Zero Tolerance Initiative > Prevention and Safety Planning

Methods for preventing abuse, neglect, and exploitation can be into two separate groups: primary prevention and secondary prevention.

Primary prevention includes those activities, services and supports designed to prevent abuse, neglect, and exploitation of persons with developmental disabilities before those instances can occur.

Examples of primary prevention include:

• Providing education and self-protection information directly to consumers so they can be made aware of what behaviors on the part of their caregivers constitute abuse, neglect, or exploitation, how to avoid becoming victimized, and who they can talk to if they have concerns or questions about the actions of their caregivers.
• Education of direct care staff members on the sexual misconduct law (which makes sexual activity between a consumer and their service provider a crime).
• Background screening/reference checks of prospective caregivers (before they begin working with consumers on an unsupervised basis).
• Unannounced visits at different times of day for the purposes of monitoring caregiver behaviors and activities.
• Growing of social circles so that the person with the developmental disability is not alone on a frequent and regular basis.

Secondary prevention includes those activities, services and supports for those individuals who have already been abused, neglected and exploited. These efforts are designed to identify and end ongoing abuse, neglect, and exploitation.

Examples of secondary prevention include:

• Education of direct care staff in recognizing and reporting the signs and symptoms of abuse, neglect, and exploitation.
• Full cooperation with police and DCF investigators to help ensure the arrest, prosecution and successful conviction of perpetrators.
• Modification of augmentative communication devices (used by persons with developmental disabilities who are unable to speak) so that abuse, neglect, and exploitation can be easily and quickly reported.
• Expansion of social circles so that more individuals would be involved in the person's life and would therefore be able to identify and report suspected cases of abuse, neglect, and exploitation.

Areas that people with disabilities often lack knowledge and skills include:

• Where to get help
• How to make health decisions about sexual activities and intimate relationships
• Personal safety skills and ways to decrease their risk for abuse
• Assertiveness skills
• Effective communication skills
• Problem-solving skills

Conducting training sessions on personal safety is one way to help empower people with disabilities to prevent abuse and be in greater control over their lives. Violence and abuse prevention training areas which are recommended for people with disabilities include:

• Personal safety
• Individual rights
• Assertiveness
• Effective communication
• Social Skills
• Sex Education
• Interpersonal and intimate relationships
• Hiring and managing care providers¹

Screening Potential Employees

You hope there will be more candidates for the work/job(s) you are offering than you need. This will give you the opportunity to choose the best person(s) to meet your needs. Screen the candidates carefully before you make any employment offer, starting with a telephone screening, and then proceeding to a face to face interview.

Telephone Screening
If you get lots of responses, you may want to consider doing a short interview on the telephone (telephone screening) to narrow down the number of people you interview in person. If you decide to do a telephone screening, start the conversation with a brief description of the job. It is not a good idea to let a potential employee tell you how much they want to be paid.

You may want to write a few things down ahead of time so you do not forget to mention something important during the conversation.

You may also want to make a list of questions you will ask the people you interview during the phone call. As a rule, your list should include no more than ten questions.

If you are able to do so, make notes as the person answers the questions you ask. Remember, this is a time for you to learn things about the potential employee so you can narrow down the number of people you interview in person. By the time you have talked to several people, it is easy to confuse them in your mind, so write down or record your initial impressions of the candidate as soon as you hang up from the call.

Be sure to mention the pay rate to the person. Do not share personal information about yourself during the telephone screening. If the applicant asks questions, only answer job related questions. You may also want to make a list of questions you did not ask on the call but would like to ask later. Make a note of these and be sure to ask them at the next interview. You will not have a face-to-face interview with everyone who applies.

Face to Face Interview
The next step is to review your notes and call the people you want to interview face to face. You may want to ask them to bring to the interview:

• Their resumes,
• Two employment references and two personal references,
• Their identification cards (with picture), and
• Their Social Security cards (not just the number).

If driving is a requirement of the job, ask them to bring their driver's license and proof of a clean driving record (available from the Office of Motor Vehicles). Make sure you have their full name and phone number in case you need to change the date or time of the interview.

Be Safe During Interview

The two safest ways to interview someone you do not know well are:

1. Have one of your friends or family members present for the interview if you choose to have it in your home.
2. Have the interview at a public place (library, senior center, Center for Independent Living, coffee shop, restaurant, etc.)

If you decide to meet at a coffee shop or restaurant, be clear about whether you are meeting for a beverage or a meal and who is paying so that there are no misunderstandings.

Be Well Prepared

When the potential employee arrives, introduce yourself and do what you can to make him/her feel comfortable.

You will need certain information about the potential employees you will be interviewing; name, Social Security number, driver's license number, current address, work history, references, etc.

Going over the job description with the potential employee carefully will prevent any misunderstanding concerning the duties of the job. Be prepared to ask questions.

At the end of the interview, check the information they have given you to ensure that you have enough information to make your decision. Tell them you will get back to them with decision.

Suggested Interview Questions You Could Ask Potential Employees
(Select the questions that are most important for you)

1. Tell me a little bit about yourself. Follow up with, "Tell me more about that."
2. If I contacted your previous supervisor and asked them what were your strengths and weaknesses are, what would your supervisor say?
3. If interviewing an Agency/Vendor, ask who will actually be doing the work for that Agency/Vendor.
4. What training related to the job duties have you had and when?
5. What experience have you had in working with people with developmental disabilities and when? What did you learn from that?
6. If you suspected an issue of abuse, neglect or exploitation of a participant, what would you do?
7. When you have questions about caring for a person with a developmental disability, who do you call?
8. How did you get interested in this field of work?
9. What other jobs have you had? What did you like/dislike about the job(s)? Would you go back?
10. Are you currently working; Part Time/Full Time? If not, why did you leave?
11. Have you ever been fired from a job, if so, why?
12. In your opinion, what is the most difficult part about working with people with developmental disabilities?
13. How would you handle the following situations regarding the person you are providing services to?
• Non-compliance with directions
• Refusal to eat
• Refusal to toilet
• Refusal to take medication
• Refusal to get on transportation vehicles
• Refusal to attend day program
• Refusal to go to work
• Anger, sadness, grief
14. 14. If a person is non-verbal, what are some indications of that person being in pain?
15. What do you do if the person you are caring for has a seizure?
16. What do you expect of a participant or a participant's family?
17. What are some ways to demonstrate respect for a person's privacy?
18. Why should I hire you over other qualified candidates?
19. At times, you may encounter problems in performing your job. Give an example of problems you have experienced at work (or in your personal life) and how you overcame them.
20. Attendance and punctuality are important for this position. Tell me how you will ensure that you will be at work, on time, each day.
21. How do you handle stress? Give me examples of how you have handled stress.

Evaluating Potential Employees

Evaluating each potential employee you interview will be helpful to you in making your hiring decision. The best time to evaluate a potential employee is shortly after the interview while the information is still fresh in your mind.

Reference Checks

It is highly recommended that you call at least two references for each potential worker. Make sure at least one is a work reference. The second could be a work or personal reference.

Explain to the person (reference) that you are a potential employer of the person you want to hire (use their name). You do not have to tell the reference your name. Ask questions about the potential employee that will help you decide about hiring.

Think about the questions you want to ask before you call. It is a good idea to write the questions down so you do not forget to ask something important.

From the very beginning, it is important to establish expectations and personal boundaries with the care providers you hire. For example, issues that should be discussed prior to allowing them to render services include:

• Sharing personal information about you with others: Discuss the information about you that you expect to be kept confidential (such as your address, telephone number, medical information, financial information, etc.)
• Use of your personal property: Decide if and what personal property may be used by your care provider. Your care provider should always ask your permission to use your personal property.
• Use of phone for personal calls while working: Discuss the use of your telephone for receiving and making calls.
• Policy on smoking: Address whether, where, and when it is acceptable to smoke.
• Use of your car: Discuss use of your car for work-related travel. Think about insurance coverage and liability if using your car. You should make sure the person has a good driving record.
• Use of your home during work breaks: Discuss where your care provider can take work breaks (e.g., inside and outside of your home, specifc rooms in your home, off the premises). Discuss the use of your refrigerator to to store food/beverages, and the stove/microwave to prepare meals. Discuss the use of your television, radio, computer, or other such devices during work breaks. Discuss the appropriateness of taking a nap.

Establishing rules and maintaining boundaries can be challenging with a care provider who lives with you, is a close family member or friend, or has worked with you for a number of years. Nevertheless, it is important that your care provider respects your wishes for your privacy, and your belongings, and how you prefer to be cared for.²

Additional tips for managing care provider relationships:

• Do not share personal information that is not needed for care providers to perfom their job (such as family history; disagreements with partners, family, or friends; finances; health or medical issues).
• If you are able to afford a home monitoring system of some kind, have it installed before hiring a care provider.
• Have caller ID installed on your telephone to track incoming telephone calls.
• Do not allow a care provider to rearrange your home (unless for a good reason and then only with your permission). This can be a sign that the care provider is tyring to assume control of the household.
• Always stay in charge; never put one care provider in charge of other care providers.
• Have friends and family make unexpected visits to your home.
• Never give or lend money to a care provider.³

Awareness of the names, faces, and addresses of convicted felons living nearby should be a key element of every safety and abuse prevention plan.

When you visit the website http://www.familywatchdog.us/ you can enter your home address and a map will pop up with your address appearing as a small icon of a house. There will be red, blue and green dots surrounding your entire neighborhood. When you click on any one of those dots, a picture of a criminal will appear with his or her home address and the description of the crime he or she has committed. This website was developed by John Walsh of the television show "America's Most Wanted" and serves as another tool we can all use to help prevent crimes against persons with developmental disabilities.

To prevent abuse of people with developmental disabilities in licensed residential facilities, adult day training programs, and other service delivery settings, administrators must strive to enhance job satisfaction and create positive work environments for staff. Good communication and teamwork are essential to cultivate employees' positive attitudes toward their jobs. Recognition that clients are consumers of their services also helps keep people with developmental disabilities safe. Employee counseling and staff support programs need to be in place when problems do occur.

Supervisory leadership

• Models and rewards good caregiving
• Models good communication and teamwork within the facility
• Models and cultivates positive attitudes about people with developmental disabilities
• Promotes a work culture of zero tolerance for abuse, neglect, and exploitation
• Encourages a team approach to dealing with behavior management

Management practices/attitudes

• Supervisors provide good role models
• Adequate and well-prepared staff
• Realistic expectations of staff responsibilities
• Recognition that clients are service consumers
• Administrative efforts to enhance job satisfaction for staff members who provide direct services, such as incentives and rewards for good caregiving
• Employee counseling and staff support programs available Policies and procedures
• Emphasis on inclusion versus segregation and isolation of clients
• Required criminal records and background checks for all staff, as part of a thorough pre-employment screening
• Clear abuse/neglect policies and procedures, including:
• Required reporting of all incidents of suspected abuse and neglect within the facility
• Consistent enforcement of reporting policies
• Protection for staff and clients who report
• Sanctions for those who do not report observed or suspected abuse, neglect, and exploitation
• Commitment to non-aversive behavior management strategies Ongoing staff training
• Inservice training and written information available to all staff about the particular developmental disabilities of the clients they serve and the behaviors that are typical for persons with these disabilities
• Positive Behavior Support training for dealing with challenging behaviors
• Training in non-violent strategies for managing crisis situations
• Support services for dealing with work-related stress

Keeping doors locked is a practical way to prevent sexual abuse. Here are some more tips for staying safe from sexual abuse that may be shared with people with developmental disabilities and their caregivers.

Recognize that you have rights

One of the most important things you can do to protect yourself is to know that you have rights.

• You have the right to decide who will touch your body, and how and when you will be touched.
• You have the right to sex education and information that will help you to understand healthy sexual activities and relationships.
• You have a right to be respected and to make decisions about your own sexual activities.
• You have a right to have safe relationships and to not be abused.

Discriminate between good touch, bad touch, and uncomfortable touch

Know the difference between good touch (hugs, comfortable pats), and bad touch (hitting, slapping, hurting), and uncomfortable touch (touch in private parts that make you feel uncomfortable).

Know the difference between good secrets and bad secrets

There is a difference between good secrets (memories of fun times between friends), and bad secrets (when someone doesn't want you to tell anyone what he or she did to you).

Trust your instincts

If something feels dangerous or intrusive to you, you have a right to say "No," and to protect yourself from harm.

Just say "No!"

Even someone you know can try to sexually abuse you. Remember that you have the right to say "no" to any unwanted touch, even from a boyfriend or girlfriend, caregiver, attendant, family member, healthcare professional or other trusted person in your life.

Tell Them to Stop, and Tell Someone

If someone touches you in a sexual way, and you do not want them to, tell that person to stop. Then be sure that you tell someone what happened. You can tell a counselor, staff person, your parents, your doctor, or someone else you trust.

Talk to Someone You Trust

If you think someone has sexually abused you, talk to someone you trust. It can help to get a second opinion of the situation and how to handle it. There may be a local sexual assault hotline in your community that you can call for support, counseling, or other referral.

Call 911

Remember to call the police (911) if you think that someone is trying to get into your home. Even if you are not sure what is happening, it is best to call the police. Also, notify police immediately if you have been physically harmed or sexually abused.

"One way to prevent abuse is to define, teach, and talk about healthy and unhealthy interaction in relationships – particularly intimate relationships. It is not enough to ask someone, "Have you been abused?" or "Are you being abused?" As you already know, people might not think they were or are being abused. It is important to teach and talk about very specific behaviors or actions that are abusive. However it is not enough to only talk about ways that people should not be treated. We also need to talk about the characteristics of relationships that are based on equality and the behaviors that reflect healthy, mutually respectful interpersonal and intimate relationships."⁴

Research indicates that the single most important way to prevent sexual abuse is through education and self-protection training for consumers.

Unfortunately, society has traditionally viewed individuals with developmental disabilities as asexual, "eternal children" and there has not been a great effort to provide any type of sexuality information to these individuals.

By not acknowledging or understanding these individuals' need for knowledge and appropriate sexual expression, society is responsible for creating a culture of ideal victims. By ignoring this issue, we may also be contributing to creating even more perpetrators of these crimes as many people with developmental disabilities (who have not been taught otherwise) may seek to express themselves sexually in inappropriate and, sometimes, illegal ways.

Some caregivers feel uncomfortable talking to persons with developmental disabilities about sexual activities. Keep in mind that many people may feel uncomfortable talking about this subject. This is understandable and expected. You most likely will feel more comfortable once you get started. Use of printed materials appropriate to the person's cognitive level will help.

Here are some tips to make the discussion easier.

1. Recognize the person's need to know.
   Don't assume that the person does not need to know about sexuality just because of her or his disability. We all need accurate information about our bodies to feel good about ourselves, to protect ourselves, and to take care of our bodies appropriately.
2. Set boundaries.
   Don't permit a child with a developmental disability to engage in inappropriate sexual behavior. This kind of behavior won't be tolerated by others as the child grows up, and it is easiest to discourage it while the child is still young. The same rules should apply to a child with a disability as to other children. For example, a child should not get away with inappropriately touching your body just because he has mental retardation. It is appropriate to set boundaries for a child's sexual behavior, as long as you do so in a way that is clear, open, and does not make her or him feel guilty for being sexual.
3. Identify appropriate behavior in public and private.
   Be very clear about what can be done in private (such as masturbation), and what can be done in public (such as hugging). This concept often presents problems for people with cognitive disabilities, and can put them at risk for socially unacceptable behavior.
4. Teach children protective behaviors.
   For example, teach men to use a urinal properly. Do not teach men to drop their pants at the urinal. While this may be easier to teach and more convenient for them and their caregivers to manage when they are small, this behavior marks these men as easy targets for sexual predators. (O'Neill, 2003)
5. Use appropriate names for genitals.
   Use appropriate names for genitalia to "demystify" these body parts. (Graham, 2000) This helps to clarify perceptions of the body and its functions, and thereby opens the lines of communication. Let persons with developmental disabilities talk about their "private areas" and tell them about the issues and boundaries of privacy.
6. Seek help when you need it.
   There are a number of books, videos, and other sources of information which can help in the development of a safety plan against sexual abuse.⁵

If you feel you need assistance or information, contact your local APD office for additional resources or ideas.

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