ABUSE, NEGLECT &
EXPLOITATION
HILL COUNTRY MHDD
CENTERS
CRISIS STABLIZATION UNIT
SUBSTANCE ABUSE PROGRAMS
ECI-1115 Waiver-Contractors
YOUR RESPONSIBILITY
To PROTECT the HEALTH
WELFARE and SAFETY of our
CONSUMERS
ABUSE
ABUSE: The negligent or willful infliction
of injury, unreasonable confinement,
intimidation, or cruel punishment with
resulting physical or emotional harm or
pain to a person with a disability by that
person’s caretaker, family member, or
other individual who has an ongoing
relationship with the person.
DFPS Rules, 40 TAC §705.1001
YOUR DUTY
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It is your duty to perform your job in a way
that will never abuse, neglect or exploit
consumers.
We will discuss ways to
RECOGNIZE what abuse, neglect or
exploitation is.
RESPOND to the consumer/allegation, and
protect every patient/consumer.
REPORT possible abuse, neglect &
exploitation to the proper reporting agency.
TYPES OF ABUSE
 Sexual
Abuse-(Sexual Exploitation)
 Physical Abuse
 Exploitation (Money, Resources,
Property)
 Verbal orEmotional Abuse
 Neglect
SEXUAL ABUSE
“Sexual abuse of an elderly or disabled person,
including any voluntary, involuntary or
consensual or nonconsensual sexual conduct that
would constitute an offense under Section 21.08,
Penal Code (indecent exposure) or Chapter 22,
Penal Code (assaultive offenses), committed by
the person's caretaker, family member, or other
individual who has an ongoing relationship with
the person..”
DFPS Rules, 40 TAC §705.1005
Sexual Abuse
Examples
Any sexual activity or conduct between
staff and consumer such as:
 Kissing.
 Staff having an intimate relationship with
a patient or consumer.
 Inappropriate touching, requesting,
suggesting or encouraging any sexual
activity.
 Sexual Assault.
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Off-hour patient interaction
(MH)
Under no circumstances will staff fraternize
with current or former patients on a personal
level. This may be grounds for disciplinary
action, up to and including possible
termination. Entering into any type of
personal relationship with a patient is
considered a conflict of interest, no matter
how minor it may be.
PATIENT INTERACTION
Examples
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You are at a party where a person who is a
known consumer asks you for a ride to their
home which is only a few blocks from the
location of the party. You recognize this
person as having been a patient at the CSU.
This person has obviously been drinking
and would not be safe walking the distance.
What would you do?
Scenario #2
You are invited to a dinner party with
friends. You arrive only to find that another
guest is a known patient at the local MH
clinic. It has been decided that after dinner
everyone is going out to a club to dance.
Should you go out with the group?
 If you are asked for a ride home from that
person, how would you respond?
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PHYSICAL ABUSE
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When an alleged perpetrator is a caretaker,
family member, or other individual who has an
ongoing relationship with the alleged victim,
physical abuse is defined as any knowing,
reckless, or intentional act or failure to act,
including unreasonable confinement, corporal
punishment, inappropriate or excessive force,
or intimidation, which caused physical injury,
death, or emotional harm.
DFPS Rules, 40 TAC §705.1003
SIGNS & SYMPTOMS
 Unusual
patterns of injuries such as
bruises, bites or burns.
 Frequent unexplained injuries.
 Fearful Behaviors.
 Extreme fear of a specific employee.
 Serious injury.
 Verbal allegations.
Physical Abuse
Examples
Striking
 Pushing
 Shaking
 Verbal Incitement
(What does Incitement mean?)
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Physical Abuse & Neglect
Scenario
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You have baby in your care who has been
assigned a nurse hired by a home health
care provider. You have observed her not
following doctor orders. Her actions place
baby in danger of death or serious physical
injury. Your obligation is to protect well
being of baby above all else. How would
you respond to this situation?
VERBAL-EMOTIONAL
ABUSE
The use of verbal or other communication,
including gestures to;
 Curse
 Vilify or Degrade (Slanderous or abusive
language)
 Humiliate
 Threaten a person with emotional or
physical harm
DFPS Rules, 40 TAC §705.1007
Verbal-Emotional Abuse
Examples
Speaking to a patient/consumer in a loud,
angry sounding voice
 Cursing at patient/consumer
 Using gestures toward patient/consumer
 Name calling
 Using threatening words and body
language
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EXPLOITATION
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Illegal or improper act or process of a
caretaker, family member, or other individual
who has an ongoing relationship with an
elderly or disabled person that involves using,
or attempting to use, the resources of the elderly
or disabled person, including the person's
social security number or other identifying
information, for monetary or personal benefit,
profit, or gain.
DFPS Rules, 40 TAC §705.1011
Exploitation
Examples
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Accepting gifts (monetary or purchased) of any
value
You may accept food items if it is shared with
co-workers AND consumers
Borrowing personal items which belong to
consumers
Consumers do not work for you
Buying or giving gifts to consumers
NEGLECT
When an alleged perpetrator is a caretaker
or paid-caretaker, neglect is defined as:
• the failure to provide for protection, food,
shelter, or care necessary to avoid
emotional harm or physical injury; or
• a negligent act or omission that caused or
may have caused emotional harm, physical
injury, or death.
DFPS Rules, 40 TAC §705.1009
NEGLECT
Examples
Failure to assist consumer when
requested
 Failure to provide adequate nutrition
(IDD)
 Failure to assist consumer with clothing
and shelter(IDD—HCS)
 Failure to provide prescribed
medications in a timely manner
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NEGLECT
Continued
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Failure to establish and carry out an
appropriate individual treatment plan of
services
Failure to assist patient/consumer with the
activities of daily living if necessary
Leaving a person unattended when unless PDP
states otherwise (IDD)
Allowing Patients/Consumers to argue/fight
without intervention
Talking or texting on cell phone while driving
NEGLECT
Continued
 While
at work, HCMHDDC staff will
NOT, watch or rent movies or
programs that are rated PG or R if the
program contains sexually explicit or
violent content.
REPORTING
ALLEGATIONS
REPORTING
It is your Legal, Ethical and Moral
responsibility to report any allegation of
Abuse, Neglect or Exploitation within one
(1) hour when you See it, Hear it, or
Suspect it.
Failure to report an incident is considered a
criminal offense: Class A misdemeanor
Texas Dept. Family &
Protective Service (TDFPS)
TDFPS
1-800-647-7418
 Facility Investigations
 Staff are on duty
 24 hours a day – 7 days a week

MAKING THE CALL
You must report all known or suspected
allegations of abuse, neglect &
exploitation within one hour from the
time you witness or learn of the incident.
 You must call only the number posted
 You may be put on hold and it could last
several minutes. DO NOT HANG UP!!!
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INFORMATION TO BE
GIVEN
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Give complete information about the consumer
– Name, Address, Phone, Age, any other
important information about the consumer, if
asked
You may give medical information if it is
necessary for the report
YOU HAVE MADE THE
REPORT!
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Before you hang up, the intake worker
will give you a confirmation number and
their staff ID #. Be sure to write down
these numbers and keep them in a safe
place.
REPORTS ARE
CONFIDENTIAL
Once you have made the report, YOU
MUST KEEP THIS INFORMATION
CONFIDENTIAL
 DO NOT DISCUSS THIS
INFORMATION WITH ANYONE
 You do not report this to your supervisor
or anyone else.
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NEED ADVICE BEFORE
CALLING?
You may call
Wm. A. Olden, R.P.O
830.258.5441
1.888.393.3629 toll free
THE INVESTIGATION
In most cases, a DFPS investigator will
come to the clinic/center to ask questions
and review the records. You are
expected to cooperate fully.
There are some cases they do not
investigate. I will investigate those cases
and determine the outcome.
YOU DO NOT
INVESTIGATE
IT IS NOT YOUR DUTY TO
INVESTIGATE OR TO ASK
QUESTIONS
FAILURE TO REPORT IN A
TIMELY MANNER
If you fail to report an incident in a
timely manner, discuss with a coworker. Or any other situation
considered neglecting your reporting
responsibility, you may be subject to
disciplinary action up to and
including termination.
RETALIATION
What is
RETALIATION?
RETALIATION
Any action intended to inflict emotional
or physical harm or inconvenience to an
employee who has reported abuse,
neglect, exploitation.
This could include harassment,
disciplinary measures, discrimination,
reprimand, threats, censure or criticism
RETALIATION IS
PROHIBITED
If you feel that someone has or is retaliating
against you for doing the right thing, you
should immediately notify:
Sheree Hess
Human Resource Director
830-792-3300 XT 2044
You must report abuse
allegations when
When you see it
When you hear about it
When you suspect it
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YOU REPORT ABUSE TO

Abuse, Neglect & Exploitation is
reported to:
DFPS
Texas Dept of Family & Protective Services
1-800-647-7418
Number can be found on the Abuse,
Neglect and Exploitation flyers in every
office & building HCMHDDC occupies.
RIGHTS
HUMAN RIGHTS
life, liberty and pursuit of happiness
 freedom from torture, or cruel, inhuman or
degrading treatment or punishment
 equality before the law not being subjected
to arbitrary arrest, detention or exile
 freedom of movement and residence
 freedom of thought, conscience and religion
 peaceful assembly and association
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CIVIL RIGHTS
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1st.
Freedom of speech, press, religion, peaceable assembly, and to
petition the government
2nd. Right for the people to keep and bear arms, as well as to maintain
a militia
3rd. Protection from quartering of troops
4th. Protection from unreasonable search and seizure
5th. Due process, double jeopardy, self-incrimination, private property
6th. Trial by jury and other rights of the accused
7th. Civil trial by jury
8th. Prohibition of excessive bail, as well as cruel and unusual
punishment
9th. Protection of rights not specifically enumerated in the Bill of Rights
10th. Powers of states and people
Consumer Rights
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To be treated with respect and dignity
To have their privacy protected
To receive age and culturally appropriate services
To understand available treatment options and alternatives
To receive care that does not discriminate on the basis of age, race, or
type of illness
People with mental illness may have additional SPECIAL rights that
are protected under the following laws
Americans with Disabilities Act.
Fair Housing Amendments Act.
Civil Rights of Institutionalized Persons Act.
Individuals with Disabilities Education Act.
SPECIAL RIGHTS
Federal & State laws were passed giving individuals with mental
illness & mental retardation additional special rights
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Right to Normalization
Least Restrictive Environment
(Most appropriate for their needs yet least
confining for their conditions
Participate & receive individualized services
Informed Consent
CONFIDENTIALITY
RIGHTS VIOLATIONS
If an individual believes their rights have
been violated, it is their right and your
responsibility to report the violation within
one (1) hour or assist them in making a call
to:
Wm. A. Olden, R.P.O.
830.258.5441
1-888-393-3609 (Toll Free)
REPORTING VIOLATIONS
Rights violations can also be reported to
the state rights protection service at:
Consumer Rights and Services Office
MH – 1-800-252-8154
MR – 1-800-458-9858
COMPLAINTS
COMPLAINTS
If a consumer, their guardian, legally
authorized representative, family or
friend wishes to file a complaint about
our services or employees, they may do so
by calling:
Wm. A. Olden, R.P.O.
830.258.5441
1-888-393-3609 (Toll Free)
OTHER COMPLAINT LINES
Texas Dept. Health & Human Services
MH – 1-800-252-8154
MR – 1-800-458-9858
CONFIDENTIALITY
WE MUST MAINTAIN
CONFIDENTIALITY
We never share personal identifying
information about those we serve with
anyone who does not have a need for the
information
Never verify an individual is receiving
services at HCMHDDC without a consent
to do so.
CONSENT TO RELEASE
INFORMATION
We do not share personal identifying
information about a patient/consumer
with anyone not directly working with
that individual unless that individual or
their LAR gives WRITTEN consent
Do not discuss your patient/consumer
with relatives, friends, family or former
employees.
SHOULD I GIVE THE
INFORMATION?
If you are not sure whether someone should
have access to confidential information,
always assume they DO NOT. Refer
them to your supervisor or call:
Wm. A. Olden, R.P.O.
Or
Sheree Hess at One Schreiner Center
EXCEPTIONS
There are some exceptions to the rule:
Patient/Consumer
Law Enforcement (In Crisis Situation)
Medical Emergency Personnel
Auditors
TDFPS Investigators
Etc.
CASE SENARIO
Two staff standing in doorway of office talking
about consumer.
You are in your office two doors away and clearly
hear them discussing how the new behavior
program is not going to work. You heard the
consumers name but do not know her.
You also overheard one of them say she got so
tired of her screaming last night that she blocked
her door when she went to her room so she
couldn’t get out for a while.
What are the problems in this
scenario?
The
2 staff should have been in the office with the
door closed.
Locking
the consumer in her room might be
considered Physical Abuse if she injured herself
trying to get out, had a seizure, etc.
Or
this action might be considered Seclusion.
CASE SCENARIO #2
A 32 year old male who is a consumer of HCMHDDC,
diagnosed with schizophrenia, comes to the clinic. He
appears as un-kempt, agitated, talking to himself, he is
making threating and paranoid statements. Reported to
have been off his meds more than a month and has been
actively hallucinating.
States he is going to kill his wife her because he believes
she is worshiping demons and is possessed by Satan.
States his plan is to wait until she is sleeping, then will set
her free. Consumer suddenly gets up and leaves the
clinic.
What action if any should be taken to protect the patient
and the wife?
CASE SCENARIO
The
staff should notify the authorities
Authorities
may notify wife to let her
know she may be in danger
EXCEPTIONS
When there is good reason to believe a
specific individual(s) is placed in serious
danger depending on the information at
hand.
i.e. when a patient shares a specific plan to
harm a particular individual (homicidal
ideation)
Tarasoff
Under ethical standards tracing back to the Roman Hippocratic Oath, doctors and mental health
professionals usually must maintain the confidentiality of information disclosed to them by patients in the
course of the doctor-patient relationship. With some exceptions codified in state and federal law, health
professionals can be legally liable for breaching confidentiality. One exception springs from an effort to
protect potential victims from a patient’s violent behavior. California courts imposed a legal duty on
psychotherapists to warn third parties of patients’ threats to their safety in 1976 in Tarasoff v. The Regents of
the University of California. This case triggered passage of “duty to warn” or “duty to protect” laws in almost
every state as summarized in the map and, in more detail, in the chart below.
Tarasoff in Texas
Texas
Tex. [Health
and Safety]
Code Ann.
§611.004
Yes Permissive
Mental Health
Professionals
Sept. 1,
2005
A mental health
professional may
disclose information only
to medical or law
enforcement personnel if
the professional
determines that there is
a probability of imminent
physical injury by the
patient to the patient or
others or there is a
probability of immediate
mental or emotional
injury to the patient.
FORMER EMPLOYEE
STOPS BY TO VISIT
A former employee stops by to visit the
staff and consumers.
Former employees have no business in our
offices or consumer areas. They are to be
asked to leave the building.
They are no longer bound by HCMHDDC
Policies & Procedures
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INFORMATION TO FAMILY
MEMBERS
Never assume a family member automatically
has a right to patient personal information.
 Check for a signed consent before giving out the
information
 If there is not one, ask the patient if they would
like to sign one. If the family member becomes
angry, refer them to your supervisor or:

Wm. A. Olden, R.P.O.
830.258.5441
MAINTAINING
CONFIDENTIALITY
Keep all records secure in locked files
 Never leave documents with patient
information exposed on your desk, car,
etc.
 If you use a computer, make sure screen
is facing away from the door where
others can see it
 Shred all unwanted files
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BREACH OF
CONFIDENTIALITY
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If you hear or know about a breach of
confidentiality by a co-worker, you should:
Talk with your co-worker about revealing
patient information.
Report the incident to the R.P.O.
Confidentiality violations threaten the integrity
of the patient-staff relationship as well as
HCMHDDC. You should always take this
seriously.
You can and may be sued and fined for
violations
REVIEW
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What should you do if you hear about a violation of
patient rights?
Who should you report it to?
How long do you have to report?
If a patient wants to make a complaint, what should
you do?
A former employee stops by to visit consumers. What
should you tell them?
If you overhear a breach of confidentiality, who do you
report to?
How should your computer screen be set up?
How do we maintain patient records for safety &
confidentiality?