2The Abuse Prevention and Response Protocol Basic ContentsSection A: Context for Addressing AbuseSection B: Focus on PreventionSection C: Response and ReportingThese speaker notes are for trainer reference only, there is no need to go through this outline.Section A Context for Addressing AbusePurposeBackground InformationPDD’s ApproachJurisdictional LinkagesResponsibility and Accountability of Key StakeholdersSection B Focus on PreventionUnderstanding VulnerabilitiesReducing VulnerabilitiesPrevention ExpectationsApplying the Principles for Determining Individual Support NeedsSection C Reporting and ResponseWhat PDD Considers AbuseReporting Allegations of AbuseAddressing ConcernsStakeholder Requirements for Addressing AbuseReviewing Allegations and Follow-up
3Context for Addressing Abuse Section A:Context for Addressing AbuseSection A
4What the Protocol is Provincial Policy Purpose Educate about abuse preventionRespond to abuse when it occursIdentify processesIdentify accountability measuresAbuse Prevention and Response Protocol is a provincial PDDProgram Policy.• Adherence to the Protocol is mandatory for all parties who are paid toprovide PDD funded supports – this includes all service providerorganizations and families/others who hire privately.• The purpose is to provide a policy framework that identifies processesand accountability measures related to abuse prevention and response.
5Context PDD Community Governance Act PDD Program Branch PDD Community BoardContextPDD Community Governance Act – a legal mandate to promote the inclusion of adults with developmental disabilities in community life, as set out in the Community Governance Act.PDD Program Branch Role – includes setting provincial policy, accountable to the Minister of Seniors and Community Supports. These policies all align with the PDD’s Vision, Mission and Values.PDD Community Board’s Role – includes supporting individuals and families, within the context of provincial policy.
6Section B: Focus on Prevention · Everyone has a role in promoting the prevention of abuse· Prevention of abuse is more likely to be a reality for all of us when we have a sense of belonging and feel accepted as valued members of our communities· For vulnerable populations within our society the focus is typically on deficits and needs which does not lead to natural connections in the community and serves to isolate people· The risk of abuse is lessened significantly when the community sees the gifts, capabilities and contributions of vulnerable populations, including individuals with developmental disabilities· PDD believes that communities have the capacity to accept and include vulnerable individuals when the focus is on their gifts, capacities and contributions· PDD has identified the importance of developing strategies for tapping into the community capacity as a critical part of promoting inclusion
7Strengthening the Protocol An increased focus on abuse preventionProactive approach rather than reactiveStrengthening the Protocol means we are:Highlighting the issue of prevention and identifying stakeholder expectations in PDD funded situations.Strengthening the training package with a prevention focus and making it available to service provider organizations and families/others who hire privately.Increasing staff awareness of how they can play a role in preventing abuse.Seeking help from adults with developmental disabilities and their families, to consider what prevention information needs to be shared and strategies for doing this is part of the process.
8Understanding Vulnerabilities Why are individuals with developmental disabilities at risk for abuse?It is important to note that the very fact of having a disability increases the probability of being abused.The main shift within the Protocol is to concentrate on prevention of abuse.Large Group Exercise: Ask participants to discuss in the large group what factors may contribute to individuals with developmental disabilities being at risk for abuse. Emphasize that these contributing factors are not present for everyone and some may reflect the evolution of services for individuals with developmental disabilities.The next slide discusses the main themes and defines them in speaker notes.
9Understanding Vulnerabilities Power imbalancesNegative attitudesLearning to be compliantIsolation and protectionLack of knowledge about relationships and sexualityPower imbalances- When abuse occurs there is always a power imbalance present. This power imbalance is evident in the life of individuals who receive supports in the sense that they are the receivers and the other people are the givers. There needs to be a change from a protective role to that of an empowerment one.Negative attitudes - Abuse occurs when people act on these negative feelings and treat individuals as if they are not valued members of society. When individuals with developmental disabilities are recognized as valued members of society and have a network of supports the probability of mistreatment is reduced.Learning to be Compliant- Historically individuals with developmental disabilities have had less experience with making choices. Sometimes individuals are not taught to make choices and are expected to defer to the opinions of others who think they know best. This becomes learned compliance, which makes individuals more vulnerable. This is further complicated by the tendency of people with developmental disabilities to want to please, especially when interacting with people in positions of authority.Isolation and Protection- Sometimes individuals with developmental disabilities are isolated from the community, and paid staff are their only source of social support. As a result individuals may have no source of outside assistance, support or advocacy to protect them from abuse and/or support them if they are ever victimized. It is crucial in the protection of individuals to provide opportunities that will expand their support networks and circles of support and promote community inclusion.
10How to Reduce Risks Knowledge and Information Promoting Inclusion Strengthening Natural SupportsInclusion means being a valued part of one’s community, being viewed as a neighbor, a friend, a co-worker, etc. Natural supports are the non-paid supports that surround all of us in our lives. Natural supports are associated with being part of one’s community- communities of interest (bowling league, hockey fans, stamp collectors, etc); and- communities of place (neighborhood, coffee shop, community recreation center, football stadium, etc.)
11Knowledge and Information Individuals and staff need to be educated and informed on preventionKnowledge is powerBoundaries, such as Ethics of TouchSocial and Sexual BehaviorHow to say “no”Opportunity for healthy relationshipsThe lack of knowledge and information can contribute to an individual’s vulnerability.Having as much knowledge as possible helps reduce the risk of abuse.Individuals with developmental disabilities may have no other contacts than paid staff. Due to the lack of relationships there can be a misunderstanding of true friendships and relationships vs. paid peopleLack of knowledge about sexuality and what is healthy sexuality contributes to the chance of being a victimService providers need to address the education of staff who support individuals with developmental disabilitiesService providers need to address the education of the individuals they support and how they are going to provide and support this.Education needs are ongoing for both individuals and staff
12Inclusion Meaningful Inclusion Shift in thinking from “client” to citizenFocus on strengths and abilitiesThe best tool that everyone has to prevent abuse is to meaningfully include individuals with developmental disabilities in regular community life, as neighbors, coworkers, volunteers and friends.Seeing people from a positive perspective of capacities and gifts, not deficits and needs.Having a quality life is defined by the person based on interests, dreams and desires.Letting the individual lead, with the support of families and friends and having paid staff play a support role to the extent necessarySmall group exercise:Have each table discuss what does meaningful inclusion mean?You may want to have each group flip chart their answers and then post them to share with the large group.Some examples to add to lists if not present:An ordinary life like other citizensBeing out and aboutVolunteering or getting paid for workPatronizing local businessesGoing places where people gather naturally - church, community league, etc.Contributing to associations/clubs of interest - historical societies, stamp collectors, bird watchers, etc.
13Natural SupportsStaff should not be the focal point in an individual’s lifeFocus should be on assisting in developing natural relationshipsLarge Group Question:Ask the question to the large group, “What does it mean to you when you hear the term natural supports?Discuss what natural supports are and that some individuals may require paid supports but these supports should not be the only relationships in an individual's life.The more an individual has natural supports the less likely it is he/she will be abused – natural supports and having meaningful connections with people reduces the risk of being abused.
14Expectations PDD Program and Community Boards Service provider organizations and families/others that hire privatelyStaff who are hired to provide supportsPDD has identified roles for key stakeholders in the prevention of abuse.The Protocol document outlines what these roles are for each stakeholder.Key point is to promote an environment that invites opportunities to discuss and share ideas on inclusion and preventionSee page 8 Protocol for specific stakeholder expectations – the trainer should be reviewing these with emphasis placed on who the audience is – for example for front line staff the emphasis would be for the service provider expectations and support staff expectations.Small Group Exercise:Assign one of the scenarios to each group. Allow ten to fifteen minutes for group discussion.Debrief by having each small group present to large group.Scenarios # 1-3 will work well for this exercise focusing on prevention. You may have other examples for scenarios that you prefer to use remembering the focus for this exercise is on prevention.
15Reporting and Response Section CReportingandResponseWhen there is an allegation of abuse the process to follow is detailed in the Protocol and outlined in Appendix VI in a flow chart.
16Protocol’s Definition of Abuse When a staff person misuses their authority by acting in a way that causes harm or potentially causes harm to individuals receiving PDD funded supportsThe next two slides go into detail of the types of abuse.The trainer needs to use his/her judgment to decide how much detail is necessary in discussing the types and indicators of abuse depending on who the audience is and what background they have had or not had with the previous Protocol.
17Abuse Abuse occurs in many ways People use different terms to describe abusePDD identifies six categories of abuseIt is important to note that people may use different words to describe these types of allegations.The allegation does not need to be intentional or to have caused harm to be worthy of a review.There are physical and behavioural indicators of abuse and some examples are given in the following two slides in the speaker notes. It is important to note that these sample indicators identified are possibilities only and may be a result of something other than abuse.
18Types of Abuse Physical Abuse Sexual Abuse Emotional Abuse Physical acts of assault (or threats of) such as hitting, punching, kicking, biting, throwing, burning or violent shaking that cause, or could cause physical injury.Possible IndicatorsUnexplained or unusual injuriesDefensiveness in regards to injuriesSudden fear of physical contactSudden inability to sleep at nightSexual AbuseSexual assault (touching of a person’s sexual features without consent) orSexual harassment (any conduct, comment, gesture or contact of sexual nature likely to cause offence or humiliation to an individual).Pain or injury to genital areasDifficult time walking or sittingSudden childlike actionsSudden sexual acting outNote: Due to the power imbalance related to staff’s authority, it is unethical for a staff person and an individual that receives support to engage in a sexual relationship.Emotional AbuseThe rejecting, ignoring, criticizing, insulting, threatening, harassing, degrading, humiliating, intimidating or terrorizing of a person. Acts or omissions that cause or are likely to cause conduct, cognitive, affective or other mental disorders, emotional stress or mental suffering.Sudden onset of speech disordersAnxiety, anger and behavioural changesConstant apologiesNightmares or sleep disturbances
19Types of Abuse Cont’d Negligence Exploitation Inappropriate use of RestrictiveProceduresNegligenceFailure to provide or make available necessities (such as food, clothing, shelter, protection from hazardous environments, care or supervision appropriate to the person's age or development, hygiene and medical care).Possible IndicatorsHealth concerns that go ignored or untreatedLoss of weight without a medical reasonAlways tired and falling asleepFrequent falls, injuries and reoccurring minor accidentsExploitationTaking advantage of a person, including but not limited to money and things, as well as persuasion to do things that are illegal or not in the individual’s best interest.Using someone’s treaty card to access benefitsBorrowing money or objects without permissionConvincing someone to give away personal possessionsConvincing someone to do something they do not want toInappropriate Use of Restrictive ProceduresUse of restrictive procedures that are outside the parameters of the Creating Excellence Together (CET) Certification Standards.Possible ExamplesWithholding a person’s possessionsUsing medications outside of the approved planned approach
20Taking Action on Concerns Ethical Responsibility to Take ActionAuthority Related to AllegationsPDD has both an ethical responsibility to act as well as an authority to act.Two levels of Ethical Responsibility:1) Situations of concern that are not receiving PDD fundingService provider organizations, families/others who hire privately and PDD have an ethical responsibility to do whatever is reasonable related to the individuals it supports, by influencing situations over which they have no jurisdiction or authority. PDD is committed to playing a role in educating and influencing such situations, as the need arises.Example:Stress while visiting in the family home.2) Situations that are receiving PDD fundingService provider organizations, families/others who hire privately and the PDD Program all have an ethical responsibility to be proactive and take action to reduce the potential for harm.Examples:Behavioral concerns with a fellow PDD funded roommate.Staffing practices or inaction creates the potential for putting the individual at risk of being harmed.Authority Related to AllegationsPDD has the authority to address allegations of abuse in situations where PDD provides funding.• In community based service providers and families who hire privately this authority comes from a contractual agreement.• In government operated facilities the authority comes from its basic duty to protect while being directly responsible for providing services to the individuals its supports.
21Becoming Aware of Abuse Witnessing itThrough physical evidenceThrough behavioural indicatorsThrough a report from a third party, orThrough a disclosure by the alleged victimIf you believe a staff person has misused their authority you need to report this.If you think it could be abuse, but are not sure, err on the side of safety by reporting the matter.It is not up to the person reporting to determine if there is sufficient evidence for any type of review.
22Receiving a Disclosure of Abuse Do not promise to keep the information you are receiving a secretBe prepared to listen immediately to the allegationDo not ask questions of the individual specific to the allegationAssist the Individual to be as Comfortable as PossibleEnsure the setting is privateRemain calmDo not express anger towards the alleged abuserDo not photograph the alleged victim.Listen to the IndividualBe non-judgemental – respect everything the person says to you without judgement.Go at a pace with which the individual is comfortable.Allow the individual to use a communication system that is comfortable to them, pictures, sign language, etc.Do not ask questions of the individual specific to the allegation – at this time you are receiving information – if needed ask open ended questions like - “Tell me about your visit to the house”?Ensure Safety and SupportSafety will be ensured and support will be provided.The guardian will be informed (if there is a guardian and he/she is not implicated).Explain that it will be reported.Local police services will be informed if the allegation is perceived to be criminal in natureIf Medical Attention is RequiredEnsure that a support person of the alleged victim’s choice accompanies him/her to the hospital or doctor’s office.Ensure that the guardian is informed.It is best if the individual:Does not change clothing.(for the purpose of a criminal investigation)Does not shower (for the purpose of a criminal investigation)Understands why it is important to go to the hospital or doctor’s office and what will occur.
23Take Immediate Action If you witness abuse, stop it Ensure the safety of the alleged victimSeek medical assistance if requiredReport the abuseThe order of the actions (stop the abuse, ensure the safety of the alleged victim, report, contact guardian) may change depending on each situation.Report to appropriate person(s): e.g. Executive Director/designate, family /other who hire privately, PDD, the police and/or the Protection for Persons in Care reporting line).Internal policy and procedure of service provider organizations and families/others that hire privately should be discussed here.Look to the section of the Protocol marked “Stakeholder requirements for addressing allegations” (page21).The guardian shall be informed within 24-hours of receiving an abuse allegation.The guardian has the legal authority to represent the dependent adult in areas outlined in the guardianship order. Appendix I in the Protocol is the “Guidelines for Involving the Guardian”.
24Obligation to ReportIf staff reasonably suspects or believes that an individual has been or is being abused, they are expected to immediately report the matter.It is mandatory for all staff to report any incident of suspected abuse.Reluctance to ReportParticipants may identify concerns with identifying abuse. For example, a staff person may fear losing his/her job. It is important to acknowledge those fears. However, as professionals, staff have a moral and ethical obligation to report abuse. While nobody can guarantee protection of an individual reporting abuse, all information is subject to the privacy provisions set out in FOIP and every effort will be made to maintain confidentiality. The protocol states that when a person reports a matter, no action is to be taken against him/her by the service provider or PDD unless the report is made maliciously or without reasonable grounds. In addition, employees who have been dismissed have other options to address the issue. For additional information contact Employment Standards with Employment and Immigration.Confidentiality and Protection of PrivacyAll information provided is subject to the privacy provisions set out in the Freedom of Information and Protection of Privacy Act. Every attempt will be made to maintain confidentiality in all aspects of the review. The Freedom of Information and Protection of Privacy Act (FOIP Act) must be complied with in the collection, use, disclosure and security of personal information obtained by or on behalf of a public body. Disclosure of any personal information collected during an investigation or through any process by or on behalf of a public body would have to be permitted by Section 40 or the FOIP Act.
25Where to Report Allegations The obligation to report under the Protocol is not fulfilled until the appropriate person(s) have been informed.The Executive Director/DesignateFamily/other who hire privatelyPDD Community BoardIt is important that the Service Provider create an environment that supports reporting and encourages as well as creates opportunities for discussion within the organization around the reporting of abuse.At this point a discussion of your organization”s policy, procedure and process around reporting would be valuableIf the allegation is believed to be criminal in nature contact the police.If unsure if the setting falls under the Protection for Persons in Care Act, get clarification from your agency or phone PPC Act reporting line.Reporter should only have to report once and then the responsibility for follow-up lies with the service provider organization or the family that hires privately.PDD will review all cases where a service provider fails to report or take action to follow-up on an allegation of abuse. If the service provider does not take appropriate action, each situation will be reviewed and acted upon, given the unique circumstances involved.
26Links with PPIC Act Protection for Persons in Care Act PDD has specific settings that fall under the ActChanges to the Act anticipated Fall 2009Protection for Persons in Care Act is Provincial legislation that addresses abuse issues for adults “in care”.The Act covers traditional care settings like hospitals, lodges and nursing homes. In addition the Act applies to some PDD settings.Note: Provide the following information only if needed to avoid focusing on the PPC Act that will divert attention away from the Protocol.Specific PDD settings that fall under the Act as “facilities” are PDD direct operations, as well as group homes and vocational rehabilitation and training centres, that meet specific criteria.Future changes to the PPC Act will determine the extent if any related to PDD funded settings.The Abuse Prevention and Response Protocol is flexible enough to be responsive, regardless of the future changes made in the PPC Act.
27Reporting to PDDService provider organizations or families/others who hire privately report all allegations of abuse to PDDReport allegations of abuse as they occurProvide preliminary report to PDD within one working dayCommunity Boards forward this data to the PDD Program Branch quarterlyService provider organizations and families/others who hire privately are now required to report abuse allegations to the PDD Community Board, as they occur.The PDD Community Board needs to be informed by way of a preliminary report to be submitted to PDD within one working day of the allegation. Appendix III in the Protocol is a sample format of the preliminary report and outlines what needs to be included in this report.Community Boards retain this data, sending a standardized summary report to the PDD Program Branch on a quarterly basis.Service provider organizations and families/others who hire privately are responsible to maintain more detailed information for their records on their internal review.The process to follow once there is an allegation of abuse is detailed in the ProtocolAgencies have policies and procedures in place that should align with the process of reporting abuse allegations.When reporting the allegation to PDD it is determined/confirmed at this time who is taking the lead in the review.
28Reviews Who does internal reviews Who does external reviews Process considerations for reviews are outlined in the ProtocolA review is required whenever there is an allegation of abuse.An internal review is always required even if there is an external reviewer to minimally address staffing issues involved.Note: Make it clear to frontline staff that chances are they will not be the reviewer in allegations but may be part of the review process.Internal reviews are conducted:By the service provider organization or family/other who hires privately orIn conjunction with PDD orThrough an agreement with a third party, at the request and responsibility of the service provider organization or family who hires privatelyExternal Reviews are conducted:By PDD, PPCA office, and/or a police service, either by their employees or through a contract with a third partySome examples of why an external review would be necessary:The staff person doesn’t trust the CEO or Board to act appropriatelyThe alleged offender is a friend of the CEO or Board memberA belief that the service provider is not handling an internal review appropriatelyThe allegation appears to be criminal in natureThe setting falls under the PPC Act
29Follow-up on ReviewsFollow-up with interim or final report within 30 daysAction plan implemented by service provider or family/other who hires privatelyPDD Community Board designate will monitor implementation of action planOnce a review is completed an interim or final report is to be submitted by the service provider organization or the family/other who hires privately to PDD within 30 days of the allegation being reported.This report is required from the service provider organization or family/other who hires privately whether the review was internal or external.The report should include summary of review, findings, recommendations and an action plan for implementation of the recommendations.The service provider organization or family/other who hires privately is responsible for the implementation of the plan.PDD Community Board designate will monitor the implementation of the action plan.Upon completion of the review, inform the individual and/or their representative, reporter and alleged perpetrator of the outcome of the review, whenever reasonable.Note: Informing of the outcome does not mean distributing copies of the final report. Information shared should identify that the allegation was addressed, and an action plan determined, with the PDD Community Board monitoring this action plan. If any details of the action plan are shared it cannot include any information that is confidential. For example you cannot share that a person was fired, but can confirm this person no longer works with the agency.
30Reviews and Follow-up Founded Unfounded Inconclusive Incomplete The findings from the review need to indicate one of these four results and this would be identified in the interim and/or final report. Each are defined below.· Founded – there was evidence that supported the allegation· Unfounded – there was evidence that did not support the allegation· Inconclusive – there was insufficient evidence to support either way· Incomplete – the allegation is still under reviewThese statistics are also tracked in the quarterly report completed by PDD Community Boards and forwarded to the PDD Program Branch.No matter what category the result falls under, it is always valuable what we learn in the process and what action plan can be taken to prevent similar situations.
31Everyone Has a Role Individuals with Developmental Disabilities Families/GuardiansCommunity membersSupport staffService provider organizationsPDDPrevention is the key and inclusion is the pathLiterature in this area is extensiveOur strategies are not exhaustiveWe as human service professionals need to keep current on best practices with respect to prevention of abuseRefer to list of resources in the attachments.Small Group exercise:Assign one of the scenarios to each group. Allow ten to fifteen minutes for group discussion.Debrief by having each small group present to large group.Scenarios # 4-6 will work well for this exercise initially focusing on response but linking it back to prevention. Depending on who your audience is, you may not need to spend a lot of time going over the response processes but more time on prevention strategies. You may have other examples for scenarios that you prefer to use remembering the focus for this exercise should link back to prevention strategies.
32Abuse Prevention and Response Protocol DiscussionWhere do we go from here?This is were you would discuss what the expectations are of your organization.Discussion may include how to promote inclusion in your organization.Discuss who staff can call if they need additional information - Refer to Appendix III – the names and numbers for additional information and support.After discussionCertificates