Well-being and management of abuse signals in institutions – adults – health, medico-social and social sector

Source: 📒 Well-being and management of abuse signals in institutions – adults – health, medico-social and social sector

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1. ANALYTICAL SUMMARY

Paragraph 1 — Context and issues: an institutional response to the General States of the fight against abuse

This work is in response to a request from the Ministry of Health as part of the General States of the fight against abuse.has-santeThe HAS summary is aimed at establishments in the health, medico-social, and social sectors that welcome adults. It starts from the observation that anyone can be affected by a situation of abuse, particularly in situations of precariousness, disability, old age, isolation, or a combination of vulnerabilities. Abuse is identified as multifactorial: it can be generated by the organisation of work (institutional abuse), a lack of equipment or maintenance, or an inadequate professional posture. Seven types of abuse are distinguished: physical, sexual, psychological, material and financial, neglect, abandonment, deprivation, discrimination, and exposure to a violent environment.

Paragraph 2 — Operational contributions: a complete ecosystem of 11 documents to move from awareness to action

This work is based on a shared foundation across all sectors, on common benchmarks, in order to support professionals and external stakeholders in better understanding the concepts of good treatment, situations of abuse, and their prevention. It aims to facilitate the identification of at-risk situations by providing keys to identify certain signals and improve the analysis and handling of established situations.has-healthThe complete documentary architecture includes: a main guide, a summary, 4 practical sheets, 3 differentiated identification grids by hierarchical level, 3 user documents adapted by sector, a methodological report, and a review notice. This comprehensiveness allows for a breakdown at all levels of an establishment, from governance to frontline professionals.

2. KEY POINTS OF THE DOCUMENT

1. A ministerial order based on the General States of Abuse, with HAS collegial validation (p. 1 of the summary; HAS page)This guide has been developed around common values and shared observations and is part of a continuous quality improvement approach within establishments.has-healthIts institutional legitimacy is twofold: validated by the HAS College on 3 October 2024, it responds to an explicit request from the Ministry of Health arising from the General States of the fight against abuse — which gives it national significance and a direct link to current public policies.

2. Institutional abuse is explicitly recognised as a distinct form (p. 2 of the summary)Beyond individual acts, the document identifies institutional abuse as resulting from managerial practices, a failing organisation, or an inappropriate management style. This recognition is structuring: it compels management to reflect on their own functioning, not just on the behaviours of field agents.

3. Seven types of abuse defined, including neglect and discrimination (p. 2 of the summary)The summary lists seven categories: physical, sexual, psychological, material and financial abuse, neglect, abandonment, deprivation, discrimination, and exposure to a violent environment. This nomenclature stems from the national consensus approach on shared vocabulary, available among the supplementary resources.

4. Differentiated detection grids according to the level of intervention — Sheet 3 (p. 3 of the summary)Sheet 3 includes three distinct grids: Grid 1 for local professionals (assistance in identifying risks of abuse of the individuals received), Grid 2 for management (risks related to professionals), and Grid 3 for governance (risks related to the establishment).has-santeThis differentiation allows for an appropriate use at each hierarchical level, without information overload.

5. Reporting as a positive indicator of institutional quality (p. 1 of the summary)The establishment promotes a culture of reporting. An establishment that does not report internal and/or external warning signals is not in a quality dynamic.has-santeThis shift in perspective is fundamental: reporting is not an admission of dysfunction, but proof of an operational vigilance system.

3. ACTION POINTS FOR LOCAL ACTORS

1. Download and deploy all 11 documents according to the targets (HAS page)The guide is accompanied by 4 practical sheets, 3 user documents (one per sector: health, social, medico-social), a supplementary report, and a review notice.has-santeEach document is available for individual download on has-sante.fr. Plan for targeted dissemination: complete guide for managers, practical sheets for field teams, user documents for the individuals received and their relatives.

2. Establish well-being referents with at least one external referent (p. 1 of the summary)"Well-being" referents are identified and known to all; at least one referent is an external person to the establishment (representative of individuals/users, psychologist, ethicist, others).has-santeThis requirement for externality is a lever for objectivity and trust for the individuals welcomed.

3. Use the three spotting grids (Sheet 3) during team meetings and supervisions (p. 3 of the summary)Deploy Grid 1 with frontline professionals, Grid 2 with management, and Grid 3 at the governance level. These grids structure times for practice analysis, internal audits, or service meetings. Identified unmet needs (e.g.: untrained replacement staff) must be integrated into the continuing education plan.

4. Map and anticipate the "sensitive moments" specific to each establishment (p. 2 of the summary)Organise a collective working time to identify risk moments: welcome, departure, emergencies, post-hospitalisation returns, end-of-life, transmissions, weekends, nights, holidays, and festive periods. Plan for enhanced presence and adapted communication protocols. Nothing should be trivialised; each signal or situation should be the subject of a collective discussion and/or a feedback experience for educational purposes, followed by regular institutional communication and an annual review.has-sante

5. Incorporate well-being into the quality evaluation and certification process, with an annual review (p. 1 of the summary)These commitments are part of the quality evaluation processes of social and medico-social establishments and the certification of health establishments.has-santePlan for an annual review of the reported signals, discussed as a team, as a quality indicator — and not as a dysfunction. Rely on Decision No. 2024.0254/DC/SBP from the HAS College dated 3 October 2024 to legitimise the approach internally.

4. ADDITIONAL REFERENCES

🔍➕ For more information, see the articles referenced by "Health Practices" on the theme of positive care ➡️🔗https://pratiquesensante.odoo.com/blog/tag/bientraitance-329

5. CROSS-ANALYSIS — VALUES OF HEALTH PRACTICES

Literacy:The document provides information materials adapted for users (three sector-specific versions available for download), mentions the comic strip Santé BD as an accessible tool, and offers an audio listening option (Xvox) on the HAS page for individuals with reading difficulties.

Empowerment:The individuals received (or their representatives if necessary) must be able to express themselves freely, indicate their experiences, feelings, satisfactions or dissatisfactions, and above all must be able to raise alerts. The formalised personalised project must be updated.has-sante

Participation:The document provides for the involvement of representatives of individuals and users as external positive care referents to the establishment, as well as their association with reflections and training — a formal mechanism for co-construction at the institutional level.

Community health:The deployment of positive care and the prevention of abuse is everyone's responsibility. It is a shared and supportive commitment between management, staff and volunteers, the individuals received, family caregivers, and their representatives.has-sante

Ethics:The document recommends using ethics as a reference in professional practice and integrating an ethicist among the references for good treatment. The HAS page classifies this publication under the theme "Ethics". Institutional biases (organisational abuse) are identified, but specific cultural biases remain underdeveloped.

Human rights:Informing the individuals received (and their relatives) about their rights, options for action, and avenues for recourse is a priority. An information support is accessible to all.has-santeFundamental rights (dignity, privacy, confidentiality, freedom of movement, consent) are explicitly mentioned.

Intersectorality:Partnerships are recommended with external actors to the establishment (user representatives, psychologists, ethicists). This guide is intended for all individuals working in health, social, or medico-social establishments.has-sante, thus covering three distinct sectors with a common foundation.

Partnership:A formalised model is described: volunteers and user representatives are involved in reflections and training, and at least one good treatment reference must be external to the structure. The ministerial order and HAS validation themselves illustrate a structured institutional partnership.

Combating discrimination:Discrimination is explicitly listed among the seven types of recognised abuse. Non-judgment is integrated into good treatment postures (autonomy, self-determination, agreement of the person), even if cultural diversity is not specifically developed.

POINTS OF VIGILANCE IN ANIMATION

Risks of emotional triggering:

This document addresses sensitive topics that may provoke strong emotional reactions in professionals or volunteers in training:

• Sexual abuseis among the seven types listed. Its mere mention can reactivate personal experiences in participants.
• Institutional abusecan put managers or directors in an uncomfortable, even defensive, position if they recognise practices from their own establishment.
• Burnout, fatigue, and inadequate professional posturesare cited as warning signs: professionals in difficulty may identify with these descriptions and react with guilt or shame.
• End-of-life supportis mentioned among sensitive moments: this topic may affect professionals who have experienced recent painful situations.
• The reporting culturecan generate resistance or anxiety in professionals who have feared or suffered consequences after a past report.

Recommendations for animation:Provide a secure speaking framework from the start of the session. Remind participants of the confidentiality of discussions. Have identified in advance a reference person or resource person if a difficult personal situation arises. Do not place participants in overly realistic situations without prior psychological preparation. Rely on Sheet 2 (positive caring postures) as a positive anchor at the beginning and end of the session.

6. EVALUATION OF THE RELIABILITY OF THE RESOURCE

Scientific relevance:Very high. The document originates from the High Authority of Health, validated by the HAS College on 3 October 2024, published online on 25 October 2024, and updated in March 2026.has-healthIt is based on a national consensus approach, on the General States of the fight against abuse, and is accompanied by a methodological report and a review opinion — ensuring the rigor of the development process. The definitions and typologies are derived from a multi-professional and institutional consultation process.

Operational relevance:Very high. The synthesis is directly usable in establishments: it articulates principles, concrete tools (4 fact sheets, 3 differentiated grids, 3 user documents) and 11 downloadable supplementary documents. Its structure in three parts (well-being / vigilance / abuse) facilitates appropriation by multidisciplinary teams, including non-specialists. The breakdown by sector (health, social, medico-social) avoids tedious local adaptations.

7. MCQ — 5 QUESTIONS

PART 1 — Presentation of the MCQ

Question 1:In what institutional framework was this HAS guide developed? a) At the request of the National Solidarity Fund for Autonomy (CNSA) b) Within the framework of the General States of the fight against abuse, at the request of the Ministry of Health c) In response to a European directive on the protection of vulnerable persons d) At the exclusive initiative of the HAS College, without external commissioning

Question 2:How many types of abuse are identified in the document? a) Five b) Nine c) Seven d) Four

Question 3:What is the specific requirement regarding the well-being referents within establishments? a) They must all be qualified health professionals b) There must be at least three per service c) At least one referent must be external to the establishment d) They must be appointed by the Regional Health Agency

Question 4 :Among the following situations, which are identified as "sensitive moments" to anticipate? a) Weekly team meetings and scheduled medical visits b) Festive periods, nights, weekends, handovers, and returns from hospitalisation c) Quality audits and inspections by the ARS d) Annual performance reviews of professionals

Question 5 :Who is the Grid 2 of Sheet 3 of the guide associated with this summary intended for? a) For the individuals received and their relatives b) For local professionals c) For the governance of the establishment d) For the management

PART 2 — Commented correction

Question 1 :In what institutional framework was this guide developed? ✅ Correct answer: b) Within the framework of the General States of the fight against mistreatment, at the request of the Ministry of Health 📝 Explanation: This work is in response to a request from the Ministry of Health within the framework of the General States of the fight against mistreatment.has-healthThis framework gives the guide a national scope and enhanced political legitimacy. — Source: page HAS

Question 2 :How many types of abuse are identified in the document? ✅ Correct answer: c) Seven 📝 Explanation: The document lists seven types of abuse: physical, sexual, psychological, material and financial, neglect, abandonment, deprivation, discrimination, and exposure to a violent environment. This nomenclature comes from the national consensus process on shared vocabulary. — Source: p. 2 of the summary

Question 3:What is the specific requirement regarding the safeguarding referents? ✅ Correct answer: c) At least one referent must be external to the establishment 📝 Explanation: "Safeguarding" referents are identified and known to all; at least one referent is a person external to the establishment (representative of individuals/users, psychologist, ethicist, others).has-santeThis externality guarantees a form of independence in the handling of situations. — Source: p. 1 of the summary

Question 4:Which are identified as "sensitive moments" to anticipate? ✅ Correct answer: b) Festive periods, nights, weekends, handovers, and returns from hospitalisation 📝 Explanation: The document specifically lists these moments as high-risk times that need to be anticipated by prior organisation. They correspond to phases where staffing is reduced or organisational transitions are more fragile. — Source: p. 2 of the summary

Question 5:Who is Grid 2 of Sheet 3 intended for? ✅ Correct answer: d) For management 📝 Explanation: Grid 2 is intended for management to assist in identifying the risks of abuse related to professionalshas-sante, while Grid 1 targets local professionals and Grid 3 targets governance. — Source: p. 3 of the summary

8. FREQUENTLY ASKED QUESTIONS (FAQ)

1. Does this guide apply to all establishments or only to the health and social care sector?This guide is intended for all individuals working in health, social or health and social care establishments, with vulnerable adult individuals.has-santeIt covers the three sectors with a common foundation, detailed in specific documents by sector for users. (Page HAS)

2. Does the concept of good treatment only concern caregivers?No. The deployment of good treatment and the prevention of mistreatment is everyone's responsibility. It is a shared and supportive commitment between management, staff and volunteers, the individuals being cared for, family caregivers and their representatives.has-sante(p. 1 of the summary)

3. What is institutional mistreatment and how can it be detected?It is mistreatment generated by managerial practices, an organisation or an inappropriate management style — regardless of individual intentions. Warning signs include a deterioration in quality of work life, tensions in staffing, a lack of team cohesion, burnout or inadequate professional behaviours. Grid 3 helps governance identify these risks. (p. 2 of the summary, Sheet 3)

4. What are the most at-risk moments in the daily life of an establishment?The document identifies "sensitive moments" to anticipate: welcome, discharge, emergencies, return from hospitalisation, delivering bad news, end-of-life support, handovers, weekends, nights, holidays, transitions, and festive periods. It is recommended to have an organisation planned in advance for these moments. (p. 2 of the summary)

5. How can the people being cared for be informed of their rights?Three user documents have been developed, one for each sector: health sector, social sector, and medico-social sector, under the title "Positive care and abuse in institutions: Understanding and acting".has-santeThese documents are available for download on has-sante.fr. The number 3133 must be communicated systematically. (p. 1 and p. 3 of the summary, HAS page)

6. How does this guide relate to the certification processes of establishments?These commitments are part of the quality evaluation processes of social and medico-social establishments and the certification of health establishments.has-santeThe guide can therefore be directly used as a reference in certification or external evaluation files. (p. 1 of the summary)

7. Are there accessible training courses to support the deployment of this guide?Yes. A continuous training plan for all staff is planned in connection with the specific needs of the population being cared for. Regular reminders are organised.has-santeThe ministry offers two online training modules: a basic module and an advanced module titled "Promoting positive care to prevent abuse". (p. 1 and p. 3 of the summary)

9. REWRITING IN EASY TO READ LANGUAGE

What this document is

This document comes from the High Authority of Health. It is an official institution in France. The government asked it to create this guide. It concerns health establishments, medico-social establishments, and social establishments.

What is positive care?

Positive care means treating each person with respect. It means listening to their needs. It means respecting their rights. It means allowing them to make their own choices.

What is abuse?

Abuse is when a person is harmed or mistreated. There are seven types of abuse:

• physical violence
• sexual violence
• psychological violence
• financial or property issues
• abandonment and neglect
• discrimination
• living in a violent environment

Abuse can come from a person. It can also come from poor organisation within the establishment.

Who is affected?

Everyone can be affected. Fragile or vulnerable people are at greater risk. For example: elderly people, disabled people, isolated people.

Everyone must act. Directors. Caregivers. Volunteers. The people being cared for themselves.

What this document concretely proposes

There are 11 documents available on the HAS website. The most important are:

• A sheet to recognise a situation of abuse (Sheet 1)
• A sheet to know how to behave well (Sheet 2)
• A sheet to identify the risks of abuse (Sheet 3 with 3 grids)
• A sheet summarising the important messages (Sheet 4)
• Documents to inform the people received and their relatives (one per sector)

The important ideas to remember

• No one should trivialise a difficult situation.
• Every worrying signal must be discussed as a team.
• An establishment that reports problems is doing well.
• A reference person for good treatment must be designated in each establishment.
• At least one person from this group must come from outside.
• The people received must be able to express themselves freely.
• They must know their rights and how to alert.