Abuse Investigation Unit Marks First-Year Progress in Five-Year National Demonstration Project

Equip for Equality's Abuse Investigation Unit (AIU) was established in 2001 as a national demonstration project by a direct congressional appropriation. Its purpose is to document the outcomes and benefits of having a nongovernmental, independent unit within a federally mandated Protection and Advocacy System (P&A) to investigate reports of abuse, neglect and death in public and private institutional and community-based facilities and programs.

The AIU's primary goal is to enhance the safety of children and adults with disabilities by examining deaths and other serious injuries, monitoring conditions, identifying dangerous practices and trends, identifying best practices, and issuing reports and recommendations to prevent future incidents.

At the end of the five-year period of the national demonstration project, EFE will submit reports to Congress and the Centers for Medicare and Medicaid Services of the U.S. Department of Health and Human Services on the AIU's accomplishments, as well as the cost of operating this function within a state P&A. This information, which will be shared with the Illinois General Assembly and the Governor, will better enable Congress to determine whether additional authority or resources are needed to allow the Systems to address issues of abuse, neglect and deaths more effectively.

The AIU focuses its investigative and monitoring activities in four key areas:

1. deaths or serious injuries resulting from restraint or seclusion, dangerous and problematic restraint, and seclusion practices;

2. incidents demonstrating a systemic issue affecting the safety or well-being of a group of individuals or that represent the use of dangerous practices;

3. incidents occurring in settings not investigated by other entities;

4. incidents demonstrating that the current investigatory system or practices are not effective.

"I am fortunate to be working with four dedicated and talented people who have taken hold of our enormous task and made wonderful strides in our first full year of operation," says AIU Director Deborah Kennedy. "All of us share a sense of real accomplishment as we tackle new challenges. I applaud the tremendous work of our investigators Karen Kirby-Hall, Mary Jo Kern and Leslie Banghart, and our Assistant David Thompson."

Highlights of AIU's first-year activities include:

Review of information related to the deaths of numerous individuals with disabilities across populations and provider settings in connection with the use of restraints or seclusion and, where appropriate, investigation into the circumstances related to such deaths.

Four such deaths have been reported. The AIU is also investigating several deaths resulting from the use of psychiatric medications.
Unannounced visits to observe conditions and obtain information on abuse and neglect, restraint and seclusion usage, and programming at 17 state-operated facilities and 26 community providers and nursing homes, with multiple visits to certain facilities.

The information is being analyzed and will be used to identify facilities for follow-up based on problematic patterns and trends.
Review of all final investigative reports issued in 2001 and 2002 by the Inspector General for the Illinois Department of Human Services, with particular attention to those reports generated from an allegation of abuse in connection with the use of restraints.

For example, EFE reported to the state its concerns that in a number of restraint episodes mandatory standards related to their application were not met. As a result, the Illinois Office of Mental Health, Department of Human Services, agreed to undertake a review of such episodes. That review remains ongoing.
Success in requests for review of practices or incidents by the state and various agencies to determine if more effective practices or policies should be implemented, such as:

The AIU achieved a positive outcome when it reopened an investigation involving a complaint of abuse during a restraint episode in which a patient suffered a broken nose. As a result, the facility implemented policy changes, including the utilization of behavior drills, development of training curriculum for the staff on optimal patient/staff interaction strategies, and the creation of a Performance Improvement Team focusing on restraint and seclusion.

AIU staff have presented information regarding the function and activity of the Unit at three statewide conferences for service providers and people with disabilities, which were sponsored by United Cerebral Palsy, the Illinois Department on Aging and the Illinois Department of Health on Injury Prevention.

Three additional trainings were conducted with the Department of Disability and Human Development, University of Illinois at Chicago, on the subject "Taking Charge: Responding to Abuse, Neglect and Financial Exploitation for Persons with Disabilities." AIU staff also presented at the American Psychiatric Association annual convention. Currently, AIU staff are participating on the Illinois Children's Mental Health Violence Prevention Task Force.

Advisory Committee

The AIU has established an Advisory Committee composed of representatives from key state agencies, including investigatory entities. Participants on the committee include directors and inspector generals from the Department of Human Services, Office of Mental Health and Office of Developmental Disabilities, and the Department of Public Health, and inspector generals from the Office of Public Aid and the Department of Children and Family Services.

The Advisory Committee works cooperatively with the AIU by identifying settings or populations that are not covered by the present state investigatory system - and by developing criteria and priorities emphasizing areas that do not duplicate current state or federal efforts to ensure safety. The Committee also relates concerns about dangerous practices or other issues, which can then be shared across agencies and settings.

Medical Review Board

The second year of the AIU's operation will see the establishment of a Medical Review Board, which will be assembled from a cross-section of medical practitioners. Its function will be to review those cases flagged by the AIU and to offer advice on those incidents warranting independent investigation. It will also provide counsel on steps facilities can take to reduce the risk of harm to service recipients. =

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