Western Maryland Regional Medical Center

Abuse Prevention, Intervention & Detection

The twentieth century will be remembered as a century marked by violence. It burdens us with its legacy
of mass destruction, of violence inflicted on a scale never seen and never possible before in human
history. It is the pain of children who are abused by people who should protect them, women injured or
humiliated by violent partners, elderly persons maltreated by their caregivers, youths who are bullied by
other youths, and people of all ages who inflict violence on themselves. This suffering and there are
many more examples that I could give is a legacy that reproduces itself, as new generations learn from
the violence of generations past, as victims learn from victimizers, and as the social conditions that
nurture violence are allowed to continue. No country, no city, no community is immune. But neither are
we powerless against it.

Child Abuse and Neglect - Topic Overview

What is child abuse and neglect?

Physical abuse is often the easiest type to notice. It includes hitting,

kicking, shaking, pinching, and burning. It may leave bruises, cuts, or other
marks and cause pain, broken bones, or internal injuries.
Emotional abuse is saying or doing things that make a child feel unloved,
unwanted, unsafe, or worthless. It can range from yelling and threatening to
ignoring the child and not giving love and support. It may not leave scars
you can see, but the damage to a child is just as real.
Sexual abuse is any sexual contact between an adult and a child or
between an older child and a younger child. Showing pornography to a
child is a type of sexual abuse.
Neglect happens when a child does not get the shelter, schooling, clothing,
medical care, or protection he or she needs. Child neglect is just as serious
as abuse and is even more common.

Child Abuse and Neglect - Topic Overview

continued...
If you think your child is in immediate danger, call 911 and get your child to a safe place and stay there.
This may be the home of a close friend or family member or a domestic violence shelter. To find help in
your area, call a trusted health professional, a child abuse organization, or the police.
If you are worried about the way someone acts around your child, find a quiet time to talk with the person
alone. Help the person learn about child development issues. If it is your partner, you could take a
parenting class together. Plan what you will do next if your concerns become more serious. Then follow
through with your plan.

How can you prevent child abuse and neglect?

To protect your child from abuse:

Listen to your child. Let him or her know it is safe to talk about anything
with you.
Get to know your childs friends and their families.
Screen all caregivers, such as babysitters and daycare centers. Find out
what they know about child health, child development, and child care. This
may include getting permission for a police background check.
Teach your child the proper names for the private parts of his or her body.
Teach the difference between "good touch" and "bad touch."
Ask a family member or friend to give you a break when you feel
overwhelmed. Learn healthy ways to manage stress. Look online for
sources of information and support, such as Parents Anonymous
(www.parentsanonymous.org).
Get help if you have ever been a victim of abuse. A good place to start is
the Child help Hotline at 1-800-4-A-CHILD (1-800-422-4453). You can talk
to a counselor for free without giving your name.

To help children in your area:

Learn to recognize the signs of abuse and neglect. For example, a child
may not grow as expected, may be dirty or unhealthy, or may seem fearful,
anxious, or depressed.
Know the names of your neighbors and their children. Offer to help a new
parent. Child abuse becomes less likely if parents and caregivers feel
supported.
Be an advocate for children. Support groups that help parents at risk of
abusing their children. Donate time, money, or goods to a local domestic
violence shelter.
If you see abuse or neglect happening, speak up. A childs life may depend
on it.

Domestic Violence - Topic Overview

What is domestic violence?
Domestic violence is abuse that happens in a personal relationship. It can happen between past or
current partners, spouses, or boyfriends and girlfriends.
Domestic violence affects men and women of any ethnic group, race, or religion; gay or straight; rich or
poor; teen, adult, or elderly. But most of its victims are women. In fact, 1 in 4 women will be a victim at
some point
The abuser may use fear, bullying, and threats to gain power and control over the other person. He or
she may act jealous, controlling, or possessive. These early signs of abuse may happen soon after the
start of the relationship and might be hard to notice at first.
After the relationship becomes more serious, the abuse may get worse.

The abuser may begin making threats, calling the other person names, and
slamming doors or breaking dishes. This is a form of emotional abuse that
is sometimes used to make the person feel bad or weak.
Physical abuse that starts with a slap might lead to kicking, shoving, and
choking over time
As a way to control the person, the abuser may make violent threats
against the persons children, other family members, or pets.
Abusers may also control or withhold money to make the person feel weak
and dependent. This is called financial abuse.
Domestic violence also includes sexual abuse, such as forcing a person to
have sex against her will.

Money troubles and problems with alcohol can make it more likely that abuse will happen.
Abuse is also common in teens that are dating. It often happens through controlling behaviors and
jealousy.
What should you do if you're being abused?
Get help.

Get in touch with a local domestic violence group for information and
support. They can help you find out about legal and social services in your
area. To find the program nearest you that offers shelter and legal support,
call the National Domestic Violence Hotline at 1-800-799-SAFE (1-800799-7233) or see the National Coalition against Domestic Violence's Web
site at www.ncadv.org/resources/state.htm.
Talk to the police.
If you are a teen, talk to a trusted adult, such as your parents, family friend,
or school counselor. Many teens don't have the life experience or maturity
to know when they are being abused. Talking to an adult may help.

Here are some other things you can do.

Make sure that you know phone numbers you can call and places you can
go in an emergency.
Teach your children not to get in the middle of a fight.
If you think you may leave, make a plan to help keep you safe. This will
help when you are getting ready to leave. Your plan might include:
Putting together and hiding a suitcase of clothing; copies of your car and
house keys; money or credit cards; and important papers, such as Social
Security cards and birth certificates for you and your children.
Opening a savings account or getting a credit card, if you can do so in
secret.

Domestic Violence - Topic Overview

continued...
Here are some things you can do to help.

Be a good listener and a caring friend.

Remind the person that no one deserves to be treated this way.

Let the person know that the abuse is against the law and that help is
available.
Help the person make a plan to stay safe.
You can also suggest that the person call the National Domestic Violence
Hotline at 1-800-799-SAFE (1-800-799-7233) to find a local domestic
violence support group.

Keep in mind that the person may not want to leave. He or she often knows the abuser best and knows
what options are safest. But it is important for victims of abuse to know where they can get help.
Why do victims stay?
People who are not abused might find it hard to understand why anyone would stay in a violent
relationship. Some people think that if a person stays in an abusive relationship, she or he must be weak
or needy. This is not true.
There is more to this issue than simply leaving or staying. A woman may fear that the abuser will hurt her
and her children or take her children away. She may have limited financial options. She may blame
herself. She may stay for religious reasons or because she does not want to break up the family. Also,
she may still love her abuser and hope that things will get better. A man who is being abused may have a
similar experience.
What are the harmful effects of domestic violence?
Domestic violence hurts victims as well as their families. Don't ignore it.
People who suffer from abuse can be badly hurt. They are also likely to have long-lasting (chronic) health
problems, such as depression, headaches, and post-traumatic stress disorder. This is because of the
repeated injuries and stress from living with abuse.
Abuse can happen more often and get worse when women are pregnant. It is dangerous for both the
mother and the baby. It can raise the baby's risk of low birth weight, premature birth, and death. The
pregnant woman is at higher risk of other problems, such as infections and bleeding.
And abuse has a big effect on children. Children who live in a home where abuse happens see violence
as a normal way of life. It also raises their chance of being in a violent relationship as adults, either as
abusers or as victims. Teens are at a greater risk for depression, drug and alcohol use, and bad
behavior.

Elder Abuse - Topic Overview

Elder abuse refers to any of several forms of maltreatment of an older person by a caregiver, family
member, spouse, or friend.
Categories of elder abuse
The 1987 Amendment to the Older Americans Act identified three separate categories of elder abuse:

Domestic elder abuse usually takes place in the older adult's home or in
the home of the caregiver. The abuser is often a relative, close friend, or
paid companion.

Institutional abuse refers to abuse that takes place in a residential home

(such as a nursing home), foster home, or assisted-living facility. The
abuser has a financial or contractual obligation to care for the older adult.
Self-neglect is behavior of an older adult that threatens his or her own
health or safety. Self-neglect is present when an older adult refuses or fails
to provide him or herself with adequate food, water, clothing, shelter,
personal hygiene, medication, and safety precautions.

Acts of elder abuse

Elder abuse can include:

Acts of violence, such as hitting, beating, pushing, shoving, shaking,

slapping, kicking, pinching, choking, or burning. The inappropriate use of
medications or physical restraints, force-feeding, and physical punishment
of any kind also are examples of physical abuse.
Forced sexual contact or sexual contact with any person incapable of
giving consent. It includes unwanted touching and all types of sexual
assault or battery, such as rape, sodomy, coerced nudity, and sexually
explicit photography.
Emotional or psychological abuse, such as name-calling, insults, threats,
intimidation, humiliation, and harassment. Treating an older person like a
baby, giving an older person the "silent treatment," and isolating him or her
from family, friends, or regular activities are examples of emotional or
psychological abuse.
Neglect, such as failing to provide an older person with food, clothing,
personal shelter, or other essentials, such as medical care or medications.
Neglect can also include failing to pay nursing home or assisted-living
facility costs for an older person if you have a legal responsibility to do so.
Abandonment or desertion of an older person by a person who has the
physical or legal responsibility for providing care.
Illegal or improper use of an older person's funds, property, or assets. This
includes forging an older person's signature, stealing money or
possessions, or tricking an older person into signing documents that
transfer funds, property, or assets.

Risk factors for elder abuse

Abuse of elders is a complex problem with many contributing factors. Risk factors include:

Domestic violence carried over into the elder years. A substantial number
of elder abuse cases are abuse by a spouse.
Personal problems of caregivers. People who abuse older adults
(particularly their adult children) are often dependent on the older person
for financial assistance and other support. This is often due to personal
problems such as mental illness or other dysfunctional personality traits.
The risk of elder abuse seems highest when these adult children live with
the older person.
Social isolation. Caregivers and family members who live with an older
person have the opportunity to abuse and often attempt to isolate the older
person from others to prevent the abuse from being discovered.

Elder Abuse - Topic Overview

continued...
Signs and symptoms of elder abuse vary widely depending on the type of abuse.

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Signs that an older person is the victim of acts of violence may include:
Bruises, black eyes, welts, lacerations, rope marks, cuts, punctures, or
untreated injuries in various stages of healing.
Broken bones, including the skull.
Sprains, dislocations, or internal injuries.
Broken eyeglasses or dentures.
Signs of being restrained.
Laboratory reports of overdose or underuse of medications.
Reports from the older adult of being physically mistreated.
An older person's sudden change in behavior.
A caregiver's refusal to allow visitors to see an older person alone.
Symptoms of possible sexual abuse include bruises around the breasts
or genital area, unexplained venereal disease or genital infections,
unexplained vaginal or anal bleeding, underclothing that is torn or stained,
and reports from the older person of being sexually assaulted.
Emotional or psychological abuse is possible if the older person appears
emotionally upset or agitated; acts withdrawn or is noncommunicative,
nonresponsive, or paranoid; exhibits unusual behavior including sucking,
biting, and rocking; or if he or she reports being verbally or emotionally
mistreated.
Signs of neglect may include dehydration, malnutrition, untreated health
problems, pressure ulcers, poor personal hygiene, hazardous or unsanitary
living conditions, and reports from the older person of being mistreated.
Abandonment includes the desertion of an older person at a hospital,
nursing facility, shopping center, or other public location.
Signs of financial exploitation include sudden changes in a bank account
or banking practice, such as unexplained withdrawals of large amounts of
money; additional names on an older person's bank card; abrupt changes
in a will or other financial document; disappearance of funds or valuable
possessions; unpaid bills or substandard care despite the availability of
funds; evidence of the older person's signature being forged; the sudden
appearance of previously uninvolved relatives; payment for unnecessary
services; and reports from the older person of financial exploitation.

Help for elder abuse

To report elder abuse or to get help, call Adult Protection Services (APS) in your state.

You can find the telephone number for the APS office by calling directory
assistance and requesting the number for the Department of Social
Services or Aging Services.
If you cannot find the correct telephone number, call Eldercare Locator tollfree at 1-800-677-1116 for assistance in locating resources. Eldercare is
sponsored by the U.S. Administration on Aging.

WebMD Medical Reference from Health wise

Last Updated: May 06, 2008

IF YOU NEED IMMEDIATE ASSISTANCE DIAL 911

To Report Child Abuse

Notify the Allegany County Department of Social Services and make a verbal report to Child
Protective Service worker -- between the hours of 8:30 a.m. and 4:30 p.m., Monday through
Friday, call Child Protective Services of Allegany County at 301-784-7122; after hours, contact a
representative through the paging system by calling 301-777-7111.
Reporting Child Abuse in Pennsylvania - 1-800-932-0313
Reporting Child Abuse in WV 1-800-352-6513

Community Referrals for Domestic Violence (at patients request)

Domestic Violence Program

Social Service Department
Department of Pastoral Care & Counseling
Emergency Mental Health Services
Family Crisis Resource Center (FCRC)
Family Crisis Resource Center 24 HOUR HOTLINE
Dove Center, Oakland, MD
Family Crisis Resource Center Keyser, WV

240.964.1256
240.964.8535
240.964.8290
240.964.1399
301-759-9246
301-759-9244
301-334-9000
304-788-6061

To Report Elder Abuse

Western Maryland Departments of Social Services Adult Protective Services:

County

Weekday Phone No.

After Hours Coverage

Allegany

301-784-7068

301-777-7111

Frederick

301-694-2482

301-694-2100 (police)

Garrett

301-533-3004

301-334-1929

Washington

240-420-2155

301-791-1121

If the abuse occurs in West Virginia or Pennsylvania, call the law enforcement in the county the abuse
was alleged to have taken place and they will assist with the emergency pager system in their area.
Pennsylvania and West Virginia also have similar laws. Telephone numbers for reporting elder abuse in
neighboring counties are:

Franklin County Area Agency on Aging

717-267-3440

Fulton, Somerset & Washington PA Dept. of Aging

717-772-2934

Hampshire & Mineral Office of Social Services

304-822-6900

West Virginia when calling from in the state

304-627-2296

For other areas of the US Elder Care Locator

800-677-1116

Parenting Resources & Support Services:

Parents Anonymous 1-800-243-7337 (24 hour helpline, education, & referrals)
Youth Crisis Hotline 1-800-448-4663
Allegany County Health Department
Family Services: 301-777-2358
Women, Infants, & Children Program: 301-777-5620
Family Support Network: 301-689-2407
National Clearinghouse on Family Support & Childrens Mental Heath: 1-800-628-1696
Family Junction -301-777-2858