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What is an MUI? MUI is an acronym for “Major UnusualIncident” An incident that must: Directly affect health and safety Be investigated by a certified InvestigativeAgent Have a clearly defined prevention plan

MUIs include... Actual events Suspected events Alleged events It does not matter if you heard it, saw it orthink something may have happened,you should report it!

Example Johnny is walking across the workshopfloor and trips on a skid. He falls andbreaks his arm. More information is needed to determinethe cause of the incident and contributingfactors of the incident so that aprevention plan can be developed.

More InformationThe skid was sitting in the walkway.Johnny has poor vision.Johnny has osteoporosis.This information provides the cause andcontributing factors.

Why Do We InvestigateMUIs? Once we determine the cause and thecontributing factors, we can manage theincident more effectively by developing aprevention plan that addresses the causeand the contributing factors. This likely reduces the recurrence of asimilar incident.

MUI Categories There are 19 types of MUIs!

Physical Abuse The use of physical force that canreasonably be expected to result inphysical harm.-slap- hit-push-throwing objects

Physical Abuse Remember that physical abuse issomething that does not have to result inharm or injury. It is an act that could havecaused harm to the individual. For example, staff is upset with anindividual and throws a baseball at theindividual but misses. This is still physicalabuse because the act could haveresulted in harm.

Example of Physical Abuse Staff allegedly slaps individual in the face Staff pulls on the individuals arm anddislocates her shoulder Staff throws a punch at an individual andthe individual ducks the punch Teacher notices cigarette burns on astudent’s back

Sexual Abuse Unlawful sexual contact – Touching erogenouszones (breast, buttocks, “private parts) Unlawful sexual conduct – intercourse (oral,anal, vaginal) Public indecency, voyeurism,importuning, etc. – Prostitution, “Peeping Tom”,Masturbating in front of an individual

Verbal Abuse Purposeful use of words orgestures that threaten, coerce,intimidate, harass, or humiliatean individual.

Example of Verbal Abuse Individual says that his staff member toldhim he would punch him if he didn’t dothe dishes Staff threatens to give an individual’s dogaway if she tells on him for slappinganother individual Staff tells an individual she is fat and uglyand will never find a boyfriend

Misappropriation Depriving, defrauding, or otherwiseobtaining the real or personal property ofan individual - Includes theft of money orproperty. AMOUNT DOES NOT MATTER!Stealing one penny is considered afelony.

Example of Misappropriation Staff eats individual’s food Individual receives bank statement andthere are several unexplained cashwithdraws Petty cash is $3.00 short Staff utilize an individual’s credit card fortheir personal purchases

Neglect When there is a duty to do so, failingto provide treatment, care, goods,supervision or services That results in a reasonable risk ofharm There does not have to be an injury!

Examples of neglect Staff leaves an individual who requires 24/7supervision, due to a seizure disorder, alone athome for three hours Staff forgets to set wheelchair brakes and theindividual rolls off the bus lift Staff send an individual out to the bus stop in 5degree weather with no hat or gloves Staff gives an individual pizza and he requiresa pureed diet

Exploitation Unlawful or improper act- Using an individual’s resourcesfor personal benefit, profit, orgain

Examples of Exploitation Staff has an individual help him moveand does not pay him Staff obtains a credit card in theindividual’s name and staff pays the bill Staff asks the individual to “add him on”the individual’s cell phone plan and staffpays his portion of the bill

Peer-toto-Peer Acts One individual against another Physical Abuse with intent to harm Verbal Abuse with intent to threaten,coerce, intimidate, harass or humiliate Any Sexual Abuse Any Exploitation Any intentional Misappropriation ofsignificant value ($10.00 or more). The $10amount only applies to peer to peer. Thereis no dollar amount otherwise.

Examples of Peer to Peer Individual touches a peer on her breast withoutpermission and does not stop when told to stop(Peer to Peer Sexual Abuse) Individual steals peer’s DVD collection (peer topeer misappropriation). Individual calls a peer a name and the peercries and leaves work for the day (Peer to PeerVerbal Abuse). Individual throws a full can of pop at a peerbecause they a fighting over a girl (Peer toPeer Physical Abuse).

Examples Staff and individual go to the movies andhold hands. Staff and individual go out to dinner andkiss each other goodnight. Staff and individual are having an explicitconversation on Facebook.

Rights Code Violation Infringing on an individual’s rights. Must present a risk to health and safety. Can either be a UI (unusual incident) orMUI.

Example of Rights CodeViolation Staff refuses to give an individual coffeeand the individual bangs his head on thewall multiple times. Staff forces an individual to go to churchand the individual “misbehaves” atchurch and is restrained. Staff instructs an individual to “beat up”another individual.

Failure to Report A person who is mandated to report hasa reason to believe that an individual is atrisk and does not report it. This can result in criminal charges aswell as being placed on the AbuserRegistry.

Examples of Failure to Report Individual tells workshop staff that hishome staff slapped him and workshopstaff does not report it because theindividual “lies”. Staff witnesses an individual fall anddoes not report it. Individual goes threedays with a broken foot.

Unapproved Behavior Support The use of any aversive strategy orintervention implemented withoutapproval of the HRC (human rightscommittee) or BSC (behavior supportcommittee).

Unapproved BehaviorSupport Individual is hitting peers and staffrestrains the individual. Individual is throwing objects in thepresence of peers and staff restrains theindividual. Individual is displaying self injuriousbehavior and staff restrains him.

Missing Individual Individual cannot be located andISP(individual service plan) states theycannot be alone due to concerns of healthand safety and a search of immediatesurrounding area has been completedOR Circumstances indicate immediatejeopardyOR Law enforcement was called to assist

Examples Individual runs away from home andcannot be found. He has 24 hoursupervision. Individual has no “alone time” and staffcannot locate him. LE is notified and amissing person report is filed.

Attempted Suicide Individual makes an actual, physicalattempt to harm self that results in: ER treatment In-patient observation Hospital Admission

Examples Individual locks himself in bathroom andstaff believe he has taken a handful ofaspirin. Individual is discovered in his bedroomwith a shoestring around his neck. Individual attempts to jump out upstairswindow.

Law Enforcement Anytime an individual is involved with thepolice and the incident involves: Charges being filed Incarceration Arrest

Examples Staff call the police because theindividual is “out of control” and the policetake the individual to jail. Individual is arrested for theft at the mall. Individual is served papers to appear incourt for assault.

Medical Emergency An incident where emergencyintervention is required to save anindividual’s life. CPR I.V. for dehydration Heimlich/back blows Epi-pen

Examples Individual receives an I.V. in order todecrease/increase insulin levels. Individual receives medication at the ERto prevent a heart attack. Individual chokes on breakfast and staffuse back blows to dislodge the food.

Known Injury Any injury that the cause is known andrequires: Immobilization (cast, splint, sling) Five or more sutures or equivalent 2 nd or 3 rd degree burns Dental Injuries Any injury that prevents an individual fromparticipating in routine daily tasks for morethan TWO consecutive days.

Examples Individual hits face on back of bus seatand knocks out a tooth. Individual falls and the doctor takes himoff work for three days. Individual burns himself while smoking. Individual cuts his finger and receivesseven sutures.

Unknown Injury An injury of unknown cause that requirestreatment that only one of the followingcan provide: Physician Physician’s Assistant Nurse Practitioner

Examples Individual is found lying in the living roomand has a fractured arm. Individual has a 2 nd degree burn andcannot tell anyone what happened. Individual is discovered to havesustained a fractured toe and there is norecord of a fall.

UnscheduledHospitalization A hospitalization that is not expected andis not addressed in the ISP.

Examples An individual has emergencyappendectomy. An individual is having chest pains and ishospitalized. An individual is admitted to a psychiatricfacility for observation.

Death Any time an individual passes away forany reason. Does not matter where the person died. Does not matter how the person died.

What to do when an MUIoccurs... Some MUIs require four hour reporting! Any allegation of abuse (verbal, physical, orsexual). Neglect Exploitation Misappropriation Suspicious or accidental death Any time there are inquiries from the media

4-hour Reporting Four hour reporting is needed forcategories stated in previous slidebecause notification to law enforcementor children services is needed. The County Board must ensure lawenforcement and/or children services isnotified timely.

Who do I call? During business hours: County Board -419-332-9296 On-Call (after hours) – 419-307-0562 or419-307-0563 CALL IMMEDIATELY to ensure health &safety. It is important to write an incident reportas soon as possible in order to ensurethe Investigative Agent and the countyboard has all relevant information.

What happens after Ireport an MUI? Measures are taken to ensure health & safety(for cases of physical/sexual abuse,misappropriation, exploitation and prohibitedsexual relations, the primary person involved(PPI) is removed from working with theindividual pending the investigation). An investigation ensues immediately by eitherthe police, children’s services, or theInvestigative Agent (IA).

Who is the InvestigativeAgent and what do they do? Investigative Agents are the only people whocan investigate MUIs. They must be certified through DODD andhave extensive training in conductinginvestigations. Sandusky County Investigative Agent: Ruth Watson Office: 419-332-9296 ext. 168 Cell: 419-366-7060 Email: rwatson@scbdd.org

What happens next... If the police have declined to investigate,the IA commences the investigation. Conducts interviews Assesses the scene of the incident Takes photographs Writes report

The investigation...cont. Determines cause & contributing factorsof the incident Ensures a prevention plan has beendeveloped by the team Submits findings to the Superintendentand DODD

Unusual Incidents... Any event or occurrence that is notconsistent with routine operations,policies or procedures, or behavior of anindividual. Med errors Falls Behaviors

Who must report? Everyone that is employed to work withindividuals with developmental disabilitiesis a mandated reporter. By law, you mustreport any reports of abuse, neglect andMUI categories. YOU ARE A MANDATED REPORTER:you are required to report at all times,even when you are not working.

When a UI occurs... Ensure immediate action! Obtain medical attention immediately, ifnecessary Separate individuals or staff Assess for injuries Call for assistance

UI Reporting (cont.) Ensure notifications have been made Guardian Family or staff at home County Board which will include theInvestigative Agent and the SSA (Serviceand Support Administrator).These notification have to be made on thesame day the incident occurs!

UI Reporting (cont.) Write the incident report as soon aspossible Include all relevant details Who What Where When Why (if you know)

Health and Safety Alerts Visit the Ohio Department ofDevelopmental Disabilities website:www.dodd.ohio.gov Under the health and safety tab there is alink to view health and safety alerts. There are areas in which the DODD(department of developmental disabilities)has identified a risk to people, and whatcan be done to avoid or reduce that risk. You should check this link often.

Abuser Registry The Abuser Registry was established bylaw to prohibit people from working withindividuals if they have committed acts ofabuse, neglect, misappropriation, failureto report, and/or prohibited sexualrelations meeting the criteria forplacement on the Abuser Registry. The Abuser Registry must be checkedprior to employment and is then checkedannually.