Training Highlights

The first part of Family Violence: An Intervention Model for Dental Professionals focuses on the basics that dental professionals should know about the abuse of children, vulnerable adults, and partners. It discusses the behavioral dynamics of family violence, myths and facts about abuse, different types of abuse and neglect, barriers to identification that may be posed by patients and dental professionals, and related clinical clues. The training then teaches dental professionals how to initiate intervention, document the situation properly, report it appropriately, identify community service providers, and establish related office protocols.

Fostering a Cohesive Community Response

The training program stresses that effective intervention requires dental professionals to see themselves as part of a community response team³⁷ that includes other health care professionals, law enforcement personnel, protection agencies, and antiviolence advocates.³⁸ Once dental professionals view themselves as part of the local intervention network, it becomes necessary to determine the best ways for them to communicate with agencies and individuals on the community response team about abuse cases and how to help victims. Likewise, community service providers need to recognize that dental professionals are likely to come into contact with victimized patients, putting dental professionals in a position to intervene on the victim’s behalf. A victim’s willingness to collaborate with dental professionals on abuse issues can promote early recognition of family violence and potentially prevent further abuse.

Reporting

The training program points out the legal and ethical responsibility of dental professionals to report cases of suspected child and vulnerable adult abuse and neglect. Reporting suspected child abuse or neglect is mandatory in every state; many states also have mandatory reporting laws for cases involving suspected abuse of the elderly or persons with disabilities. The training explores general reporting procedures and appropriate agencies to contact. Trainers stress that “although making such a report can seem intimidating, it is critical for dental professionals to know that reporters who act in good faith are immune from civil liability. In fact, not making a report when abuse is suspected poses a significantly greater legal risk than filing that report.”³⁹

Creating a Safe Environment for Disclosure

The training also examines ways that dental offices can create a safe environment for disclosure. For example, patients may respond to nonverbal cues in the dental office, such as family violence literature or posters displayed in the waiting room or restrooms, and ask for assistance or referral options.⁴⁰ Including questions about family violence on a medical and dental history intake form also provides an opportunity for patient disclosure.⁴¹ Useful questions might include—⁴²

• Have you experienced significant injury during the past year?
  
  
• Are you now being or have you been emotionally or physically abused by a family member or someone close to you?
  
  
• Have you had an injury to your face, head, neck, or jaw?

Patients may disclose abuse during a dental examination, but dentists, dental hygienists, and other dental staff should be aware of the social and clinical cues that may suggest family violence. Examples may include missed appointments, billing problems, injuries in various stages of healing, inappropriate clothing for the season, oral damage caused by neglect or traumatic injuries that are inconsistent with a patient’s explanation of how the injuries happened, or a caregiver or partner who will not allow the patient to speak to anyone alone.

Intervention

The training stresses that suspicion alone is enough to warrant further investigation into whether abuse is occurring.⁴³ Following up requires dental professionals to ask their patients questions, listen closely to understand their issues and feelings, and offer support, information, and referrals. These discussions should occur privately, without the patient’s partner, caregiver, or parent, as one of these individuals could be the abuser or may not support the victim’s attempts to get help. In cases of suspected child and vulnerable adult abuse and neglect, intervention includes mandatory reporting to appropriate protection agencies. In cases of suspected partner abuse, dental professionals can help patients consider their options, such as calling the police, talking with an advocate at a shelter, leaving the abuser, taking related brochures, or doing nothing.⁴⁴ Knowing these options, the patient can decide his or her next course of action.

The training also discusses changes to the physical environment that might help abuse victims feel more comfortable during the dental exam. For example, a victim of sexual violence may feel anxious lying back in a dental chair; therefore, minimizing the time the patient spends in this position may help him or her feel more at ease.⁴⁵ Sometimes, simply acknowledging a patient’s discomfort with a particular procedure can help alleviate anxiety. For example, victims who have experienced forced oral penetration may be nervous about the use of instruments in their mouths.

Some dental professionals may be concerned about using their limited clinical time to intervene in family violence.⁴⁶ The training emphasizes that they are not expected to be experts on this issue. In fact, referring patients to appropriate community resources is the best course of action.⁴⁷ In the vast majority of cases, an intervention need not last more than 5 to 10 minutes.⁴⁸