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INVESTIGATIONS INTO SERIOUS INCIDENTS

NARPAAugust 22, 2015

Aaryce Hayes, LMSWAaryce7@gmail.com

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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 program/setting

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Primary vs Secondary

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

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SECONDARY INVESTIGATIONS

• Review of Primary Investigations

– Focus on quality of investigation– Compliance with regulations/standards– Compliance with training– Check analysis of evidence

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PRIMARY VS SECONDARY INVESTIGATIONS

• Stakeholders are generally interested in:

allegations involving rights

abuse/neglect including restraint/seclusion

Deaths

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Why Perform Secondary Investigations?

QUALITY ASSURANCE

Identification of trends

Identification of compliance issues

Identification of policy/training issues

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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 de-escalation and 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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INITIATION

• Operationalize what is meant be initiation of the investigation

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Securing the Scene

• When initiated?• By whom?• Injuries addressed? (emotional/physical)• Relocation of alleged perpetrator?

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WITNESSES

• How identified?

Building plan or draw diagram of the sceneWhen were statements taken?

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WITNESS STATEMENTS

• There is a difference between taking a statement and conducting an interview!!!

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DISPOSITION

• Was a disposition reached?

• Unable to determine does not mean it didn’t happen!

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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

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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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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!!!!!

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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.