The coronavirus pandemic has impacted our lives far beyond how we could have ever imagined. Approximately 22 million people have filed unemployment claims in the U.S. within a four-week time frame. Food bank lines have grown considerably, people are concerned about exposure to virus when they go to the grocery store or pharmacy, and many of us know someone who has or has had the virus. [1], [2] We all have been impacted in some way, and this causes stress for everyone.
Many people also are under stay at home orders.[3] People who are not safe within their home may be at an increased risk. Individuals who experience domestic violence, children, elders, or disabled persons who experience abuse, may be confined within the home much more so than previously. Some of these individuals may live with an abuser. Individuals who have substance use issues are also at increased risk of use or relapse due to environmental factors. Add to this, financial stress and/or lack of food, isolation, and limited in-person resources due to programs being closed in the wake of social distancing rules.
During this time, many Allied Healthcare Professionals (AHPs) are engaging in telehealth via video or phone. AHPs have responsibilities as mandated reporters, but there may be challenges to assessing for abuse or neglect or risk of harm given that the patient may only be seen on a screen (or an even more challenging observation via the phone) for a telehealth session. It is important, however, that AHPs remain vigilant for signs that the patient may be experiencing abuse and neglect or risk of harm and report to relevant authorities, including the police, when indicated.
Child Abuse and Neglect
Each state has differing rules on mandated reporting of suspected child abuse, what AHPs are required to report, and whether there are penalties for failing to report. All states require that AHPs are required to report suspected child abuse; however, be aware of variations as some states may require providers to report abuse that occurred years earlier but was not disclosed until the alleged abused child is an adult.
It may be difficult to fully assess remotely on a computer, tablet, or phone; however, it is important that you fully assess your minor patients in each session. Be aware of change in demeanor, behavior that is different such as exhibiting signs of being withdrawn, any bruising, change in appearance (i.e. disheveled or unkempt), significant weight loss, indication that the child is hungry, or is not getting adequate food.[4] AHPs should objectively and thoroughly document in the patient’s medical record providing a description of direct observations. When able, use the patient’s own words if something is disclosed. If you report alleged abuse, neglect, or issues that place the patient at risk, document this in the record.
Know how to contact your state Child Abuse and Neglect Hotline before you should need to. Also, be aware of local resources such as food banks, shelters, or other community resources and, when indicated, provide this to the child’s parent/guardian.
Elders and Disabled Persons
Each state has rules on reporting suspected abuse against elders and disabled persons, which can include physical/emotional, but also financial exploitation, or elders who are at risk. It is important to be aware of the applicable rules within your state prior to encountering an issue. Be aware of change in demeanor, behavior that is different such as exhibiting signs of being withdrawn, any bruising, change in appearance (i.e. disheveled or unkempt), significant weight loss, indication that the patient is hungry, or is not getting adequate food. In addition, be aware of issues related to financial exploitation or individuals who are isolated, are at risk, in need of assistance, or if there is concern of cognitive decline such that the patient may need a higher level of care or potentially a substitute decision maker.
With respect to financial exploitation, be aware of other persons attempting to speak for the patient, interjecting so that the patient is unable to communicate, or an indication about missing/misplaced funds. Ensure you objectively and thoroughly document in the patient’s medical record providing a description of direct observations. When able, use the patient’s own words. If you should report alleged abuse, neglect, or issues that place the patient at risk, document this in the record.
Know how to contact your state Elder/Disabled Persons Abuse Hotline before you should need to. Also, be aware of local resources such as food banks, meal delivery services, shelters, or other community resources, and when indicated, provide this to the patient.
Domestic Violence
Some states have rules requiring mandated reporting of suspected domestic violence whereas other states do not. For instance, California, requires that any health practitioner employed in a health facility, clinic, physician’s office, local or state public health department, or clinic or other facility operated by a local or state public health department, report to local law enforcement medical services provided for a patient who has a physical condition , a wound, or other physical injury that is suspected to be the result of assaultive or abusive conduct...[5] It is important to know whether your state has a requirement for reporting domestic violence, and if so, what the requirements may be.
As part of ongoing assessment and treatment, look for signs of bruising or change in demeanor. It is important that providers inquire about whether the patient feels safe, discuss abuse, and then document the patient’s medical record accordingly. Be aware of other persons attempting to speak for the patient or interjecting so that the patient is unable to communicate. Ensure you objectively and thoroughly document in the patient’s medical record, providing a description of direct observations. When able, use the patient’s own words. If you report domestic violence, document this in the record.
Substance Use
Individuals who struggle with addiction may also be at increased risk of escalating use or relapse. This also could place others within the home at risk of harm or cause additional stress. It is important to be aware of this potential situation and provide patients with resources should they need them. There are online meetings and resources available.
Conclusion
With COVID-19 affecting the entire country, many individuals are socially isolated, and may be living in unsafe environments within their own homes. If you see or hear something that is of concern, it is important to seek guidance. Keep in mind, you do not have to fully investigate suspected abuse or neglect. Hotlines are available to discuss the issue and crisis workers will guide you on whether your concern should be reported. AHPs should be aware of patients who may be at risk of harm and take proper steps to ensure safety. If your patient, or someone else within the home is at imminent risk of harm, contact the local police. Safety is paramount, and if there is a concern, seek immediate assistance.
Additional Resources
It is important to know your local and state resources. For additional support, use the below programs and hotlines, which may be helpful.
- Substance Abuse and Mental Illness:
- National Alliance of Mental Illness — 1-800-950-6264 (Monday-Friday, 10 a.m.
to 6 p.m. ET)
http://www.nami.org/
- Suicide:
- 211 — National Suicide Hotline
- National Suicide Prevention Lifeline – 1-800-273-TALK (8255)
- Crisis Support:
- Crisis Textline — Text Connect to 741741
- Addiction/Family Member with Addition:
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Kristen Lambert, JD, MSW, LICSW, CPHRM, FASHRM
Healthcare Practice and Risk Management Innovation Officer
Trust Risk Management Services, Inc.
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NOTE: This information is provided as a risk management resource and is not legal advice or an individualized personal consultation. At the time this resource was prepared, all information was as current and accurate as possible; however, regulations, laws, or prevailing professional practice standards may have changed since the posting or recording of this resource. Accordingly, it is your responsibility to confirm whether regulatory or legal issues that are relevant to you have since been updated and/or to consult with your professional advisors or legal counsel for timely guidance specific to your situation. As with all professional use of material, please explicitly cite The Trust as the source if you reproduce or distribute any portion of these resources. Reproduction or distribution of this resource without the express written permission of The Trust is strictly prohibited.