Preventing and Identifying Abuse, Neglect, Exploitation and Mistreatment
People with disabilities are significantly more likely than their non-disabled peers to experience some form of abuse in their lifetime, so it is extremely important that they and the people who know them best are educated about preventing, identifying, and responding to Abuse, Neglect, Exploitation, and Mistreatment (ANEM). The following information provides insight into how OPG, Inc. works to prevent, identify, and respond to allegations of ANEM.
Content Warning: The contents of this page may include references to violent acts.
ANEM Prevention Strategies
OPG, Inc. is committed to preventing abuse, neglect, exploitation, and mistreatment in the ways that can be affected through training of employees, supervision of staff members, and education provided to people supported and guardians. There are several ways that OPG, Inc. attempts prevention of ANEM, which include:
- Personnel screening procedures: All applicants for employment, contractors, volunteers, and interns provide a sworn statement, indicating whether, to the best of his or her knowledge, he or she has ever been convicted of a crime in this State or any other jurisdiction and that all statements in the application are true, to the best of his or her knowledge. A criminal background check through two police databases, will be conducted in all counties an applicant has resided in the past three years to ensure the absence of criminal history. A Nurse Aid check will also be conducted to ensure the applicant is in good standing. This is to ensure that OPG, Inc.’s prevents any person with a violent, neglectful, or exploitive criminal history from being hired. OPG, Inc. also contacts references and past employers for information and verification of the applicant’s character, reputation and personal qualifications.
- Staff training and supervision: All staff, volunteers, contractors, or interns are trained on what constitutes abuse, neglect, exploitation, and mistreatment and are trained in all prohibited interventions. Staff are trained in the rights afforded to all people to help prevent any restriction of rights that could occur if someone is unaware of all Constitutional, civil, and personal rights. All employees and agents of OPG, Inc. are also trained in the possible consequences of this behavior including disciplinary action, termination, legal action, and possible criminal sentences.
- Education is provided to people supported and guardians at OPG, Inc.: OPG, Inc. provides all people receiving services and/or guardians information about their rights and what constitutes ANEM to increase awareness and prevention. Staff are trained to provide rights education and prevention of ANEM education to the people they support on an ongoing and regular basis.
- Encouraging self-advocacy for the people we support.
- Encouraging the development of natural support networks.
Mandatory Reporting
By law, certain professions are required to report suspected abuse, neglect, or exploitation of persons who have a functional, mental, or physical inability to care for or protect themselves. Those mandated to report include:
- Police officers
- Social Workers
- Employees of agencies who provide mental health, health care, supported living or long-termcare.
- Licensed health care providers
- Employees of Social Services Agencies
- Volunteers in all of the above agencies.
Persons that are required to report must call or email Child Protective Services or Adult Protective Services immediately to report the suspected ANEM. Instances of ANEM must also be reported to the Bureau of Developmental Disabilities Services. BDDS requires Internal Investigations into these allegation to any investigation by CPS, APS, or police. Additional information regarding Internal Investigations and Incident Reporting can be found here. By joining the OPG, Inc. team, employees understand that they are mandated to report this behavior and are provided training upon hire and annually on signs and prevention strategies. If any employee is found to have committed abuse, neglect, exploitation, or mistreatment, the employee may be terminated immediately.
Identifying Abuse, Neglect, Exploitation, and Mistreatment (ANEM)
ABUSE
Abuse is an act of physical or mental mistreatment or injury that harms or threatens a person through action or inaction by another individual. Abuse may be physical, sexual, verbal or emotional. Types of Abuse include: Physical abuse: Intentional bodily injury. Sexual abuse: Non-consensual sexual contact (any unwanted sexual contact). Mental mistreatment or emotional abuse: Deliberately causing mental or emotional pain. “Medical” abuse refers to providing too much or too little medication or other needed assistance in order to exert control over the person.
Some of the signs that may lead to suspicions of abuse are listed below: Signs of physical abuse
- Bruises, black eyes, welts, lacerations, and rope marks
- Broken bones
- Open wounds, cuts, punctures, untreated injuries in various stages of healing
- Broken eyeglasses/frames, or any physical signs of being punished or restrained
- Laboratory findings of either an overdose or under dose medications
- Individual’s report being hit, slapped, kicked, or mistreated
- Vulnerable adult’s sudden change in behavior
- The caregiver’s refusal to allow visitors to see a vulnerable adult alone
Signs of sexual abuse
- Bruises around the breasts or genital area
- Unexplained venereal disease or genital infections
- Unexplained vaginal or anal bleeding
- Torn, stained, or bloody underclothing
- An individual’s report of being sexually assaulted or raped
Signs of mental mistreatment/emotional abuse
- Being emotionally upset or agitated
- Being extremely withdrawn and non-communicative or non-responsive
- Unusual behavior usually attributed to dementia (e.g., sucking, biting, rocking)
- Nervousness around certain people
- An individual’s report of being verbally or mentally mistreated
Following are some examples of abusive behavior. This list is not all inclusive. Physical Abuse examples include:
- Slapping,
- Pinching,
- Choking,
- Kicking,
- Shoving,
- Or inappropriately using drugs or physical restraints.
Sexual Abuse examples include:
- Unwanted touching,
- Rape,
- Sodomy,
- Coerced nudity,
- And sexually explicit photographing.
Verbal or Emotional Abuse examples include:
- Intimidation,
- Coercion,
- Ridiculing,
- Harassment,
- Treating an adult like a child,
- Isolating an adult from family, friends, or regular activity,
- Use of silence to control behavior,
- And yelling or swearing which results in mental distress.
NEGLECT
Neglect occurs when a person, either through their action or inaction, deprives a vulnerable adult of the care necessary to maintain the person’s physical or mental health.
Self-neglect occurs when a vulnerable adult fails to provide adequately for themselves and jeopardizes their own well-being.
The following may be signs of Neglect by the self or by others:
- dehydration or malnutrition
- untreated bed sores
- poor personal hygiene
- unattended or untreated health problems
- hazardous or unsafe living condition (e.g., improper wiring, no heat or running water)
- unsanitary and unclean living conditions (e.g., dirt, fleas, lice on person, soiled bedding,
- fecal/urine smell)
- an individual’s report of being mistreated
- inappropriate and/or inadequate clothing
- lack of the necessary medical aids
- grossly inadequate housing or homelessness
- inadequate medical care
- not taking prescribed medications properly
Neglect examples include not providing basic items such as food, water, clothing, a safe place to live, medicine, supervision, or health care.
Self-neglect examples include a vulnerable adult living in hazardous, unsafe, or unsanitary living conditions or not having enough food or water.
EXPLOITATION
The following may be signs of exploitation:
- sudden changes in bank account or banking practice, including an unexplained withdrawal of large sums of money
- adding additional names on bank signature cards
- unauthorized withdrawal of funds using an ATM card
- abrupt changes in a will or other financial documents
- unexplained disappearance of funds or valuable possessions
- bills unpaid despite the money being available to pay them
- forging a signature on financial transactions or for the titles of possessions
- sudden appearance of previously uninvolved relatives claiming rights to a vulnerable adult’s possessions
- unexplained sudden transfer of assets to a family member or someone outside the family
- providing services that are not necessary, or not providing services that are necessary
- individual’s report of exploitation
Exploitation examples might include:
- illegally withdrawing money out of another person’s account,
- forging checks,
- stealing things out of the vulnerable adult’s house,
- using a person’s food stamps without permission
- Sending money or banking information to an unknown person
- Staff eating food a person they support has paid for
- Staff using utilities (such as taking a shower or washing their clothes) at the home of a person supported.
MISTREATMENT
Mistreatment is a general term for treating a person badly, with malicious intent. Mistreatment includes abuse, neglect, and exploitation, but also includes the intentional restriction of a person’s basic human rights for security, safety, making decisions, etc. Signs of mistreatment may indicate that abuse, neglect, or exploitation are occurring.
Signs of mistreatment may include:
- A person with bruises, welts, or burns.
- A person who appears over or under medicated.
- A person with inadequate food or water, or with unclean clothes or bedding.
- A person whose caregiver abuses alcohol or is emotionally unstable.
- A person who previously has had excellent credit or resources but now seems unable to meet expenses.
- A person who is not permitted visitors or direct communication with others.
Some examples of mistreatment include: A person who is not allowed to speak to others privately. A person who is not allowed to leave a room. A person whose assistive devices are not available to them (wheelchair, tablet, etc.)
In this video, people with disabilities talk about advocating to stop abuse, neglect, exploitation, and mistreatment.
This video from Indiana Disability Rights is about what to do when caregivers or family suspect abuse.
Prohibited Interventions
OPG, Inc. expressly prohibits abuse, neglect, exploitation, or mistreatment of any person receiving our services and we prohibit any other violations of a person’s rights. Any allegations of any of the following procedures will result in an investigation, an incident report to BQIS, suspension of the alleged person, and if allegations are substantiated then the employee will be immediately terminated.
List of Aversive Techniques and Prohibited Interventions
(Bureau of Developmental Disabilities Services, BDDS 460 0228 022)
The following are a list of prohibited interventions (including but not limited to):
- Any form of abuse (physical, sexual, emotional, verbal, medical, or mental, or any other form of abuse not expressly written)
- Emotional, or Verbal abuse, including but not limited to communicating with words or actions in a person’s presence with intent to:
- cause the person to be placed in fear of retaliation;
- cause the person to be placed in fear of confinement or restraint;
- cause the person to experience emotional distress or humiliation; cause others to view the person with hatred, contempt, disgrace or ridicule;
- cause the person to react in a negative manner.
- Any form of neglect (neglect of supervision, abandonment, neglect of necessary supports, or any other form of neglect not expressly written)
- Any form of exploitation (of resources, of finances, of labor or work, sexual exploitation, or any other form of exploitation not expressly written).
- Misappropriation of a person’s funds shall be considered a violation of a person’s rights.
- Work or chores benefiting others without pay unless:
- the Provider has obtained a certificate from the United States Department of Labor authorizing the employment of workers with a disability at special minimum wage rates;
- the services are being performed by the person in their own residence as a normal and customary part of housekeeping and maintenance duties; or
- a person supported desires to perform volunteer work in the community.
- Any form of mistreatment (treating a person badly with malicious intent, humiliating or a ridiculing a person, the intentional or malicious restriction of a person’s rights, or any other form of mistreatment not expressly written).
- Restriction of a person’s basic freedoms (food, shelter, medical treatment, and any other basic freedoms not expressly written)
- A practice that denies a person any of the following without a physician’s order:
- Sleep.
- Shelter.
- Food.
- Drink.
- Physical movement for prolonged periods of time.
- Medical care or treatment.
- Use of bathroom facilities.
- Any technique that degrades the dignity of the person
- Any form of aversive techniques, including but not limited to:
- Contingent exercise (required physical exercise after an occurrence of an unwanted behavior)
- Contingent noxious stimulation which means the administration of an unpleasant sensory agent following the occurrence of an unwanted behavior, directed at the following: sight, hearing, touch, smell, and taste;
- Corporal punishment which means intentional infliction of pain as a consequence of an unwanted behavior. This includes, but is not limited to,
- forced physical activity (contingent exercise);
- hitting;
- pinching;
- the application of painful or noxious stimuli;
- the use of electric shock; or
- the infliction of physical pain
- Negative practice, which means required practice of an unwanted behavior for an extended period of time
- Overcorrection or the repetition of appropriate behavior after the occurrence of an unwanted behavior
- Seclusion, which means the involuntary placement in a room or area alone, from which the exit is prohibited;
- Visual or facial screening (placing a cloth or other material over the face and eyes of a person and blocking their view of the environment)
- Any other aversive technique not expressly written that:
- Incorporates the use of painful or noxious stimuli;
- Incorporates denial of any health related necessity; or
- Degrades the dignity of a person.
- Use of mechanical restraint (only a physician or dentist may order and perform the use of mechanical restraint, no DSP or OPG, Inc. staff may perform this technique)
- Floor restraints, including Prone Restraint, as well as any restraint that is used for convenience or discipline; (460 Indiana Administrative Code 6-9-4 (n) )
Responding to Allegations of ANEM
All allegations of ANEM, including the use of Prohibited Interventions, are subject to reporting requirements and internal investigation. The first step in these cases is to ensure the safety of the person affected. If the allegation involves an OPG, Inc. staff member, the employee will be suspended immediately from working with people at OPG, Inc. This is required by law and helps to ensure that both the employee and the person supported are granted due process. A BDDS incident report will be filed and Protective Services will be notified. In cases where criminal activity is alleged, the police will also be notified. See the section on Incident Reporting and Internal Investigations for more detail.
The following video provides some guidance about how to respond when a person reports having been abused, neglected, exploited, or mistreated.
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