+--------------------------------+----------------------+-------------+
| **BROOKHAVEN NATIONAL          | GCRC POLICY- IC-17   | PAGE 1 OF 2 |
| LABORATORY**                   |                      |             |
|                                |                      |             |
| **GENERAL CLINICAL RESEARCH    |                      |             |
| CENTER POLICY**                |                      |             |
+--------------------------------+----------------------+-------------+
|                                | PREPARED BY: B.      |             |
|                                | Pyatt Infection      |             |
|                                | Control              |             |
+--------------------------------+----------------------+-------------+
| SUBJECT: IDENTIFICATION AND    | REVIEWED BY: W.      |             |
| MANAGEMENT OF POSSIBLE VICTIMS | Gunther GCRC Manager |             |
| OF ABUSE                       |                      |             |
+--------------------------------+----------------------+-------------+
|                                | APPROVED BY: G. J.   |             |
|                                | Wang Medical Dept.   |             |
|                                | Chair                |             |
+--------------------------------+----------------------+-------------+
|                                | EFFECTIVE DATE:      |             |
|                                | 11-07-07             |             |
+--------------------------------+----------------------+-------------+
|                                | REVISION HISTORY: 03 |             |
+--------------------------------+----------------------+-------------+

**1.0 [POLICY:]{.underline}**

Because of the nature of care provided within the ambulatory care
setting, it is possible that independent and/or nonindependent
practitioners may identify possible victims of abuse. Therefore, it is
important that professionals working in ambulatory care settings be
aware of clinical manifestations of physical assault/abuse, rape or
other sexual molestation, and domestic abuse of elders, spouses,
partners, and children.

**2.0 [PROCEDURE]{.underline}**[:]{.underline}

Symptoms of abuse or neglect may be obvious or insidious. Symptoms may
be discovered during physical examination associated with ambulatory
care services provided or during verbal interviews. Regardless of the
mechanism by which possible abuse or neglect is discovered, the law
requires reporting of known (or reasonably suspected cases in children)
cases of abuse or neglect and permits reporting of reasonably suspected
cases in the elderly. Therefore, if a subject or participant is
suspected of any of the above, he/she be referred to a local hospital
for treatment or are provided information related to public and private
community agencies that provide, or arrange for, evaluation and care for
victims of abuse.

**3.0 [CRITERIA FOR THE IDENTIFICATION OF POSSIBLE VICTIMS OF ABUSE AND
NEGLECT IN ADULTS]{.underline}**[:]{.underline}

Physical assault, domestic abuse, and neglect:

A. Injury incompatible with stated event

B. Unexplained injuries including burns, fractures, sprains, and strains

C. History of similar injuries in past. Lack of follow-through with
aftercare instructions

E. Lack of grooming and attention to cleanliness in the elderly for whom
care is provided by another

F. Evidence of unreasonable physical constraint, or prolonged or
continual deprivation of food or water

G. Evidence of injury due to failure to protect from health and safety
hazards

H. Malnutrition

I. An inexplicable delay between the time of injury/illness and the
first attempt to obtain medical care.

Sexual assault i.e. sexual battery, rape, rape in concert, incest,
sodomy, oral copulation, or penetration of a genital or anal opening by
a foreign object

A. Statements of forced sexual contact

B. Traumatic injury to urethra, vagina, or anal/rectal tissue.

C. Traumatic injury to oral mucosa that could have been caused by forced
sexual contact

D. Sexually transmitted disease.

**4.0 [CRITERIA FOR THE IDENTIFICATION OF POSSIBLE VICTIMS OF ABUSE AND
NEGLECT IN CHILDREN]{.underline}** [:]{.underline}

Psychological manifestations may include:

A. Fear of adults

B. Extremely obedient or polite

C. Fearful to cry

D. Silent

E. Withdrawn

F. Depressed

G. Views self as bad and deserving punishment

H. Promiscuous

I. Acts out violently against animals or smaller children

J. Does not cry during painful procedures

Recognition of potential physical abuse:

A. Location, pattern, distribution, or configuration of injury does not
match stated event

B. Presence of evidence of multiple old injuries

C. Presence of multiple injuries

D. Evidence of malnutrition or neglect co-existing with injury

E. History of prior injury of same or different type

F. History of nonorganic failure to thrive in victim or siblings

G. An inexplicable delay between the time of injury and the first
attempt to obtain medical care

H. Parent's account of incident is not compatible with the age and
developmental level of the victim

I. The parents are reluctant to provide information

J. Friends or relatives other than the parents bring the injured child
to the ambulatory care setting

K. Parents are depressed, suicidal, exhibit bizarre behavior, are
retarded, are overwhelmed with crisis, overreact, or reflect total
unconcern, display open hostility for the victim, indicate unrealistic
expectations of the victim, or show evidence of alcohol or drug use.

L. The medical history provided by parents fails to mention the present
injuries

M. The child shows characteristic radiological evidence skeletal or soft
tissue injury consistent with abuse

N. Differential diagnosis eliminates organic malformations, genetic
defects and disease.

Physical abuse:

A. Soft tissue injuries such as welts, bruises (especially lower lumbar
area), lacerations

B. Facial injuries of the mouth, ears, nose or eyes

C. Scalp injuries including hematoma or deformity

D. Burns (evaluated for type, characteristics, age of the victim and
anatomical location, and causative agent).

E. Fractures including evidence of multiple fractures

F. Brain damage including that which results from shaking

G. Internal injuries such as blunt trauma

H. Evidence of exposure such as hypothermia

Failure to thrive symptoms:

A. Loss of subcutaneous fat and/or muscle

B. Distended or protruding abdomen

C. Apathetic or unresponsive infant

D. Small head circumference for age

E. Poor skin turgor

F. Hair changes or loss

G. Insufficient or inappropriate clothing

H. Lack of medical attention for infections or injuries

I. Inexplicable delay in seeking medical attention for malnourished
condition

J. Untreated coexisting injuries with malnutrition

K. Poor preventative medical or dental care

L. A history of prior nonorganic failure to thrive

M. Medical record documentation of deterioration of growth pattern or
delayed development

N. Previous documented abuse or failure to thrive of a sibling

Possible symptoms of sexual assault:

A. Traumatic injure to genitalia

B. Traumatic injury to urethra, anus or rectum

C. Traumatic injury to oral mucosa or perioral area

D. Urinary tract infection by unusual pathogen

E. Sexually transmitted disease

**5.0 [DOCUMENTATION]{.underline}**[:]{.underline}

All referrals and procedures performed shall be documented in the
subject/participant's record.

The only official copy of this file is the one online at the Medical
Department website under "Clinical Research Center Policy Manual."
Before using a printed copy, verify that it is the most current version
by checking the document effective date on the website.

Attachment 1 IC-17/03

VIBES Telephone: 360-3730

New York State Office of Prevention of Domestic Violence

Capital View

Office Park

52 Washington Street

Room 366

Rensselaer, New York 12144