Category One incident reports of allegations of staff to client assault and unexplained injuries in disability services
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Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.
© State of Victoria, June 2015
Revised March 2016Version 1.2
ISBN 978-0-7311-6747-0 (pdf)
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Contents
1. Introduction
1.1 Context
1.2 Application of this guideline
1.3 Intent
2. Legislative and policy framework
2.1 Legislation
2.2 Policy
3. Quality of Support Review
3.1 What is a Quality of Support Review?
3.2 Purpose of the Quality of Support Review
3.3 When is a Quality of Support Review undertaken?
3.4 Definitions
4.1 Initiating a Quality of Support Review
4.2 Request for information from disability service provider
4.3 Request for information from divisional areas
4.4 Assessment of information provided
4.5 Assessment finding
4.6 Clarification of information provided
4.7 Meeting to review and confirm the Improvement Action Plan
4.8 What does a Quality of Support meeting involve?
4.9 Outcomes of a Quality of Support meeting
4.10 Review endorsement and completion
4.11 Informing the person with a disability and key support people within five working days
4.12 Timelines
4.13 Monitoring of the Improvement Action Plan and closure
4.14 Reporting
5. Roles and Responsibilities
6. Appendixes
Appendix A: What are physical and sexual assaults and unexplained client injuries?
Appendix B: Protecting and promoting client rights, safety, health and wellbeing
Appendix C: Risk management
Appendix D: Useful resources
1. Introduction
1.1 Context
The Department of Health and Human Services (the department) is committed to improving the quality and safety of the services it delivers and funds.
The department is responsible for a wide range of services to diverse groups of people across Victoria, including people most in need, supporting them to live safe, happy and fulfilling lives. To achieve this we plan, fund and deliver community, housing and health services both directly and with our community sector partners. This includes services currently provided or funded and registered by the department to support people with a disability.
Services and supports for people with a disability are provided in accordance with the Disability Act 2006 (the Act). The Act provides a framework for the provision of disability supports that are flexible, are tailored to the needs of individuals and key support people and provide choice and control for people with a disability. The Act also protects and promotes the rights of people with a disability to enjoy the same rights as other members of the community and to live free from abuse, neglect or exploitation.
In accordance with its commitment to ensuring that the people with a disability are supported to live safe, happy and fulfilling lives free from abuse, the department has implemented a mandatory review process for all allegations of the assault of a client by a staff member in department managed and funded disability services. Allegations of unexplained injuries of a person with a disability may also be subject to the review process. This review process is called the Quality of Support Review.
The Quality of Support Review is a mechanism for ensuring that the responses taken by disability service providers following an allegation of staff to client assaultare effectively reviewed, and that appropriate processes are established, or strengthened, and maintained, to reduce risk of occurrence of incidents in the future. Disability service providers include both department delivered services and community service organisations funded by the department to deliver disability services.
The Quality of Support Review process is built upon principles of person centeredness and is designed to ensure that the rights, safety and wellbeing of people with a disability are upheld and protected in accordance with the Act, the Charter of Human Rights and Responsibilities Act 2006 and the department’s policies. The process is also designed to ensure that sustained effort will be made to reduce the likelihood of staff to client assaults in disability services.
1.2 Application of this guideline
This guideline providesminimum requirements for divisional and disability service provider staff involved in the development, assessment, approval and implementation of the Quality of Support Review process.
These guidelines should be read in conjunction with other related documents that can be found on the Funded Agency Channel website
1.3 Intent
The rights, safety and wellbeing of people with a disability are of critical importance. The department and disability service providers have an obligation to provide a safe environment, making sustained effort to ensure that people with a disability using the services are safe and free from abuse, neglect and exploitation.
The Quality of Support Review process is intended to be of benefit to:
- People with a disability – ensuring that their rights are considered equally with the rights of staff members alleged to have been involved in assault incidents, and that their rights, safety and wellbeing are protected and promoted by the disability service provider.
- Providers of disability services – providing opportunities to learn from incidents and to review, establish and/or strengthen processes to improve service quality and reduce risk of occurrence of incidents in the future.
- Department of Health and Human Services – providing opportunities to improve quality, address systemic issues, develop and/or implement policy or practice change if required, ensure continuous quality improvement, and monitor the integrity of the services it manages and funds.
2. Legislative and policy framework
The Quality of Support Review process is underpinned by legislative and policy frameworks designed to ensure that the rights of people with a disability are upheld and protected and that the department’s commitment to continuous quality improvement is maintained and promoted.
2.1 Legislation
2.1.1 Disability Act 2006
The Act affirms and strengthens the rights and responsibilities of people with a disability, advances the inclusion and participation in the community of people with a disability, provides a framework for the provision of high quality disability supports and services, and ensures that disability service providers are accountable to the people accessing those services. The Principles of the Act (s5) include the following:
- Persons with a disability have the same rights and responsibilities as other members of the community.
- Persons with a disability should be empowered to exercise those rights and responsibilities.
- Persons with a disability should live free from abuse, neglect and exploitation.
- Disability service providers should be accountable for the quality of those services and for the extent to which the rights of persons with a disability are protected and promoted in the provision of those services.
2.1.2 Charter of Human Rights and Responsibilities Act 2006
The Charter of Human Rights and Responsibilities Act 2006 sets out basic rights, freedoms and responsibilities of all people in Victoria, and the relationship between government and the people it serves. It sets out the human rights that Parliament specifically seeks to protect and promote and imposes an obligation upon all public authorities to act in a way that is compatible with human rights. People with a disability have the same rights as other members of the community.
2.1.3 Privacy and Data Protection Act 2014
ThePrivacy and Data Protection Act 2014 regulates the collection and handling of personal information (including sensitive information).
2.1.4 Health Records Act 2001
The Health Records Act 2001 regulates fair and responsible handling of health information.
2.1.5 Protocol for Incident Report Review between: the Disability Services Commissionerand Department of Human Services April 2014
The Disability Services Commissionerprovides independent review and monitoring of the quality of responses provided to people with a disabilitywho are subject to Category One incident reports relating to allegations of staff to client assault and unexplained injuries. TheDisability Services Commissionermonitors improvements to the department’s incident review processes.
The Protocol for Incident Report Review between: the Disability Services Commissioner and Department of Human ServicesApril 2014sets out the roles and responsibilities of the department and the Disability Services Commissioner.
2.2 Policy
Key policy instructions outline the management, immediate response and reporting requirements for all disability service providers in response to allegations of physical and sexual assault of a client of the department.
These instructions form part of the department’s wider safeguarding, risk management and quality improvement frameworks and support the department’s intent to:
- Monitor and support the provision of high quality services and supports to people with a disability through the full and frank reporting of adverse events.
- Ensure timely and effective responses are taken to address immediate client safety and wellbeing.
- Ensure due diligence and responsibilities to clients are met.
- Assure and enhance the quality of services and supports through acting upon individual incidents as well as trends identified through the analysis of incident reports.
The following key policy instructions underpin the reporting of incidents involving allegations of staff to client physical and sexual assault:
2.2.1 Critical client incident management instruction: Technical update 2014
The Critical client incident management instruction: Technical update 2014 outlines the management and reporting requirements for incidents or alleged incidents that involve, or impact upon, clients during service delivery. Reporting of incidents as defined in this instruction is compulsory.
2.2.2 Responding to allegations of physical or sexual assault: Technical update 2014
Responding to allegations of physical or sexual assault: Technical update 2014 outlines the immediate response requirements for all services directly delivered or funded by the department in response to an allegation of physical or sexual assault that involves a client. This instruction forms part of a wider safeguarding framework including workforce strategies, quality of support/care reviews and external scrutiny processes.
2.2.3 Disability Worker Exclusion Scheme
The Disability Worker Exclusion Scheme is designed to ensure that people who pose a risk to the health, safety or welfare of people with a disability living in disability residential services are prevented from working with them.
3. Quality of Support Review
All disability service providers are required to report critical incidents that involve, or impact upon, clients. (Refer: Critical client incident management instruction: Technical update 2014 andResponding to allegations of physical or sexual assault: Technical update 2014).
3.1 What is a Quality of Support Review?
A Quality of Support Review is an assessment of the adequacy of actions takenby a disability service provider in response to an allegation of the assault of a client by a staff member, and incidents involving unexplained injuries.
The Quality of Support Review process is not an investigation of the allegation or the incident, but rather is a review of the actions taken in response to the allegation at the time of the incident and in the period immediately following. It is also a mechanism to identify areas for improvement and to implement strategies that will serve to mitigate the risk of further occurrence ofincidents and support the safety, health and wellbeing of clients.
3.2 Purpose of the Quality of Support Review
The purpose of the Quality of Support Review is to:
- Assess the adequacy of response to a critical client incident involving an allegation of staff to client assault (or, where relevant, unexplained client injuries).
- Ensure appropriate actions were taken by the disability service provider to protect client rights, safety and wellbeing.
- Ensure appropriate actions were taken by the disability service provider in relation to the staff involved.
- Identify underlying causes of incidents so that opportunities for service leveland/or systemicimprovements can be pursued to prevent occurrence of incidents in the future.
3.3 When is a Quality of Support Review undertaken?
A Quality of Support Review is undertaken for all allegations of the assault of a client by a staff member of a disability service provider (refer to Appendix A).
Incidents involving unexplained client injuries may also be subject to a Quality of Support Review at the discretion of director, client outcomes and service improvement and/or area director, Department of Health and Human Services.
3.4 Definitions
3.4.1 Division
The departmenthas four divisions across the state that provides strategic oversight and coordination for the areas within them. The divisions provide corporate and administrative services and oversee service implementation, quality and performance. Each division covers a mix of rural, outer-metropolitan and inner-metropolitan Victoria. Divisions manage resources across areas to maximise responsiveness to client and community needs.
3.4.2. Area
Areas are responsible for providing integrated departmental services to achieve positive client outcomes at the local level. They drive a holistic approach to meeting client needs that is strongly supported by a client-centric culture. Areas develop and foster strategic partnerships with the communities they serve and with community service organisations, local businesses and other government agencies to ensure that local issues are understood, prioritised and addressed. There are 17 areas across four divisions.
3.4.3Local connections unit
The Local Connections unit is a dedicated team that promotes the social and economic participation of the local community as well as managing relationships with funded community service organisations. The Local Connections Unit is the point of contact for, and provides advice to, funded community service organisations regarding policies, guidelines, reporting and service agreement requirements. The Local Connections unit is the point of contact for community service organisations regarding policies, guidelines, reporting and service agreement requirements including Quality of Support Reviews.
3.4.4 Residential Client Services unit
The Residential Client Services unit provides a range of departmental services and supports to meet the holistic needs of disability services clients in residential settings. The Residential Client Services unit is the point of contact for department delivered disability services regarding policies, guidelines and reporting including Quality of Support Reviews.
3.4.5 Client Outcomes and Service Improvementbranch
The Client Outcomes and Service Improvement branch drives consistent practice and positive client outcomes across all areas within a division. It supports service delivery through the provision of a performance management system (for internal and external services), quality improvement initiatives, strategic planning and business intelligence capability, strategic input into service implementation, oversight of funded-sector performance and reform and a range of client services.
3.4.6 Key support person
A ‘key support person’ or ‘support person’ for a person with a disability may include a family member, friend, advocate, ‘circles of support’ and significant others who are independent of the perpetrator and/or service.
3.4.7 Disability service provider
‘Disability service provider’ in this document refers to both department directly delivered disability services and community service organisations funded and registered by the department to deliver disability services.
4. Process and timeline for a Quality of Support Review
The diagram below describes the key steps and indicative timeline of a Quality of Support Review from the receipt of a Category One Client Incident Report alleging the physical or sexual assault of a person with a disability by staff member (or, if indicated, unexplained client injuries) through to the closure and notification of the outcome to the client.
Figure 1: Overview of the Quality of Support Review Process
Steps / ActionsStep 1
Quality of Support Review is initiated / A Quality of Support Review is initiated by the Client Outcomes and Service Improvement branch when the Category One Client Incident Report involving an allegation of staff to client assault in a disability service is registered in the departmental record information system, TRIM.
The deputy secretary, area director and/or director, Client Outcomes and Service Improvement branch may also initiate a Quality of Support Review in response to an incident report involving unexplained client injury
Note:Quality of Support Reviews are initiated where there is either:
- an incident involving an allegation of staff to client assault
- a report of unexplained client injury(s).
Step 2
Request information from disability service provider on actions taken in response to the allegation(s) / The Performance, Quality and Compliance unit request and collate information on actions taken in response to an alleged incident from the disability service provider.
Following a request from Performance, Quality and Compliance unit, the area provides the disability service provider with a copy of the Quality of Support Review template via letter or email.
The disability service provider informs the person with a disability and/or key support person of the commencement of a Quality of Support Review.
A service provider may be referred directly to a quality of support meeting (prior to the completion of a Quality of Support Review template) at the discretion of the director, Client Outcomes and Service Improvement branch.
Timeline: The Quality of Support Review template must be completed and returned by the disability service provider within 10 working days of receipt.
Step 3
Request information from divisional areas / The Performance, Quality and Compliance unit seek information and documentation from departmental staff.This may include:
- Client Record Information System (CRIS) documents and records
- Client Incident Analysis review of records of previous incidents
- previous Quality of Support Reviews.
Step 4
Assessment of information / The Performance, Quality and Compliance unit review assess:
- the information provided to determine the adequacy of the response(s) to the incident
- whether the disability service provider can demonstrate that all appropriate actions were undertaken and the client’s (and other clients using the service) rights, safety and wellbeing was upheld and protected. The disability service provider must also demonstrate that they have undertaken a causal analysis and put in place, or are planning to put in place, remediating actions.
Step 5
Assessment finding / The Performance, Quality and Compliance unit, after assessing the information, make a finding of one of the following:
- No further action required (Go to Step 9).
- Recommend outstanding actions are managed with area support and supervision (Go to Step 9).
- Recommend a Quality of Support meeting (Go to Step 6).
- Escalation to area director for consideration for formal review (Go to Step 9)
Step 6
Advise of finding of Quality of Support meeting / Performance Quality and Compliance unit advises the area director that a Quality of Support meeting is being undertaken.
Step 7
Disability service provider is advised of Quality of Support meeting / The area will advise the disability service provider of the outcome of the Quality of Support assessment and the reason for, and the purpose of, the Quality of Support meeting and may request additional information or documentation.
Notes:The Performance, Quality and Compliance unit can only request new information related to the incident and the response (that is information or documentation which addresses gaps).
The disability service provider must be advised if the meeting will include discussion of previous alleged incidents involving the client who is the subject of Quality of Support Review and of the need to provide documentation on the management of risk arising from previous incidents.
Step 8
Quality of Support meeting is convened / The Performance, Quality and Compliance unit develop the meeting agenda, invite participants and convene the Quality of Support meeting.
The outcome of the Quality of Support meeting can be one of the following:
- A finding of ‘No further action required’.
- A recommendation that outstanding actions are managed by the disability service providerwith area support and supervision.
- Escalation to area director for consideration for formal review.
Step 9
Review endorsement and completion / The performance, quality and compliance manager or delegate forwards the outcome recommendation and the completed Quality of Support Review to the divisional director, Client Outcomes and Service Improvement branch for review and endorsement.
The director, Client Outcomes and Service Improvement branch may refer a Quality of Support Review to the operational divisional Deputy Secretary at their discretion.
Upon endorsement, the completed Quality of Support Review is forwarded to the area director for information and action.
The area will inform the disability service provider of the completion and outcome of the Quality of Support Review and if appropriate the Improvement Action Plan.
Timeline:The Quality of Support Review must be completed within 60 working days of registration of a Category One Client Incident Report of allegations of staff to client assault or unexplained client injury.
Step 10
Informing the person with a disability and/or key support person / The disability service provider informs the person with a disability and/or key support people of the completion and outcome of the Quality of Support Review and of the Improvement Action Plan that may have been developed.
Timeline: The person with a disability and/or key support people must be advised of the Quality of Support Review being completed within five (5) working days of the disability service provider being informed of the completion of the Quality of Support Review.
Notes:The information is to be provided in the person’s preferred form of communication and in a format that is readily understood.
The person with a disability and/or key support people must be given the opportunity to provide feedback on the process and to raise any further concerns.
Step 11
Monitoring Improvement Action Plan and closure / The area monitors the implementation of the Improvement Action Plan.
The area director advises the director, Client Outcomes and Service Improvement branch of the satisfactory implementation of the Improvement Action Plan and closure of the Quality of Support Review.
4.1 Initiating a Quality of Support Review
A Quality of Support Review is initiated by the Client Outcomes and Service Improvement branch when the Category One Client Incident Report involving an allegation of staff to client assault in a disability service is registered in the departmental record information system, TRIM. The Quality of Support Review must be completed within 60 working days following registration in TRIM.