Presentation on theme: "Michael Hansen, Director"— Presentation transcript:
1Michael Hansen, Director The Silent Epidemic: Abuse, Neglect, and Exploitation of Individuals with Developmental Disabilities Family Café Presentation June 2012Rick Scott, GovernorMichael Hansen, Director
3Objectives Understand nature and prevalence of the problem Learn to recognize common signs and symptoms of abuse, neglect, and exploitation and what actions to takeKnow the best ways to prevent such crimes before they occur
4Statutory Definitions There are a number of laws in Florida which define and describe abuse, neglect and exploitation committed against children and adults with developmental disabilities by their caregivers (either paid or unpaid).
5Child Abuse"Abuse" means any willful act or threatened act that results in any physical, mental, or sexual injury or harm that causes or is likely to cause the child's physical, mental, or emotional health to be significantly impaired. Abuse of a child includes acts or omissions. Corporal discipline of a child by a parent or legal custodian for disciplinary purposes does not in itself constitute abuse when it does not result in harm to the child From Section 39.01(2), Florida Statutes
6Adult Abuse"Abuse" means any willful act or threatened act by a relative, caregiver, or household member which causes or is likely to cause significant impairment to a vulnerable adult's physical, mental, or emotional health. Abuse includes acts and omissions.From Section (1), Florida Statutes
7Examples of AbuseHitting, pushing, hair pulling, choking, kicking, biting, assault, or rough/inappropriate handling.Inappropriate/overuse of restraintsOver-medicating or inappropriate behavioral interventions (including bizarre punishments)Verbal harassment and threatsUnwanted sexual touching of private body partsUnwanted display of sexual parts (pornography, exhibitionism)Tricking or manipulating someone into sexual activity, sexual assault, or rape.
8Examples of Physical Abuse in Caregiving Rough physical handlingSudden movements of beddingPushing and pullingOver-medicationUnnecessary or excessive use of restraintsBathing in water that is too hot or too cold
9Examples of Emotional Abuse Exposure to domestic violenceInsults and harassmentDenial of conditions necessary for physical and emotional well-beingDenial of communicationDenial of right to family lifeDenial of social interaction and inclusionDenial of economic stabilityDenial of rights, needs, privileges, and opportunitiesDenial of ordinary freedoms
10Frightening Physical Actions Grabbing persons with visual impairments from behindJumping in front of persons with visual impairments, or trying to trip themAbruptly moving persons with mobility impairmentsForcing persons with physical disabilities to move from one position to another when they are exhausted or in pain
11From Section 39.01(45), Florida Statutes Child Neglect“Neglect" occurs when a child is deprived of, or is allowed to be deprived of, necessary food, clothing, shelter, or medical treatment or a child is permitted to live in an environment when such deprivation or environment causes the child's physical, mental, or emotional health to be significantly impaired or to be in danger of being significantly impaired….Neglect of a child includes acts or omissions.From Section 39.01(45), Florida Statutes
12Neglect of an Adult"Neglect" means the failure or omission on the part of the caregiver or vulnerable adult to provide the care, supervision, and services necessary to maintain the physical and mental health of the vulnerable adult, including, but not limited to, food, clothing, medicine, shelter, supervision, and medical services, which a prudent person would consider essential for the well-being of a vulnerable adult. The term "neglect" also means the failure of a caregiver or vulnerable adult to make a reasonable effort to protect a vulnerable adult from abuse, neglect, or exploitation by others. "Neglect" is repeated conduct or a single incident of carelessness which produces or could reasonably be expected to result in serious physical or psychological injury or a substantial risk of death From Section (15), Florida Statutes
13Self-NeglectFlorida law was recently changed to include a category under neglect of an adult called "self-neglect."Besides possibly being neglected by a caregiver, the potential exists for people to neglect themselves because of either their age or disability.Anyone who knows or suspects that an adult with a developmental disability is the victim of self-neglect must report such information.
14Examples of NeglectNot working assigned hours or not performing dutiesMistreating service animalsWithholding medications, food, medically necessary treatment, or assistive equipmentWithholding necessary personal/medical care (such as re-positioning individuals with mobility impairments)Ignoring dietary restrictionsLeaving individuals alone without a way to call for helpNot providing appropriate levels of supervision which result in harm to person.Leaving individuals in bed all day or not getting them dressedLeaving individuals on the toilet or in soiled undergarments for long periods of time
15Examples of Environmental Neglect Injury caused by leaving a loaded gun or other weapon accessible to the personUnsanitary/unsafe living conditionsInadequate clothing (especially for the prevailing weather conditions)Inadequate food
16Exploitation “Exploitation" means a person who: 1. Stands in a position of trust and confidence with a vulnerable adult and knowingly, by deception or intimidation, obtains or uses, or endeavors to obtain or use, a vulnerable adult's funds, assets, or property with the intent to temporarily or permanently deprive a vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult; or2. Knows or should know that the vulnerable adult lacks the capacity to consent, and obtains or uses, or endeavors to obtain or use, the vulnerable adult's funds, assets, or property with the intent to temporarily or permanently deprive the vulnerable adult of the use, benefit, or possession of the funds, assets, or property for the benefit of someone other than the vulnerable adult.From Section (7), Florida Statutes
17Examples of Exploitation Using the car, money or other possessions of someone with a disability without their consent.Tricking or threatening the person to purchase an item or service that they do not want or that will not be used for their benefit.
18The Sexual Misconduct Law Florida Statutes now include a new crime called “sexual misconduct” which is defined as any sexual activity between a service provider and certain individuals with developmental disabilitiesMakes the crime punishable as a second degree felonyMakes failure to report known or suspected cases of sexual misconduct a first degree misdemeanorEliminates consent by the consumer as a valid defense against prosecution for this crimeExpands Level 1 and 2 background screening requirements to include the newly-created crime of sexual misconduct as a disqualifying offense for employment(From , Florida Statutes)
19Aggravated Abuse of an Elderly Person or Disabled Adult "Aggravated abuse of an elderly person or disabled adult" occurs when a person:(a) Commits aggravated battery on an elderly person or disabled adult(b) Willfully tortures, maliciously punishes, or willfully and unlawfully cages, an elderly person or disabled adult; or(c) Knowingly or willfully abuses an elderly person or disabled adult and in so doing causes great bodily harm, permanent disability, or permanent disfigurement to the elderly person or disabled adult.A person who commits aggravated abuse of an elderly person or disabled adult commits a felony of the first degree, punishable as provided in s , s , or sFrom Section (2), Florida Statutes
20Incidence StudiesMuch research has been done which shows the high rate of abuse, neglect, and exploitation committed against people with disabilities.
21What does the data say?An estimated 90% of people with mental retardation will experience sexual violence at least once during their lives.Another study showed that, among children with disabilities, 61% of girls and 25% of boys had been sexually abused before the age of 18.Compared to children without disabilities, children with mental retardation were:3.7 times as likely to have been neglected3.8 times as likely to be physically abused4.0 times as likely to be sexually abused3.8 times as likely to be emotionally abused
22Additional research…A 2006 study involving over 7,000 women with and without disabilities revealed that the women with disabilities were 40% more likely than their disabled peers to have been the victims of domestic violence.Of 177 women with physical disabilities, 56% reported having been abused during their lifetime.A survey of 342 men with disabilities who used personal care assistance services found that 55% had experienced physical abuse while 25% had been sexually abused.Only 3% of sexual abuse cases (involving people with developmental disabilities) are ever reported.
23Frequency of Sexual Abuse (1 time)( times)(10 + times)Source: “The sexual abuse of young people with disabilities: Treatment considerations”, Mansell, Sobsey and Calder, 1992
24Frequency of Exploitation A 2001 study conducted by the National Association of Adult Protective Service Administrators (NAAPSA) reported 38,015 documented reports of financial exploitation committed against elderly and vulnerable adults.It is believed that only 1 in 14 cases get reported, meaning that the number of yearly cases of financial exploitation could be as high as 850,000.
25Why are people with developmental disabilities more likely to be victimized? may be physically unable to defend themselvesmay require assistance with the most personal and intimate activities of daily livingmay be unable to report the crimemay not be considered credible reportersmay be unable to differentiate between appropriate and inappropriate touchingare often taught to be passive and compliantmay be coerced or threatened with the withholding of needed care or equipmentmay be socially isolated
26Risk Factors Dependence on others for long-term care Lack of economic independenceReceives services in segregated settingsLack of participation in abuse awareness and personal safety programsLess education about sexuality and healthy intimate relationshipsSocial isolationOverprotectionCommunication challengesPhysical barriers to accessing supports and services (such as lack of transportation or inaccessible domestic violence/sexual assault shelters)**Source: “Combating Violence & Abuse of People with Disabilities: A Call to Action.” By Nancy Fitzsimmons. Baltimore, Maryland: Paul H. Brookes Publishing Company, 2009.
27Common Case Characteristics People with developmental disabilities are more likely to experience:Different types of abuse, neglect, and exploitationMultiple perpetratorsAbuse, neglect, and exploitation which is more severe and lasts for longer periods of time than people without disabilitiesAbused more frequently than othersLess able to escape the abuse, find justice or servicesMore likely to remain in situations that increase their vulnerability and risk of repeated abuse
28Where does abuse, neglect, and exploitation most often occur? Family HomeAssisted LivingFacilityApartmentFoster HomeIntermediateCare FacilityGroup Home
29Who are the Abusers? WHO IS A TYPICAL ABUSER? HOW OLD ? WHAT RACE? WHAT GENDER?
30CHARACTERISTICS OF AN ABUSER can represent any racial, religious, or socioeconomic groupare most frequently male (for sexual abuse)are usually known to the victimcan be of any ageANYONE WITH A HISTORY OF BEING A ABUSER IS AT HIGH RISK OF DOING SO AGAIN!!!
31Profiles of Abusive Caregivers Caregivers with limited capacityStressed caregiversBatterers (intentional abusers)Caregivers with Munchausen Syndrome by Proxy (MSBP) or other Factitious Disorders
32Behaviors of Caregivers who may be Abusers Refusal to follow directions or complete necessary personal tasksDisplaying controlling attitudes and behaviorsShowing up late or not at allWorking under the influence of alcohol or illegal drugsAbusing or harming pets or service animalsUsing threats or menacing looks/body language as a form of intimidationImpulsive
33More abusive caregiver behaviors... Using vehicle, money or other resources without consentSocially isolating person with a disability (including limiting educational and/or employment opportunities)Devalues the person with developmental disabilitiesFrequently switches healthcare providersSpeaks for the person with developmental disabilitiesCompetes with the person with developmental disabilities for attentionDisplays unwelcoming or uncooperative attitude during home visitsFrequently makes attempts to be alone with a particular individual for no apparent legitimate purpose
34Abusive caregivers may also have… Low self-esteemA mental illness, diminished intelligence, or impaired functioningA need to control othersFrustration with authority, which can lead to displaced aggression toward weaker personsA history of being abused or neglected as a childA lack of attachment to the dependent person, (which can lead to thoughts by the abuser that the victim doesn’t feel or hurt in response to their abusive actions).
35WHAT ARE SOME SIGNS AND SYMPTOMS OF ABUSE, NEGLECT AND EXPLOITATION WHAT ARE SOME SIGNS AND SYMPTOMS OF ABUSE, NEGLECT AND EXPLOITATION? IF YOU HAD TO CHOOSE ONE THING THAT WOULD BE THE MOST IMPORTANT INDICATOR, WHAT WOULD IT BE?
36The single most important thing to look for in a person with a developmental disability to indicate the possibility of abuse, neglect, or exploitation is change. A sudden or gradual change in appearance or behavior should always be noted and monitored.
37Physical Signs of Abuse BruisesBurnsCutsBroken bonesSprainsScrapes or AbrasionsBleeding from the ears, nose or mouth
38Questionable Bruises Facial Frequent, unexplained, or inadequately explainedIn unlikely placesIn various stages of healingOn several different surface areasPatterned, reflecting shapesBilateral: means bruises on same places on both sides of the body. Bruises appearing on both upper arms, for example, may indicate where the abuser applied pressure while forcefully shaking the person. Bruises on both sides of the body rarely result from accidental causes.Regularly evident after an absence, home visit, or vacation
39Questionable Cuts and Scrapes Frequent, repeated, unexplained, or inadequately explained scrapesUnusual locations such as mouth, lips, gums, eyes, external genitalia (e.g., places other than palms, knees, or other areas usually covered by clothing)Patterned scarring that may be caused by inflicted injuries such as whipping
40Burns or ScaldsPatterned burns (shaped like a cigarette butt or electrical appliance for example)Burns in specific locations such as several burns on different parts of the body or on particularly sensitive locations, such as soles, palms, back, or buttocksImmersion burns, which appear sock-like, glove-like, or doughnut-shaped on buttocks, genitalia, or limbs
41BitesHuman bite marks are easily distinguished from those of animals by their size and shape (human bite marks are arch-shaped while dog bites are typically in a shape of points) and whether flesh is torn (human bites typically don’t result in the tearing of flesh).If bites are explained as self-inflicted, the location and position of the bite must be consistent with the person’s functional abilities.
42Ligature Marks and Welts Could be the result of a whipping, being tied up, or gaggedWelts often follow clearly defined stroke patterns, especially if the person was immobile during the whippingChafing and bruising, sometimes accompanied by swelling, on the wrists, ankles, throat, or penis can be the result of being tied up or chokedEven when choking is severe or fatal, bruising may be faint or entirely absent
43Eye and Ear Injuries Sudden or unexplained hearing loss Cauliflower ears (i.e., thickened external ear structures)Bruising to the outer earsBlood behind the eardrumRetina hemorrhage or other intraocular bleeding
44Dental and Mouth Injuries Lost or broken teeth, particularly if unrelated to dental disease, normal loss of children’s teeth, or accidental causesRepeated, unexplained, or inadequately explained dental injuriesFacial bone or jaw fracturesBruising of cheeks and gums at corners of mouth (from gags)Cuts or bruises on the tongueDiscoloration of the teeth as a result of previous abuse
45Dislocations of Joints Repeated dislocations of joints in the absence of a known disease process may indicate shaking, twisting, or pullingFrequent or multiple dislocations in the absence of a clear explanation may indicate physical abuse
46FracturesRepeated or multiple fractures in the absence of a known disease process or clear explanation may indicate abuseOld, untreated fractures can indicate chronic abuseSpiral fractures that result from twisting limbs may be related to abuse in non-ambulatory children and adults with developmental disabilities
47ComaShaking and other forms of abuse can result in coma of undetermined origin without external injuries. Comas not associated with known accidental causes or clearly identified disease processes should also be suspected.
48Things to consider in distinguishing abuse from accidental injuries... Location of the injuryNumber and frequency of injuriesSize and shape of injuryDescription of how the injury occurredConsistency of the injury with the person’s developmental capability
49Physical Signs of Sexual Abuse Frequent urinary tract infections or yeast infectionsPainful urinationAbrasions, bleeding, or bruising in the genital areaIncontinence in someone who was previously toilet-trainedFrequent sore throatsSudden onset of psychosomatic complaints (males most frequently complain of stomach aches while females most frequently report headaches)Sudden difficulty walking or sittingVaginal or rectal pain
50Physical Signs of Neglect BedsoresDehydrationPoor or improper hygieneMalnourishment/weight lossLack of necessary adaptive aids (such as hearing aids, eyeglasses, walkers, etc.)Improper medication management
51Behavioral SignsCHANGES in the way affection is shown, especially if unusual or inappropriateSuddenly fears being touchedSudden onset of nightmaresCHANGES in sleep patterns; difficulty sleepingSudden regression to childlike behaviors (i.e., bed-wetting, thumb-sucking)Sudden unusual interest in or knowledge of sexual matters (including excessive masturbation)Cruelty to animalsSudden fear of bathing or toiletingSudden fear of a person or placeDepression, withdrawal, or mood swingsANY UNEXPLAINED CHANGE IN BEHAVIOR
52Signs and Symptoms of Exploitation Sudden decrease in bank account balancesSudden change in banking practices (such as making several large withdrawals from a bank account or ATM over a period of several days instead of one small withdrawal each week)Sudden problems paying bills or buying food or other necessitiesSudden changes in wills or other financial documents
53More signs of exploitation... The person begins to act very secretively. (Telephone con artists often try to isolate their victims to avoid detection by telling the victim not to let anyone know about their calls.)Unexplained disappearance of money or valuable possessionsSubstandard care being provided or bills which are late or unpaid despite the availability of adequate financial resourcesConcerns expressed by a person with a developmental disability that he or she is being exploited
54Factors That Make it Hard to Recognize Abuse, Neglect and Exploitation Victim does not recognize abuse, neglect, or exploitationCommunication challenges (which prevent both disclosure of the event and resulting problems)Self-abusive behaviorsSome symptoms may be interpreted as behavioral problems or traits of their disabilityThere is no universal response to abuse, neglect or exploitation. Every individual responds differently, and in some cases there may be no outward signs at all.
55Conditions that can Sometimes Look Like Abuse or Neglect Injuries due to fallsSensory impairmentsSkin breakdown from appliances or orthopedic equipmentSelf-injurious behavior (SIB)Poor growth and failure to thriveFracturesSensory integration problemsMongolian spots
56Mandatory Reporting Requirements Failure to report known or suspected cases of abuse, neglect, or exploitation is a crime.Keep in mind that service providers can also lose their jobs and/or face legal action for failing to report.When in doubt, report; it is always better to make a mistake on the side of caution to keep people safe from harm.Reports should be made even if the incident happened a long time ago or in a school.
57A word about “Mandatory” Reporters… Abuse/neglect reporting laws were changed a few years ago so that any person who has knowledge or suspicion that a child or a vulnerable adult is being abused, neglected, or exploited is now required by law to report such information.Certain professions (identified in statute) are, however, required to provide their name when reporting while all others may submit reports anonymously if they prefer.
58How to Report Abuse, Neglect, or Exploitation The Department of Children and Families (DCF) operates the Florida Abuse Hotline and is the state agency responsible for receiving and investigating allegations of abuse, neglect, or exploitation of children and adults with developmental disabilities committed by their caregivers.If you know or suspect abuse, neglect, or exploitation, call the Abuse Hotline, which is a nationwide, toll-free telephone number, at ABUSE ( ), or send a faxed statement to the Abuse Hotline’s statewide toll-free fax number, 24 hours a day, 7 days a week, at ), or
59Information That May be Requested by Florida Abuse Hotline Operators Name, age, sex, physical description, and location of each victim alleged to have been abused, neglected, or exploitedNames, addresses, and telephone numbers of each alleged perpetratorName, address, and telephone number of the person reporting the alleged abuse, neglect, or exploitationDescription of the physical or psychological injuriesActions taken by the reporter, if any, such as notification of the policeIt is important that you don’t delay calling the hotline just because you may not have all of the above information!!!
60What Happens After the Abuse Hotline is Contacted Within 24 hours of receiving and accepting a report, a DCF protective investigator will make a face-to-face contact with the alleged victim. If access to the alleged victim is denied to the protective investigator, the police will be called to assist.
61What happens if the hotline does not accept the call? If you believe that your call should have been accepted and/or that the hotline operator did not handle the call properly, please call the hotline back and ask to speak to a supervisor to explain the situation.Calls not accepted by the hotline (because the allegation does not involve abuse, neglect, or exploitation of a child or vulnerable adult by a caregiver) will automatically be transferred by hotline staff to the local police.
62When NOT to call the Hotline first… If you know about asituation in which thelife of a person with adevelopmental disabilityis in immediate dangerdue to abuse, neglect,or exploitation, youshould call 911 beforecalling anyone else.
63Barriers to ReportingVictims sometimes refuse to acknowledge that there is a problemPersons with disabilities are often taught to be compliant and passive and are sometimes unable to distinguish between appropriate and inappropriate physical contactPersons with disabilities may feel their report of abuse would not be believedPhysical/cognitive impairments make it difficult for the victim to seek help
64More barriers...Most augmentative communication systems (such as communication boards used by people who cannot speak) are not programmed to report abuse, neglect or exploitation.Victims do not know where to turn for help, and they are often isolatedVictims may believe they are financially or otherwise dependent on the abuser for their needs;Victims fear loss of a caregiver, even an abusing caregiver; they are fearful they will be forced to leave their current families or homes. Persons with disabilities may be more easily threatened by the withholding of needed care or equipment.
65There is a general lack of understanding or awareness of the high rate of these types of crimes. People often do not recognize abuse and are quick to dismiss the visible signs of abuse by saying it was probably caused by the person’s disability.Most people assume that no person would be capable of committing certain crimes against persons with disabilities.Because they haven’t seen actual physical abuse, they may not believe a problem exists.People fear financial or legal liability and retaliation if they report suspected abuse.Many people have the mistaken idea that their actions will not make a difference.
66Your response to a victim should always communicate… I believe you.It is not your fault.You are not alone.I want to help you.Source: Reproductive Health Care for Women with Disabilities: An Online Tutorial(http://www.acog.org/departments/womenWithDisabilities/ReproHealthCare.ppt )
67Navigating the System Education/Training Reporting Department investigations & law enforcement response (including forensic exams)Prosecution and ConvictionVictim Services
69Primary Prevention Efforts Research shows that the single most effective way to prevent abuse, neglect, and exploitation is by providing education and self-protection training directly to individuals with disabilities.
70Training and Education Self Protection SkillsAssertiveness TrainingAppropriate and Inappropriate Behaviors (by both caregivers and the people they serve)Reporting Problems to Others
71Additional Tips for Caregivers to Help Prevent Sexual Abuse Recognize the person’s need to knowSet boundariesIdentify appropriate behavior in public and privateTeach children protective behaviorsUse appropriate names for genitalsSeek help when you need it
72More primary prevention tips… Background screening/reference checks/thorough interviews of prospective caregiversGrowing of social circlesRespite for caregiversTraining for caregiversEducation of caregivers on the sexual misconduct law and other laws regarding abuse, neglect, and exploitation.Becoming familiar with the policies of service providers (including schools) on such issues as restraint, seclusion, and other behavioral interventions
73Secondary Prevention Efforts Education of caregivers in recognizing and reporting the signs and symptoms of abuse, neglect, and exploitation.Unannounced visits at different times of day.Full cooperation with police and DCF investigators.
74More secondary prevention tips… Modification of communication devices so that abuse, neglect, and exploitation can be easily and quickly reported.Expansion of social circles so that more individuals would be involved in the person’s life and would therefore be able to identify and report suspected cases of abuse, neglect, and exploitation.
75The Zero Tolerance Initiative An ongoing effort by the Agency for Persons with Disabilities to address and prevent abuse, neglect, and exploitation committed against Floridians with developmental disabilities
77Please visit our Zero Tolerance Website at: For more information...Please visit our Zero Tolerance Website at:for the complete and updated Zero Tolerance action plan, news about upcoming activities and events, APD-issued policy statements and additional resources.
78For additional information or questions concerning the Agency’s Zero Tolerance Initiative, please feel free to contact me at:or (850)