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The identification and treatment of physical and sexual violence among adolescents in a healthcare setting: The Mount Sinai Adolescent Health Center

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Title: The identification and treatment of physical and sexual violence among adolescents in a healthcare setting: The Mount Sinai Adolescent Health Center


1
The 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

2
Mount Sinai Adolescent Health Center (AHC)
AHC uses a holistic, multidisciplinary,
integrated approach to physical health,
reproductive health, mental health and health
education for adolescents
3
AHC Vision
  • To help adolescents grow up happy, healthy, and
    well-educated, with hopes and opportunities

4
A Bio-Psycho-Sociocultural-Spiritual Approach
  • Physical
  • Psychological
  • Cognitive
  • Emotional
  • Interpersonal
  • Behavioral
  • Social
  • Cultural
  • Spiritual

5
Adolescent-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

6
Building 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

7
AHC Adolescents and Services
  • Ages 10-21
  • All genders
  • Services free of charge

8
Origin of Patients Visiting the AHC, 1997-2000
9
AHC 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

10
Promoting 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

11
Adolescents 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

12
Direct 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.

13
Direct 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?

14
Age 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
15
Age 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
16
Perpetrators
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
17
Case Control Examination
  • Controls selected with no history of sexual abuse
  • Similar
  • age, education, race/ethnicity, and SES

18
Comparison of PerceivedRelationship with Mother
19
History of Running Away
20
Comparison of CoopersmithSelf-Esteem Scores
21
Comparison of Depressive Symptoms
22
Comparison of Suicidality
23
Interventions Therapy Modalities
  • Support upon disclosure
  • Crisis Interventions
  • Therapy Modalities
  • Individual
  • Family
  • Group
  • Psychoeducational
  • Psychotherapy
  • Trauma-specific therapy
  • Art therapy
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