August, 2009 bap

© 2009 APS Healthcare, Inc. 1

Abuse: Recognizing and ReportingPresented by: APS HealthcareSouthwestern PA Health Care Quality Unit(HCQU)

August, 2009 bap


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.


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.


0BJECTIVES

The participant will:

Describe types of abuse List signs of abuse Discuss the steps necessary to report abuse


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)


TYPES OF ABUSE

Neglect

Physical Abuse– Unauthorized / Inappropriate Restraint

Psychological/Emotional Abuse

Sexual Abuse

Verbal Abuse

Financial Abuse / Misuse of Funds

Rights Violation


NEGLECT

Failure to obtain or provide needed services and supports as:

– Defined by an individual’s plan

– Required by law or regulation


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


PHYSICAL ABUSE DEFINED

An intentional physical act

Causes or may cause physical injury


EXAMPLES OF PHYSICAL ABUSE

Striking– slapping, punching, hitting, scratching, kicking

Applying potentially harmful substances or conditions

Use of improper or unauthorized restraints


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


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.


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


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


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


SIGNS OF PSYCHOLOGICAL/ EMOTIONAL ABUSE

Low self-esteem

Behavioral extremes

Emotional upset

Self-blaming


SEXUAL ABUSE

Acts or attempted acts of:– Rape

– Incest

– Sexual Molestation

– Sexual Exploitation

– Sexual Harassment

– Inappropriate or Unwanted Touching by another


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


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


VERBAL ABUSE

Verbalizations that do or may:

– Inflict Emotional Harm

– Invoke Fear

– Humiliate

– Intimidate

– Degrade or Demean


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!”


VERBAL ABUSE

Verbalizations that:

Intimidate– “Come on, I dare you!”

Degrade or Demean– “Take off your pants! The doctor needs to check you

out!”


SIGNS OF VERBAL ABUSE

Low self-esteem

Behavioral extremes

Emotional upset

Self-blaming


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


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


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.


EXAMPLES OF RIGHTS VIOLATIONS

Unauthorized removal of personal property

Refusal of access to the telephone

Privacy violations

Breach of confidentiality


BILL OF RIGHTS

Review Yearly

– To help understand

– To help embrace

– To help live


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.”


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


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


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


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


IF ABUSE IS WITNESSED

Report IMMEDIATELY

Intervene as needed

Reassure the individual

Follow agency policy

Review incident management bulletin


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: I6000-04-01 INCIDENT MANAGEMENT . Retrieved August 10, 2009 from Office of Developmental Programs, Western Region, Pennsylvania Department of Public Welfare Web site: http://www.odpconsulting.net/index.php?option=com_docman&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.


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 http://www.merriam-webster.com/dictionary/Intention

Abuse. (2009). In Encarta Online Dictionary. Retrieved August 11, 2009, from http://encarta.msn.com/dictionary_1861583143/abuse.html

August, 2009 bap

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