All clients should be screened for abuse. Facilities must have procedures for identifying, reporting and treating victims of abuse. Clients have the right to expect access to protective services in the case of abuse.
|Agency Regulation (CMS, 2018)||Ongoing Required Training|
|CMS 482.13(c)(3)||The hospital, during its orientation program, and through an ongoing training program, provides ALL employees with information regarding abuse and neglect, and related reporting requirements, including prevention, intervention, and detection.|
Abuse can take many forms. It may include emotional abuse, economic abuse, sexual abuse, threats, using the threat of removing children, using privilege, intimidation, isolation, and other behaviors used to maintain fear, intimidation, and power. There are many theories as to why some people are abusers. However, the reason abusers use this behavior is that violence is an effective method for gaining and keeping control over another person.
Sexual abuse is an unwanted sexual activity with perpetrators using force, making threats or taking advantage of victims not able to give consent. Most victims and perpetrators know each other. Immediate reactions to sexual abuse include shock, fear or disbelief. Long-term symptoms include anxiety, fear or post-traumatic stress disorder. While efforts to treat sex offenders remain unpromising, psychological interventions for survivors, especially group therapy, appear effective.
Psychological abuse occurs when a person tries to control information available to another person with the intent to manipulate that person’s sense of reality or their view of what is acceptable and unacceptable. Psychological abuse often contains strong emotionally manipulative content and threats designed to force the victim to comply with the abuser’s wishes and can include constant verbal abuse, harassment, excessive possessiveness, isolating the person from friends and family, deprivation of physical and economic resources, and destruction of personal property.
Physical abuse is physical force or violence that results in bodily injury, pain, or impairment. It includes assault, battery, and inappropriate restraint. It often begins with what is excused as trivial contact that escalates into more frequent and serious attacks.
Child abuse and neglect are at a minimum, any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; and an act or failure to act which presents an imminent risk of serious harm. Physical abuse is the use of physical force that may result in bodily injury, physical pain, or impairment. Physical abuse may include acts of violence like striking, hitting, beating, pushing, shoving, shaking, slapping, kicking, pinching, and burning. This abuse may not have been intended to hurt the child, but an injury may have resulted from over-discipline or physical punishment. Neglect is the failure to provide for the child’s basic needs.
Child abuse or neglect is defined by the child welfare branch of the U.S. Department of Health and Human Services (DHHS) as:
- Any recent act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation; or
- An act or failure to act which presents an imminent risk of serious harm.
Mandatory Reporters of Child Abuse and Neglect
|Agency Regulation (Findlaw, 2018)||Ongoing Required Training|
|Public Health and Welfare U.S. Code|
Title 42 U.S.C. § 5106a(b)(2)(B)(i)
|Training to be provided under the grant (in order to receive federal grant monies) to support direct line and supervisory personnel in report taking, screening, assessment, decision making, and referral for investigating suspected instances of child abuse and neglect.|
|The Federal Child Abuse Prevention and Treatment Act (CAPTA) requires each State to have provisions or procedures for requiring reports of known or suspected instances of child abuse and neglect.|
To find statute information for a particular State or Territory, go here.
Any suspicion of abuse involving minors requires consideration of cultural values and standards of care as well as recognition that the failure to provide the necessities of life may be related to poverty.
Elder abuse can take many forms. It also may include physical, emotional, psychological, sexual abuse, neglect, abandonment, or financial and material exploitation. With the frail elderly, neglect is a major problem. Neglect is the refusal or failure to fulfill any part of a person's obligations or duties to an elderly person. Most laws concerning elder abuse are state laws and can be found in a variety of state legal codes such as criminal, probate, welfare, business, and professional codes. Please be aware of your own states’ regulations and guidelines.
Many victims of abuse are seen in healthcare settings. Healthcare professionals often fail to identify victims because there is a lack of training on what to look for and how to ask about abuse. Opportunities for intervention are missed, and victims continue to suffer the adverse health consequences of physical and emotional abuse. For example, physically battered victims seek assistance in healthcare settings, often repeatedly.
Staff should question whether abuse might have occurred if a client’s explanation of the injury does not match the actual injury. For example, a child’s x-rays may show an unexplained broken bone.
Screening for abuse must be done. The healthcare professional should document abuse in the medical record; safeguard evidence; provide medical advice, referrals, and safety planning; and show empathy with compassion. Each facility must maintain a list of private and public community agencies that provide help for abuse victims. Staff should make appropriate referrals for victims.
Screening questions should always be asked in a private room, away from the suspected batterer, and preceded by assurances of all the confidentiality allowed by law. Healthcare professionals should find ways to separate the client from the possible abuser if the abuser demands to accompany the potential abuse victim into the examining room.