CPCC Abuse & Neglect TRAINING

CPCCAbuse & NeglectTRAINING RULES, DEFINITIONS, REPORTING & PREVENTION

RULES • TAC’s (Texas Administrative Code) • TAC 711, Subchapter G - Investigations in TDMHMR Facilities & Related Programs • TAC Title 25, Chapter 414, Subchapter L – Abuse, Neglect and Exploitation in Local Authorities and Community Centers • TAC Title 40, Chapter 4, Subchapter L – Abuse, Neglect • Texas Health and Safety Code, Chapter 534, Subchapter A, and §533.035

Definitions – Physical Abuse • (1) an act or failure to act performed knowingly, recklessly, or intentionally, including incitement to act, which caused or may have caused physical injury or death to a person served; • (2) an act of inappropriate or excessive force or corporal punishment, regardless of whether the act results in a physical injury to a person served; or • (3) the use of chemical or bodily restraints on a person served not in compliance with federal and state laws and regulations

Definitions – Sexual Abuse Any of the following with a person served, with sexual intent: • Kissing; Hugging; Stroking; Fondling; • Engaging in or requesting, soliciting or compelling a person served to engage in: (A) sexual conduct or (B) any activity that is obscene. • In the presence of a person served: (A) engaging in or displaying any activity that is obscene, or (B) requesting, soliciting, or compelling another person to engage in any activity that is obscene; • Committing sexual exploitation which is a pattern, practice, or scheme of conduct against a person served, which may include sexual contact, that can reasonably be construed as being for the purposes of sexual arousal or gratification or sexual abuse of any person.; • Committing sexual assault or committing aggravated sexual assault; and/or • Causing, permitting, encouraging, engaging in, or allowing the photographing, filming, videotaping, or depicting of a person served if the employee, agent, or contractor knew or should have known that the resulting photograph, film, videotape, or depiction of the person served is obscene or is pornographic.

Definitions – Verbal/Emotional Abuse Any act or use of verbal or other communication, including gestures, by a staff or contractor towards a person served to: • (1) curse, vilify, or degrade a person served; or • (2) threaten a person served with physical or emotional harm. • (b) In order for the definition of verbal/emotional abuse to be met, the act or communication must: • (1) result in observable distress or harm to the person served; or • (2) be of such a serious nature that a reasonable person would consider it harmful or causing distress.

Definitions - Neglect A Negligent act or omission by any individual responsible for providing services to a person served, which caused or may have caused physical or emotional injury or death to a person served or which placed a person served at risk of physical or emotional injury or death. Neglect includes, but is not limited to, the failure to: • establish or carry out an appropriate individual program plan or treatment plan for a person served, if such failure results in a specific incident or allegation involving a person served; • provide adequate nutrition, clothing, or health care to a specific person served in a residential or inpatient program; or • provide a safe environment for a specific person served, including the failure to maintain adequate numbers of appropriately trained staff, if such failure results in a specific incident or allegation involving a person served.

Definitions - Exploitation • The illegal or improper act or process of using a person served or the resources of a person served for monetary or personal benefit, profit, or gain. The definitions provided were from the Texas Administrative Code (TAC) Title 40, Part 19, Subchapter 711

Real Examples of Abuse • Physical Abuse: • Using corporal punishment – such as spanking, pinching, etc… a person/child served - even if it doesn’t cause an injury! • Horseplay – this can and has resulted in injuries – we are professionals, not wrestlers, brothers and sisters in 3rd grade, nor are we here to “play around” we are here to teach • Not helping someone who has visual or physical impairments get out of a van (just sitting in the driver’s seat) and they fall. • Lifting a person the wrong way, resulting in an injury.

Real Examples of Sexual Abuse • Staff member dating a consumer • Taking a consumer to a sexually explicit movie • Making sexual comments about the consumer (e.g. “I think you are hot” or “You’ve got yourself a nice pair” or some-other inappropriate statement) • Taking a consumer to your house and making out with your boyfriend/girlfriend in front of the consumer • Asking the consumer about their love life (with the exception of clinically appropriate questions for intake or other clinical situations, obviously not worded ‘love life’)

Real Examples of Verbal/Emotional Abuse • Making statements or implying that the person is stupid or dumb. • Threatening a person with hospitalization if they don’t do what you tell them to do. • Threatening to have the person’s medications taken away, if they don’t follow up with you (the case worker). • Telling the person that they are getting fat and they need to take a bath, because they stink.

Real Examples of Neglect • Leaving a person who requires supervision while eating, unattended. • Not checking the building, before leaving, and locking a client in it. • Dropping a client off at their house, but not waiting for them to get inside (and after you leave, they realize that they don’t have their key, it’s summer time) • Knowing that the floors are slippery from all of the rain, but not putting down mats to dry off feet/shoes or signs up.

DUTY TO REPORT If you know or suspect that a person served is being or has been abused, neglected, or exploited you must: • Report such knowledge or suspicion to PRS immediately, if possible, but in no case more than one hour after knowledge or suspicion by calling the PRS toll-free number at 1-800-647-7418; • Preserve and protect any evidence related to the allegation in accordance with instructions from PRS; and • Cooperate with the investigator during the investigation.

What does “suspect” mean? • If you have been told by another person that an abusive situation occurred – you need to report it to DFPS. • You are talking to someone and they say something about a staff member mistreating a consumer in some way – Report it! • Remember, it is not our job to figure out if it actually occurred. It is our job to report the situation and DFPS’s job to investigate it. • If you do not report the situation, you could be accused of neglect for failure to report.

WHAT IS THAT NUMBER AGAIN? DFPS (Department of Family & Protective Services) 1-800-647-7418

What if the abuse is happening right now, in front of you??? • STOP the staff person from abusing the consumer! • How? The best thing to do, if the situation isn’t a physical altercation where others can get hurt is: INTERRUPT and say that you need to meet with the consumer, right now, that it is an emergency. Get the consumer to a safe, quiet area. Make sure that they are okay (physically & emotionally) and document/preserve the evidence. • If there is a physical altercation, call the police/911. • Sometimes, if there is a physical altercation, you can easily and safely get the people separated, using proper PMAB techniques. Only do this if you are trained and know that you can do this safely, for everyone’s personal wellbeing.

So, what are the steps? • STOP the abuse • PROTECT the individual (and get medical help if needed) • Preserve the evidence (document or if injuries, get nurse/doctor attention) • Report to DFPS w/in 1 (one) hour • COOPERATE with the investigator

Investigations • DFPS Facility Investigators have the right to: • Access our buildings • Interview our staff and clients • Have copies of records that they feel are pertinent to the investigation (that can be client records, staff time sheets, sign in sheets, etc…) • Basically, don’t interfere with the investigation – give them what they need

Treat everyone with respect and dignity Be a professional at all times Be friendly, not the person’s friend Stop and think, before you speak Ask yourself “Is this how I want to be treated?” Observe the situation – make sure that it is safe Ask for help – don’t set yourself up because you are afraid to ask When you aren’t sure how to handle something, ask a supervisor or other professional ABUSE PREVENTION

Prevention of Abuse & Neglect • CPCC has a policy that addresses relationships with consumers (5.5-4) • Basically, the policy requires staff to develop therapeutic relationships with consumers. • How? • By maintaining boundaries • Using self-disclosure only as a last resort • Not providing services to family members/friends • Provide the needed services, not enabling • Teach skills, help people be as independent as possible • Model appropriate behavior

CPCC’s Policy • All staff are obligated and required to report suspected abuse or neglect of a person served, within one (1) hour of their suspicion of abuse. • Staff must report to DFPS staff to client abuse:1-800-647-7418 community allegations 1-800-252-5400 (child abuse, elderly abuse, abuse of a disabled person by a community member) FAILURE TO REPORT COULD RESULT IN DISCIPLINARY ACTION!

CPCC’s Policy • Employee’s/agents/contractors are prohibited from retaliating against other employee’s/agent/contractors who report suspected abuse or neglect. • Retaliation includes harassment, disciplinary measures, discrimination, threats, reprimands, or criticism. Retaliatory action and/or situations where allegations are ignored without cause should be reported to the Executive Director. • This can also be reported to DADS/DSHS Rights Office. • DADS: 1-800-458-9858 • DSHS: 1-800-252-8154; or • The Office of the Attorney General (OAG) @ 1-512-463-2120

During an investigation, the accused staff will typically be reassigned to alternate duty or placed on administrative leave. This is to ensure that there is no contact between the accused staff and the alleged victim. This reassignment may be desk duty; no contact with the specific consumers or other staff members (reassigned case load); increased supervision; placement at the Portland office; or administrative leave, determined by management staff. Investigation Action

Disciplinary Action • Whether or not the investigation results are confirmed, a staff may be terminated from employment, due to inappropriate actions. • Staff may also be written up, receive re-training or be demoted. • Coastal Plains Community Center does not tolerate abuse/neglect of a person served. Rarely will re-training or demotion occur if there is a confirmation.

Disciplinary Action, continued • If DFPS confirms abuse, the staff will be required to sign off on the Abuse Neglect Report (AN-1-A) form. This form is entered into the Client Abuse Neglect Reporting System (CANRS), which is utilized statewide by the State agencies for tracking abuse and neglect cases. • The staff’s name, social security number, date of birth and type of abuse which they committed will be permanently part of this system.

Disciplinary Action, continued • The information in the Client Abuse Neglect Reporting System (CANRS) is part of most State agency pre-employment screenings. • Also, if the conclusion of the investigation is a serious confirmed abuse case, this information may also be entered into another data base which tracks abuse cases for the Home & Community-based Services (HCS) programs. The entry of this will be determined by DFPS and they will notify staff if this will be done. • DFPS may also enter the staff’s information into the nurses aid registry list if the abuse is serious.

NEED MORE INFORMATION??? • If you need more information about what abuse and neglect is, you can refer to the TAC’s referenced at the beginning of this presentation (the Texas Administrative Code – TACs can be located on both the DADS and DSHS web sites at www.dads.state.tx.us or www.dshs.state.tx.us • If you are receiving this training as a new employee or as refresher training, the TACs are included in your training handouts, along with CPCCs policy. • You can also contact Andrea Tippit, QM Director/Rights Officer for CPCC at • 777-3991 or 1-888-819-5312 or • atippit@coastalplainsctr.org

CPCC Abuse & Neglect TRAINING