APD > Zero Tolerance Initiative

PILLAR 1: RESPONSE, MONITORING, AND QUALITY IMPROVEMENT
PILLAR II: TRAINING AND EDUCATION
PILLAR III: PUBLIC AWARENESS
PILLAR IV: CHANGES TO FLORIDA LAWS AND RULES

PILLAR 1: RESPONSE, MONITORING, AND QUALITY IMPROVEMENT

APD Accomplishments:

  • Established the Zero Tolerance Steering Committee in 2019. The committee meets regularly to develop and coordinate activities, training, policies, and operating procedures relating to ANE and sexual misconduct. It is comprised of State Office staff from applicable Divisions/Business Units.
  • Developed and implemented the Zero Tolerance Policy (APD Policy #2-0041) in 2019, which provides guidelines for agency staff for preventing, detecting, reporting, and responding to ANE and sexual misconduct against APD clients
  • Implemented the Zero Tolerance in Community-Based Settings Operating Procedure (APD OP #3-0014) in 2021. This procedure includes additional guidelines regarding:
  • wellness visits, increased monitoring, communication with Waiver Support Coordinators (WSCs), and other follow-up actions in response to ANE allegations; and
  • referrals to waiver and non-waiver service providers for trauma-based crisis counseling for individuals who have experienced ANE and/or sexual misconduct.
  • Implemented the Zero Tolerance in Agency Operated Facilities Operating Procedure (APD OP #4-0019) in 2021. This procedure includes additional guidelines regarding:
  • detection and reporting responsibilities, known and suspected ANE reporting, risk reduction and prevention, disciplinary actions relating to verified findings, monitoring, and quality assurance, and zero tolerance training
  • Implemented protocol, via Rule 65G-2, F.A.C. and the iBudget waiver handbook, requiring that a provider’s Medicaid Waiver Services Agreement and/or residential facility license be reviewed for termination when ANE is committed by the waiver service provider or licensee 
  • Established Inspector Specialist positions at each APD-operated residential facility in 2019. Staff in these positions are responsible for conducting all investigations into allegations of ANE or sexual misconduct at the facilities.
  • Expanded monthly health and safety monitoring checklists (used by APD staff during group home inspections) to include protocols for identifying potential instances of ANE
  • Developed mandatory Zero Tolerance training for all APD staff, which includes training in identifying the signs and symptoms of ANE and sexual misconduct
  • Established a statewide alert system with immediate notification concerning situations where Quality Improvement Organization (QIO) reviewers suspect or observe ANE
  • Developed methodology to identify unreported emergency room visits/hospitalizations for APD clients who were diagnosed with injuries or conditions indicative of ANE

APD Ongoing Activities:

  • Ongoing Zero Tolerance training provided to all APD staff and contracted service providers
  • Monthly review of Medicaid emergency room claims (for APD clients) with diagnosis codes indicative of potential abuse or neglect for follow-up action by APD staff and Waiver Support Coordinators (WSCs)  
  • Monthly review of incident reports to identify ANE trends by frequency, type of incident. provider, and client
  • Level 2 background screenings required for all APD staff
  • Verification to ensure provider compliance with background screening requirements
  • Referrals to Medical Case Management Nurses to assist licensing/monitoring staff in identifying the physical signs and symptoms of potential abuse and neglect exhibited by residents of APD-licensed facilities
  • Required monitoring visits to APD-licensed residential facilities on at least a quarterly basis (when residents and staff are present) to assist in the identification of potential ANE
  • Ongoing risk assessments to identify staffing concerns in the APD-operated and APD-licensed facilities, including reviewing the number and qualifications of APD staff and overnight staffing, monitoring trends that may indicate potential ANE due to staffing issues, and developing strategies to mitigate the occurrence of future incidents attributed to staffing patterns
  • Monthly reviews of DCF protective services investigations for necessary follow-up action by APD staff
  • Routine and ongoing analysis of DCF protective services data to identify patterns, trends, high-risk clients, high-risk settings, and potential protective factors
  • Maintenance of Interagency Agreements with DCF on data sharing and delivery of adult and child protective services on an ongoing basis

  • Reviews of Medicaid claims and DCF-verified ANE reports involving APD clients in the community to determine if enhanced oversight or the provision of additional supports is necessary to maintain the health, safety, and welfare of such individuals 

APD Next Steps:

  • Enhance prevention and risk reduction strategies for inclusion within the mandatory Zero Tolerance training for providers.  This enhancement will provide recommendations to operators of APD-licensed facilities relating to staffing and admissions, which will include exploration of the feasibility of:
  • risk reviews for roommate and housemate arrangements (especially when clients have limited communication or physical capabilities); and
  • encouraging same sex direct care workers (particularly during overnight shifts).

PILLAR II: TRAINING AND EDUCATION

APD Accomplishments:

  • Developed online Zero Tolerance training, which includes information on recognizing the signs and symptoms of abuse, neglect, and exploitation (ANE). This training is required upon hire of all APD staff, and annually thereafter.
  • Developed and implemented an online Zero Tolerance training for iBudget Florida waiver service providers and classroom training for APD-operated facility staff.  
  • Provided information to Department of Children and Families (DCF) protective investigators on recommended techniques and best practices when interviewing individuals with developmental disabilities to incorporate into their training
  • To facilitate successful prosecution of cases involving ANE, APD provided a training DVD entitled “Crime Victims with Disabilities: What the Prosecutor Needs to Know About Autism, Cerebral Palsy, Mental Retardation & Traumatic Brain Injury” to every State Attorney’s Office in Florida. APD also worked with the Florida Bar to provide Continuing Legal Education (CLE) credit to Florida-licensed attorneys for viewing this training
  • Shared information and resources (https://apd.myflorida.com/zero-tolerance/docs/State%20Attorney%20Letter.pdf) with State Attorneys  across Florida to assist in prosecuting cases involving ANE committed against individuals with developmental disabilities

APD Ongoing Activities:

  • Continual review of national research and Florida-specific data to identify risk-related trends where intervention efforts should be directed
  • Support Coordinators and CDC+ Consultants are required to provide clients and their representatives with understandable information regarding recognizing and reporting ANE when developing or updating client support plans. The Divisions of Operations and Programs, with the assistance of the Communications Unit, provide periodic advisories and information to Support Coordinators and CDC+ Consultants on ANE requirements and related issues
  • Provision of training to iBudget Florida waiver service providers. The agency reviews and updates ANE training on an ongoing basis 
  • Routine updates to the Zero Tolerance section of the APD website, ensuring up-to-date and relevant information is available to the public
  • Maintaining APD’s online Community Resource Directory with up-to-date contact information of organizations throughout Florida that offer support services to survivors of domestic or sexual violence
  • APD staff, in coordination with the Zero Tolerance Steering Committee, regularly works to identify and/or develop information and related materials to empower clients to recognize, prevent, or deter ANE and sexual misconduct
  • APD staff periodically review and identify best practices from other states and entities related to risk reduction and prevention that could be implemented in Florida. This information is presented to the Zero Tolerance Steering Committee for review and appropriate follow-up actions. 

APD Next Steps:

  • Develop enhanced training for APD staff who interact directly with clients and residents, such as group home monitors and employees/staff who conduct client wellness visit
  • Develop enhanced training for APD staff who interact directly with clients and residents such as group home monitors and staff who conduct client wellness visits
  • Enhance prevention and risk reduction strategies for inclusion within the mandatory Zero Tolerance training for providers 
  • Develop enhanced training on recognizing the symptoms of ANE for APD staff with direct client contact
  • Partner with Disability Rights Florida to help to ensure that domestic/sexual violence shelters are physically and programmatically accessible to APD clients
  • Develop and provide information and training to Sexual Assault Nurse Examiners in hospital emergency rooms on working with patients with developmental disabilities
  • Partner with the Florida Department of Education to develop or augment in-service training for ESE teachers on recognizing signs and symptoms of abuse and neglect involving their students with developmental disabilities
  • Identify or develop training for State Attorneys to facilitate the successful prosecution of cases involving crime victims with developmental disabilities. Work with the Florida Bar to designate such training as eligible for Continuing Legal Education (CLE) credit.
  • Partner with the Florida Department of Law Enforcement to ensure interviewing best practices, as well as recognizing the signs and symptoms of ANE in individuals with developmental disabilities, are incorporated into the core training curriculum for Florida law enforcement officers
  • Develop a training curriculum for law enforcement officers to effectively interact with individuals with developmental disabilities and potential displays of severe behavioral outbursts. This training will include how to assess the situation upon arrival, consumer diagnosis traits to consider, and evaluating risks of suicide/homicide threats. 

PILLAR III: PUBLIC AWARENESS

 APD Accomplishments:

  • Completed major revisions to its website by enhancing the Zero Tolerance Section, which provides clients, families, service providers, and the public with comprehensive and practical information necessary to identify and protect this population from ANE
  • Updated APD’s Zero Tolerance brochure (in English, Spanish, and Creole) and posted the downloadable files on the APD website

APD Ongoing Activities:

  • Regularly include articles in The Champion and CDC+ Connection newsletters on Zero Tolerance and related initiatives
  • Routinely release statements to media outlets, raising awareness about the agency’s Zero Tolerance efforts to prevent ANE committed against Floridians with developmental disabilities
  • Raise awareness about ANE utilizing various media/venues such as:
    • Social Media – Twitter, Facebook, YouTube, etc.
    • Conferences, trainings, and presentations
    • Brochures, posters, and exhibits
  • Partner with stakeholder groups and state agencies related to various national recognitions, such as Child Abuse Prevention Month, Domestic Violence Awareness Month, etc., by supporting their messaging via social media, website, and APD blog
  • Annually provide Zero Tolerance presentations at the Family Café conference 
  • Continue Zero Tolerance Tuesday (Safety Tip Tuesday) on social media
  • Periodically share Zero Tolerance messages with providers and Waiver Support Coordinators (WSCs) via Provider Advisories and WSC Advisories
  • Distribute Zero Tolerance posters to facilities, APD offices, providers, WSCs, Family Care Councils, and other stakeholder groups
  • Participate in annual “Pinwheels for Prevention” child abuse prevention campaign
  • Regularly update the Zero Tolerance communications plan to ensure the ongoing dissemination of information across multiple platforms
  • Partner with the Department of Children and Families to continually develop and distribute public service announcements to encourage reporting of ANE by community members

PILLAR IV: CHANGES TO FLORIDA LAWS AND RULES

APD Accomplishments:

  • Modified the APD group home monitoring checklist, via an amendment to Chapter 65G-2, F.A.C., to more easily identify and monitor potential signs and symptoms of ANE

  • Amended Chapter 65G-2, F.A.C. and the iBudget Florida waiver handbook to require all direct care staff to successfully complete APD’s Zero Tolerance training before beginning work with APD clients
  • Amended Chapter 65G-2, F.A.C., requiring, as a condition of licensure, residential facilities to develop policies regarding sexual activity involving residents, as well as train all direct care staff on such policies
  • Amended Chapter 65G-2, F.A.C., requiring group homes that serve residents with documented histories of sexual violence to provide the appropriate level of supervision and environmental modification(s) to prevent the recurrence of such acts
  •  Amended Chapter 65G-2, F.A.C. and the iBudget waiver handbook, requiring termination reviews and other disciplinary actions in cases involving ANE committed against APD clients by APD licensees, service providers, or direct care staff

APD and the Florida Legislature:

  • Modified s. 393.0655, F.S., prohibiting direct care staff from working alone with persons with developmental disabilities until federal background screenings are successfully completed
  • Modified s. 415.107, F.S., allowing APD access to abuse hotline information maintained by DCF 
  • Modified s. 393.0655, requiring APD-contracted providers to undergo additional background screening if they had a break in employment of more than 90 consecutive days
  • Modified s. 393.0663, F.S., requiring Waiver Support Coordinators to, on an ongoing basis, provide education to clients and families on preventing, identifying, and reporting ANE
  • Modified s. 393.0673, F.S.  allowing APD to deny or revoke licenses of residential facilities in cases where the licensee had verified indicators of ANE
  • Designated sexual misconduct as a crime via s. 393.135, F.S., which prohibits sexual activity between a service provider and their APD client(s)

APD Ongoing Activities:

  • APD’s Background Screening Unit analyzes the criminal offenses of a sample of verified ANE perpetrators on an annual basis. This information will annually be presented to the Zero Tolerance Steering Committee to consider potential modifications to the list of criminal offenses that disqualify an individual from working with APD clients.
  • The Zero Tolerance Steering Committee members develop, consider, research, and propose additional changes to state law and administrative rules to protect APD clients from ANE. These changes may be prompted by the identification of promising practices in other states, data analysis, and/or quality assurance reviews.