CDA Essentials 2018 • Volume 5 • Issue 4

Spotting The Warning Signs Jocelyn Coupal is a domestic violence expert and senior trial lawyer who trains health care professionals in best practices in intimate partner violence recognition and intervention. ➲ Recognizing and documenting signs of abuse Dental professionals can assist patients in getting help before life-threatening injuries occur. Dentists routinely assess the head, neck and mouth, where 75% of domestic violence injuries occur. Although they are in a position to identify neglect and abuse caused by family violence and intervene, dental professionals are not likely to do so. In a survey conducted by the Journal of the American Dental Association , 61% of survey participants reported that they would like more training in this area and 94% did not have a family violence protocol in place to facilitate intervention (Love, Gerbert, Caspers et al., JADA , Vol. 132[1]). Some of the barriers to intervention reported by dentists include lack of privacy (i.e., the patient is accompanied by partner or children), lack of knowledge and practical experience in identifying domestic violence, concern about offending the patient, and embarrassment. ➲ Talking to your patient about abuse as a health care issue Even when victims of violence avoid seeking medical attention, they will keep routine and emergency dental appointments. This gives dentists an opportunity to initiate dialogue with their patients about intimate partner violence. Dental professionals can help by asking about violence, performing a brief safety assessment, documenting abuse in the dental chart, and making referrals to domestic violence experts ( AVDR: Ask, Validate, Document, Refer – see Table 1 ). It doesn’t have to be complicated or time-consuming. According to one survey, 90% of domestic abuse victims who saw their dentists when signs of abuse were present were not asked about their injuries, but the majority said they wished their dentist had asked. ➲ Appropriate referrals and resources in the community Protocols for supporting patients who are potential victims of domestic violence should be established in your practice. For example, patient intake forms can include a question about domestic violence, and information about where a victim can get help, including literature, brochures and posters, can be displayed in the waiting area or washroom. Child Maltreatment: Considerations for Health Care Providers Dr. Michelle Ward is a pediatrician who, as head of the Division of Youth Protection at the Children’s Hospital of Eastern Ontario, medically assesses and manages children with possible injuries from child maltreatment. As an associate professor at the University of Ottawa, Dr. Ward is also a teacher, researcher and knowledge mobilizer in the field of child maltreatment. ➲ Relevance for oral health professionals Child maltreatment is relevant to dental providers for three reasons: (1) Child maltreatment is incredibly common; 1 in 3 adults in Canada report having experienced maltreatment, or exposure to intimate partner violence, as children. Dental providers who see children in their practice will, on a daily basis, see children who are maltreated. (2) This D ental professionals are well-positioned to do this. They have ongoing, trusting relationships with their patients and family members, and patients may perceive the dental office as a safe and private place to discuss concerns. Dental professionals are more likely to see and recognize injuries related to family violence because certain injuries characteristic of this kind of violence are found on the head, face and neck; however, sometimes the signs and symptoms of violence are not physical. And finally, dental professionals have the skill set and scope of practice to recognize and respond safely to family violence—they don’t have to be experts in family violence to provide help and support. On April 19, 2018, participants at the Canadian Oral Health Roundtable (COHR) heard from experts who have dedicated their careers to supporting victims of family violence. CDA at W ork 16 | 2018 | Issue 4