Empowering Recovery in Hill Country Crisis Stabilization Unit

Kris Steinke, MD, Medical. Director- Hill Country CSU

Vicki Herndon, MA, LPC, CPS- Hill Country CSU

Collaborative Family Healthcare Association 14th Annual ConferenceOctober 4-6, 2012 Austin, Texas U.S.A.

Session #B3bOctober 5th __, 2012

Disclosure Statement

We have not had any relevant financial relationships with any of our references

during the past 12 months. Any references to Curriculums and

Products are for educational purposes only

Hill Country MHDD Centers

MISSION:

Promoting Independence,

Community Integration and Recovery

Hill Country MHDD CentersServes 19 counties

22,000 square milesPopulation base

560,000Provides mental health, developmental disability, early childhood intervention, veteran, and substance abuse services

Hill Country MHDD Centers

Crisis Stabilization UnitLocal state hospital moved to all

forensicState remodeled

vacant facility on state hospital campus

to meet licensing requirements

Hill Country MHDD CentersCrisis Stabilization Unit

Provides up to 14 days inpatient care for individuals

suffering from a mental health crisis primarily from 19 county service area One of 2 licensed Crisis Stabilization

Units in rural setting in state of Texas

Hill Country MHDD Centers

Crisis Stabilization UnitOperational Funding through:

Transfer of State Hospital Trust Funds Legislative Appropriation

Competitive Award of Crisis FundsTotal of $2,820,775 annually

Hill Country MHDD Centers

Crisis Stabilization UnitAdditional Start Up Funding:

Private Foundations and Local Businesses and Individuals donated $232,000 for furnishings

and equipmentCounty provided road to facility

Hill Country MHDD Centers Center

Crisis Stabilization UnitOpened May 15, 2009

Patients Served during 1st Year of Operation

434 Unique Patients 488 AdmissionsAverage Stay 10 Days

Occupancy Percentage 74%

Hill Country MHDD CentersCrisis Stabilization Unit

Staffing2 Psychiatrists

5 Registered Nurses3 Licensed Vocational Nurses

18 Direct Care Staff2 Psychiatric Rehabilitation Staff

3 Mental Health Attendants4 Support Staff

Hill Country Community MHMR Center

Crisis Stabilization UnitPrimary Services Provided

Medication ServicesPsychiatric Nursing

Psychiatric RehabilitationSocial Work

Peer Support

Hill Country Community MHMR Center

Crisis Stabilization Unit

Discharge planning begins at admission

Services geared to facilitate recovery

and reduce recidivism

Hill Country Community MHMR Center

Crisis Stabilization Unit

Studies show that medication doesn’t change molecular

structure of brain –experiences do

Dr. Eric Kandel (Nobel Prize Winner)New Intellectual Framework for Psychology

Hill Country MHDD Centers

Crisis Stabilization Unit

When enter unit asked“Do you know why you are here

and what do you want to accomplish?”

Hill Country MHDD Centers

Crisis Stabilization Unit

Work on learning opportunities and experiences

Reinforce experiences and behaviors

Hill Country MHDD Centers

Crisis Stabilization UnitConnect to

local mental health clinic

through telemedicine during staffing

Build relationship for aftercare

Hill Country MHDD Centers

Crisis Stabilization Unit

Focus on goal of individualTreat whole life

to help people reach potentialTherapy, art, yoga, exercise, etc.

Hill Country MHDD CentersCrisis Stabilization Unit

Psychiatric Rehabilitation SpecialistHolds 1 group a day and

meets individually with patients rest of day

Mental Health WorkersHold 3 groups a day including a

Relaxation & Sleepy Time Tea Group

Hill Country MHDD Centers

Crisis Stabilization UnitUtilize Peer Support(2 Groups per week)

Peers help individuals relate experiences and let them know they

are not aloneHear what never hear in clinic setting

Clients gain desire to be Peer Facilitators

Hill Country MHDD CentersCrisis Stabilization Unit GoalsReduction in Recidivism

Inpatient & Outpatient Continuity of CareConsistent recovery based,

holistic treatment philosophyConsistent and timely follow-up with

patients in outpatient setting after discharge

Empowerment Through EngagementWe empower recovery through engagement. We take a partnership approach. We strive to use the following recovery principles in our engagement of individuals and staff;

• Hope• Choice• Is trauma Informed.• Trust• Respect• Willingness • Accountability

The Partnership Pie Concept Within Inpatient Crisis Setting

Empowerment through Group & Individual Services

• We use two differing modes of psychiatric rehabilitation services;

• Groups to introduce and educate individuals about our recovery approach. Topics covered in these sessions are structured tp facilitate the understanding of recovery.

• Individual services are used to personalize treatment and build hope & trust.

Group Sessions (5) Objectives

• Help You Help You move beyond you current crisis and back into your life

• Identify Personal Blocks to Recovery • Teach Symptom Identification/ Monitoring • Increase Self Esteem through Participation • Empower their decision to choose recovery as a

way of life. ( paradigm shift; Victim-Survivor-Thriver)

Individual Sessions Objectives

• Assess for impact of childhood trauma on sense of self and initiate supportive cognitive therapy/ coping skills

• Assess for degree of ruminative thoughts and initiate supportive cognitive therapy/coping skills

• Assess for degree of emotional pain (self report) and initiate supportive cognitive therapy/coping skills

• Recommend seeking outpatient therapy to solidify gains.

Operational Definition of Recovery “Recovery is a process of readjusting our attitudes, feelings, perceptions, and beliefs about ourselves, others, and life in general.” Within systems of care, recovery applies to both the individual and the service providers.

L1) Individual Recovery Begin to see themselves as a person not a diagnosis. Start to develop hope and confidence in the value of their lives Begin to engage in trusting, supportive, and respectful

interactions with others. They begin to take risk, make objective decisions and connect.

Operational Definition Cont.• L2) Systemic Recovery • Transforms the concept of treatment from a hierarchical to a

relational paradigm without minimizing the roles of the service providers.

• It reduces stress because providers stop fixing patients and begin partnering with them.

• It improves the work environment through respect and appreciations of every team members’ contribution, including the individual served.

Approach To Services for Team

• We function as a whole• Administration, crisis stabilization and out patient

services are one organization.

• We strive for Improvement • We not only attend trainings( ROCI) but we

implement what we learn.

• We empower recovery; one interaction at a time!!!

Picture of Our Recovery Board

Picture of Our Recovery Board

Questions??

References

• Spaniol, Koehler,& Hutchinson, (2009) The Recovery Workbook, Boston , University Center for Psychiatric Research. Boston University Press, MA. (p11)

Session Evaluation

Please complete and return theevaluation form to the classroom monitor

before leaving this session.

Thank you!