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Investing in Consumer Safety: Prioritizing the Tasks

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Incidents not impacting consumer safety are handled ... Review & revise MOU with Protection & Advocacy. Developing data analytics for consumer safety ... – PowerPoint PPT presentation

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Title: Investing in Consumer Safety: Prioritizing the Tasks


1
Investing in Consumer Safety Prioritizing the
Tasks
  • Mental Health Commission
  • March 8, 2007

2
Overview
  • Prioritization results
  • Analysis framework
  • Action Strategies From recommendations to work
    plans
  • Next steps

3

4

5
  • Information management data systems to track
    safety
  • About consumer safety data analytics, not
    building a high-cost information management
    system
  • Already committed prioritized

6
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

7
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

8
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.

9
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

10
Legislation similar to Elder Abuse
  • Impact 1 Prevention

11
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

12
Redundant Failsafe Reporting
  • Impact 2 Rapid Response

13
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

14
Formal Ties with Hotlines
  • Impact 2 Rapid response

15
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

16
Fines Penalties for Failure to Report
  • Impact 2 Rapid response

17
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

18
Civil Immunity Job Performance Discussions
  • Impact 1 Prevention

19
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

20
Training for Consumers Families
  • Impact 2 Rapid response

21
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

22
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

23
DMH Provider Staff Training
  • Impacts 1 2 Prevention rapid response

24
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

25
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
    functions…The 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

26
Triage Use of External Resources
  • Impact 2 Rapid Response

27
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

28
Background Checks
  • Impact 1 - Prevention

29
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

30
Increase Supervisory Accountability
  • Impact 1 - Prevention

31
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

32
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

33
Death Review
  • Impact 1 Prevention

34
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

35
Root Cause Analysis
  • Impact 1 - Prevention

36
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

37
After Hours Monitoring Leadership
  • Impact 1 Prevention

38
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

39
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

40
DMH LC Review Rulemaking
  • Impact 2 Early identification rapid response

41
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

42
Ombudsman Program
  • Impact 2 Rapid Response

43
Next Steps
  • Detailed work plans timeframes
  • Quarterly updates progress reports
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