Mandatory reporting of intimate partner violence to police: views of physicians in California.
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OBJECTIVES: This study examined physicians' perspectives on mandatory reporting of intimate partner violence to police. METHODS: We surveyed a stratified random sample of California physicians practicing emergency, family, and internal medicine and obstetrics/gynecology. RESULTS: An estimated 59% of California primary care and emergency physicians (n = 508, 71% response rate) reported that they might not comply with the reporting law if a patient objects. Primary care physicians reported lower compliance. Most physicians agreed that the legislation has potential risks, raises ethical concerns, and may provide benefits. CONCLUSIONS: Physicians' stated noncompliance and perceived negative consequences raise the possibility that California's mandatory reporting law is problematic and ineffective. (+info)
Detecting child abuse and neglect--are dentists doing enough?
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Dental health professionals continue to under-report child abuse, despite growing awareness of their potential role in detecting this crime. This article presents an overview of child abuse and neglect and outlines the indicators that may alert dental professionals to possible maltreatment of child patients. Documentation protocols are also provided to aid in reporting child abuse identified in the dental office. (+info)
Medicolegal file. Amendments to child protection legislation. New legal accountability for physicians.
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In Ontario's past and present child protection legislation, physicians are included in the list of professionals designated to protect children and report their beliefs, suspicions, or knowledge of child abuse and neglect. Ontario's recent legislative amendments broaden the definition of child abuse and thereby widen the scope of the duty to report. (+info)
Evaluating the child for sexual abuse.
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Child victims of sexual abuse may present with physical findings that can include anogenital problems, enuresis or encopresis. Behavioral changes may involve sexual acting out, aggression, depression, eating disturbances and regression. Because the examination findings of most child victims of sexual abuse are within normal limits or are nonspecific, the child's statements are extremely important. The child's history as obtained by the physician may be admitted as evidence in court trials; therefore, complete documentation of questions and answers is critical. A careful history should be obtained and a thorough physical examination should be performed with documentation of all findings. When examining the child's genitalia, it is important that the physician be familiar with normal variants, non-specific changes and diagnostic signs of sexual abuse. Judicious use of laboratory tests, along with appropriate therapy, should be individually tailored. Forensic evidence collection is indicated in certain cases. Referral for psychologic services is important because victims of abuse are more likely to have depression, anxiety disorders, behavioral problems and post-traumatic stress disorder. (+info)
Barriers to screening for domestic violence.
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CONTEXT: Domestic violence has an estimated 30% lifetime prevalence among women, yet physicians detect as few as 1 in 20 victims of abuse. OBJECTIVE: To identify factors associated with physicians' low screening rates for domestic violence and perceived barriers to screening. DESIGN: Cross-sectional postal survey. PARTICIPANTS: A national systematic sample of 2,400 physicians in 4 specialties likely to initially encounter abused women. The overall response rate was 53%. MAIN OUTCOME MEASURE: Self-reported percentage of female patients screened for domestic violence; logistic models identified factors associated with screening less than 10%. RESULTS: Respondent physicians screened a median of only 10% (interquartile range, 2 to 25) of female patients. Ten percent reported they never screen for domestic violence; only 6% screen all their patients. Higher screening rates were associated with obstetrics-gynecology specialty (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.31 to 0.78), female gender (OR, 0.51; CI, 0.35 to 0.73), estimated prevalence of domestic violence in the physician's practice (per 10%, OR, 0.72; CI, 0.65 to 0.80), domestic violence training in the last 12 months (OR, 0.46; CI, 0.29 to 0.74) or previously (OR, 0.54; CI, 0.34 to 0.85), and confidence in one's ability to recognize victims (per Likert-scale point, OR, 0.71; CI, 0.58 to 0.87). Lower screening rates were associated with emergency medicine specialty (OR, 1.72; CI, 1.13 to 2.63), agreement that patients would volunteer a history of abuse (per Likert-scale point, OR, 1.60; CI, 1.25 to 2.05), and forgetting to ask about domestic violence (OR, 1.69; CI, 1.42 to 2.02). CONCLUSIONS: Physicians screen few female patients for domestic violence. Further study should address whether domestic violence training can correct misperceptions and improve physician self-confidence in caring for victims and whether the use of specific intervention strategies can enhance screening rates. (+info)
Simple intervention to improve detection of child abuse in emergency departments.
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PROBLEM: Child abuse is easily overlooked in a busy emergency department. DESIGN: Two stage audit of 1000 children before and after introduction of reminder flowchart. BACKGROUND AND SETTING: An emergency department in a suburban teaching hospital seeing about 4000 injured preschool children a year. KEY MEASURES FOR IMPROVEMENT: Number of records in which intentional injury was adequately documented and considered and the number of children referred for further assessment before and after introduction of reminder flowchart into emergency department notes. STRATEGIES FOR CHANGE: Nurses were asked to insert a reminder flowchart for assessing intentional injury into the notes of all children aged 0-5 years attending the department with any injury and to record the results of checking the child protection register. EFFECT OF CHANGE: Documentation of all eight indicators that intentional injury had been considered had increased in the second audit. Records of compatibility of history with injury and consistency of history increased from less than 2% to more than 70% (P<0.0001). More children were referred for further assessment in the second audit than the first, although the difference was not significant (6 (0.6%) v 14 (1.4%), P=0.072). The general level of awareness and vigilance increased in the second audit, even for children whose records did not contain the flowchart. LESSONS LEARNT: Inclusion of a simple reminder flowchart in the notes of injured preschool children attending the emergency department increases awareness, consideration, and documentation of intentional injury. Rates of referral for further assessment also increase. (+info)
Ethical considerations for research and treatment with runaway and homeless adolescents.
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Ethical considerations for working with runaway and homeless youth in research and treatment settings are presented. Issues of parents' and adolescents' consent for research and treatment are discussed, with particular attention given to the lack of explicit guidelines for working with abused and neglected youth. The principles of beneficence and justice are discussed as they apply to intervening with a high-risk, multiproblem population. The authors offer a rationale for allowing adolescents to self-consent to research and treatment. They argue that in many circumstances, requiring parental consent may not be in the youth's best interest and may preclude his or her participation in treatment and research programs. (+info)
Elder abuse and neglect: what physicians can and should do.
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Although reports of elder abuse to official agencies have been steadily increasing, physicians report only 2% of reported cases. Multiple barriers to reporting exist. This article reviews the terminology, epidemiology, and clinical signs associated with elder abuse in the community and offers practical strategies for intervention. (+info)