Transcript Person Centered Practices at The Rochester Psychiatric

Rochester Psychiatric Center
Nancy E. Carter, LCSW
Social Worker-Adolescent Unit
[email protected]
Philip G. Griffin, MPA
Director of Quality Improvement
[email protected]
Timeline: 2003-2011
 2003: Community services vocational staff attend
WNYCCP training
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Focus on incorporating person-centered practices in all CSU
staff meetings
2005: RPC contracts for on-site trainers
2006: Staff sent to train-the-trainer training
2007: Staff and service recipients from (E2) pilot
inpatient ward receive training
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Person-centeredness becomes an initiative on the RPC
Strategic Plan
The RPC Person-Centered Steering Committee is formed
Timeline continued:
 2008: E2 (pilot ward) identifies and implements
program changes
RPC New Employee Orientation (NEO) and Nursing/MHTA
competencies now include a person-centered practice (PCP)
overview
Recovery is identified as a topic for further training to enhance
PCP efforts
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2009: Recovery training is developed and rolled out to
target groups
On-site training continues to train additional staff
• NAMI is invited to present “In Our Own Voices”
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Timeline continued:
 2010: Continue with previous efforts
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Survey recipients of services to identify areas of success and
opportunities for improvement
2011: Person-centeredness no longer a stand alone
initiative on the RPC Strategic Plan
• All 2011 initiatives to include language and action items
that reflect core person-centered principles
2007 Strategic Plan Focus
 Clear targets for the person-centered initiative were
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created
The RPC Person-Centered Steering Committee was
established
Priorities for the initiative were identified and
recommended to administration
Recommendations made by the committee were
implemented
There was a Person-Centered Web Conference held on
12/10/07 with Dr. Neal Adams and Diane Grieder
2008 Strategic Plan Focus
 Person-centered introduction is included in NEO for
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all employees
Nursing staff competencies include a person-centered
overview
RPC Person-Centered Steering Committee includes
family and consumer input
Plan for Forensic Unit person-centered roll out is
drafted and implemented
WNYCCP Vital Signs of Recovery survey is completed
Plan to identify and pilot fidelity checks is created
2009 Strategic Plan Focus
 Recovery Train-the-Trainer sessions are held
 Additional recovery training facilitators are identified
and trained
 Pre and post tests are developed for recovery material
 NAMI “In Our Own Voice” sessions are held
2010 Strategic Plan Focus
 Written survey/focus groups are held to measure the
perception of recipients of RPC services as to whether
they feel they are listened to and have successfully
partnered with at least one member of the treatment
team.
 Recipients are more actively involved in the treatment
planning process as evidenced by active discussion
with primary therapist in regards to treatment plan
objectives
 Survey results confirm that recipients perceive a more
collaborative partnership in recovery
What did E2 do?
 Patient Interactive Initial Treatment Planning Note
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Focus on strengths, related strengths to recovery
Looked at what the person would do to improve recovery
Discussed medications
Relationship with family and friends
Asked questions about culture and meaningful activities
Reviewed independent living skills
Discussed staff relationship as it relates to recovery
Looked at available services
Reviewed potential symptoms
What did E2 do? Continued:
 Patient Interactive Treatment Planning Review Note
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Reflected on positive changes
Discussed areas of future focus and how it would relate to
recovery
Asked how staff could be supportive
Re-reviewed services available
What did E2 do? Continued:
 Changed the treatment planning process
 Created groups based upon client feedback, ie. Budget
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Buddies
Looked at Restraint and Seclusion data and fights and
assaults
Invested in training for all staff
Created buy in and accentuated the positive
Looked at discharge planning and residential options
Created schedules for the clients that made sense to them
Specific E2 examples
Oct-10
Jul-10
Apr-10
Jan-10
Oct-09
Jul-09
Apr-09
Jan-09
Oct-08
Jul-08
Apr-08
8
Jan-08
10
Oct-07
12
Jul-07
Apr-07
Jan-07
Oct-06
Jul-06
Apr-06
Jan-06
Oct-05
Jul-05
Apr-05
Jan-05
Oct-04
Jul-04
Apr-04
Jan-04
Oct-03
Jul-03
Apr-03
Jan-03
Oct-02
Jul-02
Apr-02
Jan-02
Oct-01
Jul-01
Apr-01
Jan-01
# Episodes
E2 - Restraint/Seclusion
16
14
Jan 2007-July
2008: staff
were trained
and
consistently
using personcentered
approaches
6
4
2
0
E2 Fights & Assaults
40
35
# Fights & Assaults
30
25
20
15
10
5
0
Jan 2007-July
2008: staff were
trained and
consistently
using personcentered
approaches
What We’ve Learned
 Person-centeredness requires cooperation at all levels of the
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organization
Training is important but successful implementation is ongoing
and there will be bumps in the road
Positive examples need to be highlighted over and over again
Staff need to be praised when implementing person centered
principles/practice
There is a parallel process that occurs
Staff need to be consistent in presenting the message
A change in culture takes time