Reducing and Eliminating Seclusion & Restraint: The Leadership Factor THE SAKS SYMPOSIUM...

Reducing and EliminatingSeclusion & Restraint:

The Leadership Factor

THE SAKS SYMPOSIUMUniversity of Southern CaliforniaGould School of LawApril 22-23, 2011

In US, an estimated 50 to 100 people die each year as a result of S & R and many more are traumatized or injured.

Research now demonstrates that psychological harm, physical injuries and death are by-products of S&R.

Research also demonstrates that injury rates to staff in mental health settings using S & R have been found to be higher than those found in high-risk settings like lumbar,

construction and mining.

Reducing harm and promoting recovery requires a shared vision of success, a clear mission and leadership at all levels.

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The efforts to reduce seclusion and restraint must be grounded to the greater vision of the organization.

Vision Definition:

The ultimate outcome of how the world should be as a result of your efforts.

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A vision is realized through accomplishing a mission.

A mission is a clear statement of what you will do in order to attain a vision.

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SAMHSA convened a national summit in December 2004 with 110 expert panelists

Issued National Consensus Statement on Mental Health Recovery

“Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.”

Source: http://www.samhsa.gov

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National summit also issued…The 10 Fundamental Components of Recovery

Self-Direction Individualized and Person-Centered Empowerment Holistic Non-Linear Strengths-Based Peer Support Respect Responsibility Hope

Source: http://www.samhsa.gov

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Recovery is an individualized journey.

Recovery is a process and an outcome.

Recovery is managing one’s illness =

managing one’s life.

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Recovery = A life in the community.

The new framing for public policy and

finance.

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Consumers define their own recovery journey in terms of the pursuit of goals, a decent place to live and connectedness to others.

If central to the concept of recovery is realizing certain goals to be a full participant in the community, then those goals should be the basis of outcome measures.

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SAMHSA National Outcomes Measures (NOMS)

Reduced Morbidity Employment/Education Crime and Criminal Justice Stability in Housing Social Connectedness Access/Capacity Retention Perception of Care Cost Effectiveness Use of Evidence-Based Practices

Source: http://www.samhsa.gov

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“I love it when a plan comes together !”

~John “Hannibal” Smith, The A-Team

1997, PA DPW/OMHSAS issued the challenge to reduce/eliminate S & R in 9 state hospitals.

The Issues:◦ Research demonstrated S&R not working◦ Recovery rates low ◦ Most patients already victims of trauma◦ No need to reinforce that trauma or retraumatize.◦ If goal is recovery, patients need to be an active

part of the process.

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Committed Leadership – Tied to Vision Alignment with Mission - Recovery and CQI Integrated system planning and

implementation Value driven, evidence-based priorities Dissemination of evidence-based technology to

define clinical practice and program design. True partnership between all levels of the

system Data-driven, incentivized, and interactive

performance improvement practices.

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Results

◦ Within 3 years: Incidences of S&R down by 74%. Patient hours spent in seclusion down 96%.

◦ AND No increase in staff injuries. Changes implemented without additional funds,

using existing staff and resources.

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PA set the highest standards of S/R in the US.

Recipient of Harvard University/Ford Foundation/Council of Effective Government Innovations in American Government Award.

Not alone in its success. NASMHPD a key

leadership partner.

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Mental health authorities in 8 states received 3-year State Incentive Grants to implement a model based on the Six Core Strategies for Reducing Seclusion and Restraint which are similar to what was used in PA.

20 of 28 facilities that reached stable implementation of the model were able to reduce seclusion hours by an average of 19% (per 1000 treatment hours).

Over half of the 28 facilities were able to reduce restraint hours by 55% (per 1000 treatment hours) on average.

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Vision and Leadership are essential ingredients to reducing seclusion and restraint in medical facilities.

From federal agencies to state agencies to hospital directors to department heads and mental health team leaders, the greater the alignment of vision and mission, the greater chances for success.

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Our main business is not to see what lies dimly at a

distance, but to do what lies clearly at hand.

~Thomas Carlyle

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