S.A.F.E.R. Initiative Update CMHA Annual Meeting – Fall 2017 November 29 – December 1, 2017 Michael R. Dunaway 5 Pillars Safety Programs Approaches to Safe Care Facts to Inform Decisions Education Regulatory Reform TASK FORCE AND LISTENING TOUR

Behavioral Health 96-Hour Holds Patient Encounters Law Enforcement Behavioral Health 96-Hour Holds Immigration Status Narcotics/ Firearms Warrants/ Blood Draws Violence/ Assaults Patient Rights Staff Responsibility and Rights GOAL: Assess Fire arms, pending legislation, opportunity for awareness/education Narcotics/HIPAA Warrants/EMTALA Search – possessions – narcotics/weapons EMTALA HIPPA Opioid Use Demographics Prioritizing the issues Behavioral health/substance abuse patients Weapons Narcotics Law enforcement executing warrants Law enforcement drop offs Violent patient encounters Policy awareness EMTALA HIPAA

Listening Tour: Demographics Eight sessions between August and October 225 participants Community: 60 percent rural Hospital size: equal distribution Organizational structure: equal distribution Position by function: 75 percent operational

Identified Threats in Ranked Order Behavioral health patient boarding in non- psychiatric facilities (more prevalent in rural settings) Violent patient encounters Law enforcement drop-offs that create holding and/or elopement concerns Search and confiscation of narcotics Search and confiscation of weapons Law enforcement presence to execute warrants of patients/visitors on site During the fall, staff listened to members recount frequent, alarming examples of workplace violence.   To develop long-term actions, staff conducted a listening tour of members to deepen understanding of workplace violence. Eight specific MHA member groups representing 225 physicians, executive leadership, clinical, human resources, security and front-line staff participated in the listening tour. Based on the quantitative and qualitative responses, the following have been identified as the greatest identified threats in ranked order. behavioral health patient boarding in non-psychiatric facilities (more prevalent in rural settings) violent patient encounters (more prevalent in urban and metropolitan areas) law enforcement drop-offs that create holding and/or elopement concerns Boarding of behavioral health/substance abuse patients in non psychiatric facilities Law enforcement drop-offs that create holding and or elopement concerns Violent patient encounters (not resulting from one of the above triggers)

Environmental Scan 50 percent (66 hospitals) reported internal violence in their top three risks on hazard vulnerability analysis 65 percent (84 hospitals) employ security workforce as hospital personnel 28 percent (36 hospitals) provided dedicated security in the ED 24/7 36 percent (47 hospitals) have armed security officers 40 percent (24) firearm 48 percent (29) TASER 31 percent (19) pepper spray 42 percent (26) baton 86 percent (111 hospitals) don’t use metal detectors

Task Force Recommendations Synthesize concerns surrounding violence, criminal behavior, behavioral health and interactions with law enforcement to provide hospital policy makers and front-line staff with education, training and technical tools to manage complex and stressful situations in a safe, legally compliant manner

Immediate Jeopardy – All Citations Source: Centers for Medicare & Medicaid, 1Q2015-2Q2017

Immediate Jeopardy — Psychiatric Source: Centers for Medicare & Medicaid, 1Q2015-2Q2017

Proposed Approach Advocacy – Immediate and Long-term - Federal - State Program Development – Long-term - Criteria to evaluate safety programs - Policy repository - Resources to integrate and empower security personnel - Data collection for benchmarking of de-escalation programs Education – Long-term - Webinars - Presentations to targeted groups - On-demand education for front-line staff Collaboration – Long-term - Regional meetings with law enforcement for shared education - Engage with statewide public safety leaders - Multi-disciplinary summit Document Respository: Healthcare Services Group’s legal staff will participate on the task force and serve as legal review to identify exemplar policies for a repository of best practices. Create document repository of vetted security-related policies for member adoption (Partner: HSG) – winter 2018

Advocacy Federal officials Call with the American Hospital Association Letter to HHS leadership CMS communication Call with the American Hospital Association State officials Letter to Governor Greitens Physician letter campaign Meeting with Dr. Williams Missouri recommendations Advocate for increased access to mental health services Governor or representative to convene law enforcement, emergency medical services and health care Collaborative approach Joint education Continued opioid reduction initiatives Balanced survey approach

Michael R. Dunaway Kansas City Metropolitan Healthcare Council 2017 CMHA Annual Meeting