Preventing Violence Trauma and the Use of Seclusion

Preventing Violence, Trauma, and the Use of Seclusion and Restraint in Mental Health Settings Real Reduction Experiences What Worked?

Real Reduction Experiences Kevin Huckshorn, MSN, RN, ICADC Former CNO and Assistant Hospital Administrator, ASH/SFSH 2/1997 to 2/2002 2

South Florida State Hospital Facility Profile • Adult State Mental Health Facility • First, fully privatized in the US (11/98) • 350 beds; Average Daily Census 350 (1998) 275 (current) • 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 disorder 3

South Florida State Hospital (now GEO Care, Inc. ) Facility Profile • 45% of residents have been involved with criminal justice system. • 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! 4

SFSH Old Administration Building 1998 5

SFSH Residential Building 1998 6

SFSH Aerial View 2001 7

SFSH New Hospital 2001 8

SFSH New Town Center 2001 • 9

South Florida State Hospital Initiative • Seclusion/restraint reduction initiative started in November 1999. • During ASH’s 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. 10

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. • SFSH was given no additional money, no consultants, no external training, & an overall reduction in staff (by 200+). 11

South Florida State Hospital Essential Components • Full support and oversight by CEO/COO/CNO. • 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. 12

South Florida State Hospital Strategies • Change in aggression control training model. • 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. 13

South Florida State Hospital Essential Components • 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. • Use of persons-served throughout project: – to interview residents and staff post-event – to make recommendations – to develop comfort rooms – to develop treatment activities 14

Florida State Hospital Essential Components • 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. • Town Center treatment mall programming implemented. 15

SECLUSION AND RESTRAINT RESULTS January 1999 - March 2004 16

RESULTS 17

RESULTS 18

EMERGENCY INTRAMUSCULAR INJECTIONS MAY 2001 - MARCH 2004 19

RESULTS 20

Restraint and Seclusion Summary March 06 – February 07 • 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. • 2 persons served had 2 events, 3 persons served had 1 event. 21

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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. • 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. 26

CHALLENGES v. Turnover of leadership staff v. Issues regarding court ordered evaluations of people from jails and prisons v. Constant need to stay on top of this initiative 27

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 33025 (954) 392 -3000 dfunston@geocareinc. com 28