Residential Director Core Training Recognizing, Reporting and Preventing Abuse and Neglect Module 4

MODULE 4

RECOGNIZING, REPORTING AND PREVENTING ABUSE AND NEGLECT

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TABLE OF CONTENTS RECOGNIZING, REPORTING AND ...... 1 PREVENTING ABUSE AND NEGLECT ...... 1 TABLE OF CONTENTS ...... 2 WHAT YOU WILL LEARN FROM THIS TRAINING MODULE ...... 4 ABUSE AND NEGLECT OVERVIEW ...... 5 RECOGNITION SECTION ...... 7 EARLY RECOGNITION IS A FORM OF PREVENTION ...... 7 TYPES OF ABUSE ...... 7 PHYSICAL ABUSE IS DEFINED AS...... 7 SEXUAL ABUSE IS DEFINED AS:...... 9 MENTAL ABUSE IS DEFINED AS:...... 11 FINANCIAL EXPLOITATION IS DEFINED AS: ...... 12 NEGLECT IS DEFINED AS: ...... 13 EGREGIOUS NEGLECT IS DEFINED AS: ...... 13 EXAMPLE OF NEGLECT ...... 13 MALTREATMENT ...... 14 POSSIBLE BEHAVIORAL INDICATORS OF MALTREATMENT ...... 16 POSSIBLE CIRCUMSTANTIAL INDICATORS OF MALTREATMENT ...... 17 HARM CAUSED BY ACCIDENTAL MEANS:...... 17 RULE 50 (ILLINOIS ADMINISTRATIVE CODE 50) ...... 19 RULE 50 MANDATES:...... 20 RULE 51 (FOR DOMESTIC SETTING CASES) ...... 21 ICF/DD RULE 350...... 21 ALLEGATION:...... 22 INAPPROPRIATE INTERACTIONS ...... 23 CHARACTERISTICS OFTEN FOUND IN ABUSERS...... 24 SEXUAL PREDATORS...... 24 WARNING SIGNS TO LOOK FOR WHEN HIRING STAFF:...... 25 REPORTING SECTION ...... 26 REQUIRED REPORTER:...... 26 PROHIBITION OF RETALIATORY ACTION AGAINST AN EMPLOYEE FOR REPORTING:...... 27 REPORTING REQUIREMENTS ...... 28 WHAT ARE THE REQUIREMENTS FOR REPORTING DEATHS?...... 28 FALSE REPORTS OF ABUSE OR NEGLECT ...... 28 REPORTING EXERCISE: ...... 30 VOLUNTEERS ...... 31 SERIOUS INCIDENTS AND ACCIDENTS:...... 31 REPORTING TO LAW ENFORCEMENT...... 31 REPORTING TO DEPARTMENT OF PUBLIC HEALTH...... 32 AGENCY RESPONSE TO REPORTS OF ABUSE: ...... 33 WHAT TO SAY WHEN SOMEONE TELLS YOU THEY HAVE BEEN SEXUALLY ABUSED...... 34 COMFORTING THE VICTIM ...... 35 OIG – INVESTIGATIVE FINDINGS...... 37 SUBSTANTIATED FINDINGS AND THE HEALTH CARE WORKER'S REGISTRY(FORMERLY KNOWN AS NURSE AIDE REGISTRY)...... 37 COMMON EXCUSES FOR NOT REPORTING...... 38 REPORTING AS A FORM OF PREVENTION...... 38 PREVENTION SECTION...... 39 EDUCATING INDIVIDUALS ...... 39 DIGNITY OF RISK...... 40 STAFF HIRING...... 41

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STAFF TRAINING ...... 41 STAFF ATTITUDE...... 42 GROUP DISCUSSION ...... 43 DIFFUSE SITUATIONS BEFORE THEY ESCALATE:...... 43 DISCUSSION EXERCISE – DIFFUSING SITUATIONS...... 44 TEAMWORK ...... 45 STRESS AND BURNOUT ...... 46 WHAT ARE THE WARNING SIGNS OF STRESS?...... 46 WHAT CAN BE DONE TO REDUCE STRESS? ...... 47 VULNERABILITY EXERCISE...... 48 WHAT ARE THE SYMPTOMS OF BURNOUT? ...... 49 PROFESSIONAL ORGANIZATIONS...... 50 RESOURCES - LINKS/WEBSITES...... 51

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What You Will Learn From This Training Module

This course discusses how to identify abuse and neglect, defines the different types of abuse, and assessments and actions to take when confronted with evidence of abuse. After completing this module, you should be able to correctly identify the types of abuse and neglect, their signs and the actions providers are required to take if they believe abuse or neglect has occurred. You will also learn the steps that providers should take to ensure that people are free from abuse and neglect. Specifically, you will learn:

• The definitions and forms of abuse and neglect, using DHS-Office of the Inspector General (OIG) and the Illinois Department of Public Health (IDPH) guidelines in accordance with the law and agency or facility policy.

• The indicators of maltreatment.

• The legal reasons to report inappropriate interaction and abuse and neglect, including handling false reports.

• How to report inappropriate interaction and abuse and neglect in compliance with the law and agency or facility policy.

• The components of, and role in, creating and maintaining a trust-producing, healthy, engaging environment.

• The principle of self-awareness of one’s own attitudes and emotions, managing your own stress and burnout, and recognizing how to prevent maltreatment.

• Strategies for preventing abuse and neglect.

• The criticalness of prompt reporting of abuse and neglect.

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ABUSE AND NEGLECT OVERVIEW

Whether you have a disability or not, you are:

• more likely to be a victim of a crime by someone you know rather than a stranger. For people with disabilities, that typically means care providers as opposed to strangers. • One of the added vulnerabilities is that people with disabilities often have several care providers, paid and unpaid, who are involved with their services. This increased vulnerability is compounded by the number and array of supports and services and the number of people who are involved in their care. The focus of this training is on: • recognition • reporting and • prevention of abuse and neglect, with emphasis on prevention. • Of course, recognition and reporting are part of prevention. The ultimate goal of every person who works at your agency, facility, or home should be prevention of abuse and neglect. You have a unique role in preventing maltreatment because you are the link between the individuals served and DSPs, other support staff, visitors and agency administration. However, we can’t prevent maltreatment if we don’t know what it is; what it looks like; how it sounds - - how it feels. • Abuse is widespread in society, affecting every socioeconomic level, both sexes, all ages and all races. However, no group is more vulnerable than people who have developmental disabilities. They are victims of physical violence, sexual abuse, and mental abuse at rates higher than people with other types of disabilities as well as in the rest of the population. We know that most incidents of abuse are underreported, whether or not it involves a person with a disability or someone in the general population. There is also the issue of believability. Often, when reports are made concerning people with disabilities, and developmental disabilities in particular, there are questions about the credibility of the person making the allegation. As you will learn in this training, the credibility of the person does not negate your legal obligation to report allegations of abuse. It is not up to the mandated reporter to determine whether or not an individual is being truthful. You must report all allegations in accordance with your agency or facility’s reporting policies and procedures.

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Did You Know…

The rate of abuse ranges from a low of 25% to a high of 83% for all people with a disability.

The perpetrators are often not strangers, but rather caregivers or someone else who is close to the person with a disability.

More than 90 percent of people with a developmental disability will experience sexual abuse at some point in their lives. (Valenti-Hein & Schwartz, 1995).

49 percent will experience 10 or more abusive incidents (Valenti-Hein & Schwartz, 1995)

Only 3 percent of sexual abuse cases involving people with disabilities will ever be reported. (Valenti-Hein & Schwartz, 1995)

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RECOGNITION SECTION

Early Recognition is a Form of Prevention

Early recognition allows the community agency or facility an opportunity for early intervention with the offending employee. Perhaps the person can be retrained. Or, perhaps the person should be terminated.

Early recognition may stop the individual from being harmed any more than he/she already has been and may prevent further victimization.

Early recognition can prevent the bad actions of one person from contaminating the rest of the employees and the home or work environment.

TYPES OF ABUSE According to the Office of Inspector General:

Abuse is defined as any:

• Physical Abuse • Sexual Abuse • Mental Abuse • Financial Exploitation

Physical Abuse is defined as: an employee’s non-accidental and inappropriate contact with an individual that causes bodily harm. Physical abuse includes actions that cause bodily harm as a result of an employee directing an individual or person to physically abuse another individual.

Bodily harm is defined as any injury, damage, or impairment to an individual’s physical condition, or making physical contact of an insulting or provoking nature with an individual.

To be reportable as physical abuse, physical abuse must be alleged, witnessed, or only suspected.

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Physical abuse now includes an employee directing someone else to physically abuse another individual.

Signs and symptoms shared by many physical abuse victims include:

• Bruises or welts • Burns, fractures, and sprains • Head injuries • Lacerations or abrasions • Multiple injuries in various stages of healing • Delay between acquiring the injury and seeking medical treatment • Evidence of restraint

Look for things like imprint marks. Does it look like somebody grabbed the person? Can you see signs that four fingers and a thumb were around somebody’s arm or around somebody’s neck? Look for places on the body where it’s difficult to bruise by accident — the inner thighs, the back, stomach, etc. Look for bruising at different stages of healing. Another thing is to pay close attention when the support worker is trying to make excuses for the physical markings on the person’s body. Does the story really sound plausible or credible? Remember that if somebody has a communication challenge, it is easy for a direct care provider to make up a story and lie. A medical doctor or forensics expert may be able to examine injuries and give some indication as to what might have caused it.

Note: Bodily harm is not always visible. For instance bodily harm could be a slap that doesn't leave a visible injury or a kick that does leave a visible injury. They are both wrong AND must be reported to OIG.

Remember that victims may not be willing to share information on their abuse. However, when questioned in a safe environment, they may open up.

Often, physical abuse is accompanied by emotional abuse; this type of abuse is covered later in this module.

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Sexual Abuse is defined as: Any sexual behavior, sexual contact or intimate physical contact between and employee and an individual, including an employee’s coercion or encouragement of an individual to engage in sexual activity that results in sexual contact, intimate physical contact, sexual behavior or intimate physical behavior.

Definition of Sexual Contact: Inappropriate sexual contact between an employee and an individual involving either an employee's genital area, anus, buttocks or breast(s) or an individual's genital area, anus, buttocks or breast(s). Sexual contact also includes sexual contact between individuals that is coerced or encouraged by an employee.

Simple personal hygiene, such as bathing or toileting, is not inappropriate sexual contact.

Examples of Sexual Abuse -Report an employee doing anything like the following: • Pressuring an individual to have sex with another individual. • Encouraging the individual to masturbate in front of others. • Taking nude photographs of an individual.

Sexual abuse can be:

• Any act of sexual contact, sexual penetration, sexual coercion, or sexual exploitation of an individual.

• There is no such thing as consensual sexual activity between an employee and an individual. Any sexual activity between an employee and an individual is reportable to OIG.

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Sexual Contact: • By mere chance, brushing up against someone’s buttocks or breasts is NOT sexual contact. But it is reportable if the individual or another employee alleges abuse. • Simple personal hygiene, such as bathing or toileting, if done properly, is not inappropriate sexual contact.

Some indicators of sexual abuse:

Sexual abuse can occur in any age group. General signs and symptoms often include: • Avoids specific persons (i.e., individual doesn’t want to be around an employee that she had previously enjoyed being with) • Avoids specific places for an unknown reason • Exhibits negative changes in behavior patterns (i.e., difficulty sleeping or other sleep disturbances, develops an eating disorder in which the individual refuses/restricts food intake or gorges/is obsessed with food, regression to engaging in old behavior patterns) • Unusual or more extreme displays of fear (i.e., fear and resistance towards physical exams) • Sudden changes in mood, especially depression • Engages in sexualized behavior (i.e., an unprompted or unexplained drawing of genitalia) • Chronic constipation • Difficulty walking or sitting • Extreme weight changes • Frequent urinary tract or yeast infections • Incontinence • Bruising on the inner thighs • Injuries, including bleeding, in the genital area • Pain and itching in the genital area • Sexually transmitted disease • Migraines and other headaches • Back pain • Gynecological complications • Unwanted pregnancies • Psychological trauma, such as shock, fear, anxiety, confusion, guilt, nervousness, withdrawal, distrust of others, depression, attempted or completed suicide, and alienation.

You may see: • Bedwetting by someone who never had that problem before. • An interest in a new sex-related topic that cannot be explained • Discloses or talks about the sexual abuse • Unexplained unusual knowledge or new words of a sexual nature that the individual had not previously known

It is also possible that the individual's history has no impact on their present behavior.

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Mental Abuse is defined as: The use of demeaning, intimidating, or threatening words, signs, gestures, or other actions by an employee, about an individual and in the presence of an individual or individuals, that results in emotional distress or maladaptive behavior, or could have resulted in emotional distress or maladaptive behavior, for any individual present.

Mental abuse is still mental abuse even if the individual's mental or physical condition keeps him/her from getting upset. Mental abuse is verbal or nonverbal. Mental abuse is not always face-to-face with the targeted individual, but at least one individual must be present at the time.

Examples of Mental Abuse- • Cursing at an individual. • A curse that is not derogatory of the individual is still reportable if the individual becomes upset by it, so it is best not to curse at all near individuals. • Joking about or making fun of an individual's condition or diagnosis. For example: Making a derogatory comment about an individual with profound mental retardation or a hearing impairment, who doesn't react.

Remember... If someone does something harmful, you must report it regardless whether the individual appears to get upset by it or not.

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Financial Exploitation is defined as:

Taking unjust advantage of an individual’s assets, property, or financial resources through deception, intimidation, or conversion (theft), for the employee’s, facility’s or agency’s own advantage or benefit.

Examples of Financial Exploitation: • Taking an individual’s umbrella for the weekend because of a forecast for rain. You have benefitted from your personal use of an individual’s property.

• As the payee, an agency decides to divert all of an individual’s Social Security funds from his account in order to pay the agency’s rent.

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NEGLECT is defined as:

An employee’s, agency’s, or facility’s failure to provide adequate medical care, personal care, or maintenance, and that, as a consequence, causes an individual pain, injury, or emotional distress, or results in either an individual’s maladaptive behavior or the deterioration of an individual’s physical condition or mental condition, or places an individual’s health or safety at substantial risk of possible injury, harm or death. Neglect now also includes placing an individual at substantial risk, even if he or she is not actually injured as a result.

Egregious Neglect is defined as: a finding of neglect as determined by the Inspector General that represents a gross failure to adequately provide for, or a callous indifference to, the health, safety, or medical needs of an individual, and results in an individual’s death or other serious deterioration of an individuals’ physical condition or mental condition.

Example of Neglect If a co-worker is assigned one-to-one (arms length) supervision to prevent an individual from eating inappropriate objects, yet the co-worker leaves him alone, you should report your co- worker for neglect if the individual then: • Eats anything harmful; • Reasonably could have eaten anything harmful; • Became upset because he was left alone; or • Acts out and needs to be on one-to-one longer as a result.

Other examples of Neglect include: • An employee fails to follow an individual’s diabetic diet resulting in the individual going into diabetic shock. • An individual complains to an employee after burning him/herself on a clothes iron. The employee tells the individual to stop bothering her/him while s/he is on the telephone. • While an employee is outside making a personal telephone call, inside a fight breaks out between two individuals that results in one individual giving another individual a black eye. Both individuals were required to be under visual observation at all times. • An individual is left in soiled clothing all day as punishment for not asking for help in time to avoid an accident. • An individual who was supposed to be under 1:1 supervision wanders away and is found unharmed on a nearby highway. N-09-01-10 Page 13 Residential Director Core Training Recognizing, Reporting and Preventing Abuse and Neglect Module 4

• An individual often has burn marks on his/her forearms. It is later learned that s/he is allowed near a hot stove without supervision. • Following an argument about how closely to monitor the individual, an employee allows an untrained, blind individual to enter a store unattended, to let him/her “learn the hard way.” The individual falls, receiving a blow to the head and suffers a concussion.

Be alert for signs and symptoms that may be the result of neglect.

• Lack of adequate food, clothing, or housing • Poor hygiene • Starvation or malnutrition • Lack of supervision • Abandonment • Unsafe living conditions • Self-destructive behavior • Depression • Abandonment • Dehydration or malnutrition • Being left in unsafe situations • Pressure ulcers • Overmedication or under-medication • Missing assistive devices (glasses, dentures, hearing aids, or walking devices)

For more information, go to the OIG Rule 50 Training link: http://www.dhs.state.il.us/page.aspx?item=33342

Imminent Danger is defined as: A preliminary determination of immediate, threatened or impending risk of illness, mental injury, or physical injury or deterioration to an individual's health that requires immediate action.

MALTREATMENT

The term maltreatment applies to a wide range of negative interpersonal interactions. For our purposes, it will serve as the term that will include acts or omissions by employees involving individuals that are improper or inappropriate, as well as acts or omissions that are abusive, negligent or exploitive

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Maltreatment encompasses all forms of inappropriate interactions, employee misconduct, abuse and neglect. Maltreatment may range from mild forms (i.e. using an unnecessarily loud tone of voice with a person served) to severe forms such as employees hitting a person served. Please refer to your agency’s procedures and policies on the subject of maltreatment. All forms of employee misconduct and inappropriate interactions are reportable to your agency or facility. Maltreatment is not reportable to OIG (or IDPH) unless it involves an allegation, incident, or suspicion of abuse or neglect. One way to know if the incident is OIG (or IDPH) reportable is to review the definitions of abuse and neglect.

There is good reason to believe that, left unaddressed, mild forms of maltreatment/inappropriate interaction might lead to more severe, reportable forms of abuse and to a negative influence on the home/work environment.

Indicators of maltreatment may include inappropriate interactions but usually apply to abuse or neglect.

Three Things to Remember About Maltreatment Indicators:

• The better you know the individuals that you support and the better you know the environment in which you work, the easier it will be for you to identify what the indicators mean in your situation. • It is possible that an indicator may be caused by something other than maltreatment. • Indicators do not have to be reported to OIG (or IDPH) unless there is a reasonable suspicion of abuse or neglect, or there is an accompanying allegation.

Possible Physical Indicators of Maltreatment

• Physical marks on the individual’s body (i.e., cuts, bruises, burns, bites) • Physical marks that are on areas of the body that are difficult to injure (i.e., bruises, burns, cuts on the back) • Physical marks that are unusual for the specific individual • Physical marks that no one can explain how they happened • Blood, semen or other physical markings on the individual’s clothing, bedding, towels, or in other areas of the environment • Torn or missing clothing

Possible Verbal Indicators of Maltreatment

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• Statements by an individual (i.e., complaints of being poorly treated, complaints of not liking an employee). • Unusual or prolonged crying, screaming, or other form of noise made by the individual. • Unusual or prolonged crying, screaming, or other form of noise made by the individual only when a particular employee is present. • Sudden changes in mood, especially depression. • Engages in sexualized behavior (i.e., an unprompted or unexplained drawing of genitalia).

Possible Behavioral Indicators of Maltreatment

• Negative changes in behavior patterns (I.e., increased aggression, sudden withdrawal from others and activities, return to engaging in old behavior challenges, changes in sleeping habits, changes in eating habits)

• Unusual or more extreme displays of fear (i.e., fear of being alone, fear of being with specific persons, fear of being touched, fear of going to a particular place, fear of specific objects)

• Sudden changes in mood (i.e., increased irritability, sadness, anger, apathy, fear)

• Negative changes in behavior patterns, unusual or more extreme displays of fear, sudden changes in mood only when specific persons are present or only after being with specific persons

• Avoids specific persons (i.e., the individual doesn’t want to be around an employee that she had previously enjoyed being with)

• Avoids specific places for an unknown reason

• Exhibits negative changes in behavior patterns (i.e., difficulty sleeping or other sleep disturbances, develops an eating disorder in which the individual refuses/restricts food intake or gorges/is obsessed with food, regression to engaging in old behavior patterns)

• Unusual or more extreme displays of fear (i.e., fear and resistance towards physical examination)

Remember: It is possible that the behavioral signs that you are observing are not always indicators of maltreatment. The signs may be due to other factors: the person may be physically sick, emotionally ill, experiencing a side effect of medication, experienced a sad event in his/her life, or some other unknown reason.

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Possible Circumstantial Indicators of Maltreatment

• Negative caregiver behavior (i.e., aggression, hostility, anger, disrespect, apathy, callousness, etc., towards self and others)

• Previous history of maltreating others

• Alcohol or drug abuse

• Negative attitudes that devalue self and others

• Past history of threatening to harm the individual

• Joking about harming the individual

• Finding humor in the pain and suffering of the individual l Whenever you observe circumstantial indicators it is best to check it out to find out what the problem really is.

It is important to document all your observations.

Again, what you are observing is not always an indicator of maltreatment. Genital discomfort could be a urinary tract infection or yeast infection. Bruises could be related to hemophilia or diabetes. The individual’s wound could be the result of self-injury. It is important to document all you see.

HARM CAUSED BY ACCIDENTAL MEANS: The law does not require reporting harm that is caused only by "accidental means." Accidental implies that you did not make a conscious decision to act or fail to act.

Examples: • Backing into someone is an accident. • Tripping over your shoes is an accident. • Hitting someone back is not an accident. • Cursing an individual you don't know is present is not an accident.

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Allegation An allegation is: An assertion, complaint, suspicion or incident involving any of the following conduct by an employee, facility or agency against an individual or individuals: mental abuse, physical abuse, sexual abuse, neglect or financial exploitation. You do not have to prove or even believe an allegation to report

Remember... • If you are told about abuse or neglect, you must report it. • If you witness abuse or neglect, you must report it. • If you just suspect abuse or neglect, you must report it.

Mitigating Circumstance Definition: A condition that is attendant to a finding, and does not excuse or justify the conduct in question, but may be considered in evaluating the severity of the conduct, the culpability of the accused, or both the severity of the conduct and the culpability of the accused.

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Rule 50 (Illinois Administrative Code 50)

State law required the OIG to adopt a formal rule with regulations on reporting allegations. The Rule that was adopted is Rule 50. It is called “Rule 50” because it is located in the Administrative Code, Title 59, Chapter 1, Part 50. Pursuant to this Rule, all DHS and community agency employees are required to report allegations to the Office of Inspector General (OIG).

(59 Illinois Administrative Code 50) is in the OIG Administrative Code that provides procedures on how to implement the law. The complete code can be found at the link below:

http://www.ilga.gov/commission/jcar/admincode/059/05900050sections.html

FYI: All of the definitions of abuse and neglect in this curriculum are taken from Rule 50.

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RULE 50 MANDATES:

Any employee who suspects, witnesses, or is informed of an allegation of abuse or neglect must report it immediately (no exceptions!). • "Suspects" means you have a suspicion based upon information or an observation, • "Witnesses" means you saw or heard it, or • "Informed of" means you were told about it (like hearsay or an anonymous letter), whether or not you think it actually happened. • You are a required reporter 24 hours a day, seven days a week, NOT only when you are at work. Every allegation must be reported to the OIG Hotline within four hours of the time it was first discovered by the staff. For abuse/neglect, "employee" means any person who provides services at the facility or agency on or off-site. The service relationship can be with the individual, the facility or agency. Also,” employee” includes any employee or contractual agent of DHS or the community agency involved in providing or monitoring or administering mental health or developmental services. This includes, but is not limited to, owners, operators, payroll personnel, contractors, subcontractors, and volunteers. For purposes of this Part, employee also includes someone who is no longer working for an agency or facility, but is the subject of an ongoing investigation for which OIG has jurisdiction.

Remember, for reporting purposes... • You are an "employee" 24 hours a day, seven days a week. • Volunteers and contractors are employees. • Employees are accountable if they commit abuse or neglect on their personal time. An employee who quits or is fired will still be investigated by OIG for abuse or neglect allegedly committed while an employee. Note: Bodily harm is not always visible. Bodily harm could only be insulting or provoking contact, like repeatedly tapping an individual on the forehead. If an employee directs an individual to shoot rubber bands at another individual, the employee is committing physical abuse. So, bodily harm could be a shove that doesn't leave a visible injury or a kick that does leave a visible injury. Remember, bodily injury could also be the result of physical abuse that is only directed by an employee. They All are wrong AND must be reported to OIG.

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RULE 51 (For domestic setting cases)

Domestic living situation" means a residence where the adult with disabilities lives alone or with his or her family or household members, a care giver, or others or at a board and care home or other community-based unlicensed facility, but it is not: • A licensed facility as defined in Section 1-113 of the Nursing Home Care Act [210 ILCS 45/1 113]. • A life care facility as defined in the Life Care Facilities Act [210 ILCS 40]. • A home, institution or other place operated by the federal government, a federal agency, or the State. • A hospital, sanitarium, or other institution, the principal activity or business of which is the diagnosis, care, and treatment of human illness through the maintenance and operation of organized facilities and that is required to be licensed under the Hospital Licensing Act [210 ILCS 85]. • A community living facility as defined in the Community Living Facilities Licensing Act [210 ILCS 35]. • A community-integrated living arrangement as defined in the Community-Integrated Living Arrangement Act [210 ILCS 135] or community residential alternative as licensed under that Act.

Rule 51 can be found in its entirety at http://www.ilga.gov/commission/jcar/admincode/059/05900051sections.html

ICF/DD Rule 350

For information about ICF/DD Rules regarding abuse and neglect, go to: http://www.ilga.gov/commission/jcar/admincode/077/077003500O32400R.html

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Questions and Answers:

ALLEGATION: An allegation is an assertion, complaint, suspicion or incident involving any of the following conduct by an employee, facility or agency against an individual or individuals: mental abuse, physical abuse, sexual abuse, neglect or financial exploitation. You do not have to prove or even believe an allegation to report it.

Question: What about "screening"?

Answer: You are not allowed to screen allegations. Screening means intentionally not reporting an allegation or omitting or changing any information in the allegation. Screening is also using any other information you know and so deciding to not report an allegation of abuse, neglect or financial exploitation. If the policy says you are to report allegations to your supervisor, you should do so. However, if your supervisor fails to report it to OIG, you are still responsible to report it. You are still a Required Reporter.

Allegations are never assumed true or false: If you hear of an allegation from an individual who frequently lies, you are still required to report it.

Allegations have no statute of limitations: If you hear of an allegation that may have occurred ten or twenty years ago, you are still required to report it.

Question: What about multiple allegations? If an individual makes multiple allegations of abuse or neglect every day, do you have to report all of them?

Answer: You should report each one as a new allegation. But you must also try to get specifics - names, dates, and times - so OIG can verify that each allegation has already been reported.

Question: What about false allegations? If an individual makes an allegation of abuse or neglect that you know is not true, do you still have to report it?

Answer: Yes

Question: What about recanted allegations? If an individual alleges that he or she was abused or neglected, and then, before you call to report it, he or she admits to just making it up, do you have to still report it?

Answer: Yes. Remember:... If you are told about abuse or neglect, you must report it. If you witness abuse or neglect, you must report it. N-09-01-10 Page 22 Residential Director Core Training Recognizing, Reporting and Preventing Abuse and Neglect Module 4

If you just suspect abuse or neglect, you must report it.

Question: What happens when people are accused of abuse or neglect?

Answer: While an investigation is pending, the accused should have no contact with any individuals.

Persons under investigation may need to be reassigned or placed on administrative leave pending the outcome of the investigation.

Inappropriate Interactions

Inappropriate interactions are interactions between staff and individuals which demonstrate a lack of respect for the individual. It may be inadvertent, but, nevertheless, it occurred.

Examples:

An employee knows that an individual is trying his/her best to perform a task but becomes a little impatient and hurries the person along.

A tired employee uses a little less care (no harm or injury is caused) than usual when transferring an individual out of his/her wheelchair.

Keep in mind:

• Employees who engage in inappropriate interaction do not intend to cause any harm to the individual. These persons are generally kind and caring caregivers.

• Isolated incidents of inappropriate interaction can become a habit.

• Inappropriate interactions may require corrective actions by the agency or facility.

• Inappropriate interaction (left uncorrected) tends to escalate over time and become more ingrained, more severe, more pervasive and may lead to abuse or neglect.

Watch and listen for inappropriate interactions and take corrective measures as soon as possible.

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CHARACTERISTICS OFTEN FOUND IN ABUSERS

While anyone can be an abuser, there are characteristics that are often found in the abuser. These signs may include: • Having been a victim of abuse as a child • Abusing drugs and/or alcohol • Having difficulty controlling anger • Displaying an attitude of indifference and not caring for the victim • Being overly jealous • Having recurring mental health problems • Having financial difficulties and poor employment records • Having limited social support systems

When accompanying the individual served to a health care appointment, an abuser may: • Insist on coming into the examining room with the individual • Control or dominate the health care appointment • Be overly solicitous • Insist on not leaving the individual alone with the medical professional.

Sexual Predators While a sexual predator can be anyone, studies have shown that, in 8 out of 10 rape cases, the victim knows the perpetrator. It is reported that 4 out of 10 sexual assault cases happen in the homes of the victims.

Some characteristics are commonly found among sexual abusers are: • Excessive or inappropriate eroticism (i.e., the employee brings pornographic material to work, seems preoccupied with sex) • Perpetrates other forms of abuse • Seeks isolated contact with individuals • Abuses drugs or alcohol • Has a history of childhood sexual and physical abuse • Behaves immaturely • Can be socially isolated • Has a preference for impersonal sex and hostility toward women • Is young (the average age of arrest is 31)

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Warning Signs to Look for When Hiring staff:

Evaluate, and watch out for people who may have some of the characteristics that are listed above, or if they: • talk about people with disabilities in a way that is either overtly demeaning or seems like they have a negative attitude toward them. • Seem to have a need to have a lot of control.

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REPORTING SECTION

REQUIRED REPORTER: Any employee who suspects, witnesses, or is informed of an allegation of any one or more of the following: mental abuse, physical abuse, sexual abuse, neglect or financial exploitation. Remember: you are a Required Reporter. You must report any alleged abuse or neglect that you: • See, • Hear, • Read, or • Suspect. You do not need to believe an allegation is true to report it. Even outlandish and far-fetched allegations - those that cannot be true - must be reported. You must report it immediately. All allegations must be reported to OIG within four hours. You must cooperate fully with every OIG investigation. Failure to do so can result in you being disciplined or discharged. You can be fired and prosecuted if you abuse or neglect someone. When an incident occurs, what you should NOT do: • Do not remove anything. • Do not wash or clean anything. • Do not handle anything that might be evidence. • Do not search for evidence yourself. Examples: An individual who is bleeding alleges to you that an employee hit him with a mop in the kitchen. Potential evidence: • the clothing worn by the accused and the victim, • any mop or broom in the kitchen, and • potentially anything in the kitchen. What you should NOT do? • move or pick up anything off the floor, or • clean blood off the kitchen or mop.

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An individual alleges to you that he just had sex with an employee in a storage room. Potential evidence: • the clothing of either person, • towels or sheets in his bedroom, and • anything in the storage room. What you should NOT do: • enter the room or let other staff enter it, or • allow the individual to shower or change.

Since June 13, 2006, intentionally reporting an allegation late–or not reporting it at all–is a Class A misdemeanor.

If you are convicted, it is punishable by: up to one year in jail and/or a $2,500 fine.

Prohibition of Retaliatory Action Against an Employee for Reporting:

"It is a violation of the law to take retaliatory action against an employee who acts in good faith in conformance with his or her duties as a required reporter." (20 ILCS 1305/1-17.)

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What Is Reportable?

Abuse, Neglect, Death and Serious Injury You must report to your AGENCY incidents or allegations of: Abuse, Neglect, Death, Serious Injury and Inappropriate Interactions. For example:

• If you observe an incident of abuse, neglect;

• If you are told of an incident of abuse, neglect; or

• If you believe there may have been an incident of abuse or neglect.

OIG must be contacted within 4 hours of initial discovery of:

• Any allegation of abuse;

• Any allegation of neglect; and

• Any injury or death of an individual that occurs within a facility or community agency when abuse or neglect may be suspected.

REPORTING REQUIREMENTS

What are the requirements for reporting deaths?

Pursuant to 59 Ill. Adm. Code 50, deaths that must be reported to OIG are as follows:

• Deaths occurring on-site in any residential or non-residential program; • Deaths within 14 days of discharge or transfer from a residential program; and • Deaths within 24 hours after deflection from a residential program.

A death must be reported to OIG within 24 hours of the staff becoming aware of it. If the death may be suspected to be the result of abuse or neglect by staff, however, the death must be reported within four hours.

False Reports of Abuse or Neglect

Reports made by individuals with a documented history of making false accusations must be taken seriously. You have little way of knowing whether or not the individual is telling the truth “this time.” Individuals with a known history of making false reports are at increased risk because perpetrators know they are an easy target and it is likely that the report will not be taken seriously. All incidents should be addressed clinically and through a behavior management program and/or training.

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Thorough documentation will help safeguard staff in the event a false report is made against them. In the event it is determined that the report is false, consider:

• Providing counseling services and/or training to the people involved. • Meet with the falsely accused employee one on one to discuss the incident in an effort to re-establish a positive working relationship with the person who made the false report.

Excerpts taken from Clearbrook curriculum.

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Reporting Exercise:

Keisha has a documented history of making false reports of abuse and neglect by staff.

All previous allegations were determined to be unsubstantiated. This time, Keisha reported to you that early today, a DSP at the home yelled at her, called her “stupid,” and slapped her on her ears.

Reporting Exercise Discussion Questions

1. What role do you have in reporting and investigating the allegation at your agency or facility?

2. What can you do to minimize the negative impact on individuals and the home/work environment while the investigation is being conducted?

3. What can you do to maintain confidentiality while the investigation is being conducted?

4. The allegation is determined to be unfounded. What steps should you and other interdisciplinary team members take to clinically and behaviorally address the problem of the individual making false allegations?

5. What could you do to reintroduce the employee into the workplace?

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Volunteers

Faculty shall direct the program. People who occasionally present programs or entertainment are not considered volunteers. Volunteers shall not take the place of qualified staff. They shall complete a standard orientation program which shall include:

• Resident rights • Confidentiality • Disaster preparedness • Emergency response procedures • Safety procedures/precautions • Infection control • Rule 50 • Contacting Law Enforcement • Serious Incidents and Accidents:

Report any incident or accident which has, or is likely to have, a significant effect on the health, safety, or welfare of a resident or residents. Incidents and accidents requiring the services of a physician, hospital, police or fire department, coroner, or other service provider on an emergency basis shall be reported to the Department (DPH). Call the Regional Office within 24 hours. Then narrative summary within 7 days.

The facility shall contact local law enforcement (911 or the local emergency number) for the following: • Physical abuse involving physical injury inflicted on a resident by a staff member or visitor. • Physical abuse involving physical injury inflicted on a resident by another resident, except where behavior is associated with dementia or developmental disability. • Sexual abuse of a resident by a staff member, another resident, or a visitor. • When a crime has been committed in a facility by a person other than a resident. • When a resident death has occurred other than by disease process.

Complaint Investigations shall be initiated within 30 days of the receipt of the complaint by the Central Complaint Registry.

Reporting to Law Enforcement

Allegations of crimes should be reported to the most appropriate law enforcement agency, especially if an immediate response is critical. However, the allegation must still be reported to N-09-01-10 Page 31 Residential Director Core Training Recognizing, Reporting and Preventing Abuse and Neglect Module 4

OIG within the time required if it involves a death or alleged abuse or neglect of an individual with disabilities.

By law and interagency agreement, OIG reports criminal allegations to the Illinois State Police OIG also may work with law enforcement agencies in investigating allegations of abuse or neglect of individuals with disabilities

Reporting to Department of Public Health

For residents of Intermediate Care Facilities for Developmentally Disabled (ICF/DDs)

• Any facility employee who becomes aware of abuse or neglect of a resident shall immediately report the matter to the facility administrator (Section 3-610 of the Nursing Home Care Act)

• The facility administrator who becomes aware of the abuse or neglect of a resident shall immediately report the matter by telephone and in writing to the resident’s representative.

• Reports must be made to IDPH in writing within 24 hours after having reasonable cause to believe that the condition of the resident resulted from abuse/neglect.

• If an employee is the perpetrator of abuse, that employee shall immediately be barred from any further contact with residents of the facility, pending the outcome of any further investigation (Section 3-611 of the Nursing Home Care Act)

• A facility employee who becomes aware of another facility employee or agent’s theft or misappropriation of a resident’s property must immediately report the matter to the facility administrator

• The facility administrator who becomes aware of a facility employee’s theft or misappropriation of a resident’s property must immediately report the matter by telephone and in writing to the resident’s representative, to IDPH, and to the local law enforcement agency. Section 3-612 of the Nursing Home Care Act)

• Also, all serious injuries are to be reported within 24 hours, no matter what the cause.

The Nursing Home Care Act can be found in its entirety at: http://www.ilga.gov/legislation/ilcs/ilcs5.asp?ChapAct=210%A0ILCS%A045%2F&DocName=&Act Name=Nursing+Home+Care+Act%2E&ChapterName=HEALTH+FACILITIES&ActID=1225&Chapte rID=21&SeqStart=&SeqEnd=&Print=True

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Agency Response to Reports of Abuse: 1. If firing is the only response to abuse, it will reduce reporting and make it more likely that abuse will occur. 2. Many supervisors have said that employees are hesitant to report because they believe that nothing is being done in response to their reports. Therefore, agencies should make individuals aware of the actions and outcomes associated with each report of abuse within the boundaries of employee confidentiality and rights. 3. Since employees look at the agency’s response to determine future actions, it is important that all employees know what to expect when they report abuse.

When an incident occurs, what you should do? • Ensure the safety of all individuals. • Notify your supervisor or investigative staff that there may be evidence. • Secure the scene, if trained by OIG to do so. • Document everything you see and do. • Avoid entering an area where the act allegedly occurred. • Report the incident to OIG within 4 hours, per your agency’s policy. • Write out a statement, if requested.

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WHAT TO SAY WHEN SOMEONE TELLS YOU THEY HAVE BEEN SEXUALLY ABUSED

Use these guidelines if an individual says they have been sexually abused. The guidelines and contact information can be put near the phone, on an index card or on a sheet of paper.

Supporting Victims of Sexual Abuse

Disclosure of Sexual Violence Provide Privacy Explain Options Support Choices Ensure Safety DO DON’T Believe Doubt Respect Judge Support Blame Assist Punish

Disclosure of Sexual Violence Say: I believe you. I’m sorry this happened to you.

Ask: How can I help you? What do you need right now?

Tell: We have a crisis center in town that can help you on the phone or in person. Help: Would you like to call them? I can help you with that.

Protect: What would make you feel safe right now? Let’s make a safety plan.

For more information on this topic, please call the Rape Crisis Center at 800-656-4673 or visit the Illinois Department of Human Services website at www.dhs.state.il.us or the Illinois Coalition Against Sexual Assault at www.icasa.org

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Comforting the Victim

You should try to comfort victims of abuse, neglect, or exploitation. It is important to say things that will reinforce the fact that abuse should have not occurred, such as:

• “You do not deserve to be abused.” • “You are not responsible for the abuse.” • “What happened to you is a crime.” • “There is help available; you are not alone.”

When working with possible victims of abuse, neglect, or exploitation, you should:

• Assess the extent and circumstances of the abuse, neglect, or exploitation in order to offer appropriate client care and referral • Protect victims and provide a safe environment for their care • Recognize clients' rights to be free from physical, sexual, and emotional abuse, neglect, and exploitation while under the care of this facility

While an investigation is pending, the person should have no contact with the alleged abuser.

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QUICK REFERENCE FOR PHYSICAL ABUSE, SEXUAL ABUSE, MENTAL INJURY, OR NEGLECT REPORTING

And you suspect that the perpetrator of the Then you should call/inform: If the consumer is: abuse/neglect is: Your supervisor Under 18, living in a private home in A family member or caregiver the community DCFS HOTLINE 1.800.252.2893 Under 18 and enrolled in any of your Your supervisor agency’s programs (non-ICF A staff member from your residential, day programs, etc. agency OIG HOTLINE included) 1.800.368.1463 Under 18 and enrolled in any of your Your supervisor agency’s programs (non-ICF A family member or caregiver residential, days program, etc. DCFS HOTLINE included) 1.800.232.2893 Over 18 and enrolled in any of your Your supervisor agency’s programs (non-ICF A staff member from your residential, day programs, etc. agency OIG HOTLINE included) 1.800.368.1463 Over 18 and enrolled in any of your Your supervisor agency’s programs (non-ICF A family member or caregiver residential, day programs, etc. OIG HOTLINE included) 1.800.368.1463 Over 18 living in a setting funded, licensed, or certified by DHS, but not Your supervisor run by your agency (ex: individual A third-party staff member attends your agency’s day program, OIG HOTLINE lives in CILA at another agency) 1.800.368.1463 Your supervisor Between 18 and 59 and living in a A family member or caregiver private home in the community OIG HOTLINE 1.800.368.1463 Over 18, living in a nursing home or Your supervisor A staff member from your facility (ICF included) run by your agency DPH HOTLINE agency 1.800.252.2893 Over 18, living in a nursing home or Your supervisor facility (ICF included) not run by your A third-party staff member DPH HOTLINE agency 1.800.252.2893 Your supervisor Over 60, NOT in a nursing home (living A family member or caregiver in private home in community) DOA HOTLINE 1.800.252.8966

• IF THERE IS IMMEDIATE DANGER or A MEDICAL EMERGENCY, CALL 911 and then inform your supervisor. • In cases of financial exploitation, inappropriate staff conduct, inappropriate staff interactions, inform your supervisor. • DPH may also require reporting of serious injury. ALL client deaths should be reported to supervisor, and then to appropriate agency, regardless of whether abuse/neglect is suspected.

Source: Clearbrook

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OIG – Investigative Findings

Allegations may be: • Unfounded - There is no credible evidence to verify the substance of the allegation. • Unsubstantiated - There is credible evidence, but less than a preponderance of evidence to verify the substance of the allegation. • Substantiated - There is a preponderance of the evidence to verify the substance of the allegation. If the offense is physical abuse, sexual abuse or egregious neglect, your name may be placed on the Health Care Workers Registry, making you ineligible for employment in the field of human services in Illinois.

SUBSTANTIATED FINDINGS AND THE HEALTH CARE WORKER'S REGISTRY (formerly known as NURSE AIDE REGISTRY)

The Department of Public Health maintains a registry that, among other things, identifies health care workers that have had substantiated findings of abuse and neglect made against them. OIG is only one entity that reports names to the Health Care Worker Registry (formerly known as Nurse Aide Registry) for physical abuse, sexual abuse or egregious neglect. OIG reports to the Health Care Worker Registry the names of employees who are substantiated to have committed physical abuse, sexual abuse or egregious neglect, unless there is still pending a grievance or a petition filed under 20 ILCS 1305/1-17(s)(3). Referral to the Health Care Worker Registry applies to all employees (which includes owners/operators, contractors, subcontractors, and volunteers). Substantiated findings of mental abuse and non-egregious neglect are never reported to the Health Care Worker Registry.

Perpetrators whose names are placed on the Health Care Workers Registry: • Are ineligible for employment in the field of human services in Illinois. • Are prohibited from being employed in providing, administering, or monitoring services. • Keep in mind that you should: • Maintain the routine of the home/work environment to the maximum extent possible. • Report and ensure the confidentiality and privacy of all parties involved to the maximum extent possible. Do not participate in gossip. • Keep thorough documentation of your actions, your co-worker’s actions, and those of the clients you support will help safeguard you in the event a false report is made against you.

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Common Excuses for Not Reporting

There are many excuses given for not reporting abuse or neglect. Mostly people do not report because of a selfish concern for themselves, and not for the individual. No excuse justifies not reporting. No excuse justifies placing individuals at continued risk. It is your job to support DSPs and other caregivers in preserving the health, safety and welfare of individuals. Ask yourself these questions: • If I don’t report, who will? • If I don’t protect the welfare of the individuals, who will? • If I don’t get involved in what is happening, who will?

Reporting as a Form of Prevention

Reporting abuse or neglect is one way to prevent future maltreatment. Reporting to appropriate agency or facility personnel will afford an opportunity for early intervention with the offending person.

• Perhaps the person can be retrained. • Perhaps the person needs to be fired. • Perhaps the person needs to be reported to the police. • Prompt reporting may prevent further maltreatment of the victim. • Prompt reporting may prevent the perpetrator from additional victimizing. • Reporting can prevent the maltreatment of one person from contaminating the other employees and the home/work environment.

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PREVENTION SECTION

EDUCATING INDIVIDUALS

Individuals should learn to identify situations that put them at risk. Providers should make sure individuals know and can identify what physical abuse is, what financial exploitation is, and what sexual abuse is. Oftentimes individuals don’t know that how they’re being treated is abusive or that how they’re being treated is a criminal offense. We need to make sure that individuals understand what various terms mean. What exactly are people doing that is physically abusive? What does it look like? What does it feel like? What does it mean? We really have to give individuals the information and tools to know what mistreatment looks and feels like. Then, we have to help people learn what positive, mutually respectful relationships look like and feel like.

Individuals should have information about what to do if they are victimized. For example; if they take the bus to day training and somebody is bothering them, they should know what to do and that it’s okay to say: “No, get away from me.” It’s okay to get up and move; it’s okay to be assertive. Individuals should know whom they can tell if they are abused, neglected or exploited so that something can be done about it. By educating individuals about their rights, the cycle of victimization can be stopped. Posting the OIG Hotline number in plain view, as required by Rule 50, is both empowering for the individual receiving services and a reminder to staff to always treat individuals with dignity.

Here are some other steps that people with developmental disabilities can take to keep themselves safe:

Self Advocacy: The more people are involved and engaged in self-advocacy types of programs that empower them to learn about their rights and the systems that are in place to protect them, the better they will be able to protect and advocate for themselves.

Intuition: We need to help people recognize and understand signs in their environment and their own body’s signs that may warn them that they are not safe. For instance - maybe their heart starts to race or their hands are clammy. Maybe they start sweating or their stomach feels upset and queasy. Sometimes our bodies know before our brain knows that we are at risk. Develop a Safety Plan: A safety plan helps a person understand what to do when they are being abused or feeling unsafe. Where do they go and who do they turn to? The safety plan includes what to do in the immediate moment of a crisis or an emergency and what to do when you realize that you’re not in a good situation.

Identify Safe People: Individuals should have at least one person they know that they can turn to and trust. Some people develop a secret code or word that they can use that lets their “safe people” know they are feeling unsafe. Sometimes people are in a situation where the abuser, or the person they’re afraid of, may be present or may be controlling them, so they don’t

N-09-01-10 Page 39 Residential Director Core Training Recognizing, Reporting and Preventing Abuse and Neglect Module 4 feel free to be able to tell, but you can have a very generic secret word or a secret couple of words, something you can say so that safe person will know they are in danger.

DIGNITY OF RISK

In order to maximize people’s safety, try to assess their level of vulnerability. What are these individuals’ protective factors, or strengths and what are their vulnerabilities? Some people have more strengths than others. Some people more vulnerabilities than others.

Residential directors must walk a fine line in trying to protect people from harm while also providing them with opportunities to interact and integrate in their communities and enjoy new and varied experiences. Today’s “best practices” promote the “Dignity of Risk” philosophy which recognizes that:

• The world is not always safe and secure. • Learning new things is an important part to being human and having a full life. • The main way people learn is to try new things. • When people try new things, they take risks, including the risk of emotional and physical pain. • Keeping people from experiencing risks keeps them from learning and therefore from full lives. Sometimes people who are overprotected become isolated which could result in their becoming more vulnerable and not understanding or being given enough information to make good choices. Respecting people requires providing them with opportunities to have choices, take chances, and make mistakes.

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STAFF HIRING

Residential directors should understand how important hiring and supervision are in creating and preventing abuse and neglect at their residential facilities.

Hiring and Probationary Period • At the very least, in addition to background checks, hiring should include, extensive interviews, full follow-up on letters of recommendation and employment history. • Expand hiring practices to include giving potential employees a case to which they must respond, a statement of their personal beliefs about persons with disabilities, and other activities that will provide insight into attitudes toward people they will serve and the field in general. • To the extent possible, consumers should be involved in interviewing and hiring employees. • Extend the probationary period for new employees to one year. • Make full use of the probationary period and the specific evaluation points to cull out those who are not well suited for work in mental retardation services before they become permanent employees.

STAFF TRAINING

Abuse and Neglect Training: • All employees (including part-time and contractual employees and volunteers) must be trained in the requirements of Rule 50 upon being hired and at least biennially thereafter. • All supervisors, managers, and executives need continuous training in detecting and preventing abuse and neglect including targeted training on characteristics of victims, potential abusers, and substantiated abuse. • Give supervisors and managers regular access to the “facts” and outcomes associated with specific abuse reports so they can learn more about the entire process of reporting, investigating, substantiating, resolving, and preventing abuse. • Offer specific training for supervisors to assess work climate and culture, and generate and implement improvements.

Performance Appraisal and Progressive Discipline • Performance appraisal and feedback should be constant. • Supervisors must use both day-to-day feedback practices as well as the formal performance appraisal system to recognize and reward positive interactions and skilled work.

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Agency Response to Reports of Abuse: • If firing is the only response to abuse, it will reduce reporting and make it more likely that abuse will occur. • Many supervisors have said that employees are hesitant to report because they believe that nothing is being done in response to their reports. Therefore, agencies should make individuals aware of the actions and outcomes associated with each report of abuse within the boundaries of employee confidentiality and rights. • Since employees look at the agency’s response to determine future actions, it is important that all employees know what to expect when they report abuse.

From: “What Do Supervisors, Managers, and Executives Know About Abuse?” Abuse Prevention Specialists TM June 2010

STAFF ATTITUDE

Attitude is what you think or feel about a person, object, situation or fact. The attitude that you bring to work each day directly impacts the individuals you support, your job performance and the performance of the staff you supervise. Your attitude can also contribute to creating and maintaining a positive, pleasant and safe environment or can contribute to creating a negative, hostile, fearful, destructive environment.

Promote positive attitudes and working environments by:

Managing Through Leadership and Coaching

Recognize employees’ accomplishments and contributions and communicating with employees on a regular basis. • Be accessible • Assess and periodically reassess your approach to employee recognition

Affirming and Enhancing the Capabilities and Motivations of Employees • Acknowledge and build upon the strengths of employees • Listen to the opinions and suggestions of employees, ask for input, give feedback so the person knows s/he has been heard. • Consistently provide positive, constructive feedback. • Acknowledge success. • Emphasize strengths.

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• Acknowledge failures. • Concentrate on solutions rather than problems • Determine what the problem is in order to quickly move on to find a solution. • Avoid focusing on assessing blame. • Refocus the team by putting energy into identifying strengths and solutions.

Group Discussion

• How do you acknowledge people’s successes at your facility?

Diffuse Situations Before they Escalate:

Assessing and diffusing a situation is a method for preventing minor incidents from being blown out of proportion or from escalating.

Teach, model and reinforce assessing and diffusing a situation at your home/work environment.

In order to diffuse a situation, engage in the four-step process called “thought stopping”.

• Stop! • Think! • Relax! • Reconsider!

Repeat the process if necessary in order to regain control of angry impulses.

You may only have a few seconds to use thought stopping but that may be enough time to prevent the wrong action.

Part of “reconsidering” is assessing the situation to determine what the best way is to diffuse the situation. Use your detective skills. Try to figure out what is bothering, upsetting, or somehow affecting the individual. You may only have a few seconds to assess the situation.

• Calmly talk to the person(s) about what happened. • Calmly explain to them what the options are for doing something different.

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• Give the person(s) readily available choices for how to handle the situation. • Use humor to break the tension. • Create a diversion; direct the individual’s attention to something or someone else. • Support the individual in taking a quiet rest period to relax or engage in an enjoyable activity. • Change the surroundings. • Release the individual from the demands that are causing the individual to be upset.

Learning how to diffuse a situation takes time, practice and teamwork! Use your leadership and coaching skills to teach this skill.

DISCUSSION EXERCISE – DIFFUSING SITUATIONS

If staff members do not work as a team, there may not be consistency in how an individual’s ISP is carried out.

What additional strategies do you use to diffuse a situation between staff members?

What do you do to support DSPs and other caregivers to effectively assess and diffuse a situation?

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Teamwork

Remember the importance of teamwork in creating and maintaining a trust-producing, healthy, engaging environment.

Teamwork is...

• Work done by several people with each person doing a part in order to ensure the successful completion of a job. • Effective teamwork requires that each person compromise or bend a little in order to complete the work in the best possible way for everyone. • Teamwork requires putting aside personality differences or negative personal feelings about co-workers.

Teamwork Discussion Question:

What are some characteristics of an ideal situation when it comes to teamwork?

What can you do you do to promote effective teamwork at your agency?

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Stress and Burnout

Providing supports to persons with developmental disabilities can be very rewarding. However, the day-to- day responsibilities and sometimes demanding work can end up taking a toll on both your body and your mind causing stress and burnout. People who are "burned out" may experience fatigue, stress, anxiety, and depression. When ignored, stress can lead to irritability that may lead to abuse and neglect. From the very start of your role as a DSP, you should build in ways to be a DSP to yourself!

What is Stress? Stress is a reaction to changes that require you to adjust or respond. Our bodies are designed to feel stress and react to it. Not always a bad thing, stress keeps us alert and ready to escape danger.

It's not always possible to avoid change or the situations that can cause stress; as a result, you can begin to feel overwhelmed and unable to cope. When it persists, stress can affect the body's immune system, leading to illness.

When you are not sure of the exact cause of your stress, it may be helpful to know the warning signs. Once you can identify these signs, you can learn how your body responds. Then you can take appropriate steps to reduce the stress.

What Are the Warning Signs of Stress? Your body sends out physical, emotional, and behavioral warning signs of stress.

Emotional warning signs: Anger Inability to concentrate Unproductive worry Sadness Frequent mood swings

Physical warning signs: Stooped posture Sweaty palms Tension headaches Neck pain Chronic back pain Chronic fatigue

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Weight gain or loss Problems with sleep

Behavioral warning signs: Over-reacting Acting on impulse Using alcohol or drugs Withdrawing from relationships Changing jobs often

What Can Be Done to Reduce Stress?

Tips for managing stress include:

• Keep a positive attitude. Believe in yourself. • Accept that there are events you cannot control. • Be assertive instead of aggressive. "Assert" your feelings, opinions, or beliefs instead of becoming angry, combative, or passive. • Learn to relax. • Exercise regularly. Your body can fight stress better when it is fit. • Stop smoking.

Practice What You Preach - Managing Your Own Emotions

Throughout every day of our lives we all experience many emotions, such as anger, joy, frustration, and sorrow. As a QSP, middle manager or professional staff, it is important that you serve as a role model for DSPs and other caregivers in managing your emotions. This means:

Doing what you say you will do and doing what you tell others to do.

Being accountable for what you say and do.

Acknowledging failures and successes.

Concentrating on solutions rather than problems

Determining what the problem is in order to quickly move on to find a solution.

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Avoid focusing on assessing blame.

Refocus the team by putting energy into identifying strengths and solutions.

Awareness is the key to managing your own emotions. Acknowledge how you are feeling and how your mood might impact individuals and others. Have you ever been… Angry with your boss, but you took your Frustrated with the person ahead of you at anger out on your spouse? the checkout counter, but took your frustration out on your kids?

Taking your anger or frustration out on individuals, DSPs and other caregivers is wrong and is inappropriate and may be a form of abuse or neglect.

Recognizing Your Own Vulnerabilities

Vulnerabilities are situations that put you at risk for losing control of your emotions.

• Be aware of the situations that set you off, make you lose control, try your patience, trigger your anger and challenge your need to be in charge.

• Awareness of your own vulnerabilities is the first step in preventing situations that are difficult for you to handle from arising.

• Once you are aware of the kinds of situations that put you at risk, be on the lookout for these situations and develop strategies for keeping your emotions in check.

Vulnerability Exercise

1. What work-related situations make you vulnerable to losing control of your emotions?

2. In your role as a supervisor or manager, what can you do to help DSPs and other caregivers recognize their own vulnerabilities and develop strategies for keeping their emotions in check?

What stratagies do you use to keep your emotions in check?

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What Are the Symptoms of Burnout?

The symptoms of burnout are similar to the symptoms of stress and depression. They include: • Withdrawal from friends, family and other loved ones. • Loss of interest in activities previously enjoyed. • Feeling irritable, hopeless, and helpless. • Changes in appetite, weight, or both. • Changes in sleep patterns. • Getting sick more often. Flare up of your own medical problems or a new illness. • Feelings of wanting to hurt yourself or the person for whom you are caring. • Emotional and physical exhaustion, chronic fatigue. • Rough handling of the persons with the disability.

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Professional Organizations

A professional is someone who has specialized knowledge, preparation, and commitment to a type of work or career.

Professional Enhancement for Supervisors

• Join and participate in the National Association of Qualified Mental Retardation Professionals or another professional organization affiliated with your profession.

• Continually increase your knowledge and skills. www.QMRP.org

• Attend local, state and national conferences, workshops and trainings.

Helping DSPs with Professional Enhancement

Encourage DSPs to join their professional organization - the National Alliance for Direct Support Professionals.

Encourage and facilitate opportunities for DSPs to improve their knowledge and skills. www.nadsp.org/

Encourage and facilitate opportunities for DSPs to attend local, state, and national conferences, workshops and other trainings

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Resources - Links/Websites

The list of Internet links below will connect you to organizations and web sites that you may find to be useful as you search for information.

DSP Resources

The College of Direct Support works with all of these organizations and we urge you to browse and check them out if you are not familiar with them.

If you have specific organizations or web sites you think we should include in this list, please email Tom King, CDS Communications Director, at [email protected].

The Institute on Community Integration URL:http://ici.umn.edu/

A University of Minnesota affiliated program dedicated to improving community services for people with developmental disabilities and their families. The staff of the ICI oversees the development of curricula for the College of Direct Support from start to finish.

The Arc of the United States URL:http://www.thearc.org/

The Arc of the United States advocates for the rights and full participation of all children and adults with intellectual and developmental disabilities. Together with a network of members and affiliated chapters, The Arc works to improve systems of supports and services; connect families; inspire communities and influence public policy.

ANCOR (American Network of Community Options and Resources) URL:http://www.ancor.org/

ANCOR is a nonprofit trade association representing private providers who provide supports and services to people with disabilities. ANCOR is distinguished in this industry by its balance of leading practices resources and advocacy for member agencies and the people and families they serve and support.

National Alliance for Direct Support Professionals URL:http://www.nadsp.org/

The NADSP is a coalition of organizations and individuals committed to strengthening the quality of human service support by strengthening the direct support workforce.

American Association on Intellectual and Developmental Disabilities URL:http://www.aaidd.org/

The AAIDD – formerly known as AAMR – promotes progressive policies, sound research, effective practices, and universal human rights for people with intellectual and developmental disabilities.

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Self-Advocates Becoming Empowered (SABE) URL:http://sabeusa.org/

SABE’s mission is to ensure that people with disabilities are treated as equals and that they are given the same decisions, choices, rights, responsibilities, and chances to speak up to empower themselves; opportunities to make new friends; and to learn from their mistakes.

Administration on Developmental Disabilities URL:http://www.acf.hhs.gov/programs/add/

The Administration on Developmental Disabilities (ADD) is the U.S. Government organization responsible for implementation of the Developmental Disabilities Assistance and Bill of Rights Act of 2000, known as the DD Act. ADD, its staff and programs, are part of the Administration for Children and Families, of the U.S. Department of Health and Human Services.

Direct Service Workforce Resource Center URL:http://www.dswrsourcecenter.org/ Address: 111 Center Park Drive, Suite 175 Knoxville, TN 37922 Phone: 877-353-2767 (toll-free) Email: [email protected]

The National Direct Service Workforce Resource Center supports efforts to improve the recruitment and retention of direct service workers who help people with disabilities and older adults to live independently and with dignity. This Resource Center provides state Medicaid agencies, researchers, policymakers, employers, consumers, direct service professionals, and other state-level government agencies and organizations easy access to information and resources they may need about the direct service workforce.

The National Association of Qualified Developmental Disability Professionals

Website: http://www.qddp.org The National Association of QMRPs was formed in 1996 by Trinity Services staff as the result of a recognized need by QMRPs - Qualified Mental Retardation Professionals (also known as Case Managers) to establish a strong resource for research, networking, and addressing issues that concern QMRPs/QDDPs/QSPs today. to establish a strong resource for research, networking, and addressing issues that concern QDDPs today. Although there were a few states that had formed groups by and for QDDPs, the need to form an organization that would address the historical, conceptual, methodological and ethical issues confronting the QDDP today on a national level was evident. The National Conference of QDDPs provides a forum to share information pertinent to the diverse interests of QDDPs: Telephone (815) 485-4781 FAX (815) 485-9145 Postal address 2081 Calistoga Drive, Suite 1S New Lenox, IL 60451 Electronic mail [email protected]

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