Module 4- Recognizing, Reporting and Preventing Abuse and Neglect

  1. Did you know?
  2. Office of Inspector General (OIG)
    1. Required Reporter
    2. Reporting allegations
    3. Screening
    4. Employee
    5. What is Physical Abuse?
    6. What is Sexual Abuse?
      1. Sexual Contact
    7. What is Mental Abuse?
    8. What is Financial Exploitation?
    9. What is Neglect?
    10. Reporting to Law Enforcement
    11. False Reporting of Abuse and Neglect
  3. What happens after an allegation is made to OIG?
    1. Unfounded
    2. Unsubstantiated
    3. Substantiated
      1. Preponderance of evidence
      2. Credible evidence
  4. Substantiated Findings and the Health Care Worker's Registry
  5. Prevention
    1. What can you do to help prevent incidents of abuse or neglect?
    2. Self-Protection
    3. Staff Training
      1. Abuse and Neglect Training:
      2. DHS Required Abuse and Neglect Training
    4. Staff Attitude
      1. Managing Through Leadership and Coaching.
      2. Teamwork
    5. Stress and Burnout
      1. What are the warning signs of stress?
      2. What Can Be Done to Reduce Stress?
      3. Practice what your preach!
      4. What are the symptoms of burnout?

Did you know?

According to a report from the National Center of Criminal Justice and Disability (NCCJD) and The Arc in 2014 (the most current year of data available) there were an estimated 1.3 million violent crimes occurred against people with ID/D. Individuals with cognitive disabilities had a higher rate of nonfatal violent crime victimization than the rates for people with all other types of disabilities. The rate of sexual assaults of people with disabilities are nearly four times the rate of people without the disabilities. The rate of youth with ID/D who are victimized is nearly 3 times higher than the rate of youth without a disability.

These types of facts are overwhelming but there is something you can do to keep the people you will be supporting safe. First and foremost, pay close attention to the individuals in your care. Many individuals will not be able to verbally communicate what is wrong, but they will give other clues. Secondly, talk with other staff, talk with other individuals to find out how the day has gone, ask questions and be aware of what is happening. If you suspect abuse or observe anything, you must immediately ensure everyone's health and safety and report anything that seems wrong to the appropriate person in your agency or to OIG directly. After you report the allegation or concern, you must document it! You are a required reporter. Every employee is required to report all allegations of abuse or neglect they become aware of, witness, suspect or are informed occurred.

We know that most incidents of abuse are underreported, whether it involves a person with a disability or someone in the general population. Often, when reports are made concerning people with intellectual disabilities there are questions about the credibility of the person making the allegation. As you will learn in this training, the credibility of the person does not negate your legal obligation to report allegations of abuse. You must report all allegations in accordance with your agency or facility's reporting policies and procedures.

As Residential Directors, preventing abuse and neglect will be a large part of your day to day job duties. Recognizing and following the appropriate steps to reporting any allegation is vital to ensuring you're providing a safe environment. As you supervise DSPs and other agency staff, you will play an important role in setting the tone and expectation for your agency. This must include creating and environment that is free from abuse and neglect. 

Office of Inspector General (OIG)

The Office of Inspector General (OIG) for the Department of Human Services works to protect people with intellectual and developmental disabilities from abuse and neglect. OIG investigates allegations of abuse, neglect, or exploitation of individuals receiving services from mental health facilities, developmental disabilities facilities, and community agencies operated, licensed, funded or certified by DHS (but not licensed, funded or certified by any other state agency). OIG investigates any assertion, complaint, suspicion or incident of abuse, neglect and exploitation involving conduct by an employee/volunteer, facility, or agency against an individual(s).

All DHS and community agency employees are required by Rule 50 to report allegations to the Office of Inspector General (OIG). It is important to know and understand that the mission of the OIG is to assist agencies and facilities, such as your place of work, in prevention efforts by investigating all reports of abuse, neglect and exploitation in a timely manner. OIG will help to make sure people who are being supported are free and safe from abuse and neglect. The best way to prevent abuse or neglect is to educate yourself, your employees and the people you support on what is considered abuse and neglect, so you can recognize when it happens.

Required Reporter

Any employee who suspects (meaning you have a suspicion based on information or observation), witnesses (meaning you saw or heard it), or is informed of (meaning you were told about it) an allegation of abuse or neglect is considered a required reporter. You must report any alleged abuse or neglect that you see, hear, read, or suspect. You do not need to believe an allegation is true to report it. Even outlandish and far-fetched allegations - those that cannot be true - must be reported. All allegations must be reported to OIG within four hours. The four-hour timeline is serious because it's four hours of real time. You must cooperate fully with every OIG investigation. Failure to do so can result in being disciplined or discharged. As a supervisor, it will be your responsibility to ensure that all your employees understand the expectations and requirements related to reporting allegations of abuse or neglect. An allegation is any assertion, complaint or suspicion you may have that abuse or neglect of an individual may have occurred. You do not have to prove the allegation or even believe it is true to report it.

You must report directly to OIG or your agency representative all incidents or allegations of abuse, neglect, exploitation or death. Your responsibility to report does not end with simply notifying your supervisor. You are responsible for ensuring that OIG is directly notified. Some agencies will report the allegation, but you should always ask for confirmation that the allegation was reported to OIG within the required time frame.

There should be information in your agency's policies that would protect you from any harm or negative consequences for making a report if you act in good faith by reporting anything you hear, read, see or suspect. Most agencies policies include specific instructions that support you in fulfilling the responsibilities that are outlined in the policies. It can be very difficult to report things that happen when it comes to abuse, neglect and exploitation especially when the co-worker/employee you are reporting about is someone you value, respect or depend on for daily operations. However, the protection of the people you support and being a required reporter are your top priorities.

Reporting allegations

Since June 13, 2006, intentionally reporting an allegation late-or not reporting it at all-is a Class A misdemeanor. If you are convicted, it is punishable by: up to one year in jail and/or a $2,500 fine.

OIG must be contacted within 4 hours for:

  • Any allegation of abuse
  • Any allegation of neglect
  • Any allegation of exploitation
  • Any injury or death of an individual that occurs within a facility or community agency when abuse or neglect may be suspected.

To ensure an investigation, someone must call...

For adult CILAs- OIG's Abuse and Neglect Hotline at 1-800-368-1463.

For ICF/DD-Call the Department of Public Health:1-800-252-4343.

For children- Contact DCFS hotline 1-800-25-ABUSE.

The Adult Protective Services Act supersedes OIG Rule 51 for reports of abuse, neglect and financial exploitation for adults living in a domestic living situation:

  • Adults 18-59 with a disability who live in a domestic living situation.
  • Adults age 60+ who live in a domestic living situation
  • "Domestic living situation means a residence where the adult with disabilities lives alone or with his or her family or a caregiver, or others, or other community based unlicensed facility.
  • "Caregiver" includes Personal Support workers (PSWs) hired by a family.

The Hotline for reporting incidents of abuse, neglect and financial exploitation for the above individuals is: 1-866-800-1409


Screening means intentionally not reporting an allegation or omitting or changing any information in the allegation. Your supervisor is not allowed to screen. If the policy says you are to report allegations to your supervisor, you should do so. However, if your supervisor fails to report it to OIG, you are still responsible to report it. You are still a Required Reporter. Allegations are never assumed true or false. If you hear of an allegation from an individual who frequently lies, you are still required to report it. Allegations have no statute of limitations. If you hear of an allegation that may have occurred ten or twenty years ago, you are still required to report it.


Employee is any person who provides services at the facility or agency on-site or off-site. The service relationship can be with the individual or with the facility or agency. Also, employee includes any employee or contractual agent of the community agency involved in providing, monitoring or administering mental health or developmental services. This includes, but is not limited to owners, operators, payroll personnel, contractors, subcontractors, and volunteers.

Remember, for reporting purposes...

  • You are an "employee" 24 hours a day, seven days a week.
  • Volunteers and contractors are employees.
  • Employees are accountable if they commit abuse or neglect on their personal time.
  • An employee who quits or is fired will still be investigated by OIG for abuse or neglect allegedly committed while an employee.

What is Physical Abuse?

Physical Abuse is defined as an employee's non-accidental and inappropriate contact with an individual that causes bodily harm. Physical abuse includes action that causes bodily harm as a result of an employee directing an individual or person to physically abuse another individual. Bodily harm is defined as any injury, damage, or impairment to an individual's physical condition, or making physical contact of an insulting or provoking nature with an individual. Insulting or provoking is defined as contact that offends a reasonable sense of personal dignity. Non-accidental is defined as occurring with volition (power of choosing) or consciousness; not occurring by chance

To be reportable, the contact must have been caused by a non-accidental and inappropriate means.

Note: Bodily harm is not always visible. For instance, bodily harm could be a slap that doesn't leave a visible injury or a kick that does leave a visible injury. They are both wrong AND must be reported to OIG.

Some examples of physical abuse include (but are not limited to)

  • pushing, hitting, slapping, kicking an individual
  • pulling an individual's hair, finger pointing to chest (making contact), prodding with an object, twisting an ear or arm, squeezing an individual's finger, arm or neck
  • snapping an individual with a towel, shooting or snapping a rubber band, throwing an object
  • man handling, roughing up, stepping or stomping on an individual's foot, etc.

What is Sexual Abuse?

Sexual Abuse is any sexual behavior, sexual contact or intimate physical contact between an employee and an individual, including an employee's coercion or encouragement of an individual to engage in sexual behavior that results in sexual contact, intimate physical contact, sexual behavior or intimate physical behavior.

Sexual abuse also includes an employee's actions that result in the sending or showing of sexually explicit images to an individual via computer, cellular phone, electronic mail, portable electronic device or other media with or without contact with the individual; or an employee's posting of sexually explicit images of an individual online or elsewhere weather or not there is contact with the individual.

Sexual abuse does not include allowing individuals to, of their volition, view movies or images of a sexual nature, or read text containing sexual content unless the individual's guardian prohibits the viewing of such movies or images or reading of such material.

Sexually explicit images include, but is not limited to, any material which depicts nudity, sexual conduct, or sado-masochistic abuse, or which contains explicit and detailed verbal descriptions or narrative accounts of sexual excitement, sexual conduct, or sado-masochistic abuse.

This does not include those images contained in sex education materials used by employees to educate individuals.

Simple personal hygiene, such as bathing or toileting, is not inappropriate sexual contact. There is no such thing as consensual sexual activity between an employee and an individual. Any sexual activity between an employee and an individual is reportable to OIG.

Sexual Contact

Sexual contact is inappropriate sexual contact between an employee and individual involving either an employee's genital area, anus, buttocks or breasts(s) or an individual's genital area, anus, buttocks or breasts(s). There should be absolutely NO CONTACT of private parts with an employee and the individual(s) he/she supports. Sexual contact also includes sexual contact between individuals that is coerced or encouraged by an employee. Sexual abuse does not just mean sexual contact. It also includes an employee's encouragement of an individual to engage in sexual behavior that results in sexual contact, intimate physical contact, intimate physical behavior or sexual behavior.

Simple personal hygiene, such as bathing or toileting, is not inappropriate sexual contact. There is no such thing as consensual sexual activity between an employee and an individual. Any sexual activity between an employee and an individual is reportable to OIG.

Examples of Sexual Abuse

  • Pressuring an individual to have sex with another individual.
  • Encouraging the individual to masturbate in front of others.
  • Taking nude photographs of an individual.
  • Showing pornography to individuals you support.

Sexual abuse/contact/misconduct with a person with a disability is considered a Class 3 felony. The victim's consent is not a defense. In addition to the prison time and fine that can imposed should an employee be found guilty, there is a mandatory registration as a sex offender with supervision, immediate loss of job, and listing on the Health Care Worker Registry which will prohibit the employee from working in any state-operated facility, community agency, or program site funded by the state.

What is Mental Abuse?

Mental Abuse is the use of demeaning, intimidating, or threatening words, signs, gestures, or other actions by an employee, about an individual and in the presence of an individual or individuals, that results in emotional distress or maladaptive behavior, or could have resulted in emotional distress or maladaptive behavior, for any individual present.

Mental abuse is still mental abuse even if the individual's mental or physical condition keeps him/her from getting upset. Mental abuse is verbal or nonverbal and includes not intervening when an individual faces an upsetting situation. Mental abuse is not always face-to-face with that individual, but at least one individual must be present at the time.

Examples of Mental Abuse

  • Cursing at an individual. A curse that is not derogatory of the individual is still reportable if the individual becomes upset by it, so it's best not to curse at all near individuals.
  • Joking about or making fun of an individual's condition or diagnosis. For example: Making a derogatory comment about an individual with profound intellectual disabilities or a hearing impairment, who doesn't react. Remember, if someone does something harmful, you must report it regardless whether the individual appears to get upset by it or not.

When individuals are mentally abused, people who are doing the abuse make either intentional or unintentional threats. An intentional threat is one that a person is fully aware of along with the potential consequences (good or bad) that may come from the threat. An unintentional threat is a threat that a person may not even realizes he/she is a threat because he/she may not have any intention of it coming off as a threat. This is because the words and gestures being used are meant to be jokes, but they can come off as threats.

What is Financial Exploitation?

Financial Exploitation is taking unjust advantage of an individual's assets, property, or financial resources through deception, intimidation, or coercion, for the employee's, facility's, or agency's own advantage or benefit. Individuals who engage in financial exploitation take advantage of a person's assets, financial resources or property in an unethical manner.

Examples of Financial Exploitation

  • Taking an individual's umbrella for the weekend because of a forecast for rain. You have benefitted from your personal use of an individual's property.
  • As the payee, an agency decides to divert all of an individual's Social Security funds from his account in order to pay the agency's rent.
  • Removing money from an individual's purse.
  • Taking money from the individual's trust fund.
  • Taking food that belongs to an individual.
  • Coercing an individual to trade you for something he or she has that you want

What is Neglect?

An employee's, agency's or facility's failure to provide adequate medical care, personal care, or maintenance, and that as a consequence, causes an individual pain, injury, or emotional distress, results in either an individual's maladaptive behavior or the deterioration of an individual's physical condition or mental condition, or places an individual's health or safety at substantial risk.

Example of Neglect

  • If a co-worker is assigned one-to-one (arm's length) supervision to prevent an individual from eating inappropriate objects, yet the co-worker leaves him alone, you should report your co-worker for neglect if the individual then:
    • Eats anything harmful;
    • Reasonably could have eaten anything harmful. It is important to understand that even if a person you support doesn't eat anything harmful, you still must report that the person could have eaten something harmful as a result of you not performing your duties. This includes if the person don't have a one on one assigned to them. As a Residential Director, you will be faced with staffing shortages however, not providing a one on one staff is reportable because it is reasonable to assume the individual could have ingested anything while they did not have the appropriate staff.
    • Became upset because he was left alone; or
    • Acts out and needs to be on one-to-one longer as a result.
  • Not using an assistive device to aid in safe ambulation
  • Failing to report a fall
  • Ignoring an individual's request for a drink because they have bothering you all shift with demands. The individual than begins to hit themselves and leaves the house un-supervised.

Reporting to Law Enforcement

Allegations of crimes should be reported to the most appropriate law enforcement agency, especially if an immediate response is critical. However, the allegation must still be reported to OIG within the time required if it involves a death or alleged abuse or neglect of an individual with disabilities.

By law and interagency agreement, OIG reports criminal allegations to the Illinois State Police or local law enforcement. OIG also may work with law enforcement agencies in investigating allegations of abuse or neglect of individuals with disabilities.

False Reporting of Abuse and Neglect

Reports made by individuals with a documented history of making false accusations must be taken seriously. You have little way of knowing if the individual is making a factual report or not. Individuals with a known history of making false reports are at increased risk because perpetrators know they are an easy target, and it is likely that the report will not be taken seriously. All incidents should be reported following the appropriate reporting guidelines. Thorough documentation will help safeguard staff in the event a false report is made against them. While it may be difficult, it is imperative that all allegations be taken seriously. Individuals with a personal history of making false allegations should have a Behavior Intervention Plan that outlines ways to prevent a false allegation, but once an allegation is made, it must be investigated.

Some employees may be tempted to not report an allegation, even allegations that could have happened, because it can upset others, cause additional work for the employee, or any number of other reasons. It is imperative that as a Residential Director, you are aware of misconceptions related to reporting and help facilitate your agency's policy in action. The individuals in your care are counting on you to help ensure their safety at all times.  This will include taking every allegation seriously and doing the extra work to keep them safe. There is no excuse for putting the individuals at risk for further abuse or neglect.

What happens after an allegation is made to OIG?

Once an allegation is made to OIG, the report will be thoroughly investigated over the course of the coming days, weeks and sometimes months. One important thing to note about any investigation that takes place is that all investigations shall be conducted in a manner that respects the dignity and human rights of all persons involved. This includes the dignity and rights as an employee, the dignity and rights of the people that work alongside you as your coworkers, and most importantly the dignity and rights of the people you have been hired to support. Once a report is made, OIG shall be granted access for the purpose of investigating abuse, neglect, or financial exploitation, to any agency or facility. OIG investigators may come to the agency or facility for a site visit that is announced or unannounced.

OIG investigators will want to gather all documentation to help them make an informed decision about what took place. OIG will be looking for any documentation that supports a possible indicator of maltreatment. OIG will pull all records from the victim of the allegation to investigate. The documentation will be an important part of that record. Please remember that you will likely not be responsible for conducting the investigation. Once the investigation is complete, OIG will determine that an allegation is unfounded, unsubstantiated, or that it is substantiated.

An allegation will be found to be…


There is no credible evidence to verify the substance of the allegation. Please keep in mind that just because something is unfounded doesn't mean that you should not have made the report. It is your responsibility as a DSP to make a report if you see, hear, or suspect anything that could be abuse or neglect.


There is credible evidence, but less than a preponderance of evidence to verify the substance of the allegation. It is important that you make sure you document and report all information necessary for the investigation.


There is a preponderance of the evidence to verify the substance of the allegation. When an allegation is substantiated, there will most certainly be consequences for the employee who is responsible for the crime. Remember, the employee can include anyone at the agency or facility who has direct or indirect interactions with the person being served by the agency or facility. In fact, it is also possible for the agency or facility as a whole to be responsible for the abuse or neglect.

Preponderance of evidence

There is a greater than 50% chance the claim is true.

Credible evidence

Any evidence related to the allegation or incident and is considered believable and reliable.

Substantiated Findings and the Health Care Worker's Registry

The Department of Public Health maintains a registry that, among other things, identifies health care workers that have had substantiated findings of abuse and neglect made against them. OIG is only one entity that reports names to the Health Care Worker Registry (formerly known as Nurse Aide Registry) for physical abuse, sexual abuse, financial exploitation or egregious neglect. OIG reports to the Health Care Worker Registry the names of employees who are substantiated to have committed physical abuse, sexual abuse, financial exploitation or egregious neglect, unless there is a pending grievance, or a petition filed under 20 ILCS 1305/1-17(s)(3). When abuse or neglect occurs, consequences for staff can result in something that impacts one employee as well as the entire agency/facility. Consequences range from the employee being fired, paying a fine, a jail sentence and being reported to the Health Care Worker's Registry. Referral to the Health Care Worker Registry applies to all employees. Substantiated findings of mental abuse and non-egregious neglect are not reported to the Health Care Worker Registry.

Perpetrators whose names are placed on the Health Care Workers Registry:

  • Are ineligible for employment in the field of human services in Illinois.
  • Are prohibited from being employed in providing, administering, or monitoring services.
  • After the name of a person is referred to the Health Care Worker Registry, he or she may request removal using the 20 ILCS 1305/1-17(s)(6) petition process no more than once per twelve-month period

Quick Reference for Physical, Sexual, Mental Abuse or Neglect Reporting:

If the individual is: And you suspect that the perpetrator of the abuse/neglect is: Then you should call/inform:
Under 18, living in a private home in the community A family member or caregiver

Your supervisor

DCFS HOTLINE 1.800.252.2873

Under 18 and enrolled in any of your agency's programs (non-ICF residential, day programs, etc. included) A staff member from your agency

Your supervisor

OIG HOTLINE 1.800.368.1463

Under 18 and enrolled in any of your agency's programs (non-ICF residential, days program, etc. included) A family member or caregiver

Your supervisor

DCFS HOTLINE 1.800.232.2873

Age 18 and over enrolled in any of your agency's programs (non-ICF residential, day programs, etc. included) A staff member from your agency

Your supervisor

OIG HOTLINE 1.800.368.1463

Age 18 and over enrolled in any of your agency's programs (non-ICF residential, day programs, etc. included) A family member or caregiver

Your supervisor

OIG HOTLINE 1.800.368.1463

Age 18 and over living in a setting funded, licensed, or certified by DHS, but not run by your agency (ex: individual attends your agency's day program, lives in CILA at another agency) A third-party staff member

Your supervisor

OIG HOTLINE 1.800.368.1463

Between 18 and 59 and living in a private home in the community A family member or caregiver

Your supervisor

OIG HOTLINE 1.800.368.1463

Age 18 and over living in a nursing home or facility (ICF included) run by your agency A staff member from your agency

Your supervisor

DPH HOTLINE 1.800.252.2893

Age 18 and over living in a nursing home or facility (ICF included) not run by your agency A third-party staff member

Your supervisor

DPH HOTLINE 1.800.252.2893

Age 60 and over NOT in a nursing home (living in private home in community) A family member or caregiver

Your supervisor

DOA HOTLINE 1.800.252.8966

  • IF THERE IS IMMEDIATE DANGER or A MEDICAL EMERGENCY, CALL 911 and then inform your supervisor.
  • In cases of financial exploitation, inappropriate staff conduct, inappropriate staff interactions, inform your supervisor.
  • DPH may also require reporting of serious injury. ALL client deaths should be reported to supervisor, and then to appropriate agency, regardless of whether abuse/neglect is suspected.
  • DHS OIG now accepts referrals of abuse/neglect allegations of the 18+ individuals with a disability still in school with an IEP. If they can investigate under Rule 51, they will. If not, they will refer it to the appropriate law enforcement agency.
  • In the Act, "Adult student with a disability" means an adult student, age 18 through 21, inclusive, with an Individual Education Program, other than a resident of a facility licensed by the Department of Children and Family Services in accordance with the Child Care Act of 1969


As a Residential Director, you will likely be tasked with the role of hiring DSPs and other support staff. The most important step in preventing abuse and neglect is ensuring that you are hiring the right kind of people. The next important  step is ensuring you are training your staff to know what is considered abuse and neglect and how to report allegations. In earlier modules, we learned how to conduct interviews to try to recognize people who may not be cut out for a caregiving role. When interviewing and hiring staff, pay attention to how the applicant talks about people with disabilities. If they are talking in an overtly demeaning tone or have a negative attitude it may be best to ask more questions before making a final determination. Applicants who appear during the interview to need to have a lot of control over situations likely would not be well suited for a caregiving role. While anyone can be an abuser, there are characteristics that are often found in someone who abuses others. It is important to recognize these traits in potential applicants to try to prevent bringing in people who may perpetuate abuse.

It is not enough for a human service agency to have a zero-tolerance policy outlawing abuse in their agency. We have those policies/statements now but abuse still occurs. It is not enough to provide training in individual rights and expect that rights will not be violated. We have that training now, however rights violations continue to occur. When organizations react to the negative influences that steal into their environment in a negative way, is it any wonder that employees react to the persons they are serving in a negative way? Words without action are useless. Often, the action of preference is disciplinary in natural against the staff. Yet, terminating the abusive employee has not eliminated abuse from our agencies either. What more can we do?

The answer is very simple but seems very hard to implement. An organization must actively participate in abuse prevention. Participation includes five basic components: the way we design and deliver services, the people we hire, the way we treat the people we hire, the way we create our organization (our values, relationships, communication, conflict resolution), and the way we respond to negative influences that will most certainly occur. The organization must have a clearly defined mission and akin to that, a means of continually assessing, evaluating, planning and delivering those services in a meaningful manner.

With that clearly outlined, we must recruit, select and retain persons who will work toward fulfilling that mission. Once we have those people on board, we must make them feel valued, treat them with respect as the integral and indispensable people they are. We owe it to them, and the people entrusted to our care that staff have a clearly defined professional identity and a recognized set of skills for which they are held accountable and for which they can be proud. Training, supervision, evaluation and organizational recognition for a job well done are all essential components of the human services agency's responsibility. Polarization (management vs. direct care staff, us vs. them mentality) cannot be allowed. Open communication will reduce the potential for rumor and innuendo while at the same time building trust and better grounds for conflict resolution. It is imperative that the organization be viewed inside and out as a cohesive group of people, with the same goals and outcomes in mind, namely those of providing excellent care. Finally, when negative influences do become apparent, the organization needs to respond in an active, meaningful manner. Stagnation, isolation, dishonesty, incivility and general deterioration cannot be allowed to seep in and destroy staff morale, or trust in the organization's administration.

*Poise Under Pressure; Organizational Dimensions of Abuse by Novelene Martin, Lori Wertz, Dewi Morgan-Jones, and Jean Morgan Abuse Prevention Specialists

What can you do to help prevent incidents of abuse or neglect?

The Residential Director is the leader for the department. You will be the voice of the mission, vision and values for the agency for your department. There are a number of things you can do to help support individuals and employees in creating a safe environment. In earlier modules and an earlier section to this module, we discussed the importance of finding quality staff to work for the individuals you are supporting. This continues to be one of the biggest things you can do to create a safe environment for the individuals. As a leader, physically going out into the homes or buildings you are supervising to interact with the individuals and the staff is important. Individuals should be able to reach you to discuss issues and problems they have with staff or in the home. As you are available and present in the environment, you will see the type of care being offered, and you will keep employees accountable for following the agency mission, vision and values every day. Agencies that have an open door policy with visitors, both friends and families of the individuals supported and advocacy agencies also help to hold employees accountable because they don't know when someone may be around. Employees who know that supervisors, and other people in positions of authority are routinely present and involved in the lives of the people supported are more likely to do the right thing when no is looking because they don't know when someone is looking. Supervisors who have regular contact and develop relationships with the individuals also are able to prevent situations that can lead to abuse or neglect. Supervisors are able to identify skill or knowledge gaps and correct problem behavior before it moves to abuse or neglect. Supervisors who have a positive, supportive relationship with employees tend to have more success with creating a trusting environment. Employees who know that supervisors are there to support them and be a resource, create a better working and living environment for everyone.


People with intellectual and developmental disabilities should learn some basic principles of self-protection to prevent incidents of abuse and neglect. As a Residential Director, you can help foster the development of self-protection skills for the individuals you are supporting. Any program of defensive strategies for people with intellectual disabilities should also acknowledge that they may still not be able to prevent the abuse and the sole responsibility of what happens falls on the perpetrator. Be very careful not to imply that if a person is abused, he or she must not have followed the rules.

People with intellectual disabilities can learn skills that will reduce their vulnerability to abuse. When introducing personal safety concepts, it is important to gauge your presentation to the age, type of disability, and the learning style of the audience.

  • Verbalize your instructions/ideas appropriately.
  • Teach definitions of abuse and neglect in a manner in which the individuals can understand
  • Stick with the concrete, avoid the abstract.
  • Break down complex ideas into smaller, clearer notions. Check frequently to make sure your message is being received as intended.

People should learn…

  • A clear understanding of healthy sexual expression.
  • Generally, know what is exploitative or harmful.
  • To be aware that sexual contact as a condition of service provision or by service providers is abuse.
  • To be aware that everyone has a right to some privacy. Your body, personal details about yourself, etc. do not need to be discussed or displayed in a manner that is embarrassing or without dignity. You have a right to say "NO" to touch that makes you feel uncomfortable. You can say "no" even to someone who you love or someone who provides care for you.
  • To seek out someone you trust who has the time to listen. Tell this person anytime someone is bothering you or if you need help deciding if a situation is okay or not.
  • Personal rights. Nobody has a right to touch you if you do not want them to. You have a right to be safe in your home, at work, and safe in the community.
  • To feel good about themselves. They should know that they are special and powerful and can stop or report someone who tries to make them feel differently.

Staff Training

Abuse and Neglect Training:

  • All employees (including part-time and contractual employees and volunteers) must be trained in the requirements of Rule 50 upon being hired and at least biennially thereafter.
  • All supervisors, managers, and executives need continuous training in detecting and preventing abuse and neglect including targeted training on characteristics of victims, potential abusers, and substantiated abuse.
  • Offer specific training for supervisors to assess work climate and culture and generate and implement improvements.

DHS Required Abuse and Neglect Training

The CILA Provider shall ensure that:

  • All employees successfully complete DHS OIG approved 59 Ill. Admin. Code 50 training at the time of hire and
  • A biennial (every two years) refresher training course approved by DHS OIG pursuant to Rule 50.

DHS also requires biennial training that contains the following components:

  • Defines who is a required/mandated reporter
  • Identifies what needs to be reported
  • Describes how to report an allegation of abuse, neglect or death
  • Provides the OIG Hotline number
  • Defines timelines for reporting, including requirement that OIG be called within 4 hours of initial discovery, even when agency policy requires first reporting to management staff
  • Includes prohibition of screening of calls
  • Outlines the potential consequences of not fully cooperating with an OIG investigation
  • Outlines the consequences of being the abuser in a substantiated allegation of abuse or neglect of an individual receiving services, including loss of job, criminal charges and referral to the Health Care Worker Registry.

sheets for any staff training must:

  • Be maintained and readily available for review by Department staff.
  • Include the following components: Module/class name, Class date, Class times, Instructor signature and Trainee signature.

Staff Attitude

Attitude is what you think or feel about a person, object, situation or fact. The attitude that you bring to work directly impacts the individuals you support, your job performance and the performance of the staff you supervise. Your attitude can also contribute to creating and maintaining a positive, pleasant and safe environment or can contribute to creating a negative, hostile, fearful, destructive environment

Managing Through Leadership and Coaching.

  • Recognize employees' accomplishments and contributions
  • communicating with employees on a regular basis.
  • Be accessible
  • Assess and periodically reassess your approach to employee recognition
  • Affirming and Enhancing the Capabilities and Motivations of Employees
  • Acknowledge and build upon the strengths of employees
  • Listen to the opinions and suggestions of employees, ask for input, and give feedback so the person knows he/she has been heard.
  • Consistently provide positive, constructive feedback.
  • Acknowledge success.
  • Emphasize strengths.
  • Acknowledge failures.
  • Concentrate on solutions rather than problems.
  • Determine what the problem is to quickly move on to find a solution.
  • Avoid focusing on assessing blame.
  • Refocus the team by putting energy into identifying strengths and solutions. 


Remember the importance of teamwork in creating and maintaining a trust-producing, healthy, engaging environment. Teamwork is work done by several people with each person doing a part to ensure the successful completion of as job. Effective teamwork requires that each person compromise or bend a little to complete the work in the best possible way for everyone. Teamwork requires putting aside personality differences or negative personal feelings about coworkers.

Stress and Burnout

Providing supports to individuals with intellectual disabilities can be very rewarding. However, the day-to- day responsibilities and sometimes demanding work can end up taking a toll on both your body and your mind causing stress and burnout. People who are "burned out" may experience fatigue, stress, anxiety, and depression. When ignored, stress can lead to irritability that may lead to abuse and neglect. Supervisors should be mindful of how much stress work is placing on an employee. Supervisors should ensure that people get the time off they need while still try to manage the staffing needs of the department. This can be a very delicate balance between managing staff stress and managing logistics of the department.

What are the warning signs of stress?

Your body sends out physical, emotional, and behavioral warning signs of stress.

Emotional warning signs:


Inability to concentrate

Unproductive worry


Frequent mood swings

Physical warning signs:

Stooped posture

Sweaty palms

Tension headaches

Neck Pain

Chronic back pain

Chronic fatigue

Weight gain or loss

Problems with sleep

Behavioral warning signs:


Acting on impulse

Using alcohol or drugs

Withdrawing from relationships

Changing jobs often

What Can Be Done to Reduce Stress?

Tips for managing stress include:

  • Keep a positive attitude. Believe in yourself.
  • Accept that there are events you cannot control.
  • Be assertive instead of aggressive. "Assert" your feelings, opinions, or beliefs instead of becoming angry, combative, or passive.
  • Learn to relax.
  • Exercise regularly. Your body can fight stress better when it is fit.
  • Stop smoking/drinking
  • Eat a healthy diet
  • Talk to a professional
  • Ask for help!

Practice what your preach!

Managing your own emotions throughout every day is a skill most of us are always working to improve. We all experience many emotions, such as anger, joy, frustration, and sorrow. As a Residential Director, QIDP,  or professional staff, it is important that you serve as a role model for DSPs and other caregivers in managing your emotions. This means:

  • Being accountable for what you say and do
  • Acknowledging failures and successes
  • Concentrating on solutions rather than problems
  • Determining what the problem is to quickly move on to find a solution
  • Avoid blaming others
  • Refocus the team by putting energy into identifying strengths and solutions
  • Awareness is the key to managing your own emotions. Acknowledge how you are feeling and how your mood might impact individuals and others
  • Be aware of the situations that set you off, make you lose control, try your patience, trigger your anger and challenge your need to be in charge.
  • Recognizing your own vulnerabilities: Awareness of your own vulnerabilities is the first step in preventing situations that are difficult for you to handle from arising.
  • Once you are aware of the kinds of situations that put you at risk, be on the lookout for these situations and develop strategies for keeping your emotions in check.

What are the symptoms of burnout?

The symptoms of burnout are like the symptoms of stress and depression.

  • Withdrawal from friends, family and other loved ones.
  • Loss of interest in activities previously enjoyed.
  • Feeling irritable, hopeless, and helpless.
  • Changes in appetite, weight, or both.
  • Changes in sleep patterns.
  • Getting sick more often. Flare up of your own medical problems or a new illness.
  • Feelings of wanting to hurt yourself or the person for whom you are caring.
  • Emotional and physical exhaustion, chronic fatigue.
  • Rough handling of the persons with disabilities.