Across practically every type of health and human services (HHS) organization, there is significant value to providing participants and residents with a consistent schedule that includes similar routines, activities, and staff. Not only does this predictability tend to help clients feel more secure and comfortable, but it typically also makes them less vulnerable, especially to sexual abuse and molestation.
Unfortunately, the arrival of the coronavirus in the U.S. and the ensuing pandemic caused an enormous disruption in the normal processes of most HHS organizations, greatly impacting the level of stability and safety that HHS participants and their families came to rely on.
The following are a few of the significant changes the Fred C. Church team witnessed across the HHS industry during the pandemic:
- Family visitation in group homes, nursing facilities, and similar residential HHS organizations was kept to a minimum, if allowed at all.
- Facility managers and staff supervisors spent less time on-site and conducted business virtually far more often than is typical.
- Numerous day habilitation and other HHS programs abruptly closed, leaving participants and their families without access to the services and support they were used to getting on a daily or weekly basis.
- Staff turnover rates worsened during the pandemic — reaching as high as 45% in some organizations.
It is extremely important to consider the pandemic-related issues above and the way they may impact future reports of sexual abuse and molestation occurrences.
Fred C. Church’s Tom Rogers, who leads the company’s Health & Human Services practice group, has been helping clients return to a mode of proactivity and prevention around this highly sensitive issue. Today, we would like to share four critical risk management strategies that Rogers recommends all HHS organizations refocus on when trying to prevent sexual abuse or molestation incidents.
Risk Management Insight #1: Consistently Test Your Policies and Procedures
Over the past few years, many HHS organizations found themselves constantly on defense, reacting to new information and issues about the coronavirus every day. In many cases, almost everything else took a backseat, including regular testing of policies and procedures designed to minimize the occurrence of abuse and molestation.
Rogers recommends that organizations revisit these essential guidelines to identify whether they are still being adhered to and are effective given the current environment. The most important question to ask during this review is, “What can go wrong with this policy?” Then, depending on what the answers are, discuss ways to improve these policies, which may be as easy as implementing additional accountability measures, at little to no cost.
One of the ways you can do this effectively is by having your staff participate in simulations of hypothetical scenarios that could result in an abuse report. At Fred C. Church, we design these activities, which we call tabletop exercises, for our clients to help them evaluate how well their policies and plans might fare given a real-life situation. During these exercises, we might ask your staff probing questions such as:
- What procedures do you have in place to address this potential risk?
- How do managers monitor compliance with these procedures?
- Could someone figure out how to skirt these procedures and avoid detection?
- How would you respond in this situation?
- What should happen next?
If there is no follow-up after policies and procedures are put in place to test their fidelity, your organization could be leaving itself exposed. Through tabletop simulations, you may be able to identify problems, gaps, and vulnerabilities before they result in an issue.
Risk Management Insight #2: Hire Cautiously and Then Do Not Let Your Guard Down
HHS organizations are extremely dependent on their staff to provide safe and appropriate services to participants, especially in times of crisis. So, the exceedingly high turnover of HHS workers during the pandemic put immense pressure on organizations to try to find people who could fill these essential roles.
We’re confident organizations continued to follow procedures to ensure that the individuals they brought on board would not pose a threat to their clients. Just as they did prior to the pandemic, this probably meant performing background checks, which can help to eliminate some potentially dangerous candidates.
Rogers points out, however, that there are a couple of reasons why these background checks do not guarantee you are eliminating all possible sexual predators:
- Criminal Offender Record Information (CORI) typically reveals only in-state convictions. In many states, like Massachusetts, for instance, the CORI check typically reveals only criminal convictions or charges in the Bay State. On occasion, the state’s CORI process may illuminate criminal activity that happened in neighboring states, but often it is going to miss offenses committed in other parts of the country.
- Most sexual predators have not been previously charged, arrested, or convicted, which means they won’t be flagged in a CORI. Some states, including Connecticut, have enacted “pass the trash” laws requiring agencies to be proactive in reporting possible abusers when they know they are applying for work at similar organizations. Elsewhere, it is still quite possible that a company will quietly discharge employees who have fallen under suspicion without filing a report.
Rogers supports national legislation to improve reporting, but until this happens, organizations should not place too much confidence in background checks. Instead, action steps should include adhering to rigorous enforcement of effective procedures (see Risk Management Insight #1), continuing to check references with candidates’ former employers, and conducting trial or introductory periods during which you and new employees can assess whether a successful employment relationship can be created.
Your policies and procedures must become a living, breathing part of your company’s culture and be incorporated into daily routines. If a predator slips through the screening process, you want to be confident that your systems are strong enough to keep the people in your care safe.
In addition, Rogers recommends increasing the frequency of in-person communication with employees, site visits, and video footage screening, beyond even what you may have been doing pre-pandemic, to ensure every staff member gets a strong sense that they are being supervised and observed.
Risk Management Insight #3: Continue to Train Staff After the Initial Orientation Period
The following are a few thoughts from Rogers on how to keep the topic of sexual abuse and molestation top of mind and help employees know what to look for and how to respond if they suspect something is wrong:
- Weekly / Monthly — Conduct pre-shift meetings where supervisors include abuse and molestation prevention reminders in their comments.
- Quarterly — Distribute printed tips on preventing sexual abuse and molestation.
- Annually — Require refresher training on sexual abuse and molestation prevention.
While you might have policies that require employees to report questionable behavior, these policies won’t be very effective if employees are not clear about what behavior crosses the line. A good training program explains not only obvious red flags to look out for, but also how to respond to situations that an employee might find ambiguous.
Some questionable behaviors may not appear outwardly illegal, palpably immoral, or obviously against company policy, which could lead employees to wonder whether they should even speak up. Proper training can give your staff the tools to sort through which behaviors merit being reported and which do not.
People have a natural reluctance to report questionable behavior that is not blatantly illegal. During the training process, organizations should emphasize that what an employee reports is simply an observed behavior and rarely results in an abuse charge; they are simply bringing something to a supervisor’s attention for further observation and discussion.
Our firm works with several insurance carriers that can provide your organization with videos and other materials that can be used to help train your employees on how to spot reportable behaviors. A comprehensive and continuous training program can help people overcome their natural hesitation in discussing abuse. When your employees feel knowledgeable about this topic, they may be more comfortable speaking up and out about something that concerns them. That willingness to act on their suspicions might ultimately save an innocent child or adult from being abused.
Rogers notes that many of our HHS clients have conducted staff trainings virtually over the past two years. Now that most social distancing mandates have been eliminated, he recommends getting back to in-person training as soon as possible. Face-to-face trainings make it easier to pick up physical cues from an individual that could signal their discomfort or anxiety over the topic of sexual abuse and molestation.
Risk Management Insight #4: Make Sure Management Has a Clear Communication Strategy
Until recently, many HHS facilities managers were rightly focused on COVID-19-related communications that had to do with staffing up, staying open, and stopping the spread of the virus. Now that the worst of the situation is starting to subside, Rogers suggests it is a good time for managers to reemphasize to their staff the need for constant two-way communication, especially on topics as consequential as sexual abuse and molestation.
From the top down, everyone in the company should not only be comfortable with the process for reporting and vetting information, but also feel that their feedback is being properly addressed. Below, Rogers outlines some steps that leadership may want to consider taking in response to an employee who has reported suspicious behavior:
- The manager responds with a thank-you to the employee who has come forward. When possible, this thank-you should be given in person by a senior manager or even the organization’s CEO to stress how important it is that employees alert supervisors to a potential threat to the people in their care.
- The manager provides feedback on how this concern will be addressed and follows up regularly. These follow-ups should include whether there truly is a problem and, if so, how it is being handled now and will be prevented in the future.
If a sexual abuse or molestation incident is uncovered, continuing to communicate effectively is crucial. Managers should be as transparent as possible with their employees; the people they care for and their families; law enforcement; funding agencies; and others with a vested interest in the organization, like a board of directors.
A clear, concise, accurate, and rapid response is even more critical in today’s social-media-driven news environment, where a story of abuse in your organization can spread almost instantly to a very wide audience. Letting your employees know that an investigation is happening, regularly updating them, and reminding them of their privacy obligations, which means not posting workplace information on their personal social media accounts, should all be elements of your communication strategy.
Finally, Rogers recommends putting a top-level person in your organization in charge of communication if an abuse situation surfaces. Ideally, this individual will have expertise in public relations as well as experience investigating sexual abuse and molestation claims.
Fred C. Church Can Help You Build a Safer Workplace Culture
Most people in the HHS industry would agree that the pandemic has significantly impacted the way their organization does business, both over the past two years and going forward. At Fred C. Church, we are keenly aware of the many ways our clients’ organizations have had to adapt and evolve during an enormously challenging period.
Accordingly, have your organization’s policies and procedures for addressing sexual abuse and molestation been reviewed and revised as necessary since the start of the pandemic? If not, the Fred C. Church team may be able to assist you. Through the use of tabletop exercises, we have coached clients on how to improve their policies and procedures to minimize the threat of an occurrence happening at their organization.
The best time to ask for help is before any abuse incident occurs. Rogers and the entire Fred C. Church Health & Human Services team are committed to refocusing with you on this critical issue.