Internal Review of Peer-on-Peer Aggression- comments/recommendations in bold 

All incidents that meet the definition of “peer-on-peer aggression” in the Human Rights Regulations are to be reviewed by the provider (include timeframe for this expectation, is it assumed it would be within 24 hours to determine if CHRIS reporting is required? Recommendation is 3 business days. If we determine it needs to be reported and further investigated, is that the date of discovery? If not, will provider be cited for late reporting? This is problematic). This (documented) internal review (provider’s standard processes) of incidents involving peer-on-peer aggression is expected to consider, at a minimum, whether provider staff followed internal policies and procedures, delivered supervision consistent with individual needs and the ISP, and acted to prevent individuals from being harmed while receiving services. In addition, the provider is expected to identify any programmatic issues that may have contributed to the opportunity for peer-on-peer aggression (e.g., policies, protocols, etc.). Upon completion of this internal review, providers are expected to implement any identified proactive measures that may reduce the number of peer-on-peer aggressions and lessen the possibility of neglect, resulting in a safer treatment environment overall. (See also 12VAC35-105-160 and 12VAC35-105-520 of the Rules and Regulations for Licensing Providers by the Department of Behavioral Health and Developmental Services [“Licensing Regulations” ] that specify various review and reporting requirements.) Please note that the internal review refers to the provider’s standard processes to review incidents to determine any further actions needed to identify and address potential harms to an individual and to reduce the likelihood of reoccurrence (move this to before the internal review for clarification that it is based on providers standard processes). This is separate from the formal (remove formal to be consistent with regulation language) investigation that would occur if the review raised suspicion of abuse or neglect.

Reporting Peer-on-Peer Aggression Potential Neglect- comments/recommendations in bold

In addition, providers shall also report incidents of peer-on-peer aggression that, upon review by the provider, meet at least one of the following criteria:

• An incident that clearly occurred because staff were not engaged in appropriate supervision (e.g., provider staff willfully ignored aggression of one peer to another, provider staff intervened but not in accordance with policy, provider staff failed to implement supervision or supports based on the specific needs identified in the ISP);This implies incident would be investigated prior to submitting to CHRIS or this information would not be known.

• Three or more incidents of peer-on-peer aggression involving the same peers within seven-day timeframe. (# of peers to include the victim or the aggressor?)This implies that there would be an internal tracking to determine if these thresholds/types of incidents were met.

Incidents of peer-on-peer aggression that are determined to be reportable after a review by the provider shall be entered in CHRIS within 24 hours of this determination. (Is determination the date of discovery versus the date of the incident? Is the date of investigation the date of the preliminary investigation to make the determination, or the date we determine further “formal” investigation is required?) These incidents should be coded under the category “Neglect Peer-on-Peer Aggression” and the description must indicate the reason for the report. For instance, when the report is concerning three or more incidents of peer-on-peer aggression within a seven-day timeframe, the provider must indicate this as the “description,” along with a brief account of the three incidents. When the complaint alleges involvement of a known provider staff person, the provider staff name (It is inappropriate to enter the name of a staff member alleged to be involved in an allegation of this or any type. Doing so has the potential to skew the focus of an investigation to look at that named staff member, instead of allowing all data to be gathered before a final determination is made. In addition, doing so further compounds the fears of staff members who are already concerned about any entry of their name into the CHRIS system.) must be entered in the description of the incident on the Accusation Tab in CHRIS. If the allegation indicates a possible programmatic failure, the provider should select “Other” and enter the provider’s name (e.g., ABC Residential) under the Accusation Tab in CHRIS. Reports of peer-on-peer aggression should be entered in CHRIS under the name of the individual who was the alleged victim of the aggression. If the aggression was mutual, a separate report must be entered for all individuals involved.

If at any time the provider has reason to suspect that an incident may be a crime, or is otherwise reportable to another entity, the provider shall report the incident to all appropriate authorities in addition to its reporting requirements to the department. Such instances may include the following:

• An incident between peers involving sexual assault, which is a form of violence and includes forced groping and rape;
• An incident involving unwanted sexual activity between minors (e.g., intercourse, kissing, touching of private areas); or
• An incident involving sexual intercourse or other sexual activity between adult peers in which at least one individual is deemed to lack capacity based on an existing assessment that indicated the individual was at risk of exploitation.
• Include other types of examples where other entities would be contacted such as physical assault, exploitation, etc.
• This could be a collaborative investigation with other entities, such as police, social services, etc. depending on the type of incident.