Vulnerable Adult Maltreatment Training
Who Is a Vulnerable Adult?
All Zumbro House clients are Vulnerable Adults.
Any person 18 years of age or older who:
Is a resident or inpatient of a licensed facility (i.e. hospital, nursing home, adult foster care home, group home, etc.).
Receives services from a licensed agency that provides home care or personal care assistance services.
OR
Any person 18 years of age or older who:
Has a physical or mental impairment (i.e. developmental disability, mental illness, traumatic brain injury, dementia, chemical dependency, or other physical, mental, or emotional impairment).
AND
The impairment severely limits the individual’s ability to provide self care without assistance.
AND
Because of the impairment and the need for assistance, the individual has an impaired ability to protect him or herself from maltreatment.
Vulnerable Adult Rights
Our clients have the right to:
Self-Determination
Dignity
Privacy
Confidentiality
Protection from maltreatment
Use of the least restrictive intervention possible
Be informed of issues concerning their care.
Make decisions, even “bad” ones.
Vulnerable adults do not have a right to deliberately harm themselves or others.
Types of Maltreatment
Physical Abuse
Sexual Abuse
Emotional Abuse
Financial Exploitation
Neglect
Physical Abuse
Examples
Any intentional infliction of physical harm
Any degree of assault
Some forms of restraint
Any conduct that could be reasonably expected to produce physical pain or injury:
hitting
slapping
punching
kicking
biting
pinching
Indicators
signs of physical trauma
bruises
cuts
scratches
burns
fractures
repeated or unexplained injury
injuries that are not consistent with the explanation given
injuries that a caregiver has failed to disclose
Sexual Abuse
Examples
any sexual contact between facility staff and a resident of the facility
any sexual contact in which the Vulnerable Adult does not give consent
any degree of Criminal Sexual Conduct
Indicators
trauma to the genital area
STD’s
psychological changes
ambivalence, deference, passivity
evasiveness, shame
anxiety, agitation
depression, hopelessness
trembling, clinging, cowering
lack of eye contact
Emotional Abuse
Examples
threats
humiliation
name-calling
inappropriate teasing
malicious or derogatory language or gestures
deprivation
any treatment that would be considered by a reasonable person to be disparaging, derogatory, harassing, humiliating, threatening, etc.
Indicators
psychological changes
- ambivalence, deference, passivity
- shame
- anxiety
- depression, hopelessness
- confusion, disorientation
behavioral changes
- evasiveness
- trembling, clinging, cowering
- lack of eye contact
- agitation
- suicidal threats or gestures
- hyper-vigilance
- hyperactivity
Financial Exploitation
Examples
a person with legal authority over a Vulnerable Adult’s financial resources fails to use those resources appropriately on behalf of the Vulnerable Adult, resulting in detriment to the Vulnerable Adult
a person without legal authority willfully withholds, uses, or disposes of a Vulnerable Adult’s funds
a person without legal authority gains control of a Vulnerable Adult’s funds through deception, fraud, harassment, etc.
a person without legal authority compels, forces, or entices a Vulnerable Adult to work or perform services for the advantage of another
Indicators
Personal belongings are missing.
Bank statements are no longer available to the Vulnerable Adult.
The Vulnerable Adult is instructed to sign documents they cannot understand or explain.
Caregivers express more concern for the Vulnerable Adult’s finances than for their physical or mental well-being.
Neglect
Failure to provide for basic needs such as:
Food
Clothing
Shelter
Health care
Supervision
It is not neglect for a Vulnerable Adult to make decisions, on their own behalf, which place them at risk when they understand the potential consequences of the decision.
Indicators
evidence that personal care is lacking
signs of malnourishment
dehydration
chronic health problems
Factors that may lead to self-neglect:
dementia
depression
illness
isolation
poverty
substance abuse
Reporting Maltreatment
All Zumbro House staff are Mandated Reporters.
Any known or suspected maltreatment of a Vulnerable Adult must be reported immediately.
Failure to report may result in:
- criminal penalties
- liability for damages resulting from failure to report
Information to report:
Who – identity of Vulnerable Adult and of alleged perpetrator
What – nature and extent of known or suspected maltreatment
When – date and time of incident(s)
Where – location of incident(s)
Any evidence/indicators of previous maltreatment
any other relevant information
Vulnerable Adult Maltreatment Report Process
Zumbro House staff report known or suspected maltreatment immediately to Christopher Onken or Grace Bailey.
An internal investigation is started.
Christopher Onken forwards the report to the county’s Common Entry Point.
The Common Entry Point forwards the report to the proper agency for investigation.
The assigned agency completes an investigation.
There are four possible outcomes or determinations at the conclusion of an investigation:
Substantiated – there is significant evidence that the alleged maltreatment occurred
Unsubstantiated – there is not significant evidence that the alleged maltreatment occurred
Inconclusive – a determination cannot be made based on the evidence available
False – there is significant evidence that the alleged maltreatment did not occur
Documentation
Documentation is an important part of the Resident Counselor responsibilities. The documentation that employees complete is used for many purposes:
- To create a record of important situations, incidents and events;
- To provide a base of information from which decisions can be made regarding medication or program changes;
- To provide proof of the services that we are providing and receiving payment for;
- And many others.
Documentation must provide an accurate and objective account of what and when events occurred, as well as identify who provided the care. It should present a clear picture of a client’s needs, the worker’s actions, and the client’s response. Good documentation has five important characteristics. It should be: (1) factual, (2) accurate, (3) complete, (4) current (timely), and (5) organized. Documentation should NOT be a subjective account of events from the writer’s perspective.
Here are some tips to remember about documentation:
- Documentation for the shift should be done during the shift. Do not leave it to be done the next day, the next time you come in, or whatever. Complete it before you go home.
- Use black or blue ink.
- Write legibly. If it can’t be read at a later date, it is if no use.
- Make sure the client’s first and last name is on every page of documentation.
- Make sure each page is dated with month and year. Progress notes and health progress notes must have a full date – Month/Day/Year
- Progress Note entries must include your signature with full last name and your title. (i.e. Mike Schmidt, RC)
- Make sure the documentation clearly explains what you are trying to record. Imagine that someone who may not know the client is reading the entry. Would they understand what the situation was?
- NEVER assume that because you recorded something in a progress note or a health progress note that everyone knows about it. Make sure to communicate any important information to your supervisor, such as incidents, health concerns, etc.
It is essential that documentation is completed promptly and that it is thorough. Some examples of documentation that are completed include:
Progress Notes–
Progress Notes provide a narrative description of how and what the client had done throughout the day/shift. There should be a progress note written for each shift. They should be written with full sentences, contain only approved abbreviations be free of opinions or slang terms, and clearly outline the details of the day for that particular client. They should also never contain other client’s names; we can use terms like peer or housemate rather than their names. Below is an example of a well written Progress Note:
10/23/2012 / 3-11pm / Joe reported that he had a conflict with a coworker today at his day placement. Staff advised Joe to speak with his job coach about the conflict when he arrives at work tomorrow. The day program staff was notified of the situation by phone at 4:00pm. Joe went to bowling and watched a movie before heading for bed at 9:30 pm.J. Jones, RC …………………………………………………………………………………………......
Health Progress Notes -
Health Progress Notes are similar to progress notes, except, of course, they address health related information. Although it may not be necessary to write in the Health Progress Notes every day, it is important to be sure that health information is recorded whenever it is applicable. It is important in Health Progress Notes to state complaints of illness or injury or other information very clearly and objectively. If a client has an ongoing health concern, such as bronchitis, Health Progress Notes should be completed every day until it is resolved. Below is an example of a well written Health Progress Note:
10/2/2012 / 3-11PM / Joe reported to staff upon returning home from work that he felt like he had a fever. Joe’s temperature was taken at 3:30pm and it was 101.3. Gave 2-500mg tablets of Tylenol at 3:45pm. Joe reported at supper, approximately 5pm that he felt much better. His temperature was taken again at 5:30pm and it was 98.6.J. Jones, RC………………………………………......
Data Tracking Sheets –
These sheets are where we keep track of target behaviors and current goals. It is important that target behaviors are documented accurately, as this data is compiled and often presented to the physician or psychiatrist to make decisions regarding medications or treatment plans. Target behaviors are tracked by indicating a (YES) - yes the target behavior was displayed during the time period, (NO) - no the target behavior was NOT displayed during the time period, or (LOA) – the client was on Leave of Absence. See the first example below. The goals/outcomes are areas decided on by the client and their team where they would like to gain more skills and independence. This documentation is compiled and analyzed to monitor the client’s progress in those areas. The second example below shows a goal tracking sheet where (YES) indicates the client completed or met task, (N/A) indicates that it was not applicable to offer the client the task that day, and (NO) indicates that the client was offered the task but refused to complete it or did not meet the goal.
Monthly Data Summary / Name: / John DoeTarget Behaviors / Month: / April / Year: / 2012
1 / 2 / 3 / 4 / 5 / 6 / 7 / (YES) - yes, target behavior was displayed during the time period
(NO) - no, target behavior was NOT displayed during the time period
(LOA) - Leave of Absence
John will remain on level 2 or higher (please indicate the actual number) / Verbal Aggression (threatening, yelling, cursing, name-calling) / Inappropriate Sexual Behavior (sexual talk, touch, staring at breasts or genitals of others) / Defiance (purposefully going against house rules or staff direction) / Elopement (leaving Zumbro House property without approval) / Property Destruction (throwing objects, slamming doors, hitting walls/doors, etc)
AM / PM / AM / PM / AM / PM / AM / PM / AM / PM / AM / PM / AM / PM
1 / LOA / LOA / LOA / LOA / LOA / LOA / LOA / LOA / LOA / LOA / LOA / LOA
2 / YES-2 / YES-2 / NO / NO / NO / NO / NO / NO / NO / NO / NO / NO
3 / YES-2 / YES-2 / NO / NO / NO / NO / NO / YES / NO / NO / NO / YES / John refused to complete his daily chore; staff provided 4 prompts. He then slammed his bedroom door.
Monthly Data Summary / Name: / John Doe
Tasks / Month: / April / Year: / 2012
1 / 2 / 3 / 4 / 5 / 6 / 7 / (YES) =client completed task or met goal
(N/A) = task was not offered to client that day
(NO) =client was offered task but refused to complete or did not meet goal
John completed his designated daily chore without staff prompting. / John will plan and prepare a meal a minimum of once per week. / John will complete the entire laundry process once per week with one verbal prompt or less. / John will plan and initiate an activity with a peer twice per month.
(LOA) = Leave of Absence
Comment below regarding variables and Changes (e.g. drugs, dose, programs, level, etc.)
AM / PM / AM / PM / AM / PM / AM / PM / AM / PM / AM / PM / AM / PM
1 / YES / YES / N/A / N/A / N/A / N/A / N/A / YES / John planned and initiated a walk around Lake Calhoun with a friend from Oliver house.
2 / YES / YES / N/A / YES / N/A / N/A / N/A / N/A
3 / NO / YES / N/A / N/A / N/A / NO / N/A / N/A / John required 4 verbal prompts to complete laundry.
Medication Administration Records –
The Medication Administration Record is where we document what medications have been given to the client. You will learn all of the details regarding this type of documentation when you review Medication Administration Policy and Procedures.
Sleep Charts –
Sleep charts are kept for each and every client, and reflect that we are checking on clients at least every hour. In addition, these sleep charts can be analyzed to monitor sleep patterns and changes in sleep patterns. Many times a change in sleep pattern or frequent difficulty sleeping can be indicator that something else is going on with the client; they may be sick, anxious, depressed, upset about something, or even experiencing an increase in psychiatric symptoms.
Incident reports –
Incident reports are completed any time there is an incident. What does that mean? An “incident” occurs any time there is a situation that is out of the normal routine, had or could have had a negative effect on the client, their housemates, the community, etc., any time the client requires physical intervention, attempts to elope, and many others, The incident report is available on the Zumbro House website as a web form. The report should be completed andsubmitted electronically, which will be automatically forwarded to the Program Coordinator and the Director of Program Services. There will be more detailed instructions on incident reporting at each site. It is essential that the incident report get completed during the shift in which the incident occurred. It is never acceptable to put it off until the next day or the next time you are scheduled. For certain incidents, Zumbro House is required to notify members of the client’s team within 24 hours. This email with incident report attached is what triggers that notification. If you are ever unsure about if an incident report should be completed, contact the Lead Counselor for guidance.
CHALLENGING BEHAVIOR
INTRODUCTION
We all have behaviors we would like to change. Some of us bite our fingernails, smoke, eat too much, lose our tempers, and so on. No matter how unusual or extreme challenging behavior may look, similar types of behavior occur in almost everyone. Nearly all challenging behavior serves a purpose for the individual. Persons with severe disabilities may not currently have the skills to get what they need any other way.
It’s not surprising that when people feel frustrated, angry or in pain, they often behave in disruptive, and often dangerous ways. When people are bored or confused; their behavior is often less predictable. Problems may arise when an individual discovers that – DISRUPTIVE OR AGGRESSIVE BEHAVIOR OFTEN WORKS.
QUALITY OF LIFE
We begin the process of building positive behavior support by looking at the present with an eye toward the future. What are the things you value in your own life?
- Where you live
- Having a supportive family
- Having good friends
- Doing activities in your community
- Being independent and in control of one’s own life
- Not being bored; having a variety of things to do, places to go and people to see.
- Feeling secure that you’re basic needs will be met, and that you can expect certain things to happen on a routine basis, and to share space with a certain core group of people.
Now think about the people we work with – especially someone who often exhibit challenging behavior. How much choice do they have over things that happen in their everyday lives? Did they choose where they live, who they live with, who their roommate is, whether to live with others, where they work, what kind of job or career they have? Do they plan when they will get up, when to bathe or shower what to eat? Do they choose how to spend their free time? Do they get to spend as much time as they choose with their family? To take part in regular community activities, to have friends outside their home?
Challenging behavior may be difficult for us to cope with, particularly when we try to support the person in improving the quality of their life.
WORKING WITH PEOPLE:
POSITIVE TECHNIQUES TO ADDRESS
CHALLENGING BEHAVIOR
INDENTIFY FACTORS THAT INFLUENCE CHALLENGING BEHAVIOR
Medical problems often are a significant variable in how a person behaves. Unfortunately, many individuals with severe medical conditions frequently have difficulty communicating their medical condition to staff. It is important when assessing behavior that staff always reviews possible medical factors affecting b behavior. Staff must be familiar with an individual’s case history, current medical conditions and medications. This information can serve as a guide in determining possible causes for a behavior. Staff needs to watch for new behavior, changes in frequency, duration or intensity of old behaviors, or abrupt discontinuance of old behaviors. Some common examples are:
Another major variable that can determine a person’s behavior is the degree of control they have over choices available to them on any given day. Self esteem rises and individuals are usually easier to get along with when treated as adults.
Remember – ALL BEHAVIOR HAS A CAUSE
REMAIN CALM – Staff must communicate before, during and after the behavior that their presence represents safety and reward, Remaining calm takes practice. A good plan can help you learn to remain calm. If you are upset, the individual you are working with is likely to become upset as well.
RE-DIRECT – Staff need to redirect the focus of the interaction to another activity or subject. Ignore the inappropriate behavior, but not the person.