Caring for the Mentally Ill Behaviorally Impaired By: Evelyn W. Stone RN.,BSN.,M.Ed.

4 Levels of Need and Care Dangerous SeriousMajor Minor

Level I a) Dangerous - serious and persistent behavioral symptoms b) Danger to self and others c) Behavioral symptoms are ongoing & UNPREDICTABLE d) Behavior interferes with client’s ability to live safely in traditional settings e) Complex interactions between physical and mental

Level I (continued) f.)Requires expertise in diverse specialties making care complex and costly. g.)Demand specialized care provided by trained professionals to assure basic safety and minimal function. h.)Requires long term care in the most restrictive, safe environment.

Level II a.)Serious and persistent symptoms that do not respond to traditional medication and therapy b.)At risk for harming self or others c.)Requires ongoing assessment and intervention… To assure ongoing stability Acceptability to live in a group setting Community placement/independent living is marginal

Level II cont. Need higher level of care. 1:1 until re- stabilized Responds well to treatment for awhile, then later for reasons unknown or known, no longer respond to therapy Exhibit dangerous symptoms that require a different/higher level of care

Level III a.)Major symptoms, intermittent and/or occasional frequency effectively managed. b.)Medication compliant.

Level IV a.)Minor behavior symptoms, intermittent, and/or occasional frequency. b.)Viewed as “competent” who occasionally have a problem.

Placement Options 2:1 1:1 GH GH

Level I - Dangerous Placement in “most restrictive” environment Not in a group setting Individualized setting with 2:1 Inpatient in long term hospital

Level II - Serious 3 incidents of serious behavior 1. Harm to self 2. Harm to others 3. Damage to property managed in a group setting with 1:1 No unsupervised time.

Level III - Major Manageable in a traditional group setting May have 1-2 hours of unsupervised time if able to manage it safely No injurious behavior

Level IV - Minor Manageable in a traditional setting May have unsupervised time per physicians order and Tx plan Candidate for “Independent living”

Conclusion: Know the levels Document & report behavior Maintain safety Know your crisis plan Notify the supervisor/director/owner Call 911 prn

Contact Instructor: Evelyn Stone, RN., BSN., M.Ed 1008-F Big Oak court Knightdale, NC (919) Phone (919) Fax

Services Policy manuals Mental Health Hab Tech Medication Aide** BON Bipolar Disorder Developmental Disability Incidents Medication Admin. Mental Illness Autism Nurse Aide Training Seizure Management Blood Borne Pathogens