Develop a "zero tolerance" policy for abuse and neglect
Any agency wishing to develop an effective Abuse Prevention Plan needs to be willing to make a commitment to a "Zero Tolerance" policy for abuse and neglect, and must impart this message to all employees, service vendors, family members, and individuals receiving services. This commitment must start at the very top of the agency, if the initiative is to be successful. Administrators, Boards of Directors, Managers and Supervisors need to be in agreement with the policy so that a clear and consistent message is given to all employees.
Components of an agency abuse prevention plan
Agency self-analysis
- Hiring and Screening Practices - It is estimated that 30% to 80% of all resumes/applications contain false information. Agencies should examine their practices regarding conducting employee reference checks, CORI and other registry checks, recruitment strategies, and interviewing methods.
- Supervisory Practices - The critical role supervisors perform in agencies cannot be understated. Without supportive, consistent, and instructive supervision, employees are "left to their own devices," oftentimes operating in isolation, susceptible to the negative attitudes of peers, and feeling frustrated and devalued. This can directly impact the nature and quality of care they deliver to those who depend upon them.
- Staffing Ratios and Practices - A chief complaint voiced by direct care staff in agencies is that of staff shortages. Budget restrictions, resulting in layoffs or staff reassignments, are often the cause of these shortages. Direct care staff are increasingly called upon to work longer hours, with less time off, for individuals who have challenging behaviors or advanced medical conditions requiring more attention. Service providers who do not effectively address these issues will see increases in the incidences of abuse and neglect in their programs.
- Staff Training - One of the best investments agencies can make is to provide extensive training opportunities for their staff. Such trainings might include: human rights; how to identify and report abuse and neglect; stress management; non-violent restraint/intervention techniques; CPR, and others. If training budgets are a problem, look for alternatives, such as free trainings, or bartering with other agencies for needed training.
- Individuals Receiving Services - Most agencies provide a range of services to individuals with varying abilities. In some cases, individuals with profound disabilities are integrated into the service system as part of the "normalization" process. In other instances, individuals with similar levels of disability may be assigned to live or work together. Either method of service delivery can present problems. Service providers need to carefully assess the characteristics that make individuals in their programs more susceptible to being victimized, and find creative ways of providing services without placing these individuals in greater jeopardy.
- Agency Policies and Practices - Agencies need to examine their commitment to adopting and implementing effective abuse prevention plans. Agencies can begin by incorporating abuse prevention into their mission statements. This helps to define the agency's role externally, and reinforces the importance of the prevention concept to all staff. The assignment of a senior staff person to take the lead in the prevention initiative reinforces the message that this is an agency priority.
- Community Relations - Community outreach/education and public relations are other areas in which agencies can enhance their abuse prevention efforts. Agencies can provide a valuable community service by educating the public-at-large about how to recognize and report suspected abuse and neglect of persons with disabilities. Good community outreach can result in the recruitment of qualified, respected community leaders to serve on Human Rights Committees and Boards of Directors. Building collaborative working relationships with other community or public agencies to address issues of mutual interest or concern is highly recommended.
Taking action
- Developing and implementing an agency action plan - Once an agency has conducted a self-analysis of its operations and practices, it can begin to develop a plan of action to address any problem areas identified. It is important that a senior staff member be assigned to oversee the development and implementation of an abuse prevention plan. This indicates a commitment on the part of the agency to address the problem of abuse and neglect, adds credibility to the concept of abuse prevention, and insures that someone is responsible for carrying out abuse prevention initiatives.
- Agencies are encouraged to develop a written Abuse Prevention Action Plan outlining areas that require action; remedial actions recommended/taken; staff persons responsible, and time frames for completion. This format is similar to that used in the development of "protective service plans" and can be modified and regularly updated as necessary.
Assessing risk
- Service providers must have an understanding of what makes individuals with disabilities more vulnerable to becoming victims of abuse and neglect, if they are to be successful in identifying and intervening in situations that place these individuals at risk.
- Risk assessment is a term used for the process of determining whether an individual is safe, or likely to be harmed in the near future, as a result of abuse or neglect. Risk assessment should not be considered a one-time determination, but rather, an ongoing process where risk is continually evaluated as new information is obtained and analyzed.
- Making a determination regarding the degree of risk present requires an assessment of several factors specific to the individual, the caregiver(s), and the environment, as illustrated below:
The individual
- Type and level of disability
- Medical conditions
- Type and location of injuries
- Degree of dependence on caregiver(s)
- Communication skills
- Social isolation
- History of abuse (or abuse allegations)
- Competency regarding decision-making
The caregiver(s)
- Relationship to/with the individual
- Access to the individual
- History of abuse
- Substance abuse history
- History of possession of weapons
- Level of stress
- Mental and physical health
- Fiduciary relationship to individual
- Training and abilities
- Dependence on individual (emotional, financial…)
The environment
- Physical condition
- Location
- Accessibility
Identifying abuse and neglect
- All new staff should receive training on identifying abuse and neglect, and reporting procedures, as part of their orientation.
- An overview regarding identifying abuse and neglect, and reporting procedures, should be provided to all other staff on at least an annual basis.
- Training on identifying abuse and neglect, and reporting procedures, should be provided to all individuals receiving services, as appropriate, as well as their families and/or guardians.
Reporting abuse and neglect
- Management should reiterate the message that reports of abuse will be kept confidential, and that reporters will be supported through the process.
- Report/incident forms should be readily available, and information regarding procedures for reporting should be prominently displayed.