Development and Validation of a Tool to Improve Physician Identification of Elder Abuse: The Elder Abuse Suspicion Index (EASI)©

ABSTRACT

This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.     

Recruitment,enrollment & data collection with victims of elder abuse and neglect identified from police incident reports

ABSTRACT

This study evaluated the success of researcher-generated recruitment, enrollment, data collection, and safety protocols for field research with victims of elder abuse and neglect (EAN) identified from police incident reports in terms of their success including cost-effectiveness, ability to generate a representative sample, and safety. After reviewing 492 police incident reports involving victims age 65 years or older to identify cases of EAN 62 victims were identified. Mail, phone, and in-person recruitment strategies were used. After 259 recruitment attempts, 52 (84%) eligible victims were contacted, of which 24 (46%) consented to participate. Phone calls were the least expensive mechanism to produce a successfully enrolled participant. Findings from a regression show completion of a research interview could not be predicted by victim, suspect, or offense characteristics, indicating that the recruited victims likely represent the population they were drawn from. No safety or adverse events occurred.     

Lifetime exposure to abuse,current stressors,and health in federally qualified health center patients

ABSTRACT

Purpose: The purpose of this study was to examine the impacts of lifetime exposure to abuse and current stressors on health, an integrative concept of physical, mental and social health, among patients of a Federally Qualified Health Center.

Method: The sample included 1,055 patients (male: N = 346; female: N = 709) who were at least 18 years of age and completed an assessment on their first visit between January 2015 and March 2017 at a Federally Qualified Health Center. The assessment contained subscales of the DUKE Health Profile measuring physical, mental, and social health; four questions assessing lifetime exposure to abuse; and a relational and socioeconomic stressor checklist.

Results: Results from structural equation modeling analyses showed that for both male and female groups, lifetime exposure to abuse, relational stressors and socioeconomic-related stressors were strongly associated with health. In the male group, socioeconomic-related stressors were the strongest predictor of health, while in the female group, lifetime exposure to abuse was the strongest predictor of health.

Conclusions: Understanding the relationships between health and the combined factors of a lifetime exposure to abuse, relational stressors, and socioeconomic stressors can provide insight to patient care professionals who treat patients in lower income, underserved communities. Ecological Systems Theory provides a framework to plan interventions or to prevent potential negative outcomes associated with these stressors.     

What Happens When There Is Presumptive 50/50 Parenting Time? An Evaluation of Arizona’s New Child Custody Statute

ABSTRACT

The current study presents the findings of an evaluation of Arizona’s 2013 revisions to the child custody statutes that directed courts to “maximize” the child’s parenting time with both parents. A state-wide survey of the four family law professions (i.e., conciliation court staff, judges, mental health providers, and attorneys) assessed their perceptions of the law 4 years after implementation. We averaged the ratings across the four professions to obtain a comprehensive perspective that gave equal weight to each profession. Results revealed that the law functions as a rebuttable presumption of equal parenting time; that it is evaluated positively overall and in terms of children’s best interests; that it is has a neutral impact on legal and interparental conflict; and that it has led to small increases in allegations of domestic violence, child abuse, and substance abuse.     

“She Got Spoilt”: Perceptions of Victims of Child Sexual Abuse in Ghana

ABSTRACT

International research has commented on social stigma as a key reason for nondisclosure of child sexual abuse. However, the actual components of this social stigma frequently remain unexplored. The present study deals with perceptions of consequences of child sexual abuse among professionals and laypeople in Ghana (N = 44), employing a bystander perspective. As a qualitative study using a grounded theory framework, it considers these consequences in light of their underlying beliefs about child and adolescent development, particularly in relation to gender-based expectations placed on girls and boys. Consequences of child sexual abuse could be divided into sexual health consequences, beliefs about “destroyed innocence” and beliefs about a “destroyed future,” which were strongly related to the sexual nature of the violence perpetrated. These perceived consequences of child sexual abuse hold implications for what surviving child sexual abuse means on a social level. Implications for practice are discussed on the basis of the data analysis.     

Awareness and attitude of medical personnel in Kerala,India to transgender persons

IntroductionBeing one of the first Indian states to come out with a transgender bill in 2015, Kerala's Social Justice Department also implemented various health-based provisions for transgender individuals catering to their physical, mental, and gender-based health. Many of these are still in the process of being set up and transgender individuals will have to wait for smoother access to healthcare.AimThis study aims to assess the awareness regarding general transgender issues and health as well as the attitude towards transgender persons among the medical community- especially medical students and doctors who are a critical link for the integration of the transgender community into society.MethodResponses were collected from 452 medical doctors and students from Kerala through scales that measured awareness level and attitude, including transphobia. The relation of gender, age, years of experience, and specialty of medical personnel to the level of transphobia and awareness about transgender issues was also analyzed using statistical methods.Result and DiscussionTransphobia levels were moderate in the sample. Women and medical students had lower levels of transphobia than men and practicing doctors respectively. Awareness levels were average for general information about the transgender community, such as its core features and difference from other similar categories but were low on health-related aspects of transgender persons (such as their physical and mental health issues, healthcare provisions, and knowledge on gender affirmation surgery).ConclusionMore inclusive actions are needed in medical education, legislative actions, advocacy groups, and the formation of multidisciplinary surgical teams to further the cause of the transgender community.     

“Allah will decide my life and death”: Religion and spirituality among populations at risk for HIV in Malaysia

ABSTRACT

We examined the influence of religion and spirituality on HIV risk contexts through in-depth interviews with men who have sex with men (n = 10) and female commercial sex workers (n = 10) in Malaysia. Using a grounded theory approach, five themes emerged from the interviews: (a) religion encourages caring for health, (b) health is influenced by a higher power, (c) prayer is a conduit to health assistance, (d) stigma is compounded by religion but it does not limit one’s spirituality, and (e) religion is not but should be incorporated into HIV campaigns. Incorporation of spirituality in service provision and addressing stigma is warranted.     

Introduction: Queering Later Life

Summary

The field of sexual trauma developed from the sociopolitical movements of the feminist, rape, and child protection movements. As thinking in the field developed, however, it has been difficult to integrate the perspective of the male survivor of sexual trauma into these perspectives. Gay men, in particular, have been notably absent from the literature, except when their abuse history is discussed as an etiology for their sexuality. It is clear that gay men suffer violence and oppression in the form of homophobia—an abuse with a sexual focus. Integrating the experience of gay men who have suffered trauma into perspectives regarding sexual trauma offers a possibility to enhance understanding about, as well as prevention efforts against, the sexual abuse of children. This includes expanding definitions and vocabulary regarding sexual trauma, as well as recognizing the impact on mental health professionals of working with survivors of sexual trauma.     

The History of College Health Nursing

Abstract

Almost from the beginning of formal college health programs in the second half of the 19th century, college health nurses were there to care for students in college and university settings. By the end of the 20th century, the role of college health nurses had evolved with the nursing field in general, but with enough unique features for the American Nurses’ Credentialing Center to recognize college health nursing as a professional subspecialty and administer the first College Health Nurse Certification examinations. In addition, new nurse practitioner programs provided practicing nurses with more independence, and their duties continued to expand beyond care of the sick to include health promotion, administrative, and teaching activities. As a result of these changes, college health nurses now play a larger role in the life of students and promoting a healthy campus community than ever before in the history of college health.     

Changing the Culture of Alcohol Abuse on Campus: Lessons Learned From Secondhand Smoke

ABSTRACT

Alcohol abuse is the single greatest public health hazard on American college and university campuses, but the culture of abusive alcohol consumption continues to be highly resistant to change. The author argues that secondhand smoke campaigns can be used as models to change the culture of alcohol abuse on campus. He proposes the implementation of “secondhand alcohol” campaigns and describes their essential components and advantages.     

Herpes: Coping and Caring—A Total College Health Program

Abstract

This article seeks to assist college health nurses in developing appropriate protocols for patient care. In addition, the authors outline factors influencing protocol content, design, and development and describe steps in creating individualized protocols by practice setting. To provide college health nurses with a basic understanding of protocols, the authors offer definitions and examples of appropriate and inappropriate use, and show how protocols can influence the delivery of patient care. Although protocols may provide college health nurses with directives for managing specific health problems, they require a sophisticated level of judgment and skill in their implementation.     

Australian Service Providers' Responses to Elder Abuse

This article presents the findings of a survey of 175 service providers in Sydney, Australia, the majority of whom were doctors in general practice. Thirty-two percent of respondents had encountered cases of physical, psychological, or financial abuse or caregiver neglect of people 65 years old and over. Community nurses and social/welfare workers were particularly likely to have encountered cases of abuse. The findings suggest that coordination between health, welfare, and criminal justice agencies in Australia needs improvement. Policies to address elder abuse and neglect in Australia are in their infancy. As a priority governments should work towards effective training of professionals and appropriate intervention guidelines for services.     

Linking Housing,Social Services and Family Well-Being

Abstract

Securing adequate housing is a key component in achieving family well-being and a decent quality of life. It is expected that as many as twenty percent of the families currently on welfare, many of whom are disproportionately female and African American, may not be employable by the end of their lifetime benefit. These families, classified as “hard-to-serve” or “hard-to-employ,” are headed by an adult who may be struggling with substance abuse, physical or mental health problems, as well as low literacy and social competency issues that inhibit achieving self-sufficiency. This author will examine existing literature on welfare-dependent households coping with substance abuse and mental health problems, and how the lack of affordable housing impacts their ability to achieve self-sufficiency. This article presents a case study     

The Status of Nutrition Education in ACHA College and University Health Centers

Abstract

An assessment of the prevalence and scope of nutrition services offered through 208 randomly selected American College Health Association member student health centers revealed that 79% of the 160 respondents provided some type of nutrition education for students. One-to-one counseling, available at 96% of the institutions, was the most common approach. The larger the school's enrollment, the more likely it was to provide programs in nutrition. All of the institutions with student populations of more than 35,000 offered some type of nutrition service, as did 52% of the 19 schools with enrollments between 2,000 and 5,000. Health educators, nurses, doctors, dietitians, and trained peer educators provided the services, with registered dietitians the most common providers and often coordinators of the programs. Costs to students for nutrition interventions were nominal; weightmanagement programs were the most expensive and showed the greatest variation in content.     

Professionals' and parents' perceptions of A&E use in a children's hospital

Helpful keywords in accessing literature on the use made of hospital accident and emergency (A&E) departments are ‘misuse’ ‘abuse’ and ‘inappropriate’. While the medical literature is inclined to present patients (and, in the case of children, their parents) as irresponsible, or misguided, social scientists looking at similar data have tended to act as apologists for patients, explaining A&E attendance in terms of poor access to GPs, mistaken beliefs about the relative skills of hospital-based doctors and GPs and ‘lay’ health beliefs. Both of these approaches see the patient (or parent) as passive recipients of health care, rather than active caretakers of their own or their children's health. On the basis of a study of minor ailments presenting at a children's A&E department, this paper explores the differing views of health workers and parents. It suggests that a view of patients (parents) as largely passive custodians of their own or their children's health is inadequate. Patients (parents) can and do play an active part as providers of primary health care and their decisions to use A&E are not as irrational as health providers sometimes suppose. In this light, attempts to ‘re-educate’ parents to use A&E in a way which would be more acceptable to health providers is unlikely to succeed.     

Development and validation of a tool to improve physician identification of elder abuse: the Elder Abuse Suspicion Index (EASI)

This study aimed to develop and validate a brief tool for physician use to improve suspicion about the presence or absence of elder abuse. A literature review on elder abuse, obstacles to its identification, limitations of detection tools, and characteristics of screeners employed by physicians were used to generate elder abuse detection questions for critique by 31 doctors, nurses, and social workers in focus groups. Six resulting questions became the Elder Abuse Suspicion Index (EASI) administered by 104 family doctors to 953 cognitively intact seniors in ambulatory-care settings. Findings were compared to a recognized, detailed elder abuse Social Work Evaluation (SWE) later administered to participants by social workers blinded to the results of the EASI. The EASI had an estimated sensitivity and specificity of 0.47 and 0.75, usually took less than 2 minutes to ask, and 97.2% of doctors felt it would have some or big practice impact. This research is a first phase in the development and validation of a user-friendly tool that might sensitize physicians to elder abuse and promote referrals of possible victims for in-depth assessment by specialized professionals.     

Self-Reported Incidence of Physical Violence in College Students

Abstract

A survey of a college student population indicates that physical abuse is prevalent in our society. The self-reported data were found to be similar to that occurring in the literature on parent-reported child abuse, documenting that approximately one-third of college students had a history of moderate abuse and 5 to 10% had a history of a severe abuse during their developmental years. Through an awareness of its high prevalence, the health care provider will question a history of physical violence when evaluating a student with a medical or psychosocial complaint and appropriately plan a management program including therapeutic counseling to decrease the effect of the prior or current physical abuse.     

Exploring community stress and empowerment among stakeholders and youth in an urban community

ABSTRACT

Community-level stress, such as pervasive substance abuse and violence, can yield negative health and mental heath outcomes for youth from disadvantaged communities. Community empowerment is a process whereby community members work together to increase control in their community. This qualitative inquiry analyzed in-depth interviews with adult stakeholders (n = 17) as well as focus group interviews with token youth (n = 85) to explore perceptions of community stress and empowerment in one disadvantaged locale. Each of the 102 total participants helped interrogate the research questions: What does it mean to live in a stressed community? How might youth and adults perceive themselves capable of impacting a stressed community’s quality of life? Emergent themes, which include a nod to the utility of coalition building, are explored. Implications for policy, practice, and future research are also discussed.     

Three Types of Memory for Childhood Sexual Abuse: Relationships to Characteristics of Abuse and Psychological Symptoms∗

ABSTRACT

Data from a clinical sample (N?=?88) reporting childhood sexual abuse was compared by types of memory, abuse characteristics, and psychological symptoms. Three types of memory were identified from a questionnaire (“Always” n?=?27 [31%], “Recovered” n?=?41 [46%], and “Both” n?=?20 [23%]). When compared with narrative reports from a subset (n?=?30) of the sample, the lines between “Always,” “Recovered,” and “Both” types of memory were ambiguous. Consistency across reports, however, was 83%. Memories classified as either “Recovered” or “Both” were associated with earlier age-at-onset and more severe psychological symptoms compared to those who “Always” remembered CSA. No significant differences were found between the “Both” and “Recovered” groups.     

Frequency and Types of Partner Violence Among Mexican American College Women

Objective and Participants: The authors studied the prevalence of partner violence, by type, among Mexican American college women aged 18 to 35 years (N = 149; response rate = 85%). Results: Twelve percent of women who reported a dating partner in the past year were physically or sexually assaulted, 12.1% were stalked, and 9.1% scored as psychologically abused. Among those experiencing partner violence, almost half experienced stalking and 89% reported psychological abuse. Few women (25%) who experienced physical violence believed violence was a problem in their relationship. Conclusions: Partner violence was prevalent in this population, and participants experienced many forms of violence. Because few women experiencing physical violence report that violence is a problem in their relationship, interventions must address perceptions of violence and its impact on women's mental and physical health in college populations.