Creating A Culture of Wellness

1. Creating A Culture of Wellness A Path To Eliminating Seclusion and Restraints February 29, 2012

2. Our Position Seclusion and restraints were part of the institutional design of the past We know that seclusion and restraints have no place in recovery-oriented environments The Copeland Center wants to partner with others across the nation to move by design toward a culture of wellness and recovery

3. Our Hope Our position paper on eliminating seclusion and restraints aspires to stimulate an active, ongoing dialogue about alternatives to any use of seclusion and restraints in any part of our mental health system Through dialogue, relationships, leadership, policy changes, peer support and staff training, together with others we can create a foundation upon which to build a person-centered, wellness and recovery-oriented mental health system free of seclusion and restraints

4. Our Committee Many thanks to the members of our committee for their time, talents and conviction Mary Ellen Copeland Katie Wilson Matthew Federici Carol Bailey Floyd Cheryl Sharp Gina Calhoun Erica Buffington Ed Anthes Sarah Bourne Audrey Garfield Ellie Goldfarb Christine Allers

5. Cheryl S. Sharp, MSW, ALWF, CPSST Special Advisor for Trauma-Informed Services The National Council for Community Behavioral Healthcare 1701 K Street, Suite 400 Washington, D.C. 20006-1526 Ph. 202/684-7457, ext. #254

6. Joan Gillece, PhD Director, SAMHSA Promoting Alternatives to Seclusion and Restraint through Trauma-Informed Care and Director, SAMHSA�s National Center for Trauma-Informed Care

7. Tonier Cain Coordinator of Consumer Affairs, SAMHSA Promoting Alternatives to Seclusion and Restraint through Trauma-Informed Care and Coordinator, SAMHSA�s National Center for Trauma-Informed Care

8. Seclusion-Restraint Reduction: Pennsylvania�s History Robbie and Aidan Altenor

9. Pennsylvania�s Guiding Principles Seclusion and restraint are NOT treatment interventions Seclusion and restraint represent power and control Very traumatizing to individuals receiving services and their caregivers Often these interventions are implemented in arbitrary, abusive and violent ways

10. Major Factors To Consider Leadership Dedicated, supportive administrative and clinical leadership Policy changes Debriefing Values-driven approach Seclusion and restraint use = Treatment failure Training For all staff Psychiatric Emergency Response Teams Treatment Recovery-supporting approach Measurement and data sharing Transparency

11. Progress Summary: December, 2011

12. Progress Summary: December, 2011

13. Outcome Hospital environments safer for individuals receiving services and their support staff Much more respectful and supportive Much less use of invasive procedures PRN medications and seclusion and restraint Focus is on treatment in support of recovery Much more hopeful Since the initiative started, 5 Pennsylvania state hospitals have closed

14. Alternatives to seclusion and restraint in Pennsylvania�s state hospitals Increased attention to special needs and individual strengths of each person Increased attention to closing/downsizing institutions Development of the Community Support Planning initiative Supports recovery-focused treatment while hospitalized and identifies supports needed upon discharge Increased attention to environment/milieu Increased transparency Invite community partners into institution; view hospital as part of, not apart from, the community Increased role of Certified Peer Specialists

15. Individuals involved in Pennsylvania�s criminal justice system State hospital data for S/R includes individuals confined in the hospitals� forensic centers Important distinction between restraint for a psychiatric emergency vs. restraint for detention/security purposes Individuals convicted and sentenced to a State Correctional Institution are under jurisdiction of Department of Corrections Collaboration between Office of Mental Health and Department of Corrections

16. WRAP Expansion at Oregon State Hospital Michael Hlebechuk Outreach Specialist Oregon State Hospital

17. WRAP Training at Oregon State Hospital (OSH) 74 patients, staff and community stakeholders received Seminar I training in September and November of 2011 48 graduates of Seminar I will receive Seminar II training beginning in March 2012 and will be certified WRAP Facilitators 18 graduates of Seminar II will receive Advanced WRAP Facilitator Training The 18 Advanced WRAP Facilitators will train and certify other OSH staff, patients and community members as WRAP Facilitators

18. OSH Treatment Malls Patients at OSH attend groups and activities for up to 20 hours a week at treatment malls WRAP Facilitators certified through the WRAP Expansion Project will facilitate WRAP training on OSH treatment malls and in local communities where most patients are discharged Every patient who elects to have a WRAP will be provided WRAP training Participation in WRAP will be self-directed

19. Projected Outcomes The expansion of WRAP at OSH is likely to increase patient recovery and decrease patient-to-patient and patient-to-staff conflict and altercations With improved recovery and decreased conflicts and altercations, seclusion and restraint is likely to decrease markedly

20. For More Information For more information e-mail Michael Hlebechuk at Michael.Hlebechuk@state.or.us

21. Question & Answers

22. WRAP Retreat May 6-10, 2012 Genesis Spiritual Life and Conference Center Westfield, MA � Join experienced recovery educators for a week of activities, workshops, and fun while expanding your wellness toolbox, trying new things, and focusing on your personal wellness. Recovery educators will be on hand to support participants in writing and expanding their WRAPs.

23. SAVE THE DATE WRAP AROUND THE WORLD CONFERENCE Oakland, CA January 26-28, 2013

24. WRAP Facilitator Training � April 9-13, 2012 in Chicago, IL - partnership with National Council for Community Behavioral Healthcare � Oct 1-5, 2012 in Brattleboro, VT � More being added to calendar! � check http://copelandcenter.com for most up to date information