Investing in Consumer Safety: Prioritizing the Tasks

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Investing in Consumer SafetyPrioritizing the
Tasks

• Mental Health Commission
• March 8, 2007

2
Overview

• Prioritization results
• Analysis framework
• Action Strategies From recommendations to work
  plans
• Next steps

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4

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• Information management data systems to track
  safety
• About consumer safety data analytics, not
  building a high-cost information management
  system
• Already committed prioritized

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Already underway

• Separated internal authority for investigative
  procedures from DMH legal counsel effective
  3/1/07
• Incidents not impacting consumer safety are
  handled administratively through disciplinary
  procedures
• Death reporting to law enforcement
  coroner/medical examiner
• Review revise MOU with Protection Advocacy
• Developing data analytics for consumer safety

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Senate Bill 3 encompasses

• Formal agreements with DHSS DSS hotlines
• Fines/penalties for failure to report A/N
• Civil immunity for discussion of individual
  consumer safety-related job performance
• DMH Fatality Review Board
• Allow public disclosure of non-confidential A/N
  information
• Creates abuse of vulnerable person similar to
  elder abuse statutes
• Redundant reporting pathways through use of DHSS
  DSS abuse hotlines
• Sprinklers

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Defining Impact

• Actions that either prevent consumer abuse
  neglect or improve consumer safety.
• Actions that result in rapid identification,
  reporting responses that
• Protect the affected consumer, and
• Identify individual or systemic solutions that
  make all consumers safer.

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Pursue Legislation Similar to Elder Abuse

• DMH shall pursue legislation to amend
  Sections 565.180, RSMo, et. seq., which pertains
  to the crime of elder abuse, to incorporate the
  crime of patient, resident, or client abuse or
  neglect of a Department consumer currently
  provided for in Section 630.155, RSMo.
• - Lt. Governors MH Task Force Report

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Legislation similar to Elder Abuse

• Impact 1 Prevention

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Redundant Failsafe Reporting

• Every DMH facility and residential
  service provider must be held responsible for a
  fail-safe methodology for timely reporting to
  CO. Such methods should include clear duality in
  the pathways through which this critical
  information flows. would allow for surveillance
  over the appropriate handling of such reports,
  and would protect against the information being
  dismissed or sequestered by administrators.
• - Building a Safer System, Mental Health
  Commission Report, August, 2006

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Redundant Failsafe Reporting

• Impact 2 Rapid Response

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Formal Ties with Hotlines

• DMH shall work with DHSS to establish formal
  ties to its adult abuse hotline with DSS for
  formal ties to its child abuse hotline, so that
  reporters of abuse and neglect of DMH consumers
  fully utilize those hotlines as another means of
  reporting abuse neglect.
• The Department shall then rigorously promote
  the use of these hotlines.
• - Lt. Governors MH Task Force Report

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Formal Ties with Hotlines

• Impact 2 Rapid response

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Fines Penalties for Failure to Report A/N

• DMH shall pursue legislation amend
  regulations that permit fines or other penalties
  against licensed, certified, or contracted
  entities for failure to report abuse and neglect,
  based upon organizational misconduct.
• - Lt. Governors MH Task Force Report

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Fines Penalties for Failure to Report

• Impact 2 Rapid response

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Civil Immunity Discussion of Consumer
Safety-Related Performance

• DMH shall pursue legislation providing
  civil immunity to providers DMH administrators
  allowing open discussion of individual job
  performance to make employment decisions that
  affect the safety of consumers. However, the
  legislation shall not protect reckless,
  misleading communication or intentional
  misstatements.
• - Lt. Governors MH Task Force Report

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Civil Immunity Job Performance Discussions

• Impact 1 Prevention

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Training for Consumers Families

• DMH and community providers shall develop
  standard individualized training for consumers
  and families on identifying and reporting abuse
  and neglect, including their responsibilities as
  permissive reporters.
• - Lt. Governors MH Task Force Report

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Training for Consumers Families

• Impact 2 Rapid response

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DMH Provider Staff Training

• DMH shall require standardized training based
  on best practices for all DMH and provider staff
  on identifying and reporting A/N.
• Law enforcement expertise should be utilized in
  the development of such training.
• DMH shall also standardize training protocol for
  investigators that includes review of policies
  and procedures, supervision levels, and training
  on the Safety First manual.
• a mentoring program for new investigators that
  will include teaming them with seasoned
  investigators.
• - Lt. Governors MH Task Force Report

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DMH Provider Staff Training

• As a matter of policy, a fixed proportion of
  facility operating expenses should be set aside
  for the exclusive purpose of supporting
  continuing education and training of staff.
• - Building a Safer System, Mental Health
  Commission Report, August, 2006

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DMH Provider Staff Training

• Impacts 1 2 Prevention rapid response

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Triage for Death Near Death Incidents with
Suspected A/N

• DMH shall develop a process for triage of
  incidents for joint investigation of all deaths
  or near deaths that are suspect for abuse or
  neglect, as well as incidents of physical assault
  sexual misconduct.
• procedural guidelines must be developed to
  allow for proper prioritizing of cases.
• This process should include notification of and
  cooperation with local law enforcement.
• - Lt. Governors MH Task Force Report

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Triage for Death Near Death Incidents with
Suspected A/N

• proper balance of investigative
  responsibility that incorporates external
  resources (such as law enforcement, outside
  consultants, or other Missouri departments, etc.)
  to supplement internal investigative
  functionsThe primary responsibility for
  investigation of most serious incidents related
  to abuse, neglect or client safety should be
  placed with external review mechanisms to
  eliminate the appearance of a conflict of
  interest.
• - Building a Safer System, Mental Health
  Commission Report, August, 2006

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Triage Use of External Resources

• Impact 2 Rapid Response

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Background Checks

• DMH shall amend its regulations to create
  a process to require providers to conduct
  background checks on all potential employees to
  determine whether the individual is the subject
  of a pending investigation or finalized abuse or
  neglect case involving disqualifying events and
  require the provider to take appropriate steps to
  provide consumer safety.
• - Lt. Governors MH Task Force Report

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Background Checks

• Impact 1 - Prevention

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Increase Supervisory Accountability

• A system needs to be implemented by which
  supervisors are consistently held responsible for
  the actions of staff under their supervisory
  authority. Supervisors must also be accountable
  for quality of service, their professionalism
  and the appropriateness of their human
  interactions with co-workers and clients.
• - Building a Safer System, Mental Health
  Commission Report, August, 2006

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Increase Supervisory Accountability

• Impact 1 - Prevention

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Death Review

• DMH shall craft a legislative proposal
  comparable to that which created Child Fatality
  Review Boards within the Department of Social
  Services. It would establish review of all deaths
  of adults who are in the care and custody of DMH.
  The board should include the expertise of
  pathologists or medical examiners, law
  enforcement, prosecutors, and advocates,
  including Missouri PA.
• - Lt. Governors MH Task Force Report

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Death Review

• All deaths in DMH funded facilities should be
  reported to a coroner or medical examiner. In
  addition, a dedicated DMH work-group supervised
  by the DMH Executive Team should review all
  deaths on a weekly basis and communicate any and
  all suspicious circumstances to the DMH E-team.
• - Building a Safer System, Mental Health
  Commission Report, August, 2006

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Death Review

• Impact 1 Prevention

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Root Cause Analysis

• DMH shall review completed investigations
  and explore Root Cause Analysis for complaints
  and issues which are recurring. Root Cause
  Analysis should include, but not be limited to
• examination of supervision levels and staffing
  and
• identification of facility system failures for
  both public and community based care.
• - Lt. Governors MH Task Force Report

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Root Cause Analysis

• Impact 1 - Prevention

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After Hours Monitoring Leadership

• Establish minimum requirements for
  facility directors to be present during night and
  weekend shifts in their respective facilities, as
  well as minimum requirements for unannounced site
  visits to all facilities.
• - Building a Safer System, Mental Health
  Commission Report, August, 2006

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After Hours Monitoring Leadership

• Impact 1 Prevention

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Redesign Licensure Certification for Community
Providers

• DMH shall redesign its process for licensure and
  review of community-based providers within the
  next 12 months. include a review of best
  practices from other states.
• Annual site visits mandatory.
• routine communication between Investigative Unit
  MRDD so facilities with increased numbers of
  allegations can be targeted for additional
  assistance in maintaining consumer safety.
• - Lt. Governors MH Task Force Report

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Legislation Rulemaking for LC

• The Department of Mental Health shall pursue
  legislation and amend regulations involving
  Licensure Certification to permit
  administrative actions, up to and including
  fines, for failure to implement plans of
  correction.
• - Building a Safer System, Mental Health
  Commission Report, August, 2006

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DMH LC Review Rulemaking

• Impact 2 Early identification rapid response

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Ombudsman Program

• Consumers, families their advocates
  should have access to both an internal external
  designated ombudsman whose responsibility is to
  independently collect complaints and reports of
  incidents, to preliminarily investigate those
  reports, and to provide summaries of the findings
  to both the DMH executive team MO PA.
  dedicated telephones should be readily available
  to consumers to allow unrestricted access for
  reporting to ombudsmen.
• - Building a Safer System, Mental Health
  Commission Report, August, 2006

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Ombudsman Program

• Impact 2 Rapid Response

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Next Steps

• Detailed work plans timeframes
• Quarterly updates progress reports