1. Western New York Children’s Psychiatric Center Lessons Learned: Implementation of the Six Core Strategies May 2011 Kathe Hayes, MA Executive Director

2. Leadership toward Organizational Change There is Leadership at all Levels – Established a steering committee with involvement of direct care staff and representation from different disciplines and levels of administrative responsibility. – Medical Staff involvement in the reduction initiative is imperative. PARS is a standing meeting agenda item. – Developed subcommittees to coincide with the core strategies. Requires Promotion of Culture Change - Revised Facility Strategic Plan to incorporate PARS values and Goals - Director and/or Deputy talk about culture change and reducing the use of restraint and seclusion at annual mandated training which includes all staff and all shifts.

3. A Work in Progress The steering committee elected to continue meeting to continue the work to reduce restraint and seclusion. Hospital Leadership continues to use available meetings to reinforce philosophy and strategies. Have made forms available so families and staff can recommend individuals or teams to be recognized. Promote and support the incorporation of the assistant dog into treatment. Seek active involvement of direct care staff in discussions about how to use PEM with specific youngsters.

4. Using Data to Inform Practice

5. Data Drives Decisions: WNYCPC has always had a robust data collection and review process. Data is used to identify trends and problems which need to be addressed. (individual transitions, etc) Data is also used to identify/celebrate achievements and recognize staff. Treatment teams have sought data about specific patients to use in treatment plan development and as feedback for patients and families. The steering committee has identified data to be reviewed to better inform our practices, i.e., events during the first 1 – 2 weeks of admission.

6. Workforce Development Starting New Employee Orientation for all new employees with our facility’s commitment and initiative to reduce R/S sets the tone that this is an important goal that we all need to work towards as a team. Including Leadership in the training helps to show their commitment to the initiative to reduce R/S and helps with the cultural shift to a less coercive environment. Hospital wide participation in Interdisciplinary Treatment Team Training to strengthen team work. Offered related training including Managing Conflict and Self as Mediator.

7. Seek and support opportunities for staff to expand knowledge of trauma informed care and sensory modulation. Implemented abbreviated PMCS program for support staff. Participating in the Learning Collaborative and support attendance of key staff as appropriate. Conducted PEM refresher for unit teams to support unit specific adjustments to PEM, i.e., no negatives on the Children’s Unit. Training must be customized to meet the needs of the patients and employees. Employees have requested additional information on Trauma Informed Care, identification of triggers and behavioral warning signs at their earliest stage, calming techniques and creating a coercive free environment.

8. Training must be participant centered and active to engage employees in the process of learning. Providing a staff recognition program, that rewards employees in a venue with their co-workers and some leadership staff has had positive results. Although we are bound by Civil Service Law, Nursing has done a nice job of including our initiative to lower the use of R/S as part of recruitment. They ask employment candidates to discuss their thoughts on R/S. Potentially this can eliminate candidates that may not have the same philosophy as our facility in regards to the use of R/S.

9. Implementing Prevention Tools Tommy, Licensed Social Dog

10. There is no ‘Single Tool’, flexibility is the Key Sensory Assessment and Modulation: learning sensory triggers and what’s soothing, then implementing a “sensory diet”: activities, teas, scents, and lotions Triggers and Calming Strategies on PEM cards Don’t Underestimate the Impact that the Environment can have. ISMP for youngest children uses pictures instead of words to identify triggers, feelings and calming choices.

11. Individualized PEM, focused on teaching aspects and with consideration for developmental, cognitive/intellectual, and psychiatric conditions (e.g.. No Negatives, Children off the Card) Increased requests for sensory assessments to include information about preferences in treatment planning. Increased availability of weighted vests and blankets. Gather information about calming choices in advance of admission.

12. Solicited ideas from youth to design comfort rooms. Transformed mini-gym on Children’s Unit to “relaxation zone” and worked with patients to design and identify use of the space. Provided pictures of the hospital to acute hospitals from which patients are referred to allay some anxiety. Provide a “welcome” snack at admission. Nutritional Services tailoring menus to individual tastes and preferences. Dietician’s involvement in PARS fosters partnership in treatment.

13. Each youth is supported in developing a personal comfort box. Families are encouraged to provide pictures and other comforting items. Continue to expand the appreciation of comfort tools apart from privileges. Encouraged the use of outdoors and physical activity. Routinely seek youth input about preferences. Offer Tommy. Increasing Tommy’s involvement from Animal Assisted Activity to include Animal Assisted Therapy

14. Youth and Family Involvement Have very active, involved Family Advisor. Provide gas cards to families to assist in involvement and visitation. Take children home for visits when no other means is possible, including driving great distances at times. Adolescents select a representative to convene their community meeting and report concerns to staff. Family Advisor works with kids to paint pictures and inspirational messages on hospital walls.

15. Seek suggestions from youths about how to celebrate “safe” days. Dietician presented information about nutrition and calming foods to families. Dietician works with families to teach cooking of tasty, healthful foods. Support flexibility and individual choice to the greatest extent possible. Access to special community outings with staff when family or other resources are not available.

17. Rigorous Debriefing Continue to revise and improve all associated forms and documentation to get the most useful information. Members of Cabinet debrief on all three units. Promote kid specific, flexible approaches. Steering Committee plans to initiate a problem solving process to improve debriefing.

18. PARS keeps on giving