By Rebecca Kasey, CQL Director of Special Projects
Human services agencies have a great responsibility to promote freedom from abuse, neglect, mistreatment, and exploitation (ANME) for the people they support. Organizations develop prevention measures like improving staff screening and hiring procedures, providing better training to their staff, and educating people receiving services about ANME. Unfortunately, ANME still occur in the human services field and organizations must have thorough investigation procedures for these situations.
CQL | The Council on Quality and Leadership provides best practices to organizations with tools like the Basic Assurances® System and the Personal Outcome Measures® process. CQL’s Basic Assurances® guides organizations in how to ensure that allegations and substantiated cases of ANME are objective, prompt, and thorough with mechanisms for support after an incident occurs. Investigation requirements vary by state, but all staff members in human service agencies are mandated reporters.
This Capstone details how two different organizations, Opportunities for Positive Growth, Inc. and CHI Friendship, have each designed their investigation procedures. It also explores Personal Outcome Measures® data about ANME, and shares ways that support can affect ANME incidents.
Investigation Procedures from Accredited Organizations
The responses below are from two different organizations. Opportunities for Positive Growth, Inc. (OPG, Inc.) is accredited by CQL and is located in Fishers, Indiana. Elizabeth Garretson, OPG Inc.’s Director of Policy and Quality Management, answered questions about their procedures for internal investigations. CHI Friendship (Friendship) is also accredited by CQL and is located in Fargo, North Dakota. Dori Leslie, President, Carrie Balster, Director of Quality Assurance, Grant Fogel, Quality Assurance, and Ryan Orcutt, Director of Education collaboratively answered questions about Friendship’s procedures for internal investigations.
CQL: Please describe your investigation procedure.
OPG, Inc.: Once a report is received, the investigation process has five steps:
- Immediate suspension of the alleged perpetrator.
- Reporting and notifications to external agencies and stakeholders.
- The Lead Internal Investigator gathers evidence through interviews and a review of records, personnel, and personal files, as needed, to determine if a preponderance of evidence exists to support allegations.
- Findings and recommendations, which may be related to this specific situation or the organization, are reviewed by the CEO and CSO to determine actions..
- Follow-up with the person supported, the specific employee, and the organizational recommendations.
CHI Friendship: When a report of a suspected ANME incident is received:
- The first step Friendship does is ensure risk management has been completed. Risk management may include providing medical care/assessment, emotional support, reassignment of employees, immediate retraining, etc.
- The second step involves collecting all needed documentation such as incident reports, program plans, and employee training records.
- The third step involves conducting interviews and may include the person supported, Direct Support Professionals, QIDP, guardians/family members, and anyone else determined to have information involving the incident.
CQL: How has your investigation process changed over time?
OPG, Inc.: Our organization has been in business for about 25 years and a lot has changed in that time. There has been a consistent trend of increasing professionalism, transparency, and process refinement over the years. There have been many positive changes to the process and a formal and clear system has been put in place to support all people involved.
Investigations can be stressful for both people supported and employees. OPG, Inc. offers an Employee Assistance Program (EAP) that has proven to be an integral part of the action to improve the internal investigation process. The EAP at OPG, Inc. provides an array of resources and services to employees and their families. OPG, Inc. sent out our ‘Pursuit Newsletter’ describing these changes.
CHI Friendship: Friendship has seen changes over the past several years in the importance of providing annual training to people supported and mandated reporters in an upbeat format. Investigators have made themselves approachable by providing fun, lively, and upbeat annual trainings.
Friendship’s most recent ANME training was formatted as a daytime talk show. It involved a live studio audience (staff receiving the training). To involve the staff, they were prompted to cheer, clap, and boo throughout the presentation as if they were at a live show. Parts of the skit included a host, on-stage skirmishes being stopped by security, and more!
Many staff stated this was the best training yet, combining fun and relevant information to be equipped for these incidents. The investigators have incorporated other creative training methods such as a mock news program, skits, Jeopardy!, presidential debates, and many more. After the training is completed, all staff are required to complete a competency quiz.
CQL: How are staff members and the people you support informed on the use your investigation procedure?
OPG, Inc.: All staff at OPG, Inc. receive training on the investigation procedure, including the impact on their employment, during orientation and annual training. This information is clearly outlined in the policies and procedures, as well. Our website includes a page regarding Incident Reporting and Investigations that any member of the community can access. People supported, families, and guardians are reminded of this access during the annual consent packet completion process.
CHI Friendship: All employees are trained on ANME prevention, definitions, and reporting procedures upon hire and on an annual basis. These trainings include what an investigation may involve, focusing heavily on investigators gathering information to prevent repeat occurrences, rather than focusing on finding fault. In addition, all employees and people supported by Friendship receive a contact card with the phone numbers of each investigator to make reporting accessible to everyone.
CQL: How are victims informed of what is occurring during and after an investigation?
OPG, Inc.: Alleged victims are usually, though not always, notified of a report being made at the time of the allegation. They are told what to expect, that someone will be contacting them to discuss the issue, and reassured that they have done the right thing. The investigator may work with a trusted staff or family member to schedule first contact with the person affected.
During the investigation, the person is provided support by existing paid or natural supports to manage their concerns about the investigation. Finally, the person should be notified that the investigation is ended and about any changes being made that relate to them.
CHI Friendship: When an investigator receives a report, the person supported, as well as the legally authorized representative, is informed that an investigation will take place. The person supported is always interviewed about the incident unless there is a specific reason they should not be interviewed. The person supported and/or the legally authorized representative is asked for input regarding their recommendations or any details pertinent to the investigation they’d like to share. Once an investigation has been completed and recommendations developed, the person supported and/or the legally authorized representative is informed of the findings and recommendations.
CQL: How do you communicate or follow-up with staff members who are the alleged perpetrators of abuse, neglect, mistreatment, or exploitation?
OPG, Inc.: Generally, we use their stated preferred method of communication. Phone, text, and email communications are most common, though virtual or in person interviews do occur.
CHI Friendship: During the investigation, interviews are set up with the alleged perpetrator and others related to the incident. This is an important aspect of any investigation because it helps piece together a well-rounded picture of the incident. It may involve disciplinary action, retraining, updating the person’s plan, reassignment, etc. Friendship focuses on preventing the potential re-occurrence of the incident versus finding who was at fault. This has also contributed to staff feeling more comfortable with the ANME process and self-reporting. Closure is given to the alleged perpetrator through the investigator or the supervisor to answer any remaining questions they may have.
CQL: What kind of trauma-informed supports are provided to people who have been the victim of abuse, neglect, mistreatment, or exploitation?
OPG, Inc.: To some degree or another, every person supported who is involved in an investigation does receive support and reassurance throughout and following the investigation. If an incident was especially traumatic, we might recommend further support through therapy.
CHI Friendship: Each person supported by Friendship participates in a Personal Outcome Measures® interview on an annual basis. During these discussions, it may be discovered that a person may have been the victim of ANME, whether in the past or present. The person’s team is responsible to ensure the person receives comprehensive supports to help them process what happened, receive counseling, training, self-advocacy skills, and other beneficial supports.
The Impact of Distress from ANME on Quality of Life
By Carli Friedman, CQL Director of Research
People with disabilities face high rates of ANME. In fact, Personal Outcome Measures® interview data from 7,000 people with disabilities (2015 to 2022) reveals that almost 1 out of every 4 people with disabilities are experiencing personal distress from any occurrence of ANME (past or present).
People with Disabilities Experiencing Distress from ANME
Experiencing distress and trauma from ANME hinder people’s mental health. For example, it can result in behavior events as a way for people to express unmet needs and/or cope with this distress. Distress from ANME also impacts people with disabilities’ quality of life. In fact, my research found that experiencing distress from ANME negatively impacted almost every other area of people with disabilities’ quality of life (see figure below), even when all other sociodemographic factors were controlled. For example, people with disabilities that experienced distress from ANME were 1.7 times less likely to have intimate relationships than people with disabilities that did not experience distress from ANME. From relationships to community integration to choices to rights, distress and trauma has a negative impact on it all.
The Impact of Distress from ANME on Quality of Life
Given not only the prevalence of this distress but also its impact on quality of life, supporting people with disabilities to minimize this stress and promoting coping behaviors is important. So too is ensuring all allegations of ANME are reported and investigated. In fact, when all allegations of ANME are reported and investigated according to organizational policy and procedure and applicable law, people with disabilities are 1.7 times less likely to experience distress from ANME. They are also 2.7 times more likely to be free from abuse and neglect.
Closing the Loop
By Michael Clausen, CQL Director of Personal Outcomes
Investigative systems and practices, as well as regulatory requirements in IDD systems are often missing a critical component: A process to support victims, reporters, and alleged perpetrators through the investigative process. For victims, a process to “close the loop” provides closure and assurance that an organization has taken adequate steps to protect them from future abuse.
Supporting people to know that a perpetrator of abuse will no longer be working with them or providing reassurance that a staff member who made a mistake has been retrained helps assure safety and organizational supports to people supported. Along with support to overcome trauma associated with being the victim of abuse, this important step should be formally included within investigation procedures and documented in investigation reports/follow-up.
Following up with reporters of abuse strengthens a system by affirming that reports are taken seriously, effectively investigated, and resolved. While it may not always be appropriate to share sensitive details and information, it is critical that reporters are provided with validation to report what they witnessed or heard. Being the target of an investigation can be a traumatizing experience. Organizations may have to suspend or take employment related actions for long periods of time while an investigation is being conducted, particularly when investigations involve outside entities.
Not all reports of abuse are substantiated, so it is important that organizations provide support for staff members that were proved not to have perpetrated abuse. This support should include regular updates while they are out of work, and additional support to help them resume their duties when they return. By closing the loop, organizations can ensure that investigations demonstrate thorough review and adequate support.
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Designing Internal Investigation Procedures