Adult Abuse

Rationale

Adult abuse or intimate partner violence is very common and can occur in many different circumstances or interactions. Human trafficking is a complex and largely hidden crime. Abuse and trafficking are often kept hidden by the victim and may be difficult to diagnose, yet they cause significant physical and emotional morbidity. They can also lead to the death of the abused or trafficked person.

Causal Conditions

(list not exhaustive)

The following are components of adult abuse and human trafficking:

1. Physical abuse
2. Psychological abuse
3. Emotional abuse
4. Social isolation
5. Sexual abuse/exploitation (sex trafficking)
6. Economic abuse
7. Forced/exploitive labour (human trafficking)
8. Forced criminal activity (e.g., drug trade, theft)
9. Forced marriage

Key Objectives

Given a patient experiencing possible adult abuse, the candidate will diagnose the cause, severity, and complications and will initiate an appropriate management plan. In particular, the candidate will assess immediate and short-term risk to the patient, and devise a safe and effective plan for this patient.

Enabling Objectives

Given a patient experiencing possible adult abuse, the candidate will

1. list and interpret critical clinical findings, including those based on
   1. the identification of possible factors putting the patient at increased risk of abuse (e.g., pregnancy, threat to leave);
   2. whether the partner/companion has risk factors for being violent;
   3. the varied nature of symptoms and signs that may indicate potential abuse or trafficking (e.g., repeated presentations that demonstrate inconsistencies between history and clinical findings);
   4. the nature of the interaction between patient and partner/companion (e.g., large age difference, power imbalance) as well as the importance of interviewing and examining the patient alone; and
   5. the level of immediate and short-term danger for the patient as determined through an assessment of risk factors for lethality or serious injury;
2. list and interpret critical investigations, including the careful documentation of the location and nature of injuries and appropriate investigation of physical injuries via physical examination and other tests, as needed; and
3. construct an effective initial management plan, including
   1. maintaining an empathic therapeutic relationship;
   2. ensuring confidentiality, apart from legal reporting requirements;
   3. assisting the patient in devising a safety plan;
   4. giving information regarding access to transition housing and support services;
   5. arranging supportive follow-up; and
   6. ensuring safe care of dependents.