1. 1

2. 2 What is a Serious Incident Any event affecting a child or a program ’ s operation that is potentially of serious consequence is considered a serious incident. All serious incidents will be reported in TFACTS by DCS staff or provider staff in accordance with DCS policy.

3. 3 Why do we need to report SIRS? Best practice and program fidelity compel DCS contract agencies and DCS to record and track incidents for the children they serve. Tracking incidents provides agencies and the Department with both quantitative and qualitative data to monitor and support program efficacy.

4. Incident Types Abduction Abuse or neglect Arrest of child or youth Arrest of parent, surrogate or staff person Assault Contraband Emergency Mental Health Services Emergency/ Urgent Medical Treatment Emergency Use of Psychotropic Medication(s) 4

5. Incident Types Major Event at Agency Mechanical Restraint Medication Error Physical Restraint Runaway (off facility property and out of physical sight or staff) Seclusion 5

6. Subtypes In addition to incident types some incidents have sub types. For example: The incident assault has a sub type of with or without injury. Incidents with a subtype might also have a subtype. IncidentOwnerSub-type-1Sub-type-2 Emergency Use of Psychotropic medication(s) Heath Advocacy NurseAcute psychotic episode Acute behavioral outburst Seclusion and restraint Other (detail below) Oral medication (list medication name and dose below) Injection (list medication name and dose below) See chart at the end of the presentation for a complete list of sub- types 6

7. Abduction A child (or youth) is taken from the placement by unauthorized individuals (i.e. alleged perpetrators of abuse, non- custodial parents or relatives). This category does not apply to incidents of runaway. Subtypes Abducted by stranger Abducted by associate Abducted by case manager Abducted by caregiver Abducted by parent or guardian Abducted by non-custodial parent Abducted by other For further information regarding this type of incident contact Central Intake 1-877-237-0004 7

8. Abduction Case Example Biological parent has an unsupervised visitation with the custodial child. The child was not returned at the appointed time. When called parent refused to return them. This would be reported under Abduction : Abduction by Parent or Guardian 8

9. Abuse or Neglect A DCS or contract agency staff member or any person in contact with the youth is alleged to have physically, sexually or verbally abused a child or youth. Subtypes Environmental neglect Nutritional neglect Lack of supervision Abandonment Sexual contact Adult on child Child on child Drug exposed infant or child Psychological harm/trauma Physical Clarification: All situations of sexual contact should be reported even if the child/youth states it is consensual. For further information regarding this type of incident contact Central Intake 9

10. Abuse or Neglect Case Example Custodial child reports that she and her boyfriend had consensual sex. This should be reported under Abuse and Neglect: Child on Child. Be sure to include all know information in the narrative. Staff does not decide whether or not abuse has occurred but is required to file SIR. 10

11. Arrest of child or youth A child or youth is arrested while in the custody or control of DCS, and the arrest has been confirmed by a law enforcement agency. For further information regarding this type of incident contact Regional Management 11

12. Arrest of parent, surrogate or staff The arrest of a DCS or a contract agency staff member, including foster parent or others affiliated with the youth and/or family, and has been confirmed by a law enforcement agency. For further information regarding this type of incident contact Internal Affairs Subtypes Outside facility and licensing practice During employment Clarification: The arrest of a parent or surrogate speaks specifically to DCS or provider placement. 12

13. Assault A willful and malicious attack by a child/youth on another person (this is not meant to include horse-play) Clarification: Assault is a physical attack done by the child/youth, not by caregiver/staff (see abuse/neglect). It is not a verbal threat. This does not include sexual contact (see abuse/neglect). Subtypes With injury Without injury For further information regarding this type of incident contact DCS Regional Management 13

14. Contraband - Any item possessed by a child/youth or found within the placement location that is prohibited by law or by the rules/regulations of the placement location and is rationally related to legitimate security, safety or treatment concerns. Subtypes Tobacco Alcohol Illegal Drugs Prescription Drugs Drug Paraphernalia Weapon Pornographic Materials Other (specify) Clarification: Each incident of contraband should be reported. For further information regarding this incident type contact DCS Regional Management 14

15. Emergency Medical Treatment A child/youth has been injured or has suffered an illness that requires emergency medical attention. (When a child/youth receives emergency medical treatment, the child or youth's custodial adult must be notified.) Subtypes Injury - accidental Injury - non- accidental Illness - ongoing Illness - sudden onset Outside medical clinic evaluated/treated and released the child/youth Agency medical staff evaluated/treated and released the child/youth Contact with PCP prior to ER visit (child/youth evaluated/treated and released) No Contact with PCP prior to ER visit (child/youth evaluated/treated and released) Hospitalization Clarification: This is an unplanned emergency event. A scheduled surgery would not be considered emergency medical treatment. For further information regarding this incident type contact DCS Regional Nurse 15

16. Emergency Use of Psychotropic Medication An emergency one-time dose of a psychotropic medication in the event of a psychiatric emergency, when all other measures have been determined unlikely to prevent the child/youth from imminent harm to self and/or others. Subtypes Acute psychotic episode Acute behavioral outburst Seclusion and restraint Other (detail below) Oral medication (list medication name and dose below) Injection (list medication name and dose below) For further information regarding this incident type contact DCS Regional Nurse 16

17. Major Event at Agency An event causing a significant disruption to the functioning of the program or necessitating a call to an emergency official. Subtypes Police Fire Evacuation Riot Other For further information regarding this incident type contact child placement private provider Clarification: Anytime the police are called to an agency/placement the incident should be reported. Some examples would include, if the police are called to assist with the de-escalation of a youth or if a youth is involved in a traffic stop. 17

18. If a youth sets off the sprinkler system at a residential facility and it floods an entire wing of the facility, which causes several youth to be moved to another location in the building, that would be a Major Event at an Agency/Flood.

19. Mechanical Restraint The use of a mechanical device that is designed to restrict the movement of an individual. Subtypes Security and Control Psychiatric Crisis Other (detail below) 4-Point 5-Point Handcuffs Anklets Ankle cuffs Other (detail below) Restraint chair Chains For further information regarding this incident type contact DCS Regional Psychologist DCS Policy 27.1 Please add in the narrative any information how policy was adhered to. 19

20. Medication Error A medication error is when a medication is not administered according to the prescribing provider’s orders and/or according to DCS policy and procedure. Subtypes No harm Increased monitoring, no harm Medical treatment/hospitalization, potential temporary harm Near death/death, permanent harm Medication unavailable Failed to administer medication Child/youth refused medication for at least 48 hours Child/youth hid (cheeked) medication Wrong Dose Wrong Medication Wrong Time Expired Medication No Informed Consent Medication missed on pass Clarification: Refer to Provider Policy Manual for more information on medication refusals. *Only submit one incident when it is discovered after the fact that multiple medication errors have occurred on consecutive days. For further information regarding this incident type contact DCS Regional Nurse 20

21. Mental Health Crisis A child or youth has engaged in or experienced: self injurious behavior; suicidal ideation or behavior; homicidal ideation or behavior or acute psychotic episode. Subtypes Mobile crisis phone Mobile crisis face to face ER staff - non-mobile crisis Intervention by in-house agency clinician/therapist Hospitalization for acute psychiatric reasons ER evaluated/treated and released the youth Hospitalization for medical reasons (put hospital name below) Agency medical staff evaluated/treated and released the youth Outside medical clinical evaluated/treated and released the youth For further information regarding this incident type contact DCS Regional Psychologist 21

22. Physical Restraint The involuntary immobilization of a child/ youth without the use of mechanical devices. Subtypes No injury to youth Injury to youth - Agency medical staff evaluated/treated & released Injury to youth - Outside medical clinical evaluated/treated and released Injury to youth - Emergency Room evaluated/treated and released Injury to youth - Youth hospitalized for injuries Duration 0 - 14 minutes Duration 15 - 30 minutes Duration over 30 minutes For further information regarding this incident type contact DCS Regional Psychologist DCS Policy 27.3 Please add in the narrative any information regarding how policy was adhered to. 22

23. Runaway Child or youth leaves a program without permission and their whereabouts are unknown or not sanctioned. For further information regarding this incident type contact Absconder Recovery Unit DCS Policy 27.10 Please add in the narrative any information regarding how policy was adhered to. 23

24. Seclusion The placement or confinement of an individual alone in a locked room or egress is prevented. Subtypes Duration 0 - 30 minutes Duration 31 - 60 minutes Duration over 60 minutes (detail below) For further information regarding this incident type contact DCS Regional Psychologist DCS Policy 27.2 If a child/youth is place in any room that the exit is prevented or block that would be considered seclusion. 24

25.  When multiple incident categories arise out of a single event, please use the Prioritization Tier Chart (provided on the next slide) as a guide to aid your reporting, along with discretion according to the facts of the incident.  The Prioritization Tier Chart reflects through tiers and ranking an attempt to assist in prioritizing incidents according to frequency and accountability; they are not ranked for severity, as the severity is discretionary based on events.  If the incident and concurring events fall under more than one type within a Tier, please use your discretion as related to the facts of the case, and provide detail in the narrative.

27. Abduction A child (or youth) is taken from the placement by unauthorized individuals (i.e. alleged perpetrators of abuse, non-custodial parents or relatives). Abuse or Neglect A DCS or contract agency staff member or any person in contact with the youth is alleged to have physically, sexually or verbally abused a child or youth. Arrest of child or youth A child or youth is arrested while in the custody or control of DCS, and the arrest has been confirmed by a law enforcement agency. Arrest of parent, surrogate or staff The arrest of a DCS or a contract agency staff member, including foster parent or others affiliated with the youth and/or family, and has been confirmed by a law enforcement agency. Glossary 27

28. Glossary Assault A willful and malicious attack by a child/youth on another person (this is not meant to include horse-play) Contraband - Any item possessed by a child/youth or found within the placement location that is prohibited by law or by the rules/regulations of the placement location and is rationally related to legitimate security, safety or treatment concerns. Sub-Type 1 Categories with Severity Ratings Tobacco - 2 Alcohol - 2 Illegal Drugs - 3 Prescription Drugs - 2 Drug Paraphernalia - 2 Weapon - 3 Pornographic Materials - 3 Other (specify) - 3 28

29. Glossary Emergency Medical treatment A child/youth has been injured or has suffered an illness that requires emergency medical attention. (In an instance of treatment of a child or youth, the child or youth's custodial adult must be notified. Emergency Use of Psychotropic Medication An emergency one-time dose of a psychotropic medication in the event of a psychiatric emergency, when all other measures have been determined unlikely to prevent the child/youth from imminent harm to self and/or others. Major Event at Agency An event causing a significant disruption to the functioning of the program or necessitating an emergency official is called. Mechanical Restraint The use of a mechanical device that is designed to restrict the movement of an individual. Mechanical restraints shall be defined as handcuffs, chains, anklets, or ankle cuffs, or any other DCS approved or authorized device. 29

30. Glossary Medication Error A medication error is when a medication is not administered according to the prescribing provider’s orders and/or according to DCS policy and procedure. Mental Health Crisis A child or youth has engaged in or experienced: self injurious behavior; suicidal ideation or behavior; homicidal ideation or behavior or acute psychotic episode. Physical Restraint The involuntary immobilization of an individual without the use of mechanical devices; this includes escorts where the youth is not allowed to move freely. Runaway Child or youth leaves a program without permission and their whereabouts is unknown or not sanctioned. Seclusion The placement or confinement of an individual alone in a locked room or egress is prevented. 30

31. SIR Incidents and Sub-Types IncidentOwnerSub-type-1Sub-type-2 Abduction Central IntakeAbducted by stranger Abducted by associate Abducted by case manager Abducted by caregiver Abducted by parent or guardian Abducted by non-custodial parent Abducted by other Abuse or neglect Central IntakeEnvironmental neglect Nutritional neglect Lack of supervision Abandonment Sexual contactAdult on child Child on child Drug exposed infant or child Psychological harm/trauma Physical Assault Regional ManagementWith injury Without injury 31

32. IncidentOwnerSub-type-1Sub-type-2 Emergency Medical Treatment Heath Advocacy NurseInjury - accidental Injury - non-accidental Illness - ongoing Illness - sudden onset Hospitalization Outside medical clinic evaluated/treated and released the child/youth Agency medical staff evaluated/treated and released the child/youth Contact with PCP prior to ER visit (child/youth evaluated/treated and released) No Contact with PCP prior to ER visit (child/youth evaluated/treated and released) 32

33. IncidentOwnerSub-type-1Sub-type-2 Physical Restraint Heath Advocacy PsychologistNo injury to youth Injury to youth - Agency medical staff evaluated/treated & released Injury to youth - Outside medical clinical evaluated/treated and released Injury to youth - Emergency Room evaluated/treated and released Injury to youth - Youth hospitalized for injuries Duration 0 - 14 minutes Duration 15 - 30 minutes Duration over 30 minutes Contraband Regional ManagementTobacco Alcohol Illegal Drugs Prescription Drugs Drug Paraphernalia Weapon Pornographic Materials Other (specify) 33

34. IncidentOwnerSub-type-1Sub-type-2 Major Event at Agency Child Placement and Private ProviderPolice Fire Evacuation Riot Other Arrest of child or youth Regional ManagementNone Arrest of parent, surrogate or staff personInternal Affairs Outside facility and licensing practice During employment 34

35. IncidentOwnerSub-type-1Sub-type-2 Medication Error Heath Advocacy NurseNo harm Increased monitoring, no harm Medical treatment/hospitalization, potential temporary harm Near death/death, permanent harm Medication unavailable Failed to administer medication Child/youth refused medication for at least 48 hours Child/youth hid (cheeked) medication Wrong Dose Wrong Medication Wrong Time Expired Medication No Informed Consent Medication missed on pass 35

36. IncidentOwnerSub-type-1Sub-type-2 Mental Health Crisis Heath Advocacy PsychologistMobile crisis phone Mobile crisis face to face ER staff - non-mobile crisis Intervention by in-house agency clinician/therapist Hospitalization for acute psychiatric reasons ER evaluated/treated and released the youth Hospitalization for medical reasons (put hospital name below) Agency medical staff evaluated/treated and released the youth Outside medical clinical evaluated/treated and released the youth Emergency Use of Psychotropic medication(s) Heath Advocacy NurseAcute psychotic episode Acute behavioral outburst Seclusion and restraint Other (detail below) Oral medication (list medication name and dose below) Injection (list medication name and dose below) 36

37. IncidentOwnerSub-type-1Sub-type-2 Mechanical Restraint Heath Advocacy PsychologistSecurity and Control Psychiatric Crisis Other (detail below) 4-Point 5-Point Handcuffs Anklets Ankle cuffs Other (detail below) Restraint chair Chains Seclusion Heath Advocacy PsychologistDuration 0 - 30 minutes Duration 31 - 60 minutes Duration over 60 minutes (detail below) Runaway (off facility property and out of physical sight of staff) Absconder Recovery UnitNone 37