Best Practices and Helpful Practices From the Fidelity Reviews - PowerPoint Presentation

Best Practices and Helpful Practices From the Fidelity Reviews 1 Paul Smits, LCSWSenior Policy AnalystUniversity of South FloridaM. Scott Young , PhDResearch Assistant ProfessorUniversity of South Florida

Overview Managing Resident CrisisSafe Rooms and Safe LoungesSafety PracticesAmnesty BoxesPeer Support Evidence Based PracticesGetting Staff Buy InIncident Reviews 2

Managing Resident Crisis Have safety plan in placeShift your approach from a sanctions based approach to an engagement based approachMore TX isn’t always better –find the right counselor, right groups and programsWork collaboratively with the resident to resolve problems Only ask Veterans to leave who pose a safety risk 3

Provider Innovation: Safe Rooms and Sober LoungesWhy Were They Created?Response to aggressive behavior at the facility Effort to minimize disruptionsAlternative to police involvement / Deterrent to police contactMotivation of program staff and administration Desire to increase retention rates4

What is Their Purpose? To ensure client safetyTo monitor client health and behaviorTo provide private area for recovery from substance use, medication effects, or unmanageable emotional distressTo provide a private space for any client needing it 5

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Typical Operation of the Safe Room Staff direct residents who are escalating to the Safe Room.Resident is instructed to spend 15 minutes in the Safe Room.Staff are able to observe residents in the Safe Room through a window on the door to the room.If a resident falls asleep in the room, staff make sure that resident is in a recovery position.Resident is offered food and non-alcoholic beverages by staff. At the 15 minute mark, staff re-evaluate the resident and determine if the Veteran is appropriate to re-enter the community.If resident falls asleep, the resident is allowed to stay in the room for additional time if appropriate. 7

Encountering Resistance Many sites have noted resident resistance to using the Safe RoomIf resident is resistant to entering or staying in the Safe Room, he or she is allowed to take a 15 minute walk in the community insteadPossible techniques to manage resistance:Prior to Safe Room use, remind Veteran that the facility is a calm, therapeutic environment Ensure Veteran of the need to observe them for their safetyEncourage Veteran to think how their behavior affects their fellow Veterans Create a comfortable environment in the Safe Room (comfortable furniture, food and drink) If resistance to staff direction continues, police may be contacted in those instances8

Safety Practices Contraband policyBag and locker searchesSign in / Sign out (staff observation)CurfewsAmnesty boxes 9 For additional information, see: Safety Practices for Low Demand Programs available at https://www.va.gov/HOMELESS/nchav/gpd-ta/GPD-LD.asp

Amnesty Boxes 10

Use of Amnesty Boxes Amnesty boxes should be located in the entrance to the facility where anonymous disposal can occurThe container should be of sturdy, steel construction and be lockedThe container must be attached in a way that cannot be removedThe container should be constructed in a manner that does not allow residents to remove items, and only staff should have access to the keys for the purpose of removing items Residents should not face discipline or sanctions for use of the amnesty boxThe program should maintain written polices for confiscation of contraband from the amnesty boxes Weapons taken from the amnesty boxes should be disposed of in accordance with local law enforcement policy11

12 Peer Support Low Demand Programs can maximize retention by involving residents in helping roles, including incentivizing chores Find out each resident’s skill sets and interestsGive residents recognition and rewards for their helping rolesInvolve senior residents in peer orientation to program

Giving Residents a Voice Hold routinely scheduled community meetingsEncourage resident participation and inputEncourage Veterans to give feedback and discuss community improvements that they would likeHave Veterans set up and coordinate some activities Use the Shared Decision Making ModelDiscuss reasonable options Veterans can pursue regarding their recovery, and then support their choices 13

Use of Evidence Based Practices Stages of Changehttp://www.psychotherapy.com.au/fileadmin/site_files/events/pdfs/APPLYING_THE_STAGES_OF_CHANGE_JOHN_NORCROSS.pdfMotivational Interviewing https://www.integration.samhsa.gov/clinical-practice/motivational-interviewingSeeking Safety https://www.treatment-innovations.org/seeking-safety.htmlTrauma Informed Care https://www.samhsa.gov/nctic/trauma-interventions De-Escalation Techniques / Crisis Responsehttps://www.crisisprevention.com/Blog/June-2011/De-escalation-Tips?lang=en-US https://store.samhsa.gov/product/Core-Elements-for-Responding-to-Mental-Health-Crises/sma09-4427 14

Getting Staff Buy In Review the core values of the model oftenHelp staff practice harm reduction strategiesUse real life scenarios to help staff practice the modelReward staff who show they are adopting the model 15

Incident Reviews Involve staff in incident reviews (The Morning Huddle)Brainstorm on effective interventionsHelp staff model engagement with the resident, and use sanctions only as a last resortBe patient with staff as they learn harm reduction strategies 16

Questions? / Discussion 17