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
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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
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Devereux Family Bill of Rights Family Advisory Council
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Commitment to Servant Leadership
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Culture of Caring Award
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Family standard of care
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Parents in board composition
02 | ROBUST POLICIES AND PROCEDURES ..........................................................................................22 ֘
Risk Management Committee
֘
Enhanced safety data collections
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Comprehensive 10-year incident review ֘
System-wide safety data dashboards
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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
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Reducing turnover and vacancies
֘
Pre-employment clearances
֘
Taking the lead to address the healthcare staffing crisis
֘
Implementing the Diana Screen
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Championing wage increases to elevate care
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Enhanced screening tools and evaluations
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Enhanced mandatory safety training
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Expanded staff structures and supervision
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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
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DEV EREUX SA FET Y AN D QUAL I T Y R E PORT 2021
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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
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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.
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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.
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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
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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
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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
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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.
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INTEGRATED SAFETY AND QUALITY MODEL 01
SUMMARY OF PROGRESS AND ACHIEVEMENTS
CULTURE OF CARING
02
05
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
04
•
03
ENHANCED STAFFING, TRAINING & SUPERVISION
SIGNIFICANT DECREASE IN MAJOR RISK EVENTS
All Services - Rate of MREs per 100 Individual Days
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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.
02
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
01
standards of safety, quality and accountability.
CULTURE OF CARING
03
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
02
05
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.
04
BEST-IN-CLASS SAFETY SYSTEMS & TECHNOLOGIES As an industry leader, we have invested in best-
04
BEST-IN-CLASS SAFETY SYSTEMS & TECHNOLOGIES
03
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.
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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
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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
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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.
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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.
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] 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
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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
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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
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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
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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
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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
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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.
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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.
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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
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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
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Trauma-informed care
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Workplace safety
— Devereux Parent, 2021
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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.
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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
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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.
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•
,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
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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
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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
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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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CLINICAL AND COMMUNITY IMPACT
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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
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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.
0
•
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.
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© Devereux Advanced Behavioral Health 444 Devereux Drive, Villanova, PA 19085 800.345.1292