Teaching Mental Health to Hospital Administration: The Managing Challenging Families CourseClaire M. De Souza BSc MD FRCP(C) Hospital for Sick Children, University of Toronto, Toronto, Canada

Much has been written about workplace violence in hospitals and its devastating impact. However, most educational initiatives do not address the psychological costs. As well, non-mental health professionals may lack knowledge and skills for managing families with complex mental health issues. In 2007/8, the Managing Challenging Families course was developed in response to managers dealing with aggressive parents of medically ill children by critical incident reporting and the impact that this was having on workplace stress, as well as the recruitment and retention of front-line staff. Also noted was the infrequent use of Code Whites despite the critical incident reports.

Introduction

1) Meetings of Interdisciplinary Course organizers: • Led by Human Resources & Administration• Risk Management • Patient Representative • Nursing • Social Work • Security • Psychiatry

2) Needs Assessment:• 40 managers were asked to submit cases which were incorporated into the one day course.

3) Course Development

4) Evaluation: • self-reflection questionnaires • satisfaction questionnaires

Course Material

Results

Conclusion

References

• Approaches for dealing with challenging families• The use of Code whites (“violent person”) • Interdisciplinary Team Members to involve • Approaches for self-care • Support for staff during and after challenging encounters

• The course was very well received by the 40 managers & directors who attended.

• Nurse educators requested aspects of the course be taught at their education days for front-line nursing staff

• Managers identified that more resources were needed.

• Aspects of psychiatry were conveyed: • reflecting on what makes families challenging (formulation)• methods for working with challenging families effectively, including de-escalating interventions• tips on improving communication • building a support network, self-care, caring for others• knowing which services to consult with, including when to call a code white.

• The course facilitated interdisciplinary collaboration.

• Farrell G, Cubit K. Nurses under threat: a comparison of content of 28 aggression management programs. Int J Ment Health Nurs. 2005;14(1):44-53. • Forster JA, Petty MT, Schleiger C, Walters HC. kNOw workplace violence: developing programs for managing the risk of aggression in the health care setting. Med J Aust. 2005; 183(7):357-61.• Hurlebaus AE, Link S. The effects of an aggressive behavior management program on nurses' levels of knowledge, confidence, and safety. J Nurs Staff Dev. 1997;13(5):260-5. • Phillips. Countering workplace aggression: an urban tertiary care institutional exemplar. Nurs Adm Q. 2007;31(3):209-18. • Kerrison SA, Chapman R. What general emergency nurses want to know about mental health patients presenting to their emergency department. Accid Emerg Nurs. 2007; 15(1):48-55. • Rintoul Y, Wynaden D and S McGowan. Managing Aggression in the Emergency Department: Promoting an interdisciplinary approach. Int Emerg Nurs 2009 (17): 122-127.• Williams ML, Robertson K. Workplace violence. Prevalence, prevention, and first- line interventions. Crit Care Nurs Clin North Am. 1997; 9(2):221-9.

Methods

• The topic of Working with Challenging Families is a useful approach for teaching hospital administration about mental health. • Input from Psychiatry can enhance programs which target workplace aggression. • Non psychiatrists may be more receptive to learning about the practical aspects of mental health & how it impacts their practice. • An interdisciplinary approach is useful, incorporating the necessary stakeholders to convey its importance.

Teaching Methods• didactic and interactive · large and small group

• reflection exercises · relaxation exercises• case discussions · brainstorming• panel discussion ∙ (+ refreshments & lunch)

Acknowledgements• Tracey Deline, Director, Organizational Development, Human Resources• Krista Cauz, Director, Child Health Systems• Sarah Beaver, Manager, Psychiatry • John Bond, Protection Services Manager• Janice Campbell, Risk Management • Nancy Cornish, (past) Director, Patient Representative• Judy van Clief, Director, Child Health Systems• Pam Hubley, Associate Chief of Nursing• Barbara Neilson, Social Work