Abuse and Neglect  Prevention  Recognition  Investigation

Neglect – Definition:  The failure to provide goods or services necessary to avoid physical or psychological harm.  The failure to provide proper care and attention to an individual that results in significant harm or jeopardy of harm to the individual’s health, safety, or well- being;  The failure to provide necessities such as food, clothing, essential medical treatment, adequate supervision, shelter or a safe environment.

Examples of Neglect:  Weight loss due to denied nutritional food  Lack of weather appropriate clothing  Wearing same clothing every day with no opportunity for cleaning  Lack of timely follow-up regarding professional recommendations

Neglect – Physical Signs and Symptoms:  Unattended medical needs  Lack of supervision  Consistent hunger, inappropriate dress, poor hygiene  Distended stomach, emaciated  Inadequate nutrition

Neglect – Behavioral Signs and Symptoms:  Regularly displays fatigue or falls asleep frequently  Steals or begs for food  Self destructive behavior  Extreme loneliness and need for attention

Abuse – Definition:  Refers to the ill-treatment, violation, revilement, maligning, exploitation, and/or otherwise disregard of an individual, whether purposeful or due to carelessness, inattentiveness, or omission of the perpetrator.  The mistreatment or mishandling of an individual that results in physical or emotional injury of the individual or endangers the physical or emotional well being of the individual.  A perpetrator may be an employee, intern, volunteer, consultant, contractor, visitor, another individual receiving service or any other person.  Abuse can occur whether or not the victim is or appears to be harmed.  The failure to exercise one’s duty to intercede on behalf of an individual that is being abused also constitutes abuse.

Categories of Abuse:  Physical Abuse  Sexual Abuse  Psychological Abuse  Verbal Abuse  Abuse of Funds  Seclusion  Threat  Use of Aversive Techniques  Inhumane Treatment  Violation of Individual Rights  Injuries of Unknown Origin  Physical Aggression

Physical Abuse  Refers to any physical motion or action (e.g. hitting, slapping, punching, kicking, pinching, etc.) by which bodily harm or trauma occurs. It includes the use of corporal punishment as well as use of any restrictive, intrusive procedure to control inappropriate behavior for purposes of punishment.  Physical contact which is not necessary for the safety of the individual and causes discomfort with more force than is reasonably necessary.

Physical Abuse – Physical Signs and Symptoms:  Unexplained bruises  Unexplained fractures, lacerations, or abrasions  Unexplained burns  Swollen areas  Evidence of delayed or inappropriate treatment for injuries

Physical Abuse – Behavioral Signs and Symptoms:  Self destructive behavior  Behavioral Extremes: Withdrawn and/or aggressive  Complaints of soreness or moves uncomfortably  Bizarre explanation of injuries  Avoids contact with others  Wears clothing inappropriate for the weather

Sexual Abuse  Any sexual activity between an individual and an employee, intern, volunteer, consultant, or contractor of an SRC/community agency;  Any touching or fondling of an individual directly on or through clothing for the arousing or gratifying of sexual desires;  Causing an individual to touch another person for the purpose of arousing or gratifying sexual desires.  May also include non-touching activities of a sexual nature, such as self-exposure, showing pornography, derogatory or sexual talk.

Sexual Abuse – Physical Signs and Symptoms:  Torn, stained, or bloody underclothing  Pain, swelling or itching in the genital area  Difficulty walking or sitting  Bruises or bleeding in the genital area  Venereal disease  Frequent urinary or yeast infections  Incontinence or bed-wetting

Sexual Abuse – Behavioral Signs and Symptoms:  Sudden change in appetite  Experiences Nightmares  Threatened by physical contact, closeness  Demonstrates bizarre or unusual sexual knowledge or behavior  Suicide attempts

Psychological Abuse  Includes, but is not limited to, humiliation, harassment, and threats of punishment or deprivation, sexual coercion, intimidation, or whereby the individuals suffer psychological harm or trauma.  The use of verbal or non-verbal expression or other actions in the presence of one or more individuals that subjects the individual(s) to ridicule, humiliation, scorn, contempt, or dehumanization or is otherwise socially stigmatizing.

Verbal Abuse  Refers to any use of oral, written or gestured language by which abuse occurs.  This includes derogatory terms to describe persons with disabilities.

Psychological/Verbal Abuse – Signs and Symptoms:  Behavioral Extremes – passive and/or aggressive  Sleep disorders  Repetitive Behaviors (e.g. sucking, rocking, biting)  Development of ulcers  Speech disorders  Delayed physical development

Abuse of Funds  Exploitation is any action which involves the misuse of a vulnerable adult’s funds, property, or person. Vulnerable Adult:  An adult who lacks the physical or mental capacity to provide for the adult’s daily needs  Spending money of an individual: Against their expressed wishes, if the expenditure was not necessary for the direct or immediate benefit and welfare of the resident; or For the use of benefit of a person other than the resident if the expenditure is not also for the direct and immediate benefit of the resident or consistent with an express wish and past behavior of the resident.

Seclusion  The involuntary placement of an individual in any area from which they are prevented from leaving.  Not a permitted behavioral intervention at Potomac Center.  Highly restrictive, and does not provide an opportunity for therapeutic intervention.  Always use the least restrictive form of intervention!

Other Categories:  Threat: Is any condition/situation which could cause or result in severe, temporary, or permanent injury or harm to the mental or physical conditions of individuals, or cause death.  Use of Aversive Techniques: The application of painful or noxious stimuli to the body which is intrusive upon an individual’s physical, mental, or emotional well-being in order to terminate challenging behavior.

Other Categories – Cont:  Inhumane Treatment: Any deliberate act of cruelty that endangers the physical or emotional well-being of an individual; The deliberate and willful determination of an SRC/community agency to follow treatment practices  That are contradicted by the individual plan,  That violate an individual’s human rights, or  Do not follow accepted treatment practices and standards in the field of developmental disabilities.

Other Categories – Cont:  Violation of Individual Rights: Any action or inaction that deprives an individual of the ability to exercise his or her legal rights as articulated in State or Federal law.  Injuries of Unknown Origin: Must meet both:  The source of the injury was not observed by any person or the source of the injury could not be explained by the individual; and  The injury is suspicious because of the extent of the injury or the location (e.g. the injury is located in an area not generally vulnerable to trauma), or the number of the injuries observed at one particular point in time, or the incidence of injuries over time.

Other Categories – Cont:  Physical Aggression: An incident involving physical contact or alleged physical contact between two or more individuals that does not result in injury; or, if an injury is sustained it is defined as mild injury.

Procedure for Investigation  Assess the Individual Nurse documents assessment on the bottom of the incident report. All allegations of neglect or abuse, including injuries of unknown origin or misappropriation of an individuals’ property, are to be reported immediately to the Director. In her absence, allegations should be reported to the Program Director, Assistant Director, Security, or Officer of the Day. Collect, retain, and safeguard any material(s) pertinent to the investigation.  Investigation is completed by security.

Procedure for Investigation – Cont.  Administrative Action (OD, Director, Assistant Director, Program Administrator) Take whatever steps necessary to safeguard the resident from further abuse. The alleged abuser will not have access to the individual. All allegations must treated with the same immediate response.  Follow-up If no abuse is found, seek reasons for allegation and respond to alleviate situation. If abuse is substantiated, the following happens immediately:  If employee, they are placed on administrative leave and Human Resources is notified.  Maryland State Police or Hagerstown Police Department are notified.  Western Maryland Regional Office and DDA representatives are notified.