1. Reducing and Eliminating Seclusion & Restraint: The Leadership Factor THE SAKS SYMPOSIUM University of Southern California Gould School of Law April 22-23, 2011

2.  In US, an estimated 50 to 100 people die each year as a result of S & R and many more are traumatized or injured.  Research now demonstrates that psychological harm, physical injuries and death are by-products of S&R.  Research also demonstrates that injury rates to staff in mental health settings using S & R have been found to be higher than those found in high-risk settings like lumbar, construction and mining.  Reducing harm and promoting recovery requires a shared vision of success, a clear mission and leadership at all levels. The Curie Group, LLC, April 2011 2

3.  The efforts to reduce seclusion and restraint must be grounded to the greater vision of the organization.  Vision Definition:  The ultimate outcome of how the world should be as a result of your efforts. The Curie Group, LLC, April 2011 3

4.  A vision is realized through accomplishing a mission.  A mission is a clear statement of what you will do in order to attain a vision. The Curie Group, LLC, April 2011 4

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6. 6 VISIONMISSIONPRIORITIESGOALS OUTCOME METRICS

7.  SAMHSA convened a national summit in December 2004 with 110 expert panelists  Issued National Consensus Statement on Mental Health Recovery “Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.” Source: http://www.samhsa.gov The Curie Group, LLC, April 2011 7

8. National summit also issued… The 10 Fundamental Components of Recovery  Self-Direction  Individualized and Person-Centered  Empowerment  Holistic  Non-Linear  Strengths-Based  Peer Support  Respect  Responsibility  Hope Source: http://www.samhsa.gov The Curie Group, LLC, April 2011 8

9.  Recovery is an individualized journey.  Recovery is a process and an outcome.  Recovery is  managing one’s illness =  managing one’s life. The Curie Group, LLC, April 2011 9

10. Recovery = A life in the community. The new framing for public policy and finance. The Curie Group, LLC, April 2011 10

11. The Curie Group, LLC, April 201111

12.  Consumers define their own recovery journey in terms of the pursuit of goals, a decent place to live and connectedness to others.  If central to the concept of recovery is realizing certain goals to be a full participant in the community, then those goals should be the basis of outcome measures. The Curie Group, LLC, April 2011 12

13. SAMHSA National Outcomes Measures (NOMS)  Reduced Morbidity  Employment/Education  Crime and Criminal Justice  Stability in Housing  Social Connectedness  Access/Capacity  Retention  Perception of Care  Cost Effectiveness  Use of Evidence-Based Practices Source: http://www.samhsa.gov The Curie Group, LLC, April 2011 13

14. The Curie Group, LLC, April 2011 14 “I love it when a plan comes together !” ~John “Hannibal” Smith, The A-Team

15.  1997, PA DPW/OMHSAS issued the challenge to reduce/eliminate S & R in 9 state hospitals.  The Issues: ◦ Research demonstrated S&R not working ◦ Recovery rates low ◦ Most patients already victims of trauma ◦ No need to reinforce that trauma or retraumatize. ◦ If goal is recovery, patients need to be an active part of the process. The Curie Group, LLC, April 2011 15

16.  Committed Leadership – Tied to Vision  Alignment with Mission - Recovery and CQI  Integrated system planning and implementation  Value driven, evidence-based priorities  Dissemination of evidence-based technology to define clinical practice and program design.  True partnership between all levels of the system  Data-driven, incentivized, and interactive performance improvement practices. The Curie Group, LLC, April 2011 16

17.  Results ◦ Within 3 years:  Incidences of S&R down by 74%.  Patient hours spent in seclusion down 96%. ◦ AND  No increase in staff injuries.  Changes implemented without additional funds, using existing staff and resources. The Curie Group, LLC, April 2011 17

18.  PA set the highest standards of S/R in the US.  Recipient of Harvard University/Ford Foundation/Council of Effective Government Innovations in American Government Award.  Not alone in its success. NASMHPD a key leadership partner. The Curie Group, LLC, April 2011 18

19.  Mental health authorities in 8 states received 3-year State Incentive Grants to implement a model based on the Six Core Strategies for Reducing Seclusion and Restraint which are similar to what was used in PA.  20 of 28 facilities that reached stable implementation of the model were able to reduce seclusion hours by an average of 19% (per 1000 treatment hours).  Over half of the 28 facilities were able to reduce restraint hours by 55% (per 1000 treatment hours) on average. The Curie Group, LLC, April 2011 19

20.  Vision and Leadership are essential ingredients to reducing seclusion and restraint in medical facilities.  From federal agencies to state agencies to hospital directors to department heads and mental health team leaders, the greater the alignment of vision and mission, the greater chances for success. The Curie Group, LLC, April 2011 20

21. Our main business is not to see what lies dimly at a distance, but to do what lies clearly at hand. ~ Thomas Carlyle The Curie Group, LLC, April 2011 21