ABUSE TOPICS (ABUSE, NEGLECT, EXPLOITATION)
On Intake and Annually, discuss the meaning of and how to report abuse, neglect, and exploitation, the client's personal history regarding abuse, neglect, and/or exploitation, and whether the client has resolved (or may want to resolve-through discussion, counseling, etc) any issues that arose due to any personal history of abuse, neglect, and/or exploitation. Describe the client's explanation in his own words or describe what you observe when you ask each question
Client	Date
Definition of Abuse, Neglect, Exploitation
Yes	No	The client and/or client guardian agree to discuss the definitions of abuse, neglect, and exploitation with staff.
Ask the client to define, describe, and/or explain in his own words the meaning of each term.
Abuse

Neglect

Exploitation

Reporting Abuse, Neglect, Exploitation
Yes	No	The client and/or client guardian agree to discuss reporting abuse, neglect, and exploitation with staff.
Ask the client to describe in his own words how he would report abuse, neglect, and exploitation.
Abuse

Neglect

Exploitation

Client History
Yes	No	The client and/or client guardian agree to discuss personal history about abuse, neglect, and exploitation with staff.
Ask the client to describe his experience regarding abuse, neglect, and/or exploitation. Write the description in the client's own words or describe what you observe when you ask the question. Client history may be personal or may relate to someone he knows.
Abuse

Neglect

Exploitation

Client Resolution
Yes	No	The client and/or client guardian agree to discuss resolutions to issues of abuse, neglect, and exploitation with staff.
Ask the client if he resolved any issues that arose due to his experience with abuse, neglect, or exploitation. Write the explanation in the client's own words or describe what you observe when you ask the question.
Abuse

Neglect

Exploitation

Individual	Signature	Date
Client
Guardian
Staff