Mental Health and Substance Abuse Services Bulletin COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE SUBJECT

Mental Health and Substance Abuse Services Bulletin COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF PUBLIC WELFARE SUBJECT BY NUMBER: ISSUE DATE: EFFECTIVE DATE: Community Incident Management & Report System OMHSAS- DRAFT Deputy Secretary for Mental Health and Substance Abuse Services SCOPE: It is the intent of OMHSAS to implement an Incident Management system, for the purpose of assuring the health and safety of consumers in the community on a phased in basis, beginning with a narrowly defined set of services, and expanding over time to include all of the major elements of the community system of mental health care. This Bulletin will initially limit the Scope of the Incident Management requirements to Community Residential Rehabilitation Services (CRRS) and Long Term Structured Residences (LTSR). The Bulletin will be revised as additional programs and services are phased in for inclusion under the requirements for Incident Management. This bulletin applies to the following mental health facilities and programs: OMHSAS licensed Community Residential Rehabilitation Services and Long Term Structured Residences. PURPOSE: The purpose of this Bulletin is to establish a consistent statewide process for reporting, categorizing and investigating incidents involving consumers in the public mental health system. This process also includes structure for taking immediate corrective actions as well as analyzing incident trends to prevent recurrence. As a result, the Commonwealth s Mental Health system will be better able to systematically monitor and protect the health, safety, dignity and welfare of individuals receiving services and treatment. BACKGROUND: Providers of mental health services throughout the public mental health system must ensure that safeguards are in place to protect the health, safety and rights of consumers receiving these services. Currently, OMHSAS does not have a unified incident reporting system for county mental health programs and providers. All providers of Mental Health services, including the County Mental Health Programs, and Behavioral Health Managed Care Organizations, are partners in the effort to assure the health, safety and rights of persons receiving mental health services. 1

DISCUSSION: The primary goal of an incident management system is to assure that when an incident occurs the response will be adequate to protect the health, safety and rights of the individual. This bulletin communicates clear and specific requirements to assure appropriate responses at the provider, county and state levels to an incident. The standardization of reporting, the time frames for reporting, investigation procedures and follow-up are key to conducting individual, provider, countywide and statewide analysis of incidents. The continuous review and analysis of reported incidents at the provider, county and state levels is aimed at protecting consumers, identifying trends and formulating action to prevent recurrence. In addition to the OMHSAS reporting processes described in this bulletin, reporting requirements of other laws, regulations and policies must also be followed. REPORTING RESPONSIBILITIES: Responsibility for reporting an incident as outlined in this policy, including the use of the standardized incident report form (Appendix A), is as follows: Residential providers, licensed by OMHSAS, limited to: Community Residential Rehabilitation Services (CRRS) and Long Term Structured Residences(LTSR). These entities are responsible for completing incident reports on anyone in their care, including any incident that occurs while the consumer is at a provider supervised event or activity or while the consumer is away from the program site. TIME FRAME FOR REPORTING: The initial notification of the occurrance of an incident is due within 24 hours after the incident, or within 24 hours after the provider learns of the incident. INCIDENTS TYPES: The following lists the different types of incidents. Deleted: The incident report is due within 5 days of the incident. Death - all deaths are reportable Suicide Attempt: The intentional and voluntary attempt to take one's own life. A suicide attempt is limited to the actual occurrence of an attempt and does not include suicidal threats. Medication error, including a missed medication, incorrect medication or incorrect dosage, where a consumer requires treatment greater than first aid for adverse effects of the medication Any event requiring the services of the fire department, or a law enforcement agency. Abuse, alleged or suspected abuse, neglect of a consumer which could include physical, verbal, psychological or sexual abuse, exploitation, neglect and misuse of a consumer s funds. 2

An injury or illness of a consumer where the consumer requires medical treatment more intensive than first aid. First aid includes assessing a condition, cleaning an injury, applying topical medications applying a band aid, etc. Treatment beyond first aid includes but is not limited to lifesaving interventions such as CPR or use of the Heimlich maneuver, wound closure by a medical professional, casting or otherwise immobilizing a limb. Evaluation/assessment of an injury by emergency personnel in response to a "911" call is reportable even if the individual is not transported to an emergency room. This incident type includes diseases reportable to the Department of Health, defined as - any disease reportable on the Pennsylvania Department of Health List of Reportable Diseases. Report only required when disease is initially diagnosed. This incident type includes Emergency Room Visits defined as - The use of a hospital emergency room. This includes situations that are clearly "emergencies" as well as those when an individual is directed to an emergency room in lieu of a visit to the primary care physician (PCP) or as a result of a visit to the PCP. The use of an emergency room by an individual's PCP, in place of the physician's office is not reportable. This incident type includes Hospitalization, defined as - An inpatient admission to an acute care facility for purposes of treatment. Scheduled treatment of medical conditions on an outpatient basis is not reportable. A consumer who is out of contact with staff for more than twenty-four (24) hours without prior arrangement, or a consumer who is in immediate jeopardy because he/she is missing for any period of time. Any fire, disaster, flood, earthquake, tornado, explosion, etc.; any natural disaster or unusual occurrence that necessitates the temporary shelter in place or relocation of residents. Seclusion or Restraint. Due to the high risk of these types of procedures, use of seclusion or restraint must be reported as an unusual incident. PROCEDURE: Providers and counties must follow the procedures outlined below in order to ensure consistent reporting and management of incidents. PROVIDERS MUST: Develop written policies and procedures for an incident management process which include the following: Deleted: Note: As a general rule, final reports on all incidents reports should be faxed transmitted to OMHSAS and County MH offices within 5 working days of the incident unless the incident is being investigated by the provider, county or OMHSAS. Deleted: and suspected abuse. o A sufficient supply of incident report forms at each of their locations. o A process that assures timely notification of County MH Programs, OMHSAS Regional offices and OMHSAS Central Office of an incident as outlined above. 3

o A designated individual with overall responsibility for Quality Assurance, Risk Management and the incident report process. o A process for the internal review and investigation of incident reports. In many cases, the information gathered during the completion of the incident report will constitute an adequate investigation. In other cases, further investigation will be necessary to gather all the facts required to adequately analyze the incident. Investigations may include collection of physical evidence, witness interviews, document review and or visual inspection of the incident location. o Procedures to address the various levels of incidents. Investigations must be complete and thorough based on the nature of the incident. The seriousness of the incident will determine the level and intensity of the investigation. o Trend analyses to identify individual consumer and provider program systemic issues. o Information sharing with staff, including direct care workers, consumers, family members and advisory groups as appropriate. o A process to review the incident with the consumer and the staff involved in an incident. o A mechanism to provide written notification to the consumer, family member or responsible contact, with consumer permission, on the closure of an incident investigation. o If requested by the consumer, assistance with making internal and external complaints related to a reportable incident. o Procedure for a review to occur following the death of any consumer served in the program. o A procedure to systematically analyze the cause and methods of prevention of certain incidents, which would at a minimum include: any accidental death; injury resulting in a major, permanent loss of function in a consumer; significant assault including rape and abuse; and any other incident determined by the provider, county or OMHSAS to warrant this level of review. Ensure that staff, volunteers, and others who come in contact with consumers have proper orientation and training to respond to, document and report incidents. Assure compliance with all applicable laws, regulations and policies. Notify the family of the consumer, with the express consent of the adult consumer, obtained at the time of the incident (unless the consumer is physically unable to provide consent). Maintain an incident file within the agency that includes all documents related to the incident and the investigation. Assure the consumer and family member has the opportunity to provide written comment about the incident. Deleted: of Deleted: and their Deleted: on Deleted: mortality Formatted: Bullets and Numbering Deleted: Identify activities that will be taken to prevent future occurrences of the incident. Deleted: n investigation file Deleted:. COUNTY OFFICES of MENTAL HEALTH MUST: Develop written policies and procedures for an incident management process that include the following: Deleted: and MANAGED CARE ORGANIZATIONS 4

Review and approval of each contracted providers and or Behavioral Health Managed Care Organizations (BH-MCO s) policies and procedures relating to incident management. Review of provider investigations, and a process to initiate county investigations as indicated independently or in collaboration with OMHSAS. Analysis and sharing of information with appropriate individuals. Establishment of procedures for reviews to occur following the death of any consumer. Deleted: mortality Deleted: not Monthly review of incident data, by individual consumer and program for trends in order to: o Identify consumers at risk. o Identify programs with unsafe incident trends. o Assure provider and or BH-MCO compliance with plans of correction resulting from incident investigations. o Assess providers and or BH-MCO s incident management and investigative processes. o Follow up in writing with local program administrators when individual consumer or program issues are identified. Response to concerns from individuals or their families about the reporting and investigation processes and results, including request for County OMH or OMHSAS investigations when needed. THE OMHSAS REGIONAL FIELD OFFICE WILL: Review each county s incident management process, policies, and procedures. Formatted: Bullets and Numbering Identify incidents in need of further review or investigation. Respond to concerns from individuals/families about the incident reporting and investigation processes and results. Respond to requests for an OMHSAS investigation. Coordinate with other agencies as necessary to investigate certain incidents. Reserve the right to issue provisional licenses/apply appropriate sanctions to an agency based on the outcome of an investigation. THE OMHSAS CENTRAL OFFICE WILL: Create an incident management review process which: o Administers the statewide incident report database system. o Analyzes data to identify consumers at risk. o Analyzes data by provider for unsafe incident trends. o Identifies issues and initiates systemic changes and provides periodic feedback to all stakeholders on the community incident report process. 5

o Evaluates county and provider reports and analysis of trends and actions taken to promote consumer and program safety. Deleted: E REPORTING: Counties and providers must report incidents, as defined in this bulletin, on the specified form found in Appendix A according to the procedures outlined below. PROVIDERS MUST: Identify a point person who will receive verbal reports of incidents and ensure that written reports are submitted on time as specified in this Bulletin and the providers approved policies. Formatted: Bullets and Numbering The point person is responsible to: Take prompt action to protect the consumer s health or safety. Assure completion of the incident report form. Transmit the attached incident report to the county MH office the OMHSAS regional field office and OMHSAS central office no later than 24 hours after the incident or no later than 24 hours after the provider learns of the incident. Formatted: Bullets and Numbering Deleted: <#>and takes witness statements as appropriate. Deleted: T Contact appropriate law enforcement agencies when there is suspicion that a crime has occurred. Investigate the incident per provider policy. (Any reportable incident may be investigated by the provider, county and/or OMHSAS. This investigation process in no way precludes investigations by law enforcement agencies). COUNTIES MUST: Based on the outcome of the investigation, determine closure on the incident including all actions taken to prevent reoccurrence of the incident and transmit this information to the County MH office as part of the final report.. Submit the final report to the County MH office within 5 working days of the incident unless further investigation of the incident is occurring. In cases where further investigation of the incident is occurring, the provider is required to submit an update report to the County MH office within 5 working days of the incident. The final report is to be submitted to the County MH Office within 20 working days. Identify a point person with overall responsibility for incident reporting and management. The point person is responsible to Formatted: Bullets and Numbering Deleted: e county OMH and OMHSAS as a final incident report Deleted: Deleted: <#> Formatted: Bullets and Numbering Deleted: <#>Final reports are expected to be completed within 5 working days of the incident date except in those situations where a provider level, county level or OMHSAS level investigation is being done. by a certified investigator. Formatted: Bullets and Numbering 6

: o Evaluate the need for an immediate response to any reported event. This includes contacting the provider to ensure that appropriate steps have been taken to protect the health and safety of the consumers and to resolve the incident. o Assure that the provider has submitted the incident report to OMHSAS. NOTE: The County MH office is required to submit the final report to the OMHSAS regional field office and OMHSAS central office within 7 working days of the incident unless further investigation of the incident is occurring either by the provider or County. In cases where further is occurring, the County is required to submit an update report to the OMHSAS regional and central offices within 7 working days of the incident. THe final report must be submitted to the OMHSAS regional and central offices within 30 working days of the incident. o Investigate the incident per county policy and procedure. (Any reportable incident may be investigated by the provider, county and/or OMHSAS. This investigation process in no way precludes investigations by law enforcement agencies) Deleted: and complete an incident report form Formatted: Bullets and Numbering Formatted: Bullets and Numbering Deleted: <#>Notify the appropriate OMHSAS Field Office according to the established time frame and fax transmit follow-up reports to OMHSAS within 5 working days. INCIDENT REVIEW AND DATA ANALYSIS PROVIDER ROLE It is recommended that providers dedicate time each day to review prior day incident reports to assure they are proplerly completed, make decisions on actions to prevent reoccurrence and establish closure on events not under investigation. Trend analysis is another important aspect of this process. It provides the agency, the county and OMHSAS with insights into specific issues that cannot be gained from the review of individual incident reports. It involves reviewing the incident data, and is done on each consumer and individual program locations operated by the provider over time and should be done routinely. The provider review process shall include review of all incident reports and investigations. Incident reports must be reviewed individually to determine if provider action has been appropriate and sufficient. They are to be reviewed in aggregate to determine if trends may be developing that warrant further intervention for the individual or systemic intervention, beyond the actions that were taken in response to the individual incident. The provider s administrative responses may include, but not be limited to, revision of an individual plan or any other action necessary to promote the health, safety and rights of individuals served by the provider. COUNTY ROLE 7

The county must have procedures in place for the review and analysis of incident report data. This bulletin will not direct any specific procedure for this to occur. However, it is recommended that county MH staff dedicate time each day to do the following: Review prior day incident reports to assure they have been properly completed. Assure follow-up actions have been taken by the provider to protect the consumer and prevent reoccurrence on any incident. Assure that a thorough investigation has been conducted by the provider. Monitor incidents in need of closure by provider staff. Trend analysis is another important aspect of this process. It provides the agency, the county and OMHSAS with insights into specific issues that cannot be gained from the review of individual incident reports. It involves reviewing the incident data, and is done on each consumer and individual program locations operated by the provider over time and should be done routinely. OMHSAS REGIONAL FIELD OFFICE ROLE The OMHSAS regional staff will review each incident report and final report to assure that an appropriate action and investigation of each incident is being conducted by the provider/ County. The OMHSAS regional staff will contact the County and provide direction when further investigation is warranted. The OMHSAS regional office will review data on all reported incidents as they are received to determine if consumers are at risk and to identify what trends may be developing and take appropriate investigative and/or administrative steps to intervene. OMHSAS CENTRAL OFFICE ROLE The OMHSAS central office will review data on all reported incidents to identify any trends that may be developing statewide. OMHSAS will incorporate these findings into the Annual Quality Management Plan. Deleted: may be developing statewide or by county Deleted: In addition, OMHSAS staff will enter incident report data into the state database, issue an annual incident data file for each county, and make reports available from the system upon request to all stakeholders. 8

Appendix A Pennsylvania Department of Public Welfare, Office of Mental Health & Substance Abuse Services Community Incident Report Form Fax to: (888) NNN-NNNN Provider Seq#: OMHSAS Seq#: Report Type: New Update Final Consumers Name: Incident date: Consumers Gender: Male Female Consumers Address: Provider Name: Provider MPI #: Mental Health Service Type Code: Prime Incident Type Code: CIS#: SSN#: Incident time (military HH:MM): MA#: Race Code: Date of Birth: City: Telephone #: E-mail address: County: Is this Consumer Under 18? Yes No DOW Code (Sun=1): 2nd Incident Type Code: Prime Incident Modifier 1: 2nd Incident Modifier 1: Primary Closure: Family notified about this Incident? Yes No Modifier 2: Modifier 3: Modifier 4: Modifier 2: Modifier 3: Modifier 4: 2nd Closure 3rd Closure 4th Closure: 9

Description of incident: (Who, What, Where, When,-reference others involved by CIS or SSN number only): Signature & Title Date. Form Number: Effective Date: 1/1/2004 Consumer s Report about the incident Not Applicable Declined. Signature Date Names of Witnesses Others Notified (Including Family) Date Time Notified by: Provider Review & Additional Incident Closure Comments: Was a Provider level investigation initiated? Yes No Investigators name: Date: 10

Signature Title Date County Review & Comments: Was a County level investigation initiated? Yes No Investigators name: Date: Signature Title Date OMHSAS Review & Comments: Was a OMHSAS level investigation initiated? Yes No Investigators name: Date: Signature Title Date Date 8/4/03 Community Incident Report Code Sheet MH Service Type Code Incident Type Codes Long Term Structured Residence 1 Death 1 Community Residential Rehab Service 2 Suicide Attempt 2 Medication Error 3 Incident involving Police, Fire Department 4 Abuse 5 Injury or illness 6 consumer out of contact with staff 7 natural disaster or unusual occurrence 8 seclusion or restraint 9 Closure Codes Race Codes Change(s) in the Consumers level of supervision 1 White, Non-Hispanic 1 Change(s) in Physicians order 2 White, Hispanic 2 Change(s) in program procedures 3 Black, Non-Hispanic 3 Corrective action with staff 4 Black, Hispanic 4 Consumer counseling and education 5 American Indian 5 Physical health medication change 6 Asian/Pacific Islander 6 Psychiatric medication change 7 Unknown 7 No further action at this time 8 Treatment plan revised 9 Consumer transferred 10 Referred for investigation 11 Police notified 12 Consumer discharged from the program. 13 Other-specify in comments section 14 Staff training provided 15 11

Issue date: 8/4/2003 Incident Modifiers Code 1, Abuse Modifiers Modifier 1-Type Modifier 2-Investigation Modifier 3-Police Modifier 4-Outcome Exploitation 1 County level 1 Police not notified 1 Pending 1 Funds misuse 2 No Investigation 2 Police notified 2 Substantiated 2 Physical 3 OMHSAS level 3 Police 3 Undetermined 3 investigation Psychological 4 Provider level 4 Unsubstantiated 4 Sexual 5 Verbal 6 Unauthorized restraint 7 Unauthorized seclusion 8 Code 2, Death of a Consumer Modifiers Modifier 1-Type Modifier 2-Coroner Modifier 3-Autopsy Modifier 4-Coroner Ruling Accidental 1 Coroner notified 1 Autopsy performed 1 Not applicable 1 Natural Causes 2 Coroner not 2 Autopsy not 2 Accidental 2 notified performed Suicide 3 Coroner s case 3 Natural causes 3 Undetermined 4 Suicide 4 Other 5 Other 5 Code 3, Medication Error Modifiers Modifier 1-Type Modifier 2-Severity Modifier 3-Number of errors Modifier 4-Med type Wrong med 1 Minimal effect 1 Insert number of errors Physical health 1 med Over dose 2 ER visit-not 2 Psych med 2 admitted Under dose 3 Hospitalized 3 Any combination 3 of above Wrong time 4 Wrong route 5 Missed dose 6 Wrong consumer 7 Any combination of 8 dose/time/route Code 4, Missing Consumer Modifiers (Used by residential program providers only) Modifier 1-Type Modifier 2-Return time Modifier 3-Return date Modifier 4- Missing person report filed Left from residence 1 Insert military time Insert date Consumer yes 1 Left from other program was found. 2 no 2 Left while on approved leave 3 Code 5, Emergency Residential Program Closure (Used by residential program providers only) Modifier 1-Cause Modifier 2-Duration Modifier 3-None Modifier 4-None Fire 1 Permanent 1 Storm damage 2 Temporary 2 Staffing crisis 3 Unknown 3 Smoke damage 4 Other (specify) 5 Code 6, Police, Fire Department contact Modifiers Modifier 1-Type Modifier 2-Reason Modifier 3-None Modifier 4-None 1 Fire/smoke 1 Fire department 2 False fire alarm 2 12

Police 3 Consumer arrest 3 Other 4 Investigation 4 Other 5 crime victim 6 Code 8, Physical or Personal Restraint use Modifiers Modifier 1-Cause Modifier 2-Use Modifier 3-Consumer injury Modifier 4-None Aggression 1 Approved Behv No injury from restraint 1 Assault peer 2 program 1 Minor Injury first aid 2 Assault staff 3 Emergency use 2 Serious injury-hospital/er 3 Property destruct 4 Self Injurious acts 5 Other 6 Code 9, Mechanical Restraint use Modifiers Modifier 1-Prime Cause Modifier 2-Use Modifier 3-Device Modifier 4-Consumer injury Aggression 1 Approved Ambulatory 1 No injury from restraint 1 behavior program 1 restraint Assault peer 2 Chair restraint 2 Minor injury-first aid 2 Assault staff 3 Emergency use 2 Bed restraint 3 Serious injury-hospl/er 3 Property destruction 4 Other-specify 4 Self injurious acts 5 Other 6 Code 10, Seclusion use Modifiers Modifier 1-Cause Modifier 2-Use Modifier 3-Consumer Injury Modifier 4-None Aggression 1 Approved behavior No injury from seclusion 1 Assault peer 2 program 1 Minor injury-first aid 2 Assault staff 3 Emergency use 2 Serious injury-hosp/er 3 Property destruct 4 Self injurious acts 5 Other 6 Code 11, Serious Injury Modifiers Modifier 1-Prime Cause Modifier 1-Prime Effect Modifier 2-Body Part Modifier 3-Hospital Accident-auto 1 1 1 Not hospitalized 1 Accident-other 2 Body system 2 2 ER visit only 2 illness Animal bite 3 Bone fracture 3 3 Hospitalized 3 Assault 4 Burn(s) 4 4 Fall 5 Choking 5 5 Fire 6 Seizure 6 6 Self-injurious behv. 7 Loss of 7 7 consciousness Sudden acute ill 8 Breathing 8 8 problem Other 9 Severe pain 9 9 bleeding 10 10 Other 11 11 Code 12, Suicide Attempt Modifiers Modifier 1-History Modifier 2- Modifier 3- Yes 1 No 2 Modifier 2- Modifier 3- Modifier 4- result Method Overdose /poisoning Intent 1 Impulsive act 1 No injury 13

Weapon 2 Stated plan 2 First aid on-site Hanging 3 No plan 3 Treatment in emergency room Fall/jump 4 On close watch due to verbal threats Other 5 4 Hospitalized for treatment of injury 14

Attachment 1 OFFICE OF MENTAL HEALTH AND SUBSTANCE ABUSE FIELD OFFICES Southeast Office of Mental Health and Substance Abuse Services Norristown State Hospital Building 57 1001 Sterigere Street Norristown, PA 19401-5397 610 313-5844 FAX 610 313-5845 Northeast Office of Mental Health and Substance Abuse Services Scranton State Office Building Room 321 100 Lackawanna Ave. Scranton, PA 18503 570 963-4336 FAX 570 963-3050 Central Office of Mental Health and Substance Abuse Services Clothes Tree Harrisburg State Hospital Cameron and Maclay Streets P.O. Box 2675 Harrisburg, PA 17105 717 705-8396 FAX 717 705-8386 Western Office of Mental Health and Substance Abuse Services 413 Pittsburgh State Office Building 300 Liberty Avenue Pittsburgh, PA 15222 412 565-5226 FAX 412 565-5393 15

Attachment II Pennsylvania Department of Health List of Reportable Diseases (PA Code, Title 28, Chapter 27) 1. AIDS (Acquired Immune Deficiency Syndrome). 2. Amebiasis. 3. Animal bite. 4. Anthrax. 5. Botulism. 6. Brucellosis. 7. Campylobacteriosis. 8. Cancer. 9. Chlamydia trachomatis infections. 10. Cholera. 11. Diphtheria. 12. Encephalitis. 13. Food poisoning. 14. Giardiasis. 15. Gonococcal infections. 16. Guillain-Barre syndrome. 17. Haemophilus influenzae type b disease. 18. Hepatitis non-a non-b 19. Hepatitis, viral, including Type A & B 20. Histoplasmosis. 21. Kawasaki disease. 22. Legionnaires disease. 23. Leptospirosis. 24. Lyme disease. 25. Lymphogranuloma venereum. 26. Malaria. 27. Measles. 28. Meningitis all types. 29. Meningococcal disease. 30. Mumps. 31. Pertusis (whooping cough). 32. Plague. 33. Poliomyelitis. 34. Psittacosis (Ornithosis). 35. Rabies. 16

36. Reye s syndrome. 37. Rickettsial diseases including Rocky Mountain Spotted Fever. 38. Rubella (German Measles) & congenital rubella syndrome. 39. Salmonellosis 40. Shigellosis. 41. Syphilis all stages. 42. Tetanus. 43. Toxic shock syndrome. 44. Toxoplasmosis. 45. Trichinosis. 46. Tuberculosis all forms. 47. Tularemia. 48. Typhoid. 49. Yellow Fever. Please note that the list of legally reportable diseases in Pennsylvania is subject to change (work is in progress to modify the regulation to match more recent public health policy and science). Also, please note that certain broad categories such as #13 ( Food Poisoning ), and #28 ( Meningitis - all types ) should be construed to mean all such illnesses, even if the etiology is either not otherwise listed here, or a specific etiology cannot be determined. Similarly, acute Hepatitis C infections should be reported under the authority of #18 ( Hepatitis non-a non-b ), and Ehrlichiosis should be reported under the authority of #37 ( Rickettsial diseases ). Finally, note that local jurisdictions may require reports of additional conditions not listed here within their jurisdictions. In addition to the diseases listed above, CDE requests the voluntary reporting of either laboratory identification of, or illness caused by the following pathological agents: (1) E. coli O157:H7 and other verotoxin-producing (enterohemorrhagic) E. coli, (2) Cryptosporidium, (3) Cyclospora, (4) Hantavirus, (5) Hemolytic uremic syndrome (a likely marker of infection with verotoxin-producing E. coli), (6) Invasive disease due to Group A Streptococcus (such as necrotizing fasciitis, but not pharyngitis) and (7) Listeria monocytogenes. 17

Attachment III Victim s Assistance Programs When individuals are abused, neglected, injured or victims of crimes, there are resources to assist them physically, emotionally, financially and legally. Organizations have been developed based on the need to support victims through the criminal justice system, recognizing that victim s needs are oftentimes overlooked. Individuals with disabilities who fall victim to crimes, especially physical violence and sexual assaults should be encouraged and assisted to access these resources. It is suggested that providers develop relationships with local entities and assist individuals in accessing such services when appropriate. There are two main types of victim assistance programs: system and community-based organizations. System-based programs which generally operate out of a District Attorney s office, provide notification to victims/witnesses of court proceedings. Community based programs are designed to provide support and assistance to victims. Usually, the programs fall under the categories of: Rape Crisis/Sexual Assault programs providing services to victims and their family/supporters. Domestic Violence programs provide counseling and temporary housing to victims, as needed. Crime Victim Services provide supports and assistance to victims of crimes excluding sexual assaults and domestic violence. There are domestic violence centers, rape crisis centers and victim assistance offices throughout the Commonwealth. In order to locate the most appropriate resource for individuals, you may contact the following statewide organizations. Additional information regarding local resources are available through these organizations: PA Commission on Crime and Delinquency [PCCD] [717] 787-2040 PA Coalition Against Rape [PCAR] [800] 692-7445 [717] 728-9740 PA Coalition Against Domestic Violence [PCADV] [800] 932-4632 Office of Victim Advocate [crime victim compensation] 18