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PROTOCOL FOR ASSESSMENT / INTERVENTION / REPORTING
OF VICTIMS OF ABUSE OR NEGLECT
Policy Number:
CLIN. 42
Goal:
Patients are assessed for indications of abuse or neglect. Patients indicating positive
responses to assessment criteria are treated as appropriate to the situation or referred to
community agencies. Reporting of actual or suspected abuse is carried out according to
current laws and regulations.
Scope:
This protocol applies to all HDI medical and dental sites.
Responsibility:
All health care providers have a responsibility to be alert to the indications given
by patients that they may be potential victims of abuse or neglect. This
responsibility embraces all patients, that is: infants, children, victims of sexual
assault, victims of spousal or partner abuse, and geriatric patients.
Protocol:
1.
The criteria listed below are a representative, but not an exclusive list of indications that health
care providers should be alerted as part of any patient care contact:
A.
Child Abuse:
1.
Physical Indications:
a.
Lacerations
b.
Bruises
c.
Unexplained swelling
d.
Unexplained broken bones
e.
Significant unexplained weight loss
2.
Behavioral Cues:
a.
Nervous or inappropriate laughing or smiling
b.
Crying
c.
Sighing
d.
Anxiety
e.
Defensiveness, Anger
f.
Lack of eye contact, or fearful eye contact
g.
Minimizes seriousness of injuries
h.
Reluctance to speak in the presence of a potential abuser
3.
Verbal Cues:
a.
Talks about a “friend” who has been abused
b.
Refers to a parent’s “anger” or “temper”
c.
Responds affirmatively to any of the following questions –
1.
Have you been hit or harmed any time in the past year?
2.
Have your parents ever destroyed things you cared about?
B.
Spousal or Partner Abuse:
1.
Physical Indications:
a
Lacerations
b.
Bruises
c.
Injuries to the facial area
d.
Unexplained swelling
e.
Unexplained broken bones
f.
Significant unexplained weight loss
2.
Behavioral Cues:
a.
Nervous or inappropriate laughing or smiling
b.
Crying
c.
Sighing
C.
D.
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d.
Anxiety
e.
Defensiveness, Anger
f.
Lack of eye contact, or fearful eye contact
g.
Minimizes seriousness of injuries
h.
Overly attentive, aggressive or defensive partner
i.
Reluctance to speak in the presence of a potential abuser
3.
Verbal Cues:
a.
Talks about a “friend” who has been abused
b.
Refers to a partner’s “anger” or “temper”
c.
Responds affirmatively to any of the following questions 1.
Have you been hit or harmed any time in the past year?
2.
Are you in a relationship with someone who hurts or threatens
you?
3.
Has your partner ever destroyed things you cared about?
4.
Has your partner ever forced you to have sex when you did not
want to?
Sexual Assault:
1.
Physical Indications:
a.
Lacerations
b.
Bruises
c.
Injuries to the vaginal area
2.
Behavioral Cues:
a.
Nervous or inappropriate laughing or smiling
b.
Crying
c.
Sighing
d.
Anxiety
e.
Defensiveness, Anger
f.
Lack of eye contact, or fearful eye contact
g.
Minimizes seriousness of injuries
3.
Verbal Cues:
a.
Talks about a “friend” who has been abuses
b.
Responds affirmatively to any of the following questions 1.
Are you in a relationship with someone who hurts or threatens
you?
2.
Has your partner ever destroyed things you cared about?
3.
Has your partner ever forced you to have sex when you did not
want to?
Elder Abuse:
1.
Physical Indications:
a.
Lacerations
b.
Bruises
c.
Unexplained swelling
d.
Unexplained broken bones
e.
Significant unexplained weight loss
f.
Any evidence of malnutrition
2.
Behavioral Cues:
a.
Nervous or inappropriate laughing or smiling
b.
Crying
c.
Sighing
d.
Anxiety
e.
Defensiveness, Anger
f.
Lack of eye contact, or fearful eye contact
g.
Minimizes seriousness of injuries
h.
Overly attentive, aggressive or defensive partner, care giver
3.
2.
3.
4.
5.
6.
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i.
Reluctance to speak in the presence of a potential abuser
Verbal Cues:
a.
Talks about a “friend” who has been abused
b.
Refers to an adult child’s “anger” or “temper”
c.
Responds affirmatively to any of the following questions:
1.
Have you been hit or harmed any time in the past year?
2.
Are you ever hurt or threatened by a caregiver or close
relative?
3.
Has your caregiver ever destroyed things you cared
about?
All patients are assessed for abuse/neglect at least annually - usually during a Health
Maintenance visit.
The “Abuse and Assessment Screen” form #M102, may be used. The form is given to the patient
to complete or is read to the patient and completed by the provider support staff, (see attached).
Any positive responses to the “Abuse and Assessment Screen” questions or to any of the above
questions should be noted by the provider and discussed with the patient. If a “yes” response is
indicated on question #2, the patient is given a copy of the “Non-Physical Abuse Danger
Assessment” form and asked to complete it. If the patient answers “yes” to questions 1,3, and/or
4, a copy of the “Danger Assessment” form is given and the patient is asked to complete it (see
attached).
The provider may refer the patient to appropriate community agencies for further assistance, e.g.
Underground Railroad, 989-755-0411.
Reporting responsibilities:
A.
Domestic Violence: Michigan does not have mandatory reporting requirements for
domestic violence of spouses or partners. It is the responsibility of the abused person in
a domestic situation to report the abuse to the proper authorities. However, Michigan
does have a law requiring health care professionals to report any gunshot or stab
wounds, or any other injuries that they suspect are inflicted by means of violence .
Physicians and nurses should thoroughly document in the patient’s records any indication
of injuries (physical, sexual and emotional) caused by abuse.
B.
Child Abuse: Physicians and nurses who have reasonable cause to suspect child abuse
or neglect, are required to make or cause to be made an oral report immediately to the
Department of Human Services - Child Abuse & Neglect, 989-758-1791 (Saginaw), Child
Protective Services Bay County, 989-895-2147. The reporting person must complete a
written report, Form 3200, and mail the report to:
Centralized Intake for Abuse & Neglect
5321 28th Street Court S.E.
Grand Rapids, MI 49546
The Form 3200 may also be Faxed to: 616-977-1154 or 616-977-1158 or emailed to:
DHS-CPS-CIGroup@michigan.gov
C.
A “child” means a person under 18 years of age. “Child abuse” means harm or
threatened harm to a child’s health or welfare; sexual abuse; sexual exploitation; or
maltreatment. “Child neglect” means harm or threatened harm to a child’s health or
welfare which occurs either through negligent treatment (including the failure to provide
adequate food, clothing, shelter or medical care) or through placing a child at an
unreasonable risk to the child’s health or welfare by failure of the parent (or other
responsible person) to intervene to eliminate that risk when that person is able to do so
and has, or should have, knowledge or the risk. The pregnancy of a child less than 12
years of age or the presence of a venereal disease in a child who is over 1 month of age
but less than 12 years of age is reasonable cause to suspect child abuse and neglect
have occurred and triggers the requirement to report.
Elder Abuse: Physicians and nurses who suspect or have reasonable cause to believe a
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“vulnerable person” has been abused, neglected, or exploited must make an immediate
oral report to Adult Protective Services in the Family Independence Agency. A written
report is not required but may be submitted. An exception exists if the suspected
incidents involve residents of facilities licensed by the Department of Public Health or the
Department of Mental Health. These reports should be sent to the Michigan Department
of Public Health or the local Department of Mental Health, Recipient Rights Advisor,
respectively.
“Vulnerable persons” mean those who are unable to protect themselves from
abuse, neglect or exploitation because of a physical or mental impairment, or
because of advanced age. “Abuse” means harm or threatened harm to an
adult’s health or welfare caused by another person. It includes non-accidental
physical or mental injury, sexual abuse or maltreatment. “Neglect” means harm
to an adult’s health or welfare caused by the inability of the adult to respond to a
harmful situation or by the conduct of a person who assumes responsibility for a
significant aspect of the adult’s health or welfare. It includes the failure to provide
adequate food, clothing, shelter or medical care. “Exploitation” means an action
that involves the misuse of an adult’s funds, property or personal dignity by
another person.
Related Policies:
Reviewed By: Quality Improvement Committee
Effective Date: November 25, 2000
Revision Date: March 20, 2006; January 8, 2007; August 12, 2013
Review Date: November 25, 2001; December 3, 2003; March 20, 2006; January 8, 2007;
August 12, 2013
Approval:
________________________________________
Medical Director
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ABUSE AND ASSESSMENT SCREEN
Name:_____________________________________________DOB:___________________________
Date:
1. Are you afraid of your partner or anyone living in
your home?
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
2. Have you repeatedly been called names, told you
were worthless, ugly or verbally threatened by a
partner or someone important to you?
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 NO
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
 YES
By Whom?
How many times has this happened in the last year?
Has this happened since you became pregnant?
How many times?
3. Have you ever been hit, slapped, kicked or
otherwise physically hurt by a partner or someone
important to you?
If yes, by whom?
If yes, has it occurred within the last year?
How many times?
Has this happened since you became pregnant?
How many times since you became pregnant?
When was the last time this happened?
4. Has anyone ever forced you to do sexual things
that you did not want to do?
If yes, by whom?
How many times has this happened within the last
year?
Has this happened since you became pregnant?
How many times since you became pregnant?
When was the last time this happened?
5. Have you ever told anyone before about how you
have been mistreated
If yes, who?
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Non-Physical Abuse Danger Assessment
Name: ___________________________________________
Date: __________________
This questionnaire is designed to measure the non-physical abuse you have experienced in your
relationship with your partner. It is not a test, so there is no right or wrong answer. Answer each
item as carefully and as accurately as you can by placing a number beside each one as follows:
0 = Never
1 = Rarely
2 = Sometimes
3 = Often
____ My partner belittles me.
____ My partner demands obedience to his or her whims.
____ My partner becomes surly or angry if I say he or she is drinking too much.
____ My partner demands that I perform sex acts that I do not enjoy or like.
____ My partner becomes very upset if my work is not done when he or she thinks it should be.
____ My partner does not want me to have any male/female friends.
____ My partner tells me I am ugly and unattractive.
____ My partner tells me I couldn’t manage or take care of myself without him or her.
____ My partner acts like I am his or her personal servant.
____ My partner insults or shames me in front of others.
____ My partner becomes very angry if I disagree with his or her point of view.
____ My partner is stingy in giving me money.
____ My partner belittles me intellectually.
____ My partner demands that I stay home.
____ My partner feels that I should not work or go to school.
____ My partner does not want me to socialize with my male/female friends.
____ My partner demands sex whether I want it or not.
____ My partner screams and yells at me.
____ My partner shouts and screams at me when he or she drinks.
____ My partner orders me around.
____ My partner has no respect for my feelings.
____ My partner acts like a bully towards me.
____ My partner frightens me.
____ My partner treats me like a dunce.
____ My partner is surly and rude to me.
____ TOTAL SCORE
Thank you. Please talk to your nurse, advocate, or counselor about what the danger assessment
means in terms of your situation.
From: Hudson. W. W. (1992). The WALMYR assessment scales scoring manual. Tempe, AZ: WALMYR Publishing Co.
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SCORING THE “ABUSE ASSESSMENT SCREEN”
If you get a “yes” on question number 2, give the patient/client a copy of the “Non-Physical
Abuse Danger Assessment” form and ask him/her to complete it. Use the “Scoring the NonPhysical Abuse Danger Assessment” to score this form and follow the appropriate actions.
If the patient/client answers “yes” to questions numbered 1, 3, and/or 4, give him/her a copy of
the “Danger Assessment” form and ask him/her to complete it. A “Yes” answer to any of these
questions calls for an immediate referral for counseling. When making a referral, include the
“Danger Assessment Screen” with the referral information.
SCORING FOR THE “NON-PHYSICAL ABUSE DANGER ASSESSMENT”
To score the “Non-Physical Abuse Danger Assessment” measurement, use the following steps:
1.
Total the scores. This will give you a number between 0 and 75. If the patient/client has
not answered all the questions, ask why and encourage him/her to complete the
unfinished items.
2.
Use the following guide:
Score
Action Taken:
0
No intervention is necessary at this time. Re-administer screen on next
visit.
1 – 25
Mild Danger. Discuss with patient/client that “NO ONE DESERVES TO
BE (name specific behavior(s))” and offer a referral for counseling. Readminister screen on next visit.
26 – 50
Moderate Danger. Emphasize to patient/client that “NO ONE
DESERVES TO BE (name specific behavior(s))” and encourage referral
to counseling. Re-administer screen on next visit.
51 – 75
Severe Danger. Emphasize to patient/client that “NO ONE DESERVES
TO BE (name specific behavior(s))” and make a referral to counseling.
Re-administer screen on next visit.
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DANGER ASSESSMENT
Name: _______________________________________
Date: _______________________
Several risk factors have been associated with homicides (murder) of both batterers and battered women in
research that has been conducted after the killings have taken place. We cannot predict what will happen in
your case, but we would like you to be aware of the danger of homicide in situations of severe battering and for
you to see how many of the risk factors apply to your situation. (The “he” in the question refers to anyone who
is currently physically hurting you).
Please check YES or NO for each question below.
YES NO
____ ____ 1.
Has the physical violence increased in frequency over the past year?
____
____ 2.
Has the physical violence increased in severity over the past year and/or has a weapon or
threat with a weapon been used?
____
____ 3.
Does he ever try to choke you?
____
____ 4.
Is there a gun in the house?
____
____ 5.
Has he ever forced you into sex when you did not wish to do so?
____
____ 6.
Does he use drugs? Drugs includes “uppers” or amphetamines, speed, angel dust,
cocaine, “crack” street drugs, heroin or mixtures.
____
____ 7.
Does he threaten to kill you and/or do you believe he is capable of killing you?
____
____ 8.
Is he drunk every day or almost every day?
____
____ 9.
Does he control most of all of your daily activities? For instance, does he tell you whom
you can be friends with, how much money you can take with you shopping or when you
can take the car? (If he tries, but you do not let him, check here ____.)
____
____ 10.
Have you ever been beaten by him while you were pregnant?
____
____ 11.
____
____ 12.
Is he violently and constantly jealous of you? (For instance, does he say, “If I can’t have
you, no one can.”)
Have you ever threatened or tried to commit suicide?
____
____ 13.
Has he ever threatened or tried to commit suicide?
____
____ 14.
Is he violent outside of the home?
____ TOTAL YES ANSWERS Thank you. Please talk to your nurse, advocate or counselor about what the
danger assessment means in terms of your situation.