Applying Person-Centered Practices on Inpatient Psychiatric Units January 21, 2011

1. Applying Person-Centered Practices on Inpatient Psychiatric UnitsJanuary 21, 2011 Rochester Psychiatric Center Nancy E. Carter, LCSW Social Worker-Adolescent Unit ROSWNEC@omh.state.ny.us Philip G. Griffin, MPA Director of Quality Improvement ROOTPGG@omh.state.ny.us

2. Timeline: 2003-2011 • 2003: Community services vocational staff attend WNYCCP training • Focus on incorporating person-centered practices in all CSU staff meetings • 2005: RPC contracts for on-site trainers • 2006: Staff sent to train-the-trainer training • 2007: Staff and service recipients from (E2) pilot inpatient ward receive training • Person-centeredness becomes an initiative on the RPC Strategic Plan • The RPC Person-Centered Steering Committee is formed

3. Timeline continued: • 2008: E2 (pilot ward) identifies and implements program changes • RPC New Employee Orientation (NEO) and Nursing/MHTA competencies now include a person-centered practice (PCP) overview • Recovery is identified as a topic for further training to enhance PCP efforts • 2009: Recovery training is developed and rolled out to target groups • On-site training continues to train additional staff • NAMI is invited to present “In Our Own Voices”

4. Timeline continued: • 2010: Continue with previous efforts • Survey recipients of services to identify areas of success and opportunities for improvement • 2011: Person-centeredness no longer a stand alone initiative on the RPC Strategic Plan • All 2011 initiatives to include language and action items that reflect core person-centered principles

5. 2007 Strategic Plan Focus • Clear targets for the person-centered initiative were created • The RPC Person-Centered Steering Committee was established • Priorities for the initiative were identified and recommended to administration • Recommendations made by the committee were implemented • There was a Person-Centered Web Conference held on 12/10/07 with Dr. Neal Adams and Diane Grieder

6. 2008 Strategic Plan Focus • Person-centered introduction is included in NEO for all employees • Nursing staff competencies include a person-centered overview • RPC Person-Centered Steering Committee includes family and consumer input • Plan for Forensic Unit person-centered roll out is drafted and implemented • WNYCCP Vital Signs of Recovery survey is completed • Plan to identify and pilot fidelity checks is created

7. 2009 Strategic Plan Focus • Recovery Train-the-Trainer sessions are held • Additional recovery training facilitators are identified and trained • Pre and post tests are developed for recovery material • NAMI “In Our Own Voice” sessions are held

8. 2010 Strategic Plan Focus • Written survey/focus groups are held to measure the perception of recipients of RPC services as to whether they feel they are listened to and have successfully partnered with at least one member of the treatment team. • Recipients are more actively involved in the treatment planning process as evidenced by active discussion with primary therapist in regards to treatment plan objectives • Survey results confirm that recipients perceive a more collaborative partnership in recovery

9. What did E2 do? • Patient Interactive Initial Treatment Planning Note • Focus on strengths, related strengths to recovery • Looked at what the person would do to improve recovery • Discussed medications • Relationship with family and friends • Asked questions about culture and meaningful activities • Reviewed independent living skills • Discussed staff relationship as it relates to recovery • Looked at available services • Reviewed potential symptoms

10. What did E2 do? Continued: • Patient Interactive Treatment Planning Review Note • Reflected on positive changes • Discussed areas of future focus and how it would relate to recovery • Asked how staff could be supportive • Re-reviewed services available

11. What did E2 do? Continued: • Changed the treatment planning process • Created groups based upon client feedback, ie. Budget Buddies • Looked at Restraint and Seclusion data and fights and assaults • Invested in training for all staff • Created buy in and accentuated the positive • Looked at discharge planning and residential options • Created schedules for the clients that made sense to them • Specific E2 examples

14. What We’ve Learned • Person-centeredness requires cooperation at all levels of the organization • Training is important but successful implementation is ongoing and there will be bumps in the road • Positive examples need to be highlighted over and over again • Staff need to be praised when implementing person centered principles/practice • There is a parallel process that occurs • Staff need to be consistent in presenting the message • A change in culture takes time