Major Projects

LRA has gained national recognition for our courses on incident management and conducting investigations.

Since 1984, LRA has had many opportunities to work with clients in developing creative and cost effective ways to deliver training programs and other consulting interventions.

LRA is frequently involved in effectively assisting agencies under scrutiny by CMS or DOJ, or agencies involved in other litigation to improve the quality of investigations and incident management practices. In addition to the approximately 100 investigative and incident management training programs that LRA conducts each year, the following is a list of just some examples of LRA projects and experience:

1. Developed a process for evaluating the quality of investigations including a set of standards and methodology that allows investigators and the agencies in which they work to measure the quality of their work. We have assisted agencies in developing and implementing a self-assessment or quality improvement process for investigations at the following agencies:
   • • The Texas Department of Protective and Regulatory Services (Adult Protective Services) (1996).
     • State agencies serving persons with behavioral health and intellectual or developmental disabilities in Tennessee (1996), New York (2011), Pennsylvania (2001), New Jersey (2011), District of Columbia (2006), Iowa Department of Human Services (2006), New Mexico (1992), Illinois (Equip for Equality, 1993), Alabama (2002), and Kentucky (1995).
     • National private providers of services to persons with intellectual and developmental disabilities (Res-Care in 1997 and Mosaic in 2010).
2. Developed a certified investigators program that has been implemented in both private and public agencies, including oversight agencies. This program has been implemented state-wide in agencies providing developmental disabilities and/or mental health services in Tennessee (2016), Pennsylvania (2001), Alabama (2003), New Jersey (2003), Kentucky (2005), Virginia (2018), Arizona (2018), Iowa (2006), and the District of Columbia (2007). Several private providers of IDD services require that any potential investigator successfully completes the training and passes an exam before they are permitted to conduct investigations.
3. Delivered a train-the-trainers program for our Conducting Serious Incident Investigations course for several clients. They are now able to provide our curriculum on an on-going basis to meet demand for additional investigators, and as refresher training for those already trained. We have delivered the train-the-trainers program to state agencies in Iowa, Louisiana, Tennessee, Missouri, Alabama, New Jersey, Iowa, Rhode Island, Arizona, Virginia and New Mexico, as well as Mosaic and Devereux, private providers of IDD services.
4. Developed an expanded four-day certified investigators training program in Pennsylvania (Office of Developmental Programs) required for all investigators in both public and private agencies. From 2001 to 2008, 167 sessions of this course were delivered by LRA with the certification of more than 4,000 individuals. In addition to developing and delivering the training portions of the program, LRA assumed a large part of the administrative responsibilities for registering and scheduling students, keeping examination records and notifying students of exam results.
5. Assisted the following state agencies serving persons with mental illness or intellectual and developmental disabilities in the development of state-wide incident management policies: Iowa (2006), District of Columbia (2006), New Jersey (2003), Alabama (2002), Pennsylvania (2001), Kentucky (2000), Tennessee (1995), and Louisiana (1990).
6. Developed a specialized investigations training program in 2012 for the Texas Department of Aging and Disability Services (Regulatory Services) to enhance their ability to meet federal requirements to investigate incidents in programs serving the elderly in nursing homes and persons with intellectual disabilities in State Supported Living Centers. A train-the-trainers program was also developed and implemented including a certification program for state survey agency investigators entitled Conducting Incident and Complaint Investigations: Techniques for Observation, Interviewing and Record Review.
7. Developed a course curriculum in 2018 for the Colorado Department of Adult Protective Services to address reports of abuse, neglect and exploitation investigated by APS caseworkers. The course content reflects the high volume of investigations in community and family homes and is consistent with APS investigative terminology and investigative process.
8. Developed training programs to address specific categories of incidents which require additional or specialized inquiry. The Mortality Review and Death Investigations class focuses on issues unique to those incidents involving the death of an individual receiving services within the context of an organization’s incident management and quality improvement processes. The Root Cause Analysis course teaches participants how to use an interdisciplinary process to help organizations identify underlying causes of serious incidents that can have an impact on those receiving services. The technique includes not just the identification of root causes, but the requirement that organizations identify and implement potential solutions. The principles taught are consistent with The Joint Commission definitions of root cause analysis and use with sentinel events.
9. Provided ongoing external evaluations of the quality of investigations for the Kentucky Department of Mental Health and Mental Retardation, Pennsylvania Office of Developmental Programs, Iowa Department of Human Services, District of Columbia Division of Developmental Services, the Illinois Department of Mental Health and Developmental Disabilities, and the Tennessee Department of Intellectual and Developmental Disabilities.
10. Developed and provided incident management training programs designed for both management and direct care staff.
11. Developed and provided a training curriculum, Protecting People from Harm, designed to promote understanding among direct care staff regarding the circumstances likely to result in serious incidents, identifying strategies to respond to those circumstances and ways in which management and supervisory staff can support their efforts.
12. Provided ongoing support to investigators in Pennsylvania with a web-based Investigators’ Help Desk, which offered investigators a wide range of additional supports including: on-line access to manuals and policies; an opportunity to ask questions on-line and view written answers to other investigators’ questions; and, additional training materials, including links to articles and websites related to investigations.
13. Conducted the following studies in conjunction with Equip for Equality (EFE), the protection and advocacy agency for Illinois:
    • • Reviewed 130 investigations as part of base-line and follow-up studies of the quality of investigations conducted by Office of the Inspector General investigators in 4 Chicago area facilities (1996). A report was issued for each phase of the study (Not Our Problem: Executive and Legislative Response to Violence in State Operated Institutions in Illinois).
      • Assessed the implementation of state policy regarding restraint and seclusion use in state mental health and mental retardation facilities in Illinois (2000). Findings were reported in Use of Physical Restraints on Residents with Mental Illness in Illinois State Hospitals.
      • Assessed 61 children and adults who died while in restraints in the National Review of Restraint Related Deaths, a project funded by Congress (2009). Lana Norwood, President of LRA, was hired to coordinate the development of the review methodology, aggregate and analyze the data, and compile a written report of the findings of the analyses. The review process was designed to facilitate an accurate and reliable analysis of the relationship between the restraint and the individual’s death; the degree to which application of the intervention met relevant federal regulations, Joint Commission on Healthcare Organizations (JACHO) standards, and best practices; and the specific risks associated with the use of restraints in each case.

• • Conducting Serious Incident Investigations, An Instructor’s Manual
  • Conducting Serious Incident Investigations, A Manual for Investigators
  • Conducting State Survey Investigations: Techniques for Observation, Interviewing and Record Review
  • Advanced Course in Investigations, workbook and curriculum
  • Weighing Evidence and Drawing Conclusions, workbook and curriculum
  • Writing Investigative Reports Course, workbook and curriculum
  • Interviewing Persons with Disabilities Course, workbook and curriculum
  • Refresher Course in Investigations, workbook and curriculum
  • Introduction to Investigations, workbook and curriculum
  • Understanding Serious Incident Investigations, A Training Program for Direct Care Staff, workbook and curriculum
  • The Role of the Supervisor in Conducting Serious Incident Investigations, Participants’ and Instructors’ Manuals
  • Incident Management: Creating Effective Incident Management Policies and Procedures, manual, workbook and curriculum
  • Mortality Review and Death Investigations, manual, workbook and curriculum
  • Facilitating Root Cause Analysis, Workbook, manual and curriculum
  • Protecting People from Harm, A Manual for Direct Care Staff on the Principles of Incident Management
  • Conducting Investigations [multi-media CD to be tailored by site]
  • Evaluating Investigations [multi-media CD to be tailored by site]
  • APS Investigations: Conducting Investigations of Abuse, Neglect and Exploitation
  • Conducting Incident and Compliant Investigations: Techniques for Observation, Interviewing and Record Review (a course for State Surveyors Agencies)

Aaryce Hayes
Policy Specialist, Disability Rights Texas