1. Real Reduction Experiences What Worked? Creating Violence Free and Coercion Free Service Environments for the Reduction of Seclusion and Restraint

2. 2 Real Reduction Experiences Kevin Huckshorn, MSN, RN, ICADC Former CNO and Assistant Hospital Administrator, ASH/SFSH

3. 3 South Florida State Hospital Facility Profile Adult State Mental Health FacilityAdult State Mental Health Facility First, fully privatized in the country (11/98)First, fully privatized in the country (11/98) 325 beds; Average Daily Census 275325 beds; Average Daily Census 275 Average Length Of Stay:Average Length Of Stay: –220 days since privatization –3 years (all residents) Primary Diagnoses: schizophrenia, major depression with psychosis, schizoaffective disorderPrimary Diagnoses: schizophrenia, major depression with psychosis, schizoaffective disorder

4. 4 South Florida State Hospital Facility Profile 45% of residents have been involved with criminal justice system.45% of residents have been involved with criminal justice system. 95% of residents are involuntarily committed, or court ordered.95% of residents are involuntarily committed, or court ordered.

5. 5 South Florida State Hospital Initiative Seclusion/restraint reduction initiative started in November 1999.Seclusion/restraint reduction initiative started in November 1999. During ASH’s first year of operation a total of 264 seclusions and 197 restraints were administered.During ASH’s first year of operation a total of 264 seclusions and 197 restraints were administered. Since May 2002 there has been only 1 seclusion (> hour) and 5 restraints.Since May 2002 there has been only 1 seclusion (> hour) and 5 restraints.

6. 6 South Florida State Hospital Strategies Decision made by executive management group (EMG) after CEO attended a NASMHPD conference and learned about PA initiative.Decision made by executive management group (EMG) after CEO attended a NASMHPD conference and learned about PA initiative. No additional money, no consultants, no external training, no additional staff.No additional money, no consultants, no external training, no additional staff.

7. 7 South Florida State Hospital Strategies Change in aggression control training model.Change in aggression control training model. Converting CPI (Crisis Prevention Institute) to NAPPI (Non-abusive Psychological & Physical Intervention) training and certification with primary emphasis on staff to persons served relations and assessment and response to behaviors.Converting CPI (Crisis Prevention Institute) to NAPPI (Non-abusive Psychological & Physical Intervention) training and certification with primary emphasis on staff to persons served relations and assessment and response to behaviors.

8. 8 South Florida State Hospital Essential Components Full support and oversight by CEO/COO.Full support and oversight by CEO/COO. Strong policy statement and revised policies and procedures.Strong policy statement and revised policies and procedures.

9. 9 South Florida State Hospital Essential Components Use of data, graphed and posted for unit comparisons.Use of data, graphed and posted for unit comparisons. Debriefing including root cause analysis (RCA) and daily reports to EMG; non-punitive environment.Debriefing including root cause analysis (RCA) and daily reports to EMG; non-punitive environment.

10. 10 South Florida State Hospital Essential Components Change in staff roles (security, nursing, direct care staff).Change in staff roles (security, nursing, direct care staff). Supervisors responding to every incident; on call EMG member involved for oversight 24/7.Supervisors responding to every incident; on call EMG member involved for oversight 24/7. Use of persons served throughout project:Use of persons served throughout project: – interview residents and staff – make recommendations –comfort rooms.

11. 11 South Florida State Hospital Essential Components Project placed on every meeting agenda.Project placed on every meeting agenda. Staff encouraged and acknowledged.Staff encouraged and acknowledged. Town Center programming implemented.Town Center programming implemented.

12. 12 SECLUSION AND RESTRAINT RESULTS January 1999 - March 2004

13. 13 RESULTS

14. 14RESULTS

15. 15 EMERGENCY INTRAMUSCULAR INJECTIONS MAY 2001- MARCH 2004

16. 16RESULTS

17. 17 CHALLENGES  Resources  Resistance  Training

18. 18 South Florida State Hospital Key Contact Debra Kirsch, MD Clinical Operations Director Atlantic Shores Healthcare, Inc./ South Florida State Hospital 800 E. Cypress Drive Pembroke Pines, FL 33025 (954) 392-3000 dkirsch@sfsh.org