Chapter 7: Family Violence and Human Trafficking

Family Violence and Human Trafficking systematically categorizes maltreatment into four primary domains: intimate partner violence (IPV), which encompasses physical force, sexual assault, stalking, and psychological aggression, along with emerging threats like teen dating violence and cyber abuse; child abuse and neglect, detailing the severe consequences of emotional, physical, and sexual maltreatment and emphasizing the clinician's legal obligation for mandatory reporting; elder abuse, focusing on physical and psychological harm, caregiver neglect, and financial exploitation; and human trafficking, a global crisis of forced labor and commercial sex acts that disproportionately targets highly vulnerable populations, including unhoused individuals, undocumented migrants, and sexual and gender minorities (SGM). The text thoroughly analyzes the profound pathophysiological and psychological health consequences of trauma, ranging from acute traumatic brain injuries and reproductive complications to chronic systemic diseases and severe mental health disorders like posttraumatic stress disorder (PTSD) and depression. Furthermore, it addresses the intersection of genetics, environment, and societal stressors, highlighting how systemic discrimination, poverty, and legal fears create significant barriers to culturally appropriate care. Clinically, the chapter underscores the paramount importance of meticulous, unbiased forensic documentation. It instructs practitioners on using precise forensic terminology to distinguish between contusions, abrasions, avulsions, lacerations, and specific patterned injuries, alongside best practices for digital photographic evidence collection. Finally, it outlines evidence-based subjective screening methodologies—such as the Hurt, Insult, Threaten, Scream (HITS) tool, the Elder Abuse Suspicion Index (EASI), and the Danger Assessment for homicide risk—while guiding objective physical examinations to identify suspicious clinical presentations, such as atypical bruising on non-ambulatory infants, immersion burns, defensive wounds, and radiographic evidence of occult fractures.