© 2009 APS Healthcare, Inc. 1 Abuse: Recognizing and Reporting Presented by: APS Healthcare Southwestern PA Health Care Quality Unit (HCQU) August, 2009 bap

© 2009 APS Healthcare, Inc. 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.

© 2009 APS Healthcare, Inc. 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.

© 2009 APS Healthcare, Inc. 4 0BJECTIVES The participant will:  Describe types of abuse  List signs of abuse  Discuss the steps necessary to report abuse

© 2009 APS Healthcare, Inc. 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)

© 2009 APS Healthcare, Inc. 6 TYPES OF ABUSE  Neglect  Physical Abuse –Unauthorized / Inappropriate Restraint  Psychological/Emotional Abuse  Sexual Abuse  Verbal Abuse  Financial Abuse / Misuse of Funds  Rights Violation

© 2009 APS Healthcare, Inc. 7 NEGLECT  Failure to obtain or provide needed services and supports as: –Defined by an individual’s plan –Required by law or regulation

© 2009 APS Healthcare, Inc. 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

© 2009 APS Healthcare, Inc. 9 PHYSICAL ABUSE DEFINED  An intentional physical act  Causes or may cause physical injury

© 2009 APS Healthcare, Inc. 10 EXAMPLES OF PHYSICAL ABUSE  Striking –slapping, punching, hitting, scratching, kicking  Applying potentially harmful substances or conditions  Use of improper or unauthorized restraints

© 2009 APS Healthcare, Inc. 11 SIGNS OF PHYSICAL ABUSE  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

© 2009 APS Healthcare, Inc. 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.

© 2009 APS Healthcare, Inc. 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

© 2009 APS Healthcare, Inc. 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

© 2009 APS Healthcare, Inc. 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

© 2009 APS Healthcare, Inc. 16 SIGNS OF PSYCHOLOGICAL/ EMOTIONAL ABUSE  Low self-esteem  Behavioral extremes  Emotional upset  Self-blaming

© 2009 APS Healthcare, Inc. 17 SEXUAL ABUSE  Acts or attempted acts of: –Rape –Incest –Sexual Molestation –Sexual Exploitation –Sexual Harassment –Inappropriate or Unwanted Touching by another

© 2009 APS Healthcare, Inc. 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

© 2009 APS Healthcare, Inc. 19 SIGNS OF SEXUAL ABUSE  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

© 2009 APS Healthcare, Inc. 20 VERBAL ABUSE Verbalizations that do or may: –Inflict Emotional Harm –Invoke Fear –Humiliate –Intimidate –Degrade or Demean

© 2009 APS Healthcare, Inc. 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!”

© 2009 APS Healthcare, Inc. 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!”

© 2009 APS Healthcare, Inc. 23 SIGNS OF VERBAL ABUSE  Low self-esteem  Behavioral extremes  Emotional upset  Self-blaming

© 2009 APS Healthcare, Inc. 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

© 2009 APS Healthcare, Inc. 25 AVOIDING FINANCIAL ABUSE  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

© 2009 APS Healthcare, Inc. 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.

© 2009 APS Healthcare, Inc. 27 EXAMPLES OF RIGHTS VIOLATIONS  Unauthorized removal of personal property  Refusal of access to the telephone  Privacy violations  Breach of confidentiality

© 2009 APS Healthcare, Inc. 28 BILL OF RIGHTS Review Yearly – To help understand –To help embrace –To help live

© 2009 APS Healthcare, Inc. 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.”

© 2009 APS Healthcare, Inc. 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

© 2009 APS Healthcare, Inc. 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

© 2009 APS Healthcare, Inc. 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

© 2009 APS Healthcare, Inc. 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

© 2009 APS Healthcare, Inc. 34 IF ABUSE IS WITNESSED  Report IMMEDIATELY  Intervene as needed  Reassure the individual  Follow agency policy  Review incident management bulletin

© 2009 APS Healthcare, Inc. 35 REFERENCES  Beth Barol, Ph.D. (2009, June). Peer to Peer Violence: Do We Make a Difference?. Peer to Peer Abuse and Violence Training, Cranberry, PA.  Office of Developmental Programs (2004, February). Bulletin: I INCIDENT MANAGEMENT. Retrieved August 10, 2009 from Office of Developmental Programs, Western Region, Pennsylvania Department of Public Welfare Web site: man&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.

© 2009 APS Healthcare, Inc. 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 webster.com/dictionary/Intention Abuse. (2009). In Encarta Online Dictionary. Retrieved August 11, 2009, from