ABUSE, NEGLECT & EXPLOITATION

1. ABUSE, NEGLECT & EXPLOITATION HILL COUNTRY MHDD CENTERS CRISIS STABLIZATION UNIT SUBSTANCE ABUSE PROGRAMS ECI-1115 Waiver-Contractors

2. YOUR RESPONSIBILITY To PROTECT the HEALTHWELFAREand SAFETY of our CONSUMERS

3. ABUSE ABUSE: The negligent or willful infliction of injury, unreasonable confinement, intimidation, or cruel punishment with resulting physical or emotional harm or pain to a person with a disability by that person’s caretaker, family member, or other individual who has an ongoing relationship with the person. DFPS Rules, 40 TAC §705.1001

4. YOUR DUTY • It is your duty to perform your job in a way that will never abuse, neglect or exploit consumers. • We will discuss ways to • RECOGNIZE what abuse, neglect or exploitation is. RESPONDto the consumer/allegation, and protect every patient/consumer. REPORT possible abuse, neglect & exploitation to the proper reporting agency.

5. TYPES OF ABUSE • Sexual Abuse-(Sexual Exploitation) • Physical Abuse • Exploitation (Money, Resources, Property) • Verbal orEmotional Abuse • Neglect

6. SEXUAL ABUSE “Sexual abuse of an elderly or disabled person, including any voluntary, involuntary or consensual or nonconsensual sexual conduct that would constitute an offense under Section 21.08, Penal Code (indecent exposure) or Chapter 22, Penal Code (assaultive offenses), committed by the person's caretaker, family member, or other individual who has an ongoing relationship with the person..” DFPS Rules, 40 TAC §705.1005

7. Sexual AbuseExamples • Any sexual activity or conduct between staff and consumer such as: • Kissing. • Staff having an intimate relationship with a patient or consumer. • Inappropriate touching, requesting, suggesting or encouraging any sexual activity. • Sexual Assault.

8. Off-hour patient interaction(MH) Under no circumstances will staff fraternize with current or former patients on a personal level. This may be grounds for disciplinary action, up to and including possible termination. Entering into any type of personal relationship with a patient is considered a conflict of interest, no matter how minor it may be.

9. PATIENT INTERACTION Examples • You are at a party where a person who is a known consumer asks you for a ride to their home which is only a few blocks from the location of the party. You recognize this person as having been a patient at the CSU. This person has obviously been drinking and would not be safe walking the distance. What would you do?

10. Scenario #2 • You are invited to a dinner party with friends. You arrive only to find that another guest is a known patient at the local MH clinic. It has been decided that after dinner everyone is going out to a club to dance. Should you go out with the group? • If you are asked for a ride home from that person, how would you respond?

11. PHYSICAL ABUSE • When an alleged perpetrator is a caretaker, family member, or other individual who has an ongoing relationship with the alleged victim, physical abuse is defined as any knowing, reckless, or intentional act or failure to act, including unreasonable confinement, corporal punishment, inappropriate or excessive force, or intimidation, which caused physical injury, death, or emotional harm. • DFPS Rules, 40 TAC §705.1003

12. SIGNS & SYMPTOMS • Unusual patterns of injuries such as bruises, bites or burns. • Frequent unexplained injuries. • Fearful Behaviors. • Extreme fear of a specific employee. • Serious injury. • Verbal allegations.

13. Physical AbuseExamples • Striking • Pushing • Shaking • Verbal Incitement (What does Incitement mean?)

14. Physical Abuse & NeglectScenario • You have baby in your care who has been assigned a nurse hired by a home health care provider. You have observed her not following doctor orders. Her actions place baby in danger of death or serious physical injury. Your obligation is to protect well being of baby above all else. How would you respond to this situation?

15. VERBAL-EMOTIONAL ABUSE The use of verbal or other communication, including gestures to; • Curse • Vilify or Degrade (Slanderous or abusive language) • Humiliate • Threaten a person with emotional or physical harm DFPS Rules, 40 TAC §705.1007

16. Verbal-Emotional AbuseExamples • Speaking to a patient/consumer in a loud, angry sounding voice • Cursing at patient/consumer • Using gestures toward patient/consumer • Name calling • Using threatening words and body language

17. EXPLOITATION • Illegal or improper act or process of a caretaker, family member, or other individual who has an ongoing relationship with an elderly or disabled person that involves using, or attempting to use, the resources of the elderly or disabled person, including the person's social security number or other identifying information, for monetary or personal benefit, profit, or gain. DFPS Rules, 40 TAC §705.1011

18. ExploitationExamples • Accepting gifts (monetary or purchased) of any value • You may accept food items if it is shared with co-workers AND consumers • Borrowing personal items which belong to consumers • Consumers do not work for you • Buying or giving gifts to consumers

19. NEGLECT When an alleged perpetrator is a caretaker or paid-caretaker, neglect is defined as: • the failure to provide for protection, food, shelter, or care necessary to avoid emotional harm or physical injury; or • a negligent act or omission that caused or may have caused emotional harm, physical injury, or death. DFPS Rules, 40 TAC §705.1009

20. NEGLECTExamples • Failure to assist consumer when requested • Failure to provide adequate nutrition (IDD) • Failure to assist consumer with clothing and shelter(IDD—HCS) • Failure to provide prescribed medications in a timely manner

21. NEGLECTContinued • Failure to establish and carry out an appropriate individual treatment plan of services • Failure to assist patient/consumer with the activities of daily living if necessary • Leaving a person unattended when unless PDP states otherwise (IDD) • Allowing Patients/Consumers to argue/fight without intervention • Talking or texting on cell phone while driving

22. NEGLECTContinued • While at work, HCMHDDC staff will NOT, watch or rent movies or programs that are rated PG or R if the program contains sexually explicit or violent content.

23. REPORTING ALLEGATIONS

24. REPORTING It is your Legal, Ethicaland Moral responsibility to report any allegation of Abuse, Neglect or Exploitation within one (1) hour when you See it, Hear it, or Suspect it. Failure to report an incident is considered a criminal offense: Class A misdemeanor

25. Texas Dept. Family & Protective Service (TDFPS)

26. TDFPS • 1-800-647-7418 • Facility Investigations • Staff are on duty • 24 hours a day – 7 days a week

27. MAKING THE CALL • You must report all known or suspected allegations of abuse, neglect & exploitation within one hour from the time you witness or learn of the incident. • You must call only the number posted • You may be put on hold and it could last several minutes. DO NOT HANG UP!!!

28. INFORMATION TO BE GIVEN • Give complete information about the consumer – Name, Address, Phone, Age, any other important information about the consumer, if asked • You may give medical information if it is necessary for the report

29. YOU HAVE MADE THE REPORT! • Before you hang up, the intake worker will give you a confirmation number and their staff ID #. Be sure to write down these numbers and keep them in a safe place.

30. REPORTS ARE CONFIDENTIAL • Once you have made the report, YOU MUST KEEP THIS INFORMATION CONFIDENTIAL • DO NOT DISCUSS THIS INFORMATION WITH ANYONE • You do not report this to your supervisor or anyone else.

31. NEED ADVICE BEFORE CALLING? You may call Wm. A. Olden, R.P.O 830.258.5441 1.888.393.3629 toll free

32. THE INVESTIGATION In most cases, a DFPS investigator will come to the clinic/center to ask questions and review the records. You are expected to cooperate fully. There are some cases they do not investigate. I will investigate those cases and determine the outcome.

33. YOU DO NOT INVESTIGATE IT IS NOT YOUR DUTY TO INVESTIGATE OR TO ASK QUESTIONS

34. FAILURE TO REPORT IN A TIMELY MANNER If you fail to report an incident in a timely manner, discuss with a co-worker. Or any other situation considered neglecting your reporting responsibility, you may be subject to disciplinary action up to and including termination.

35. RETALIATION What is RETALIATION?

36. RETALIATION Any action intended to inflict emotional or physical harm or inconvenience to an employee who has reported abuse, neglect, exploitation. This could include harassment, disciplinary measures, discrimination, reprimand, threats, censure or criticism

37. RETALIATION IS PROHIBITED If you feel that someone has or is retaliating against you for doing the right thing, you should immediately notify: Sheree Hess Human Resource Director 830-792-3300 XT 2044

38. You must report abuse allegations when • When you see it • When you hear about it • When you suspect it

39. YOU REPORT ABUSE TO • Abuse, Neglect & Exploitation is reported to: DFPS Texas Dept of Family & Protective Services 1-800-647-7418 Number can be found on the Abuse, Neglect and Exploitation flyers in every office & building HCMHDDC occupies.

40. RIGHTS

41. HUMAN RIGHTS • life, liberty and pursuit of happiness • freedom from torture, or cruel, inhuman or degrading treatment or punishment • equality before the law not being subjected to arbitrary arrest, detention or exile • freedom of movement and residence • freedom of thought, conscience and religion • peaceful assembly and association

42. CIVIL RIGHTS • 1st. Freedom of speech, press, religion, peaceable assembly, and to petition the government • 2nd. Right for the people to keep and bear arms, as well as to maintain a militia • 3rd. Protection from quartering of troops • 4th. Protection from unreasonable search and seizure • 5th. Due process, double jeopardy, self-incrimination, private property • 6th. Trial by jury and other rights of the accused • 7th. Civil trial by jury • 8th. Prohibition of excessive bail, as well as cruel and unusual punishment • 9th. Protection of rights not specifically enumerated in the Bill of Rights • 10th. Powers of states and people

43. Consumer Rights • To be treated with respect and dignity • To have their privacy protected • To receive age and culturally appropriate services • To understand available treatment options and alternatives • To receive care that does not discriminate on the basis of age, race, or type of illness • People with mental illness may have additional SPECIAL rights that are protected under the following laws Americans with Disabilities Act. Fair Housing Amendments Act. Civil Rights of Institutionalized Persons Act. Individuals with Disabilities Education Act.

44. SPECIAL RIGHTS Federal & State laws were passed giving individuals with mental illness & mental retardation additional special rights • Right to Normalization • Least Restrictive Environment (Most appropriate for their needs yet least confining for their conditions • Participate & receive individualized services • Informed Consent • CONFIDENTIALITY

45. RIGHTS VIOLATIONS If an individual believes their rights have been violated, it is their right and your responsibility to report the violation within one (1) hour or assist them in making a call to: Wm. A. Olden, R.P.O. 830.258.5441 1-888-393-3609 (Toll Free)

46. REPORTING VIOLATIONS Rights violations can also be reported to the state rights protection service at: Consumer Rights and Services Office MH – 1-800-252-8154 MR – 1-800-458-9858

47. COMPLAINTS

48. COMPLAINTS If a consumer, their guardian, legally authorized representative, family or friend wishes to file a complaint about our services or employees, they may do so by calling: Wm. A. Olden, R.P.O. 830.258.5441 1-888-393-3609 (Toll Free)

49. OTHER COMPLAINT LINES Texas Dept. Health & Human Services MH – 1-800-252-8154 MR – 1-800-458-9858

50. CONFIDENTIALITY