IMPLEMENTING BBI PRINCIPLES IN TEXAS: A RESIDENTIAL TREATMENT CENTER PERSPECTIVE

Transcription

1 IMPLEMENTING BBI PRINCIPLES IN TEXAS: A RESIDENTIAL TREATMENT CENTER PERSPECTIVE

2 MEET THE PRESENTERS Jason Drake- Executive Director at Krause Children s Center. He s worked exclusively with adolescents and families for the past 18 years. Fun Fact: Jason LOVES the Matrix movies. Amanda Martin- Clinical Director at Krause Children s Center. Amanda has a Ph.D in Family therapy and holds 3 licenses. Amanda has worked with children and families with complex and developmental trauma for the past 11 years. Fun Fact: Amanda is crafty and loves to create and/or restore furniture. Monica Jones- Program Director at Krause Children s Center. Monica has over 9 years experience working in residential treatment centers and is a dynamic trainer in verbal de-escalation and team building. Fun Fact: Monica can only sneak up on you if she s wearing shoes. Why. Her toes pop when she s barefoot. Shelley Evans- Clinical Program Manager at Krause Children s Center. She has 25 years experience working with children and families in foster care and worked in 5 states. Fun Fact: Shelley loves the outdoors and spending time with her boxers.

3 MEET THE PRESENTERS Sherri Hammack- National Coordinator for Building Bridges Initiative. She has more than 38 years of experience in health and human services. Fun fact is that she and Amanda Martin attended the same University. Sandra Flores- Principal at Trinity Charter School. Sandra has 17 years of experience in education. Fun Fact: Sandra is half Cuban and holds a process servers license. Carlos Calderon- Married for 20 years and father of 7 children. He s been a Licensed Professional Counselor for 17 years and in private practice for 15 years. One of his favorite cars is a Mustang 5.0. Ana Calderon- Married to Carlos for 20 years and mother of 7 children. Before becoming a stay at home mom, she worked as an accountant for Oil and Gas companies. She started running at the age of 15 and hasn t stopped! Amanda Calderon- youth with lived experience of RTC treatment. Amanda is an avid reader and artistic.

4 THE KRAUSE CHILDREN S CENTER Opened in 1994 Provides 24 hour therapeutic residential services to girls ages who have experienced simple trauma to chronic and complex trauma. Total capacity of 60 with average daily census of 57. Serve Specialized and Intensive level of care. One of 10 Residential Treatment Centers in Texas who work with Intensive Psychiatric Transition Program (IPTP) level of care. On-site Charter School through Trinity Charter Schools (TCS).

5 KRAUSE CHILDREN S CENTER: STAFFING 1 Program Director & 1 Program Manager 55 Direct Care Staff (DCS) including: 11 Behavior Support Specialists 28 DCS I 4 DCS II 6 Team Leads 6 Shift Lead 1 Clinical Director, 1 Clinical Program Manager and 5 licensed Clinicians 1 Spiritual Care Counselor 3 Case Managers

6 OBJECTIVES Building Bridges Initiative Principles Steps taken to become youth and family driven Outcome data on restraint reduction Calderon family experiences with BBI Questions from the audience for the panel

7 IT ALL STARTED WITH A PILOT. Krause s journey with implementing the BBI principles has included a lot of teamwork, collaboration, research, laughs and prayers. Goals of the pilot

8 BUILDING BRIDGES INITIATIVE PRINCIPLES Family driven and youth guided care Clinical excellence and quality standards Accessibility and community involvement Cultural and linguistic competence Transition planning and services

9 FAMILY DRIVEN CARE Partnering with families and involving them in all aspects of treatment: Setting goals; Designing, implementing, and evaluating programs; Monitoring outcomes; Culturally and linguistically competent supports, services and providers; and Partnering in funding decisions.

10 YOUTH GUIDED CARE Giving youth an equal voice in treatment Transparency Include youth in policies, practices and staff trainings Youth involvement in community Youth advocacy

11 CLINICAL EXCELLENCE AND QUALITY STANDARDS Using Trauma Informed Care practices Integrating community resources Preventing restraints and seclusions Tracking outcomes long term positive outcomes Best practices in medication Ongoing commitment to the culture change process

12 ACCESSIBILITY AND COMMUNITY INVOLVEMENT Shift in thinking about residential treatment that it is a place for youth to get better away from family; Emphasis on family engagement and involvement; Providing support and flexibility when families are unavailable, or incapable of providing a sense of belonging; and Ongoing commitment to ensure services and supports for the youth that started in residential treatment continue in the community.

13 CULTURAL AND LINGUISTIC COMPETENCE Integration and transformation of knowledge, behaviors, attitudes, and policies that enable everyone to work effectively in cross-cultural situations. Commitment to helping youth and families stay connected to meaningful, positive and prosocial cultural traditions and practices. Cultural lens should be applied to all aspects of assessments, treatment, and discharge planning. Ensuring language access for any youth or families that may need assistance.

14 TRANSITION PLANNING AND SERVICES Start discharge planning at the start of services Continued focus on integrating community involvement during and after treatment Focus on maintaining services that were effective and supportive after they youth transitions out of treatment

15 STEPS TO SUCCESS Research and Collaboration Conferences and ongoing collaboration with outside providers Updating policies and procedures to become more youth guided and family driven. These include:

16 STEPS TO SUCCESS Pre-placement interviews with youth Youth participate in administrative meetings regarding policy, procedure and practices Youth participate in interviewing new potential employees Unlimited phone calls at anytime Youth participation in training with staff Family Days at the center and Skype/Gotomeeting.com options for computer face time for families with distance barriers Youth attending community functions Job readiness program for youth of employment age

17 STEPS TO SUCCESS Professional Training for all employees that included Collaborative Problem Solving Trainings on moving from a Culture of Control to a Culture of Collaboration Restraint training Six Core Strategies Increased community involvement with volunteer services Rigorous debriefing after any restraint an/or serious incidents. Dorm meetings weekly for increased collaboration between clinicians and direct care staff on youth progress and individualized interventions Increased community outings

18 STEPS TO SUCCESS Increased volunteer mentor program Increased vocational training services offered for youth Reduced restrictions and increased privileges for youth based on their recommendations Improving environment aesthetics with youth input- flooring, wall murals, individual wall décor in bedrooms Clinical team being more proactive in family search and advocating for extensive family search with the youth s legal team.

19 STEPS TO SUCCESS WITH EDUCATION Cross training with RTC and Educational Employees on Trauma Informed Care and Building Bridges principles Genuine dedication to educate the youth where they are at despite behavioral dysregulation (no suspensions expulsions) Creating quiet educational spaces for youth that struggle with a classroom setting One on One meetings with the Principal on educational goals Commitment from every employee that each youth is talented, appreciated and capable of being successful in school

20 KRAUSE DAYROOM BEFORE AFTER

21 PILOT GOALS Krause had 2 primary goals in the BBI pilot: 1. Restraint reduction 2. Moving away from a level system We are still in the process of moving away from a level system, but the transformation is in motion with a start date of September 1, 2017.

22 RESTRAINT REDUCTION Monthly Personal Restraint Totals January February March April May June July August September October November December Restraints

23 RESTRAINT REDUCTION Monthly Personal Restraint Totals January February March April May Restraints

24 RESTRAINT REDUCTION Training staff to be more collaborative to prevent power struggles that could lead to restraints Patience I have all the time in the world Including the youths voice in all areas of treatment Debriefing on multiple levels on restraints

25 FEEDBACK FROM YOUTH I wish you would have done an interview with me. I was really mad for months when I came here and it would have helped if they would have asked me. (Youth s feedback after participating in a pre-placement interview with a potential youth for placement). I m glad you are finally asking our opinion. No offense, but most adults just don t get it. (Youth giving feedback after being invited to the leadership meeting). The last 2 youth that completed the treatment program that also participated in the job readiness program had a paying job within 2 months.

26 WHAT S NEXT FOR KRAUSE S JOURNEY? Implementing Collaborative Problem Solving framework throughout the facility Moving away from the level system with a defined plan Seeking a family advocate volunteer position Fundraising for additional resources for families Additional training on Cultural and Linguistic Competence Setting up wraparound services Ongoing networking in the community to have additional resources and partnerships

27 CALDERON FAMILY EXPERIENCE

28 PANEL QUESTIONS Sherri What do you feel is the best principle to work on first if a provider is looking to move towards the BBI framework? Sandra- What changes has Trinity Charter made that you feel has had significant impact on youth served since participating in the BBI pilot? Monica What were some steps that Krause took to changing the culture from control to collaboration between the direct care staff and youth? Shelley How would you summarize the changes the facility and therapists have taken to be more family driven?

29 PANEL QUESTIONS Jason Describe what you feel has been the most value experience in working with the BBI team. Amanda M- What would you describe as creating a significant change in the facility moving to a youth guided framework? Amanda C- Did you feel your input in your treatment was valued and please give an example? Ana- What did you find more helpful and difficult about your experience? Carlos- What did you find helpful in facilitating you having a voice in Amanda s treatment and with the team at Krause?

30 QUESTIONS FROM THE AUDIENCE FOR THE PANEL

31 BUILDING BRIDGES INITIATIVE FALL 2017 TRAINING PROGRAM October 4 7, 2017 in Andover, MA Purpose: To increase participant s ability to use and/or support implementation of best practices in both residential and community settings that result in sustained positive outcomes for youth and families who receive a residential intervention. Attendees will leave the training event with practical strategies to improve policies and practices in their programs (residential and/or community) or agencies (oversight/funding), as well as with an understanding of business strategies to use to transform agencies operating residential programs to ensure long-term positive outcomes It is recommended that teams of executives, leaders/advocates /families/youth from the same agency/program attend the event together. How to Register:

32 SUGGESTED READING RESOURCES Residential Interventions for Children, Adolescents, and Families: A Best Practice Guide edited by Gary Blau, Beth Cadlwell, and Robert Lieberman Six Core Strategies for Reducing Seclusion and Restraint Use- BBI website for many more helpful articles

33 REFERENCES National Association of State Mental Health Program Directors (July 2008). The National Building Bridges Initiative [Video webinar]. Retrieved from Blau G. M., Caldwell B., & Lieberman R. E. (Eds.). (2014). Residential interventions for children, adolescents, and families: A best practice guide. New York, NY: Routledge. National Association of State Mental Health Program Directors (2008). Six core strategies for reducing seclusion and restraint use. Retrieved from ocument.pdf