ANCHORS FOR ADULT - MALTREATMENT

EXTREME - 4

  1. Death due to abuse or neglect
  2. Physical assaults resulting in life threatening injuries
  3. Injuries to head, face or genitals
  4. Home environment presents life threatening risk to the adult
  5. Battering during pregnancy
  6. Stalking
  7. Use of weapons and/or objects
  8. Burns
  9. Internal Injuries
  10. Dehydration and/or malnutrition due to neglect that is life threatening
  11. Hypothermia that is life threatening (due to neglect)
  12. Strangulation
  13. Killing pets
  14. Threatening suicide, homicide or both as a means of control
  15. Hostage taking
  16. Broken bones
  17. Sexual abuse (including individuals lacking capacity to consent)
  18. Sexually transmitted diseases (STD's) in persons who lack the capacity to consent
  19. Rape
  20. Knowingly infects with a sexually transmitted or communicable disease
  21. Sexual Exploitation
  22. Lives in a constant state of fear
  23. Acute depression (diagnosed by a mental health professional)
  24. Lack of food, shelter, supervision, or medical care which presents life threatening risk to the adult
  25. Bone exposed due to bed sores
  26. Immersion in extremely hot or cold water
  27. Urine burns
  28. Locked in/out of residence by caretaker
  29. Abandonment or desertion
  30. Financial exploitation (totally depletes financial resources)
  31. All threats to harm a child witness to domestic violence
  32. Unable to protect self due to mental, physical or intellectual functioning
  33. Any other situation the FSOS considers extreme risk to the adult

SEVERE - 3

  1. Physical assault resulting in injuries (sprains, dislocations, significant bruising to torso or extremities)
  2. Lack of food, shelter, utilities, supervision or medical care which presents significant risk to the adult
  3. Psychological battering
  4. Surveillance (related to domestic violence or stalking)
  5. Threats of violence toward alleged victim and/or other family members
  6. Threatens with or access to weapons
  7. Controlling activities (sleeping, eating, access to money, travel, transportation, etc.)
  8. Physical restraints or chemical restraints (using medication to control adult's behavior)
  9. Cutting, burning, destroying clothes, destroying car/tires, heirlooms, family photos, or furniture.
  10. Isolation
  11. Force feeding
  12. Forced to perform degrading acts
  13. Injuries that are inconsistent with explanation
  14. Family member/caretaker forces adult from adult's home
  15. Deliberate over-medication(overdose) or under medication
  16. Unable to manage medication as prescribed or indicated
  17. Skin breakdown, bed sores
  18. Dehydration and/or malnutrition due to neglect that is not life threatening
  19. Hypothermia
  20. Wandering
  21. Parasite infestation in/on the adult's body
  22. Theft of funds, property, and resources by caretaker/family member
  23. Individual lacks capacity to understand document(s) to be signed (POA's wills, contracts, etc.)
  24. Any other situation the FSOS considers severe risk to the adult

MODERATE - 2

  1. Name calling and other verbal abuse
  2. Repetitive falls
  3. Controlling access to friends, family, employment, and/or education
  4. Using male privilege/sex role stereotypes (playing mind games)
  5. Deprives spouse of medical or support services
  6. Physical assaults with minor injuries (bruises)
  7. Prior history of abusive/neglectful behavior
  8. Inappropriate treatment during caretaking/rough transfers (moving adult from bed to wheelchair, etc.)
  9. Unexplained genital infections.
  10. Poor personal or oral hygiene creating health problems for the adult
  11. Lack of utilities or disconnection of utilities
  12. “Doctor Shopping” (multiple health care providers)
  13. Unsanitary home environment presents health risk to adult
  14. Lack of necessary aides (walker, cane, eyeglasses)
  15. Caregiver unstable or exhibits antisocial behavior
  16. Contractures
  17. Fails to follow medical, therapy, or safety recommendations.
  18. Misuse of funds, property, and/or resources by caretaker or family member
  19. Excessive charges for food, shelter, care or services
  20. Caretaker/family member threatens to place adult out of home
  21. Inappropriate food, clothing or shelter
  22. Any other situation the FSOS considers moderate risk to the adult

MILD - 1

  1. Lack of respect for adult's autonomy (ignoring, silent treatment, treating adult like a child, etc)
  2. Broken assistive devices
  3. Locking self in/out of residence depending on climate
  4. Incorrect positioning by caretaker
  5. Attempts to isolate the adult from support system
  6. Adult or caretaker/family member neglecting financial obligations
  7. Any other situation the FSOS considers mild risk to the adult

NONE - 0

  1. There is no indication of adult abuse, neglect, and/or exploitation

ANCHORS FOR ADULT - FAMILY DEVELOPMENTAL STAGES AND TASKS

EXTREME - 4

  1. Constant state of chaos
  2. Controls activities of family through violent means
  3. Adult is afraid for their safety and the safety of others
  4. Controls all aspects of family life
  5. Doesn’t allow the adult to have relationships with extended family/community resources
  6. Total isolation of the adult
  7. Threatens to harm self or others
  8. Doesn’t allow privacy for family members
  9. Intimidates family members
  10. Chooses to use violence toward others
  11. Abuses self

SEVERE - 3

  1. Doesn’t respect adult's right to self determination and privacy
  2. Unrealistic expectations of adult's abilities (i.e. MR/DD, physical dysfunction)
  3. Denial of health problems (mental and/or physical)
  4. Ashamed to admit that a problem or situation exists
  5. Refuses assistance on behalf of an adult although the adult’s needs are not being met
  6. Controls activities of the family through nonviolent means
  7. History of unresolved conflicts that lead to abuse or neglect
  8. Manipulative use of affection to control others
  9. Withholding affection or use of guilt to control others
  10. Encourages dependence

MODERATE - 2

  1. Family members not able to effectively communicate their needs
  2. Total dependence on another family member to meet their emotional needs
  3. Lowered self esteem/self worth (fear of rejection or loss)
  4. No established routine or schedule leading to a neglectful situation
  5. Wants to assist but is incapable of doing so
  6. Unable to define family roles
  7. Recognizes that the adult has a problem but doesn’t know how to seek assistance
  8. Difficulty in meeting basic needs

MILD - 1

  1. Adult usually able to function
  2. Inconsistent roles and expectations
  3. Can usually communicate needs but has difficulty discussing subjects such as chronic health problems, impairment, aging, and lifestyle changes

NONE - 0

  1. Family roles and expectation discussed and acceptable to all family members
  2. Capable of communicating needs
  3. Family affection expressed appropriately
  4. Supportive of each other during changes in life
  5. Able to resolve conflicts without violence
  6. Accepts and adjusts to changes (i.e. out of home placement, need for assistance with ADL's)
  7. Stable home environment
  8. Recognizes and seeks assistance when needed

ANCHORS FOR ADULT - EDUCATION, EMPLOYMENT, TRAINING (Victim/Perp Screen)

EXTREME - 4

Adult has no education, employment, or training necessary for self sufficiency.

SEVERE - 3

Adult has limited education, employment, or training necessary for self sufficiency.

MODERATE - 2

Adult has some education, employment, or training necessary for self sufficiency.

MILD - 1

Adult has few needs regarding education, employment, or training necessary for self sufficiency.

NONE - 0

Adult has no needs regarding education, employment, or training necessary for self sufficiency.

ANCHORS FOR ADULT - HISTORY OF ABUSE

(Victim/Perp Screen)

NO RATING ANCHORS

ANCHORS FOR ADULT - LEVEL OF FUNCTIONING (Victim/Perp Screen)

EXTREME - 4

  1. Adult often demonstrates behavior that results in potential harm to self or others
  2. Pattern of high-risk behavior is escalating
  3. Criminal history of violence
  4. Perpetrator believes that there should be no consequences for violent behavior
  5. Adult abuses drugs(including prescription drugs) or alcohol resulting in total incapacity
  6. Adult has an untreated mental illness or indicators of mental illness resulting in high risk behavior or incapacity
  7. Adult victim/perpetrator is acutely depressed(i.e. longing for death)
  8. Unable to protect self
  9. Unable to effectively learn coping skills
  10. Unable to communicate needs
  11. Unable to carry out any activities of daily living
  12. Lacks the capacity to consent for services
  13. Non-ambulatory
  14. Multiple physical and/or mental impairments
  15. Lives in an abusive or dangerous situation
  16. History of substantiated abuse allegations
  17. Becomes physically or verbally aggressive on a consistent basis
  18. Consistently blames others for problems or actions
  19. Adult victim/perpetrator suffers from Post Traumatic Stress Disorder
  20. Adult victim or perpetrator's behavior interferes with access to services

SEVERE - 3

  1. Adult does not always recognize danger to self
  2. Perpetrator makes unreasonable demands of others
  3. Adult abuses drugs(including prescription drugs) or alcohol resulting in substantial incapacity
  4. Adult minimizes, denies problems and refuses services
  5. Unable to carry out numerous activities of daily living
  6. Needs assistance with mobility and transferring (moving from wheelchair to bed, etc.)
  7. Demonstrates marked disorientation and confusion
  8. Reluctant to provide care for adult
  9. Employment problems and unhealthy dependency

MODERATE - 2

  1. Adult is able to recognize some dangerous situations
  2. Infrequently takes action to protect self
  3. Unrealistic expectations of self or others
  4. Able to carry out several activities of daily living
  5. Mobile non-ambulatory
  6. Some difficulty in establishing and maintaining relationships

MILD - 1

  1. High risk behaviors rarely occur
  2. Inconsistent in decision making, but does not present a danger to self or others
  3. Adult has limited mobility
  4. Able to carry out most activities of daily living
  5. Behavior usually appropriate to situation
  6. Adult demonstrates ability to plan for their own safety
  1. Often takes actions to protect self

NONE - 0

  1. Adult is able to resolve conflict in a healthy manner
  2. Consistently able to protect self and/or provide for own needs
  3. Communicates needs and feelings appropriately
  4. Has consistent social support
  5. Able to carry out all activities of daily living
  6. Demonstrates independence through employment or other means

ANCHORS FOR ADULT - NATUR OF ABUSE (Victim/Perp Screen)

NO RATING ANCHORS

ANCHORS FOR ADULT - SAFETY PLAN (Victim/Perp Screen)

NO RATING ANCHORS

ANCHORS FOR ADULT - SYSTEMS OF SUPPORT

EXTREME - 4

  1. Family/friends encourage adult to remain in a dangerous situation
  2. Total isolation
  3. Community agency withdraws services without notice
  4. Family/friends discourage adult from seeking agency assistance
  5. Community agency does not provide adequate or appropriately trained staff

SEVERE - 3

  1. No family or extended family
  2. No contact with extended family
  3. Resources available, but adult cannot access services due to extensive waiting list
  4. Unable to access any community resources
  5. Family/friends lack sufficient knowledge or abilities to meet the adult's needs
  6. No formal support from clubs, churches or other community partners
  7. Community agency contracts to provide services which they are unable to deliver
  8. Community agency threatens to withdraw services without adequate notice

MODERATE - 2

  1. Family/friends are not supportive of adult making decisions
  2. Adult has contact with extended family, but refuses their assistance
  3. Community agency has no funds available for services
  4. Limited support from clubs, churches or other community partners
  5. Family/friends have a conflict with the adult that prohibits needed support
  6. Community agency did not respond to request for services

MILD - 1

  1. Family/friends do not respect adult's lifestyle
  2. Community agency does not coordinate well with other community partners
  3. Family/friends threaten to withdraw support or assistance

NONE - 0

  1. Community agency coordinates well with other community partners
  2. Family/friends willing to support and assist adult
  3. Adult is supported by a network of clubs, churches or other community partners

ANCHORS FOR ADULT - SEQUENCE OF EVENTS

EXTREME - 4

  1. Multiple incidents of maltreatment with a pattern of escalation
  2. Public display of violence toward the victim
  3. Escalation of batterer's risk taking behavior
  4. Maltreatment is justified by the perpetrator
  5. Use of a weapon
  6. Total incapacitation due to drug (including prescription drug) or alcohol abuse
  7. Revenge or retaliation
  8. Trauma to the genitals, breast and/or rectum
  9. Danger to self or others
  10. Total dependence for personal care
  11. Total depletion of assets or resources
  12. Perpetrator has no recognition of high risk triggers
  13. Unable to pay for food, shelter, utilities, medication or medical care
  14. Failure of caretaker/adult to seek medical treatment resulting in a life threatening situation
  15. Mentally/physically incapable of providing for self
  16. Fantasies of homicide/suicide
  17. Medical treatment required as a result of maltreatment
  18. Multiple life threatening health problems
  19. Excessive fear in the presence of the perpetrator
  20. Perpetrator has total access to property or finances which leads to maltreatment

SEVERE - 3

  1. Abusing drugs (including prescription drugs) or alcohol that contributes to the maltreatment
  2. Needs to control and dominate victim/family
  3. Blames the victim
  4. Forced by circumstances to provide care for the adult
  5. Perpetrator believes the victim is property
  6. Violent behavior outside the home
  7. History of violence in family of origin
  8. History of criminal charges or civil protective orders (EPO/DVO)
  9. Serious unmet mental health needs
  10. Physically and/or mentally unable /unwilling to provide for personal/financial needs
  11. Lack of support system
  12. Caretaker/adult delays seeking medical attention resulting in a serious medical situation
  13. Perpetrator has minimal recognition of high risk triggers, but does not respond
  14. Isolation
  15. Impaired communication
  16. Adult victim/perpetrator's prior history of violent relationships
  17. History of domestic violence offender treatment
  18. Extremely upset when bathed, changed or examined
  19. Bruises in different stages of healing
  20. Refuses to allow adult to speak for self
  21. Exaggerated defensiveness
  22. Perpetrator alleges to have legal authority for the adult (legal guardian/ conservator, POA, payee, etc) resulting in exploitation or neglect.

MODERATE - 2

  1. Intermittent history of violence
  2. Perpetrator has lost job or suffered other significant loss
  3. Perpetrator has "Jeckyll and Hyde" personality
  4. Emotional or physical withdrawal from the victim
  5. Unrealistic caregiving expectations
  6. Resentful of having to provide care
  7. Impaired mobility
  8. Perpetrator is reluctant to allow adult to speak for self
  9. Unusual financial activity (i.e. large withdrawals from accounts, questionable sale of property, etc)
  10. Perpetrator recognizes high risk triggers, but responds inconsistently
  11. Ambivalent feelings toward perpetrator

MILD - 1

  1. Limited eye contact from adult
  2. Caretaker is immature
  3. Some success in problem solving skills
  4. History of alcohol/drug (including prescription drug) use with no current problem
  5. Unmet personal care needs that do not pose significant risk to the adult
  6. Inappropriate concern about adult's finances
  7. Caretaker overly concerned with adult's finances

NONE - 0

  1. No indicators of abuse, neglect or exploitation

Continuous Quality Assessment (CQA) Rating Anchors

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