© 2009 APS Healthcare, Inc. 1
Abuse: Recognizing and ReportingPresented by: APS HealthcareSouthwestern 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
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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)
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TYPES OF ABUSE
Neglect
Physical Abuse– Unauthorized / Inappropriate Restraint
Psychological/Emotional Abuse
Sexual Abuse
Verbal Abuse
Financial Abuse / Misuse of Funds
Rights Violation
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NEGLECT
Failure to obtain or provide needed services and supports as:
– Defined by an individual’s plan
– Required by law or regulation
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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
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PHYSICAL ABUSE DEFINED
An intentional physical act
Causes or may cause physical injury
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EXAMPLES OF PHYSICAL ABUSE
Striking– slapping, punching, hitting, scratching, kicking
Applying potentially harmful substances or conditions
Use of improper or unauthorized restraints
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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
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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.
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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
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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
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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
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SIGNS OF PSYCHOLOGICAL/ EMOTIONAL ABUSE
Low self-esteem
Behavioral extremes
Emotional upset
Self-blaming
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SEXUAL ABUSE
Acts or attempted acts of:– Rape
– Incest
– Sexual Molestation
– Sexual Exploitation
– Sexual Harassment
– Inappropriate or Unwanted Touching by another
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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
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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
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VERBAL ABUSE
Verbalizations that do or may:
– Inflict Emotional Harm
– Invoke Fear
– Humiliate
– Intimidate
– Degrade or Demean
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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!”
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VERBAL ABUSE
Verbalizations that:
Intimidate– “Come on, I dare you!”
Degrade or Demean– “Take off your pants! The doctor needs to check you
out!”
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SIGNS OF VERBAL ABUSE
Low self-esteem
Behavioral extremes
Emotional upset
Self-blaming
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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
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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
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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.
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EXAMPLES OF RIGHTS VIOLATIONS
Unauthorized removal of personal property
Refusal of access to the telephone
Privacy violations
Breach of confidentiality
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BILL OF RIGHTS
Review Yearly
– To help understand
– To help embrace
– To help live
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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.”
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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
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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
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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
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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
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IF ABUSE IS WITNESSED
Report IMMEDIATELY
Intervene as needed
Reassure the individual
Follow agency policy
Review incident management bulletin
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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.
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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
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