MUI Training

1. MUI Training Incidents adversely affecting health and safety. OAC 5123:2-17-02

2. Investigative Agents for DCBDD • Craig Hill 740-201-3608 Fax is same# • Angie Rayburn 740-201-5812 Fax is same #

3. Objectives: • Provide new and/or current staff/providers with an awareness of the importance incident reporting • Create awareness about abuse and neglect so staff can identify and report information • Educate staff on types of Unusual Incidents and MUI’s • Educate staff/providers on the procedures and process of reporting incidents • Educate staff/providers of roles and responsibilities of providers, support administrators, and investigative agent

4. Common Acronyms • DCBDD: Delaware County Board of Developmental Disabilities • DODD: Ohio Department Of Developmental Disability • SA/SSA: Support Administrator/Case Manager • ISP: Individual Support Plan • BSP: Behavior Support Plan • DD: Developmental Disability Occurring before age of 22.

5. Common Acronyms • DCBDD: Delaware County Board of Developmental Disabilities • DODD: Ohio Department Of Developmental Disability • SA/SSA: Support Administrator/Case Manager • ISP: Individual Support Plan • BSP: Behavior Support Plan • DD: Developmental Disability Occurring before age of 22.

6. The Rule: • Establishesthe requirements for managingincidents adversely affecting health or safety. • Implementsa continuousquality improvementprocess in order to prevent or reduce the risk of harm to individuals.

7. The Rule: • The Purpose is to establish a system to: • Report • Investigate • Review • Remedy • Analyze

8. An Unusual incident (UI) is: • An event or occurrence involving an eligible individual that is not consistent with routine operations, policies and procedures, or the care or individual service plan of the individual, but is not an MUI . • Unusual incidents directly relate to and are written about the individual receiving services that the incident happens to. Reports are about the victim, not the perpetrator

9. UI’s includebut are not limited to: • Minor Injuries • Behavioral Episode • Self-Medication Errors • A-typical Behavior

10. Minor Injuries • lacerations, scrapes, contusions or • discolorations of known origin, minor burns, rash, minor • recreational/work related injuries, falls; peer-to-peer incidents that are not MUIs; • overnight relocation of an individual due to fire, natural disaster, or mechanical failure; • any injury to an individual that is not an MUI.

11. Behavioral episode • a physical or verbal outburst of an eligible individual that does not require physical intervention.

12. Self-medication errors • an individual who administers their own medication (as outlined in their ISP) fails to administer the medication as prescribed (with no adverse effects).

13. Atypical behavior • an occurrence where an eligible individual displays behavior that is unusual or displays a typical behavior increasingly which causes concern for health and safety.

14. A Major Unusual Incident (MUI) is: • The alleged, suspected or actual occurrence of an incident when there is reason to believe the health or safety of an individual may be adversely affected. • Or when an individual may be placed at a reasonable risk of harm. • If such individual is receiving services through the DCBDD service system or will be receiving such services as a result of the incident. • Major Unusual incidents directly relate to and are written about the individual receiving services that the incident happens to. Reports are about the victim, not the perpetrator

15. MUI’s include: • Abuse • Attempted suicide • Death • Exploitation • Failure to report • Known injury • Law enforcement • Medical emergency • Misappropriation

16. MUI’s include: • Missing individual • Neglect • Peer-to-Peer acts • Prohibited sexual relations • Rights code violation • Unapproved behavior support • Unknown injury • Unscheduled hospitalization

17. PROTOCOL MUI’s • Require 4 hour notification to DCBDD • Require immediate Notification to Law Enforcement or Children Services in cases of suspected child abuse (up to age 21 for DCBDD Eligible individuals). • Require immediate notification to Law Enforcement for criminal cases.

18. When a person has reason to believe that an individual has suffered or faces substantial risk of suffering from any wound, injury, disability, or condition of such a nature as to indicate abuse or neglect. Including misappropriation. Failure to report:

19. And that person does not immediately report the incident to: Law enforcement Children Services The DCBDD The Omission of the reporting is itself the MUI and must be reported immediately. Failure to report:

20. Abuse: • Physical: • use of physical force • That can be expected to or does result in physical or serious physical harm. • Including but not limited to: • Hitting • Slapping • Pushing • Throwing objects at an individual

21. Abuse: • Sexual Abuse: • Unlawful sexual conduct or sexual contact • Verbal Abuse: • Purposefully using words or gestures to threaten, coerce, intimidate, harass, or humiliate an individual

22. Misappropriation: • Depriving, defrauding, or otherwise obtaining the real or personal property of an individual by any means prohibited by the Ohio Revised Code. • It is a felony to steal even one penny!

23. Exploitation: • The unlawful or improper act of using an individual’s resources for monetary or personal benefit, profit, or gain.

24. Neglect: • When there is a duty to do so, failing to provide an individual with: • Treatment • Care • Goods • Supervision • Services necessary to maintain the health or safety of the individual.

25. Neglect: • Consideration must be given to whether there is reasonable risk to health and safety. • Neglect includes patient endangerment which means an MR/DD caretaker has created a substantial risk to the health or safety of an individual.

26. Peer to Peer Acts: • Act committed by one individual against another when there is: • Physical abuse with intent to harm • Verbal abuse with intent to intimidate, harass, or humiliate • Any Sexual abuse • Any Exploitation • Intentional misappropriation of property of significant value – determined by DODD to be about $10.00

27. Prohibited Sexual Relations: • An DD employee engaging in consensual sexual conduct or having consensual sexual contact with an individual who is not the employee’s spouse, and for whom the DD employee was employed or under contract to provide care at the time of the incident and includes persons in the employee’s supervisory chain of command.

28. Death MUI • IA will ensure County Coroner is notified • EI and SSA’s are required to fill out • DCBDD Death Notification form and send copies to Superintendent, Direct Supervisor, and IA. • Family is not notified further by IA

29. Rights Code Violation: • Any violation of the rights enumerated in section 5123.62 of the Revised Code that creates a reasonable risk of harm to the health or safety of an individual.

30. NON PROTOCOL MUI • Required to report the same day • Required to implement immediate plan of correction to ensure health and safety. • Only an MUI if a DODD provider including County Board is giving service at the time of the incident. • DCBDD files an MUI for all LE MUI’s.

31. Attempted Suicide: A physical attempt by an individual that results in emergency room treatment, in-patient observation, or hospital admission. Attempted Suicide

32. Injury from a known cause:

33. Law Enforcement: • Any incident that results in the individual being charged, incarcerated, or arrested.

34. Medical Emergency: • An incident where emergency medical intervention is required to save an individual’s life: • Heimlich maneuver • CPR • IV fluid for dehydration

35. Missing Individual: • An incident that is not considered neglect and the individual cannot be located for a period of time longer than specified in the Individual Service Plan (ISP) • And the individual cannot be located after actions specified in the ISP • And the individual cannot be located in a search of the immediate surrounding area • Or the circumstances indicate that the individual may be in immediate jeopardy • Or Law enforcement has been called to assist in the search

36. Unapproved Behavior Support: • The use of any aversive strategy or intervention implemented without approval by the human rights committee or behavior support committee or without informed consent.

37. Unknown Injury: • An injury of an unknown cause that is not considered possible abuse or neglect and that requires treatment that only a physician, physician’s assistant, or nurse practitioner can provide.

38. Unscheduled Hospitalization: • Any hospital admission that is not that is not scheduled unless the hospital admission is due to a condition that is specified in the ISP or nursing care plan indicating the specific symptoms and criteria that require hospitalization.

39. (D)(1) Any Person with DODD Not Served • Report possible Abuse including Misappropriation or Neglect • To local law enforcement and the county board OR • Public Children’s Service Agency and county board • Entry page on ITS

40. Reporting MUI’s on Person served • Abuse, Neglect, Exploitation, Misappropriation, Death, Prohibited Sexual Relations, and Failure to Report • Regardless of where the incident occurred • Follow all rule requirements • Remaining categories (All other MUI’s) when: • Incident occurs in program operated by the county board • OR • When the individual is being served by a licensed or certified provider • Follow all requirements

41. (D)(3) Upon Identification or Notification of MUI, Provider or County Board Shall: • Take immediate actions to protect all at risk individuals which shall include: • Immediate or ongoing medical attention as appropriate • Remove employee from direct contact until determined unnecessary • Other measures as necessary • The Department shall resolve any disagreements

42. (E) Alleged Criminal Acts • Immediate reporting to law enforcement • Allegations of Abuse including Misappropriation and Neglect which may constitute a criminal act • The county board ensures notification has been made

43. (F) Abused or Neglected Children • Allegations of Abuse or Neglect per Ohio Revised Code 2151.03 and 2151.031 • Under the age of 21 • Report to local public children’s agency • The county board shall ensure reports have been made

44. (D)(5) Immediate to 4 Hour Reporting • Provider or county board as a provider • Using county board identified system for MUIs • Report incidents or allegations of: • Abuse • Neglect • Exploitation • Misappropriation • Suspicious or accidental death • Media inquiries

45. (D)(10) • County board shall have a system available 24-7 to receive and respond to reports. • MUI notification numbers: • During business hours (8am–4:30pm M-F) Craig Hill (740) 203-3608 Angie Rayburn (740) 203-5812 • After hours (4:30pm-8am), weekends, and holidays: (740) 272-2812

46. (G)(1) Notifications Upon Awareness of an Incident • To be made by provider or county board as a provider • Made the same day • Include immediate actions taken • Guardian, advocate, or person identified • SSA for individual • Licensed or certified residential provider • Staff or family in the home

47. (G)(2)-(4) • Notifications or effort to notify shall be documented • The county board ensure notifications have been made • Do not notify the PPI, PPI’s spouse, or significant other • Not needed if the report came from person to be notified or in the case of death where the family is already aware

48. (D)(4) County Board Upon Notification Shall: • Ensure reasonable measures are appropriate • Determine if additional measures are needed

49. (D)(6) Submit Written Incident Report by 3:00 p.m. the Next Working Day • Agency providers, individual providers, and county boards as providers • Department prescribed format: DCBDD IRF is included in training packet • Fax #: (740) 548-6798 or use our direct lines Attn: MUI Investigative Agent • Find out appropriate SA fax number • DCBDD IA and SA must have report by 3pm the next working day – do not use postal service or inter-office mail; if fax is not available, hand delivery is suggested

50. (G)(5) Notification to Providers When PPI Works for Multiple Providers • The Department makes these • Alleged crimes • The other provider determines if steps are needed to ensure health and safety • Notification of case disposition • Providers, county boards, developmental centers to notify the Department if the PPI works elsewhere in the system