HCBS-AMH Critical Incident Report

 Critical Incident Report

Critical Incident Report (CIR) is a functionality in CMBHS application which allows Recovery Managers and Provider Agency staff to report a critical incident to the HCBS-AMH program under the statewide reporting requirements.  

Critical Incident report is an effective method of documenting, evaluating, and monitoring certain serious occurrences and assuring that, the state receives all the required information related to the incident.

All allegation of Abuse, Neglect, and Exploitation of an HCBS-AMH individual must be reported, as well as, any incidents involving Emergency Services, Hospitalization, the ‘Death’ of the HCBS-AMH individual, the involvement of Law Enforcement, any Environmental Hazards that compromise the health and safety of the HCBS-AMH individual and any Elopement or missing HCBS-AMH client.

Critical Incident Report requires an authorization from HHSC staff.

 Before you Start

• The user must be assigned a CMBHS role that allows you to utilize “Critical Incident Report (CIR)” functionality in the CMBHS application. Click here to view CMBHS Roles and their Read-Only and Read-Write Page Rights.
• The Client must have Client Profile in CMBHS

 

 How to access "Critical Incident Report" from CMBHS Application

To access and create Critical Incident Report (CIR) in CMBHS, Recovery Management Entity and Provider Agency staff should follow the steps below:

• When the user logs into CMBHS, they should click on the Find/Add Client Menu tab on the left-hand side of the screen in the Client Services toolbar > find the correct client and select the Client Workspace.
• Click on Critical Incident Report (CIR) to the left to fill the CIR form.

To access the existing Critical Incident Report (CIR) in CMBHS, follow the steps below:

• When the user logs into CMBHS, they should click on the Find/Add Client Menu tab on the left-hand side of the screen> find the correct client and select the Client Workspace.
• From the Client Workspace> under the document list section>select the document type “Critical Incident Report (CIR)” from the drop down.
• The system will display the Critical Incident Report (CIR) created for the Client/individual.

Critical Incident Report Screen

Critical Incident Report have the following sections:

Section 1: Demographic Information

Demographic Information has following data input fields

1. Individual Name (Read Only):  System defaults the data from Client Profile. 
2. Care ID (Read Only): System defaults the data from Client Profile.
3. Gender (Read Only): System defaults the data from Client Profile.
4. CMBHS ID (Read Only): System defaults the data from Client Profile.
5. Medicaid Number (Read Only): System defaults the data from Client Profile.
6. Population Type (Required): Select one of the radio buttons from the following options: 

• Emergency Department Diversion Population
• Jail Diversion Population
• Long Term Psychiatric Hospitalization Population

7. County of Residence (Required): Select one of the values from the drop-down.
8. LMHA/LBHA (Required): Select one of the LMHA/LBHA parent provider from the drop-down.
9. Legally Authorized Representative Name (Read Only): System defaults the data from Client Profile. If there is an update to LAR, make changes to Client Profile, so that system can pull the most recent data.
10. Legal Status (Required): Select one of the values from the following drop-down values:

• N/A
• Charges Pending 
• Inpatient, 46B, Incompetent to Stand Trail
• Inpatient, 46C, Not Guilty by Reason of Insanity
• Civil Outpatient Commitment/AOT
• Outpatient Commitment, 46B, Incompetent to Stand Trail
•  Outpatient Commitment, 46C, Not Guilty by Reason of Insanity
• Parole
• Probation

11. Individual’s Residence Type: Select one of the values from the drop-down values:

• Apartment
• Assisted Living
• Host Home/Private Residence
• Homeless
• Jail/Prison
• Medical Facility
• Nursing Home
• State Hospital
• Supported Home Living/Private Residence
• Supervised Living
• Other

Note: If ‘Other' is selected from the drop-down, then the system displays conditional free text box to enter other individual's residence type 

l. Residence Address: System defaults the address from Client Profile in read only in following fields:

 

• Address Line 1
• Address Line 2
• Zip Code 
• City

Section 2: Incident Details

Incident Details section have the following data input fields

1. Date of Incident: Enter the date in the date field
2. Time of Incident: Enter the time of the incident in time field.
3. Incident Location: Select one of the values from the drop-down. Based on value selected in the drop-down, the system would display certain set of radio buttons. Then, select one of the radio buttons.  

  Section 3: Organization Details

Depending on the user login credentials, the system will display user specific fields.

For Recovery Managers, the system would display following fields:

• Recovery Management Entity Name (Read Only): System populates the name of the login RME Organization.
• Recovery Manager Name (Required): Select the name of the ‘Recovery Manager’ from the drop-down.
• Recovery Manager Phone Number (Read only): System pre-populate the phone number of the selected ‘Recovery Manager’ from the ‘Recovery Manager Name’ field.
• Head Office Number (Optional): Enter the ‘Head Office’ phone number.
• Date RM learnt of incident (Optional): Enter the date when the RME staff learnt about the incident.
• Provider Agency Name (Required): Select the name of the Provider Agency organization from the drop-down.
• Was the Provider Agency Informed of Incident? (Optional): Select one of the radio buttons from ‘Yes’ and ‘No’ options. 

For Provider Agency staff, the system would display following fields

• Provider Agency Entity Name (Read Only): System populates the name of the login PA Organization.
• Provider Name (Required): Select the name of the ‘PA Provider’ from the drop-down.
• Provider Phone Number (Read only): System pre-populate the phone number of the selected ‘PA Provider’ from the ‘Recovery Manager Name’ field.
• Head Office Number (Optional): Enter the ‘Head Office’ Phone number
• Date of PA learnt of Incident (Optional): Enter the date when the PA staff learnt about the incident.
• Recovery Management Entity Name (Required): Select the name of the Recovery Management Entity Organization.
• Was the Recovery Manager informed of incident? (Optional): Select one of the radio buttons from ‘Yes’ and ‘No’ options.

Section 4: Other Persons Involved in Incident

1. Other Person Type (Optional): select the other person type from the drop-down values: Staff, Victim, Witness and Other
2. Name (Optional): Enter the name of the selected ‘Other Person Type’.
3. Phone Number (Optional): Enter the Phone Number of the selected ‘Other Person Type’. 

Section 5: Critical Incident Details  

Critical Incident Type

Please select only one Primary Incident Type. If multiple incident types are involved, the most serious incident type should be selected as Primary and any other incident type as “Associated”. To change the Primary Incident Type, the original incident type must be unselected.

In case the incident involves multiple incident types, the user will select the most serious type as “Primary” and include other types as “Associated” and provide detail in CIR narrative”

 

All the ‘Critical Incident Types’ are provided in ‘collapsed’ and ‘un-collapsed’ framework. Select (+) in parallel to any ‘Critical Incident Type’ in order to un-collapse the section and to have access to fields associated with Critical Incident Type.

• Allegation of Abuse, Neglect, and Exploitation
• Allegations against individual rights
• Self-abuse, self-neglect or self-harm
• Violence by Individual
• Medication Error 
• Injury, Severe illness or Medical Emergency
• Behavioral Health Emergency 
• Environmental Emergency
• Justice System
• Restraint
• Individual Departure or Elopement
• Eviction from Residence
• Property Destruction/Damage/Fire Setting
• Contraband 
• Death
• Health or Safety Risk
• Extended Nursing Home Placement
• DFPS ANE Investigative Report Final
• Other Incident Type   

Details about Critical Incident Types:

If user selects ‘Allegation of Abuse, Neglect and exploitation’ as Primary or Associated, then the user is required to enter details into the following fields

1. Allegation of Abuse, Neglect or Exploitation

• Allegation of Abuse, Neglect or Exploitation (Optional): Select one of the radio buttons from ‘Primary’ and ‘Associated’.
• Type of Abuse, Neglect or Exploitation (Optional): Select the check boxes from the field.
• DFPS Intake (Optional): Enter the DFPS Intake number.
• Date of DFPS Reporting (Optional): Enter the date in the field.
• Time of DFPS Reporting (Optional): Enter the time in the field with format (hh:mm)
• What was the timeline of ANE Complaint with DFPS abuse hotline? (Optional): Select one of the radio buttons from the list.
• Perpetrator (Optional): Select one of the radio buttons from the list given for the field.

2. Allegation against individual rights: if Allegation against individual Rights ‘Critical Incident Type’ has occurred, then select ‘Primary’ or Associated’ from the given field.
3. Self -abuse, self -neglect or self-harm: If ‘Self-abuse, self-neglect or self-neglect’ has occurred, then select ‘Primary’ or Associated’ from the given field.
4. Violence by individual: If Violence by Rights has occurred has occurred, then select ‘Primary’ or ‘Associated’ from the radio buttons and select the applicable set of check box from the ‘Select that all apply’ field.
5. Medication Error: If ‘Medication Error’ has occurred has occurred, then select ‘Primary’ or ‘Associated’ from the radio buttons and enter the data into the following fields:

• Medication Administered By (Optional): Select one of the radio buttons from the given list for the field.
• Type of Medication Error (Optional): Select one of the value from the drop-down.

6. Injury, Severe Illness or Medical Emergency Requiring Intervention

'Injury, Severe Illness or Medical Emergency Requiring Intervention: Examples include, but not limited to calling to 911, MCOT, Emergency Medical Service, Hospital Emergency Department: If this incident has occurred, then select this as ‘Primary’ or Associated as Critical Incident Type and enter data into the following fields: 

• Did the incident involve Physical Injury? (Optional): Select one the radio buttons from ‘Yes’ and ‘No’ values.
• Hospital Admission (Optional): Select one of the radio buttons from ‘Yes’ and ‘No’ values.

7. Behavioral Health Emergency requiring intervention

Behavioral Health Emergency requiring intervention: Examples include, but not limited to calling to 911, MCOT, Emergency Medical Service, or Mental Health Deputies, Hospital Emergency Department: If this incident has occurred, then select this as ‘Primary’ or Associated as Critical Incident Type and enter data into the following fields:

• Psychiatric or Behavioral Health Emergency due to (Optional): Select all the applicable check boxes from the list.
• Hospital Admission (Optional): Select one of the radio buttons from ‘Yes’ and ‘No’ values.

8. Environmental Emergency

If this incident has occurred, then select this as ‘Primary’ or Associated as Critical Incident Type

9. Justice System

If this incident has occurred, then select this as ‘Primary’ or Associated as Critical Incident Type and enter data into the following fields:

• Justice System (Optional): Select one of the radio buttons from the list for the given field.
• Date of Detainment/Arrest (Optional): Enter the date.
• Discharge Date (Optional): Enter the date.
• Location (Optional): Select one of the radio buttons.
• Reason (Optional): Enter the text in the free text field.

10. Restrictive Intervention:

If this incident has occurred, then select this as ‘Primary’ or Associated as Critical Incident Type and select all the applicable check boxes from ‘Select that all apply’ list.

11. Individual Departure or Elopement:

If this incident has occurred, then select this as ‘Primary’ or Associated as Critical Incident Type and enter the data into the following fields:

• Police Report Number (Optional): Enter the Police Report Number into the field.
• Date (Optional): Enter the date in the date field.

12. Eviction from residence: If this incident has occurred, then select this as ‘Primary’ or Associated as Critical Incident Type
13. Property Destruction/ Damage / Fire Setting: If this incident has occurred, then select this as ‘Primary’ or Associated as Critical Incident Type
14. Contraband: If this incident has occurred, then select this as ‘Primary’ or Associated as Critical Incident Type and select one of the radio buttons from the list in the ‘Contraband Type’ field.
15. Death: If this incident has occurred, then select this as ‘Primary’ as Critical Incident Type and select one of the values from the radio button list of ‘Death’ field.
16. Health or Safety Risk: If this incident has occurred, then select this as ‘Primary’ or ‘Associated’ as Critical Incident Type
17. Extended Nursing Home Placement: If this incident has occurred, then select this as ‘Primary’ or ‘Associated’ as Critical Incident Type.
18. DFPS ANE Investigative Report Final: If this incident has occurred, then select this as ‘Primary’ or ‘Associated’ as Critical Incident Type
19. Other Incident Type: If Other Incident Type has occurred, then the select one of the radio buttons from ‘Primary’ or Associated options of the field and enter the text into free text box.

 

Provide a brief description of incident with any additional helpful detail (who, what, when, where)"

Enter data into the optional free text box, if needed. 

If individual is hospitalized, please provide following information:

This section must have following fields:

• Hospitalization (Optional): Select one of the radio buttons from the list.
• Admission Date (Optional): Enter the date.
• Discharge Date (Optional): Enter the date.
• Brief description of event, treatment plan, and discharge plan (Optional): Enter the text into the free text field.

Did the incident involve a Medication Error? (Required): Select one of the radio buttons from the list.

Were any of the following informed of the Incident? (Optional): ): Select one of the values from the check box values. If multiple values are applicable, then select all the values from check boxes.

Did the incident result in property damage? (Required): Select one of the values from the radio buttons.

Immediate actions taken to secure individual’s safety and proposed prevention plan (Required): Select all the applicable check boxes from the given list for the field. 

Actions taken after invention to minimize recurrence of same or similar Incidents in future

Select all the check box given in the field.

Does Critical Incident Report require an update/follow up' field (Required)

 

Some critical incident types after initial reporting, may require follow-up and updates over time to document progress and outcome. Examples may include but are not limited to participate hospitalized or discharged from hospital, released from jail, returned after departure, or upon receipt of AE Final Investigative Report from DFPS”. 

The update will be required in incidents involving ANE, hospitalization, legal involvement, departure, and any other incident that has not reached a logical conclusion.

If update is required on the created ‘Critical Incident Type’, then select ‘Yes’. But, if no update is not required on the created ‘Critical Incident Type’, then select ‘No’.

If update is required on the initial ‘Critical Incident Report’, then the user would provide all the update on the closed complete ‘Critical Incident Report’. On Closed Complete ‘Critical Incident Report’, the system would display following fields to provide update on the form.

Update 1

• Name
• Date
• Time
• Update Description

Update 2

• Name
• Date
• Time
• Update Description 

Update 3

• Name
• Date
• Time
• Update Description 

Update 4

• Name
• Date
• Time
• Update Description 

 

Signature Section (Read Only)

The system would pre-populate the name of the user login in the ‘Name’ field along with ‘Date’ and Time 

For HHSC staff only:

All the fields displayed under this section can be filled by HHSC staff only section.

Following are the fields displayed under the section:

• Case Status for Allegation of Abuse, Neglect and Exploitation (Optional): HHSC staff will select the radio buttons and enter the date in the date field.
• Case Status for Critical Incident including Allegations of Abuse, Neglect or Exploitation (Optional): HHSC staff will select the radio buttons and enter the date in the date field.
• Did the incident involve restrictive intervention? (Optional): HHSC staff selects the radio buttons.
• HHSC follow up (Optional): HHSC staff enters the text into the free text field
• Incident Resolved and Closed Complete (Optional):  HHSC staff select the radio buttons
• Date: HHSC staff enters the date.

Creation of CIR

• CMBHS application allows the user to create another Critical Incident Report for the client, irrespective of existing Critical Incident Report documents in ready for review in the Client Workspace on the login provider location or different provider location. 

Document Status

Select ‘Ready for Review’ from the Document Status drop-down.

Note: When the users place the CIR document in “Ready for Review” status, then the CMBHS application would send an automated email to HCBS-AMH.CIR@hhs.texas.gov.

Audit Information

This section provides following details to the user, when the document is saved in the system

• Created By: It is a system generated value. It displays the name of the user who has the initiated to complete the document.
• Created Date: It is a system generated value. It displays document saved date and time.
• Last Saved by: It is a system generated value. The system displays the name of the user, who saved the document in the system.1
• Last Saved Date: It is a system generated value. The system displays the document last saved date.
• Approved By: This information is displayed only when the document is in closed complete status.
• Approved Date: It is a system generated value. The system displays the last saved date of document and time.