Introduction

Providing consistent supervision that is appropriate to each consumer's support needs can be challenging. A consumer may intentionally leave a location without staff knowledge. When this occurs, the consumer may be either (a) expressing a dislike of something or (b) seeking to obtain some other preferred activity, place, person or item. He or she may want to do something that support staff take exception to, such as visiting a friend late at night. Some consumers may simply be expressing their desire for independence.

Oftentimes a missing person incident occurs because of a breakdown in staff supervision. Consider the following scenarios that result in a person being missing or becoming lost:

• A staff member mistakenly assumes a consumer is with another staff member and the consumer is accidentally left without supervision.
• Staff leaves a consumer alone in a vehicle while the staff member goes into a store to make a quick purchase.
• A staff member receives an emergency personal call and does not realize that a consumer has left the home until the call is completed.

The above scenarios could have been avoided if effective supervision strategies were in place. Listed below are suggestions for common supervision practices that help reduce the risks of a missing person incident.

Strategies

• Have a system for staff to know the supervision needs of each consumer. Simple written guidelines or instructions are beneficial in reminding staff on how to best support each consumer. Such written information is especially helpful to new staff or relief staff who may work infrequently.
• Provide special staff training as may be needed. Staff may need special training regarding a person's supervision needs and unique risk factors. Some consumers may have more complex support needs regarding supervision that require staff to have special skills.
• Make specific staff assignments. In situations in which there is more than one staff person working at the same time, each staff person on-duty should have specific assignments for supporting consumers. Such assignments help to provide accountability and avoid mistakes. While assignments are most often made 'per consumer' or 'per group of consumers', there are situations in which it is effective to make assignments based upon activities or areas of the home or day program. For example, one staff member may be assigned to support consumers in the kitchen during meal preparation while other staff support consumers choosing to watch television in the living room.
• Establish a good communication system. Effective supervision requires good communication between staff members. Staff members need a system, such as a written log, to ensure they communicate important information and transfer supervision responsibilities during and between shifts. Events that may trigger an incident should be communicated to oncoming staff. Prior to a staff member taking a break or going off-duty, consumer's supervision responsibilities should be formally transferred to another staff member.
• Identify peak activity times. It is important for managers to carefully consider all the activities that occur to identify and evaluate the busiest activity times. Managers may be able to adjust the times for some activities to maximize staff resources (e.g., avoid routinely planning to assist consumers with their laundry during meal preparation times). Common peak activity times include shift changes and transitions between locations such as from the residence to a day program location. Some peak activity times may require additional staff resources for brief periods of time. For example, the early morning and evening hours at a residence most often can be the busiest times. It may be necessary for managers to consider scheduling staff to work split shifts to work during these times. During peak activities there may be a need to further structure activities or for supervisors to be present at these times themselves.
• Have backup resources available to staff. A system should be in place for staff members on-duty to use in the event they need extra resources. Crisis situations may suddenly develop in which additional staff is needed to support a consumer. Staff may need to talk with a manager or clinician over the telephone about a problem situation. A staff member on-duty may unexpectedly need to leave before the shift is over, e.g., becomes too ill to work, and needs to be relieved. Staff on-duty should readily know who they should call for additional assistance. Managers should have a system in place to immediately respond to staff needs for additional resources.

Reminder - Reporting Requirements

Title 17 of the California Code of Regulations requires that all vendors and long-term health care facilities report special incidents to the regional center (see Chapter 3, Sub-Chapter 2, section 54327). A special incident includes a missing person if the consumer was receiving services and supports from the vendor or long-term health care facility at the time of the incident and a missing person report has been filed with a law enforcement agency. The initial report must be made to the regional center (either by phone, electronic mail, or fax) immediately, but not more than 24 hours after the incident occurred. The vendor or long-term health care facility must also submit to the regional center a written report of the special incident within 48 hours.