1. Creative Ideas to Support Community Reintegration: Lessons Learned from Western State Hospital Presented by: Marylouise Jones, PhD; Roger Mah, MD; Sheryl Lamberton, PhD; Jan Chase, COTA & Jessie Kastl, MSW

2. Approx. 800 Consumers 30 wards Approx. 1,950 Staff Four WSH Areas: Adults Older Adults Forensics Developmentally Disabled Western State Hospital (WSH) Tacoma, WA

3. 3 It can have many causes: Brain Injury is any injury that results in brain cell death and the loss of function. Traumatic Brain Injury (TBI) Caused by External Force Falls Motor vehicle accidents Gunshot wounds Being shaken Interpersonal violence Acquired Brain Injury (ABI) TBI’s + Other Causes Anoxia Stroke Toxins Infections Tumors Diseases-Huntingtons, AIDS…. Substance abuse Encephalopathy

4. 4 COMMON BEHAVIORS RELATED TO BRAIN INJURY Emotional outbursts Sudden aggression-may be out of proportion to injury. Disinhibition-yelling, intrusive sexual behaviors, touching others, talking too much…. Inertia- laying in bed, refusing groups, refusing to do self-care… Perseveration-asking the same questions repeatedly, stating the same information over and over…

5. Staff Qualities that Promote Alliance Empathic, caring Reliable Warm Listen to our clients Know our clients as persons Genuine Gentle speech Non-confrontational, non-punitive, non-blaming Put client needs first Respectful “ON THE FLOOR” SPEECH

6. DISCHARGE WORK WITH COMMUNITY TO FIT W/ CLIENT NEEDS COMMUNITY INTEGRATION SKILLS BUILDING and AWARENESS of BRAIN INJURY MODIFY ENVIRONMENT TREATMENT PLAN INITIAL ASSESSMENT

7. E-7 Treatment Domains Improve Physical/Mobility Increase Independent self-care Manage Psychiatric Symptoms Improve Behavioral/Impulse Control Improve Concentration/ Attention Practice Interpersonal Skills Process Psychological/ Emotional Issues Increase Meaningful/ Vocational Activities Increase Leisure Activities

8. ANTECEDENT-what got the person distressed. EARLY WARNING SIGNS-how we first know the person is distressed. CRISIS BEHAVIORS-actual aggression, yelling, out of control behaviors. CALMING-when the patient is feeling more relaxed. Don’t discuss incident! RECOVERY-client now able to discuss incident calmly/get feedback. Prevention is better than consequences in reducing violence. INTERVENE EARLY

9. Definition: The Comfort Room, formerly called the “Quiet” or “Time-Out” room, is a room that provides sanctuary from stress, and/or can be a place for persons to experience feelings within acceptable boundaries. (Bluebird, 2004) Comfort Room

11. Recovery Model Recovery is a personal and unique process. Everyone with a psychiatric illness develops his or her own definition of recovery. There are certain concepts or factors that are common to the recovery process. These include: – Hope – Mediation/Treatment – Empowerment – Support – Education/Knowledge – Self-help – Spirituality – Employment/Meaningful Activity

12. 12 All staff are focused on helping E-7 clients meet their treatment goals and live successfully in their community. Note that “community” may be group home, Skilled Nursing Facility, Adult Family Home, with family, independent, etc.

13. DISCHARG E WORK WITH COMMUNITY TO FIT W/ CLIENT NEEDS COMMUNITY INTEGRATION SKILLS BUILDING and AWARENESS of BRAIN INJURY MODIFY ENVIRONMENT TREATMENT PLAN ASSESSMENT Telling Potential Placements: What client might look like in “community” How to help client & others be safe. What variables affect behaviors.

14. Discharge Planning Process 1.Individualized treatment goals/discharge goals 2.Treatment team agrees patient is ready for discharge 3.Community Liaison agrees patient is ready 4.Financial department begins financial eligibility process for benefits (Medicaid, etc.) 5.CARE (level of care needed) assessment is done 6.Liaison/Home & Community Services (HCS) locate community facility 7.Patient/family visits facility 8.Community follow-up appointments are scheduled 9.Patient discharges from WSH!!