INVESTIGATIONS INTO SERIOUS INCIDENTS

1. INVESTIGATIONS INTO SERIOUS INCIDENTS NARPA August 22, 2015 Aaryce Hayes, LMSW Aaryce7@gmail.com

2. INVESTIGATIONS INTO SERIOUS INCIDENTS • EVERYTHING CAN BE CONSIDERED AN INVESTIGATION • Variance • type of evidence collected and analyzed • entity responsible for the primary investigation • regulations governing the program/setting

3. Primary vs Secondary What’s the difference? Primary • Performed by entity with statutory authority • 1st on site • Primary role in collecting evidence

4. SECONDARY INVESTIGATIONS • Review of Primary Investigations • Focus on quality of investigation • Compliance with regulations/standards • Compliance with training • Check analysis of evidence

5. PRIMARY VS SECONDARY INVESTIGATIONS • Stakeholders are generally interested in: • allegations involving rights • abuse/neglect including restraint/seclusion • Deaths

6. Why Perform Secondary Investigations? QUALITY ASSURANCE Identification of trends Identification of compliance issues Identification of policy/training issues

7. TOOLS TO EVALUATE PRIMARY INVESTIGATIONS LAWS & REGULATIONS - Governing rights, medication, restraint & abuse investigations. TRAINING • familiarity with the investigatory training • familiarity with the de-escalation and physical techniques used by the entity • Labor Relations, Inc. provides training for investigations of incidents in health and human service settings

8. INITIATION • Operationalize what is meant be initiation of the investigation

9. Securing the Scene • When initiated? • By whom? • Injuries addressed? (emotional/physical) • Relocation of alleged perpetrator?

10. WITNESSES • How identified? Building plan or draw diagram of the scene When were statements taken?

11. WITNESS STATEMENTS • There is a difference between taking a statement and conducting an interview!!!

12. DISPOSITION • Was a disposition reached? • Unable to determine does not mean it didn’t happen!

13. CORRECTIVE ACTION NOT EVERYTHING VIOLATION WILL RESULT IN LITIGATION • Disciplinary action • Restitution • Training • Policy changes • Programmatic changes • Referral to law enforcement, licensure entities • Media attention

14. VIOLATIONS MOST LIKELY INVOLVE COMPLIANCE ISSUES • Did the behavior meet the definition of behavioral emergency??? • Imminent harm to self or others • Restraint or seclusion authorized as last resort less restrictive measures ineffective

15. TYPICAL COMPLIANCE ISSUES • Orders specify behaviors that were of risk of harm Could others back away and be safe? • Use of seclusion (least restrictive alternative)? (cannot be used for discipline, retaliation or punishment) Is it ever necessary? Certainly can never be justified for self injury!!!!!

16. POTENTIAL COMPLIANCE ISSUES • Care - (safety, bathroom and water) • Release criteria (as soon as the threat is removed) (unconscious or asleep) • Debriefing - Did it occur? With whom?

17. ALTERNATIVES TO RESTRAINT CAREGIVERS How are you communicating? • ROLE MODEL APPROPRIATE BEHAVIORS BACK OFF AND SHUT UP! • DO NOT INCITE Body Language, Space, Tone of Voice

18. ALTERNATIVES TO R/S • DEVELOP A CULTURE OF SAFETY & TRUST • PROVIDE TRAUMA INFORMED SERVICES • SUPPORT THE DEVELOPMENT & USE OF A DE-ESCALATION PREFERENCE TOOL

19. USE OF RESOURCES • Limited resources require a screening of cases and a determination when issues are identified, how should they be addressed? • Not every issue will rise to the level of litigation

20. RESOLUTIONS • You will find lack of compliance in many cases. • Is the compliance issue sufficient for litigation? • Prioritize how to handle issues that fail to rise to the level of litigation. • Identifying patterns in practice issues have resulted in changes in policies and development of best practices.