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INVESTIGATIONS INTO SERIOUS INCIDENTS

NARPASEPTEMBER 9, 2014Aaryce Hayes, LMSW

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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 issue

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PRIMARY VS SECONDARY INVESTIGATIONS

• Stakeholders are generally interested in:

allegations involving rights

abuse/neglect

including restraint/seclusion

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SECONDARY INVESTIGATIONS

• REVIEW OF PRIMARY INVESTIGATORY

The quality of the entity’s investigation

Compliance with regulations and standards governing the investigations

Analysis of the evidence and the determination rendered

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TOOLS TO EVALUATE PRIMARY INVESTIGATIONS

LAWS & REGULATIONS - Governing rights, medication, restraint & abuse investigations.

TRAINING – familiarity with the investigatory training – familiarity with the physical techniques used by the entity

• Labor Relations, Inc. provides training for investigations of incidents in health and human service settings

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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

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POTENTIAL 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)

Can it ever be justified for self injury?

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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?

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ALTERNATIVES TO RESTRAINT

CAREGIVERS How are you communicating?

• ROLE MODEL APPROPRIATE BEHAVIORSBACK OFF AND SHUT UP!

• DO NOT INCITE Body Language, Space, Tone of Voice

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ALTERNATIVES TO R/S

• DEVELOP A CULTURE OF SAFETY & TRUST

• PROVIDE TRAUMA INFORMED SERVICES

• SUPPORT THE DEVELOPMENT & USE OF A DE-ESCALATION PREFERENCE TOOL

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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

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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.