INTIMATE PARTNER VIOLENCE
It’s important that you normalize the data captured about your Intimate Partner Violence (IPV) as soon as possible to avoid biased record keeping. Referencing an authoritative source for guidance will normally pay off huge dividends by standardization sooner.
While women are at higher risk for IPV, men are also victims of abuse. Some Health Guardians express concern that screening everyone may cause unintended harm, but no research evidence supports that concern.
History questions in your health record template, including prior hospitalizations, treatment for injuries, and delayed treatment, may give some ques, especially if a person has been injured multiple times. Record the event, describe the circumstances surrounding the injury and make sure the circumstances match the type of damage. Many times, a little probing thought will reveal a truer perspective of the surrounding circumstances.
One example of a partial questionnaire you might have in your health records could be:
Over the last month, how often did your partner:
- Physically hurt you
- Insult or talk down to you
- Threaten you with harm
- Scream or curse at you
Asking questions such as:
Has your partner threatened you with violence?
Has your partner thrown, broken, or punched things?
These types of questions or ques can increase sensitivity to IPV circumstances that many of us accept because we don’t know of anything better. Whether or not we’re aware of it, the harmful health effects of these types of environments are real. Early intervention may result in fewer long-term physical and mental health consequences. Using a record template with high levels of sensitivity and specificity will allow Health Guardians to better screen for and recognize violence and abuse.
Approximately 10% of teens report being victims of physical violence and 10% report sexual victimization. Teens who experience dating violence are at higher risk for mental and physical health consequences. Early identification and intervention are needed for better pathology prevention.
CHILD ABUSE AND NEGLECT
Health Guardians should monitor their health records for signs of child abuse and neglect. The Health Guardian is in an ideal position to screen for and prevent child abuse and neglect. By providing anticipatory guidance, the Health Guardian can support young children. During your contact with children, watch their interaction with you. Does the child appear to trust you? Does the child appear anxious? Overly quiet?
The use of developmental health record templates can identify risk for abuse and provide a platform for educating the family. When a Health Guardian is aware of expected development and upcoming developmental changes (e.g., the normal periods of excessive crying in the newborn period), the may be less likely to become frustrated with the child.
For nonverbal children, subjective data will come from the Health Guardian. During examinations, be attentive to the between yourself and the child. If an injury is identified, or abuse is suspected from siblings, partner, educator, or clergy member, be mindful of whether the information provided surrounding the injury/event matches what you observe.
If the child is verbal, a history should be obtained from the Health Guardian through open-ended questions or spontaneous statements. It is important to remember that children may have suffered significant trauma yet respond only minimally to open-ended questions. Keeping the questions short and using age-appropriate language and familiar words can help enrich the history taking. Children older than 11 years can generally be expected to provide a history at the level of most adults.
ELDER ABUSE AND NEGLECT
Examples of record templates for the elderly could include questions and ques such as:
- Have you relied on people for any of the following: bathing, dressing, shopping, banking, meals?
- Has anyone prevented you from getting food, clothes, medication, glasses, hearing aids, or medical care or from being with people you wanted to be with?
- Have you been upset because someone talked to you in a way that made you feel shamed or threatened?
- Has anyone tried to force you to sign papers or to use your money against your will?
- Has anyone made you afraid, touched you in ways that you did not want, or hurt you physically?
As with other populations, types of abuse may vary. In the elderly, it is important to consider financial or material abuse, including theft, forcible transfer of property, and coercion to steal assets.
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