CDA Essentials 2018 • Volume 5 • Issue 4

How can we provide professionals with the ability to advocate for their patients? When you get more safe spaces for people to disclose, you’ll get more disclosures and then how do you act on that? Family violence is an area that has been historically underfunded; become an advocate for the shelter sector or an advocate for children who are maltreated and get this higher on the agenda.” – Dr. Nadine Wathen, The VEGA Project population of children will have more oral health issues than their peers. (3) Of children who are medically assessed because of concerns about child abuse, 60% have injuries to the head, face or neck . ➲ Recognizing child maltreatment Dental providers should observe how their pediatric patients interact or behave. Consider any serious or unusual injury that can’t be explained, or is unsuitably explained. For example, ask open-ended questions like: “I notice that your lip is swollen or bruised. What happened?” or “How do people in your family get along?” Many health professionals feel uncomfortable assessing signs of maltreatment, but they are already equipped with the skills they need to do so. Dental providers with questions about recognizing child maltreatment or managing a specific situation can consult an expert in their community or pediatricians like Dr. Ward who work at medical school-affiliated pediatric hospitals across the country and are board certified in child abuse pediatrics (American Board of Pediatrics). ➲ Responding to child maltreatment The role of dental professionals is to provide oral health care, acknowledge concerns and provide support, report to the child welfare agency as appropriate, document, and plan to follow up. For example, conclude with “When can I see you again?” Careful documentation includes objectively documenting injuries; it’s not the role of the dentist to decide whether the injuries are definitive signs of abuse. The dental provider can document what the injuries are, the extent of the injuries and anything they’ve been told about those injuries. These pieces of information are important for child welfare workers to put together with other information from their investigation, when needed, in order to best respond to concerns for maltreatment. Table 1: Using the AVDR Approach Ask • ‘’Sometimes when I see (a loose tooth) (broken teeth) (bruises) like this, it means the person is being hurt by someone. Could this be happening to you?’’ • ‘’I am concerned about you and these injuries. Is everything ok?’’ • ‘’It looks like you’ve been hurt by someone. How are things going for you at home? Is there anything you would like to talk about?’’ Validate • ‘’As your dentist, I have to ask when I see signs that are often associated with abuse. A lot of people have that problem and no one deserves to be abused.” • ‘’Whatever is happening, you didn’t cause this. You do not deserve to be hit or hurt no matter what happened.” • ‘’Everyone ought to feel safe at home. I’m concerned about your safety and well-being.” Document • Document presenting signs and symptoms of abuse location, size, duration, color, shape. • Take photos if patient consents. • Document patient disclosures in specific and detailed manner, using patient’s exact words in quotations, including names, locations and witnesses. Refer • Offer a list of local domestic violence resources/referrals in private. • If patient declines (may note feel ready; may not feel safe enough), let her know that these are available. • Follow up at next visit with ‘’How are things at home?’’ Validate and offer referrals again in non-judgmental way. Source: Adapted from AVDR training materials with permission from Dr. Barbara Gerbert, director, Centre for Health Improvement and Prevention Studies, University of California at San Francisco. A V D R CDA at W ork 17 Issue 4 | 2018 |