Virginia Beach Recovery Center. Virginia Beach Department of Human Services MHSA Division 409 Birdneck Circle Virginia Beach, VA 23451

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1 Virginia Beach Recovery Center Virginia Beach Department of Human Services MHSA Division 409 Birdneck Circle Virginia Beach, VA 23451

2

3 Recovery Center

4 Overview Opened as primary non-medical Detoxification Center in 2002 (Social Detox Philosophy) Began providing medically-monitored detox and crisis stabilization in Funded by federal, state, and city funds Total 17 licensed crisis stab beds - 13 Crisis Stabilization, 4 Medically Monitored Detoxification One of 3 Crisis Stabilization programs in Region V, Recovery Center is the only program that provides psychiatric stabilization and medically monitored detox services

5 Vision Who are we How did we get here Where are we going How do we get there

6 Organizational Culture Needs Assessment External Silos Internal Social Detox Access Treatment Continuity Process Improvement Quality Clinical Variation Customer Service Staff (People / Tools / Processes)

7 Mission Redefine meaning of Recovery* Promotes recovery through an array of coordinated and person-centered services including Prevention education Medical and clinical treatment Promote our unique competencies Promotes community and regional collaboration *Mental health recovery - SAMHSA

8 Admission Criteria Admission and exclusion criteria are outlined in section VI of Clinical Program Description Only absolute admission criteria An individual must be 18 years or older. Demonstrating a clinical need for Crisis Stabilization services due to acute substance and psychiatric crisis that places them at risk for psychiatric/substance abuse hospitalization. Relative admission criteria Clients must have co-occurring disorders and must meet one or more of the following criteria at the time of admission: Difficulty in activities of daily living such as maintaining personal hygiene, preparing food, maintaining adequate nutrition, or managing finances to such a degree that health or safety is jeopardized; Inappropriate behavior such that immediate interventions by mental health and other agencies are necessary; Clinical manifestations (symptoms and signs) severe enough to preclude assessment and treatment in less intensive setting Less restrictive approaches have not been effective Cognitive difficulty such that she/he is unable to recognize danger to self or significantly inappropriate behavior.

9 Exclusion Criteria Medical Exclusions Any active medical problem that prevents or limits significantly a client s participation in treatment program and/or poses a significant risk to health or safety. These may include but are not limited to: Clients who have experienced seizures within the past 24 hours. Clients with active infection: as evidence by a fever (Temperature > 101.5) New Onset Cardiac Arrhythmias (e.g., atrial fibrillation, ventricular tachycardia). Acute stroke, respiratory distress, ischemic heart disease (chest pain). Severe hypertension, regardless of symptoms: ( SBP >170, DBP >110) Methadone use > 80 mg/day Uncontrolled Diabetes Any Clinical Laboratory Test results that may suggest patient has unaddressed or uncontrolled medical problems. Psychiatric Exclusions Severe psychosis and / or agitation as evidenced by inability to cooperate with Emergency Services Pre-screening or significantly interfere with a client s participation in the treatment program No use of physical restraints or seclusion in the past 48 hours. Lack of adequate response to treatment at a higher level of care. Recovery Center Staff recommends higher level of care as evidenced by material not covered by the pre-screen report or criteria mentioned above: History of previous contact with client and participation in RC program that was disruptive and resulted in aggression towards staff and/or peers. Current Recovery Center s unit acuity level that may negatively impact client s participation or safety in the program. None of these examples by themselves can be used as sole exclusion criteria All recommendations for denial of admission must be reviewed by Program Medical Director and Administrative Supervisor during the normal workday and by Standby On-Call Provider and Administrative Supervisor on call after hours and during the weekends.

10 VB Recovery Center s Strategic Plan 2010 Needs Assessment for RC in terms of staffing models Policies / Procedures Manual Scope of Services for RC Development of Data Collection Tools PI Opportunities Weekend Scheduling / Work Expectations 2011 Data Collection Process / Data Review Program Review / Redesign Physical Space Utilization Revised / Improved Admission Review Process Staff Resource Staffing Education Morale

11 VB Recovery Center s Strategic Plan 2012 Focus on Patient Safety Electronic prescribing Standardization of Clinical Care Medication Stock List Expectations for On-Call duties Implementation of TDO Admissions Improved Space Utilization Continued improvement in access to treatment Data Collection / Review Process Readmission Rate Staff Resources Education and Training

12 Access Referral declined due Referral withdrawn by referring agency Week Ending # of admissions # of referrals # of referrals declined No Bed Acuity too high Acuity too low Medical Need SA Need Not Co-occuring Other/Description Withdrawn Inquiry only Other 6/12/ /19/ /26/ /3/ /10/ /17/ /24/ /31/ /7/ /14/ /21/ /28/ /4/ /11/ /18/ /25/ /2/ /9/ /16/ /23/ /30/ /6/ /13/ /20/ /27/ /4/ /11/ /18/ /25/ /1/ /8/ /15/

13 Access Date # Referrals # Referrals # Admissions # of Referrals No Beds Actual Submitted Withdrawn Declined Denials 10/2/ /9/ /16/ /23/ /30/ /6/ /13/ /20/ /27/ /4/ /11/ /18/ /25/ Denial Rate* *February April /

14 Clinical Data ( ) Crisis Stabilization Medically Monitored

15 Clinical Data ( ) Crisis Stabilization Medically Monitored

16 Clinical Date ( YTD) Crisis Stabilization Medically Monitored

17 Hours of Operation/Staffing Recovery Center is a 24 hour facility and admissions are accepted at any time Administrative Staff: Program Supervisor, Staff Psychiatrist (Medical Director), Clinical Supervisor, Nursing Coordinator Day Shift : 4 clinicians, 2 nurses, 1 physician (Addictionologist), 2 clerical staff, 1-2 cooks Evening Shift : 3-4 clinicians and 2 nurses Night Shift : 2 clinicians and 1 nurse Standby Coverage: 2 Psychiatrists, 1 Internist and 4 NPs Peer Support Specialists: 2 (Part-time)

18 Program Objectives Provide an alternative to hospitalization Provide crisis stabilization and detoxification Capability to provide temporary detention that is appropriate and safe for the client & community Facilitate the client s transition into the appropriate level of care for ongoing treatment

19 Services Offered Individualized Person-Centered plan, group and individual counseling and discharge planning Psychiatric and medical evaluation Medically supervised detox Protocols Community support and services Fast track to outpatient services for CS patients (including day treatment) Referral to Residential Services, Oxford House, and other housing HIV education and testing

20 Detox Protocols Alcohol (3 7 days) Opiates (6 days) Benzodiazepines (6 days)*

21 Evidence-Based Practices Motivational Interviewing Co-occurring Treatment: Integrated Dual Disorders Treatment Illness Management and Recovery Psychiatric Medication for Substance Use Disordered Individuals Evidence-based practices that emphasize individual participation, choice, recovery, and self-determined outcomes have the potential to significantly improve the quality of life for individuals receiving services.

22 Recovery Center Program Schedule MONDAY TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY 7:00 7:30 Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast Breakfast 9:00 9:30 Community/Daily Goal Setting Community/Daily Goal Setting Community/Daily Goal Setting Community/Daily Goal Setting Community/Daily Goal Setting Community/Daily Goal Setting Community/Daily Goal Setting 9:30-10:30 Stages of Change Process Group Co-occurring Issues (Carolyn W.) CBT for MHSA Assertive Communication or Coping with Loss Medical Aspects of Co-occurring DO MHSA Recovery Process Group + Individual Couns. MHSA Recovery Process Group 10:30-11:00 Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs 11:00 12:00 Individual Counseling Individual Counseling Individual Counseling Individual Counseling (Peer Counselor ) Individual Counseling NA Group (10:45am 11:45am) Individual Counseling and/or Acupuncture 12:00 12:30 12:30-1:00 Lunch Outdoor Activity Lunch Lunch Outdoor Activity Lunch Lunch Outdoor Activity Lunch Lunch Outdoor Activity 1:00-1:30 Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs 1:30-3:00 Acupuncture HIV/AIDS Education ACCESS and Staff Acupuncture Employment Skills and Resources Wellness Management (Adrian) MHSA Relapse Prevention I 12 Step Men s Group and Women s Group 3:00 5:00 Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs 5:00 5:30 Journaling/Reflective Journaling/Reflective Journaling/Reflective Journaling/Reflective Journaling/Reflective Journaling/Reflective Journaling/Reflective 5:30-6:00 Dinner Dinner Dinner Dinner Dinner Dinner Dinner 6:00 7:00 Free time/vital signs Outdoors/vital signs Free time/vital signs Outdoors/vital signs Free time/vital signs Outdoors/vital signs Free time/vital signs 7:30 8:30 Recovery via Art Relationships & Boundaries Recovery via Art Physical/Spiritual Recovery Self-esteem Building MHSA Relapse Prevention II Recovery via Art 8:30 9: Step Group 7:30pm 8:30pm 12- Step Group Step Group 12- Step Group 12- Step Group 6 pm 7 pm 12- Step Group 6pm 7pm 12- Step Group 9:30-11:00 Snacks & Wrap Up Group Snacks & Wrap Up Group Snacks & Wrap Up Group Snacks & Wrap Up Group Snacks & Wrap Up Group. Snacks & Wrap Up Group Snacks & Wrap Up Group 11:00 Lights out Free time/vital signs Acupuncture, Free time/vital signs Acupuncture, Free time/vital signs Acupuncture, Free time/vital signs Free time/vital signs Free time/vital signs Free time/vital signs All Clients are expected to attend group activities unless excused by the medical staff. 10 P.M.: Television and Telephone are turned off. Acupuncture or Stress management may be offered at this time.

23 Types of Groups Community Meeting Coping with Losses Cognitive Behavioral Therapy Stress Reduction Acupuncture Impact of Co- Occurring Illness on Families Relapse Prevention Anger Management Motivational Enhancement AA/NA Meetings Wellness - My Recovery Plan HIV/AIDS Prevention Medical Aspects of Co-occurring Disorders Recovery via Art Relapse Prevention Tools

24 Training Recovery Center staff have attended Dr. Meinkoff s training in Co-occurring disorders Staff have received training in the recovery model and person-centered planning In 2011, staff participated in monthly inservice training provided by Recovery Center Medical Staff All staff have received training in crisis management and prevention

25 Milieu Management Nursing pre-screen / assessment Client Search Observational Watch Vital Signs Monitoring Group Attendance Contacting On-Call Provider Emergency Care (911) Laboratory Testing Disruptive Behavior

26 TDO Admissions Statutory Clarification Enhancement of Physical Plant for Client Safety Assessment, Treatment and Management Procedures Staff Training

27 Level II Criteria Purpose To provide those clients who are stable at The Recovery Center and demonstrate their active involvement in the treatment program. Previous Stable Vital Signs and off all precautions Absence of withdrawal signs and symptoms Absence of suicidal thinking Absence of aggressive behavior Attend all scheduled therapy groups and meetings Demonstrate an interest in treatment by working on the goals and objectives in the Individualized Service Plan New Completion of applicable detox protocol Contracting for safety (Verbal or in writing if applicable) Absence of aggressive behavior Full participation in all scheduled therapy groups and meetings Review of eligibility will take place each weekday at morning change of shift meeting. Recommendation and approval for level advancement will be made by the treatment team assembled at the meeting. Those elevated to level II status will be eligible for visitation with family and/or friends. Logistics of visitation (schedule, length, etc) will be facilitated by RC clinical staff. All visitations require a physician (nurse practitioner) order.

28 Recovery Center Satisfactory Survey % of the Recovery Center clients were satisfied or very satisfied with the services they received. Some comments were: you all really helped me understand myself and my addiction. I was never made to feel ashamed, just responsible for my actions I know what I learned here will help me make the right decisions now and in the future.

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