- Looking for signs of domestic violence coming up next on Call The Doctor.

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- Domestic violence can take many forms that include physical, economic, psychological and sexual that can be directed towards women, children and men.

Abusive behaviors always involve an imbalance of power and control.

Recognizing signs of abuse is not always as obvious as they might appear.

Much of domestic abuse is about controlling someone's mind and emotions as much as abusing them physically or sexually.

This abuse can be aimed at not only women and children, but also men.

Children are especially vulnerable to domestic violence even if no one is physically attacking them.

Being exposed to violent family behavior can make children have serious developmental problems that can lead to psychiatric disorders.

The COVID pandemic has also contributed to the problem by isolating people for long periods.

While violence is the main form of physical abuse.

There are other ways of committing abuse such as economic and financial.

This happens when the abuser makes a victim entirely financially dependent with no power or say in the relationship.

It is estimated that more than 10 million people are physically abused each year with women more at risk than men.

Looking for signs of domestic violence, now on Call The Doctor Welcome to Call The Doctor here on WVIA.

I'm Paola Giangiacomo.

Tonight our topic is Domestic Violence.

Joining us on the panel, Tammi Burke, she is the Manager of Community Services at the Victims Resource Center in Luzerne, Wyoming and Carbon counties.

Dr. Frank Maffei practices Pediatric Critical Care Medicine at Geisinger and Marsha Pigga, she is the Executive Director at the Children's Advocacy Center.

I would like to remind our viewers that you can participate in the conversation at wvia.org/ctd.

You can also submit your questions for future shows by emailing ctd@wvu.org or using the hashtag WVIACTD.

And be sure to check our website for listing of future programs and watch Call The Doctor episodes anytime on the WVIA app.

Tammi, there are many types of domestic abuse what are they?

- Well, there's physical and I think that people think it's really obvious but domestic violence isn't always include physical.

There's emotional, there's verbal, there's psychological, there's financial.

- What is the impact or how significant is of a problem is child abuse.

- I mean, child abuse happens often it happens day.

You know, that there's there's many kids I mean that we, we're not actually seeing now because of COVID, but there's reports made across Pennsylvania every single day to child line on child abuse that takes place.

- Dr. Maffei, how impactful is child abuse as on our society?

- It's tremendously impactful because not only is the event, the abusive event, so devastating for the child at that moment, so disruptive to the family, but the long lasting effects of child abuse are immeasurable.

If you think about the number one cause of behavioral crisis or risk factors, rather for behavioral crisis as adults, it's child maltreatment.

If you look at adverse childhood experiences, something we use an acronym ACEs for child abuse is the dominant experience that leads to later physical and mental crisis.

So the long lasting effects of child abuse not only on that unfortunate child but the family and society are at times overwhelming and at times immeasurable because it affects so much of that child's life.

It may also be something that is generational and that child now an adult who is been marred by that experience may be more prone to be abuser him or herself.

So, the remarkable, the long-term effects and they're not just mental and behavioral health but we know just physically youngsters who have those emotional difficult events and those abusive events in particular will have long-term health consequences both physical and mental diabetes, hypertension, propensity towards alcoholism and then those behavioral health crisis that I've mentioned.

- Thank you.

And I'm sure the consequences are not only on children who suffer from child abuse, but adults as well.

Marsha, what are some of the signs of domestic abuse or domestic violence that would be apparent?

- Well, for children, you can see that they would have ongoing anxiety or depression.

There might be emotional distressed.

You'll see some eating and sleeping disturbances.

They might also complain of headaches or stomachaches.

They might find it hard to manage stress, have low self-esteem, have thoughts of harming themselves.

They may be aggressive in school or with friends.

Oftentimes they blame themselves for the violence and they have trouble forming positive, healthy nurturing relationships.

They may have preoccupations regarding the violence that they had witnessed or experienced.

They may have some insomnia, phobias, some bullying might occur, difficulty concentrating, less empathy and caring for others.

There's a whole plethora of signs and symptoms that can indicate that a child had witnessed domestic violence.

- And Tammi in an adult relationship, what would be some abusive signs that a partner may exhibit?

- On the victim it would be maybe person that's very meek or apologetic.

I mean, if you're worried about another person being evicted domestic violence some signs to look for would be like the meekness, the apologetic, anxiousness, difficulty sleeping, sometimes victims attempt suicide or have completed, you know, suicide- - What about signs the abuser, how the abuser would be treating his or her victim?

- Extremely controlling, watching where they go, controlling who they talk to, making sure that the isolate them, name calling, but sometimes those things don't happen in public, that happens behind closed doors.

So, you know that people in the community sometimes aren't aware of those things that are going on.

- So why does an abuser feel that he or she needs to be abusive?

- It's about the in order to gain control.

I believe that often they don't feel really good about themselves and the way to gain some and they have their own loss of control and way to get that control back is by gaining control over another person.

You know and that is by abusing them.

- An abuse isn't just physical.

- No, you know, sometimes it is, it often is, but I often feel that the psychological and the emotional part can be more or if not as much damaging as a physical abuse.

When it comes to physical abuse, bruises heal, broken bones heal and cuts heal.

But the things that somebody hears over and over again it's like a tape recorder in their head, you know?

And when you hear something over and over again you start to believe those things.

- Dr. Maffei is abuse a learned behavior?

- Great question.

You know, this sort of gets to the point where is the abuser really a product of the environment or whether there is some inherent transmittable traits that occur within parents and adults that are more prone to abuse.

It's very complex, I think that there's both nature and nurture here.

And certainly as we sort of alluded to earlier, coming from a chaotic environment and coming from an environment where physical corporal punishment is an acceptable alternative to discipline which we know is wrong, that person is more likely to behave in that manner.

The other thing that makes it very complex is that sometimes the stressors that are happening intergenerationally or happening to that person who might be an abuser they may not have financial security, they may have job loss, they may have addiction problems.

They may be prone to anger and outbursts that they've never learned to control.

So I think it's a very good question.

There is some data actually, it's interesting, just that of the lancet to sort of try to understand whether or not they could tease out those inheritable sort of patterns versus those that are truly environmental.

- And this is a big problem in the US not just child abuse but domestic violence overall, correct?

- Absolutely and I think we have two experts that would sort of agree that when you track intimate partner violence it tracks right along with child abuse.

There are a couple of trends that are somewhat firm, one is if there's intimate domestic violence occurring in the household, there's likely child abuse happening.

The other one that's interesting is unemployment.

And the stress of unemployment on a family, when we see unemployment rates go up we also see the likelihood of child abuse seem to rise congruently.

- And it's not just physical abuse but neglect is also a form of abuse also, right Marsha?

- Yes, neglect is a form of abuse as well as physical abuse, sexual abuse.

And in looking at domestic violence specifically to follow up one in four children are exposed to domestic environments with 5 million children witnessing it a year.

And then more than 15 million children live in homes where domestic violence happens at least once.

And those numbers are just staggering.

- So what can we do as a society if you see abuse going on?

How can you offer help or what can you do?

- Yeah, it's somebody I didn't know when I thought something was going to escalate I would contact the police or call 911.

But if it was somebody I knew, you know, I would talk to them a little bit about what my concerns were or what I was saying.

Let them know that we would have conversations that were confidential.

That I wasn't going to go out and tell everybody.

For family members just believe in support.

The offender wants to isolate them, and they're hoping that the family will go away.

So just support them, let them know that it's not their fault, victims often think that it's their fault.

- Why do victims think that it's their fault doctor?

- I think that oftentimes victims feel almost guilt that they have not been able to solve a problem with the abuser that is so inherent that there may not be a manner in which them by themselves can make the person a better person, a better father, a better parent.

So I think there's this inherent guilt and they take it upon themselves that perhaps it's their problem but I'm sure other guests can comment on that as well but that's my feeling, again I don't deal with so much domestic partner violence, mainly with child abuse but I think it's a very good question why.

- Marsha what are some red flags if you're in a relationship and what are some red flags to help you determine that, hey, this may not be the best partner for me.

- Well, I think as in any relationship we need to look at, what is a healthy relationship.

So if someone is being physically, emotionally financially, even spiritually abused by another person, that would be something that they would need to look at in this relationship, may not be a healthy relationship.

It's very important to, for that person to establish healthy limits and boundaries within that relationship.

So they know what is, what does constitute make up a healthy relationship and what doesn't.

- And doctor, is there a way to prevent domestic abuse or child abuse?

As a society how can we work together to reduce this problem?

- Yeah, certainly we'll comment on that but I think Marsha made a really really good point and it actually does sort of address some of the preventative things too.

She talked about a healthy relationship and so one of the areas of child abuse that we've been very concerned about we know that more often than not it's going to be one of the parents but the other group that is very disturbing to child abuse experts are people that are invited into the home, often a mother's boyfriend.

And if a mother's boyfriend is coming into the home, I think the mother has to ask and the family around the mother has to ask, is that a healthy relationship?

This boyfriend may be coming into our home with a small infant that may not be his, and ultimately that may not be a relationship that's going to be sort of bi-directional.

It may be one that's a lot of taking.

And when a new boyfriend comes into the home, sometimes you know, we refer to them as a paramour come into the home, you'd have to ask yourself, what are the reasons for that person to be in the home.

There might be some altruism to help with the baby, but what we're learning is oftentimes that's a risk relationship.

And if you just Google mother's boyfriend what you'll see is a litany of horrific abuse cases.

So in Pennsylvania, it's enough of a concern that we do look at that population in particular as perhaps a high risk population.

So just building on what Marsha said about questioning the relationship as you bring someone into a home with a small infant I think is very, very important.

- Yeah, that sounds smart.

And what about protection from abuse orders?

You hear so often that an abuse victim files a PFA and then a short time after that, that person who filed the PFA ends up dead.

So are these PFAs even, do they make sense?

They don't seem to work, Tammi.

- I think PFAs I mean they're a really important part of the process.

They are actually supposed to keep the offender from having contact with the victim.

But you're right when somebody separates or they file for a PFA, their lethality goes up.

So with that PFA, the victim also needs a safety plan and they need support around that.

So that I've worked a lot with victims, that have gone through that process but it needs both pieces.

- But isn't it true that sometimes in an abusive relationship the person who's being abused starts to feel isolated and doesn't reach out to their friends or family and a lot of these people who they were once close with don't even know what's going on.

- Right, but there's resources in every County, across Pennsylvania there's a Domestic Violence Center in every County that a victim could reach out to at 24 hours a day, there's shelters available, there's resources available, there's legal help available.

And there's somebody that could walk you through that whole process.

- What if they're afraid that they might get caught Googling Domestic Violence Centers or they may see a phone number on their phone, is there a way to do it secretively?

- Yeah, I mean that you can go and I mean you could call the hotline 24 hours a day.

And when you go onto different sites it'll tell you that it's not safe.

To mean, a lot of the domestic violence sites now when you go to even look at anything they'll let you know that it's easier to track on the domestic violence sites, you know, so, that when you had the opportunity to go somewhere and use the phone, I would pick up the phone and call a hotline.

- Are there centers also in our area where people can escape to the resource center shelter?

- Right, so in Luzerne and Carbon counties, those counties here Domestic Violence Service Center provides that and they have the shelter and they have a group.

We serve domestic violence victims in Wyoming County.

So we would make sure that they have a safe place to go.

- What about schools?

Isn't it usually that schools are the ones who intervene or maybe even hospitals, if a victim is up at the hospital, don't those institutions actually end up being the ones who intervene and offer help, Dr. Maffei?

- Yeah, they're actually mandated, right?

So this is Pennsylvania law, which is likely the reason why we've had an increased number of reports over the last seven, 10 years, which is, you know again, it's disturbing that we have so many reports and I think last year we had close to 45,000 reports.

But the flip side of that is that we are mandating adults who have contact with children in a formal manner, whether it be at a school, whether it be at a nursery, whether it be at church or synagogue, anywhere where there is formal contact with the child we are now sort of looking to them as mandated reporters.

It is their obligation.

Is their obligation to assess children for the possibility of abuse and sometimes it is better to sort of think of the call to child line which I'll give you the number in a moment, as a call to sort of discern it.

You just need reasonable cause you don't need certainty.

And then let the folks at child line, the experts there that they do a great job to sort of help to distinguish whether or not this is truly a child abuse case.

But the child line number 1-800-932-0313.

So as mandated reporters, you have to do it.

The other thing as mandated reporters, if I don't have the child in front of me but I have a colleague who tells me about the child, I am mandated.

Alright, so I don't have to have direct contact with the child in order to need to place a report.

So getting back to one of your questions earlier about prevention or prevention starts with identity, making sure that we're identifying the cases that are occurring right now, and so that we can sort of work back to sort of identify what we could be doing so that phone call may perhaps didn't need to happen.

But right now the imperative is to identify those children who may be at risk for abuse.

So reasonable cause you're a mandated reporter, you need to call.

- And not only physical abuse, neglect child abuse, but child sexual abuse is also a significant problem.

Isn't that right Marsha?

- Yes, child sexual abuse actually is a very significant problem.

And here at the Children's Advocacy Center, we provide excellence in the assessment treatment of child abuse and neglect as well as sexual abuse cases for children.

It's really the first stop for children before they enter the justice system.

And what we do that's so unique is we use a coordinated multidisciplinary team approach, bringing law enforcement and Child Protective Services agencies together with other professionals involved in the case at our center putting the needs of that child first.

So really what we're doing is we're avoiding requiring a victim to take into multiple agencies throughout the law enforcement and child protection system and we're minimizing the amount of interviews children have to experience by bringing the child to the center here and having that multidisciplinary team, develop a specialized child centered plan for that child to help them heal.

- And who are the most known perpetrators when it comes to child sexual abuse?

Who should we be worrying about the most when it comes to who's around our kids?

- 85 to 90% of the time when a child's been sexually abused it's by somebody they know.

You know so it's a parent, it's a neighbor, it's the aunt, the uncle or sibling, 85 to 90% of the time it's somebody the child knows.

- So how can we prevent it, I mean, if you think your child is with someone safe and they're really not?

- One of the things is to educate.

Victims Resource Center, we go on to the schools and we do programs on No, Go, Tell.

We could teach parents on things that they can do to teach their kids it's like, you know, we don't wanna make them paranoid but it's like crossing the road.

You've gotta tell them more than one time.

And they need to know that there's people that they can come and talk to.

- So we need to talk to our kids.

This is what can happen to you and you need to come talk to me if something should happen.

- And we have materials that we can give or they could bring their children in and we could do prevention education in the office or like I said, we're in all the school districts in Luzerne, Wyoming and Carbonn Counties doing those programs from preschool through high school.

- So you can talk to them about that as young as preschool age?

- Yes.

- Of the 42,000 reports in 2019, 40% of the majority were actually sexual abused, about 30% were physical abused.

So it's a very large portion of the reports.

The fatalities obviously are occurring in the physical abuse category, but again, the long-term and acute effects of sexual abuse are horrific.

So, we do have to sort of be on the lookout and be careful in who we are sort of trusting our children with and being absolutely careful with not putting them in situations where they are at risk.

Even a babysitter that's an older babysitter that you don't know and so forth you gotta be very careful in vetting and understanding every individual you're leaving along with your child.

- Or maybe install 90 cams, if you can.

And with the time we have left, is there any research going on that could help improve this situation, doctor?

- So there's a lot of research in child abuse and there's several types of research in child abuse.

The first is, you know, where I think we have a lot of expertise.

In Pennsylvania has some of the greatest experts in child abuse research in the in the nation at UPMC Dr. Rachel Berger at CHOP, Cindy Christian.

And they've done a lot of research in identifying a cult injuries that are likely related to abuse.

But I think the tide in research is really turning to prevention.

How can we identify those vulnerable populations very early on?

How could we identify a vulnerable family upon the birth of the child without being showing bias or discrimination but really trying to do it in a very constructive manner not a punitive manner, to sort of support those fragile families or those vulnerable populations.

So I think that's where the research should be heading to sort of do that preventative type of research.

- Okay, well, let's hope it all works.

Thank you all for joining us, once again I'd like to thank our panelists for participating in our discussion on Domestic Violence and Child Abuse.

For more information and resources on this topic, visit wvia.org/ctd.

I'm Paola Giangiacomo for Call The Doctor.

Thank you for watching.

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