Lecture 9.1 - De-escalation, Addressing Human Trafficking, and Child Maltreatment Flashcards
What is a crisis?
A situation that results in a failure of coping mechanisms
What are the priorities during crisis?
- Safety - no means to harm self/others, proximity to exits
- Build rapport through respect and using person’s name
Recognize that all behaviour is a form of communication and that our approach changes everything
How does an abuse survivor present to the hospital?
1 - through ED triage
2 - Self-referral or external provider referral
What is the different between medical and forensic consent?
Medical - obtained from a patient deemed competent and capable of making informed decision. The HCCA allows us to provide life saving medical procedures without consent to incapacitated patients.
Forensic - Must be informed. If intoxicated or incapacitated, a multidisciplinary approach with an ethics team may need to be included.
What are the elements of evidence collection for survivors of sexual abuse and/or human trafficking?
Assault Hx
Physical exam
Documentation of injuries and findings
Photography
Physical evidence collection
What is meant by high threshold of severity for mandatory reporting of child maltreatment?
The legislation across Canada concentrates understandings of abuse and when protection is needed onto a relatively small proportion of cases where children are harmed in severe ways.
–> Understandings of abuse are reserved for when children are, or are likely to be harmed.
What is the issue with mandatory reporting when there is “reasonable grounds” to suspect child maltreatment?
This response closes off dialogue needed to address discriminatory practices of child protection
–> Retributive justice does not address the issue upstream
What kind of statements can be useful for validation?
The no wonder response
Which areas have the highest reported cases of trafficking?
Metropolitan areas such as Toronto, Ottawa, London, Montreal, Halifax
What are the legal exceptions to confidentiality?
Youth under 16 witnessing harm, abuse, neglect, or at risk of sexual exploitation.
Sexual misconduct by a healthcare provider
Elder abuse in LTC setting
Person at imminent risk of harm to self or direct threat to a specific group or person
Reportable communicable disease
Gunshot wound
What is meant by coercive control is a crime of liberty?
Coercive control is the subordination and domination of one human being to another.
–> characterized by fear and erodes the sense of self
–> Produced sense of entrapment
What three discursive figurations are obstacles to meaningful responses to child neglect and abuse?
The Vulnerable Child
The Responsible Family (Mother)
The Monstrous Perpetrator
Which three faulty assumptions underpin the model that prioritizes case-by-case reporting on child neglect and abuse?
- It is rare and can be addressed on child at a time
- If you look carefully enough you can see it
- It can be addressed by identifying perpetrator and holding them accountable within the justice system
What is the goal of violence informed care?
To minimize harm or potential for retraumatization, not treat trauma
What are the four principles for implementing trauma and violence informed care?
- Understand trauma and violence and their impacts on peoples’ lives and behaviour
- Create emotionally and physically safe environments
- Foster opportunities for choice, collaboration, connection
- Provide a strengths-based and capacity-building approach to support client coping and resilience
What kinds of barriers prevent nurses from engaging in preventative measures against CN&A?
Lack of knowledge about how to identify abuse
Absence of concrete definition of abuse
Lack of time and resources to invest in clients
Organizational constraints and reports not being taken seriously
What recommendations does Einboden et al., 2017 make to change our approach to child neglect and maltreatment?
- Respect children an equals in society
–> include children in social life, abolish corporeal punishment, acknowledge coercive control in children’s lives, analyze dominant beliefs about children - Develop the infrastructure to support parents
–> Support basic needs, address reproductive labour exploitation, the isolation of women and children, and analyze dominant beliefs about families that hinder just approaches - Reform laws and policies
–> Challenge mandatory reporting, redistribute funding, decentralize decision making power
What pattern of behaviours is seen in coercive control?
- Love-bombing
- Isolation
- Restrictions of activities
- Enforcing trivial demands + eroding boundaries
- Demonstrate omnipotence and surveillance
- Alter-perceptions
- Degrade
- Threaten
- Abuse
- Ongoing
What are the four major harms caused by coercive control?
- Crime of liberty
- Erodes sense of self
- Produces sense of entrapment
- Primary harm is political
Understanding coercive control requires us to challenge our dominant understandings of IPV. What changes in our perspective must be made?
- See IP violence as a product of social inequity - not a few ‘bad’ individuals
- View IPV as nuances and normalized - not occasional and discrete eruptions of physical violence
- View coercion and control as serious forms of violence - more dangerous than physical violence and more likely to escalate to serious harm/femicide
How does an abuser’s intimate knowledge of their partner lead to increased control over them?
Use of privileged access to information leads to increased vulnerability - abuser will use personal knowledge against victim
How is coercive control underpinned by patriarchy?
Ideologies of masculinity lead men to feel entitled to control through their role as protector - plus dominant social understandings of love and romance are conflated with jealousy.
Why do many abusers in IPV believe themselves to be the victims?
Humiliated fury - they cannot reach the illusion of control in their relationship that is perpetuated by dominant patriarchal understandings of romance.
What is the relationship between power and violence in IPV?
As power wanes, violence will rise.
