Critical Incident Reporting Analysis System (CIRAS)

Illinois Department of Human Services 

Division of Developmental Disabilities 

Information Bulletin

DD.25.017

Purpose:

This Information Bulletin (IB) addresses the requirement of providers and Independent Service Coordination (ISC) agencies' use of the Critical Incident Reporting and Analysis System (CIRAS) to report critical incidents. The bulletin also reflects a summary of the recent changes reflected in the revised CIRAS manual.

Background:

In accordance with the Home and Community-Based Services (HCBS) Waiver, the Division of Developmental Disabilities (DDD) must establish safeguards to assure the health and welfare of waiver participants. To align with this requirement, DDD must operate a critical incident reporting and management process. This is met via the following reporting requirements:

  1. Administrative Code Title 59, Part 50 "Office of Inspector General Investigations of Alleged Abuse, Neglect, or Financial Exploitation." This code requires the reporting of alleged abuse, neglect, exploitation, and deaths of individuals receiving services in settings that are licensed, certified, or funded by DDD.
  2. Critical Incident Reporting and Analysis System (CIRAS). DDD requires reporting of other critical incidents in the CIRAS system that are not considered to be alleged incidents of abuse, neglect, or exploitation.

This bulletin focuses solely on the critical incident reporting via the CIRAS system.

Current guidance (remains applicable in revised manual):

Providers must report incidents within two (2) working days of discovering or being informed of the incident. ISC agencies should submit reports for incidents they become aware of that have not been reported. Unresolved issues with CIRAS incidents should be reported to the Division by the ISC per the Problem and Conflict Resolution Protocol.

There are eleven (11) categories of critical incidents as shown below. The definitions for certain categories have been revised to provide additional guidance. Refer to "New/Revised guidance" section for the specified revisions.

Critical Incidents are defined below:

911 Call: All calls to 911 for emergency personnel response that do not meet the requirements of any other category. Calls for emergency response that are initiated by persons receiving supports from the provider agency should be included here, even if they are later determined to be inappropriate.

Calls to 911 for medical assistance for a medical reason that is not to save an individual's life (or, does not result in hospitalization) should be reported as a 911 Call. Calls to 911 for medical emergencies to save an individual's life should be reported as "Medical emergency." A description of the reason for the call should be included in the narrative.

911 Call is also known as an emergency call.

Deaths: Deaths of participants who receive services while living in their own or family's home. Deaths of participants residing in residential settings are not reported in CIRAS as they are reported to OIG per Rule 50.

Known injury: A known injury is any injury from a known cause that is not considered abuse or neglect and that requires immobilization, casting, five or more sutures or the equivalent, second or third degree burns, dental injuries, eye injuries, or any injury that prohibits the individual from participating in routine daily tasks for more than two consecutive days. In some cases, an injury may not be immediately recognized as requiring reporting. A known injury becomes reportable at the point where there is recognition that it fits this definition.

Law enforcement: Any incident that results in the individual being charged, incarcerated, or arrested. If a 911 call to law enforcement does not result in the individual being charged, incarcerated, or arrested, the incident must not be reported in this category. The selection of a more appropriate category is required.

Medical emergency: Any incident where emergency medical intervention is required to save an individual's life (e.g., Heimlich maneuver, cardiopulmonary resuscitation (CPR), intravenous (IV) therapy for dehydration).

  1. Calls for 911 medical assistance to save an individual's life should be reported as "Medical emergency" even if the cause is other than the examples provided above. A 911 Call is not required for an issue to be reported as a "Medical emergency" (i.e., an incident can be classified as a "Medical emergency" even if a 911 Call is not made).
  2. A medical emergency resulting in hospitalization should be reported as a "Medical emergency".
  3. Incidents that are resolved through intervention of agency staff that could have resulted in death if the action had not occurred.

Calls for 911 medical assistance for a medical reason that is not to save an individual's life should be reported as 911 Call.

Missing individual: An incident that is not attributed to neglect, as defined by Rule 50, and the individual cannot be located for a period of time longer than specified in the personal plan; the individual cannot be located after actions specified in the personal plan are taken; the individual cannot be located in a search of the immediate surrounding area; circumstances indicate that the individual may be in immediate jeopardy; or law enforcement has been called to assist in the search for the individual. (If applicable, indicate individual has been located.)

Peer-to-peer acts: Acts committed by one individual against one or more individuals when there is physical abuse with intent to harm; verbal abuse with intent to intimidate, harass, or humiliate resulting in emotional distress or maladaptive behavior; any sexual abuse; any exploitation; or intentional misappropriation of property. In some cases, such incidents may need to be reported to OIG as potential staff neglect or exploitation, rather than reported in CIRAS. If peer-to-peer actions occur due to failure of staff to intervene to prevent or stop the act, a neglect report is appropriate. In cases where one individual is clearly the aggressor, it is acceptable to make only one CIRAS entry in the name of the aggressor, listing the name(s) of the victim(s) in the narrative. However, if two or more people become involved in an altercation that meets this definition and the aggressor is identified as multiple individuals, a separate CIRAS report should be completed for each aggressor. Acts committed against staff should be reported in the "Peer-to-staff" option.

Peer-to-staff: Acts committed by one individual against one or more staff members when there is physical abuse with intent to harm or verbal abuse with intent to intimidate, harass, or humiliate. In cases where one individual is clearly the aggressor, it is acceptable to make only one CIRAS entry in the name of the aggressor, listing the name(s) of the victim(s) in the narrative. However, if two or more people become involved in an altercation that meets this definition and the aggressor is identified as multiple individuals, a separate CIRAS report should be completed for each aggressor.

Unauthorized restraint: Any use of restraint beyond the provisions outlined in Appendix G of each Waiver. Refer to Illinois Mental Health and Developmental Disabilities Code for details. (See 405 ILCS 5/1-125 and 405 ILCS 5/2-108 for details.).

  • "Restraint." The direct restriction through mechanical means or personal physical force of the limbs, head, or body of an individual except as part of a medically prescribed procedure for the treatment of an existing physical disorder or the amelioration of a physical disability. The partial or total immobilization of an individual for the purpose of performing a medical or surgical procedure shall not constitute restraint. Momentary periods of physical restriction by direct person-to-person contact, without the aid of material or mechanical devices, accomplished with limited force, and that are designed to prevent an individual from completing an act that would result in potential physical harm to the individual or another shall not constitute restraint, but shall be documented in the individual's record. [405 ILCS 5/1-125]
  • Types of restraints which are prohibited include prone restraint, supine restraint, mechanical restraint, and chemical restraint other than those medications legally prescribed and administered as part of an individual's regular medical regimen. [59 Ill. Adm. Code 115.245 (a)]. Since these types of restraints are not allowed, the use of prohibited restraints must be reported via CIRAS (as "Unauthorized restraint") as well as reported to OIG as appropriate. (Note: all "Unauthorized restraint" incidents are not required to be reported to OIG, only prohibited restraints and any alleged abuse by staff during the restraint process must be reported to OIG.)

Unknown injury: Any injury of an unknown cause that is not considered possible abuse or neglect and that requires treatment that only a physician, physician's assistant, or nurse practitioner can provide. If the cause of the injury is known, follow instructions in KNOWN INJURY and/or MEDICAL EMERGENCY categories.

Unscheduled hospitalization: Any hospital admission that is not scheduled in advance. Hospitalization admissions that occur as a result of a "Medical emergency" or "911 Call" should not be reported in this category but should be reported in the appropriate category.

New/Revised guidance:

  1. A Table of Contents has been added. When clicking a section title, the CIRAS manual scrolls to that section.
  2. The following statement has been added: "Providers must communicate to the ISC any serious incidents not defined in this manual where the health or safety of the individual may be impacted."
  3. If a definition was substantially revised it is shown below. Refer to previous section for the full critical incident definitions. Revisions to the definitions are as follows:
    • 911 Call: statement has been added to distinguish the difference between a 911 Call and a Medical Emergency.
    • Law enforcement: statement has been added to expand upon when to use this category or a more appropriate category.
    • Medical emergency: added additional language to clarify when this category should be used.
    • Missing individual: added statement "If applicable, indicate individual has been located". Often the Division cannot determine if the individual has been located due to lack of information in the incident narrative. By indicating whether the individual has been located impacts the next steps taken by the Division.
    • Unauthorized restraint: additional language has been added to reflect the definition of a "Restraint", which is cited in Administrative Code Title 59, Part 115.120 "Definitions."
  4. An example is provided to clarify when an incident is reported in CIRAS and to OIG. Such incidents capture separate and specific reporting requirements.
  5. Introduction of the CIRAS Liaison Role. Each agency must designate a staff member to serve in this role.
    • The Executive Director (or an authorized representative) must identify a CIRAS Liaison by emailing the specific information as shown in the CIRAS manual.
    • The identified CIRAS Liaison can be a Designated Agency Reporter [refer to Section 5, "ISC and Community Provider Agencies (Designated Agency Reporters), of the CIRAS manual]", the OIG Liaison, a Quality Assurance staff member, an Information Technology staff member, or any staff member designated by the Executive Director (or, an authorized representative).
    • Only one CIRAS Liaison shall be identified at any given time for each ISC/community provider agency.
    • It is important for the CIRAS Liaison emails to be formatted as shown in the CIRAS manual.
    • The duties of the CIRAS Liaison are included in the CIRAS manual.
  6. The following section has been added to assist agencies with references/resources when working with CIRAS: "Useful applications/websites for CIRAS process."
  7. The sending of a complete CIRAS registration packet has been added. This is useful in that the CIRAS unit staff has had numerous inquiries regarding which documents are needed to register a community staff member (i.e., Designated Agency Reporter). Adding this section to the CIRAS manual (briefly summarized) equips the community agencies with appropriate information to process their CIRAS registrations.
  8. Additional instructions are provided for the completion of Department of Information Technology (DoIT) forms. It is important to note that the following forms (used for CIRAS registration) must be completed electronically, bearing an electronic signature. DoIT/DDD will not accept scanned or handwritten forms. (It is recommended to use Adobe Acrobat application for completing the forms)
    • Community Provider/External User I.D. And System Access Request (IL444-2022 / IL444-2022S)
    • Request for MIS Hardware, Software and Services (IL444-4144)
    • Emphasis on electronic signatures, using Entrust or Docusign, has been added.
    • Sample templates for completing the forms have been updated and revised.
  9. When a user's identity is unable to be verified by DoIT (usually occurs due to a name change or out-of-state driver's license) when attempting to establish an external ID (used for logging onto the CIRAS system), additional steps to obtain an ID must be taken. The manual now reflects these steps.
  10. Reporting Critical Incidents Through CIRAS [Section 6].
    • The following was reflected in DDD Communication, June 18, 2025, "Revisions to Input Screen For CIRAS Incident Reporting".
    • The CIRAS manual has been revised to distinguish between the actual date/time of the incident and the discovery date/time of the incident. Definitions/comments have been updated to further explain the difference. Examples are provided for clarification also.
    • The following has been added to comments for the narrative description: "The name or initials of the individual must be included in the description. This demonstrates that the individual's name reflected in the narrative description refers to the same individual whose name is shown in the demographic information of the incident report."
  11. The following notes have been added:
    • Emphasis on reporting agencies assuring the accuracy of demographic information on the system's incident report. If necessary, the provider agency must update the information in the Reporting of Community Services (ROCS) system, which interfaces with the CIRAS system.
    • Agencies must avoid using non-standard acronyms in the incident narrative that are specific to the agency. Standard, common acronyms, such as IDD (Intellectual Developmental Disabilities), are acceptable.
    • ISC use of provider names when entering critical incidents.
  12. A section "CIRAS Interim Incident Reporting" has been added to outline steps that must be taken when an agency is not able to access an individual's demographic via the CIRAS system.
    • "…in the interim the incident must be submitted via email to DHS.DDD.CIRAS@illinois.gov (with a cc: to the ISC) until such time incidents can be entered in CIRAS for the individual. The email must contain all data and information elements as defined in this section for reporting critical incidents. The purpose of the email is to assure appropriate follow-up actions occur in a timely manner, if necessary."
  13. The ISC has two (2) working days [previously one (1) day] to make a CIRAS follow up entry for Law Enforcement and Missing Individual incidents.
  14. Routinely, the Division conducts follow up tasks with agencies. The following statement has been added to reflect when this follow up is not applicable: "If the incident is absent of risks to health and safety of the individual or others and does not contain potential threats and harm to operational functions, follow up will not be required."
  15. Removing Staff/User Names from CIRAS [Section 8]. This section includes expanded language citing reasons for removing staff/user names
  16. Data Reports and Analysis [Section 9].
    • The following statement has been added: "Provider agencies must have a process to review CIRAS incident data (and other reported incidents) for any trends and patterns at least quarterly. It is the expectation that the outcome of the review and analysis will help to improve supports and services for individuals."
    • Reviewing trend reports has been expanded to capture the review and analysis process conducted by the Division.

The Division encourages staff members of providers and ISCs to review and refer to the revised CIRAS manual.

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