PREVENTION OF CLIENT ABUSE, NEGLECT & EXPLOITATION
Primary Responsibility protect To protect the HEALTH HEALTH and SAFETY SAFETY of all Consumers of Hill Country MHMR Center
It is your DUTY To do your job in a way that will never abuse, neglect or exploit consumers. To: Recognize - abuse, neglect, or exploitation Respond – safeguard the consumer Report – abuse, neglect or exploitation Cooperate – with DFPS investigative authorities
Types of Abuse SEXUAL ABUSE/EXPLOITATION PHYSICAL ABUSE EXPLOITATION EMOTIONAL/VERBAL ABUSE NEGLECT
Sexual Exploitation “Defined as a practice, or scheme of conduct against a person served, which may include sexual contact, that can reasonably be construed as being for the purposes of sexual arousal or gratification or sexual abuse of any person.”
Examples ANY sexual activity or conduct between staff and a consumer, such as: Kissing with sexual intent Hugging with sexual intent Stroking with sexual intent Request, suggesting or encouraging sex Sexual assault Oral Sex Sexual Intercourse Anal Sex NOTE: it IS considered abuse whether the consumer believes it is voluntary or not; i.e. responding to a kiss or hug.
Signs/Symptoms Verbal allegations Extreme fear of a specific employee or fear of being alone with a member of the opposite sex Evidence of injury to genital areas Pregnancy Sexually transmitted diseases
Physical Abuse “An act or failure to act performed knowingly, recklessly, or intentionally, including incitement to act, which caused or may have caused physical injury or death to a person served.”
Actions Striking Pushing Shaking Incitement to Act: Telling or asking someone to act in an abusive manner or to take matters into their own hands
Signs of Abuse Unusual patterns of injuries, such as bruises, bites, burns Frequent unexplained injuries Fearful behaviors Extreme fear of a specific employee Serious injury Verbal allegations Reports
Exploitation Illegal or improper act or a process of using a person served or their resources for monetary or personal benefit, profit, or gain. Personal gain means to the staff’s advantage
Examples A provider accepts refreshments regularly from a consumer. A consumer washes a provider’s car. An provider charges a consumer $10.00 a week for helping the consumer cash his check at the bank. A consumer buys a staff member’s lunch. A provider uses consumers movie card to rent Movies/DVD/Games, etc.
Exploitation There WILL NOT be an exchange of money between consumers and staff, however there are some exceptions to this rule: Consumer owns/operates a local business Consumer has a booth at the local “Trade Days” Etc. The prices in that business are determined by the consumer for the general public.
Verbal Abuse Any act or use of verbal or other communication, including gestures to: Curse Vilify – slanderous or abusive statements Degrade Humiliate OR Threaten a person served with emotional or physical harm
Verbal/Emotional abuse : Results in observable distress or harm to the person served: or Be of such serious nature that a reasonable person would consider it harmful or causing distress
Actions Name Calling Nicknames – Unless refers to self with that nickname Gestures Cursing Loud, angry voice Threatening with words or tone
Neglect What is Neglect? Neglect of a child includes (1) failure to provide a child with food, clothing, shelter and/or medical care; and/or (2) leaving a child in a situation where the child is at risk of harm. Neglect of a person 65 years or older or an adult with disabilities that results in starvation, dehydration, over- or under-medication, unsanitary living conditions, and lack of heat, running water, electricity, medical care, and personal hygiene.
Includes but not limited to… Failure to establish or carry out an appropriate individual plan for a consumer, if such failure results in a specific incident or allegation Failure to provide the requirements of adequate nutrition, clothing, or health care to a specific consumer Failure to ensure the provision of a safe environment for consumers, if such failure results in a specific incident or allegation Failure to assist a consumer with hygiene
Unintentional Neglect Failure to assist consumers to take their medications Leaving consumers unattended in vehicles, shopping malls, etc Allowing consumers to argue or fight with each other without staff intervention
Classes & Disciplinary Actions CLASS I Keyword: serious physical injury Physical abuse; Sexual abuse & sexual exploitation Termination CLASS II Keyword: non-serious physical injury Physical abuse with non-serious injury; exploitation Suspension up to 10 days, demotion or termination CLASS III Keyword: verbal Verbal abuseWritten reprimand, suspension up to 10 days, demotion or termination NEGLECTNeglectWritten reprimand, suspension up to 10 days, demotion or termination
YOU MUST REPORT ANY suspected incidents of client abuse, neglect or exploitation within ONE hour.
Reporting It is your LEGAL, ETHICAL & MORAL RESPONSIBILITY to report abuse and neglect and exploitation within one hour of the alleged incident.. Report when you SEE it Report when you HEAR about it Report when you SUSPECT it Failure to report an incident is a criminal offense! There are no exceptions to this rule!
Texas Department of Family and Protective Services (TDFPS) 1-800-647-7418 24 hours a day, 7 days a week
Making the Call You must report any/all known or suspected allegations of client abuse neglect & exploitation within ONE (1) hour from the time you witness or learn of the incident Call 1-800-647-7418 DO NOT HANG UP if you are put on hold Give them the information completely Write down the ID number they give you and put in a safe place for later reference
Reports are Confidential Once you make the phone call to report Abuse/Neglect, it must be kept CONFIDENTIAL. Do not discuss the case with ANYONE. Supervisors, co-workers, friends, relatives, etc. If you have questions or feel you must discuss the case you may call: Thom Guderian,RPO 830.792.3300 XT 266 THERE ARE NO EXCEPTIONS TO THIS RULE!
Investigation The Texas Department Family and Protective Services (TDFPS) Investigator will begin the investigation. IT IS NOT YOUR DUTY TO INVESTIGATE OR ASK QUESTIONS!
Failure to Report If you fail to report the incident or fail to report it in a timely manner, go to a co-worker to discuss the case, or any other situation neglecting your responsibilities of reporting, you will be subject to disciplinary action. Ranging from disciplinary action consistent with the HCCMHMRC Performance Improvement Program up to and, including Termination. Fear of Retaliation is not an acceptable reason for not reporting!
What is Retaliation? Any action intended to inflict emotional or physical harm or inconvenience to an employee that is taken because the employee has reported abuse, neglect or exploitation. This includes harassment, disciplinary measures, discrimination, reprimand, threats, censure & criticism.
Retaliation is PROHIBITED If you feel you have been retaliated against for reporting abuse, neglect or exploitation you should immediately notify: SALLY DERR Human Resource Director 830-792-3300
Prevention of Abuse/Neglect Report all injuries Be aware of situations that are upsetting to consumers Remain constantly aware of consumer’s surroundings and conditions Communicate with other Staff – review documentation in charts Be alert for clues that someone may be upset or be near an emotional crisis Manage Stress – back off when YOU are stressed or frustrated – know your “buttons” Ask for help when you need it! If you don’t get the immediate help you need, call the supervisor on-call Model appropriate behaviors at all times
Consumers are Citizens too We recognize and empower consumers as PEOPLE first. They were people before they had their disabilities. We will not view people as “mechanical equipment” or distinguish or separate them by their disabilities…
Human Rights To be treated with respect & dignity Ex: Age appropriateness To privacy Ex: Knocking before entering To personal possessions Ex: TV, Radio, books & etc To freedom of movement Ex: Going to baseball game To freedom from fear Ex: Intimidations
Human Rights To make choices Ex: To pick out clothes and activities To a clean, safe, humane environment Ex: Clear of health hazard and staff are trained (PMAB, CPR & etc..) To have final approval of Plan of Services Ex: To have input in the PDP
Civil Rights Freedom of speech & open communication Ex: Can express opinions without any retaliation Freedom of religion Ex: To attend any/none church of their choice Freedom to vote in elections Ex: Presidential or local voting
Civil Rights cont. To have an attorney Ex:Legal Services To receive due process Ex: Rights Restriction
Special Rights Federal & State laws were passed that gave people with mental illness and mental retardation additional special rights: To normalization Ex: living a normal life To the Least Restrictive Environment Ex: most appropriate for their needs yet least confining for their conditions
Special Rights To participate & receive Individualized Services Ex: Unique needs of a particular consumer To informed consent Ex: Consumer must first give written approval to the services and treatment To CONFIDENTIALITY Ex: Staff cannot share identifying or personal information about our consumers with others who are not directly working the consumers
COMPLAINT PROCEDURE If a consumer and/or guardian have a complaint regarding HCCMHMRC staff or services. Refer them to: Consumer Rights Coordinator Thom Guderian 830-792-3300 or 1-888-393-3609 or TX Dept. of Health & Human Svcs. Consumer Services and Rights Protection MH - 1-800-252-8154 MR – 1-800-458-9858
Least Restrictive Environment Each person lives with the minimum amount of interference or intervention from us as possible.
Individualized Services Each consumer is guaranteed Individualized Services from Hill Country Community MHMR Center Services are requested by the consumer. We provide the services to make the consumer as independent as possible. All Services are based on individual preferences, capabilities and needs.
Rights Restrictions Identify what specific right may need to be restricted Determine/evaluate the need for a restriction Consult the team Write a Plan Present Plan to Human Rights Committee for review and approval PLAN MUST BE APPROVED BY HRC BEFORE IMPLEMENTATION!!
What is the HRC? A Team led by the Consumer Rights Coordinator assisted by community citizens who ensure consumer rights are not violated or removed without just cause
Violation of Consumer Rights Imagine you or one of your loved ones had a diagnosis of mental illness or mental retardation. What if the violation went unreported? How would you feel if your loved one experienced a violation of rights? What if the right to dignity, privacy, respect, or a clean & safe environment was violated?
Reporting As a general rule, if you are not sure if it is a rights violation and is serious or not, ALWAYS contact the Consumer Rights Coordinator. Thom Guderian 819 Water Street, Suite 300 Kerrville, Texas 78028 830-792-3300 1-888-393-3609
What Does This Mean? You cannot share identifying or personal identifying information about consumers with others who are not directly working with the person without the WRITTEN consent of the consumer or his/her representative. You cannot tell ANYONE that a person is a client of your Center. You cannot TALK with your spouse, friends, or relatives about clients you serve in your center or their illnesses.
Need or Authority to Know The Privacy Act is very complex and covers many specific circumstances. Basic rule of thumb: If you aren’t sure whether someone should have access to confidential information, always assume they DO NOT. Refer them to your supervisor.
People Who May Have Access to Records Consumer Parent or guardian Law Enforcement Emergency Personnel Auditors Another person on consumer’s behalf with consumer’s written permission Other Hill Country employees who work directly with the consumer Texas Department of Family and Protective Services (TDFPS)
What if a family member asks how the consumer is doing? Without explicit permission from the consumer (written consent), it is unjustifiable and prohibited to give out any information.
Exception When there is good reason to believe a specific individual(s) is placed in serious danger depending on the information at hand. i.e. – when a consumer shares a specific plan to harm a particular individual (homicidal ideation)
Confidentiality Case 1 A 36-year old female consumer with schizophrenia and major depression has just told you that the voices in her head are telling her she must kill her children to save them from the devil and she plans to drown them in the bathtub. What is your responsibility? What would you say to the consumer?
Confidentiality Case 1 You must report the information to someone who can take care of the children (CPS, father, etc.) You must document the information on the progress notes You must consult the psychiatrist or the LPHA You must encourage the consumer to keep coming to the Clinic for medications and counseling
Confidentiality Case 2 You are working the evening shift at a residence of three male consumers. A person you do not know comes to the house and tells you he is here to pick up one of the consumers to take him out to eat. You have no record or prior arrangements. What do you do?
Confidentiality Case 2 You DO NOT allow the person to remove the consumer from the home. You must call the supervisor immediately for further instructions. You DO NOT confirm or deny that the consumer lives in that residence. You document on progress notes the incident. If the consumer steps up and states that is his uncle and they had plans to go out to dinner, you must STILL verify with the supervisor.
Maintaining Confidentiality Keep all client records secure and other papers with client information put away when not in use (includes computer screen) Use private office areas for client contacts, where appropriate. Papers which are to be thrown away must be shredded first if they contain ANY identifying information. Discuss client information on a need to know basis only. Avoid discussing client information over breaks or lunchtime where you may be overheard.
Breach of Confidentiality If you hear a breach of confidentiality by a co-worker, you should: Interrupt, talk with the co-worker, remind of client confidentiality rule. Report to the Consumer Rights Coordinator Client confidentiality violations threaten the integrity of the client-worker relationship, as well as the Center itself. They should all be taken seriously. You may also be sued for violations.
Release of Information A release of information is a written permission to share information with other agencies, friends, or family members of the consumer, landlords, employers, etc. If it isn’t in writing, you weren’t given permission! Verbal consent is NOT VALID! MUST BE IN WRITING! MUST BE IN WRITING!! MUST BE IN WRITING!!
Unintentional Violations Computers – letters, records and other information stored on computer files or information left on the screen and visible to others Notes and other papers on your desk, in your car, etc. Telephone conversations – incoming calls during interviews, privacy for all calls Office conversations Remarks to other consumers Remarks or conversations in the presence of “invisible people” (repair people, delivery people, janitors, etc.) Consumer names on lists on bulletin boards in offices, workshops, etc.
Remember Protect Health and Safety of Consumers Prevent and Report (1 hour) any/all client abuse/neglect (known or suspected) Maintain Confidentiality at ALL times Value Consumer Human Rights and empower consumers to success Treat all consumers (PEOPLE) with dignity and respect!
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