Department of Mental Health

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(No Transcript)
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Protect, Report, Preserve Abuse Against Persons
with DisabilitiesA training video and manual on
reporting suspected abuse against persons with
disabilities

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Protect, Report, Preserve Manual Review

• Prevalence of Violence
• How is Violence Possible Risk Factors
• Recognizing Abuse Types and Indicators
• Structure and Role of Adult Protective Services
• Reporting Abuse and Neglect
• What TO DO and What NOT TO DO

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Prevalence of Violence Against Persons with
Disabilities

• 54 million Americans with disabilities
• (U.S. Department of Justice, 1998)
• 5 million crimes committed against persons with
  developmental disabilities each year in the U.S.
  compared with (Petersilia, Ph.D., UCD)
• 1.4 million Child Abuse
• 1 million Spousal Abuse
• 1 million Elder Abuse
• 800,000 Hate Crimes

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Prevalence of Violence

• Adults with developmental disabilities are at
  risk of being physically or sexually assaulted at
  rates four to ten times greater than other adults
  (Sobsey, Dick 1994).
• A study of psychiatric inpatients found that 81
  percent had been physically or sexually assaulted
  (Jacobson Richardson, American Journal of
  Psychiatry, 1987)

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Prevalence of Violence

• 62 of women with physical disabilities reported
  experiencing emotional, physical or sexual abuse
  (Nosek Howland, 1998)
• Only 3 of sexual abuse cases involving people
  with developmental disabilities will ever be
  reported (Valenti-Hein Schwartz, 1995)

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How is Violence Possible?Risk Factors Page 10

• Social isolation
• Dependency on care
• May feel powerless
• Communication abilities
• Physical capabilities
• Poverty
• May not understand the concept of strangers
• May not have received sex education
• May not be believed

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Where Does Violence Occur?

• Private Homes
• Community Residences
• Long Term Care Facilities
• State Facilities
• Work and Day Programs
• Transportation Vehicles
• Anywhere

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Recognizing Crime, Abuse and Neglect Types of
Abuse Pages 11 13

• Physical
• Sexual
• Neglect (Omission)
• Emotional
• Financial Exploitation

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Indicators of Physical Abuse Pages 11 12

• Human bite marks
• Unexplained internal injuries
• Fracture to ribs, skull, arms and leg bones
• Burns shaped like an object
• Bruises in various stages of healing
• Bilateral bruises
• Extreme changes in behavior

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Indicators of Sexual Abuse Pages 11 12

• Torn or stained clothing
• Difficulty walking or sitting
• Vaginal or rectal bleeding
• Bruising in genital area or inner thighs
• Incontinence
• Extreme changes in behavior
• Unexplained gifts from caregiver
• Frequent bathing

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Indicators of NeglectPages 12 13

• Patient on patient abuse
• Dehydration or malnutrition
• Outdated/unmarked medications
• Decubiti (bedsores), skin rashes, lice
• Evidence of poor hygiene
• Improperly dressed for weather conditions
• Lacks needed dentures, eyeglasses, hearing aide,
  walker, wheelchair, TTY, communication board

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Indicators of Emotional AbusePage 13

• Screaming, shouting, yelling, cursing
• Threatening violence
• Making discriminatory remarks
• Mimicking, cruel teasing
• Sexual harassment
• Threatening withdrawal of food, shelter, care,
  clothes, possessions or necessary equipment
• Using demeaning labels
• Intimidating gestures

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Behavioral Indicators (Victim)

• Distrust of others
• Emotional outbursts
• Obsess, worry, anxious
• Low self-esteem
• Sudden loss of appetite
• Fear of caregiver

• Self-injurious behavior
• Stress-related illness
• Incontinent
• Refuse assistance
• Deteriorate physically

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Behavioral Indicators (Victim)

• Fear of dark, isolation
• Cry easily, frequently
• Emotionally withdrawn
• Startled responses
• Feel hopelessness

• Fearful of touch
• Aggressive, disruptive
• Guilt, shame, self-hate
• Sexually promiscuous
• Substance abuse

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Structure and Role ofMassachusetts Adult
Protection and Human Services Agencies
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Disabled Persons Protection Commission

• Created in 1987 as an independent state agency
  responsible for the investigation and remediation
  of instances of abuse against persons with
  disabilities within our Commonwealth
  (M.G.L.c.19C)

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Child and Adult Protection Agencies
DSS Children
DPPC Adults
EOEA Elders
DPH All Ages
Department of Social Services
Disabled Persons Protection Commission
Department of Public Health
Executive Office of Elder Affairs
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Adult Protective Service System
Disabled Persons Protection Commission (DPPC)
Department of Mental Retardation (DMR)
Department of Mental Health (DMR)
Massachusetts Rehabilitation Commission
(MRC)
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DPPC INTAKE UNIT 24 HOUR HOTLINE

• Operates a 24-hour Hotline, 1-800-426-9009
• Receives reports of suspected physical,
  emotional, sexual abuse, neglect and deaths of
  adults with disabilities
• Evaluates reports to determine
• required response emergency or
• non-emergency and jurisdictional criteria
• Provides information and referrals to callers

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DPPC HOTLINE
V/TTY
1-800-426-9009
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Disabled Persons Protection CommissionState
Police Detective Unit
[phone]
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DPPC/SPDU Criminal Screening

• District Attorneys office notified
• Designated Assistant District Attorney assigns
  criminal investigations to
• Local Police
• DAs SPDU
• DPPCs SPDU
• Human Service agency contacts notified
• Civil Investigator proceeds with protective
  services

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DPPC 19C Civil Investigations Conducts
abuse/neglect investigations, assesses risk and
recommends protective service actions
DPPC
DMH
DMR
MRC
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DPPC Oversight Assesses victims risk, monitors
civil and criminal investigation and ensures
protective services are in place
DPPC
DMH
DMR
MRC
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Reporting Abuse, Neglect and Mistreatment of
Persons with DisabilitiesPages 14 16
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Mandated Reporters

• A person, who as a result of their profession, is
  more likely to be aware of the abuse
• Mandated Reporters are required by law to report
  instances of suspected abuse to the DPPC Hotline

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Who are Mandated Reporters

• Medical personnel
• Medical Examiners
• Social workers
• Foster parents
• Police Officers
• Dentists
• Public or private school teachers
• Educational administrators
• Psychologists

• Guidance or family counselors
• Day care workers
• Employees of private agencies providing services
  to people with disabilities
• Employees of state agencies within the Executive
  Office of Health and Human Services

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What is Reportable?

• The standard for reporting suspected abuse or
  neglect in Massachusetts is reasonable suspicion
  that abuse or neglect exists

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What Makes Reporting Difficult for Victims

• Unable to explain abuse due to the nature of
  disability
• Uncomfortable sharing private, personal
  information
• Having intense feelings of fear, shame and guilt
• Dependent upon the caregiver

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What Makes Reporting Difficult for Victims

• Fearful of being blamed
• Fearful of threats of further harm
• Fearful of getting the caregiver in trouble
• Fearful of being left without a home/family
• Fearful of violating the caregivers orders
• Fearful of rejection

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Reporting Difficulties - Professionals

• Shocked, angered or embarrassed by information
• Hearing information contrary to personal
  standards
• Unclear of responsibility to report
• Not exactly sure what abuse or neglect is
• Reluctant to get involved
• Fearful that reporting will exacerbate situation

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Reporting Difficulties - Professionals

• Reluctant to break Code of Silence among
  employees
• Fearful of being brought into legal matter
• Fearful of retaliation
• Fearful of alienating caregiver and losing
  services
• Reluctant when caregiver is a colleague

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Mandated Reporter Protection

• Mandated Reporters are immune from civil or
  criminal liability as a result of making a report

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Failure to Report

• Failure to report can result in severe
  consequences for victims, other potential victims
  and Mandated Reporters
• Mandated Reporters, who fail to report, are
  subject to a fine of up to 1,000

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Recognizing and Reporting Abuse

• Things are not always what they appear to be
  sometimes we can be fooled by first impressions!
• If you get that sick feeling in your stomach, and
  you suspect abuse or neglect, trust your feelings
  and address the situation immediately!

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How to File an Abuse Report

• Call the DPPC 24-Hour Hotline at
• 1-800-426-9009
• In Case of a Crime or an Emergency Call
• Local Police or 911
• followed by a call to the DPPC

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DPPC M.G.L. c. 19C Reporting Requirements

• File ORAL REPORT immediately to DPPCs 24 hour
  hotline at 1-800-426-9009
• File WRITTEN REPORT to the DPPC within 48 hours

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• Responding to Suspected Abuse Against Persons
  with Disabilities
• What TO DO What NOT TO DO
• Protect, Report, Preserve

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Protect, Report, Preserve

• REMEMBER
• Victims most often disclose to someone they trust
• IF THIS IS YOU.. Contain your emotions
• Stay calm and remain non-judgmental
• Be supportive and ensure the individuals safety
• Explain the requirement to immediately report to
  DPPC or your local APS agency
• Listen closely if the victim wants to talk

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Protect, Report, Preserve

• Do gather essential information, by asking
• What happened? - Only enough to establish that
  abuse or a crime has occurred
• Where did it happen? - Important to know for
  notifying appropriate police department
• When did it happen? - If within 120 hours of
  sexual assault, go to an emergency room for a
  sexual assault exam
• Who is alleged abuser? If appropriate, ask
  obvious questions of the alleged abuser about
  what happened

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Protect, Report, Preserve

• Gather and document basic information on the
  alleged victim and alleged abuser
• If possible, collect relevant logs, schedules,
  and correspondence etc.
• Prevent loss or destruction of known evidence
• Contain control the situation
• Ensure allegations are not repeated to others
• Speak directly with the original source of the
  report
• Ensure all contact with the alleged
  abuser/suspect is by one person

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Protect, Report, Preserve

• DO NOT
• Try to conduct an investigation
• Re-interview the individual
• Interpret or edit the information
• Interrogate the alleged abuser/suspect
• Involve other persons
• Interview other individuals or staff
• Go looking for evidence
• Touch physical evidence

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Protect, Report, Preserve File an Abuse Report

• In an emergency or if you suspect a crime has
  been committed Call 911
• Report abuse and neglect to the DPPC Hotline
  1-800-426-9009 V/TTY immediately

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Multidisciplinary Agency ResponseJoint
Investigations

• No one person or agency possesses all of the
  skill, knowledge, and resources necessary to
  respond to the complex problems of mistreatment
  and abuse.
• Each agency brings a different perspective and
  different information to the table

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Benefits to Building Partnerships

• Improved communication and coordination
• Less trauma for victims and families
• Improved civil and criminal investigations
• Increased reporting, criminal investigations and
  prosecutions
• Enhanced access to the criminal justice system
  for victims with disabilities
• Institutionalized systemic improvements
• Improved data collection and documentation
• Common goal
• Increased protection for victims with disabilities

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