This "4-strikes and you're out" policy designed by DBHDS is absurd.  As defined by this document, the guidance is not only impossible to fairly implement across the various sizes and scopes of services and organizations across the state, it's now further prioritizing an arbitrary time-sensitive reporting requirement over the quality service provision that happens during all the other moments not defined by a "level."  

How is it justifiable to give a small provider the same number of "strikes" as a larger provider?  If one outpatient clinic in a region with a large population serves 2000 clients in a year, but another one in a rural community serves 100, how is it fair that both have the same number of strikes when one of them has a much higher risk of incident simply because they support more people?

Same question, different service... How about case management services for people with substance use disorders?  Different CSBs have varying numbers of clients and therefore different numbers of case managers.  That means the level of probability for an incident to take place varies across CSBs.  But by the guidance outlined in this document, they each have the exact same number of strikes before their ability to perform the service will be taken away by the department.  

As a Risk Management Specialist working in compliance, I can certainly understand how unbelievably frustrating it is when people don't follow the rules.  Regulations, policies, procedures, guidance documents... those are the pages of the rule book and they outline the way it should be and what could happen if it isn't that way.  

But ultimately, those consequences must be in line with the severity of the infraction.  And realistically, submitting a CHRIS report sometime after 24 hours just isn't that severe when you realize that no one from DBHDS is going to read it before 8am or after 5pm on any given Monday through Friday.  Nor will they read the report on Saturday, Sunday or any recognized holiday.  

Enforcing a consequence for not following the rules is understandable and necessary... but threatening to end an essential service to the community because a report was late only 4 times in 2 years (rolling, calendar, fiscal, who knows?) is an indefensible position.  

Failing to report an incident is far different and far more concerning than late-reporting.  The first indicates either a deliberate attempt to hide an incident or (much more likely) a general and possibly systemic misunderstanding of what constitutes an incident. 

The second indicates that someone or a group of someones forgot, but something was in place to make sure it got reported anyway, regardless of consequences from the department for being late.  

And yet, this guidance document draws no such distinction.  The same citation schedule is implemented for both infractions and the deliberate or unintentional non-reporting is rewarded because that's only get to "caught" if there's an audit.  

Therefore, what would be the motivation for a provider to report an incident after the 24th hour at all?  According to this guidance document it's a guaranteed threat to their license at that point, while only a possible threat (of equal severity) to their license if it is discovered during a site visit, etc.?  

The providers that have frustrated the department by reporting late (the providers that this guidance document is clearly targeting) will simply stop reporting late.  They might try to implement the various vague risk management strategies outlined in the CAP process, but eventually they're going to decide to stop reporting incidents after the 24th hour.  The incidents will still happen of course, but the department won't find out unless they discover it during an audit.  

That's horrifying.  And this guidance document is encouraging it.  

The rest of the providers, the ones who stubbornly insist on ethical behavior, will get caught in the trap.  And those providers will spend even more time and money, not supporting people in need, but attempting to revise or develop more administrative policy and procedures (with ongoing monitoring... whatever that means) to eliminate the ever-present human error factor that goes into 1.) deciphering what constitutes an incident or injury or both, 2.) what "level" that falls into and 3.) how to make sure somebody gave the department a reason to further scrutinize and threaten them within 24 hours of it all happening.  

Please reconsider this guidance document in its entirety.  It's hard enough to find, hire and train qualified professionals willing to perform all the different services necessary to support our communities living with mental health disorders, substance use disorders and developmental disabilities. 

It's going to be even harder when they have to do that work under the constant threat of license revocation for having the audacity to support a person through an incident but forgetting to tell the department in time.