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Module 6

Module 6. Sustaining Change through Consumer and Staff Involvement. Learning Objectives Upon completion of this module the participant will be able to:. Recognize leadership roles for administration, staff, and consumers as it relates to the elimination of seclusion and restraint

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Module 6

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  1. Module 6 Sustaining Change through Consumer and Staff Involvement

  2. Learning ObjectivesUpon completion of this module the participant will be able to: • Recognize leadership roles for administration, staff, and consumers as it relates to the elimination of seclusion and restraint • Describe the role of the Office of Consumer Affairs/Consumer Advocate and the role they play in eliminating the use of seclusion and restraint • Identify key elements of debriefing, advance crisis management, and data collection and analysis • Outline the pro’s and con’s of having an external monitoring system related to seclusion and restraint • Identify key characteristics of the Role of the Champion

  3. “The terror of confinement, the pain of restraint, and the wound to my soul made me want to stay as far away from the mental health system as possible. It didn’t matter that it might offer me something helpful; I didn’t want any of it if that horrible experience was going to be a part of the package.”Will Pflueger, Consumer

  4. Overview • Ideal world has no seclusion or restraint • Seclusion and restraint: LAST resort • Learn from each event: debriefing, treatment plans, data, external monitoring, ideas from others • Advance crisis management to avoid

  5. Leadership and Change • Staff and consumers have leadership roles to play in eliminating the use of seclusion and restraint • Leadership is a broad concept: “the capacity to guide or direct the course” • Policy changes do nothing…people do everything • Sustainable changes require champions to hold the course

  6. Administrators can sustain change by providing: • Policies & Procedures that move toward a seclusion and restraint free environment • Adequate staffing • Initial staff training and continuous in-services • Seclusion and restraint training on all meeting agendas from the housekeeping department to the board of directors • Personal involvement in debriefing after every incident of seclusion or restraint that supports problem solving

  7. Meaningful Consumer Involvement means learning from who receives • Beyond tokenism • Many consumers, many voices, real influence • Beyond review and comment • Set the agenda, frame the issue, empowerment • Beyond advice • Participate in governance and policy-making • Beyond sign-off • Directing own recovery

  8. Levels of Consumer Participation • National level • State level • Community advocacy • Agency policy and governing • Helping advocate for individuals

  9. 45 states have an Office of Consumer Affairs (OCA) so that consumer/ survivor voices are part of meaningful system change initiatives

  10. Benefits of an Office of Consumer Affairs • De-stigmatizing people diagnosed with mental illness or psychiatric disability • Ongoing process of consumer participation • Recognizing the civil and human rights of people diagnosed with mental illness/psychiatric disabilities

  11. Office of Consumer and Family Affairs at Indiana’s DMHA • DMHA has several councils • DMHA Advisory Council • DMHA Consumer Council (focus on transforming to recovery oriented service system) • State Mental Health Planning Council with 3 subcommittees • Adults with Mental Illness • Children • Critical Populations • Indiana Addiction Planning Council: 2 subcommittees • Prevention • Treatment

  12. Office of Consumer Affairs Areas of Responsibility • Policy and Regulation Development • Program Planning • Evaluation and Monitoring • Training • Finance and Contract Management • Complaints and Grievances

  13. Some agencies have Consumer Advocates on site • Peer specialists who provide direct care • Represent consumers/families/ guardians from their perspective in policy and oversight of services • Promote highest standard of care for people receiving treatment for a mental illness

  14. Job of Consumer Advocate Protect Consumer Rights!

  15. Examples of Consumer Advocate Roles in Agencies • Administer De-escalation Form • Making regular rounds on units • Being part of policy making and new initiatives (e.g., • Comfort Rooms, special programs, recognition, festivities • Being present at team meetings • Being the “eyes and ears” for executive committee • Discharge satisfaction surveys

  16. P&A Nationwide Network Protection and Advocacy is a nationwide network of congressionally mandated, legally-based disability rights agencies

  17. Protection and Advocacy Responsibilities: • Provide legal representation • Maintain a presence in facilities, if possible • Monitor, investigate and attempt to remedy adverse conditions Visit www.napas.org

  18. Participant Manual: Listing of Protection & Advocacy Offices

  19. Exercise: National Technical Assistance Center Networks“Restraint is Not Therapeutic”

  20. “Restraint is not Therapeutic”Discussion • What kinds of feelings have you experienced as a result of using seclusion and restraint? • What is the personal impact on you when you use seclusion and restraint? • How accurate do you think this consumer is about the shame?

  21. Exercise: Direct Care Staff Leadership Brainstorm: What can you do as leaders to change the culture at Richmond State Hospital to move towards eliminating seclusion and restraint……..

  22. Debriefingrequirement to meet patient care standards…its really about learning from everyone’s perspective to prevent future use of seclusion and restraint

  23. “I don’t know what caused me being put in seclusion. I have asked for 26 years because I NEVER want to cause that again.”Consumer, NAC/SMHA Survey

  24. Debriefing can be used for different purposes: • Risk Management • Quality Improvement • Staff Support “not a blame game”

  25. Staff Debriefing Sessions include the following: • Discussion of the emergency safety situation that led to the use of seclusion or restraint • Alternative Techniques • Staff procedures that may be used to prevent the reoccurrence • Outcomes

  26. Basics of Debriefings with consumers and staff • Non-involved person conducts meeting • Ground rules • No one is forced to talk • Only respectful communication is allowed • Confidential

  27. Debriefing Model - Rupert Goetz, M.D. • Facts • Feelings • Leader validates all feellings • Education • Review normal adaptive responses to stress as well as maladaptive, common stress responses for both staff and consumers • Planning. Treatment plan changes?

  28. Participant Manual:Debriefing Survey for Consumers

  29. Exercise: Debriefing Role Play

  30. Advance Crisis PlanningHow do we prevent using seclusion or restraint?What works?Triggers?What makes it worse?

  31. “I’m afraid of closed in places and this is in my files.No one took time to look at it or even read it.”Consumer, NAC/SMHA Survey

  32. Data Collection • All seclusion and restraints are documented and reported • Trends identified and shared throughout the organization • Benchmarks through ORYX on state and national data • How are we doing???

  33. External MonitoringSome systems/agencies open the door to third parties to visit and provide systematic feedback

  34. Goals of External Monitoring • Improve and enhance the quality of life for consumers • Promote effective communication between consumers, staff, and families

  35. Examples of what external monitors looking for • Overall appearance and cleanliness of unit • Census, number of staff, number of consumers on the unit • Interaction between consumers and staff • Activities currently available • Number of consumers sleeping or in their rooms • Quality and choices of food • Number of incidents of seclusion and restraint • Supplies/equipment available to consumers

  36. Monitors are typically trained in the following areas: • Confidentiality • What to look for on a site visit • How often to visit • When to visit • How to accurately document • How to write a report • How to follow up on issues reported • How to report emergency issues • How to evaluate milieu issues (not clinical issues)

  37. Change is at the individual’s level • Shared vision is rooted in personal vision • Real vision comes from within Role of the Champion

  38. “Cowardice asks the question – is it safe?Expediency asks the question – is it politic?Vanity asks the question – is it popular?But conscience asks the question – is it right?And there comes a time when one must take a position that is neither safe, nor politic, nor popular, but one must take it BECAUSE it is right.”Dr. Martin Luther King, Jr.

  39. Seclusion and Restraint • No longer “right” • Does not change behavior • Does not teach better management of symptoms, emotions, or triggers • Can re-traumatize • Traumatizes both staff and consumers

  40. Journal/Take Action Challenge

  41. Video Introduction Click Here For Video 13Min

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