum   Fearfulness (unusual for age/stage of development)  Particularly of parent/caregiver  Odd behaviour for age/stage of development Physical  Bedwetting, acting younger or older than expected Abuse:  Hypervigilance Non-Physical  Jumpy, anxious, always ‘on guard’ Signs & Symptoms  Overly compliant, unusually calm when examined  Especially painful procedures  Dissociated  Thousand-yard stare  Physical Abuse: Non-Physical Signs  Accidental vs Non-Accidental?  Consider age and ability  Disabled/bed-bound adults should sustain minimal injuries Physical  Elderly people and those on blood thinners Abuse: bruise easily Adults/Elders  Elderly skin is much thinner and susceptible to tearing/breakdown  Consider the accompanying story in comparison to the presenting injuries Petechial Haemorrhage  Female Genital Mutilation (FGM):  Predominantly in African countries, as well as some Middle Eastern countries  Type I, also called clitoridectomy: Partial or total Physical removal of the clitoral glans and/or the prepuce. Abuse:  Type II, also called excision: Partial or total removal of the clitoral glans and the labia minora, with or without Cultural/ excision of the labia majora. The amount of tissue that is removed varies widely from community to community. Religious  Type III, also called infibulation: Narrowing of the vaginal orifice with a covering seal. The seal is formed by cutting and re-positioning the labia minora and/or the labia majora. This can take place with or without removal of the clitoral glans/prepuce.  Type IV: All other harmful procedures to the female genitalia for non-medical purposes, for example: Pricking, piercing, incising, scraping or cauterization. Physical Abuse: Cultural/ Religious  Spirit or Demonic Possession  In some belief systems and/or cultures, children who do not conform to perceived societal ‘norms’ may be assumed to be being possessed by a spirit or demon  This often results in attempts to restrain, imprison and/or exorcise the child Physical “A Virginia man was convicted in the death of a 2-year-old who died during exorcism. Eder Guzman-Rodriguez beat his daughter Jocelyn Abuse: to death in an attempt to rid her of the demon he believed was inside her.” Cultural/ “A childminder heard Victoria (8yo) being called a “wicked girl” Religious before she told pastors that she believed Victoria was possessed by an evil spirit. Days later, Victoria died after being starved for days while tied up in a black plastic bag with her hands and feet bound, lying in her own excrement without heating between being beaten and burned.” “Nusayba (4yo) was disembowelled by her mother after she accused her of being possessed, with her father finding her body. Reports said the child’s heart and other organs had been removed and placed in different rooms.” Sexual Abuse   Any form of sexual penetration  Inappropriate sexual touching of a child, whether clothed or unclothed  Forcing or encouraging a child to touch an adult in a sexual manner Sexual Abuse:  Forcing a child to strip or masturbate  Taking, downloading, viewing or distributing Children sexual images of children  Not taking measures to protect a child from witnessing sexual activity or images  Engaging in any kind of sexual activity in front of a child, including watching pornography   Genital or anal pain, irritation, and/or bleeding  Injuries to external genitalia or inner thighs  Difficulty walking or sitting  Torn, stained, or bloody underclothing  Sexually transmitted diseases  Child exhibiting distress when a particular Sexual Abuse: caregiver approaches Children  Child re-enacts the abuse through engaging in “mimicking” behavior, re-enacts the abuse during Indications play or age-inappropriate play with toys, self or others  Bizarre, sophisticated or unusual sexual knowledge  Seductive behavior  Regression, anger, frustration, depression, isolation  Any contact or non-contact sexual activity which occurs without consent or understanding, or with forced consent  Rape/Date rape  Attempted rape/sexual assault  Groping/forced kissing  Exposing genitals Sexual Abuse:  Any other form of sexualized activity Adults Sexual exploitation of a person with a physical or psychological disability  Long Term Care Facilities  Group Homes  Home Care Services  Human trafficking involves the recruitment, transportation or harbouring of a person and includes controlling or influencing their movements with the goal of exploiting, or facilitating the exploitation of, a person  Victims are often young girls who are held hostage and forced into the sex trade.  Often have a traumatic past, wanting to escape their current situation  The most common type of trafficker is the ‘Romeo’ or ‘boyfriend’ trafficker who will lure a victim in online or in person with fancy gifts, promises of Human love and a better life.  Then held hostage and forced to ‘repay’ this debt Trafficking  Victim is introduced to drugs and isolated from friends and family, taking away her cell phone and her identification.  Often, she is moved from hotel room to hotel room in different cities and sold by the trafficker for sex several times a day. Common in large cities and border towns Human trafficking can also be associated with slave/forced labour  Children or adults in vulnerable positions are forced to work for little/no wages, to repay a ‘debt’ – often associated with bringing them into the country Human Trafficking: Signs Tattoos/Brands:  Crown, rose, barcodes, dollar signs, names  Often at neck, wrist, collarbone areas Human Trafficking: Signs Tattoos/Brands:  Crown, rose, barcodes, dollar signs, names  Often at neck, wrist, collarbone areas   Tattoos/Brands  Young women inappropriately dressed for weather or for their age  Young women in unusual places or company at odd times of day  Controlling individual  Trafficker often called ‘Boyfriend’ Human  Can be female, often called ‘Bottom’ – trusted worker Trafficking:  for trafficker, helps recruit and control Not knowing where they are, not being aware of Signs surroundings  Coaching on how to speak to professionals – given limits to what they can say  May only give basic information, may sound scripted  Significant lack of eye contact, especially females with males  Injuries – often hidden. Person is a ‘product’ for sale  Hostility when questioned outside of script/limitations Psychological Abuse   Humiliating or constantly criticizing  Threatening, shouting at, or calling them demeaning names  Making them the subject of jokes, or using sarcasm to demean  Blaming and scapegoating  Making them perform degrading acts  Not allowing them to have friends Psychological  Persistently ignoring them Abuse  Never saying anything kind, expressing positive feelings or congratulating them on successes  Manipulation  Gaslighting  Pushing a child for perfection, or being ignorant of their limitations  Failing to promote a child's social development  Failure to respond to a child’s emotional needs (Childhood Emotional Neglect) Neglect   Unmet basic needs:  Food/Water  Clothing  Warmth  Shelter  Hygiene Neglect  Inadequate access to health care services  Inadequate education  Inadequate supervision  Inadequate protection from hazards Can include self-neglect (adults) Financial Abuse  Pressuring, forcing or tricking someone into:  Theft of money/possessions  Lending or giving away money, property or possessions  Selling or moving from their home  Changing their will / power of attorney  Signing legal or financial documents that they don't understand Financial  Working for little or no money, including caring for children or grandchildren Abuse  Making a purchase they don't want or need  Using their bank cards/cheques or withdrawing funds without consent  Providing food and shelter to others without being paid  Standard of living not in-keeping with person’s financial status  No/limited access to own financial accounts Paramedic Roles and Responsibilities  You cannot find what you are not looking for…  Privileged position of seeing inside a home without warning/prep time  Insight into how the person/family live  Look in the fridge (elderly)  Odd behaviour is more noticeable in the home  Children oddly quiet/compliant Assessment  Lack of evidence of children living there  Listen to how family members speak to or about patient/each other  Especially elderly, dementia patients  Try not to be too overt when assessing for additional injuries  If abuse is suspected, don’t voice this openly  Be slow and gentle with assessments when possible  Some may be triggering for abuse victims   Assume nothing!  DO NOT interrogate patient or caregivers  Actively listen  Probe GENTLY around story and listen for inconsistencies  Continue to maintain a professional, polite manner with those suspected of abuse/maltreatment History Taking  Make no accusations or judgmental remarks  Consent to examine, treat and transport may be withdrawn if you show suspicion  Give the patient privacy away from family/caregivers to discuss/disclose any concerns  Do not appear shocked, disgusted or any other strong emotion  Do not question or belittle their experiences   Be aware of your OWN beliefs, biases and pre- judgements  Poor ≠ neglected; rich ≠ well cared-for  Nice clean home ≠ good home life  Not meeting YOUR standards ≠ abuse  Never make assumptions Therapeutic Approach  Conduct a thorough assessment and history taking  Safe, private space  Start with least invasive questions/assessments – build rapport  Active listening, sensitivity, dignity, respect  Reassurance   Paramedics must function as patient advocates  Using our position of power to speak up on behalf of those in weaker or more vulnerable positions  Paramedics are “mandated reporters”  ‘Duty to Report’ any and all suspected or known cases of child maltreatment Patient   This overrides professional confidentialities and PHIPA laws You have protection from liability Advocacy &  Except in cases of malicious reporting or without reasonable grounds for suspicion Duty to Report (Children)  Children in Need of Protection  Call Children’s Aid Society Directly  Will ask for child’s name, age (DOB if possible) and address  Give as much detail about your concerns as possible  Even if someone else says they will report, we ALL have to make a report  Pass on any concerns to hospital staff at triage (privacy!)  Which less obvious situations Discussion might prompt you to make a CAS referral?  If a child is in imminent and/or significant danger: Child in  Have police attend scene for assistance Imminent Danger? What situations might this include?   Paramedics must function as patient advocates  We have the same responsibility to adult patients as children with regards to advocacy: Using our position of power to speak up on behalf of those in weaker or more vulnerable positions  Paramedics are “mandated reporters”  ‘Duty to Report’ any and all suspected or known cases of Patient  abuse involving an incapable adult This overrides professional confidentialities and PHIPA laws Advocacy &  There is no CAS equivalent for adults Duty to Report  Police report (emergency/non-emergency)  Pass concerns on to ED staff (Adults)  What about adults who have the capacity to consent, vulnerable or otherwise?  Any adult with capacity is entitled to make their own decisions  We cannot make a report or referral on behalf of a capable adult without their consent  Give them options and help them in whatever way they will allow  What services are available?  Police  Children’s Aid Societies External  Victim Services Assistance  Crisis Centres  Temporary shelters  National Human Trafficking Helpline Child in Need of Prote ction Standard General Geriatric Stan dard Sexual Assault (Repor ted) Standard