August, 2009 bap

1. Abuse: Recognizing and ReportingPresented by: APS HealthcareSouthwestern PA Health Care Quality Unit(HCQU) August, 2009 bap

2. Disclaimer Information or education provided by the HCQU is not intended to replace medical advice from the consumer’s personal care physician, existing facility policy or federal, state and local regulations/codes within the agency jurisdiction. The information provided is not all inclusive of the topic presented. Certificates for training hours will only be awarded to those who attend a training in its entirety. Attendees are responsible for submitting paperwork to their respective agencies.

3. Note of Clarification While mental retardation (MR) is still recognized as a clinical diagnosis, in an effort to support the work of self-advocates, the APS SW PA HCQU will be using the terms intellectual and/or developmental disability (I/DD) to replace mental retardation (MR) when feasible.

4. 0BJECTIVES The participant will: • Describe types of abuse • List signs of abuse • Discuss the steps necessary to report abuse

5. DEFINITIONS OF ABUSE “Maltreatment: the physical, psychological, or sexual maltreatment of a person” (Encarta Dictionary) “Infliction of injury, unreasonable confinement, intimidation, punishment, mental anguish, sexual abuse, or exploitation” (PA Office of Developmental Program)

6. TYPES OF ABUSE • Neglect • Physical Abuse • Unauthorized / Inappropriate Restraint • Psychological/Emotional Abuse • Sexual Abuse • Verbal Abuse • Financial Abuse / Misuse of Funds • Rights Violation

7. NEGLECT • Failure to obtain or provide needed services and supports as: • Defined by an individual’s plan • Required by law or regulation

8. SIGNS OF NEGLECT • Lack of supervision • Disregard for necessities-food, clothing, shelter • Lack of medical care • Unattended personal hygiene • Unsanitary living conditions • Unsafe living conditions

9. PHYSICAL ABUSE DEFINED • An intentional physical act • Causes or may cause physical injury

10. EXAMPLES OF PHYSICAL ABUSE • Striking • slapping, punching, hitting, scratching, kicking • Applying potentially harmful substances or conditions • Use of improper or unauthorized restraints

11. Unexplained injuries Bruises Swelling Cuts Burns Welts Scratches Sprains Medication or substance abuse Unusual crying, acting out, becoming emotional Complaints by consumer Self-isolation Behavior changes or extremes SIGNS OF PHYSICAL ABUSE

12. RESTRAINTS TYPES Physical Chemical Mechanical Used to control acute, episodic behavior that restricts movement or function of all or portions of the individual’s body.

13. ABUSE AND UNAUTHORIZED RESTRAINTS • Performing a restraint that is not approved as part of an individual’s plan • Performing a restraint for a reason other than a crisis situation

14. PSYCHOLOGICAL / EMOTIONAL ABUSE • Acts, other than verbal, which may: • Inflict Emotional Harm • Intentionally ignoring an individual requesting attention • Invoke Fear or Humiliation • Laughing at an individual’s mistakes

15. PSYCHOLOGICAL / EMOTIONAL ABUSE • Acts, other than verbal, which may: • Intimidate • Posturing or showing body language that appears threatening • Degrade or Demean • Showing disgust or disdain towards an individual’s actions, especially in front of others

16. SIGNS OF PSYCHOLOGICAL/ EMOTIONAL ABUSE • Low self-esteem • Behavioral extremes • Emotional upset • Self-blaming

17. SEXUAL ABUSE • Acts or attempted acts of: • Rape • Incest • Sexual Molestation • Sexual Exploitation • Sexual Harassment • Inappropriate or Unwanted Touching by another

18. SEXUAL ABUSE • Any sexual contact between staff and an individual • Any sexual exposure of staff to an individual • Unwanted sexual exposure or contact from another individual

19. Difficulty walking and/or sitting Torn, stained, bloody clothing Genital pain or itching External genitalia bruising/bleeding STD’s Pregnancy Inappropriate or sudden knowledge Nightmares Bedwetting Dramatic changes SIGNS OF SEXUAL ABUSE

20. VERBAL ABUSE Verbalizations that do or may: • Inflict Emotional Harm • Invoke Fear • Humiliate • Intimidate • Degrade or Demean

21. VERBAL ABUSE Verbalizations that: • Inflict Emotional Harm • “You’re so dumb!” • Invoke Fear or Humiliation • “If you make a mess at dinner again, you are going to be sorry!”

22. VERBAL ABUSE Verbalizations that: • Intimidate • “Come on, I dare you!” • Degrade or Demean • “Take off your pants! The doctor needs to check you out!”

23. SIGNS OF VERBAL ABUSE • Low self-esteem • Behavioral extremes • Emotional upset • Self-blaming

24. MISUSE OF FUNDS/FINANCIAL ABUSE • Intentional act resulting in loss or misuse of individual’s money or personal property • Requiring an individual to pay for a service that is normally provided • Requiring an individual to pay for items used by several individuals

25. Count and document each individual’s money Report discrepancies in funds immediately Avoid co-mingling of funds Be aware of budgets and spending limits When in doubt, seek guidance AVOIDING FINANCIAL ABUSE

26. RIGHTS VIOLATION An act which is intended to improperly restrict or deny the human or civil rights of an individual including those rights which are specifically mandated under applicable regulations. This does not include restrictions that are imposed by court order or consistent with a waiver of licensing regulations.

27. EXAMPLES OF RIGHTS VIOLATIONS • Unauthorized removal of personal property • Refusal of access to the telephone • Privacy violations • Breach of confidentiality

28. BILL OF RIGHTS Review Yearly • To help understand • To help embrace • To help live

29. INDIVIDUAL TO INDIVIDUAL ABUSE DEFINED • ODP’s IM Bulletin Definition “An interaction between one individual receiving service and another individual receiving services resulting in the allegation or actual occurrence of the infliction of injury, unreasonable confinement, intimidation, punishment, mental anguish, sexual abuse or exploitation.”

30. INDIVIDUAL TO INDIVIDUAL ABUSE:Defining Intention • Definition: • “A determination to act in a certain way” • Intent relates to the conduct or contact itself. It is abusive if the target (aggressor) performed the abusive act intentionally. • Questions to help determine intent

31. EFFECTS OF INDIVIDUAL TO INDIVIDUAL ABUSE • Types of abuse remain the same • Signs of abuse remain the same • Causes same traumatic effects as abuse perpetrated by anyone else • Should be reported

32. REPORTING ABUSE:When an Individual Self-Reports • Self-reports of abuse should not be dismissed or ignored • Ensure individual’s immediate safety and well-being • Seek professional assistance as needed • Report per agency guidelines and state regulations

33. REPORTING ABUSE: Allegations of Abuse • All allegations of abuse are reportable • Allegations can come from victims or other eyewitnesses • Allegations can’t always be proven, but must be reported

34. IF ABUSE IS WITNESSED • Report IMMEDIATELY • Intervene as needed • Reassure the individual • Follow agency policy • Review incident management bulletin

35. REFERENCES • Beth Barol, Ph.D. (2009, June). Peer to Peer Violence: Do We Make aDifference?. Peer to Peer Abuse and Violence Training, Cranberry, PA. • Office of Developmental Programs (2004, February). Bulletin: I6000-04-01 INCIDENT MANAGEMENT . Retrieved August 10, 2009 from Office of Developmental Programs, Western Region, Pennsylvania Department of Public Welfare Web site: http://www.odpconsulting.net/index.php?option=com_docman&task=cat_view&gid=163&Itemid=73 • ODP Western Region (2009, June). Understanding Individual to Individual Abuse. Peer to Peer Abuse and Violence Training, Cranberry, PA.

36. REFERENCES • ODP Western Region (2009, June). Individual to Individual Abuse and HCSIS. Peer to Peer Abuse and Violence Training, Cranberry, PA. • Intention. (2009). In Merriam-Webster Online Dictionary. Retrieved August 11, 2009, from http://www.merriam-webster.com/dictionary/Intention Abuse. (2009). In Encarta Online Dictionary. Retrieved August 11, 2009, from http://encarta.msn.com/dictionary_1861583143/abuse.html