Abuse.pptx

© 2009 APS Healthcare, Inc. 1
Abuse: Recognizing and Reporting
Presented by: APS Healthcare
Southwestern 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_doc
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.

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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