Lucas County Board of Developmental Disabilities

1. MUI Rule Training Lucas County Board of Developmental Disabilities Lucas County Board of Developmental Disabilities

2. Mission 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. Lucas County Board of Developmental Disabilities

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

4. Unusual Incidents "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. Lucas County Board of Developmental Disabilities

5. Unusual Incidents Continued 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. Lucas County Board of Developmental Disabilities

6. MUI Means…. Major Unusual Incident 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 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. 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. 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. Physical Abuse What does it look like?

11. 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. 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. 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. 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. Verbal Abuse Purposeful use of words or gestures, or other communicative means Threaten, coerce, intimidate, harass, humiliate

16. 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. 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. 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. Death All deaths of individuals served Suspicious or accidental deaths require additional investigation

20. 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. 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. 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. Exploitation Unlawful or improper act Using individual Individual’s resources for personal benefit, profit, or gain

24. 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. 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. 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. 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. 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. 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. 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. 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. 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. Rights Code Violations Any violation of rights listed in Ohio Revised Code 5123.62 and it creates a reasonable risk of harm

34. 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. 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. 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. 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. 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. Attempted Suicide Physical attempt that: Results in ER treatment or Inpatient observation or Hospital admission

40. Medical Emergency Emergency medical intervention required to save one’s life Abdominal Thrusts, CPR, Epi pen usage, and IV for dehydration, etc.

41. 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. Significant Injury Known or Unknown cause Not Abuse or Neglect Requires: Immobilization or casting (including air casts) Five or more sutures or equivalent 2nd or 3rd degree burns Concussion Dislocation

43. Protocol C MUIs Law Enforcement Unapproved Behavior Supports Unscheduled Hospitalization

44. Law Enforcement Individual is charged (C) incarcerated (I) arrested (A)

45. 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. 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. 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. 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. 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 Consultations MUI Unit (419) 381-5206 WHEN IN DOUBT - CALL!

50. 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)