Confronting Chronic Neglect The Education and Training of Health Professionals on Family Violence (2002) / Chapter Skim
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2 Defining the Problem
2 Defining the Problem
Pages 21-34
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From page 21... ...
DEFINITIONS AND MAGNITUDE Family violence is widely regarded as a serious problem that affects large numbers of adults and children throughout the life span.) Although the exact figures are frequently disputed, conservative estimates suggest that the prevalence and incidence of child abuse and neglect, intimate partner violence, and elder maltreatment affect up to 25 percent of the population annually, involving millions of children, women, and men in the United States (CDC, 2000a, 2000b; Tjaden and Thoennes, 2000~.
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Child Abuse and Neglect The current understanding of child abuse and neglect has expanded greatly since Kempe and colleagues in 1962 first coined the term battered child syn
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23 by o Em an al o .
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Intimate partner violencea Elder maltreatment · emphasis on the victimization of elderly persons, defined by a particular age · recognition of financial or material abuse and abandonment in addition to physical, psychological, emotional, and sexual forms of abuse and neglect · recognition of self-neglect as an important entity aThe definition used in this report is broader than that used in the 1993 National Research Council report, in which the term was more narrowly defined to refer to physical violence. drome to characterize "a clinical condition in young children who have received serious physical abuse, generally from a parent or foster parent" (p.
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Approximately half of the women who are victims of interpersonal violence have children in their home under age 12, and so the potential number of child witnesses is high (Greenfeld et al., 1998~. Intimate Partner Violence Intimate partner violence is described by several names, including domestic violence, gender violence, violence against women, and spousal abused Following the example of the Centers for Disease Control and Prevention, the committee elected to use the term intimate partner violence as the best choice to describe the situations of spousal, partner, and acquaintance violence addressed in this report.
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unwarranted control are categories unique to elder maltreatment. Because of the recency of interest by health care researchers in elder maltreatment, there are substantially fewer data regarding the prevalence, incidence, and medical consequences of this problem compared with child abuse and neglect and intimate partner violence.
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. A small minority requires reporting of intimate partner violence.
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The effects of witnessing intimate partner violence in the home are not yet
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Children of a parent who commits intimate partner violence are also at increased risk for physical abuse themselves, and the risk is higher if the father is the perpetrator (Ross, 1996~. Evidence also suggests that interventions to prevent child abuse are compromised when there is intimate partner violence in the home (Eckenrode et al., 2000~.
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Of the 2.9 million cases of intimate partner physical abuse of men, 581,391 victims were injured and 124,999 received medical care (Tjaden and Thoennes, 2000~. Approximately 7 percent of victims of nonfatal intimate partner violence sought care in emergency departments, which represents about 15 percent of those who experience an injury.
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An examination of annual costs to a managed care plan for a group of women who had experienced intimate partner violence compared with randomly selected controls found that the overall cost to the plan was 1.9-fold higher in the abused group, with treatment of each victim resulting in net costs that were $1,775 more annually for each victim than for comparison patients. Differences in costs in emergency department utilization and hospitalizations between an abused group and a random sample were not significantly different, so extra costs for abused women are due to additional general ambulatory care and mental health care (Wiener et al., 1999~.
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In one descriptive study that tracked the emergency department utilization of known elderly victims of physical abuse identified through adult protective services, 114 individuals had 628 emergency department visits during a 5-year window surrounding the referral; 30 percent of these visits resulted in hospital admission (Lachs et al., 1997~. Elder maltreatment differs from family violence experienced by younger individuals, in large part because of the higher prevalence of chronic disease in older people and issues of capacity or competence.
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A better understanding of the baseline problems, health care needs, and costs associated with family violence could reinforce the need for health professionals' attention to the issue, provide guidance as to how to respond, and inform and improve health care professional education and practice. · The definitions, data sources, and methods used in research on family violence are variable and result in inconsistent research findings about its magnitude, severity, and effects on the health care system and society.
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The Centers for Disease Control and Prevention have developed such uniform definitions and measurement terms for intimate partner violence (Saltzman et al., 1999~. The definitions and data elements recommended in their report reflect attention to the potential health care uses of the terms, recognizing incidents of violence, threats of violence, and consequences of violence, including those relevant to medical settings.
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