What is Kentucky Domestic Violence?
Family and domestic violence, which includes child abuse, violence between partners, and elder abuse, is a widespread issue in the United States, and notably, in Kentucky. It’s estimated that domestic violence affects 10 million people across the country every year. This is not just a family issue; it’s a major public health concern and it’s likely that all healthcare providers will treat a victim of family or domestic violence at some point in their careers.
This type of violence sadly often leads to other forms of violence and continues in a “cycle of abuse”, affecting children who grow up in violent homes and potentially continue these patterns into their adult relationships and onto their elderly caregivers. Family and domestic violence can take many forms, such as economic, physical, sexual, emotional, or psychological abuse. This can occur between partners, towards children, or elders.
Intimate partner violence often involves stalking, sexual and physical harm, as well as psychological manipulation by a current or former partner. Unfortunately, a large number of American women and men are victims of domestic violence. These offenses tend to remain unreported. The effects aren’t limited to the victims; they reach the victims’ families, colleagues and the community, leading to negative mental and physical health outcomes, poorer quality of life, and decreased productivity.
The economic cost of domestic and family violence in the country is staggering; it exceeds 12 billion dollars per year. It’s projected that the number of individuals affected will increase in the next 20 years, particularly amongst the elderly population.
To better understand these issues, let’s define some terms:
- Family and domestic violence refers to abusive behaviors where one person gains power over another.
- Intimate partner violence usually involves sexual or physical harm, psychological aggression, and stalking, either from a current or previous partner.
- Child abuse pertains to emotional, sexual, or physical harm, or neglect of a child which results in potential harm or threat of harm.
- Elder abuse is an intentional or negligent act by a caregiver that causes or poses a risk of harm to an elderly person.
The Centers for Disease Control and Prevention defines domestic violence as harm caused by a current or former intimate partner, including physical or sexual violence, stalking, and psychological aggression.
The unfortunate truth is that domestic and family violence can be found in any intimate relationship, regardless of a person’s cultural, racial, religious, or socioeconomic status. Therefore, all healthcare professionals need to understand that this type of violence is quite common in our society. They should be equipped to recognize it and make appropriate referrals to help.
In Kentucky, domestic violence is overseen by the Kentucky Cabinet for Health and Family Services and the Division of Protection and Permanency. Domestic violence is legally defined as causing physical harm or fear of harm between family members or members of an unmarried couple.
The types of violence can include stalking, economic harm, emotional or psychological harm, sexual harm, neglect, and even harm done by someone who cares for a person but makes up or exaggerates their health problems to gain attention (Munchausen syndrome by proxy). This violence occurs in all races, ages, and genders, and can affect people of any cultural, socioeconomic, educational, religious, or geographic background, as well as individuals with different sexual orientations.
These abuses can take specific forms, such as stalking someone, controlling someone’s finances, emotionally or psychologically harming someone, or neglecting a child or elder’s well-being. Physical violence is also a major problem, where one uses physical strength that results in harm or even death.
Typically, the cycle of violence and abuse begins with verbal threats that escalate to physical violence. The victims can often not predict when violent episodes will occur and they live in constant fear of the next violent attack. Violence and abuse are part of a relentless cycle involving three phases: the build-up of tension, the explosive outbreak, and the ‘honeymoon’ phase where the abuser may apologize and promise to change.
What Causes Kentucky Domestic Violence?
Violence within families, including child abuse, violence between intimate partners, and elder abuse, typically begins when one person feels the need to control or dominate over another. This type of abuse often starts with threats and may escalate to physical violence, putting the victims in constant fear. After violent outbursts, the abuser may apologize, but sadly this cycle generally repeats itself.
There are a variety of reasons why abusers feel the need to control, such as anger management issues, jealousy, inferiority due to lack of education or low socio-economic status, certain cultural beliefs, mental disorders, or it could be a behavior learnt from their own family where violence was considered normal. Alcohol and drugs can also contribute to this as they can weaken a person’s ability to control violent impulses.
Several risk factors play a role in domestic and family violence, including individual, relationship, community, and larger societal issues. On an individual level, less education, past experiences of childhood abuse, aggressive behaviour during youth, antisocial personality disorder, low self-esteem, poor parenting, and psychiatric history all pose as risk factors. Certain situations can also contribute to it, such as corporal punishment in the household, pregnancy, economic stress, low annual family incomes, and marital issues like infidelity or discord.
The cycle of abuse can affect children who are involved or have witnessed such violence, leading them to believe that violence is an acceptable way to resolve disputes. Boys may grow up with a skewed perspective of respecting women, leading to abusive tendencies in adulthood, and girls who saw such violence are more prone to becoming victims in their future relationships. Additionally, studies have indicated that alcohol and drug abuse can strongly correlate with a high likelihood of violence.
Domestic and family violence can involve emotional, physical, and sexual abuse, which may occur due to a combination of personal and environmental factors. This could be because the abusers saw and experienced violence in their own families, communities, or cultures.
Regardless of the reasons and circumstances, domestic and family violence is never justified. It’s crucial to understand the causes to comprehend an abuser’s behavior better, but the utmost priority is to separate the abuser from the potential victim and get professional help to address their destructive behavior, to prevent severe consequences for everyone involved.
Risk Factors and Frequency for Kentucky Domestic Violence
Domestic violence is a serious health concern that affects approximately one third of women and one in ten men aged 18 and above. In America, over 1500 people die yearly due to domestic violence, including up to 200 in Florida where more than a third of women and a quarter of men have experienced violence, stalking, or rape.
Victims often suffer severe physical injuries that require hospital treatment, which places a financial burden on them and society. It’s estimated that the yearly national cost related to domestic violence is over $8 billion. Unemployment and financial hardship can contribute to domestic violence, and calls to the National Domestic Violence Hotline increase during economic downturns.
On a positive note, the rate of nonfatal domestic violence is decreasing nationwide due to factors like lower marriage rates, reduced domesticity, better access to shelters, improved economic status for women, and an aging population.
- Most victims and offenders don’t seek help.
- Healthcare professionals often have the first chance to identify domestic violence.
- Nurses are usually the first healthcare providers victims encounter.
- Domestic violence affects women, men, parents, and children.
- Half of women in emergency departments report a history of abuse.
- Only a third of victims identified by the police are identified in the emergency department.
- Healthcare professionals need to be alert for domestic violence since family members might be the abusers.
In Kentucky, a task force has proposed standards to determine the extent of domestic violence and develop educational and public awareness strategies. The results led to legislation requiring specific professionals to report incidents. Kentucky law requires primary care doctors to complete a 3-hour domestic violence training course within three years of licensure. A digital system is available for these professionals to report non-emergency situations, and protections have been expanded to all victims.
- Approximately 40 deaths occur annually in Kentucky due to domestic violence, with most perpetrators being male and victims female.
- Two-thirds of victims lived with the perpetrators, and a quarter had a previous domestic violence report.
- Kentucky lacks a formal system to track and review intimate partner violence-related homicides.
Risk factors for both sexual and physical abuse include age, family income, and ethnicity. While the risk of physical abuse is gender-neutral, gender is a significant risk factor for sexual abuse. Child maltreatment cuts across race, culture, ethnicity, and socioeconomic status. The genders are equally affected, but the homicide rates are slightly higher in males. Abused children may suffer from long-term physical and mental health problems, and mortality increases with multiple incidences of trauma.
Between a quarter to a third of women and up to a sixth of men will experience physical or sexual violence during their lifetime. Approximately 5 million acts of domestic violence occur annually, with women experiencing most of these incidents. Incidences of violence from intimate partners have dropped by over 60% in recent years.
Domestic violence rates differ between racial groups, however, these differences decrease when sociodemographic and relationship variables are considered. The spousal homicides are higher in interracial marriages and significantly higher among African Americans than Whites. Women are significantly more likely to experience violence from their partners than any other person.
There is also evidence of higher levels of sexual violence in the LGBTQ+ community. About 10% of women living with female partners, 15% of men living with male partners, and a third of women with male partners report being victims of violence. Domestic violence often leads to homelessness, especially in women and families.
Young women, particularly those between 16 and 24 and women in college, are most likely to be victims of violence. Homicide rates peak in people aged 15 to 24 and decline with age for African Americans, but not for whites. The risk of spouse homicide increases as the age difference between partners increases.
Close to 2 million deaths and injuries occur annually due to domestic violence. Only a third of domestic violence patients will seek care in an emergency department. Injuries can range from gunshot and stab wounds, fractures, internal injuries, and loss of consciousness, to intimate partner sexual assault and soft tissue trauma. More than half of all homicides of females were preceded by a visit to an emergency department within two years. Domestic violence is prevalent in pregnant women and is five times more likely to result in a homicide.
Elderly abuse is estimated to occur in 3 to 10% of the elderly population. However, difficulties arise due to underreporting and shortage of samples. Fear, guilt, ignorance, or shame often prevent the elderly from reporting, and clinicians also underreport due to insufficient understanding of the problem, and concerns about doctor-patient confidentiality. Abuse affects elders across all races, ethnicities, and socioeconomic backgrounds.
Victims of elder abuse have a much higher mortality rate than non-abused individuals, and early detection can lead to decreased morbidity and mortality. Healthcare provider involvement is critical since only a small fraction of victims report mistreatment to legal authorities.
Signs and Symptoms of Kentucky Domestic Violence
Doctors need to take into account the age of the person when examining them for signs of physical harm.
Child Abuse:
Typical injuries in abused children are fractures, bruises, and internal bleeding. If pre-walking infants have unexplained injuries, these should be investigated. Any unusual injuries to areas like the ears, neck or torso need a satisfactory explanation from the caregiver, else, further investigation is needed. Abused children might look neglected or malnourished. They may have behavioral issues, like being overly aggressive or withdrawn, and poor communication skills. They usually miss a lot of school.
Possible signs of child abuse include:
- Bites
- Chipped teeth
- Burns from cigarettes or cigars
- Injuries to the head, face, and neck
- Friction burns
- Injuries in different stages of healing
- Injuries to multiple organs
- Brain bleeding
- Broken long bones
- Marks that look like they came from a belt buckle or cord
- Oral burns, bruises, or cuts
- Patterned injuries
- Poor dental health
- Sexually transmitted diseases
- Skull fractures
- Injuries from strangulation
- Unusual injuries
The gap between top canine teeth in a human bite is typically over 3 centimeters, this can help to distinguish it from an animal bite.
Intimate Partner Abuse:
About a third of women and a fifth of men suffer partner abuse. Common injury sites are the head, neck, and face. Clothes may hide injuries on other parts of the body. Injuries should always match the given account, else, suspicions should arise. Signs of self-defense like injuries on the forearms and hands are common. Victims may also exhibit psychological symptoms like anxiety, depression, and fatigue, and suffer from specific or vague health issues like headaches, chest pain, painful intercourse, or chronic pain.
Specific injuries may include:
- Bruises or cuts on the abdomen
- Injuries on both sides of the body
- Bites
- Black eyes
- Bruises
- Burns
- Cigarette burns
- Fractured bones
- Fractured teeth
- Rope burns
- Wounds in different stages of healing
Abuse during pregnancy could account for around 10% of hospitalizations. These symptoms could indicate abuse:
- Abusive partner exhibits controlling behavior and hostility
- Anxiety or depression
- Chronic unexplained pain
- Distrust
- Muted emotions
- Extreme fear
- Having many children
- Substance abuse
- Suicide attempts
- Starting prenatal care late
- Multiple visits to the emergency department or doctor’s office
- Over compliance
- Symptoms of post-traumatic stress
- Prior history of abuse
- Single
- Unplanned pregnancy
- Young age
If these signs are noticed, the patient should be spoken with in private. Clear communication about confidentiality and considerate questioning are essential.
Domestic violence is prevalent among couples of the same sex, too. It may be difficult to identify. There’s a general lack of resources for victims, and shared friends or support groups could complicate things. Control may be exerted by threatening to disclose sexual orientation.
Men constitute around 15% of all domestic violence cases. Men are less likely to seek medical assistance, and so cases may go underreported. These individuals may have been victims of child abuse.
Elder Abuse:
Even if there are no signs of abuse, it may be beneficial to question geriatric patients about it.
Risk factors include:
- Dementia
- Perpetrators characteristics including dementia, mental illness, and substance abuse
- Living with the abuser
- Social isolation
A high degree of suspicion should be maintained when assessing patients. Ask questions in a non-threatening way and interview the patient and caregiver separately. Detailed and accurate documentation helps in case there are criminal trials or guardianship hearings. Thorough examination should be done to assess injuries, including looking for back injuries, bruises, and bedsores.
The following findings suggest further investigation:
- Agitation
- Bruises
- Burns
- Bedsores
- Dehydration
- Depression
- Injuries in various stages of evolution
- Cuts
- Unexplained injuries
- Treatment delays
- Unmatch between the injury and the given history
- Poor hygiene
- Discrepancy in caregiver and patient explanations
- Differing lab results indicating mismanaged medication
- Rope marks
- Sexually transmitted diseases
- Welts
During physical examination, it’s crucial to document injury size, shape, and location. Pictures or sketches can be useful. Remember that elder abuse can occur at home or institutional settings due to factors like low pay, heavy workload, stress, and burnout.
Testing for Kentucky Domestic Violence
If you are coming to a hospital or doctor’s office because you’re scared due to domestic violence, it could be sometimes hard for doctors to identify your situation. But, they try their best by always keeping in mind that family violence could be a reason behind your health issues. They make sure that they ask the necessary questions when they see patients in primary care setups, women’s clinics, mental health clinics, children’s clinics, urgent care, and emergency departments.
Knowing for sure that injuries are due to domestic abuse can be tricky. Treating serious, life-threatening injuries will always come first. Once you’re stable, they might run some lab tests or use imaging (like X-rays, CT scans, or MRIs). Doctors will always treat the main health issue that made you seek medical help first.
Doctors will ask you for a complete history of your health and examine you thoroughly. They will screen all women for domestic violence and assist those who test positive, even if they show no physical signs of abuse. It’s important that all healthcare facilities make a plan to identify, provide necessary care and refer patients who may be victims of intimate partner violence. They also need to properly document the situation and follow up with the patient.
Doctors face challenges like lack of proper training, time constraints, sensitivity of the issue, and lack of privacy when trying to screen for domestic violence. Although awareness of this issue has improved, many patients and providers are still afraid to talk about abuse. Patients showing signs of domestic violence, physical signs like bruises, cuts, broken bones, burns, or gun or knife wounds should be properly examined. Typically, victims of domestic abuse have injuries to the head, face, neck, chest, and musculoskeletal system at various stages of healing. In contrast, accidental injuries usually involve the arms and legs.
Victims of domestic violence may also suffer from mental health issues, like anxiety and depression. They may report unexplained physical pain, fatigue, restlessness, loss of appetite, and sleep problems. Women victims are more at risk for asthma, irritable bowel syndrome, and diabetes.
Once the patient is stable and pain-free, a complete evaluation should take place if they disclose that they’re a victim of abuse. Safety is a top priority, and having a list of standard questions can help. If a patient is in immediate danger, doctors should refer them to support services, such as hotlines, shelters, or legal authorities.
If the danger is not immediate, the focus will then shift to assessing mental and physical health and uncovering any history of current or historical abuse. Doctors also have to respect the patient’s cultural beliefs. Dealing with patients in a culturally sensitive manner can enhance their treatment experience.
Some patients may fear for their lives and might decide against accepting a referral. Doctors have to reassure them that the decision is entirely up to them, and they will provide help no matter what they decide. The goal is to make sure that the patient feels safe and secure and knows that help is readily available. If the patient chooses to leave their abuser, they should be given information on local resources, such as shelters. If the patient’s life or limbs are in danger, or if injuries are evident, they should be referred to local law enforcement. Counselors such as social workers, psychiatrists, and psychologists, specializing in treating domestic abuse victims, can be a great help.
If a child is involved in a domestic abuse situation, an in-depth exam should take place. If head injury is suspected, an eye examination can be helpful.
Lab tests can sometimes prove crucial in legal matters related to abuse. Rarely, certain diseases can mimic signs of child abuse and these have to be ruled out.
Urinalysis can screen for sexually transmitted diseases or kidney trauma. If a child has symptoms like altered consciousness, agitation, coma, or is discovered in a dangerous environment, urine drug screen is necessary. Child abuse victims may test positive on a urine drug screen.
It’s important not to destroy evidence. Evidence might include tissue specimens, blood, urine, saliva, and specimens from the vagina and rectum. Bites can be swabbed to collect saliva. If the clothes are stained with blood, saliva, or vomit, they should be preserved for forensic purposes.
Treatment Options for Kentucky Domestic Violence
When a patient comes into the emergency or pre-hospital setting, the first and foremost priority is to address their immediate medical concerns and stabilize them. However, once this has been accomplished, healthcare personnel may spot signs of violence that need to be looked into.
In such situations, emergency medical personnel might have attended the patient at the location where the harm took place, and could have seen indicators of domestic or sexual violence that should be reported to doctors and, potentially, the police. This applies even if the medical issue for which they were called out isn’t specifically related to the abuse. Victims of domestic violence may sometimes refuse to be transported to the hospital after an assessment, and in these cases, healthcare professionals can still recognize signs of domestic violence and suggest appropriate measures.
It’s important that all emergency medical staff be trained to identify signals of domestic violence and provide advice.
Once the patient reaches the hospital or doctor’s office, various steps should be taken:
- Create and maintain a safe environment.
- Handle physical injuries and any other medical or surgical issues.
- Identify any telltale signs of domestic violence.
- Confirm if domestic violence is the problem.
- Ensure the patient understands the violence is not their fault.
- Examine and treat the emotional effects of the trauma.
- Make detailed notes of the patient’s history and interventions.
Patient records should be maintained diligently as they can serve as valuable evidence in legal proceedings against the abuser. The records should thoroughly document the evaluation, treatment, and referrals involved in the patient’s case. Any physical evidence that cannot be depicted clearly through photographs should be supported by drawings. In cases of sexual assault, obtain the required consent to follow protocols for physical examination and evidence collection.
When a victim of abuse comes in for treatment, it’s crucial for healthcare professionals to treat all information and potential evidence as confidential and with respect. This is in line with the requirements of The Joint Commission, an organization that ensures hospitals meet certain standards for patient care. Hospitals themselves should have policies that clearly define the responsibility for gathering this evidence.
Before discharging a patient, assess whether they are in potential danger if they return home, consider their state of mind and any threats made by the abuser. Discuss what help they are willing to accept. If they don’t want to go to a shelter, provide them with advice and the contact details for hotlines and support services to use later if needed.
If the patient is returning to a potentially violent situation, it’s important for them to have a safety plan in place. This could include strategic places to avoid arguments, escape routes, arrangements with neighbors for emergency help, and an emergency stash of essential documents, medicines, keys and clothes. In severe cases, the patient may need to consider changing locks or installing additional safety devices at home.
Even if a patient chooses to go back to an abusive situation after getting medical help, it’s important to make them aware of the assistance available from resources like shelters and hotlines. Additionally, social workers, psychologists, or psychiatrists should be consulted if the patient has suicidal or homicidal tendencies.
Preventive measures are essential to avoid a repeat of abuse, and these usually involve intervention from community programs and careful follow-up to assess the living situation.
What else can Kentucky Domestic Violence be?
The list of potential diagnoses can differ based on the type of injury and the age of the person.
For children, the following conditions may be considered in the case of different types of injuries:
Head Trauma
- Accidental injury
- Arteriovenous malformations
- Bacterial meningitis
- Birth trauma
- Cerebral sinovenous thrombosis
- Hemophilia
- Leukemia
- Neonatal alloimmune thrombocytopenia
- Metabolic diseases
- Solid brain tumors
- Unintentional asphyxia
- Vitamin-K deficiencies
Bruises and Contusions
- Accidental bruises
- Birth trauma
- Bleeding disorder
- Coining
- Cupping
- Congenital dermal melanocytosis (Mongolian spots)
- Erythema multiforme
- Hemangioma
- Hemophilia
- Hemorrhagic disease
- Henoch-Schonlein purpura
- Idiopathic thrombocytopenic purpura
- Insect Bites
- Malignancy
- Nevi
- Phytophotodermatitis
- Subconjunctival hemorrhage from vomiting or coughing
Burns
- Accidental burns
- Atopic dermatitis
- Contact dermatitis
- Impetigo
- Inflammatory skin conditions
- Sunburn
Fractures
- Accidental
- Birth trauma
- Bone fragility with chronic disease
- Caffey disease
- Congenital syphilis
- Hypervitaminosis A
- Malignancy
- Osteogenesis imperfecta
- Osteomyelitis
- Osteopenia
- Osteopenia of prematurity
- Physiological subperiosteal new bone
- Rickets
- Scurvy
- Toddler’s fracture
The following conditions may be considered in the case of intimate partners and elderly:
- Accidental burn
- Alcohol abuse
- Accidental fall
- Acute subdural hematoma
- Consensual intercourse
- Depression
- Suicide attempt
- Substance abuse
What to expect with Kentucky Domestic Violence
If abused individuals do not get proper help from social services and mental health care providers, the cycle of abuse often continues and may even get worse, making recovery less likely. Domestic and family violence can be especially challenging because it tends to happen again and again and often becomes more frequent and severe if not treated.
Here’s some alarming statistics: More than 75% of those who have been hurt by domestic violence continue to experience abuse. Over half of abused women who try to end their own lives will make a second attempt, and the second attempt often succeeds, unfortunately.
The situation for children is especially concerning as the harm from abuse can affect them for the rest of their lives. Aside from the physical injuries, the mental impact can be devastating. For instance, research shows a strong link between child sexual abuse and a higher risk of mental health disorders later in life. Notably, there is a high chance that the cycle of violence seen in the child’s early life will continue.
Children who grow up in households where sexual abuse is present may develop a range of issues including:
– Attention deficit hyperactivity disorder (ADHD)
– Behavior problems (Conduct disorder)
– Depression
– Bipolar disorder (a disorder that causes extreme mood swings)
– Panic disorder (which can cause sudden feelings of intense fear)
– Sleep disorders
– Attempts to end their own lives
– Post-traumatic stress disorder (PTSD – a disorder that develops in response to traumatic events).
The effects of domestic and family violence can also manifest in physical health complications. Long-term injuries like broken bones, injuries to the brain, and injuries to the body’s internal organs can occur. Other related health problems can also develop, including:
– Asthma
– Insomnia (trouble sleeping)
– Fibromyalgia (a long-term condition that causes pain all over the body)
– Headaches
– High blood pressure
– Chronic pain
– Digestive disorders
– Women’s health issues
– Depression
– Panic attacks
– PTSD.
