Lisa Gordish, Psy.D. LICDC-CS Liz Smith, Training Officer Alan Freeland, MD, Justin Trevino, MD Marjorie Kukor, PhD All-Ohio Institute on Community Psychiatry March 28, 2015
Twin Valley Behavioral Healthcare Twin Valley Behavioral Healthcare, TVBH, located in Columbus, Ohio, is one of the Ohio Department of Mental Health and Addiction Services hospitals. TVBH is a 200+ bed facility, which is JCAHO accredited, as well as Medicare\Medicaid approved for acute care and specialized forensic maximum and minimum-security services. 2
What is Reaching Safety Together? Reaching Safety Together Model of Clinical Care Model of Organizational Structure Based upon three Evidenced-Based Practices Recovery Model Substance Abuse/Mental Illness, SAMI/IDDT Trauma Informed Care Shared principles and values 3
Recovery Model Mental Health Recovery (1999- present) Principles Consumer-Directed, Hope, Holistic, Trust, Strength-based, Collaborative, Involvement of Family/Community 9 components of the Recovery Model: Clinical Care, Family Support, Peer Support & Relationships, Work/Meaningful Activity, Power & Control, Stigma, Community Involvement, Access to Resources, Education 4
Recovery Model- Implementation Full staff training Shifting from traditional medical model to collaborative patient centered model evidenced by: Patient involvement in treatment planning Focus on patient goals and strengths Offering more services/programs: Work Program, Educational support, Family support group, Peer Support program Recovery Journal provided to patients upon admission Core groups based on Recovery Components 5
Substance Abuse/Mental Illness (SAMI)/IDDT Integrated Dual Disorder Treatment Model Adapted for Inpatient Setting (2000-present) Principles Core Values: Shared Decision-Making- (Respect, Consumer-Driven, Hope, Critical role of families) Additional Guiding Principles: Same clinicians, same program/agency, same time Comprehensiveness Residential Services, Case-Management, Supported Employment, Family Psychoeducation, Social Skills Training, Training in Illness Management, Pharmacological Treatment 6
SAMI/IDDT Additional Guiding Principles Assertive outreach/engagement Reduction of Negative Consequence Time-Unlimited Services, Major Life changes, recover at own pace, in own time Multiple Psychotherapeutic Modalities: Individual, Group, Family, Self-help, Pharmacology Motivation-based Treatment 7
SAMI/IDDT Stage-wise Assessment &Treatment STAGES OF CHANGE IDDT STAGES OF TREATMENT MAJOR THERAPEUTIC GOALS MAJOR THERAPEUTIC FOCUS Pre-contemplation Engagement Relationship building Engagement/ Assertive outreach/crisis Intervention Contemplation Early persuasion Insight/ Education Family and peer support Motivational Interviewing/Support Groups Preparation Late persuasion Insight development/ Build awareness of problem, set goals Action Active treatment Skill acquisition (social, living, leisure) Maintenance Relapse prevention Maintenance /Relapse Prevention Motivational Interviewing/Support Groups Individual Group Treatments Support groups Individual/Group and Support Interventions 8
The Opiate Factor Rise in admissions with opiate abuse Concern of opiate-related deaths in the community Shift of SAMI resources to acute care units using SBIRT model Implementation of DAWN kits 9
Trauma Informed Care 2008 Trauma Informed Care identified as a vehicle to restraint reduction Decision to train all staff with assistance from NCTIC in the following areas: What is Trauma and Why is it Important Neurobiology of Trauma Trauma & Recovery- Peer Advocate Personal Comfort Plans and Interventions All staff trained over 6 month period 10
Staff Training session With Dr. Joan Gillece National Center for Trauma Informed Care 2009 Staff TIC Training Session March 2009 With Dr. Joan Gillece, NCTIC 11
Trauma Informed Care Core Principles of TIC Safety Trust and Transparency Peer Support and Mutual Self-Help Collaboration and Mutuality Empowerment, Voice and Choice Cultural, Historical and Gender Issues 12
Trauma Informed Care Implementation Personalized Comfort Plans with Admissions Comfort Boxes on the units Safety Plans for acutely aggressive situations ID Triggers and Warning Signs, individualized targeted interventions TIC Training in Orientation Trauma Specific Training for Licensed Clinicians- Seeking Safety Staff Self- Care/Vicarious Trauma training 13
Trauma Informed Care- Maintenance Good Results, reduction in S/R, fewer injuries Integrate purchase of comfort box items into standard ordering of supplies Patient worker for inventory and filling boxes Comfort Items at admissions Review and monitoring of Safety Plans within Behavior Therapy Committee Standardize Safety Plan template and add to shared drive for easy access upon readmission 14
Organizational Changes and Challenges Changes in leaders, fiscal issues, increased admissions, increased staff stress and workload, opiate epidemic Lost ground, S/R went up, staff morale went down Clear that we needed to reassess our models of care and pay more attention to concept of parallel processes 15
Birth of RST Performance Improvement Group identified need to address organizational challenges and organizational culture- Reaching Safety Together (June 2012) Identified Overlap of Core Values among EBPs in place Identified the Parallel Process concept imbedded in TIC model that could assist with organizational challenges Did not want to create new flavor of the month but rather deepen the quality care already in place, given the continued relevancy of all three EBPs 16
Parallel Process Staff to patient interactions can often mirror Administration to staff interactions and vice versa Sandra Bloom, 2008 17
Sandra Bloom, MD, Sanctuary Model, 2008 18
Parallel Processes Data Informed Goals All staff organizational survey All staff Cafés - Leadership staff interacting and listening to direct care staff Developed goals for organizational improvement and one direct care goal disciplinary process, staff appreciation and support, staff assault response, TIC training needs and patient recovery tool kits. 19
RST Progress Improvements made towards a more supportive rather than punitive management response to staff issues Re-instated staff appreciation efforts Development of Staff Wellness Committee; Communication oversight committee Made specific changes in our process of response to staff assaults Developed new training module for continued staff training of TIC Utilized staff and patients to develop a toolkit to expand upon the comfort box and recovery journal 20
Potential Outcomes Healthier work environment Healthier workforce Improved Collaboration Fewer silos Lower staff turnover Fewer injuries 21
Future Work- Are We There Yet? Current leadership has integrated RST into TVBH strategic plan (not an initiative, but foundational) Three priority areas of the strategic plan include: Respect (Continued parallel process awareness) Community Connections Fostering a Learning Community 22
Future Work RST is foundational Everything we do, clinically or organizationally, falls under the umbrella of RST Core values support how we function as an organization, support our staff, and interact with patients While remaining focused on the evidenced based clinical treatment of mental health, substance abuse and trauma 23
Future Work More robust training in multiple areas of RST Further integration of TIC to staff training curriculum for responding to crisis and pre-crisis events Looking at how to measure organizational impact given that culture change is a long-term commitment 24
Partners and Supports Ohio Department of Mental Health and Addiction Services (Ohio MHAS) Center for Evidence- Based Practices (CEBP) National Center for Trauma Informed Care (NCTIC) 25
Thank you! Lisa.Gordish@mha.ohio.gov Liz.Smith@mha.ohio.gov Richard.Freeland@mha.ohio.gov Justin.Trevino@mha.ohio.gov Marjorie.Kukor@mha.ohio.gov Twin Valley Behavioral Healthcare 2200 W. Broad St. Columbus, Ohio 43223 (614) 752-0333 26