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Pipeline Weekly

Feb 29
Part 2-MUIs: Ensuring Health and Safety

sdfdsfsdf.pngThe health and safety of the individuals served is the first priority for Ohio's DD system, and it is something that we all play a role in – individuals, families, friends, providers, and staff. This is the second article in a series about one process that was put into place to help with that – Major Unusual Incidents (MUI). Read through the series to learn more about the MUIs process, and steps you can take to help ensure individuals' health and safety.

Investigating MUIs

As we learned in the first article, MUIs: Ensuring Health and Safety, MUIs must be reported within four or 24 hours of discovery, depending on the category of the MUI. So what happens once an MUI is reported?

What is an MUI investigation?

An MUI investigation is an administrative investigation – in this case, administrative investigation means the gathering and analysis of information related to a major unusual incident so that appropriate action can be taken to address any harm or risk of harm and prevent recurrence. An administrative investigation is different than a law enforcement investigation.

Who investigates MUIs?

MUIs are investigated by Investigative Agents (IA). IAs are certified by DODD, and have extensive training in investigative procedures and practices. Training occurs when an IA is hired, and annually thereafter.

Most MUIs are investigated by the County Board – each County Board employs IAs. DODD conducts investigations when there is a potential for conflict for the County Board, such as when a County Board employee is involved. DODD IAs follow the same procedure as County Board IAs.

What's the process?

When a reportable incident occurs:

  1. The incident is reported to the County Board by phone or online. Incidents must be reported within 24 hours; the requirement is four hours for MUIs in the categories if of Abuse, Neglect, Misappropriation, Exploitation, and Suspicious Death.
  2. The County Board enters a report in the Incident Tracking System (ITS), and takes action to ensure immediate protection from harm for the individual served as well as any other at-risk persons. This may include medical attention, placing the Primary Person Involved (PPI – or alleged perpetrator) on leave, and making appropriate notifications to law enforcement, children's services, and the individual's guardian and Service and Support Administrator (SSA). DODD intake personnel review incidents the same day they are entered in to ITS to ensure this occurs.
  3. The County Board IA investigates the case. Investigations include interviews with the individual, interviews with witnesses, visits to the location, gathering a personal history of the individual (medical and psychiatric diagnoses, medications, behavioral history, background, previous MUIs), and gathering documentation such as police reports and coroner's reports.
  4. The IA submits the final report to DODD via ITS. DODD's Regional Manager reviews the report to ensure that a thorough and complete investigation has occurred, causes and contributing factors have been identified, an appropriate prevention plan addressing cause and contributing factors has been implemented, and patterns and trends have been effectively addressed.
  5. Once all criteria has been met, the DODD Regional Manager closes the case.

What are the key components of an investigation?

There are two important components to every investigation:

  • Causes and contributing factors: What caused the incident to occur? There can be multiple causes and contributing factors that can be either directly controlled, or indirectly controlled by responding to the factor. Examples of causes and contributing factors include inadequate supervision levels, a lack of training, missed meals or medication, missed medical appointments, cable service being disrupted, peers spending too much time together, and individuals needing to be redirected from activities. It's important to identify everything that led up to the MUI.
  • Prevention plan: What steps can keep a similar incident from occurring in the future? Prevention plans are proactive, and include comprehensive steps to reduce the risk of the same type of event from occurring again. Examples of prevention plans include retraining staff, updating procedures, counseling for individuals, scheduling activities and meals at different times, increased supervision, and skill training for individuals. 

It's important to note that every MUI investigation includes these components – even in MUIs that weren't substantiated, or where the individual wasn't harmed. This is important because it helps the DD system understand where there is the potential for harm, and ways to prevent harm in the future. This is why quality reporting, or reporting every suspected, alleged, or actual occurrence, is a critical part of the system.

What's the timeframe for an investigation?

All MUI investigations must be completed within 30 working days. IAs can apply for an extension – extensions are granted under extenuating circumstances such as waiting for a law enforcement investigation or children's services investigation to be completed (criminal investigations take precedence over administrative investigations), waiting for a coroner's report, extra work needs to be done on a prevention plan, or multiple interviews have to be conducted and can't be completed within the established timeframe.

What are the outcomes of an MUI?

MUIs are an opportunity to learn and get better by identifying causes and contributing factors, and completing the prevention plan. Every MUI, whether or not it was substantiated or the individual was harmed, helps us understand what steps can be taken to ensure the well-being of individuals.

For the few most serious cases, a person can be added to the Abuser Registry, which bans them from working in the system for life. The Registry – which is publicly available – is one of the six required items on background investigations for staff; a criminal conviction is not required to add someone to the Registry. Also, DODD supports the prosecution and conviction of abusers by advocating for prosecution, and working with law enforcement and the court system through the investigative process and criminal proceedings.

If a provider shows a pattern of substantiated significant MUIs that could easily have been prevented, DODD may require a plan of correction as part of a special compliance review. If issues aren't addressed, DODD can move to suspend admissions and revoke the provider's certification.

Who needs to know about MUIs?

When an MUI is discovered, providers are required to notify the individual's guardian or representative, the Service and Support Administrator, and staff and/or family living with the individual who are responsible for their care.

If an MUI is a criminal act, such as abuse, neglect, and misappropriation, local authorities also must be notified. This includes local law enforcement or the Ohio State Patrol, and children's services.

What do parents/guardians receive at the conclusion of the MUI?

Once an investigation is complete, the County Board will share the outcome with parents/guardians. The parent or legal guardian can request a copy of the complete investigation report.

Can anyone look at MUI reports? Who else has eyes on the system?

MUI reports are excluded from public records under the Ohio Revised Code. This is because MUI reports are like medical records, and include a lot of private health information such as medical and psychiatric diagnoses, medications, and behavioral history. They also include information that can be used to identify and individual, such as an individual's current and previous living arrangements and work information. Keeping MUI records private protects an individual's privacy. It also encourages people to report alleged or suspected MUIs, rather than waiting until they are certain there is wrongdoing. 

There are many people who have access to MUI reports outside of Ohio's DD system, including guardians, law enforcement and prosecutors, State agencies such as the Ohio Department of Medicaid, and Disability Rights Ohio (Ohio's independent, non-profit advocacy organization). These groups regularly review specific cases as well as comprehensive data. These checks and balances ensure that the system is working effectively.

How do I report an MUI?

You should report MUIs to your County Board by calling your County Board's MUI hotline. If you don't feel comfortable reporting the MUI to your County Board, you can report the MUI to DODD by calling 866-313-6733 or by completing the DODD online complaint form.

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