Crystal Ball: QCSI Initiative

On 3/4/13, DMH Central Office chartered each of the 7 state psychiatric hospitals to develop one of the following: Treatment & Recovery Philosophy & Policy (Chicago-Read) Active Treatment & Recovery Definition (Alton)

Crystal Ball: QCSI Initiative Serious Incident Management (McFarland) Risk Assessments: Self-harm/Suicide (Choate) Harm to Others/Violence (Elgin) Falls (Chester) Elopement (Chester) Health crisis (Madden)

Crystal Ball: QCSI Initiative EMHC requested “Harm to Others/Violence,” aware that we are very good at preventing violence. This gave us the opportunity to look at why we are good at it and to share with fellow hospitals. Along the way, we identified ways to improve further.

Crystal Ball: QCSI Initiative Ultimate goal ? Statewide standards in areas identified by Central Office as critical. Steps so far: Develop the process, Pilot the Charter (training & evaluation), Review with hospital peers.

Crystal Ball: QCSI Initiative The charge to EMHC is: develop & articulate the process, identify & develop training, develop & plan evaluation, by 5/10/13. Completed on time, initial steps are being communicated in multiple settings including this presentation.

Crystal Ball: QCSI Initiative EMHC QCSI Team: Consumer, DON, Hospital Administrator, Medical Directors, Recovery Specialists, QM, Unit Psychologist

Crystal Ball: QCSI Initiative Developing a process for Risk Assessment – QCSI Team completed a staff survey & obtained patient input on reducing the risk of violence at EMHC. Professional literature was sought, practices at all state hospitals were reviewed, including EMHC’s.

Crystal Ball: QCSI Initiative The results of those recommendations, models & research led to plans & training that EMHC will implement in the coming months. These include changes to each step of the process...

QCSI Initiative: Risk of Harm to Others Screening: ensure screening staff is aware of & uses all available information to alert unit staff &/or MOD to the potential risk (Nursing to address with new screeners.) Evaluation: feedback from unit staff to ensure screening is providing all the information available.

QCSI Initiative: Risk of Harm to Others Assessment: additional validated risk factors added to Comprehensive Psychiatric Evaluation as of June 17: History of Substance Abuse Neurological Impairment Current mania Evaluation: audits to ensure the new version is in use.

QCSI Initiative: Risk of Harm to Others Use of HCR-20 by CPS psychologists for indicated patients: 1) training for CPS Psychologists in using the HCR- 20 2) guidance to CPS Psychiatrists for referrals to unit psychologists of patients with legal involvement Evaluation: audits to ensure it is being used appropriately

QCSI Initiative: Risk of Harm to Others Revived Community Meeting Process to include patient responsibility in reducing violence potential. Morning & evening meetings, addressing issues of concern to the community.

QCSI Initiative: Risk of Harm to Others Technician and Patient Input into Treatment Plan Patient Input – piloting a Patient Treatment Plan Review form on selected units. Technician Input – part of Active Treatment enhancement

QCSI Initiative: Risk of Harm to Others Wellness, team-building & the Language of Caring Training for all hospital employees – refreshing our skills in Trauma-Informed Care. Wellness Training for all staff over the next 9 months, developed by EAP & Training Coordinator with pre- & post-testing, from the Violence Prevention Committee.

QCSI Initiative: Risk of Harm to Others Post-incident debriefing for all patients and staff, review & enhance. Are staff members & patients encouraged to reconnect with the community & to feel safe, after a traumatizing incident? How can this best be accomplished?

QCSI Initiative: Risk of Harm to Others Review “expectations” versus “rules” from Coercion-free Initiative with return of role-plays - how we can interact more safely, for better outcomes. Involve selected NGRI patients as role models for patient responsibility to UST and CPS patient groups or individuals. Evaluation: Audits of environment, Community Meetings & Treatment Plans to see how these actions are working.

QCSI Initiative: Risk of Harm to Others Enhanced Active Treatment – review and renew on CPS, pilot and support on FTP. Planning to incorporate recommendations from the QCSI team working on Active Treatment.

QCSI Initiative: Risk of Harm to Others For most items, training or reminders to precede implementation. For most items, audits will follow and the actions will be evaluated with our Violence Prevention Indices, Staff and Consumer Survey results.

QCSI Measure: Pt Harm to Staff in CPS, trending down over 10 years

QCSI Measure: Pt Harm to Staff in FTP, trending down over 10 years

QCSI Measure: Restraints Use in CPS, trending down over 10 years

QCSI Measure: Restraints Use in FTP, trending down over 10 years

QCSI Measure: Pt Harm to Pts in CPS, trending up over 10 years

QCSI Measure: Pt Harm to Pts in FTP, trending up over 10 years

QCSI Measure: Staff Safety Climate Survey Results, ’08 – ‘12

QCSI Measure: Consumer Satisfaction Survey Results, ’10 – ‘13

Crystal Ball: QCSI Initiative What about the other QCSI initiatives? No clear answer yet, but we hope to incorporate helpful actions (from the QCSI group looking at Active Treatment, for example) in our change process.

Crystal Ball: QCSI Initiative Questions? Suggestions? Barriers?