Title: The identification and treatment of physical and sexual violence among adolescents in a healthcare setting: The Mount Sinai Adolescent Health Center
1The identification and treatment of physical and
sexual violence among adolescents in a healthcare
setting The Mount Sinai Adolescent Health Center
- By Angela Diaz, MD, MPH
- Physical and Sexual Violence Among Youth
Intervention Policies and Programs - March 1, 2005
2Mount Sinai Adolescent Health Center (AHC)
AHC uses a holistic, multidisciplinary,
integrated approach to physical health,
reproductive health, mental health and health
education for adolescents
3AHC Vision
- To help adolescents grow up happy, healthy, and
well-educated, with hopes and opportunities
4A Bio-Psycho-Sociocultural-Spiritual Approach
- Physical
- Psychological
- Cognitive
- Emotional
- Interpersonal
- Behavioral
- Social
- Cultural
- Spiritual
5Adolescent-Friendly Health Care
- Bio-psycho-sociocultural-spiritual approach
- Comprehensive and integrated services
- Accessibility
- Geographic
- Financial services regardless of ability to pay
- Confidentiality
- Involvement of parents and family is encouraged,
but confidential services are provided when
necessary - Trained staff
- Experts in adolescent health
- Innovative
- Adapting to changing needs of adolescents
6Building Competencies
- Comprehensive and integrated services
- Health education
- Prevention
- Risk reduction support
- Nutrition education and counseling
- Physical health care
- Routine care, acute and chronic illness
- Reproductive health care
- Mental health services
- Individual, family, group therapy
- Crisis intervention and case management
7AHC Adolescents and Services
- Ages 10-21
- All genders
- Services free of charge
8Origin of Patients Visiting the AHC, 1997-2000
9AHC Sexual Victimization Experience
- 1985
- anonymously surveyed 60 female patients - 35
(58) reported sexual assault with 25 being
incest - 1989
- interviewed 141 female patients - 32 (23)
reported sexual assault with 66 being incest - 2001
- 68 (15) of 450 consecutive female patients
presenting for mental health services self-report
coerced sex
10Promoting Disclosure
- All staff, including support staff, trained and
supported to feel comfortable to assess signs of
abuse and to respond appropriate to their role - Posters and other visible messages that this is a
safe place to disclose - Educational materials
- Screening Measures
- Direct Inquiry
11Adolescents seeking mental health services
Adquest
- They are experiencing violence
- 74 have witnessed violence
- 43 worry about safety
- 37 worry they do dangerous things
- 37 have been victims of violence
- 24 have been sexually abused
- 24 have been threatened or assaulted with weapon
- 10 have been raped
- 7 are in violent dating relationship
- They want to talk
- 82 want to talk about school
- 80 want to talk about family and home life
- 76 want to talk about friends
- 71 want to talk about safety and violence
- 65 want to talk about work
- 62 want to talk about substance use
12Direct Inquiry
- Disclosure rates of abuse increase if clients are
asked directly by their providers - Of a study group at AHC (1997), 22.7 disclosed
sexual abuse when asked directly by their
physician during their routine medical screening - 81 of these patients accepted referrals to
counseling as a result of this disclosure - Diaz, A. Manigat, N. (1999). The health care
providers role in the disclosure of sexual
abuse the medical interview as a gateway to
disclosure. Childrens Health Care Journal,
28(2), 141-149.
13Direct Inquiry - Questions
- Has anyone ever touched your body in a way that
made you feel uncomfortable or when you did not
want them to? - Has anyone ever forced you to perform any sexual
act on your body or on theirs? - Has anyone ever touched your breast when you did
not want them to? Your vagina? Penis? Buttocks?
Anus? Or any other part of your body? - If yes, who was it? Was it your father? Mother?
Brother? Sister? Uncle? Aunt? Grandparent?
Neighbor? Teacher? Stranger?
14Age of Victim at First Episode
Age (years) N 3-4 12 5-6 19 7-8 16
9-10 22 11-12 13 13-14 11 15-17
7 mean age at first episodes was 8.8 year
15Age of Perpetrator at First Episode
Age (years) N 10-19 20 20-29 19 30-39
28 40-49 20 50-59 5 60-69 7 70-79
3 unknown 4 mean age of perpetrator was
32.0 year
16Perpetrators
First Episode All Episodes N N
() Father 31 34 (21) Father
surrogate 22 32 (19) Mother or surrogate 2
3 (2) Siblings 7 13 (8) Other
relatives 23 36 (22) Nonrelatives 15 47
(28) Total 100 165
17Case Control Examination
- Controls selected with no history of sexual abuse
- Similar
- age, education, race/ethnicity, and SES
18Comparison of PerceivedRelationship with Mother
19History of Running Away
20Comparison of CoopersmithSelf-Esteem Scores
21Comparison of Depressive Symptoms
22Comparison of Suicidality
23Interventions Therapy Modalities
- Support upon disclosure
- Crisis Interventions
- Therapy Modalities
- Individual
- Family
- Group
- Psychoeducational
- Psychotherapy
- Trauma-specific therapy
- Art therapy