Abuse Prevention Specialists
- Instilling Emotionally Responsible Caregiving Values
in Direct care staff and Supervisors

Roger MacNamara

På svenska

Abuse Prevention Specialists offer seminars and literature that might interest you. If I can be so bold, send me your best, those persons you regard as your prime change agents now or to be, and I will make certain

1. They know the nature of and reasons for the persistence of abuse
2. Personal and organizational dimensions of the problem
3. How to assess caregiving environments
4. How to teach their employees emotionally responsible caregiving

• We know what good caregiving practice is, and we must teach, recognize and reward its use.
• We know what bad caregiving practice is, and we must halt it at once, right there, not later, not by memo or meeting, but in the full light of day where it occurs.

The latter recommendation requires an agency wide commitment to eradicate custodialism in all its forms and to constantly monitor and assess the quality of the caregiving tone in each residence.

If we regard abuse as a grave problem and a continuous temptation for employees who are tired, frustrated or misplaced in human services, why do so many managers wait for a case before they act on their concerns? Could the delay be a function of priorities? What is our number one priority? Quality care? A healthy bottom line? Agency integrity and reputation? Mission values? A coherent, cohesive organization? One abuse case means a problem in all of the above. There is another explanation. Managers tend to regard abuse prevention as a policy issue. It is most decidedly not a policy issue. It is a dilemma. We have made abuse a direct care problem with the result that we receive fewer and fewer reports of abuse and neglect . This loss of communication is the consequence of divided loyalties and common animosities, and these feelings do not yield to administrative authority, slogans, mission statements or a few hours of training. States across the Country require providers to offer abuse prevention training to their employees.

1. This is the policy.
2. Count to ten before responding angrily.
3. Seek help when you need it.
4. Report any and all instances of mistreatment, neglect or unusual or excessive responses by co-workers.

This is not abuse training, and adding booklets, discussions and role-plays are mere decorations. Abuse is an organizational dilemma not a direct care problem.

There are immediate correlations between abuse and consumer care practices. Abuse contaminates life, and emotionally responsible caregiving prevents abuse. Therefore, the objective of abuse prevention is to teach emotionally responsible caregiving throughout the organization: at all levels and to each employee. Nothing else works.

We can rightfully argue that caregiving is kinder and gentler in today's settings, but kinder and gentler disappear with fatigue, the erosion of values and beliefs and with the temptations accompanying the anger impulse. Abuse prevention is not a strong dose of policy or even an appeal to employees' higher values. In order to decrease the likelihood of mistreatment, we must replace cutodialism in all its forms. Abuse is best prevented by its antithesis, good care, but good is an amorphous and relative concept. Emotionally responsible caregiving can be defined, illustrated, taught and evaluated.

The most perplexing and disconcerting character of abuse is its cruel persistence. In the past thirty years, much has changed except the persistence of what we have falsely believed to be episodic mistreatment. We call it the abuse of vulnerable persons. Employees do not always see it that way. They know that abuse is wrong. They know they can lose their jobs and even risk legal penalties. But... abuse persists. We must acknowledge it as a basic reality. If clients, consumers, patients, vulnerable persons are not safe with the caregivers we recruit, train, supervise and evaluate we are at fault.

It can be difficult to convince leadership that crisis management is not its most vexing task. The true challenge is not in arranging services as in X consumers + Y staff living in Z settings equals quality of life. Y equals quality of life for our most challenging consumers. Until the agency recognizes that creating quality at the Y level is the most intellectually and administratively demanding task of all, recurring themes, especially abuse, will persist.

What We Believe Can Blind Us

Organizational leaders will insist that they have good staff, who receive sound, practical training, who are evaluated by the use of competency based standards and who receive direct, immediate supervision. We hear vague references to "that other influence" and occasional admissions that agency priorities are not uniformly shared across organizational lines. We believe there is one fundamental strategy for the abuse dilemma. The entire organization must embrace a set of shared principles that serve to elevate the human being be he or she consumer or employee. These principles must be conveyed in everyday courtesies, tolerances and support strategies and must never be diluted, compromised or ignored. There is a right and a wrong way to treat and respond to one another, and these ways must be inculcated into organizational and personal relationships. This is not philosophy. This is not poetry. This is real world thinking that can become real world living.

Training can be a device we use to convince ourselves that we have helped employees or consumers meet our expectations. We must teach employees and consumers not train them. We need to teach them about human emotions, human problems and the ways that enlightened human beings attempt to solve their problems. Each organization must have a core of people who constantly monitor the caregiving tone: employees' responses to consumers and consumers' responses to employees. Principles to be in practice must be observed, recognized and honored. Deviations from principles must be halted at once. We must not wait for employees to ask us to help them understand what is occurring between them and consumers. Advanced abuse prevention study is available for managers, supervisors, rights officers, quality assurance specialists, case managers, which they can apply wherever consumers are provided services.

New mechanisms for old problems

Providers already have quality control mechanisms, but periodically, they create new organizational mechanisms. Managers can re-invent, or they can teach their organizations emotionally responsible caregiving, the entire organization, top to bottom, neophyte and veteran, supervisor and case manager, secretary and behaviorist, administrator and the last person hired for the third shift. Abuse is a two dimensional problem. It is an interplay of personal and organizational forces. Knowing this, we must address both issues. Let me be more specific. How can training compete with the anger impulse especially when the angry employee believes he or she is following the natural order of things? Do we assume by telling them they must behave differently at work then they do at home, that this admonition suffices? The anger impulse elicits an abusive act when an oft-repeated sequence is replayed in the caregiving environment.

1. Employees are told that punishment is not allowed at work because these are "special people," but employees believe the reason consumers misbehave is the absence of consequences for objectionable acts.
2. Ergo, employees do not believe what they have been told (taught), but follow the policies because they have been warned they will be fired if they do not.
3. Employees who are in conflict with their own beliefs are susceptible to anger spikes.

I have devoted a lifetime of study to management solutions to abuse. In contrast with advances in service methodology, cutodialism remains a residential reality. Emotionally responsible caregiving can displace old (and not so old) beliefs while teaching employees about human emotions and behavior, especially their own. My associates and I have designed abuse prevention strategies that can be incorporated into organizational frameworks at once and without additional expenditures. These strategies require thought, effort, focus, time (not finance) and one absolutely essential intangible: MANAGEMENT DETERMINATION.

Abuse Prevention Specialists Employee Performance Appraisal Guide

This is an employee performance appraisal guide with a difference. It defines good from poor practices. There is an introductory narrative concerned with the reviews we perform on the men and women and the lack of connection to employee appraisals. Thereafter, there are a series of scales with questions that guide the reviewer in making decisions about the quality of the care provider and his or her understanding of the caregiving art.

Examining Potentially Caregiving Environment

Doctors recommend annual "check ups" a good preventative medicine. Do we do the same for our caregiving environments? Healthy caregiving environments can only be maintained by constant vigilance. Examining a caregiving environment can prevent "creeping" depersonalization. As with Instilling, Examining contains scales with true-life questions that guides the examiner into the very heart of caregiving practices.

I would like to share a few of our perspectives with you:

There are direct correlations between abuse and consumer care practices. Abuse contaminates life, and emotionally responsible caregiving prevents abuse. Therefore, the objective of abuse prevention is to teach emotionally responsible caregiving throughout the organization: at all levels and to each employee. Nothing else works.

Providers have supervisors, but periodically, we create new organizational mechanisms, quality assurance, for example. Managers can re-invent, or they can teach their organizations emotionally responsible caregiving, the entire organization, top to bottom, neophyte and veteran, supervisor and case manager, secretary and behaviorist, administrator and the last person hired for the third shift. Nothing else works.

1. Employees are told that punishment is disallowed at work because these are "special people," but secretly many employees believe the reason consumers misbehave is the absence of consequences for objectionable acts.
2. Therefore, employees do not always believe what they have been told (taught), but follow the policies because they have been warned they will be fired if they do not. Care by self-control produces stress.
3. Employees who are in conflict with their own beliefs are susceptible to anger spikes and abusive conduct.
4. When separate cultures evolve at agencies, the probable result is "organizational drift" during which employees adopt attitudes and practices that are the antitheses of emotionally responsible caregiving. The questions that cannot be answered by simplistic views of employee-consumer relationships are:

   a) Why are most abuse reporters new employees?

   b) Why do employees tolerate abusive peers?

We know the immediate reasons for consumer mistreatment.

• Power struggles
• Inappropriate responses to distraught persons
• "Behavior plans" that legitimatize confrontations
• Inadequate, inattentive or poor supervision

What can you do? Teach your organization emotionally responsible caregiving, the entire organization, top to bottom, neophyte and veteran, supervisor and case manager, secretary and behaviorist, administrator and the last person hired for the third shift. Nothing else works.

We can predict abuse. And if we can predict it, we can prevent it.

I just received a copy of the first report filed by two of my participants in "Training to be an Abuse Preventionist" and felt like a proud father. Their work at a sister agency was splendid and will assist it to avoid grim problems. Each participant received five days of training, two manuals and two sets of transparencies.

Contact Roger MacNamara noabuse@neca.com, at Abuse Prevention Specialists to purchase the following literature:

The Abuse Prevention Monitor, a scintillating monthly newsletter, $12.50

The Foremost Solution for the Abuse Problem: The Will to Manage

Not Knowingly Do Harm, $29.00

Management Foundations for Emotionally Responsible Caregiving, $10.00

Instilling Responsible Caregiving Values In Direct Care Staff & Supervisors Through Performance Appraisals, $30.00

Examining Caregiving Environments for Potential Contamination, $35.00

Freedom from Abuse & Creating Abuse-free caregiving Environments Available from Charles C. Thomas, Publishers - Springfield, IL

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