Devereux Safety and Quality Report 2021: Protecting Those In Our Care by Devereux Advanced Behavioral Health

PROTECTING THOSE IN OUR CARE Safety and Quality Report 2021

D E VE RE UX SAF E TY AND Q UALI TY RE P ORT 2021

TABLE OF CONTENTS INTRODUCTION AND OVERVIEW.....................................................................................03 • About Devereux • Century-long Commitment to Safety • Safety & Quality Actions and Progress • Successful Regulatory and External Reviews • Serving Those with Significant Emotional / Behavioral Health Challenges INTEGRATED SAFETY AND QUALITY MODEL - ACTIONS AND PROGRESS...................12 01 | CULTURE OF CARING ......................................................................................................................16 ֘

Mission and values

Devereux Family Bill of Rights Family Advisory Council

Commitment to Servant Leadership

Culture of Caring Award

Family standard of care

Parents in board composition

02 | ROBUST POLICIES AND PROCEDURES ..........................................................................................22 ֘

Risk Management Committee

Enhanced safety data collections

Comprehensive 10-year incident review ֘

System-wide safety data dashboards

Expanded disclosure and reporting protocols

03 | ENHANCED STAFFING, TRAINING AND SUPERVISION..................................................................28

We believe that the safety and well-being of children, adolescents and adults in behavioral care settings is a fundamental human right and the very foundation of effective clinical and compassionate care.

What it takes to become a Devereux employee

Reducing turnover and vacancies

Pre-employment clearances

Taking the lead to address the healthcare staffing crisis

Implementing the Diana Screen

Championing wage increases to elevate care

Enhanced screening tools and evaluations

Enhanced mandatory safety training

Expanded staff structures and supervision

Direct care professional compensation initiative

04 | BEST-IN-CLASS SAFETY SYSTEMS AND TECHNOLOGIES..............................................................36 ֘

Multi-million dollar investments in Video Technologies ֘

Real-time observations ֘

Capital improvements / facility upgrades

05 | INDUSTRY COLLABORATION AND ACCREDITATION.....................................................................40 ֘

A century of partnership and accountability ֘

Rigorous independent inspections and accreditations ֘

Highest level industry accreditations

CLINICAL AND COMMUNITY IMPACT..............................................................................46

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

INTRODUCTION & OVERVIEW Thank God for Devereux, a place where the kids feel at home - they help us parents stay calm, knowing our children are, and feel, good. Thank you all very much.” — Devereux Pennsylvania Parent, 2021

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

ABOUT DEVEREUX

Devereux was founded in 1912 by a pioneer in

DEVEREUX HAS OPERATED AS A

the fields of special education and residential care,

NONPROFIT ORGANIZATION SINCE

Helena T. Devereux. More than a century later,

THE 1930S.

Devereux is now a national, nonprofit partner for individuals, families, schools and communities,

All revenues beyond expenses are reinvested in our

serving many of the most vulnerable members

mission to continuously strengthen our programs,

of our society living with autism, intellectual and

services and impact.

developmental disabilities (I/DD) and specialty

CENTURY-LONG COMMITMENT TO SAFETY

mental health, education and foster care needs. Informed by the latest advancements from the

Despite sweeping progress and enhancements

scientific and medical research communities,

throughout the industry, the issue of safety remains

we combine evidence-based treatments and

a critical and complex challenge for all care providers.

interventions with compassionate care, and a

There are no easy answers, but with laser focus on

unique focus on supported family engagement to

the issue, supported by broad industry collaboration,

help change lives. Our programs are offered in hospital, residential, community- and school-based, and in-home settings.

dedicated ourselves to developing, implementing and closely overseeing meaningful safety and quality solutions, so everyone receiving care at Devereux

SCOPE OF SERVICES •

systems can and must continuously improve. We have

feels safe, protected and loved – and so their families

Comprehensive mental health and I/DD

can enjoy genuine peace of mind.

assessments and diagnoses services, and special education programming

SAFETY-FIRST ACTIONS AND PROGRESS

Transition to adulthood and independent living

To ensure the highest levels of oversight and

services

accountability across all Devereux centers spanning

•

Family support and education

our 13 states of operation, our leadership initiated

•

Training and continuing education for behavioral

• •

Evidence-based treatment, supports and

health and special education professionals •

Resilience assessments and social and emotional learning supports for the general public

•

Translational research initiatives and publications

a comprehensive organizational redesign in 2018. The initiative evolved Devereux from a historically decentralized operating model to an integrated and aligned structure embedding granular oversight to help further ensure safety and quality.

to advance the field •

Advocacy, public awareness and prevention campaigns

Devereux Advanced Behavioral Health is one of the largest and most advanced nonprofit behavioral healthcare providers in the United States. We are privileged to serve and support more than 25,000 children and adults across the country every year.

The responsibility that entails – ensuring the safety of our individuals, the quality of our programs, the peace of mind of our Devereux families – is a sacred trust, and living up to that responsibility is always our chief focus.

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

SAFETY & QUALITY ACTIONS AND PROGRESS SAFETY LEADERSHIP

A NEW ERA OF LEADERSHIP

NATIONAL FAMILY ADVISORY BOARD

ENHANCED STAFFING

INDUSTRY SAFETY LEADERSHIP

Formation of leadership

Comprehensive

Established independent

Enhanced staffing

Leading industry initiative

Risk Management

operational restructure,

board to provide peer

structures and supervision

to establish quality safety

Committee

from decentralized to an

support, and insights to

protocols for all direct

and security standards

aligned model

improve safety

care staff

through research and collaboration

SAFETY INVESTMENTS

ENHANCED PROTOCOLS

INCREASED STAFF PAY

INDEPENDENT REVIEWS

CHIEF RISK OFFICER

Increased starting

ENHANCED SAFETY TRAINING

Multi-million-dollar

Significantly

Comprehensive

Launched

investments in safetydirected facility upgrades

expanded and

pay above market

Revamped safety

and independent

national search

enhanced incident

rates to boost

and awareness

reviews of all safety

to secure

& video technology

reporting protocols

recruitment and

training for

practices and

industry leader

and channels

retention levels

Devereux staff

protocols

to serve as Chief Risk Officer

2017

2016 — 2017

80% of senior leadership team naturally retires

2018

JANUARY 1, 2018

Carl E. Clark II appointed President & CEO

2019

2020

2021

MARCH 15, 2018

Historic Reorganization Plan adopted by Board of Trustees

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

SUCCESSFUL REGULATORY AND EXTERNAL REVIEWS Over the last 18 months, more than 700 reviewers and system partners, including state and county regulatory authorities and service funders, as well as external surveyors, have conducted announced and unannounced visits to our Pennsylvania campuses. These exhaustive reviews included a broad review of our client-safety policies, procedures, hiring standards, risk management protocols and physical plants.

INDEPENDENT REGULATORY AND PAYER FINDINGS / OUTCOMES INVOLVING PENNSYLVANIA CAMPUSES • • •

No regulatory citations No license revocations Validated culture of transparency / accountability

700+ 8

INDEPENDENT / OUTSIDE ASSESSMENTS OF QUALITY & SAFETY IN PAST 18 MONTHS

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

SERVING THOSE WITH SIGNIFICANT EMOTIONAL / BEHAVIORAL HEALTH CHALLENGES

CARING FOR THE MOST VULNERABLE Our historic and ongoing commitment to safety is born of a deep understanding of the significant psychological, cognitive, emotional and behavioral challenges many of the individuals in our care must manage every day. Unlike conventional hospitals and health systems, those in our care live with a host

MITIGATING THE LONGTERM IMPACTS OF TRAUMA Studies have shown that the higher a person’s ACE score (Adverse Childhood Experiences), the higher the risks of long-term health and social problems.

of complex, multi-layered differences and challenges requiring

DISRUPTIVE MOOD DYSREGULATION DISORDER DIAGNOSIS In fiscal year 2020-21, 43 percent of individuals entering our care presented with disruptive mood dysregulation disorder (DMDD), while 32 percent presented with a major or other depressive disorder (MDD).

a broad array of extremely customized care options – ranging from state-of-the-art clinical treatments to tried and true therapeutic modalities, to ongoing special education and living and working supports. These complex needs present very differently for each

PRIMARY DIAGNOSIS OF DISCHARGED INDIVIDUALS

individual in our care. For many of the adults with autism we serve, a compassionate set of basic living and working supports can help them live engaged, happy and fulfilled lives. For others, such as adolescents and teenagers with acute emotional and behavioral needs, far more complex and intensive treatments are required to ensure safety and well-being related to skill deficits in impulse control, emotion

With an ACE score of 4 or higher, the long-term

regulation and the ability to engage in age-appropriate

physical and psychological impacts escalate

developmental activities.

significantly.

In most cases, these intense needs relate directly to serious

THE AVERAGE CHILD ENTERS OUR CARE

trauma these individuals have experienced at home or in the

WITH AN ACE SCORE OF

community. Serious and repeated trauma left unaddressed can lead to significant and life-long consequences. The traumas these children have suffered, through absolutely no fault of their own, can profoundly impact the way their brains function and the way they see themselves – and the

Source: Devereux Children’s Behavioral Health Center FY 19-20

world around them. Individuals often come to us with chronic feelings of emptiness, fear, abandonment, hopelessness and impulsivity – all of which can lead to extremely selfdestructive behaviors.

10 10

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

INTEGRATED SAFETY AND QUALITY MODEL 01

SUMMARY OF PROGRESS AND ACHIEVEMENTS

CULTURE OF CARING

BEST-IN-CLASS SAFETY SYSTEMS & TECHNOLOGIES

Safety remains a critical and complex challenge for all providers

•

We have a renewed, laser focus on an innovative project management approach to ensure alignment with all national initiatives

•

Senior leadership meets weekly to drive system-wide investments and progress

•

We have made significant strides but are committed to sustainable interventions

•

We serve as an industry leader advancing the issue of safety for own communities and the broader industry

ROBUST POLICIES & PROCEDURES

INDUSTRY COLLABORATION & ACCREDITATION

•

ENHANCED STAFFING, TRAINING & SUPERVISION

SIGNIFICANT DECREASE IN MAJOR RISK EVENTS

All Services - Rate of MREs per 100 Individual Days

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

INTEGRATED SAFETY AND QUALITY MODEL 01

CULTURE OF CARING Grounded in our founding principles of compassion, care and Servant Leadership, our culture helps ensure a continual commitment to safety and quality for all of those in our care.

ROBUST POLICIES & PROCEDURES By taking a holistic, system-based approach, we have made sweeping enhancements to all dimensions of our operations to set the highest

standards of safety, quality and accountability.

CULTURE OF CARING

ENHANCED STAFFING, TRAINING & SUPERVISION Over the last 20 years, we have supported our model of care with comprehensive recruiting, hiring, training and staffing protocols that

ROBUST POLICIES & PROCEDURES

INDUSTRY COLLABORATION & ACCREDITATION

CONTINUOUSLY ELEVATING SAFETY, QUALITY AND ACCOUNTABILITY

Our commitments to safety and quality span the entire care

The World Health Organization defines patient safety as

1. Culture of Caring

“a framework of organized activities that creates cultures,

2. R obust Policies and Procedures

processes, procedures, behaviors, technologies and environments

3. Enhanced Staffing, Training and Supervision

in health care that consistently and sustainably lower risks and

help our thousands of dedicated team

reduce the occurrence and impact of avoidable harm.”

members best support the individuals

We recognize that ensuring meaningful, continuous quality

we serve every day.

BEST-IN-CLASS SAFETY SYSTEMS & TECHNOLOGIES As an industry leader, we have invested in best-

BEST-IN-CLASS SAFETY SYSTEMS & TECHNOLOGIES

ENHANCED STAFFING, TRAINING & SUPERVISION

continuum and are focused on five critical areas:

4. Best-In-Class Safety Systems and Technologies 5. Industry Collaboration and Accreditation

and safety improvements in the behavioral healthcare field

Our focused, holistic model ensures the consistent progress

requires dedicated focus and commitment, as well as significant

all responsible healthcare providers must make on an ongoing

investments of time and capital resources. By taking a holistic,

basis: enhanced visibility on the ground, in care settings, where

system-based approach to safety and quality, we have made, and

it matters most; ever-stronger controls and oversight of safety,

will continue to make, sweeping and significant enhancements to

quality and risk management; faster cycles of decision-making;

all dimensions of our operations, culture, systems and standards.

and complete accountability at every level.

in-class technology, programs and facilities to improve the safety of our physical spaces and mitigate risk across the full spectrum of our care.

INDUSTRY COLLABORATION & ACCREDITATION Working in close partnership with hundreds of families, educators, policymakers, regulatory agencies and law enforcement groups, our national network is dedicated to creating an even safer environment for all. 14

If Devereux never stepped in, I’d be dead, in jail or on the streets. Devereux saved me.” — Former Devereux Residential Individual, 2020

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

01 CULTURE OF CARING I love that I have the privilege of working for an organization whose culture supports fellow-minded people who inspire each other to work better.” — Devereux Direct Care Team Member, 2021

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

01 | CULTURE OF CARING

MISSION

SERVANT LEADERSHIP

To change lives – by unlocking and nurturing human potential for people living with emotional, behavioral, or cognitive differences.

Servant Leadership is recognized in the healthcare industry as an effective cultural model that decentralizes and enhances care accountability.

OUR CORE VALUES COMPASSION: We have a deep and abiding understanding of, and respect for, our individuals and their families.

Since our implementation of Servant Leadership principles, we have experienced an 8 percent reduction in employee turnover and an acceleration of safety programs and progress.

COMMITMENT TO SERVANT LEADERSHIP

Since our implementation of Servant

Supporting our culture of compassion is an

demonstrating the positive cultural shifts

organization-wide commitment to Servant

produced and supporting a key employee

Leadership – a philosophy, set of values and

data point, which correlates directly to

practices that builds better organizations

greater markers of safety and quality.

and creates a more just and caring world. Servant Leadership is recognized in the healthcare industry as an effective cultural

KNOWLEDGE: We rely on data and evidence to inform our care. Our work requires a marriage of science and art.

model that decentralizes and enhances care

COLLABORATION: We require an integrated team approach based on respect, shared goals and altruism.

employee and direct care staff personal

DEDICATION: We maintain relentless optimism and perseverance to support the lifelong journey of those we serve. LEARNING: We pursue continuous personal improvement, professional development and expanding impact. PROGRESS: We are Always en Route, continually incorporating new innovations to advance our services, our industry and the lives of those we serve.

accountability. Adopted by many hospitals and health systems, it is proven to forge

Leadership principles, we have experienced an 8 percent reduction in employee turnover,

This study was spearheaded by one of Devereux’s doctoral interns, whose research was accepted for a poster presentation at the American Psychological Association’s conference in Chicago in August 2019.

more compassionate environment of mutual

THE DEVEREUX FAMILY STANDARD OF CARE

respect and personal accountability.

Our programs, practice settings and systems

We are delighted to see and experience the

of care must match the same high levels of

a more patient-centric mindset, improve development and growth, and lead to a

impact of Servant Leadership on safety and quality. A recent study of Devereux centers

quality and compassion of those we would choose for our own family members.

shows through data points that our centers that are the most progressed in adopting Servant Leadership practices have the highest number of positive discharges of individuals. This positive cultural momentum is thrilling to see in action and helps us chart tactical Servant Leadership adoption plans for our other centers.

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

] 01 | CULTURE OF CARING

FA M I LY B I L L O F R I G H T S

For more than a century, Devereux has held a core belief that each individual served should be treated with the utmost care and respect. Grounded in compassion, our approach provides sensitive and flexible care that takes into account the developmental, psychological, emotional, and social needs of children, adolescents, and their families. We formalized this commitment by establishing a standardized set of principles and practices that is now a model for the industry.

ALL FAMILIES AND LOVED ONES IN OUR CARE HAVE THE RIGHT TO: Deliver on the promise of its Family Standard •

•

seriously, and addressed in a safe and timely manner

Actively engage in their loved one’s care and treatment •

•

treatment model •

planning team meetings, evaluations, and feedback sessions •

•

Receive person-centered and strength-

Receive equitable care – race, ethnicity, national origin, religion, ability, gender, gender identity, sexual orientation, and age will not impact quality of care

•

up of current and past family members of individuals in our care, foster parents and siblings and other family connected members. The board facilitates improved communication between Devereux and the

CULTURE OF CARING AWARD The Culture of Caring Award, now in its 17th year, is presented to a direct support professional at each center who goes above

Be heard and supported regarding their

and beyond, daily, to help the individuals

views, opinions, and concerns

we serve reach their full potential.

Have ongoing and frequent communication

These employees improve organizational excellence by putting our Servant

PARENTS IN BOARD COMPOSITION Our national Board of Trustees is required to ensure that 33 percent of the board be comprised of Devereux family members.

Leadership principles into action by being

Receive comprehensive information about

Compassionate Collaborators and Persons

diagnoses, medications, individualized

of Character, and by Putting Others First

treatment options and plans, available

and Leading with Moral Authority.

progress, and expected outcomes •

Board. This all-volunteer board is made

Be actively involved in the discharge

programs, activities and experiences,

one’s needs

established the Devereux Family Advisory

family support and counseling.

their loved one’s staff and treatment team •

and expand the roles families play, we

loved one’s diagnoses and conditions

with their family member in care, as well as

Receive timely and appropriate medical

child, sibling, or loved one. To formalize

role in providing peer-to-peer, family-to-

•

is the first and foremost expert on their

and continuing education regarding their

Receive services in treatment settings

Receive appropriate levels of care

At Devereux, we recognize that family

families we serve and plays an important

appreciation, and empathy

Be treated with dignity, respect,

FAMILY ADVISORY COUNCIL

Receive resources, trainings, supports,

planning process

based care individualized to their loved

•

Participate meaningfully in treatment and

Communicate openly and in the way that best meets the unique needs of them and their loved one

care and follow-up •

Incorporate their own family values, culture, and preferences into the

according to the needs of their loved one •

Be recognized and valued for their expertise regarding their loved one

that foster positive family relationships •

Have questions and grievances taken

Each award recipient receives a letter from our president and CEO, a $500 check, and

Request an interpreter to facilitate full

recognition from their center executive

communication and understanding in the

director and staff.

family’s preferred language

Have their confidentiality and privacy protected

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

02 ROBUST POLICIES & PROCEDURES I can’t say it enough – you all form the MOST amazing team, and we are incredibly thankful for all of the ways you have loved my son these past 14 years. He is a fundamentally different person because of you. I hope you take deep joy and satisfaction, knowing each one of you has played a real role in who he has become today.” — Devereux Pennsylvania Parent, 2021

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

02 | ROBUST POLICIES & PROCEDURES

As one of the country’s largest behavioral healthcare organizations, we are committed to advancing our industry by identifying, analyzing and modeling best practices in quality and safety. Over the last century, Devereux has worked in close partnership with families, educators, policymakers, regulatory agencies and law enforcement groups to enhance and expand industryleading policies and protocols. Our goal is to create an even safer environment for the children, adolescents and adults entrusted to our care, and to provide a road map for the rest of the industry to follow.

SAFETY SUMMIT:

COMPREHENSIVE 10-YEAR INCIDENT REVIEW JANUARY, 2021 - 10-YEAR INCIDENT REVIEW: •

Key learnings of every incident over the last 10 years

•

Trending of key data points and themes

•

Systemic improvements and intervention points

•

Key action areas and steps in response to themes

We have made significant strides in strengthening our

RISK MANAGEMENT COMMITTEE

reporting and response protocols. Devereux centers track

A key anchor of our restructuring was the reorganization of the Devereux Risk Management Committee – which now comprises an interdisciplinary team of senior leaders, experts, academics and practitioners with a targeted focus on the most critical metrics to ensure individual safety and success. Through a datadriven approach with formal project management supports, the committee recently:

service lines, including allegations and Major Risk

•

Established a dedicated interdisciplinary Risk Management Committee

•

onsistent focus on MREs, specifically allegations of abuse / C neglect

•

Established a new leadership role: chief safety and risk officer

•

Enhanced incident reporting for individuals and care teams

•

Enhanced incident investigation protocols

•

Enhanced employment screening tools and protocols

•

nhanced reviews and evaluations for direct support E professionals

and report more than 70 categories of incidents across all Events (MREs). Front-line staff report every incident, from routines that occur throughout the normal course of treatment (e.g., medical illness, administration of first aid) to serious events (treatment beyond first aid, any allegation of abuse made by an individual, under any circumstance).

Thank you for all your support you gave Samantha. Thank you for watching out for our baby during the hardest decision we’ve ever had to make.” — Devereux Parent, 2021

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

02 | ROBUST POLICIES & PROCEDURES

EXPANDED DISCLOSURE AND REPORTING PROTOCOLS

SYSTEM-WIDE SAFETY DATA DASHBOARDS

In addition, we have instituted expanded methods for our individuals,

To further enhance the transparency of our incident data and reporting, we launched an innovative dashboard that provides a clear and comprehensive view of incidents.

families and staff to raise questions or concerns, and submit reports about any matter, anywhere across the organization. EXPANDED DISCLOSURE OPTIONS INCLUDE: •

Therapeutic disclosures

•

Family member disclosures

•

A nonymous disclosures

•

New web link for family grievances

•

Remote quality improvement oversight

•

Observational visits

•

Unannounced / overnight visits

ENHANCED SAFETY DATA COLLECTIONS

High-value data from the organization’s internal systems and, increasingly, from external sources, is structured in a configuration that joins information from various sources and functional domains. All direct care managers can see and act on a variety of important data in real time. Devereux’s RADAR dashboard (incident reporting) can be filtered to display only those events where a personal emergency intervention

(PEI) was employed, to supply information on the utilization and effectiveness of prevention strategies or injury statistics. This includes: data by state, center, incident, time periods and program area. It also shows trending information to help us identify and address any red flags in our operations ahead of time. REAL-TIME DATA FILTERED BY: • • • • •

State Center Incident Time periods Program area

ACCURATE, VISIBLE AND ACTIONABLE A focus area of Devereux’s National Quality Improvement (NQI) team is to ensure that data collected is accurate, visible, consumable and actionable. The system was modified to automatically trigger Major Risk Events (MREs), elevating incident data to leadership. Note: Our NQI team reviews every MRE within 24 hours. When trends or spikes in data are identified, focused improvement / turnaround projects are initiated at the center using agile project management in partnership with operations and clinical staff. Specific project focus areas include elopements, choking events, suicidal behaviors and personal emergency interventions.

Tracking and Reporting More than 70 Incident Categories Across All Service Lines and All Centers. DECREASE IN MAJOR RISK EVENTS

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

03 E NHANCED STAFFING, TRAINING AND SUPERVISION Throughout the hiring process, every effort is made to gain a complete picture of each applicant and his or her ability to do what we consider to be the most important work in the world.” — Devereux People Operations Leader, 2021

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

03 | ENHANCED STAFFING, TRAINING AND SUPERVISION

RIGOROUS PRE-EMPLOYMENT CLEARANCES

ENHANCED SCREENING TOOLS AND EVALUATIONS

wrenching, heroic work. Many of the individuals we serve have

All potential employees undergo a robust and comprehensive

To continue to elevate and enhance the ways in which we

complex treatment needs or trauma-induced behaviors. They

screening process that meets and exceeds background checks

qualify, select, screen and hire our direct care teams, all direct

come to us with a history of hurting themselves or others;

required by law. This thorough employment screening process

support professionals undergo 50 hours of safety training upon

running away from home or other care settings – in ways their

includes:

hiring and 40 hours per year thereafter on the topics of abuse

At the heart of providing safe, secure and quality care is a dedicated and talented team of compassionate direct care staff. It takes a special kind of professional to do this heart-

own families cannot manage alone.

We can develop the most sophisticated and safest systems of care, but it comes down to our high-quality employees and their decisions that make the ultimate difference.

and neglect, as well as appropriate boundaries and interactions

•

Criminal history check

•

FBI and motor vehicle records check

•

Child abuse clearance check

All direct care staff undergo a comprehensive evaluation

•

Medicaid Sanctions Screening (OIG, SAM, State

after 90 days of employment, and again after 12 months of

Exclusions)

employment to ascertain job performance and competency.

•

Fraud and Abuse Control Information Systems (FACIS)

•

E-Verify clearance

•

Pre-employment physical and drug screening test

•

Three Reference Checks

WHAT IT TAKES TO BECOME A DEVEREUX EMPLOYEE

Potential employees must provide three references that are

Over the last 20 years, Devereux has employed more than

Devereux culture and values.

checked and thoroughly vetted for potential inaccuracies in experience and qualifications, as well as for potential fit with

61,000 staff members – all of whom live and breathe our

with individuals in care.

EXPANDED STAFF STRUCTURES AND SUPERVISION Devereux maintains robust staffing ratios, generally far exceeding those required by regulation. For example, in our short-term intensive children’s therapeutic residential programs, two staff members are dedicated to caring for each child during waking hours.

mission. To that end, we have developed comprehensive

Our residential classrooms are staffed, at a minimum, by both

recruiting, hiring, training and staffing protocols that help our

a special education teacher and a specialized teacher’s aide.

team members best support the individuals we serve every day.

Ample, high-quality, compassionate staff are central to providing excellent care – a central focus for Devereux.

SCREENS ADMINISTERED

IMPLEMENTING THE DIANA SCREEN

2020

2021

In early 2020, our National Risk Management Committee led an initiative to research, identify and implement an applicant screening tool that provides another layer of safety and quality. We adopted the “Diana Screen®,” which was first validated for use in 2019, as a tool to evaluate applicants’ ability and capacity to recognize sexual boundaries between adults and children. Candidates who do not pass the Diana Screen are not offered employment.

ESSENTIAL SKILLS FOR BEHAVIORAL HEALTH PROFESSIONALS Devereux has developed a new model of employee learning and professional development to enhance the quality of treatment and safety for the individuals and families we serve. Essential Skills for Behavioral Health Professionals is a skillbased learning program for Devereux’s behavioral health professionals, including direct support professionals, teachers, clinicians, nurses and their supervisors. The Essential Skills are focused on teaching positive behaviors, preventing and responding to challenging behaviors.

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

03 | ENHANCED STAFFING, TRAINING AND SUPERVISION

REDUCING TURNOVER AND VACANCIES

CHAMPIONING WAGE INCREASES TO ELEVATE CARE

Sourcing, attracting, evaluating, hiring, training and retaining the best professionals in the industry is the single greatest thing we can do to maintain and improve the quality of our programs and services. This is also one of the industry’s greatest challenges.

Devereux is committed to championing superior hiring and employment practices in the behavioral healthcare industry. For the last decade, our compensation structures and recruitment programs have attracted the best talent and maintained the highest retention levels.

TAKING THE LEAD TO ADDRESS THE HEALTHCARE STAFFING CRISIS In a 2018 survey regarding direct support professionals (DSPs) in Pennsylvania, it was determined that there was an annual turnover rate in excess of 38 percent and an open position rate of about 20 percent. The impact of these figures, combined with other routine employee absences, creates a situation whereby, for any given shift, one out of three employees may be missing. Through tremendous effort as an organizational focus, Devereux’s turnover rate has decreased 10 percent over the past two years. At 30.5 percent, Devereux’s turnover rate is significantly below the industry average of 38 percent to 45 percent. Our vacancy rate is a measure that determines the percentage of positions that are open (vacant) against the total number of positions. This measure showed more than 50 percent improvement over the past two years. Our vacancy rate currently stands at 7.6 percent, three to four times lower than commonly reported average vacancy rates in the human services field of 20 percent to 30 percent.

A quick note that our son has been doing well since he got home. He misses you, the nurses, the staff and the teachers very much. He has been constantly telling me how grateful he feels about all the love, care and support he received from you and the Devereux team. Without that, he could not have improved so much and could not have graduated from high school this summer. We just can’t thank you more for all the great support from you and the team! He has only been home for four days, but he already asked when he could go back to visit Devereux.”

ENHANCED MANDATORY SAFET Y TR AINING

COMPREHENSIVE EVALUATION AFTER 90 DAYS OF EMPLOYMENT, AND AGAIN AFTER 12 MONTHS

50 HOURS

OF SAFETY TRAINING UPON HIRING

40 HOURS

OF ANNUAL TRAINING

•

Quality care

•

Regulations and quality

•

Abuse and neglect

•

Corporate compliance

•

CPR and first aid

•

Culture diversity

•

Documentation

•

Driver safety

•

Fire safety

•

Food safety and dietary precautions

•

LGBTQ rights

•

Positive care approaches

•

Rights of individuals in care

•

Safe and appropriate interactions

•

Safe physical management of individuals

•

Sexual harassment

•

Supervision

•

The family perspective

•

Trauma-informed care

•

Workplace safety

— Devereux Parent, 2021

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

03 | ENHANCED STAFFING, TRAINING AND SUPERVISION

DIRECT CARE PROFESSIONAL COMPENSATION INITIATIVE While there are many factors that go into whether an applicant considers a position with a new employer, none is more influential than pay at the direct care level. Unfortunately, the current human services system does not support pay for direct support professionals (DSPs) at levels on par with medical care staff. The vast majority of DSPs need to supplement their base pay with a significant amount of overtime and/or a second or third

PROGRESS AND MOMENTUM Over the past two years, we have seen retention rates increase, while turnover and vacancy rates have decreased. Rolling retention – Defined by the number of employees who are still employed that were employed on the same date one year ago:

job to support their families. DSP work is extremely rewarding, but it also can be difficult and stressful at times. We deeply understand the value of DSPs for those in our care and believe a fair wage for DSPs is $20 per hour. While the system does not support levels of pay in that range, we have made a commitment to do everything possible to push wages higher for our valuable DSPs. In the short-term (fiscal

Annual turnover – Defined by the percentage of employees who termed employment within the year:

year 2021), we have made the commitment to move our starting DSP pay at least $1 per hour above the market midpoint. Longer-term, our goal is to be at $2 per hour above the market.

Our investment in higher wages across 4,000 DSPs translates to a $20 million annual investment in our people.

Vacancy rate – Defined by the percentage of vacant staff positions against the total number of positions available:

In the past two years, we have made significant strides in DSP pay. At the start of 2018, our average DSP pay was

*(Began tracking vacancy rate in 2019)

$12.50 per hour. Today, it is $17.17 per hour. Annually, this is greater than $4,900 per employee, and an increase of nearly 20 percent in just a two-year period.

34 34

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

04 BEST-IN-CLASS SAFETY SYSTEMS AND TECHNOLOGIES I think Devereux has changed our life in that they’ve taken our son in and given him a safe place to live and given him the therapy he needs to come home again.” – Devereux Parent, 2021

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

04 |

Over the past several years, Devereux has invested in significant upgrades and enhancements to our video and monitoring safety systems. These upgrades have included an increase in the number of locations being monitored on our campuses, as well as a robust and industry-leading procedure for reviewing and evaluating video footage, including both random live checks and detailed analysis and investigation if / when incidents are reported.

Enhanced video management features include:

Over the past three years, we have invested more than $50 million in safety-directed facility improvements and video technologies. MULTIMILLION-DOLLAR INVESTMENTS IN VIDEO TECHNOLOGIES Since 2018, we have added 600 cameras to our centers for a total of 2,000 active cameras. In the coming year, we will be adding nearly 3,000 cameras. The additional cameras facilitate the review of video, whether remotely or in real time, by center and national staff with improved search functionality. Videos permit real-time monitoring of care, assist supervisors in understanding the cause and scope of incidents, and are useful in developing remedial and, as necessary, corrective actions.

•

,000+ state-of-the-art video 5 cameras across all centers

04 | BEST-IN-CLASS SAFETY SYSTEMS AND TECHNOLOGIES

REAL-TIME OBSERVATION An additional area of focus is the method used to track the monitoring of our individuals during overnight shifts. To address the challenges of timely reporting and oversight, Devereux is piloting

nhanced visibility (e.g., zooming E features and compression technologies)

two new technology solutions. One option utilizes radio frequency

•

Centralized and secure video management

depend on proximity of the recording device (typically a tablet

•

ranular permission sets to manage G access rights

•

rchival methods to store video A outside of live feed process

•

Enhanced backup procedures

•

xport capability from the video E archive for review by authorized and approved entities

•

inimum recording speed of 15 feet M per second (fps)

•

Enhanced low light recording

These security protocols are a proactive safety measure used in common spaces to provide an additional layer of supervision and accountability for our individuals and staff. They are not required by law or license, and our centers receive no direct funding for these additional safety measures. We believe this same commitment to safety and security should be made by all nonprofit behavioral healthcare providers across the country. We will continue to advocate for broader use of video across the industry to protect our individuals and report instances of harm more effectively.

identification (RFID) and the second depends on Bluetooth. Both systems identify those individuals assigned to each room and or smartphone) to the RFID or Bluetooth transmitter embedded in the room itself. When the recording device is in range, the recorder visualizes the individual assigned to that room or notes their absence. Both methods can send notices to managers when observations are not recorded within the expected interval. This technology has already been piloted at certain Devereux Pennsylvania locations with plans for expansion.

CAPITAL INVESTMENTS / FACILITY UPGRADES Devereux has strategically acquired and significantly improved real estate assets, all of which are employed in the direct delivery of services to the individuals in our care or in support of those services. To maintain our facilities, and to ensure they adequately support the needs of our individuals, ongoing reinvestment and maintenance is required.

OUR SAFETY-LED INVESTMENTS

Capital Projects

Facility and residential center upgrades, repairs, maintenance

$54

MILLION

$83

MILLION

Traditional level of non-reimbursed capital investments in Behavioral Health sector

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

05 I NDUSTRY COLLABORATION AND ACCREDITATION If our son couldn’t be at Devereux, he wasn’t going anywhere! Let us tell you why. The Devereux team – local, regional and national – operates at a standard of excellence few others can rival. Devereux is progressive in its approach to preventative measures, and is forward-leading in areas of training, teaching and staff development, both personally and professionally.” — Devereux Parent, 2021

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

05 | I NDUSTRY COLLABORATION AND ACCREDITATION

Devereux works in close partnership with families, educators, policymakers, regulatory agencies and law enforcement officials to create an even safer environment for the children, adolescents and adults entrusted in our care, and to provide a road map for the rest of the industry to follow.

A CENTURY OF PARTNERSHIP AND ACCOUNTABILITY Many of our partnerships with industry leaders and organizations span decades of proactive collaboration. Over the years, our own staff have risen to significant leadership positions serving on boards, leading committees and managing initiatives, setting standards and mentoring the next generation of industry leadership. Our connections and collaborations with organizations throughout the industry are far reaching. LEADING MENTAL AND BEHAVIORAL HEALTHCARE AGENCIES AND ASSOCIATIONS Leading national and industry organizations at the top of their field that share our commitment to the delivery of responsive,

policy and advance the practice of behavioral healthcare and child welfare for the industry and our communities QUALITY ACCREDITATION AND LICENSING ORGANIZATIONS Global, national and regional accrediting bodies that work with us to ensure we meet the highest standards of care through an ongoing and unbiased assessment of quality achievement in patient care and safety for all programs and services in all states. CHILD SAFETY AND WELFARE AGENCIES AND ASSOCIATIONS Hundreds of leading private and public agencies in 30 states committed to advancing the practice of serving the nation’s most vulnerable children and families.

accountable and clinically effective prevention, treatment and care

PARENT ASSOCIATIONS AND COALITIONS

for individuals with mental health and substance abuse disorders.

National, state and regional groups of committed families,

STATE DEPARTMENTS OF HEALTH AND HUMAN SERVICES Leading governmental and quasi-governmental licensing, funding and policymaking organizations at the federal and state level working side by side with us to ensure quality, inform

coalitions and volunteers who work with our leadership and direct care teams to best advocate for the clinical, emotional and personal interests of children with intellectual and psychological challenges. PUBLIC AND PRIVATE UNIVERSITIES

INTERNATIONAL PARTNERS

Dozens of leading academic institutions and programs whose

Ongoing relationships with a number of industry-led behavioral

clinical experts, scientists and thought leaders partner with our

health initiatives in four countries beyond the U.S. to advance

teams to advance evidence-based treatments and university-led

the understanding and improvement of specialized behavioral

initiatives and studies.

healthcare treatment for children and adolescents.

LAW ENFORCEMENT AGENCIES

AUTISM INDUSTRY PARTNERS

A collaborative network of state, local and regional enforcement

Collaborative network of leading national and industry

agencies and entities that serve as our partners in developing

organizations at the top of their field that share our commitment

enhanced standards for responding to mental health crises,

to the delivery of responsive, accountable and clinically effective

issues, incidents and challenges with compassion, collaboration

prevention, treatment and care for individuals with autism

and consistency.

spectrum disorder.

PUBLIC SCHOOLS AND EDUCATION LEADERS A decades long partnership with more than 60 public school districts nationwide to ensure the delivery of therapeutic support is made available to students and families in need of traumabased mental health support, family counseling and behavioral interventions and support. 42

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

03 | ENHANCED STAFFING, TRAINING AND SUPERVISION

RIGOROUS INDEPENDENT INSPECTIONS AND ACCREDITATIONS Rigorous and continuous reviews are a cornerstone of our safety and quality approach. We partner closely with a broad network of state and county regulatory authorities, licensing agencies, industry experts and consultants. These ongoing, unrestricted, thorough and exacting reviews of our

Beyond our own stringent standards, we meet or exceed hundreds of specific federal standards and state licensure benchmarks. These independent reviews cover our physical plants, operating practices and risk management protocols. Each is supported by interviews with the children and adults in our care, as well as their families, and our front-line staff. Information from these reviews is shared widely with our staff and industry partners to continue to improve and enhance the clinical and community impact of our important work.

programs and services ensure that we meet or exceed all safety policies and procedures for our individuals and families and serve as a model for the industry.

HIGHEST LEVEL INDUSTRY ACCREDITATIONS

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DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

CLINICAL AND COMMUNITY IMPACT

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021

CLINICAL AND COMMUNITY IMPACT

INTELLECTUAL AND DEVELOPMENTAL DISABILITIES – FACTS AND FIGURES •

Years serving our communities

43%

of our served population presented with disruptive mood dysregulation disorder

250+ 70+

Treatment locations and community living homes nationwide

50%

Decrease in Major Risk Events (MREs) across the Enterprise

Incident categories tracked and reported in real time across all centers

5k+

Cameras across all Devereux facilities capturing 110,000 hours of video daily

•

425k+

individuals with I/DD live

developmental disabilities

with a caregiver. There are 473,000 people with

•

About one in six (17 percent

I/DD on waiting lists across

of children between the ages

the U.S. and states have been

of 3 to 17) was diagnosed with

slow to respond to the needs

a developmental disability, as

of the individuals waiting for

reported by parents, during a

placement in the community.

study period between 2009

Individuals cared for since founding

Currently, 80 percent of

•

diagnosed with intellectual and (I/DD) in the U.S.

DEVEREUX BY-THE-NUMBERS

100+

There are 6.5 million people

to 2017. These disabilities

Between 20 percent and

•

40 percent of individuals with

included autism, attention-

I/DD also have a mental health

deficit/hyperactivity disorder,

$50M

Knowing my son is at a place where people care so much for his whole health makes a huge difference. I want all of Sara’s supervisors to know what a blessing she is, and what an incredible nurse and person she is.”

diagnosis requiring additional

blindness and cerebral palsy,

— Devereux Massachusetts/

behavioral health supports

among others.

Rhode Island Parent, 2021

and services.

Invested in safety technology and capital improvements in the last five years alone

AUTISM SPECTRUM DISORDER - FACTS AND FIGURES DEVEREUX’S CLINICAL/COMMUNITY IMPACT

25k Individuals served annually

86%

Successful transitions to lower levels of care

86%

Overall satisfaction rates (patients, funders, families)

2:1

Ratio of unique care to individuals in short-term care programs

20% 700+ Increase in wages for direct support professionals in two years

Individual independent, third-party on-site reviews over the last 18 months

•

96% Making functional communication improvements

About one in 44 children has

•

Regulatory Citations or Licenses Sanctions in the past two years

Mothers of children with ASD, who

have an intellectual disability

tend to serve as the child’s case

according to estimates from

(intelligence quotient [IQ] <70)

manager and advocate, are less

the Centers for Disease Control

with significant challenges in daily

likely to work outside the home.

and Prevention’s (CDC) Autism

function; 25 percent are in the

and Developmental Disabilities

borderline range (IQ 71–85).

estimated 40 percent of people

•

with autism are nonverbal.

•

autism spectrum disorder (ASD),

Monitoring (ADDM) Network. An

•

31 percent of children with ASD

ASD is reported to occur in all racial, ethnic and socioeconomic groups.

•

On average, medical expenditures for children and

Nearly two-thirds of children

adolescents with ASD were 4.1

with autism between the ages of

to 6.2 times greater than for

6 and 15 have been bullied.

those without autism.

Nearly 28 percent of 8-year-olds with ASD have self-injurious behaviors. Head banging, arm biting and skin scratching are among the most common behaviors.

DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021