Understanding the MUI Reporting System

ALPHABET SOUP! Here are some commonly used acronyms relating to MUIs… MUI – MAJOR UNUSUAL INCIDENT UI – UNUSUAL INCIDENT OIR – OFFICE OF INCIDENT REVIEW ITS – INCIDENT TRACKING SYSTEM IA – INVESTIGATIVE AGENT “INDIVIDUAL” – PERSON RECEIVING SERVICES PPI – PRIMARY PERSON INVOLVED DODD OR “THE STATE” – OHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES

What is a Major Unusual Incident (MUI)? A MUI is … the alleged, suspected or actual occurrence of an incident that adversely affects the health and welfare of an individual. MUIs are defined by very specific criteria in Ohio Administrative Code: 5123: 2-17-02.

How is a MUI different than a UI (unusual incident)? Unusual Incidents are incidents that are not consistent with daily routines or care of that person but do not meet the criteria for a MUI. **You are not responsible for determining what is a UI or a MUI. Your responsibility is to report the incident.**

What is the purpose of the MUI system? The MUI system is set up to… Document an incident that impacts health and welfare. Identify what caused an incident to happen. Develop a prevention plan to reduce the likelihood of it happening again to that person or other people. To see trends that are affecting the people we are serving so we can address them. To improve the system for everyone who receives services.

Who is required to report MUIs? All providers who are contracted, certified or licensed to serve persons with developmental disabilities are required to report MUIs to the county board. **Everyone in this room is required to report.**

How and to whom are MUIs reported? You will follow camp policies and procedures but the county board receives reports at: Rebekah Lyons(Intake) 513-867-5992 Fax 513-887-8028 After Hours 513-867-5913 DODD Reporting Hotline: 1 (866) 313-6733

When An Incident Occurs TAKE ACTION/INTERVENE Make sure everyone is safe including all at risk individuals. Provide first aid/CPR if needed. Call 911 if needed. Contact the nurse to check anyone who may be hurt or ill. Separate the person/others from what caused them harm. Take any other actions necessary.

What next? AFTER everyone is safe… FOLLOW YOUR AGENCY’S REPORTING PROCEDURES. COMPLETE AN INCIDENT REPORT: Include who, what, where & when. Include what you did to ensure health and safety. List all witnesses. Give as much information as possible. You should complete an incident report if you see an incident or an allegation is reported to you.

Provider’s Responsibilties… Take immediate action to protect the health and safety of the person and anyone else at risk. Notifies legal guardian (same day). Notifies the county board immediately (no later than 4 hours) of Abuse, Neglect, Misappropriation, Exploitation, Suspicious or Accidental Death. Notifies the police or children’s services when there is an alleged crime. Sends a written report to the county board by 3:00 p.m. of the next working day. Develops preventative measures to reduce the chance of something happening again.

County Board’s Responsibilities… Ensures provider requirements were completed. Submits a report on DODD’s incident tracking system (ITS) by 3:00 p.m. the next working day following notification. Completes an investigation/review of the incident. Sends a summary letter to legal guardian and home provider 5 calendar days after the case has been recommended for closure by the county board. Makes sure preventative measures were created and implemented to reduce the chance of an incident happening again.

MUI DEFINITIONS… There are two types of MUIs: Protocol- Where there is an allegation against someone (the PPI) which is substantiated or unsubstantiated. Non-protocol- There is no allegation (no PPI) but it meets the definition for a MUI. A review of the incident is completed, and a summary is completed, but there is no (un)substantiation.

Protocol Cases Physical Abuse Exploitation Sexual Abuse Failure to Report Verbal Abuse Peer to Peer Acts Neglect Rights Violation Misappropriation ALL protocol cases for individuals receiving services are filed regardless of location and regardless of whether or not a provider was present.

Physical Abuse Use of physical force that can reasonably be expected to result in physical harm.

Sexual Abuse Unlawful sexual contact/conduct. To include public indecency, importuning, and voyeurism.

Verbal Abuse Purposefully using words or gestures to threaten, coerce, intimidate, harass or humiliate an individual.

PREVENTING ABUSE Avoid power struggles. It isn’t about “winning.” Keep you tone and language professional. Stay calm and know your own limitations. Ask someone to step in to assist if you need a break. Watch for signs of increasing frustration/anger in other staff and step in to assist if needed.

NEGLECT When there is a duty to do so, failing to provide an individual with any treatment, care, goods, supervision or services necessary to maintain health & safety.

PREVENTING NEGLECT Be aware of the person’s needs. Do they require specific care, services or supervision? If you aren’t sure, ask. Never hesitate to seek medical attention. It is better to err on the side of caution. “Better safe than sorry.” Be extra vigilant at meal times, during higher risk activities (swimming/boating) and during transitions. Pay close attention to symptoms of sunburn, heat exhaustion, dehydration, stings/bites, etc.

Misappropriation and Exploitation The unlawful or improper act of using an individual or an individual’s resources for monetary or personal benefit, profit, or gain. MISAPPROPRIATION Depriving, defrauding or otherwise obtaining the property of an individual through means prohibited by law.

Failure to Report Is when a required reporter fails to report a situation when there is a reasonable risk of harm to the individual.

REPORT, REPORT, REPORT! If you know it, you own it. If someone reports an allegation to you or if you witness an allegation, you are responsible to report it. Failing to do so could place an individual at risk of harm and you at risk of being the PPI in a Failure to Report MUI. If in doubt, write it out. Don’t know if something is a MUI? Don’t know if an allegation is true? It doesn’t matter. Report any allegations as well as ANYTHING suspicious or that just “doesn’t seem right” and we will sort out what needs to happen from that point.

PEER TO PEER ACTS Physical Abuse –with intent to harm. Verbal Abuse – with intent to intimidate, harass or humiliate. Sexual Abuse. Exploitation. Intentional Misappropriation – of property of significant value.

Rights Violation A Rights Violation that creates a reasonable risk of harm to the Health and Safety of the individual. **More detailed information regarding rights is addressed later in this training.**

Abuser Registry What is it? The Abuser Registry was established by law. It prevents people from working with individuals if they have committed acts of abuse, neglect, misappropriation, failure to report, and/or prohibited sexual relations by placing them on a list of people prohibited from working in this field. Offenses must meet specific criteria for placement on the Abuser Registry.

Non-Protocol Cases Attempted Suicide Unapproved Behavior Support Death Unscheduled Hospitalization Missing Person Law Enforcement Significant Injury Medical Emergency Non-protocol cases are only filed if the individual is a county operated program or with a licensed provider at the time of the incident (except death cases which are ALL filed).

Attempted Suicide Actual physical attempt that results in emergency room treatment, in-patient observation, or hospital admission.

Death Due to any cause.

Missing Person An individual is considered to be a missing person when: They cannot be located in an immediate search of the surrounding area. Circumstances indicate that they may be in immediate jeopardy. Law enforcement assist in the search.

Known Injury Of known origin that has a significant impact on the individual’s health.

Unknown Injury Any injury of an unknown origin that requires treatment that only a physician, physician assistant, or nurse practitioner can provide.

Medical Emergency Sudden onset of a medical condition that requires emergency medical intervention in order to save an individuals life. Such as Heimlich maneuver, CPR, etc.

Unapproved Behavior Support Any method that is aversive or implemented without approval by the human rights or behavior support committees, or without informed consent, which may adversely affect the health and safety of the individual.

Unscheduled Hospitalization Any hospital admission that is not scheduled as a part of a person’s medical condition and not included in ISP.

Law Enforcement Filed when an individual who receives services is: Arrested Charged Incarcerated

LAW ENFORCMENT SUPPORT FOR VICTIMS WITH DEVELOPMENTAL DISABILITIES

Training BCBDD staff have been providing training to several law enforcement jurisdictions in Butler County Possible ways to identify a person with a disability How to support them when coming in contact with them Who to contact with concerns

Prosecutor’s Office An Assistant Prosecutor has been assigned to handle cases for victims with a protected status (DD, elderly, etc.)

Collaboration with BCSO Since July 1st, 2017 Already improved cooperation and communication with local LE agencies in the county Better outcomes/resolution for cases that are criminal

EXPECTATIONS OF PROVIDERS SUPPORT COMPLIANCE

Provider Support New providers Website Community Resource Coordinator Existing providers Training (links on website and in person) Requests for specific training Identified needs for training

Provider Compliance Reviews are conducted for waiver providers a minimum of every 3 years may be done by a DODD reviewer or the CB reviewer Provider Compliance services for BC are provided by the COG Special Reviews can be done when issues arise Reviews are shared with the SSA to address identified needs in the Service Plan A Plan of Correction is required for deficient areas The Review is not closed until the POC has been verified

Medication Administration Quality Assurance Reviews Reviews are conducted every 3 years for individuals who received assistance/support from paid staff to take medication BCBDD employs an RN for this specific mandated task

How can you support your family member to stay safe? Promote self-determination People with greater self-determination are: Healthier More independent More well-adjusted Better able to recognize and resist abuse - Khemka, Hickson, & Reynolds, 2005; O’Connor & Vallerand, 1994; Wehmeyer & Schwartz, 1998

Encourage them to speak up At the time if something is occurring If something doesn’t feel right Teach them it’s ok to trust their gut Promote safety Internet/Social Media Financial Assist with running a credit report

Consider a self defense course or safety awareness training Become involved with your local LE agency and fire department Complete a Police Alert Form to share pertinent information about your family member

QUESTIONS? Karen Bessette, Quality Assurance Director Butler County Board of DD (513) 785-4677 ksbessette@butlerdd.org