HIPAA & ABUSE

1. HIPAA & ABUSE

2. Objectives ( HIPAA) At the end of the session the students will be know about the following: What is HIPAA? What is PHI? Patient’s Rights Potential consequences of breaking the law

3. Objectives (Abuse) At the end of the session the following will be known: What is neglect and or abuse What is domestic violence? Nursing responsibilities in the care abused client

4. Neglect – a situation wherein a basic need of the client is not being provided • Abuse - an incident involving some type of violation to the client • Domestic violence – is a pattern of controlling behavior and assaults including physical, sexual and psychological attacks and economic control that adolescents and adults use against their intimate partners

5. Nursing Responsibilities.. • Responsible for knowing the law especially mandatory reporting about domestic violence and abuse. • The National Domestic Violence HOTLINE 1800- 799 – 7233 ( SAFE)

6. Domestic abuse is most often one of the following: • child abuse • abuse of a spouse or domestic intimate partner • elder abuse

7. What is the definition of domestic abuse between intimate partners? • Domestic abuse between spouses or intimate partners is when one person in a marital or intimate relationship tries to control the other person. The perpetrator uses fear and intimidation and may threaten to use or may actually use physical violence. Domestic abuse that includes physical violence is called domestic violence.

8. The key elements of domestic abuse are: • intimidation • humiliating the other person • physical injury 

9. What are the types of domestic abuse? • The types of domestic abuse are: • physical abuse (domestic violence) • verbal or nonverbal abuse (psychological abuse, mental abuse, emotional abuse) • sexual abuse • stalking or cyberstalking • economic abuse or financial abuse • spiritual abuse

10. Physical abuse includes: • pushing, throwing, kicking • slapping, grabbing, hitting, punching, beating, tripping, battering, bruising, choking, shaking • pinching, biting • holding, restraining, confinement • breaking bones • assault with a weapon such as a knife or gun • burning • murder

11. What is emotional abuse or verbal abuse of a spouse or intimate partner? • Mental, psychological, or emotional abuse can be verbal or nonverbal. Verbal or nonverbal abuse of a spouse or intimate partner consists of more subtle actions or behaviors than physical abuse. While physical abuse might seem worse, the scars of verbal and emotional abuse are deep. Studies show that verbal or nonverbal abuse can be much more emotionally damaging than physical abuse.

12. Verbal or nonverbal abuse of a spouse or intimate partner may include: • threatening or intimidating to gain compliance • destruction of the victim’s personal property and possessions, or threats to do so • violence to an object (such as a wall or piece of furniture) or pet, in the presence of the intended victim, as a way of instilling fear of further violence • yelling or screaming • name-calling • constant harassment • embarrassing, making fun of, or mocking the victim, either alone within the household, in public, or in front of family or friends • criticizing or diminishing the victim’s accomplishments or goals • not trusting the victim’s decision-making • telling the victim that they are worthless on their own, without the abuser • excessive possessiveness, isolation from friends and family • excessive checking-up on the victim to make sure they are at home or where they said they would be • saying hurtful things while under the influence of drugs or alcohol, and using the substance as an excuse to say the hurtful things • blaming the victim for how the abuser acts or feels • making the victim remain on the premises after a fight, or leaving them somewhere else making the victim feel that there is no way out of the relationship

13. What is sexual abuse or sexual exploitation of a spouse or intimate partner? • Sexual abuse includes: • sexual assault: forcing someone to participate in unwanted, unsafe, or degrading sexual activity • sexual harassment: ridiculing another person to try to limit their sexuality or reproductive choices • sexual exploitation (such as forcing someone to look at pornography, or forcing someone to participate in pornographic film-making)

14. What is economic or financial abuse of a spouse or domestic partner? • Economic or financial abuse includes: • withholding economic resources such as money or credit cards • stealing from or defrauding a partner of money or assets • exploiting the intimate partner’s resources for personal gain • withholding physical resources such as food, clothes, necessary medications, or shelter from a partner • preventing the spouse or intimate partner from working or choosing an occupation

15. What is spiritual abuse of a spouse or intimate partner? • Spiritual abuse includes: • using the spouse’s or intimate partner’s religious or spiritual beliefs to manipulate them • preventing the partner from practicing their religious or spiritual beliefs • ridiculing the other person’s religious or spiritual beliefs • forcing the children to be reared in a faith that the partner has not agreed to

16. How do I know if I am in an abusive relationship? What are the signs and symptoms of an abusive relationship? • The more of the following questions that you answer Yes to, the more likely you are in an abusive relationship. Examine your answers and seek help if you find that you respond positively to a large number of the questions.

17. Are you fearful of your partner a large percentage of the time? • Do you avoid certain topics or spend a lot of time figuring out how to talk about certain topics so that you do not arouse your partner’s negative reaction or anger? • Do you ever feel that you can’t do anything right for your partner? • Do you ever feel so badly about yourself that you think you deserve to be physically hurt? • Have you lost the love and respect that you once had for your partner? • Do you sometimes fantasize about ways to kill your partner to get them out of your life? • Are you afraid that your partner may try to kill you? • Are you afraid that your partner will try to take your children away from you? • Do you feel that there is nowhere to turn for help? • Are you feeling emotionally numb? • Were you abused as a child?

18. Your partner’s lack of control over their own behavior • Does your partner have low self-esteem? Do they appear to feel powerless, ineffective, or inadequate in the world, although they are outwardly successful? • Does your partner externalize the causes of their own behavior? Do they blame their violence on stress, alcohol, or a “bad day”? • Is your partner unpredictable? • Is your partner a pleasant person between bouts of violence? • Your partner’s violent or threatening behavior • Does your partner have a bad temper? • Has your partner ever threatened to hurt you or kill you? • Has your partner ever physically hurt you? • Has your partner threatened to take your children away from you, especially if you try to leave the relationship? • Has your partner ever threatened to commit suicide, especially as a way of keeping you from leaving? • Has your partner ever forced you to have sex when you didn’t want to? • Has your partner threatened you at work, either in person or on the phone? • Is your partner cruel to animals? • Does your partner destroy your belongings or household objects?

19. Your partner’s controlling behavior • Does your partner try to keep you from seeing your friends or family? • Are you embarrassed to invite friends or family over to your house because of your partner’s behavior? • Has your partner limited your access to money, the telephone, or the car? • Does your partner try to stop you from going where you want to go outside of the house, or from doing what you want to do? • Is your partner jealous and possessive, asking where you are going and where you have been, as if checking up on you? Do they accuse you of having an affair?

20. Your partner’s diminishment of you • Does your partner verbally abuse you? • Does your partner humiliate or criticize you in front of others? • Does your partner often ignore you or put down your opinions or contributions? • Does your partner always insist that they are right, even when they are clearly wrong? • Does your partner blame you for their own violent behavior, saying that your behavior or attitudes cause them to be violent? • Is your partner often outwardly angry with you? • Does your partner objectify and disrespect women? Does your partner see you as property or a sex object, rather than as a person?

21. In my workplace, what are the warning signs that a person is a victim of domestic violence? • Domestic violence often plays out in the workplace. For instance, a husband, wife, girlfriend, or boyfriend might make threatening phone calls to their intimate partner or ex-partner. Or the worker may show injuries from physical abuse at home. • If you witness a cluster of the following warning signs in the workplace, you can reasonably suspect domestic abuse: • Bruises and other signs of impact on the skin, with the excuse of “accidents” • Depression, crying • Frequent and sudden absences • Frequent lateness • Frequent, harassing phone calls to the person while they are at work • Fear of the partner, references to the partner’s anger • Decreased productivity and attentiveness • Isolation from friends and family • Insufficient resources to live (money, credit cards, car) • If you do recognize signs of domestic abuse in a co-worker, talk to your Human Resources department. The Human Resources staff should be able to help the victim without your further involvement.

22. Reason for Domestic Violence • Individuals living with domestic violence in their households have learned that violence and mistreatment are the way to vent anger. Someone resorts to physical violence because • they have solved their problems in the past with violence, • they have effectively exerted control and power over others through violence, and • no one has stopped them from being violent in the past. • Some immediate causes that can set off a bout of domestic abuse are: • stress • provocation by the intimate partner • economic hardship, such as prolonged unemployment • depression • desperation • jealousy • anger

23. State Coalition List • California Alliance Against Domestic Violence926 J Street, Suite 210Sacramento, CA 95814(916) 444-7163 Fax: (916) 444-7165(800) 524-4765 NationwideWebsite: www.caadv.orgEmail: caadv@cwo.com • Statewide California Coalition for Battered Women3711 Long Beach Blvd. #718Long Beach, CA 90807(562) 981-1202 Fax: (562) 981-3202(888) 722-2952 NationwideWebsite: www.sccbw.orgEmail: sccbw@sccbw.org

24. What is the definition of child abuse? • Child abuse consists of any act or failure to act that endangers a child's physical or emotional health and development. A person caring for a child is abusive if he or she fails to nurture the child, physically injures the child, or relates sexually to the child.

25. What are the types of child abuse? • The four major types of child abuse are: • Physical abuse • Sexual abuse • Emotional abuse • Neglect • Child Exploitation

26. What is physical abuse? • Physical abuse is any non-accidental physical injury to a child. Even if the parent or caretaker who inflicts the injury might not have intended to hurt the child, the injury is not considered an accident if the caretaker's actions were intentional. This injury may be the result of any assault on a child's body, such as: • beating, whipping, paddling, punching, slapping, or hitting • pushing, shoving, shaking, kicking or throwing • pinching, biting, choking, or hair-pulling • burning with cigarettes, scalding water, or other hot objects. • severe physical punishment that is inappropriate to child's age.

27. What is sexual abuse? Sexual abuse of a child is any sexual act between an adult and a child. This includes: fondling, touching, or kissing a child's genitals making the child fondle the adult's genitals penetration, intercourse, incest, rape, oral sex or sodomy exposing the child to adult sexuality in other forms (showing sex organs to a child, forced observation of sexual acts, showing pornographic material, telling "dirty" stories, group sex including a child) other privacy violations (forcing the child to undress, spying on a child in the bathroom or bedroom) sexual exploitation enticing children to pornographic sites or material on the Internet luring children through the Internet to meet for sexual liaisons exposing children to pornographic movies or magazines child prostitution using a child in the production of pornography, such as a film or magazine

28. Other names for emotional abuse are: verbal abuse mental abuse psychological maltreatment or abuse Emotional abuse can range from a simple verbal insult to an extreme form of punishment. The following are examples of emotional abuse: ignoring, withdrawal of attention, or rejection lack of physical affection such as hugs lack of praise, positive reinforcement, or saying "I love you" yelling or screaming threatening or frightening negative comparisons to others belittling; telling the child he or she is "no good," "worthless," "bad," or "a mistake" using derogatory terms to describe the child, name-calling shaming or humiliating habitual scapegoating or blaming using extreme or bizarre forms of punishment, such as confinement to a closet or dark room, tying to a chair for long periods of time, or terrorizing a child parental child abduction

29. What is neglect? • Neglect is a failure to provide for the child's basic needs. The types of neglect are: • physical • educational • emotional • Physical neglect • Physical neglect is not providing for a child's physical needs, including: • inadequate provision of food, housing, or clothing appropriate for season or weather • lack of supervision • expulsion from the home or refusal to allow a runaway to return home • abandonment • denial or delay of medical care • inadequate hygiene • Educational neglect • Educational neglect is the failure to enroll a child of mandatory school age in school or to provide necessary special education.

30. Emotional (psychological) neglect • Emotional neglect is a lack of emotional support and love, such as: • not attending to the child's needs, including need for affection • failure to provide necessary psychological care • domestic violence in the child's presence, such as spousal or partner abuse • drug and alcohol abuse in the presence of the child, or allowing the child to participate in drug and alcohol use

31. What are the signs and symptoms of child abuse? • If you suspect child abuse, but aren't sure, look for clusters of the following physical and behavioral signs. • Some signs of physical abuse • Unexplained burns, cuts, bruises, or welts in the shape of an object • Bite marks • Anti-social behavior • Problems in school • Fear of adults • Drug or alcohol abuse • Self-destructive or suicidal behavior • Depression or poor self-image

32. Some signs of emotional abuse • Apathy • Depression • Hostility • Lack of concentration • Eating disorders

33. Some signs of sexual abuse • Inappropriate interest in or knowledge of sexual acts • Seductiveness • Avoidance of things related to sexuality, or rejection of own genitals or bodies • Nightmares and bed wetting • Drastic changes in appetite • Overcompliance or excessive aggression • Fear of a particular person or family member • Withdrawal, secretiveness, or depression • Suicidal behavior • Eating disorders • Self-injury

34. Some signs of neglect • Unsuitable clothing for weather • Being dirty or unbathed • Extreme hunger • Apparent lack of supervision

35. What are the causes of child abuse? • Why would someone abuse a child? What kind of person abuses a child? Not all abuse is deliberate or intended. Several factors in a person's life may combine to move them toward abusing a child: • general stress • the stress of having children in the family, when one didn't have children before • dealing with a child who has a disability or difficult behaviors • the stress of caring for someone besides oneself • a personal history of being abused (childhood trauma) • alcohol or drug use • marital conflict • unemployment

36. From any state, to get immediate guidance and help when you suspect child abuse, call the Childhelp USA National Child Abuse Hotline:1-800-4-A-CHILD (1-800-422-4453)

37. What is the definition of elder abuse? • Elder abuse is the intentional or unintentional hurting, either physical or emotional, of a person who is age sixty or older. • What are the types of elder abuse? • Elder abuse usually occurs in one of two locations: • domestic elder abuse (in the elder's home) • institutional elder abuse (in a nursing home or other long-term-care facility)

38. The types of senior abuse are: • Physical abuse of the elderly • Emotional abuse of the elderly (psychological or verbal) • Neglect or abandonment of elders by caregivers • Self-neglect by elders • Sexual abuse of the elderly • Financial exploitation of seniors (elder financial abuse) • Healthcare fraud or healthcare abuse of the elderly

39. What is physical abuse of the elderly? • Physical abuse is • physical force that results in injury, impairment, or physical pain, or • the threat of such physical force • Physical violence against an elder in the home is a form of domestic violence. • The injury from physical abuse may be from physical punishment of any kind, such as: • assault (for example, during a mugging) • beating, whipping, hitting (with or without an object), paddling, slapping, or punching • pushing, shoving, shaking, choking, or throwing • kicking, pinching, biting, or scratching • spitting, force-feeding, hair-pulling, or burning • inappropriate use of drugs and physical restraints • rough handling during caregiving, moving the body, or administration of medicines

40. What is emotional abuse of an elder? • Emotional elder abuse is a verbal or nonverbal act that inflicts emotional pain, anguish, or distress on the elder. It is sometimes also known as verbal abuse, mental abuse, or psychological abuse. • Emotional elderly abuse is almost always accompanied by another form of abuse, such as physical abuse. Emotional abuse of the elderly can range from a simple verbal insult to an extreme form of verbal punishment. The following are examples of emotional abuse: • ignoring the elder, yelling or screaming • isolating an elderly person from family, friends, or regular activities • habitual scapegoating or blaming • harassment, name-calling, cursing, humiliating, insulting, or ridiculing • threatening to punish or deprive, intimidating • treating an elder like an infant • using extreme or bizarre forms of punishment, such as confinement to a closet or dark room, tying to a chair for long periods of time, or terrorizing

41. What is sexual abuse of the elderly? • Elder sexual abuse is sexual contact with an elder without that person's consent. This includes: • coerced nudity • fondling, touching, or kissing, particularly the genitals • making the elderly person fondle someone else's genitals • forcing the elder to observe sexual acts • photographing the elder in sexually explicit ways • sexual assault of any type (coercion to perform sexual acts), including rape or sodomy • showing the elder pornographic material • spying on the elder in the bathroom or bedroom • telling "dirty" stories

42. What is financial exploitation of the elderly? • cashing an elder's checks without authorization • using the elder's charge card number for one's own benefit • handling an elder's money without durable power of attorney (which authorizes the person to manage the elder's finances) • withdrawing cash from an elder's bank account with an ATM card, without the elder's permission • scamming an elder by convincing him or her to withdraw money from the bank, and then taking the money • stealing elders' checks, such as Social Security checks or pension checks, from the U.S. mail • identity theft, including collecting checks and cashing them after the person has died • convincing or forcing an elder to sign a contract that results in unwanted financial or material commitments

43. convincing or forcing an elder to alter a will to benefit someone that a clear-thinking elder would not have chosen • enrolling a senior in unneeded services or subscriptions • getting donations from an elder under false pretenses • defrauding an elder so that they sign up for a particular investment opportunity that isn't really appropriate (investment fraud) • giving the elder incorrect change for a purchase in a store • stealing household goods or money while caring for an elder • telemarketing fraud • selling sweepstakes entries where the elder is extremely unlikely to win anything • forging the senior's signature • in a long-term-care facility, not depositing resident funds in separate interest-bearing accounts • embezzling • marrying someone for his or her money, either for a current lifestyle change or to inherit their money after death

44. California888-436-3600800-231-4024In-state only Adult Protective Services County Contact List