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Department Policy and Initiatives For Continuous Improvement of Services for the Health and Safety of Consumers
The Department's highest priority is the health and safety of all residents of developmental centers (DCs) and the protection and quality of care including ongoing efforts to assess, improve and enhance the provision of supports and services. In order to ensure these individuals are protected, the Department has a number of systems in place as safeguards and standards. These expectations extend beyond those required by regulation and legislation in order to ensure appropriate levels of supervision and support are provided at all times to meet the intensive service needs of the DC population.
In 2008 the Department underscored its Zero Tolerance policy, instituting increased reporting requirements regarding allegations of abuse, neglect and mistreatment.
This "Zero Tolerance" directive required:
- Annual training of all DC employees on the mandated reporter requirements.
- Increased methods to prevent abuse including background and fingerprinting of all DC employees prior to the offer of employment.
- Immediate removal of any employee alleged to have committed abuse or neglect Increased reporting requirements of the Office of Protective Services and to the local law enforcement.
- Investigation by the Office of Protective Services for all allegations of abuse, all deaths and serious injuries of unknown origin that are reported to outside law enforcement when the local law enforcement does not accept the case.
- A 'no exception' policy where any employee determined to have engaged in the physical or sexual abuse of a consumer will be terminated from employment with the Department and granted no reward on this action.
The reporting requirements for special incidents pursuant to WIC 4427.5 include a variety of reporting levels including the Office of Protective Services and outside law enforcement, as well as notifications to:
- The Family member, Conservator or Designated Authorized Representative and to the Clients' Rights Advocate/Human Rights Committee, and the involved Regional Center.
- The Developmental Centers Division (DCD) and notification to Department of Public Health Licensing and Certification and Other Agencies as appropriate.
Initiatives for Continuous Improvement
The Department is committed to the continuous improvement of DC services. Through a constant review of input received, lessons learned from past experiences, and changes in the consumer population the DC system is always responding and improving practices and policies to ensure the highest standard of quality care.
The DCs regularly participate in a number of planned and unplanned reviews of clinical practices and systems, such as the licensing surveys by the Department of Public Health (DPH), mock surveys by DDS headquarters teams, and contracted consultation with subject-matter experts who have nationwide experience. In addition, a variety of investigative processes are in place for closer examination of specific incidents when they occur. These resources and the feedback received generate important information about current services and are essential to the identification of areas for improvement.
The DC system provides intensive services to individuals who require a level of services and supports that are not available in other settings, and although the population continues to decrease as residents transition into community settings and fewer consumers are admitted into the state operated facilities, the needs of the DC population are changing. This requires adjustments in both service delivery and staff support.
From January 2008 through December 2011 the combined population for the four existing developmental centers and one community facility has reduced by approximately 20%, receiving an average of 100 new admissions per year. During this period of time, there has been a growth in the percentage of individuals with increased risk factors including persons with severe behaviors, autism, dual diagnosis (developmental disability and mental health condition), and vision and hearing deficits.
As the population becomes more focused in areas of medical and personal care needs and those with extensive behavioral support needs, so do the risk factors increase in relation to health and medical conditions and staff supervision to protect/prevent injury.
Additionally the DC population, not unlike our own communities, is an aging population with almost 50% of the population age 52 years or older, including 17% who are 62 years or older. As people age the need for increased supports are evident and the risks associated with health and support needs increase.
Data for the entire DC system population as of 2011 is as follows:
- 69% have severe to profound intellectual disability
- 60% are persons with a dual diagnosis (developmental disability and mental health condition) an increase of over 10% since 2008
- 46% have severe behavior conditions
- 54% require support to walk/move about their environment
- 45% of the total population have visual deficits
- 87% are persons with diagnosed medical conditions requiring treatment
In addition, 55% of the overall population has one or more special conditions or behaviors. Nearly half of this group has three or more special conditions. These special conditions include inappropriate sexual behavior, assaultive behaviors, attempted suicide, theft, vandalism or property destruction, a recent history of behaviors that could result or have resulted in fire setting. These conditions result in an increase in the level of activity at the DCs, including interactions between consumers that may contribute to recent increases in peer assaults noted by the Department. At the same time there has also been an overall decrease in the number of highly restrictive interventions (also known as restraints) used throughout the system. The Department will monitor and review regularly to assure continued focus on areas impacted by the special conditions of the population served.