PREVENTION

Actions taken to minimize and/or eliminate social, psychological, or other conditions. Prevention can occur at the individual, group, community, and societal levels and enhances opportunities to achieve positive fulfillment.		  
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  MANAGEMENT

See ADMINISTRATION		  
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  PRACTICE

Established actions or ways of proceeding in the regular performance of organizational duties. Policies and procedures often guide practice.		  
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  LIABILITY

An obligation, responsibility, or debt. 		 
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  SERVICE RECIPIENT

The individuals, groups, organizations, or communities that use, receive, or benefit from programs and services. Service recipients can include consumers, patients, family members, legal guardians, advocates, public/private organizations, employers, and purchasers. All are regarded as significant stakeholders served in a variety of agencies and practice settings.		  
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  CASE RECORD

A written compilation that describes the client and the services delivered. Records can be in hard copy and/or electronic format. The case record can be used as a source of information for quality improvement or other evaluation activities, for research purposes, or to demonstrate accountability to funding bodies. 		 
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  PROCEDURES

Written instructions that outline the steps for performing a task(s) or operationalizing an administrative or service delivery process. A procedure can be written as a step-by-step set of instructions or as a narrative description of a process. A procedure tells someone how to do something not just what to do.

Unlike policies, procedures do not need to be approved or reviewed by the governing body, and need not be associated with a specific policy. For example, whereas a broad anti-discrimination policy requires grievance or other procedures in order to be operationalized within an organization, assessment procedures do not require a governing body approved assessment policy.

Note: Procedures are sometimes referred to as administrative policies.

  
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  CASE

A general term used to designate clients (including individuals, families, and groups) served by an organization for purposes of monitoring the provision of services. A foster care case is generally based on the placement of an individual child, although casework for the child may include services to the child's family. A child protective services case is based on an entire family household if a family assessment model is used; otherwise a case is defined as a child.		  
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  COMMUNITY

A specific group of people living in the same locality and who may share a common culture, values, and norms. Communities can also be defined by race, religion, ethnicity, age, occupation, political status, tribal affiliation, interest in particular problems or outcomes, or other common bonds. The term "community" encompasses worksites, schools, tribes, residential neighborhoods, business districts, recreational areas, and health and human service sites.		  
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  ADVOCACY

An act performed with or on behalf of others through direct intervention, empowerment, or representation. Case advocacy refers to actions taken in relation to a particular individual consumer. Cause, social, or systems advocacy refers to actions taken in relation to a common issue affecting a group of persons.		  
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  SERVICE

One or more organization-operated programs or activities that have a common general objective and deploy the organization's material and human resources in a planned and systematic manner. An organization that publicly promotes or identifies itself in writing as offering a service, is licensed to deliver a service, assigns personnel and/or space to a service, or allocates financial resources to a service is considered to offer that service.		  
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  CLINICAL

The study, assessment, and diagnosis of the client situation followed by direct treatment to help the client achieve prescribed goals.		  
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  CRISIS INTERVENTION

The immediate response to the acute needs of a person in crisis including referral to appropriate community resources, advocacy, support, or direct assistance.		  
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  PROGRAM

A system of services offered by an organization. For example, an organization providing a mental health service may offer several mental health programs to different populations, e.g., a mental health program for adolescent teens. The word "program" can be used interchangeably with the word "service" or to describe specific programs.		  
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  LEGAL GUARDIAN

A person who has legal responsibility for the care and management of a person incapable of administering his/her own affairs. In the case of a minor child, the guardian is charged with the legal responsibility for the care and management of the child and of the minor child's estate.		  
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  PERSONNEL

The body of employees and/or volunteers that carries out the organization's tasks under the organization's administration and/or supervision. This definition does not include foster parents who are specifically referenced in relevant standards		  
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  CONFIDENTIALITY

An ethical and practice principle that requires the protection of information shared within a professional-client relationship. An organization that upholds confidentiality prohibits personnel from disclosing information about persons served without their written consent.		  
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  POLICY

A written statement of principles, values, or intent that provides a basis for consistent decision making and guides the actions of staff, management, and board of trustees. A policy is intentionally broad in its language and application. The following is an example of an anti-discrimination policy:

"[Organization Name] shall not discriminate on the basis of race, color, religion (creed), gender, age, national origin (ancestry), disability, marital status, sexual orientation, or military status, in any of its activities or operations. These activities include, but are not limited to, hiring and firing of staff, selection of volunteers, selection of vendors, and provision of services."

In contrast, a procedure is a detailed, step-by-step description of a process. It tells the reader how to do something. Generally, policies are implemented through procedures. For example, the above anti-discrimination policy would require a detailed grievance procedure in order to operationalize it within an organization.

The governing body has the fiduciary responsibility for setting organizational policy. Therefore, policies must be approved and periodically reviewed by the organization's governing body. However, the governing body typically delegates (via policy) the responsibility for policy development to management. In owner-operated for-profit companies, the owner can act as the company's governing body, depending on the company's corporate structure.

In a public agency the responsibility for setting and reviewing policies may belong to the agency's management team, elected officials, another governmental agency, or as is often the case, a combination of the above.

  
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  PROFESSIONAL PERSONNEL

Individuals who have met standards of specialized education or training, have demonstrated their mastery of a systematic body of knowledge, and comply with the code of ethics required by their professional groups. Professionals in family and children's organizations traditionally include, but are not limited to social workers, psychologists, psychiatrists and other physicians, nurses, teachers, nutritionists, gerontologists, certified alcohol and drug abuse counselors, persons with advanced degrees in related human service fields, and educators with various specialties. The entry-level professional degree in social work is the B.S.W., but in certain service sections, it is explicitly stated that an advanced degree is required. The greater specificity takes precedence.		  
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  FAMILY

Two or more people who consider themselves family and who assume obligations, functions, and responsibilities generally essential to healthy family life. Child care and child socialization, income support, long-term care, and other caregiving are among the functions of family life. The definition of "family" will rest with an individual's indication of who plays a family member role, including current or former foster family, adoptive family, extended family members, fictive kin, or significant others. Organizations that believe family is the central constellation in a child's life, and that family attachments are of primary importance for human development, will strive to work with professional staff to develop a common understanding of "family."		  
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  SENIOR MANAGEMENT

Employees who assume administrative oversight for the organization's programs. Senior management positions may include vice presidents, chief operating officers, assistant commissioners, directors, or other positions that involve management of program administration. The term does not include supervisors of direct service workers.		  
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  QUALIFIED PROFESSIONAL

An individual licensed by the state in which the organization operates to perform duties outlined in the regulation requirements. Similar terms include: qualified health practitioner, qualified clinician, and qualified medical practitioner. 		 
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  OBJECTIVE

A sub-goal stated in operational terms, i.e., a statement that makes clear what expected results are to be measured or assessed.		  
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  CRITERIA

Systematically developed, objective, and quantifiable statements used to assess the appropriateness of specific decisions, services, and outcomes.		  
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  CONTRACT

A formal written agreement between two or more parties that specifies the services, space, or products to be provided in exchange for some form of compensation. Also known as "purchase of service arrangement."		  
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Risk Prevention and Management
  
Private Org Public Agency  

RPM 8: Access to Case Records*

 
Service recipients or designated legal representatives can access their case records, consistent with legal requirements.
Update: Revised Second Note, Revised First NA, Added Second NA - 03/01/11; Update: Added Second Note, Deleted NA, Added NA - 12/01/10

RPM 8 Original Second Note and First NA:

Note: RPM 8 does not apply to Community Change Initiatives (CCI), Early Childhood Education (ECE), Out-of-School Time (OST), and/or Youth Development (YD) programs. However, if organizations provide both those and other services, the standards will apply to the organization and should be implemented in all programs/services other than CCI, ECE, OST, and YD. Organizations that provide other types of non-clinical group or crisis intervention services should contact their Accreditation Coordinator if they have questions about the applicability of these standards.

NA The organization provides only Community Change Initiatives (CCI), Early Childhood Education (ECE), Out-of-School Time (OST), and/or Youth Development (YD) Services.

RPM 8 Original First NA - 12/01/10:

The organization provides non-clinical group or crisis intervention services.

Interpretation: Organizations are expected to have policies and procedures that address access to case records by service recipients.
Interpretation: For networks, RPM 8 applies to case records and case information that is maintained by the network management entity, as well as records maintained by members of organizations or subcontracted providers.
Note: See DV 17 for further guidance about the information to be included in case records for Domestic Violence Services (DV).
Note: If the organization operates a program that qualifies for an NA but also provides other types of services, the standards should be implemented in all programs aside from those that qualify for the NA.
NA The organization provides only Community Change Initiatives (CCI), Early Childhood Education (ECE), Out-of-School Time (OST), Social Advocacy (SOC), and/or Youth Development (YD) Services.
NA The organization provides only non-clinical group, crisis intervention, and/or information and referral services.

RPM 8.01

 

Access to confidential case records meets legal requirements, and is limited to:

  1. the service recipient or, as appropriate, a parent or legal guardian;
  2. personnel authorized to access specific information on a “need-to-know” basis;
  3. others who are permitted access;
  4. former service recipients;
  5. requests for records of deceased service recipients; and
  6. auditors, contractors, and licensing or accrediting personnel consistent with the organization’s confidentiality policy.
Interpretation: Case records should not be left in public areas such as on carts in hallways, on desks, or in non-secured areas. When not being used by authorized staff, files should be returned to a secure area.

RPM 8.02

 

Reviews of case records by service recipients are:

  1. conducted in the presence of professional personnel on the organization’s premises; and
  2. carried out in a manner that protects the confidentiality of family members and others whose information may be contained in the record.

RPM 8.03

 

If the organization determines that it would be harmful for a service recipient to review his/her case record, and applicable law provides no guidance on case record access, then:

  1. senior management reviews, approves in writing, and enters into the case record the reasons for refusal; and
  2. procedures permit a qualified professional to review records on behalf of service recipients, provided the professional signs a statement that information determined to be harmful will be withheld.
Interpretation: An individual's right to review his or her care or treatment may be denied, or otherwise limited, only in the most extreme circumstances where serious harm is likely to ensue. In such cases, objective criteria must guide decisions to deny access. In all cases, the organization must operate in accord with applicable law.

RPM 8.04

 
Contracts with subcontracted provider organizations and independent practitioners ensure that the network management entity has access to the case records of persons and families receiving network services.
Interpretation: Network management entities require access to case information in order to conduct utilization management activities, verify billing, provide care coordination, and other network management activities.
NA The organization is not a network management entity.
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PURPOSE: Comprehensive, systematic, and effective risk prevention and management practices reduce the organization’s risk, loss, and liability exposure.
 
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