these were for abuse, 30 (17 percent) for neglect, 8 (5 percent) for exploitation, and 128 (73 percent) for self-neglect (Lachs et al., 1998). The data also show that those who suffered from mistreatment by others had worse survival rates that those with self-neglect.


Professional Responsibility

With regard to family violence, a primary function of health care professionals is to treat resultant physical and psychological conditions and injuries. They may encounter family violence victims in the course of routine care (e.g., annual physicals) or specifically due to victimization.

In addition to this clinical role in the lives of victims, health professionals have a role defined by law. All states require that health professionals, among others, report situations of child abuse and neglect, and most require reporting for elder maltreatment (see Appendix C). A small minority requires reporting of intimate partner violence. The law enforcement and justice systems may also depend on health professionals’ assessments as documented in medical records, in order to better provide protection to victims, prosecute abusers, and address custody issues.

Recognizing the clinical and legal responsibilities that health professionals may bear with regard to family violence, a number of health professional organizations have issued policy statements, recommendations, practice guidelines, and requirements for family violence education (see Appendix B) as well as practices related to family violence. Their positions variously emphasize recognition of types of family violence as significant public health threats and encourage their members to provide care, to identify and report (as appropriate per law or ethics) situations of family violence, and to assume positions of leadership in preventing and responding to family violence.

Numerous health professional organizations described and provided these positions and offered recommendations to the committee during a public forum held on June 22, 2000, at the National Academy of Sciences in Washington, DC. Among the participants were representatives from the American College of Nurse Midwives, the National Association of Orthopedic Nurses, the American Psychological Association, the World Psychiatric Association, the Council on Social Work Education, the American Medical Association, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists. Many other health professional organizations submitted written materials to the committee. A review of their positions and recommendations indicates that all of these organizations recognize the impact of health professionals in detecting and responding to family violence and the need for comprehensive training on the signs of victimization and the medical needs of victims.

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