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Case 1

Questions

Class

  1. Yes in suspecting sexual abuse. Need to take more detailed history. Doesn't want to be around men, staying away from school, wetting the bed, withdrawn, feelings were especially like that when at Sarah's place - furthers your suspicions.
  2. Ask a thorough history: social and behavioural. Talk appropriately to child - simple language. Forensic specialists; difficulty sitting down, difficulty walking, excessive bathing, increasing displays of sexuality, suddenly knowing about sex at that age. Seek help from Community and Family Services.
  3. Mandatory to report all suspected sexual assault to Community and Family Services. Ethical: false report (only need suspicion), ethics of not reporting, letting go of not changing things at home. No legal obligation to tell the mother you're reporting to DOCS (esp. since the mother's brother is the one who is accused - if you're in a remote area you don't want to lose the patients. The child needs the help of the doctor). Whether you tell the mother or not, the mother will know you've reported. Maybe ask the mother "why do you think this is the case?". Not an immediate threat because the man lives away from the child. If you think they're in immediate danger (eg. father), let DOCS know your suspicions and they'll act quicker. Do what is best for the patient.
  4. Inexperienced, can't refer away, confronting physical examination (e.g. bloodied and torn underwear or semen stains).

Recommended not to do this alone; ask for help; there is a hotline.

SDL

Case 2

Questions

Class

Suspicion comes from cluster of red flags in lecture.

    • Patient discloses in screening (intro, then screening questions: 1) have you been hit 2) are you scared of partner? 3) are you safe to go home). Start with open questions, emotions. Often these people are embarrassed.
      • Yes
        • Direct threat on life
          • Yes --> police
          • No --(precontemplate)--> discussion and examine her, then Readiness to change (stages of change) model, see lecture. E.g. "you've come with bruises... this can commonly be associated with ..."
      • No --> options for talking at a later point (follow up); let her know what her options are
  1. Stages of change model; once determined to change, we point her to support and community help; and followup
  2. Signs and symptoms and readiness to change model are in lecture. Note the unique circumstances of rural area: confidentiality and remoteness.
  • Gain trust

SDL

Case 3

Questions

Written on paper

Case 4

Questions

Class

  1. Screen all women over 16 at D+A, Mental Health, antenatal and early childhood services. Preamble ("confidentiality + I ask this of every woman"), then 3 questions: "in the last year, have you been hit, slapped, hurt; are you frightened of partner". Yes: "are you safe to go home? would you like some help?". No: give stats and information, say it's common
    • don't use the term "abused" - it's subjective and loaded question.
  2. She's at the contemplation phase. Ask more questions, identify yourself as agent of support and change.
    • Mandatory to report violence against a person under age of 18 (child has been hurt) - so you must report it (especially with the other cluster of indicators).
    • OARS: Open questions, affirming - "thank you for telling me - that must be stressful for you", reflecting -"you seem concerned, afraid etc", summarising at the end
  3. Disclosing if remote area - no financial support; sometimes the woman is blamed too
    • Man abused by woman - noone will understand it, really ashamed, not macho
    • Some societies say that women dressed a certain way "should be abused"
    • Gay relationships - can still happen between two men

SDL