Question 1

Most violent acts occur among/within which groups?

Accepted Answer

Violence can be defined as "the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment, or deprivation" (World Health Organization [WHO], 2002, p. 4). Although the media often portrays violence perpetrated by strangers, in reality the majority of violence occurs within families and among acquaintances (Christoffel & Gallagher, 2006). Elders, women, and children are most frequently the targets of violence, and the perpetrators are often people they know. LGBTQ+ youth face bias, which may place them at greater risk for a variety of physical and mental violence, including being threatened with a weapon and being bullied via electronic means, as well as dating violence (Centers for Disease Control and Prevention [CDC], 2017). In addition, people with disabilities are more often the targets of violence than their nondisabled counterparts. The social context of disability, including factors such as poverty, isolation, and dependence on support services, significantly increases a person's risk for abuse.

Question 2

A theoretical model that views violence as a public health problem and is used in violence mitigation is the:

Accepted Answer

A public health approach to violence includes the identification of risks and protective factors in order to design programs based on epidemiological data, the evaluation of program effectiveness, and the modification of prevention strategies based on evidence. Risk elements associated with violence include personal factors, such as male gender, alcohol abuse, and childhood trauma, as well as environmental and social factors, such as access to guns and poverty. A theoretical model that matches this approach and that has been used to develop programs to address complex health problems such as violence mitigation is the social ecological model (CDC, n.d.-b; Reitz, Scaffa, Campbell, & Rhynders, 2010). This approach simultaneously examines individual, environmental, and broader societal aspects of health behavior and promotes the use of multiple intervention strategies to address community and population health needs. Health interventions that examine the interrelationships between these social and physical contextual factors tend to demonstrate higher-level success. The key concepts in this model are identified in Table 27-1. The social ecological model of violence prevention is recommended as an approach for community and population health change advocates to examine the connections between individuals, relationships between individuals and groups, the community, and society in approaches to violence mitigation (CDC, n.d.-c). An interactive tool that provides additional information on the model and its use in violence mitigation is available (CDC, n.d.a).

Question 3

Most homicides are a result of which of the following?

Accepted Answer

Most homicides are not the result of organized criminal activity but rather of family dysfunction, alcohol and drug use, and poverty. In 2017, 28% of homicides were perpetrated by friends or acquaintances, 12% by family members, and 10% by strangers. In the remaining 50%, the relationship between the victim and perpetrator was unknown (FBI, 2019). Low-income neighborhoods are disproportionately affected by violent crimes, particularly homicide. Social organizations, job opportunities for youth, and residential stability are associated with lower crime rates (U.S. Department of Housing and Urban Development, 2016). Alcohol and drugs are frequently associated with homicide deaths. A meta-analysis of case files, self-reports, and toxicology data indicated that 37% of perpetrators were under the influence of alcohol at the time of the murder (Johns Hopkins University, 2015).

Question 4

Which modern phenomenon has been linked to suicides?

Accepted Answer

The phenomena of taunting individuals who appear to be contemplating suicide was documented as early as the 1920s (Mann, 1981). This taunting usually occurred when people who were contemplating jumping to their deaths were in a public place with a crowd. Mann suggested that crowd size, leading to anonymity, and adverse temperatures may lead to taunting. Mann also suggested that a lengthy waiting time to observe the conclusion (i.e., the person threatening to jump is indecisive over a prolonged period) also may lead to taunting, as the crowd becomes impatient while awaiting the event's conclusion. This phenomenon seems to have evolved with the advent of social media. More recently, cyberbullying (Milosevic & Livingstone, 2018) and taunting by phone have been linked to suicides (Harvard Law Review, 2018). This new type of taunting will need to be monitored and prevention initiatives modified to address this suicide threat. Suicide is a public health problem that requires evolving community-based prevention strategies.

Question 5

Chloe is a 4-year-old placed in child protective services because her parents left her in a closet and provided limited access to food. Which aspect of violence is this example?

Accepted Answer

Family violence takes the form of child abuse and neglect, intimate partner violence, and elder abuse. According to the National Coalition Against Domestic Violence (NCADV), each year 10 million people, or an average of 20 people every minute, experience physical abuse at the hands of an intimate partner. A perpetrator's access to a firearm increases the risk of homicide by 500% (NCADV, n.d.). Individuals with disabilities are at a higher risk of domestic violence, especially women (AOTA, 2017). These numbers may only approximate the true scope within the United States; domestic violence often remains hidden within the community because it is difficult for many people to leave these unsafe situations. Thomas, Goodman, and Putnins (2015) explored the required "trade-offs" faced by survivors of domestic violence. While safety is the primary focus of domestic violence programs, it is also is important to understand the impact of forfeiting housing and financial stability for safety. Thomas et al. (2015) found that for some survivors, safety "comes at a cost so high that it does not seem worth pursuing" (p. 170), which leads them to call for a breakdown of the silos of social service provision.

Question 6

Chloe's abusers were her parents. Her father had recently lost his job and her mother was not working. Which stress factor likely contributed to the abuse?

Accepted Answer

Child mistreatment "is the abuse and neglect that occurs to children under the age of 18" (WHO, 2016, para. 2). Worldwide, it is estimated that 22.6% of children under the age of 18 have experienced physical abuse, 36.3%, emotional abuse, and 16.3%, physical neglect (WHO, 2014a). In the United States in 2012, out of 1,000 children under age 18, 9.2 were reported victims of child maltreatment. This same year it is estimated that 2.2 children per 100,000 died of abuse. For these children, maltreatment was evident in several forms, including neglect (70%) and physical abuse (44%), with some children also having experienced another form of or a combination of other maltreatment. Overall, girls are at slightly higher risk for child maltreatment than boys. The highest rate of child maltreatment is for children from birth to 3 years of age, and the rates decline as children get older. In most cases, the perpetrator of child abuse is a family member. In 80% of the cases, the parents were the abusers; in 10% of the cases, they were other relatives; and in 4%, they were unmarried partners of a parent (CDC, 2014). Child abuse can be found in all socioeconomic groups, and family stress, particularly economic stress, is a major determinant in abuse. Children who are abused often become abusive parents themselves and also have a higher likelihood of committing other violent acts (Christoffel & Gallagher, 2006).

Question 7

Which unhealthy occupational engagement in adulthood is associated with a history of child abuse?

Accepted Answer

Child abuse negatively impacts childhood and adult occupations. A study of 219 dancers in California (Thomson & Jaque, 2018) found that dancers who had experienced multiple childhood adversities displayed greater internalized shame and anxiety. Through studies of children's play habits, it has been found that an abused child's play tends to be impulsive, disorganized, and lacking a play theme (Cooper, 2000), in comparison to the play of a non-abused child. This is of great concern, because for young children play is the most important means of adapting and developing the skills needed to prepare for more advanced tasks. Unhealthy occupational engagement, which includes smoking and alcohol and drug use, as well as unsafe sex behaviors, is also associated with childhood abuse (Springer et al., 2003). Because occupational therapy practitioners provide services to individuals with these health conditions, it is important for occupational therapy practitioners to be aware of these links to child abuse.

Question 8

Which of the following is an example of an occupation-based program for violence mitigation?

Accepted Answer

Evidence-based programs and strategies are available to help reduce child abuse and child maltreatment (National Center for Injury Prevention and Control [NCIPC], 2019). In the NCIPC document "Essentials for Childhood: Creating Safe, Stable, Nurturing Relationships and Environments for All Children" (n.d.), specific evidence-based examples are provided. Examples of such programs include Parent-Child Interaction Therapy (PCIT); Safe Environment for Every Kid (SEEK), which uses a self-administered questionnaire during an office visit with a trained primary care provider supplemented by resources and follow-up; and the Nurse-Family Partnership (NFP), which utilizes home visits to first-time mothers and their infants. The programs and strategies are geared toward providing parents with information to better equip them to cope with the various challenges and stresses associated with parenting. They pertain to just two of the strategies (parent and caregiver support, and education and life skills initiative) identified by the WHO (2016) in INSPIRE: Seven Strategies for Ending Violence Against Children (see Table 27-2). The WHO (2014a, 2016) and the NCIPC (n.d., 2016, 2019) offer a variety of resources to assist in the development of programs to mitigate and prevent child maltreatment.
While no evidence-based occupational therapy prevention strategies for child mistreatment of domestic violence could be found, one potential intervention for enhancing mother and child interaction following domestic violence was located (Waldman-Levi & Weintraub, 2015). The intervention, Family Intervention for Improving Occupational Performance (FIOP), was compared to participation of a control group in a play area program. Both programs were conducted in the same, completed in a domestic shelter, was compared to participation in the play area of a domestic shelter. Improvements in the interaction between mothers and children, as well as play skills in children, were noted in the groups receiving the FIOP intervention. However, playfulness did not improve in the FIOP group but did in the comparison group (Waldman-Levi & Weintraub, 2015). These findings warrant the further refinement and investigation of this promising approach to improving the relationship of children with their mothers following domestic violence.

Question 9

Intimate partner violence is least likely in which population group?

Accepted Answer

IPV occurs more frequently in adolescence and young adulthood, with prevalence decreasing as people age. Among U.S. high school students who had dated in the previous year, 10% experienced physical dating violence, and 11% reported sexual dating violence. These reports vary by gender, with 21% of girls who had dated the previous year reporting physical and/or sexual violence, compared to 10% of boys (Niolon et al., 2017). Worldwide, almost a third of women who have been in a relationship have experienced a form of IPV in their lifetimes. The prevalence rates of IPV vary globally by geographical and economic region (see Fig. 27-4). War, the period shortly afterward, and human displacement may increase and expand IPV and other violence (WHO, 2017).

Question 10

Most elder abuse occurs in which environment?

Accepted Answer

"Abuse can happen to anyone-no matter the person's age, sex, race, religion, or ethnic or cultural background. Each year, hundreds of thousands of adults over the age of 60 are abused, neglected, or financially exploited. This is called elder abuse" (National Institute on Aging [NIA], 2016, para. 3). Because 95% of older adults live outside of institutions such as nursing homes or assisted living facilities, it is not surprising that the majority of such abuse occurs in the home (American Psychological Association [APA], 2012). The perpetrator is most frequently a professional or family caregiver (National Institutes of Health [NIH], 2017).

Question 11

Nancy is a 16-year-old who reports that a classmate has been calling her names and she does not know what to do. This type of behavior is characterized as which of the following type of bullying?

Accepted Answer

Bullying is a term used to describe a collection of unwanted and aggressive behaviors that cause harm or distress to a targeted individual (Gladden, Vivolo-Kanor, Hamburger, & Lumpkin, 2014). These intentional and repeated acts of aggression can greatly affect both the victim's and the perpetrator's mental and physical health (Gladden et al., 2014; Volk, Veenstra, & Espelage, 2017), even into adulthood (Byjos, Dusing, Zartman, & Cahill, 2016). Acts of bullying can be classified into three distinct categories: direct, indirect, and cyberbullying (American Occupational Therapy Association [AOTA], 2013). Direct bullying includes physical acts of aggression and verbal taunting or name-calling. Indirect bullying is characterized by relational acts of aggression such as spreading rumors. Finally, cyberbullying involves threatening or hurtful messages or images that are posted on social media or received through text or e-mail.

Question 12

School shootings most often occur in which environment?

Accepted Answer

School shootings are often concentrated in suburban and rural environments and are typically performed by white, middle-class individuals whose family members obtained firearms through legal channels (Bushman et al., 2016). Access to multiple firearms, including semiautomatic weapons, high levels of academic achievement, and symptoms of mental illness are commonly associated with individuals who perform school shootings (Bushman et al., 2016; Ferguson, Coulson, & Barnett, 2011).

Question 13

Most workplace assaults occur in which working environment?

Accepted Answer

The published data from the Bureau of Labor Statistics revealed that health-care workers were nearly four times more likely to require time away from work because of violence. Nearly 75% of the workplace assaults occurred in a health-care setting. For example, OSHA (2015) reports show that between 2011 and 2013, U.S. health-care workers suffered 15,000 to 20,000 serious workplace-violence-related injuries. The latest workplace violence statistics indicate that 80% of emergency medical services personnel are attacked by patients, while 78% of emergency department physicians have been attacked by patients (Lebron, 2017). Studies show that between 35% and 80% of hospital staff have been physically assaulted at least once during their careers (Clements, DeRanieri, Clark, Manno, & Kuhn, 2005).

Question 14

Andrea is a 38-year-old nurse who works nights at the local hospital. Which of the following has been linked to workplace violence in the health-care arena?

Accepted Answer

A wide range of factors related to specific tasks or situations and the organization of work have been identified as potential antecedents of workplace violence. Individuals working with people in need of physical or emotional care, or with substance or drug addiction, are at greater risk. Other specific high-risk tasks and situations include evening and night work, delivery of goods and services, shift work or working alone, on-location work, valuables handling, jobs that exercise physical control over others, and specific physical design features of the workplace (Chappell & Di Martino, 2006). Often, the potential for violence also arises when an employee needs to deny an individual's request, or when a request is made to do something an individual does not want to do. Conditions that may lead to higher stress levels in the workplace may include interpersonal conflicts, constant contact with the public, role ambiguity, low job control, time pressure, low-quality teamwork, and high workloads; situations such as these increase the risk of both external and internal violence. Terminations, demotions, layoffs, disciplinary actions, and unresolved or unsatisfied resolution of employee complaints and grievances are also considered contributing factors to incidents of workplace violence (Calabro & Baraniuk, 2003). For health-care providers, the quality of health care received by patients, which may include long waiting times and satisfaction with treatment, has been linked to workplace violence. Fatigue or stress resulting from high-strain work may also undermine the conflict management skills of workers, decreasing their ability to defuse potentially violent situations. Finally, workers may actually be the instigators of violent interactions due to anger or frustration caused by working under strain.

Question 15

One way to prevent elder abuse is to ensure that all paid caregivers:

Accepted Answer

Background checks are imperative when hiring a caregiver. The backgrounds of perpetrators may reveal problems with substance abuse, lack of training, or mental illness (CDC, 2018b). Educating and cautioning the service recipient and/or family members against hiring people from newspaper ads or by word of mouth may prevent future problems. Hiring assistants through an agency or hospital who complete comprehensive background investigations may help reduce the likelihood of victimization. If problems occur, the family can turn to the agency to help or intervene. When abuse is suspected from an independent provider, the family recourse is more cumbersome.

Question 16

One strategy to reduce falls and resident-to-resident mistreatment in nursing homes is:

Accepted Answer

In long-term care living (e.g., nursing homes), "resident-to-resident elder mistreatment (R-REM), although not often studied, occurs with relatively high frequency" (Teresi et al., 2018, p. 15). The study acknowledged that R-REM, including acts of aggression like pushing, often results in falls and other injuries. The study authors aimed to use the education of frontline staff (e.g., certified nursing assistants) focused on anticipating and intervening with R-REM to reduce falls and injuries. There was a reduction in falls in facilities where staff received the training. The authors hypothesized that this program might also be of use in assisted living and acute care settings.

Question 17

Tory is a school-based occupational therapist asked by the principal to develop a program to prevent bullying. Tory should consider programs that teach skills related to:

Accepted Answer

Focused interventions often center on the early identification of children and youth at risk for bullying (Jansen et al., 2012) and teaching social skills to potential victims (Cantone et al., 2015). However, the literature suggests that such bullying prevention programs are only somewhat effective, and that more effective programs target potential victims and perpetrators and focus on the development of empathy (Evans, Fraser, & Cotter, 2014). Effective programs teach children and youth to experience what others feel and include empathic skills training in a group setting (Van Noorden, Haselager, Cillessen, & Bukowski, 2015).

Question 18

An evidence-based approach focused on conflict management that can prevent school violence is:

Accepted Answer

Creating positive school environments that foster a sense of belonging for all students is an important universal intervention associated with reducing school violence (Bushman et al., 2016). The most effective interventions build a foundation of trust between youth and the adults who work in the school and include mechanisms to address peer conflict management (Bushman et al., 2016). Examples of ways conflict management is effectively addressed is through the use of peer juries, group conferencing, and peer mediation (Braithwaite, 1999).

Question 19

One effective strategy to ensure the prevention of workplace violence is annual:

Accepted Answer

Training both supervisors and employees regularly is an important element in prevention (Gallant-Roman, 2008). Both supervisors and employees must participate in the training so that buy-in is created from the top down. Training must be provided annually, and the content should focus on hazards found in the workplace, as well as the organization's prevention policies and procedures, highlighting reporting, review, response, and evaluation procedures.

Question 20

Greg is a school-based occupational therapist who notices consistent bruising on a 6-year-old with developmental delays. Greg is required to do what with this information?

Accepted Answer

A primary role of occupational therapy practitioners is in fulfilling their role as mandated health-care providers to report suspected child abuse and neglect. This is a serious legal and ethical responsibility. Procedures for reporting may vary across health-care facilities and from state to state, so the practitioners must familiarize themselves with state law and regulatory acts. Reports of child abuse and neglect should always be documented. Failure to do so would place the occupational therapy practitioners in violation of laws and the AOTA Occupational Therapy Code of Ethics (2015). In addition, given the high representation of women in the occupational therapy profession, it is statistically likely that a peer is currently or has previously experienced domestic violence (AOTA, 2017). Occupational therapy practitioners also have a responsibility beyond the care of individual clients or families in the prevention of children maltreatment and domestic violence. Other actions highlighted in Table 27-2 (WHO, 2016) are within the expertise and responsibility of occupational therapy practitioners, such as advocating for policies and laws as well as participating in and providing bystander training. A technical package provided by the NCIPC (2016) is a useful tool for the development of policy, advocacy, and programming activities.

Quiz 27: Violence Prevention and Mitigation Introduction