1. Lucas County Board of Developmental Disabilities MUI Rule Training

2. Lucas County Board of Developmental Disabilities The Mission of the Lucas County Board of Developmental Disabilities is to assure that people with developmental disabilities have the same opportunities and life experiences as all other citizens. We will inspire possibilities and create activities throughout the community that will further this ideal. Mission Lucas County Board of Developmental Disabilities

3. Manage Incidents Continuous Quality Improvement Prevent Recurrence Why are investigations done? Lucas County Board of Developmental Disabilities

4. " Unusual incident" means an event or occurrence involving an individual that is not consistent with routine operations, policies and procedures, or the individual's care or service plan, but is not a major unusual incident. Unusual Incidents Lucas County Board of Developmental Disabilities

5. Unusual incident includes, but is not limited to: dental injuries; falls; an injury that is not a significant injury; medication errors without a likely risk to health and welfare; overnight relocation of an individual due to a fire, natural disaster, or mechanical failure; an incident involving two individuals served that is not a peer-to-peer act major unusual incident; and rights code violations or unapproved behavior supports without a likely risk to health and welfare. Unusual Incidents Continued Lucas County Board of Developmental Disabilities

6. Alleged, suspected or actual occurrence Reason to believe a person is at risk of harm based on facts present not opinion Receiving services or will be as a result of incident MUI Means…. Major Unusual Incident Lucas County Board of Developmental Disabilities

7. Immediate Actions Immediate actions MUST be put in place to ensure the individuals health and safety. Examples of immediate actions include but are not limited to: –Removing staff from client contact –Notifying law enforcement –Retraining of staff –Development of safety plan –Respite placement –Any other action that ensures immediate safety

8. Lucas County Board of Developmental Disabilities Three Types of MUIs Protocol A – requires immediate investigation; cases investigated by IAs, LCCS, or law enforcement Protocol B – cases investigated by IAs Protocol C – cases investigated by IAs; prescribed format requirements

9. Lucas County Board of Developmental Disabilities Protocol A MUI’s Abuse; Physical, Sexual and Verbal Accidental or Suspicious Death Exploitation Failure to Report Misappropriation Neglect Peer to Peer Acts Prohibited Sexual Activity Rights Code Violations

10. Lucas County Board of Developmental Disabilities Physical Abuse What does it look like?

11. Lucas County Board of Developmental Disabilities Physical Abuse Physical force Reasonably be expected to result in harm –Examples: Hitting, slapping, pushing, dragging or throwing an object when the allegation indicates that it could reasonably result in harm.

12. Lucas County Board of Developmental Disabilities Physical Abuse Individual tells work staff that this Morning, Sarah pulled her hair and drug her out of bed because it was time for work. Individual refuses to go to nursing to be checked for injuries.

13. Lucas County Board of Developmental Disabilities Sexual Abuse Unlawful sexual contact (touching of an erogenous zone) Unlawful sexual conduct (oral sex, vaginal/anal intercourse with body part or object) Public indecency, voyeurism, importuning (soliciting sex from a minor with DD) For the purpose of arousing/gratifying either party

14. Lucas County Board of Developmental Disabilities Sexual Abuse Individual states that while walking home from the grocery store, a man she didn’t know, grabbed her, touched her breasts and kissed her.

15. Lucas County Board of Developmental Disabilities Verbal Abuse Purposeful use of words or gestures, or other communicative means Threaten, coerce, intimidate, harass, humiliate

16. Lucas County Board of Developmental Disabilities Verbal Abuse Individual states that 2 weeks ago, the lady on the bus told him that if he didn’t sit down and shut up, she was going to pull the bus over and slap his mouth.

17. Lucas County Board of Developmental Disabilities Neglect A duty to provide treatment, care, goods, supervision or services necessary to maintain health and safety – Failing to complete this duty – Failure could result in a reasonable risk of harm

18. Lucas County Board of Developmental Disabilities Neglect Individual has line of sight supervision and when he comes to work he tells staff that last night, he took the trash out by himself because staff was sleeping on the couch.

19. Lucas County Board of Developmental Disabilities Death All deaths of individuals served Suspicious or accidental deaths require additional investigation

20. Lucas County Board of Developmental Disabilities Death Home staff report that last evening, individual passed away due to a seizure. Home staff also state that third shift staff had not been giving the individual his seizure medication properly.

21. Lucas County Board of Developmental Disabilities Misappropriation With intent Deprive, defraud, or otherwise obtain real or personal property – Any amount or value – Felony to steal even one penny from an individual with developmental disabilities.

22. Lucas County Board of Developmental Disabilities Misappropriation Individual states that when they arrived home last night, their home had been broken into and their x-box, television, and games had been stolen.

23. Lucas County Board of Developmental Disabilities Exploitation Unlawful or improper act ­ Using individual ­ Individual’s resources for personal benefit, profit, or gain

24. Lucas County Board of Developmental Disabilities Exploitation Individual attempts to get Columbia Gas in their name for the first time and is told they cannot because someone already has gas in their name.

25. Lucas County Board of Developmental Disabilities Peer to Peer Acts Physical –Physical act that occurs when an individual is targeting, or firmly fixed on another individual such that the act is not accidental or random. The incident results in an injury that is treated by a physician, physician assistant, or nurse practitioner. Allegations of one individual choking another or any head or neck injuries such as bloody nose, a bloody lip, a black eye or other injury to the eye, shall be considered major unusual incidents.

26. Lucas County Board of Developmental Disabilities Peer to Peer Acts Minor injuries such as scratches or reddened areas not involving the head or neck shall be considered unusual incidents and shall require immediate action, a review to uncover possible cause/contributing factors, and prevention measures.

27. Lucas County Board of Developmental Disabilities Peer to Peer Acts Any Exploitation Any intentional Misappropriation of significant value ($20.00) Verbal Abuse –Verbal act which means the use of words, gestures, or other communicative means to purposefully threaten, coerce, or intimidate the other individual when there is the opportunity and ability to carryout the threat. Any Sexual Abuse

28. Lucas County Board of Developmental Disabilities Peer to Peer Acts Individual walks over to peer and scratches his face and punches him in the left arm leaving a bruise (MUI as he scratched the face) Individual walks over to peer and punches him in the left arm leaving a bruise the size of the fist (UI, as did not require treatment from physician, etc) Individual with 24 hour supervision and who does not ride same bus and does not work in same building sends text message threatening to kill peer. (UI as no access) Individual with 24 hour supervision who lives in same home as peer sends text message threatening to kill peer. (MUI as they have access to each other)

29. Lucas County Board of Developmental Disabilities Failure to Report DD employee unreasonably failed to report Abuse, Neglect, Exploitation or Misappropriation Knew or should have known Failure would result in a substantial risk of harm

30. Lucas County Board of Developmental Disabilities Failure to Report Individual reports that her staff has been threatening to punch her for the past week. Individual states that she has told 3 home staff and the staff person continues to come to her home and threaten her.

31. Lucas County Board of Developmental Disabilities Prohibited Sexual Relations DD employee Consensual sexual conduct or contact With an individual who is not their spouse Employed or under contract to provide care to the individual at the time of the incident Anyone in the DD employee’s supervisory chain of command

32. Lucas County Board of Developmental Disabilities Prohibited Sexual Relations Individual reports that they are having sex with their night staff person and they are in love and going to get married.

33. Lucas County Board of Developmental Disabilities Rights Code Violations Any violation of rights listed in Ohio Revised Code 5123.62 and it creates a reasonable risk of harm

34. Lucas County Board of Developmental Disabilities Rights Code Violations Individual is told that if they don’t do their laundry, they can’t go to the movie that they have been wanting to see. Individual becomes upset by this, starts to self abuse, resulting in staff implementing a physical restraint. Individual continues to escalate resulting in the police being called.

35. Lucas County Board of Developmental Disabilities Substantiation of Categories The following categories are substantiated or unsubstantiated: –Physical Abuse –Sexual Abuse –Verbal Abuse –Misappropriation –Neglect –Exploitation –Rights Code Violations –Prohibited Sexual Relations

36. Lucas County Board of Developmental Disabilities Substantiation Substantiation is based on 51% evidence that the incident occurred. Unsubstantiated for Insufficient Evidence means that there was not enough evidence to substantiate the incident. Unsubstantiated due to being Unfounded means that the incident did not occur as reported.

37. Lucas County Board of Developmental Disabilities Abuser Registry All providers are required to run name against abuser registry prior to client contact. Cannot work in the state of Ohio in this field if you are on the abuser registry. Cases meeting requirements for the abuser registry are: –Abuse: Physical, Sexual, ad Verbal –Misappropriation of $100 or more –Prohibited Sexual Relations –Failure to Report –Severe Neglect

38. Lucas County Board of Developmental Disabilities Protocol B MUIs Attempted Suicide Medical Emergency Missing Individual Death (if not suspicious or accidental) Significant Injury (taking place of known and unknown injuries categories)

39. Lucas County Board of Developmental Disabilities Attempted Suicide Physical attempt that:  Results in ER treatment or  Inpatient observation or  Hospital admission

40. Lucas County Board of Developmental Disabilities Medical Emergency Emergency medical intervention required to save one’s life – Abdominal Thrusts, CPR, Epi pen usage, and IV for dehydration, etc.

41. Lucas County Board of Developmental Disabilities Missing Individual Has been reviewed for neglect Not located per ISP and actions identified in plan and in search of immediate surrounding area and Individual is believed to be at or pose an imminent risk of harm to self or others (If missing longer than ISP and not at or pose imminent risk; UI)

42. Lucas County Board of Developmental Disabilities Significant Injury Known or Unknown cause Not Abuse or Neglect Requires: – Immobilization or casting (including air casts) – Five or more sutures or equivalent – 2 nd or 3 rd degree burns – Concussion – Dislocation

43. Lucas County Board of Developmental Disabilities Protocol C MUIs Law Enforcement Unapproved Behavior Supports Unscheduled Hospitalization

44. Lucas County Board of Developmental Disabilities Law Enforcement Individual is –charged (C) –incarcerated (I) –arrested (A)

45. Lucas County Board of Developmental Disabilities Unapproved Behavior Support Any adverse strategy or intervention Implemented without approval by committee and guardian or without informed consent. Results in a likely risk to health and safety

46. Lucas County Board of Developmental Disabilities Unapproved Behavior Support UIR An intervention that is prohibited by paragraph (J)of rule 5123:2-02 of the O.A.C. and does not likely pose a likely risk to health and welfare shall be investigated as an unusual incident.

47. Lucas County Board of Developmental Disabilities Unscheduled Hospitalization Hospital admission that is not scheduled Unless Due to condition specified in ISP/BSP or nursing care plan Specific symptoms and criteria must be listed that lead to hospitalization

48. Lucas County Board of Developmental Disabilities Prevention Prevention is put in place to prevent similar incidents from occurring in the future. The individual and their team should develop prevention. Prevention should address: –Root Cause –Contributing Factors –Any other factors concerning health and safety

49. Lucas County Board of Developmental Disabilities MUI Contact Information: Verbal Reports MUI Unit (419) 381-5206 M-F 8:30 - 4:30 (Abuse, Neglect, Misappropriation, Current Health & Safety Risks) Written Reports MUI Fax (419) 381-8308 After Hours Reports Emergency #(419)380-5100 ConsultationsMUI Unit(419) 381-5206 WHEN IN DOUBT - CALL!

50. Lucas County Board of Developmental Disabilities Reporting Requirements All MUI’s MUST be reported to the MUI unit If a crime has taken place, law enforcement may need to be contacted. If abuse or neglect of a child is involved, Lucas County Children Services MUST be notified (419) 213-3200. (21 yrs & under)

51. Lucas County Board of Developmental Disabilities Reporting Requirements Reports regarding the following major unusual incidents shall be filed and the requirements of this rule followed regardless of where the incident occurred: Attempted Suicide Death Exploitation Failure to Report Law enforcement Misappropriation Missing Person Neglect Peer to Peer Physical abuse Prohibited sexual relations Sexual abuse and Verbal abuse

52. Lucas County Board of Developmental Disabilities Reporting Requirements Reports regarding the following major unusual incidents shall be filed and the requirements of this rule followed only when the incident occurs in a program operated by a county board or when the individual is being served by a licensed or certified provider: Medical emergency Rights code violation Significant injury Unapproved behavior support; and Unscheduled hospitalization.

53. Lucas County Board of Developmental Disabilities Reporting Requirements; Must be reported verbally within 4 hours: All providers & the county board as a provider must report Reporting must comply with the county board identified system for reporting Report incidents or allegations of: ­ Abuse; physical, sexual, verbal ­ Accidental or suspicious death ­ Neglect ­ Exploitation ­ Misappropriation ­ Media inquiries ­ Peer to Peer Act

54. Lucas County Board of Developmental Disabilities Submit Written Incident Report All MUI’s must be submitted in writing Applies to all agency and independent providers and the county board as a provider Potential or determined MUI’s Reports should be submitted by fax (419) 381-8308

55. Lucas County Board of Developmental Disabilities What is YOUR role? You are a mandated reporter. Never assume someone else will report an incident. Write accurate reports immediately. (Who, What, Where, When, How) Better to write-up an incident that is not an MUI rather than to not write-up one that is. Carefully document all injuries and if possible take photographs.

56. Lucas County Board of Developmental Disabilities Peer to Peer Notifications Notification shall be made to the individuals, individuals' guardians, and other persons whom the individuals have identified in a peer-to-peer act unless such notification could jeopardize the health and welfare of an individual involved.

57. Lucas County Board of Developmental Disabilities Analysis All agency providers shall produce a semi-annual (not quarterly) and annual report regarding MUI trends and patterns which shall be sent to the county board. The county board shall semi-annually review all individual providers for MUI trends and patterns. The semi-annual review shall be cumulative for the first two quarters and include an in- depth analysis. The annual review shall be cumulative for all four quarters and include an in-depth analysis. Each review period shall include the preventive measures taken to address the trends and patterns.

58. Lucas County Board of Developmental Disabilities Analysis All reviews and analyses shall be completed within thirty calendar days following the end of the six-month period. The semi-annual and annual analyses shall contain the following elements: Date of review; Name of person completing review; Time period of review; Comparison of data for previous three years; Explanation of data; Data for review by major unusual incident category type

59. Lucas County Board of Developmental Disabilities Analysis Continued Specific individuals involved in established trends and patterns –(i.e., five major unusual incidents of any kind within six months, ten major unusual incidents of any kind within a year, or other pattern identified by the individual's team); Specific trends by residence, region, or program; Previously identified trends and patterns; and Action plans and preventive measures to address noted trends and patterns.

60. Lucas County Board of Developmental Disabilities Unusual Incidents Requires the provider to investigate unusual incidents, identify the cause and contributing factors when applicable, and develop preventive measures to protect the health and welfare of any at-risk individuals.

61. Lucas County Board of Developmental Disabilities Unusual Incidents Continued Independent providers shall complete an incident report, notify the individual's guardian or other person whom the individual has identified, as applicable, and forward the incident report to the service and support administrator or county board designee on the day an unusual incident is discovered. Independent Providers will also maintain a log of unusual incidents.

62. Lucas County Board of Developmental Disabilities Oversight The county board shall review, on at least a quarterly basis (not monthly), a representative sample of provider logs, including logs where the county board is a provider, to ensure that major unusual incidents have been reported, preventive measures have been developed, and that trends and patterns have been identified and addressed in accordance with this rule. The sample shall be made available to the department for review upon request.

63. Lucas County Board of Developmental Disabilities Oversight Continued When the county board is a provider of services, the department shall review, on a monthly basis, a representative sample of county board logs to ensure that major unusual incidents have been reported and that trends and patterns have been identified and addressed in accordance with this rule. The county board shall submit the specified logs to the department upon request.

64. Lucas County Board of Developmental Disabilities Training Agency providers and county boards shall ensure staff employed in direct services positions are trained on the requirements of this rule regarding the identification and reporting of MUIs and UIs prior to direct contact with any individual. Thereafter, staff employed in direct service positions shall receive training during each calendar year which shall include annual training on the requirements of this rule including a review of health and welfare alerts issued by the department since the previous calendar year's training.