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

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 2

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

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

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

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

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 7

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

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

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

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

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

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 13

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 14

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!!!!! 15

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? 16

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 17

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 18

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 19

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. 20