Risk management protects both clients, the staff and the facility's solvency. View the Video here: https://youtu.be/Kg015iSH1vQ Earn counseling CEUs: https://www.allceus.com/member/cart/index/product/id/696/c/

1. Risk Management:
An Ethical Obligation
Instructor: Dr. Dawn-Elise Snipes
Executive Director: AllCEUs Counselor Education
Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery
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2. Objectives
 Define Risk
 Explore the benefits of risk management
 Learn how to categorize risk
 Explore common risks in a behavioral health
environment and ways to mitigate them
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3. What is Risk
 The combination of the probability of an event
and it’s consequences
High Consequences Low Consequences
High Probability (if
steps not taken)
Drug Use on Premises
Assault in unlit parking
lot
Slip on wet floor
No toilet paper in the
bathroom
Electricity goes out in
a storm
Low Probability (even
if steps not taken)
Client Suicide
Major Data Failure
Clients Medication
Noncompliant
Client becomes ill on
premises
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4. Benefits of Risk Management
 Provides a framework for consistent, quality
services
 Improves decision making, planning and
prioritization
 Contributes to efficient use/allocation of
resources
 Protects and enhances assets including reputation
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5. Types of Financial Repercussions
 Suits against the agency for:
 Medical bills
 Lost wages / earning capacity
 Pain and suffering
 Emotional distress and loss of ability to enjoy life
 Property damage
 Wrongful death
 Punitive damages if there was negligence
 Loss of funding
 Loss of license
 Loss of reputation (client base)
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6. Classifying Risk
 Consequences
 High: Financial impact is likely to exceed Z; Significant
impact on the organizations ability to operate.
 Medium: Financial impact is between Y and Z and will
have a moderate impact on operational abilities
(layoffs?)
 Low: Financial impact is less than Y and will have a low
impact on ability to operate.
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7. Probability
 High: 25% chance it will happen in a 12-month
period
 Medium: 25% change it will happen in a 10 year
period
 Low: Less than 2% chance of occurrence or Not
likely to occur in a 10 year period
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8. Multiple Types of Risk
 Strategic and Financial (Keep $$ coming in)
 Organizational Objectives
 Cash Flow
 Service Market
 Legal and Regulatory Issues
 Employee Risk (Maintain Efficient Workforce/Reduce
Turnover)
 Workers Compensation
 Termination
 Burnout
 Injury or Victimization
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9. Types of Risk cont…
 Technology Risk (Regulatory and Legal Compliance)
 HIPAA/HITECH compliance
 Meaningful use
 Data Breach
 Disaster (Data failure)
 Patient Safety Risk Management (Regulatory and
Safety Compliance)
 Physical Environment
 Interpersonal
 Client/Client
 Client/Staff
 Destabilization
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10. Common Suits Against Therapists for Patient
Safety Issues
 Boundary violations
 Inappropriate or excessive self-disclosure
 Dual Relationships
 Using techniques without proper training (or
licensure)
 Deliberately using incorrect diagnosis to get insurance
coverage or other funding
 Inadequate documentation (paybacks)
 Wrongful death
 Breach of confidentiality
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11. Common Suits Against Agencies
 Sexual Harassment
 Environment of Care (Safety)
 Improper billing practices
 Billing for services not provided
 Unbundling
 Waiving copays and deductibles
 https://www.hollandhart.com/waiving-copays-and-deductibles
 http://cbsbilling.net/ioi-copay.html
 http://www.hcpro.com/REV-46459-2477/Beware-of-waiving-copays-and-
deductibles.html
 https://www.webpt.com/blog/post/legal-compliance-one-more-reason-to-collect-
patient-deductibles-and-copays
 Therapist malpractice
 Wrongful termination / Civil rights
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12. General Questions
 Based on information provided from other resources, managers should
conduct analyses to determine potential risks. The analysis should
identify:
 What could possibly happen?
 How likely is something to happen (measuring risk)?
 How severe will the outcome be if something did happen?
 How can the likelihood something will happen be mitigated on the forefront?
 What can be done to reduce the impact (and to what degree)?
 What is the potential for exposure or what cannot be proactively avoided?
Example: Slip and fall inside; slip and fall on stairs leading into the office
Prevention
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13. Risk Analysis
 A systematic approach to evaluating risks to business operations and
patient safety
 Start with one area, i.e. Environment of Care.
 Identify all possible risks based on personal knowledge and historical
research
 Classify risks based on probability and consequences
 Develop a plan to address/remediate risk
 Ensure a budget for “risk funding”
 Ensure all individuals are aware of their responsibility for risk
reporting and management
 Regularly audit for risk management compliance
 When an event occurs, review whether risk management policy
mediated risk.
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14. Policies and Risks They Address
 Agency has a written code of ethics
 Staff/Client environment of care
 Agency carries general liability insurance
 Personal injury
 Damage to property (Client’s or Act of God)
 Comply with State and Federal guidelines and the
guidelines of payors
 Financial Risk (fines/closing/criminal charges/loss of
funding)
 Reputation
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15. Policies and Risks
 Clearly identify staff qualifications and their duties
 Environment of care (reduce frustration, grievances and
abuse reports)
 Support guidelines for termination
 Ensure environment is free of alcohol and drugs via
policy, possibly including contraband search and
random drug screens
 Drug free workplace/Worker’s compensation
 General liability
 Client relapse/overdose
 Needle sticks
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16. Policies and Risks
 Collect and report accurate process and outcome
data (intakes, length of stay, successful completion,
unsuccessful terminations, AMAs)
 Reputation/Strategic Positioning Agency and the Field
 Funding
 Accounting system documents all monies owed,
billing, payments
 Policy to address nonpayment of fees
 Cash flow
 Ethical complaints/reputation
 Prevent client abandonment
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17. Policies and Risks
 Client rights and emergency procedures (i.e. fire) posted in a
conspicuous location
 Reputation
 Regulatory compliance
 All staff certified in CPR and First Aid
 Reputation
 Regulatory compliance
 Staffing Plan
 Regulatory compliance (staff to client ratio)
 Continuity of care
 Clear description of admission criteria for each program
including diagnosis, age, disqualifying issues (medical, criminal)
 Safe environment of care for current clients
 Defense against discrimination suits
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18. Policies and Risks
 Appropriate intake processes
 Ensure a safe and supportive environment of care
 Provides referrals as needed to ensure client stabilization
 Client data is stored in compliance with HIPAA and
HITECH regulations
 Continuity of care
 Regulatory compliance
 Reputation
 Orientation process for new clients
 Communicates rights and responsibilities to ensure a safe
environment
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19. Policies and Risks
 Handling missed appointments
 Client destabilization/suicidality
 Client dissatisfaction/reputation
 Termination due to client drop out
 Prevent complaint of abandonment
 Prevent liability for suicide
 Ensuring medication compliance
 Ensure client stabilization
 An unclean environment can be considered breach of duty
if a patient contracts an illness—more applicable to group
homes, residential and hospitals
 Personal injury liability
 Reputation of the agency and the Field
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20. Policies and Risks
 Agency should have a disaster response policy to
maintain continuity of care in the event of a data
failure or physical disaster (flood, sink hole, tornado)
 How to access data at the remote location
 Where clients are to go to receive treatment in the event of
a physical disaster / displacement
 Policy to address handling clients or potential clients
in crisis if the therapist is out sick.
 Policy to refer clients if the agency or a program
therein should shut down
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21. Did you know…
 Health and safety inspections should include refrigerator temperature
monitoring every week
 A MSDS book should be on the premises and include data on all
hazardous chemicals stored there.
 Facilities are required by HIPAA to store data backups in a secure
location in the event of local data failure
 Many states have regulatory limits on client to staff ratios and
guidelines for the number of sq. ft per client.
 Level of Care Guidelines inform the agency what services must be
provided to prevent possible paybacks and termination of provider
contracts
 To be effective, risk analysis surveys must be completed regularly and
updated as the organization changes (i.e. addition of a new program)
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22. More things to be aware of…
 Employees should complete a training on emergency procedures
(fire, flood, power outage, severe weather etc.) annually
 It is a good idea to consider having a policy which clients sign
regarding suspected drunk driving and/or attending treatment
under the influence
 Social networking and internet data (client or employee) has
been used in legal cases and can significantly damage a
company’s reputation…
 Facebook
 Instagram
 Yelp
 Google places
 Health grades
 InTheRooms.org
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23. Summary
 Risk Management involves not only professional and ethical risk,
but also managing the risks at your facility.
 Risks can come in the form of:
 Causing harm (directly or indirectly—Law suits, reputation)
 Breaking the law (criminal and or civil fines and punishments;
reputation)
 Violating regulatory codes (Temp/permanent shut down)
 Failure to plan/adapt to funding changes (Loss of cash flow)
 Effective risk management occurs regularly (at least annually)
and is updated with agency changes or addition of new
programs
 Effective risk management reduces monies required for non-
mission oriented purposes, manages reputation and prevents
financial catastrophe.
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