1. ABUSE, NEGLECT & EXPLOITATION HILL COUNTRY MHDD CENTERS CRISIS STABLIZATION UNIT (CSU) SUBSTANCE ABUSE PROGRAMS ECI-1115 Waiver and Contractors

2. YOUR RESPONSIBILITY To PROTECT the HEALTH WELFARE and SAFETY of our CONSUMERS

3. What is Abuse? ABUSE: The negligent or willful infliction of injury, unreasonable confinement, intimidation, or cruel punishment which caused or may have caused physical or emotional harm or pain to a person with a disability by that person’s caretaker, or paid caretaker, family member, or other individual who has an ongoing relationship with the person. DFPS Rules, 40 TAC §705.1001

4. What is a Disability? The ADA (Americans with Disabilities Act) defines a person with a disability as: A person who has a physical or mental impairment that substantially limits one or more major life activities. (major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, walking, standing, lifting, bending, speaking, breathing, learning, concentrating, thinking, and working.) The ADA also makes it unlawful to discriminate against a person with a disability. "disability is a natural part of the human experience and in no way diminishes the right of an individual to participate in, or contribute to society." - Unknown

5. YOUR DUTY It is your duty to perform your job in a way that will never abuse, neglect or exploit consumers. We will discuss ways to RECOGNIZE what abuse, neglect or exploitation is. RESPOND to the consumer/allegation, and protect every patient/consumer. REPORT possible abuse, neglect & exploitation to the proper reporting agency.

6. TYPES OF ABUSE Sexual Abuse-( Sexual Exploitation ) Physical Abuse Exploitation ( Money, Resources, Property ) Verbal orEmotional Abuse Neglect

7. SEXUAL ABUSE “ Sexual abuse of an elderly or disabled person, including any voluntary, involuntary or consensual or nonconsensual sexual conduct that would constitute an offense under Section 21.08, Penal Code (indecent exposure) or Chapter 22, Penal Code (assaultive offenses), committed by the person's caretaker, paid caretaker family member, or other individual who has an ongoing relationship with the person ” DFPS Rules, 40 TAC §705.1005

8. Sexual Abuse Examples ANY sexual activity or conduct between staff and consumer such as: Kissing. Staff having an intimate relationship with a patient or consumer. Inappropriate touching, requesting, suggesting or encouraging any sexual activity. Sexual Assault.

9. PHYSICAL ABUSE When an alleged perpetrator is a caretaker, paid caretaker, family member, or other individual who has an ongoing relationship with the alleged victim, physical abuse is defined as any knowing, reckless, or intentional act or failure to act, including unreasonable confinement, corporal punishment, inappropriate or excessive force, or intimidation, which caused or may have caused, physical injury, death, or emotional harm. DFPS Rules, 40 TAC §705.1003

10. SIGNS & SYMPTOMS Unusual patterns of injuries such as bruises, bites or burns. Frequent unexplained injuries. Extreme fear of a specific employee. Serious injury. Verbal allegations. Hitting Pushing Spitting

11. VERBAL-EMOTIONAL ABUSE The use of verbal or other communication, including gestures to; Curse Vilify or Degrade (Slanderous or abusive language) Humiliation Threaten a person with emotional or physical harm DFPS Rules, 40 TAC §705.1007

12. Verbal-Emotional Abuse Examples Speaking to a patient/consumer in a loud, angry sounding voice Cursing at or in the presence of a consumer Using gestures toward patient/consumer Name calling Using threatening words and body language

13. EXPLOITATION Illegal or improper act or process of a caretaker, paid caretaker, family member, or other individual who has an ongoing relationship with an elderly or disabled person that involves using, or attempting to use, the resources of the elderly or disabled person, including the person's social security number or other identifying information, for monetary or personal benefit, profit, or gain. DFPS Rules, 40 TAC §705.1011

14. Exploitation Examples Accepting gifts (monetary or purchased) of any value You may accept food items if it is shared with co-workers AND consumers Borrowing personal items which belong to consumers Consumers do not work for you Buying or giving gifts to consumers

15. NEGLECT When an alleged perpetrator is a caretaker or paid-caretaker, neglect is defined as: the failure to provide for protection, food, shelter, or care necessary to avoid emotional harm or physical injury; or a negligent act or omission that caused or may have caused emotional harm, physical injury, or death. DFPS Rules, 40 TAC §705.1009

16. NEGLECT Examples Failure to assist consumer when requested (reasonable request) Failure to provide adequate nutrition clothing or shelter (IDD-HCS) Failure to provide prescribed medications in a timely manner

17. NEGLECT Continued Failure to establish and carry out an appropriate individual treatment plan of services Failure to assist patient/consumer with the activities of daily living if necessary Leaving a person unattended when unless PDP states otherwise (IDD) Allowing Consumers to argue/fight without intervention Talking or texting on cell phone while driving

18. NEGLECT Continued While at work, HCMHDDC staff will NOT, watch or rent movies or programs that are rated PG or R if the program contains sexually explicit or violent content.

19. Off-hour patient interaction (MH) Under no circumstances will staff fraternize with current or former patients on a personal level. This may be grounds for disciplinary action, up to and including possible termination. Entering into any type of personal relationship with a patient is considered a conflict of interest, no matter how minor it may be.

20. PATIENT INTERACTION Examples You are at a party where a person who is a known consumer asks you for a ride to their home which is only a few blocks from the location of the party. You recognize this person as having been a consumer with Hill Country MHDD Centers. This person has obviously been drinking and would not be safe walking the distance. What would you do?

21. REPORTING ALLEGATIONS

22. REPORTING It is your Legal, Ethical and Moral responsibility to report any allegation of Abuse, Neglect or Exploitation within one (1) hour when you See it, Hear it, or Suspect it. Failure to report an incident is considered a criminal offense: Class A misdemeanor Texas 2013 HB 1205- Makes the penalty for a professional who knowingly fails to make a report a Class A misdemeanor, except that the offense is A State Jail Felony if it is shown during the trial of the offense that the actor intended to conceal the abuse, neglect or exploitation.

23. Classification of Misdemeanors In Texas Misdemeanors are classified according to the relative seriousness of the offense into three categories : 1. Class A Misdemeanor: MA. Punished by: Fine not to exceed $4,000 or confinement in jail for a term not to exceed one year; or both such fine and imprisonment. 2. Class B Misdemeanor: MB-Punished by: A fine not to exceed $2,000 or confinement in jail for a term not to exceed 180 days; or both such fine and imprisonment. 3. Class C Misdemeanor: MC- Punished by: A fine not to exceed $500. Examples of class C include certain types of assault, aiding suicide, leaving a child in a vehicle, criminal mischief, reckless damage or destruction and criminal trespass.

24. Classification of Felony's 1. First Degree Felony: F1-Punished by: Confinement in the institutional division for life or for any term not more than 99 years or less than 5 years and a fine not to exceed $10,000. 2. Second Degree Felony: F2-Punished by: Confinement in the institutional division for life or for any term not more than 20 years or less than 2 years and a fine not to exceed $10,000. 3. Third Degree Felony: F3-Punished by: Confinement in the institutional division for life or for any term not more that 10 years or less than 2 years and a fine not to exceed $10,000; and State Jail Felony Punishment: FS Punished By: An individual adjudged guilty of a state jail felony shall be punished by confinement in a state jail for any term of not more than 2 years or less than 180 days; and a fine not to exceed $10,000.

25. Texas Dept. Family & Protective Service (TDFPS)

26. TDFPS 1-800-647-7418 Facility Investigations Staff are on duty 24 hours a day – 7 days a week

27. Texas Department of State Health Services (DSHS) Hill Country MHDD Staff who are stationed at the Crisis Stabilization Unit will call the number posted at the CSU for DSHS- Listen carefully to the instructions, once complete call the Rights Protection Officer. DSHS- 888.973.0022 x 2606 RPO- 830.258.5441 or x 2066

28. MAKING THE CALL You must report all known or suspected allegations of abuse, neglect & exploitation within one hour from the time you witness or learn of the incident. You may be put on hold and it could last several minutes, don’t hang up.

29. INFORMATION TO BE GIVEN Give complete information about the consumer – Name, Address, Phone, Age, any other important information about the consumer, if asked. You may give medical information if it is necessary for the report.

30. REPORTS ARE CONFIDENTIAL Once you have made the report, this information is required to remain confidential. You are not at liberty to discuss with anyone. Do not report any allegations to your supervisor or anyone else.

31. NEED ADVICE BEFORE CALLING? You may call Wm. A. Olden, R.P.O 830.258.5441 or x 2606 1.888.393.3629 toll free

32. THE INVESTIGATION In most cases, a DFPS investigator will come to the clinic/center to ask questions and review the records. You are expected to cooperate fully. There are some cases they do not investigate. I will investigate those cases and determine the outcome.

33. RETALIATION What is RETALIATION?

34. RETALIATION Any action intended to inflict emotional or physical harm or inconvenience to an employee who has reported abuse, neglect, exploitation. This could include harassment, disciplinary measures, discrimination, reprimand, threats, censure or criticism DFPS Rules, 40 TAC §705.1003

35. RETALIATION IS PROHIBITED If you feel that someone has or is retaliating against you for doing the right thing, you should immediately notify: Sheree Hess Human Resource Director 830-792-3300 XT 2044

36. You must report abuse allegations when When you see it When you hear about it When you suspect it

37. YOU REPORT ABUSE TO Abuse, Neglect & Exploitation is reported to: DFPS Texas Dept of Family & Protective Services 1-800-647-7418 DFPS number can be found on the Abuse, Neglect and Exploitation flyers in every office & building HCMHDDC occupies.

38. RIGHTS

39. HUMAN RIGHTS life, liberty and pursuit of happiness freedom from torture, or cruel, inhuman or degrading treatment or punishment equality before the law not being subjected to arbitrary arrest, detention or exile freedom of movement and residence freedom of thought, conscience and religion peaceful assembly and association

40. CIVIL RIGHTS 1 st. Freedom of speech, press, religion, peaceable assembly, and to petition the government for redress 2 nd. Right for the people to keep and bear arms, as well as to maintain a militia, this right shall not be infringed. 3 rd. Protection from quartering of troops 4 th. Protection from unreasonable search and seizure 5 th. Due process, double jeopardy, self-incrimination, private property 6 th. Trial by jury and other rights of the accused 7 th. Civil trial by jury 8 th. Prohibition of excessive bail, as well as cruel and unusual punishment 9 th. Protection of rights not specifically enumerated in the Bill of Rights 10 th. Powers of states and people

41. Consumer Rights Right to be treated with respect and dignity Right to receive age and culturally appropriate services Right to understand available treatment options and alternatives (informed consent) Right to receive care that does not discriminate on the basis of age, race, or type of illness Right to privacy and personal possessions Freedom of movement, from fear and to make treatment choices

42. SPECIAL RIGHTS Federal & State laws were passed giving individuals with mental illness & mental retardation additional special rights Right to Normalization Least Restrictive Environment Participate in and receive individualized services Informed Consent CONFIDENTIALITY People with mental illness may have additional rights that are protected under the following laws: Americans with Disabilities Act. Fair Housing Amendments Act. Civil Rights of Institutionalized Persons Act. Individuals with Disabilities Education Act.

43. RIGHTS VIOLATIONS If an individual believes their rights have been violated, it is their right and your responsibility to report the violation within one (1) hour or assist them in making a call to: Wm. A. Olden, R.P.O. 830.258.5441 1-888-393-3609 (Toll Free)

44. Reporting Rights Violations Rights violations can also be reported to the state rights protection service at: Consumer Rights and Services Office MH – 1-800-252-8154 MR – 1-800-458-9858

45. COMPLAINTS

46. If a consumer, their guardian, legally authorized representative, family or friend wishes to file a complaint about our services or employees, they may do so by calling: Wm. A. Olden, R.P.O. 830.258.5441 or x 2066 1-888-393-3609 (Toll Free)

47. OTHER COMPLAINT LINES Texas Dept. Health & Human Services MH – 1-800-252-8154 MR – 1-800-458-9858

48. CONFIDENTIALITY

49. WE MUST MAINTAIN CONFIDENTIALITY We never share personally identifying information about those we serve with anyone who does not have a need for the information Never verify an individual is receiving services at HCMHDDC without a written consent to do so.

50. CONSENT TO RELEASE INFORMATION We do not share personal identifying information about a patient/consumer with anyone not directly working with that individual unless that individual or their LAR gives WRITTEN consent. Do not discuss your patient/consumer with relatives, friends, family or former employees.

51. SHOULD I GIVE THE INFORMATION? If you are not sure whether someone should have access to confidential information, always assume they DO NOT. Refer them to your supervisor or call: Wm. A. Olden, R.P.O. x 2066 Or Sheree Hess Dir. HR. x2044

52. EXCEPTIONS There are some exceptions to the rule: Patient/Consumer can talk to anyone they wish Law Enforcement (Crisis Situation) Medical Emergency Personnel (Crisis Situation) Auditors and TDFPS Investigators.

53. CASE SENARIO Two staff standing in doorway of office talking about consumer. You are in your office two doors away and clearly hear them discussing how the new behavior program is not going to work. You heard the consumers name but do not know her. You also overheard one of them say she got so tired of her screaming last night that she blocked her door when she went to her room so she couldn’t get out for a while.

54. What are the problems in this scenario ? The 2 staff should have been in the office with the door closed. Locking the consumer in her room might be considered Physical Abuse if she injured herself trying to get out, had a seizure, etc. Or this action might be considered Seclusion.

55. CASE SCENARIO #2 A 32 year old male who is a consumer of HCMHDDC, diagnosed with schizophrenia, comes to the clinic. He appears as un-kempt, agitated gentleman, who is talking to himself, he is making threating and paranoid statements. Reported to have been off his meds more than a month and has been actively hallucinating. States he is going to kill his wife because he believes she is worshiping demons and is possessed by Satan. States his plan is to wait until she is sleeping, then he will set her “free”. Consumer suddenly gets up and leaves the clinic. What action if any should be taken to protect the patient and the wife?

56. CASE SCENARIO The staff should notify the authorities- 911 Authorities may notify wife to let her know she may be in danger

57. EXCEPTIONS When there is good reason to believe a specific individual(s) is placed in serious danger depending on the information at hand. Example: When a patient shares a specific plan (homicide) to harm a specific individual (wife).

58. Tarasoff in Texas

60. FORMER EMPLOYEE STOPS BY TO VISIT A former employee stops by to visit the staff and consumers. Former employees have no business in our offices or consumer areas. They are to be asked to leave the building. They are no longer bound by HCMHDDC Policies & Procedures

61. INFORMATION TO FAMILY MEMBERS Never assume a family member automatically has a right to a patient’s personal information. Check for a signed consent before giving out the information. If there is not one, ask the patient if they would like to sign one. If the family member becomes angry, refer them to your supervisor or: Wm. A. Olden, R.P.O. 830.258.5441 or x2066

62. MAINTAINING CONFIDENTIALITY Keep all records secure in locked files Never leave documents with patient information exposed on your desk, car, etc. If you use a computer, make sure screen is facing away from the door where others can see it Shred all unwanted files

63. BREACH OF CONFIDENTIALITY If you witness or hear about a breach of confidentiality by a co-worker, you should: Talk with your co-worker about revealing patient information. Report the incident to the R.P.O. Confidentiality violations threaten the integrity of the patient-staff relationship as well as HCMHDDC. You should always take this seriously. You can as an indiviual be sued and fined for violations