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Optimizing Treatment: Developing the Talent Within NY Office of Mental Health Lessons Learned Conference Optimizing Treatment: Developing the Talent Within NY Office of Mental Health Lessons Learned Conference ~ May 25, 2011 Janice Le. Bel, Ph. D. MA Department of Mental Health & NASMHPD Consultant 1

Outline Hiring: Who & How? Tips & pearls of wisdom Orienting: What do you Outline Hiring: Who & How? Tips & pearls of wisdom Orienting: What do you Teach? More tips, more pearls Promoting Growth: How do you Do it? Still more wisdom from colleagues What’s New in Talent Development? 2

Hiring: Who & How? 3 Hiring: Who & How? 3

According to the Experts: DO NOT. . . Kevin Huckshorn – DE Commissioner: Do According to the Experts: DO NOT. . . Kevin Huckshorn – DE Commissioner: Do not ever hire “just to fill vacancies” Lydia Todd – NFI Assoc. Executive Director: “Do not hire by the pound. . . Bigger is not always better. ” NY OMH Learning Collaborative Facilitators: Do not start your hiring process without consulting with peers, youth and families. Get their input on key qualifications, competencies and the role being considered 4

According to the Experts: DO. . . Per Anders Rydelis, Sweden, Chief C/A Psychiatry: According to the Experts: DO. . . Per Anders Rydelis, Sweden, Chief C/A Psychiatry: “We hire people we like. . . the friends of our good staff” Kathy Fuentes, BU IRTP: “I’d rather hire someone with no experience in residential or inpatient care then someone who has been using restraint and seclusion for years. ” Alex at House of Good Shepherd: “Hire staff who know how to have fun – if they can’t tell you what they like to do for fun – how good can they be with kids? ” 5

According to the Experts: DO. . . Bill Anthony, BU Ctr. for Psychiatric Rehab: According to the Experts: DO. . . Bill Anthony, BU Ctr. for Psychiatric Rehab: “Clarify your organizational values – and make sure it is in writing. They are the ‘glue’ that bind vision with the operations. ” Kevin Huckshorn, DE Commissioner: “. . . adopt the IOM (2003) recommendations toward developing the health care workforce, including: developing core competencies, providing consumercentered care, working in interdisciplinary teams, using evidence-based practices, understanding the principles of quality improvement, and using informatics. ” 6

According to the Experts: DO. . . Kevin Huckshorn, DE Commissioner: decide on your According to the Experts: DO. . . Kevin Huckshorn, DE Commissioner: decide on your job descriptions and describe the knowledge, skills and attitudes you want in your workplace Include the value and focus on violence-free care and improved safety in your job descriptions & postings talk about creating a culture of recovery and resiliency inform candidates that you work closely with families and peers to create your system of care focus on the importance of trauma informed care, preventing violence, ensuring safety, and consumer inclusion 7

According to the Experts: DO. . . Lori Hollinger, Dir. Human Resources Fulton State According to the Experts: DO. . . Lori Hollinger, Dir. Human Resources Fulton State Hospital - MO Conduct your own Values-Driven Hiring Initiative Conduct a pre-interview Conduct a values survey with potential employees Centralize the hiring practices and make more uniform decisions Ensure staff are literate , organize literacy classes Include consumers in the employee hiring & orientation process: what it is like to have mental illness the experience of RS a client-lead Tour A member of the initial interview team follows up with the new employee (post hire) to ensure a smooth transition to the job/role 8

Interviewing Questions Ask applicants about: their thoughts about working with consumers in recovery as Interviewing Questions Ask applicants about: their thoughts about working with consumers in recovery as staff how they view families, their role, working with families their knowledge of trauma, mental illness and any personal experiences (friends/family, etc. ) their knowledge of S/R and national trends when would it be used and be specific e. g. not when person is sitting on the floor, or refuses to attend a meeting, or refuses medications, or curses, etc. what they would do if they saw a staff member act in a way that was punishing, neglectful, abusive, hostile or disrespectful? 9

Human Resource Essentials ü Do criminal background check ü Get reference from most recent Human Resource Essentials ü Do criminal background check ü Get reference from most recent supervisor, make this a mandatory reference if possible ü Do a drug screen ü Do a credit check ü Provide a vignette of a clinical event and ask applicant to record what they would write in the medical record as a result ü Do observe candidates with consumers & solicit consumer feedback ü Do supervise closely, especially during probationary period 10

Reconsider Who the Workforce Is! Many Peer Roles are Emerging Director of Consumer Affairs Reconsider Who the Workforce Is! Many Peer Roles are Emerging Director of Consumer Affairs Director of Mission Effectiveness Peer Bridger Peer Specialists Peer Mentors Peer Coaches / Wellness Coach Peer Advocates Recovery Specialists Patient Liaison / Debriefer Resident Support Specialist Respect Speaker Director of Consumer & Family Engagement Director of Family Services Parent Partner Parent Advocate Family Liaison Executive Director Commissioner* Community Service Advisor* WRAP Facilitator WRAP Instructor (College !) Trauma Specialist *NZ

“Peers have helped us transform our organization making it recovery oriented in design and “Peers have helped us transform our organization making it recovery oriented in design and in service delivery. Our peer employees have helped us achieve and maintain a new way of being with people that does not require seclusion and restraint interventions. . . ” Lori Ashcraft Director Recovery Education Center Recovery Innovations

Orienting: What Do You Teach? 13 Orienting: What Do You Teach? 13

Orientation: Leadership Sets the Stage Lisa Hilton, COO Millcreek Behavioral Health Magee, MS Largest Orientation: Leadership Sets the Stage Lisa Hilton, COO Millcreek Behavioral Health Magee, MS Largest provider of c/a services in MS Reduced R/S 99% x 4 years >225 youth served: RTF &ICF MR Joint Commission Award First message, first meeting 14

Orientation Recommendations from Some NY RTFs Alex & Peers at House of Good Shepherd: Orientation Recommendations from Some NY RTFs Alex & Peers at House of Good Shepherd: Teach staff how to have patience Teach staff how to give kids time and space Jasmine at SCO-Ottilie: Teach staff how to forgive kids if kids hurt them Teach youth what staff are taught Mickey Toker, W. NY Parent Advisor: Teach parents what staff are taught Fran Bahi at SCO-Ottilie: Teach with simulations/scenarios Ask what makes you think you’ll be a good counselor 15

Orientation Recommendations Graham Varney, CAMH: “I teach our staff to not say ‘no!’” Kathy Orientation Recommendations Graham Varney, CAMH: “I teach our staff to not say ‘no!’” Kathy Fuentes, BU IRTP: “Keep your hands to yourself. Put your hands in your pocket. If you want to get hit – touch someone without their permission. ” “You have more time than you think you do. ” “The louder youth get, the quieter you get. ” “The more agitated they are, the more space you give them. ” TCI: Space and time relieve pressure 16

Orientation Recommendations Katie Mc. Leese Stephenson – Cedars, NE: “We realized by using R/S Orientation Recommendations Katie Mc. Leese Stephenson – Cedars, NE: “We realized by using R/S we were only solving the staff’s’ problem – not the youth’s problem. ” Established 2 broad goals for treatment: Youth to become more proficient in language skills, communicating & problem solving Youth to become more proficient in self-regulation & managing their physical state Taught mediation, dispute resolution & negotiation to youth & staff at orientation and ongoing 17

Orientation Recommendations Co-teach with peers/youth/families to maximum extent Emphasize the importance of: working with Orientation Recommendations Co-teach with peers/youth/families to maximum extent Emphasize the importance of: working with consumers and families person-first language documenting clearly, descriptively, without jargon continuous quality improvement and every staff’s role in this accountability for the program culture reporting problems to their supervisor 18

De-escalation Skill Building Boston Medical Center: Teach pre-de-escalation skills, being present, observation & surveying De-escalation Skill Building Boston Medical Center: Teach pre-de-escalation skills, being present, observation & surveying for earliest sign of problem Cambridge Health Alliance: 4 hours/week supervision/skill building with CPS MO State Hospital System: Shifted to 3: 1 ratio (verbal: physical skill technique) PA State Hospital System: Annual training quarterly training Changed focus: now more time spent on verbal/relational skills than physical techniques 19

Novel Approaches to Prevent R/S Caroline Mc. Grath Pre-Witnessing George Bell Resident Support Team Novel Approaches to Prevent R/S Caroline Mc. Grath Pre-Witnessing George Bell Resident Support Team Simon Taylor NCCF Cell phones for parents, they are the first call for first response to a problem Andrew Benedetti Walk in My Shoes Kim Sanders Schedule of Support Westboro Adol. Svcs. Chauncy Hall IRTP Transitions IRTP Grafton 20

Novel Approach to Prevent R/S: Grafton Trained Extraordinary Blocking techniques to prevent R/S & Novel Approach to Prevent R/S: Grafton Trained Extraordinary Blocking techniques to prevent R/S & injuries Introduced many natural, soft items into the environment

Novel Approaches to Change R/S Practice Andrew Benedetti Surpass minimum standards Lydia Todd Break Novel Approaches to Change R/S Practice Andrew Benedetti Surpass minimum standards Lydia Todd Break up R/S training, teach physical skills with CPR, not with verbal skill training Mary Guilfoyle Not everyone is taught R/S Brian Farragher R/S cannot be used until at least 3 months of experience with close supervision Transitions IRTP NFI Devereaux Glenholme Andrus Children's Ctr. 22

Promoting Growth: How Do You It? 23 Promoting Growth: How Do You It? 23

Novel Approaches to Development Staff have safety plans Staff sign non-violence commitment Preceptors / Novel Approaches to Development Staff have safety plans Staff sign non-violence commitment Preceptors / mentors assigned Upward / 360 reviews: consumers evaluate staff; staff evaluate supervisors Direct-care staff co-lead/co-facilitate treatment teams, presents cases, etc. Professionalize staff – have them present at conferences, work on quality improvement projects Teach manners & customer service, everyone is the: Director of First Impressions 24

Map Staff Skills & Competencies Maria Tebeau (right) Chauncy Hall IRTP Developed roster of Map Staff Skills & Competencies Maria Tebeau (right) Chauncy Hall IRTP Developed roster of skills & competencies by role and tenure to supervise and evaluate staff over time and promote growth and movement thru the organization 25

Use Data to Teach & Supervise Staff JT Tormey (center) - Merrimack Center Close Use Data to Teach & Supervise Staff JT Tormey (center) - Merrimack Center Close observation and daily tracking of youth and staff behavior generates pragmatic information that informs treatment, supervision, change of shift-report, etc. 26

Involve Staff in Creative Problem Solving & Culture Building Rob Terreden (left) Three Rivers Involve Staff in Creative Problem Solving & Culture Building Rob Terreden (left) Three Rivers Created ‘massive doses of signals of caring’ Continual effort to maximize: Fun Flexibility & early intervention Facilitate soothing & self-soothing Partnership with families Staff influence & creativity Rainbow Dance 27

Supporting Staff Bob Quam Town Hall meetings Tommy Davis Lunch with Tommy Ann Bailey Supporting Staff Bob Quam Town Hall meetings Tommy Davis Lunch with Tommy Ann Bailey Branding & marketing the new culture So. Florida State Hospital Central LA State Hospital Central St. Hospital - VA Greg Smith / Ray Flannery PERT Team / ASAP Team PA St. Hospitals / MA St. Hospitals 28

Supervising, Mentoring & Acknowledging Bob Roca Shephard Pratt HCS “Green Beaders” Candy Ingalls Centerpoint Supervising, Mentoring & Acknowledging Bob Roca Shephard Pratt HCS “Green Beaders” Candy Ingalls Centerpoint IRTP Walk About Andrew Benedetti Transitions IRTP Caught in the Act Marty Martin Fulton State Hospital Recognition & Encouragement Lines 29

Rewarding Staff Linda Rivera Golden Bed Pan Award Ellen Flowers Life Saver Awards Gayle Rewarding Staff Linda Rivera Golden Bed Pan Award Ellen Flowers Life Saver Awards Gayle Bluebird Good Stories - Nurses Day Russ Hughes Jim Gaynor Random acts of kindness with no expectation of reciprocity Gain-sharing Ken Duckworth DMH R/S Awards Elmhurst Hosp. Ctr. – Forensic Svc. Tewksbury State Hospital So. FL State Hospital So. Carolina DMH Grafton MA Dept. of Mental Health 30

What’s New in Talent Development? 31 What’s New in Talent Development? 31

Supporting Workforce & Service Transformation 2005 - SAMHSA awards 9 states 5 -year State Supporting Workforce & Service Transformation 2005 - SAMHSA awards 9 states 5 -year State Incentive Grants ($13. 5 M/each) to support a cross-systems approach to implementing significant broad-ranging reforms in service delivery. 2010 – SAMHSA awards 20 states/agencies 5 year grants ($3. 7 M/each) to implement systemic trauma informed care as transformation framework

Workforce Transformation NASMHPD – OTA NEW Curriculum (2011) 18 modules: Preparing the Adult Mental Workforce Transformation NASMHPD – OTA NEW Curriculum (2011) 18 modules: Preparing the Adult Mental Health Workforce to Succeed in a Transformed System of Care Presentations, References, Post Test/Answers Training direct care staff working in inpatient and community residential adult mental health treatment settings in a “shared understanding” of the key components, competencies and principles of a transformed mental health system

Recovery to Practice Initiative The RTP Initiative is a 5 -year project funded by Recovery to Practice Initiative The RTP Initiative is a 5 -year project funded by SAMHSA’s Office of the Associate Director for Consumer Affairs, to translate the vision of recovery into the concrete and everyday practice of mental health professionals of all disciplines. Gayle Bluebird, RN serves on the nurses initiative which is training nurses how to integrate recovery in their practices http: //www. apna. org/i 4 a/pages/index. cfm? pageid=4416

Building Bridges Transforming residential care through partnership Joint resolution (2006): “. . . identifies Building Bridges Transforming residential care through partnership Joint resolution (2006): “. . . identifies an urgent need for transformation and envisions a comprehensive, flexible family-driven and youth-guided array of culturally competent and community-based services and supports, organized in an integrated and coordinated system of care in which families, youth, providers, advocates, and policymakers share responsibility for decision making and accountability for the care, treatment outcomes and wellbeing of children and youth with mental health needs and their families. . . ”

Building Bridges Resources Innovative Practices White Paper Tip Sheets for Families Tip Sheets for Building Bridges Resources Innovative Practices White Paper Tip Sheets for Families Tip Sheets for Youth Self-Assessment Toolkit for Staff & Advocates Self Assessment Toolkit for Youth & Families Available at http: //www. buildingbridges 4 youth. org/getinvolved/contact-us

Resources 37 Resources 37

Resources NASMHPD-Office of Technical Assistance Preparing the Adult Mental Health Workforce to Succeed in Resources NASMHPD-Office of Technical Assistance Preparing the Adult Mental Health Workforce to Succeed in a Transformed System of Care Training Curriculum Available at: http: //www. nasmhpd. org/WFPresentations. cfm

Resources Millcreek of Magee Lisa Hilton, COO Email: info. mc-ms@yfcs. com Phone: (601) 849 Resources Millcreek of Magee Lisa Hilton, COO Email: info. [email protected] com Phone: (601) 849 -4221 900 1 st Ave. NE Magee, MS 39111 39

Resources Grafton School, Inc. Jim Gaynor, President & CEO Kim Sanders, EVP/Chief Outcomes Officer Resources Grafton School, Inc. Jim Gaynor, President & CEO Kim Sanders, EVP/Chief Outcomes Officer PO Box 2500 Winchester, VA 22604 540 -542 -0200 x 6412 [email protected] org www. grafton. org

Paving New Ground & Peer Roles Contact Information Gayle Bluebird, RN DPC Peer Support Paving New Ground & Peer Roles Contact Information Gayle Bluebird, RN DPC Peer Support Coordinator Delaware Psychiatric Center 1901 Du. Pont Hwy. New Castle, DE 19720 Office: 302 -255 -9701 Cell: 352 -219 -1095

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