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

• Approx. 800 Consumers• 30 wards• Approx. 1,950 Staff•Four WSH Areas:

Adults

Older Adults

Forensics

DevelopmentallyDisabled

Western State Hospital (WSH) Tacoma, WA

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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

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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…

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

DISCHARGE

WORK WITH COMMUNITY TO

FIT W/ CLIENT NEEDS

COMMUNITYINTEGRATION

SKILLS BUILDING andAWARENESS of BRAIN INJURY

MODIFY ENVIRONMENT

TREATMENT PLAN

INITIAL ASSESSMENT

E-7 Treatment Domains

Improve Physical/Mobility

IncreaseIndependent 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

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.

INTERVENEEARLY

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

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

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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.

DISCHARGE

WORK WITH COMMUNITY TO

FIT W/ CLIENT NEEDS

COMMUNITYINTEGRATION

SKILLS BUILDING andAWARENESS 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.

Discharge Planning Process1. Individualized treatment goals/discharge goals2. Treatment team agrees patient is ready for discharge3. Community Liaison agrees patient is ready4. Financial department begins financial eligibility process for

benefits (Medicaid, etc.)5. CARE (level of care needed) assessment is done6. Liaison/Home & Community Services (HCS) locate community

facility7. Patient/family visits facility8. Community follow-up appointments are scheduled9. Patient discharges from WSH!!