0% A BETTER WAY: PROMOTING AGENCY AMONG DIRECT CARE WORKERS IN LONG-TERM CARE SETTINGS Sara J. English University of South Carolina, Columbia, South Carolina INTRODUCTION FINDINGS FROM A REVIEW OF CURRENT LITERATURE CONCEPTUAL MODEL FOR “A BETTER WAY”  Certified Nursing Assistants (CNAs) provide the majority of hands-on care in nursing facilities and are first in-line responders to residents experiencing acute behaviors related to Serious Mental Illness (SMI). Due to their fundamental role in the provision of care, CNAs who are aware of symptoms and behaviors associated with mental illness have the potential to increase the quality of life for persons who are living in Long Term Care (LTC) and experiencing SMI. Lack of training, coupled with the hierarchical nature of LTC, creates a work environment which promotes learned response, resulting in a lack of agency among direct care staff. Training programs developed with the active input of CNAs will increase the agency and social learning of direct care staff   within the LTC community. Training programs which implement Social Learning can address this gap of care and enhance the knowledge and response of CNAs regarding SMI (Bandura, 2001; Liu, Liu, & Wang, 2011). SMI can impact persons throughout the life span. Studies report more than 500,000 persons experiencing SMI and living in LTC (Centers for Disease Control and Prevention, 2014; PASRR Level I National Review, 2014). These admissions may be associated with a decrease in funding and in-patient options. Currently, SMI has been noted as a primary factor for LTC admissions (Grabowski, Aschbrenner, Feng, and Mor, 2010; Molinari, et al., 2011); however, LTC homes are not required to provide training regarding SMI to direct care staff. Absence of training fails to individualize care for these residents and fails to incorporate alternative therapies, thus maintaining dependency upon pharmaceutical interventions for persons with SMI, not related to Alzheimer’s Disease and other Dementias. 84% of all LTC homes provide services to residents experiencing some form of SMI 0% of states require on-going training for CNAs regarding mental illness, not related to dementia THE ROLE OF SOCIAL WORK Social workers can collaborate with CNAs and other disciplines to develop a staff training program providing general information regarding mental illness, alternative interventions, de-escalation techniques and methods of active response.  This training will increase the self-perceived and recognized knowledge of direct care staff. Social Work educators have the capacity to both emphasize and promote policy. They can advocate for mental health training for direct care workers.  Social work educators can create a methodology of practice which focuses on inclusion of all staff members in the development of individualized plans of care.   Inclusion and training will encourage agency of direct care staff and implement more personalized care for LTC  residents who are living with SMI.   SMI training will positively impact the environment of the facility and the lives of vulnerable persons who live in LTC, which has implications for use in all residential settings which may include residents living with SMI. SMI training responds to the Grand Challenge of social isolation, as identified by the American Academy of Social Work & Social Welfare. Currently federal and state guidelines fail to require SMI-specific training for CNAs. Lack of training may be associated with: Inappropriate response to residents who experience acute symptoms associated with SMI Lack of agency among CNAs regarding response to residences experiencing SMI Increased pharmacological response to residents Increased environmental stress Higher staff turnover Table 1 SMI Training Requirements for Mental Illness training for CNAs in Nursing Homes ____________________________________________________________ Training Pre- CNA Continuing Ed. Dementia Training 50 states 45 states (1-2 hours, annually) Mental Illness Training 5 states 0 states require SMI training (SMI, specific)   (Health Policy and Management Research, 2016) OBJECTIVES Explain the rise in LTC admissions for persons living with severe mental illness and introduce the psychosocial and political factors which are associated with the dramatic increase in this population. Illustrate the role of staff agency and non-pharmacological response to acute symptoms of mental illness for residents who live in LTC. Demonstrate the relationship between Social Learning Theory and the agency of direct care workers in skilled nursing facilities. Discuss the milieu of LTC and how SMI training may enhance the environment of the LTC facility. Additional information available from author at sarae@email.sc.edu IMPORTANCE OF “A BETTER WAY” Leads to greater agency and creative response to residents who experience acute symptoms related to SMI. Contributes to the overall culture of the nursing home and incorporates alternative, non-pharmaceutical interventions. Personalizes plans of care and creates a multidisciplinary and holistic response to residents’ psycho-social needs. Focuses on alternative response to SMI, improving quality of life by increasing mental and other health outcomes, decreasing pharmacological response to SMI. Increases social interaction and responds to the Grand Challenge of social isolation, which threatens the safety and well-being of persons experiencing SMI (Lubben, Gironda, Sabbath, Kong, & Johnson, 2015)