Supporting PCPs: Responding to Abuse

Primary care providers (PCPs) are often the first line of defense in identifying and responding to abuse and crisis situations. Whether it's child abuse, partner violence in the home, or substance use, PCPs play a crucial role in recognizing warning signs and knowing the appropriate steps to take. 

Whether you learned the signs yesterday or thirty years ago, it always helps to brush up on the basics when watching for abuse. Let’s get into it:

Identifying Abuse and Neglect

During physical exams, PCPs are always vigilant for any indications of abuse. Some of the common signs of physical abuse can include:

• Bruises in the shape of a handprint, belt, or other objects
• Unexplained fractures or burns
• Frequent injuries with inconsistent explanations

Neglect can manifest as:

• Signs of malnutrition or dehydration
• Poor hygiene and inappropriate clothing for the weather
• Chronic absenteeism from school
• Medical neglect, such as failure to seek care for serious conditions

Questions like, Do you feel safe at home? can open the door for disclosures. Similar to the questions and reactions I shared in the Talking Suicide Prevention piece, it’s all about giving the child space to share without creating pressure or fear. 

Mandatory Reporting and State Variations

Every state has mandated reporting laws for suspected child abuse, but reporting processes differ. For minors (17 and under), cases are typically reported to the Department of Health and Human Services or child protective services. For adults experiencing abuse, mandated reporting varies by state and often involves law enforcement. Given these differences, it helps for PCPs to stay abreast of any changes with their local reporting requirements through their state’s Department of Health and Human Services.

If your practice hasn’t confirmed these requirements lately, it could be a good time to check in.

Substance Use and Screening

Substance use often intertwines with abuse and neglect. Children living in homes where parents abuse substances may experience neglect or direct harm. Substance use in children and adolescents is also a growing concern, with some starting as young as 8 or 9 years old.

Screening for substance use should start early. While screenings often begin in the teenage years, research shows that early exposure—often through family members or peers—can be a precursor to long-term addiction. Signs of substance use include:

• Social withdrawal or risky behavior
• Declining academic performance
• Frequent mood swings or agitation

PCPs are careful to incorporate urine drug screens when substance use is suspected, particularly if a patient presents with depression, anxiety, or behavioral changes.

When Is Substance Use a Crisis?

Obviously substance use isn't just a concern when it becomes habitual. Binge use, blackouts, or participation in risky drug-related behaviors (e.g., "Skittles parties," where mixed prescription drugs are consumed) can constitute a crisis.

One major concern is fentanyl-laced substances that can lead to fatal overdoses even with a single use. Many young people unknowingly take fentanyl because it is mixed into counterfeit prescription medications. Educating patients about these dangers, even if they aren't using drugs themselves, can be lifesaving.

For an updated list of drug street names and slang, PCPs can refer to the DEA’s Drug Slang Reference Guide. Staying on top of the evolving language of substance use helps us recognize when a patient may be referencing drug activity.

Basics for PCPs

1. Screen early and consistently. Begin substance use screenings earlier than the teenage years, particularly for at-risk patients.
2. Know your state’s reporting requirements. Each state has different processes for reporting abuse—check with your local Department of Health and Human Services.
3. Recognize crisis situations. Abuse, neglect, and extreme substance use behaviors should prompt immediate intervention, whether through social services, law enforcement, or crisis response teams.
4. Educate patients and caregivers. Many families do not recognize the risks of prescription medications, fentanyl, or binge drinking. Providing education on these topics can be preventative.

PCPs play a vital role in protecting patients from abuse and substance-related harm. By staying informed, they ensured their patients receive the support they need.

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