Real Reduction Experiences What Worked? Preventing Violence, Trauma, and the Use of Seclusion and Restraint in Mental Health Settings 2 Real Reduction Experiences Kevin Huckshorn, MSN, RN, ICADC Former CNO and Assistant Hospital Administrator, ASH/SFSH 2/1997 to 2/2002 3 South Florida State Hospital Facility Profile Adult State Mental Health FacilityAdult State Mental Health Facility First, fully privatized in the US (11/98)First, fully privatized in the US (11/98) 350 beds; Average Daily Census 350 (1998) 275 (current)350 beds; Average Daily Census 350 (1998) 275 (current) Average Length Of Stay:Average Length Of Stay: 220 days since privatization started 3 years ALOS (all residents) including LOS of people who have been in residence for 8-30 years. Pop Primary Diagnoses: schizophrenia, major depression with psychosis, schizoaffective disorderPop Primary Diagnoses: schizophrenia, major depression with psychosis, schizoaffective disorder 4 South Florida State Hospital (now GEO Care, Inc.) Facility Profile 45% of residents have been involved with criminal justice system.45% of residents have been involved with criminal justice system. 95% of residents are involuntarily committed, or court ordered.95% of residents are involuntarily committed, or court ordered. Charge from state MH Office was to change from long term care to intermediate care facility; end gridlock on admits; get Joint Commission accreditation; & reduce SR, injuries, IM med use, AWOLS, recidivism rates; improve community relationships, & BUILD NEW HOSPITAL!Charge from state MH Office was to change from long term care to intermediate care facility; end gridlock on admits; get Joint Commission accreditation; & reduce SR, injuries, IM med use, AWOLS, recidivism rates; improve community relationships, & BUILD NEW HOSPITAL! 5 SFSH Old Administration Building 1998 6 SFSH Residential Building 1998 7 SFSH Aerial View 2001 8 SFSH New Hospital 2001 9 SFSH New Town Center 2001 10 South Florida State Hospital Initiative Seclusion/restraint reduction initiative started in November 1999.Seclusion/restraint reduction initiative started in November During ASHs first year of operation a total of 264 seclusions and 197 restraints were administered. Prior to that we are not sure.During ASHs first year of operation a total of 264 seclusions and 197 restraints were administered. Prior to that we are not sure. Important note: Privatization process changed status of staff from public to private. Unions were eliminated but most staff stayed on.Important note: Privatization process changed status of staff from public to private. Unions were eliminated but most staff stayed on. 11 South Florida State Hospital Strategies Decision made to eliminate S/R use by executive management group (EMG) after CEO attended a NASMHPD conference, heard about service user experiences, and learned about Pennsylvania initiative.Decision made to eliminate S/R use by executive management group (EMG) after CEO attended a NASMHPD conference, heard about service user experiences, and learned about Pennsylvania initiative. SFSH was given no additional money, no consultants, no external training, & an overall reduction in staff (by 200+).SFSH was given no additional money, no consultants, no external training, & an overall reduction in staff (by 200+). 12 South Florida State Hospital Essential Components Full support and oversight by CEO/COO/CNO.Full support and oversight by CEO/COO/CNO. Strong policy statement and revised S/R policies and procedures.Strong policy statement and revised S/R policies and procedures. Kick-off of initiative that included staff, residents and families, state office, Florida legislators, advocates, & the local community mental health centers.Kick-off of initiative that included staff, residents and families, state office, Florida legislators, advocates, & the local community mental health centers. 13 South Florida State Hospital Strategies Change in aggression control training model.Change in aggression control training model. Use of data, graphed and posted for unit comparisons every month/all units.Use of data, graphed and posted for unit comparisons every month/all units. Debriefing including root cause analysis and daily reports to Executive Management Group; non-punitive environment.Debriefing including root cause analysis and daily reports to Executive Management Group; non-punitive environment. 14 South Florida State Hospital Essential Components Change in staff roles in crisis response (security, nursing, direct care staff).Change in staff roles in crisis response (security, nursing, direct care staff). Supervisors responding to every incident; on call EMG member involved for oversight 24/7.Supervisors responding to every incident; on call EMG member involved for oversight 24/7. Use of persons-served throughout project:Use of persons-served throughout project: to interview residents and staff post-event to make recommendations to develop comfort rooms to develop treatment activities 15 Florida State Hospital Essential Components Florida State Hospital Essential Components Project placed on every meeting agenda.Project placed on every meeting agenda. Staff encouraged and acknowledged through individual certificate awards, quarterly unit awards, write-up in monthly newsletter, and Good Stories annual report by G. Bluebird.Staff encouraged and acknowledged through individual certificate awards, quarterly unit awards, write-up in monthly newsletter, and Good Stories annual report by G. Bluebird. Town Center treatment mall programming implemented.Town Center treatment mall programming implemented. 16 SECLUSION AND RESTRAINT RESULTS January March 2004 17 RESULTS 18RESULTS 19 EMERGENCY INTRAMUSCULAR INJECTIONS MAY MARCH 2004 20RESULTS 21 Restraint and Seclusion Summary March 06 February 07 From May 2002 to February 06 there have been only 5 seclusions (> hour) and 16 restraints.From May 2002 to February 06 there have been only 5 seclusions (> hour) and 16 restraints. Geo Care/SFSH had a total of 7 restraint and seclusion events between March 06 and February 07.Geo Care/SFSH had a total of 7 restraint and seclusion events between March 06 and February persons served had 2 events, 3 persons served had 1 event.2 persons served had 2 events, 3 persons served had 1 event. 22 23 24 25 26 Review of S/R Events Reviewed reasons for restraint - causes were all related to assault toward self or others and one case of extreme agitation and violent behavior.Reviewed reasons for restraint - causes were all related to assault toward self or others and one case of extreme agitation and violent behavior. This information is referred to the Assault Reduction Task Force.This information is referred to the Assault Reduction Task Force. No restraint or seclusion incidents resulted in injury to person served or staff. One person served did have abrasions on forehead from head banging not related to the restraint/seclusion event.No restraint or seclusion incidents resulted in injury to person served or staff. One person served did have abrasions on forehead from head banging not related to the restraint/seclusion event. 27 CHALLENGES Turnover of leadership staff Issues regarding court ordered evaluations of people from jails and prisons Constant need to stay on top of this initiative 28 South Florida State Hospital Key Contact Diane Funston, Chief Executive Officer Atlantic Shores Healthcare, Inc./ South Florida State Hospital 800 E. Cypress Drive Pembroke Pines, FL (954)