Integrating a sustainable, inter-disciplinary approach to ...

Integrating a sustainable, inter-disciplinary approach to ...

Victorian Reducing Restrictive Interventions Project (RRI) Dr Rosemary Charleston (Formerly RRI Project Director) Manager Western Victorian Mental Health Learning & Development Cluster Ms Andrea Hall (Formerly RRI Project Officer) Project Manager, Melbourne Health Outline Overview of the RRI Project Aims of the Project Composition & role of the Project team Project Activities Lessons learnt Evaluation of the Trauma Informed Care Trial in Emergency

Departments Evidence to support the need for TIC education in EDs Project Aims Project development Evaluation Broad Aims Aims to support the reduction, and where possible elimination, of restrictive interventions in mental health services and emergency departments Assist MHS to develop and implement Local Action Plans (LAP) Assist EDs to consider local data capture/use, as

well as other factors that may contribute to use of RI Composition & Role of the Project team Lead Western Victorian Mental Health Learning & Development Cluster RRI Project team: Rosemary Charleston (Project Director) Julie Blackburn (Mental Health Nurse) Vikki Dearie (Mental Health Nurse) Maggie Clarke (Mental Health Nurse) Natasha Tudor (Occupational Therapist) Andrea Hall (Emergency Department Nurse) Lindy Chayeler (Carer Project Officer) Joanne Switserloot (Consumer Project Officer) Backgroun d DH&HS Investment Creating

safety Pilot Project Local MHS RRI activities 2008 RRI Project Aug 2013 Jun 14 RRI Project DH&HS Expert Reference Group RRI Literature Review 2013

RRI Framework 2013 Stage 1 & 2 26th August 21st Dec 2013 Engagement & communication Statewide site visits MHS & EDs Local Action Plans submitted Stage 3 Jan Jun 2014

RRI Trainer events Emergency Dept activities Evaluation & Reporting MHS Implementation Local Action Plans DH&HS Funding May 2014 MHS Local Action Plans implementation May 2014 Jun 2015

Lessons Learnt Strengthen key enablers: Leadership, communication, collaboration, organisational culture, systems, capture and use of data, emphasis on sustainability Similar needs, demands, and priorities exist for services need to strengthen mechanisms for networking & sharing regarding RRI work already done/or in progress Strengthen input of lived experience roles Identify strategies to strengthen staff toolkits Strengthen relationship/partnerships within & between MHS and emergency departments

Actively seek mechanisms between ED and MHS that increase the understanding of the: different contexts, responsibilities and priorities Evaluation of the Trauma Informed Care (TIC) Educational Trial in Victorian Emergency Departments Evidence to support the need for TIC education Rising number of presentations to EDs Australia wide (Victorian Department of Health ,2013b) It is now widely recognized that many people who have a mental illness may have experienced a traumatic event at some point in their life (NASMHPD; NETI, 2005)

The Victorian Framework for Reducing Restrictive Interventions emphasises the need to provide care in the least restrictive environment possible (Victorian Department of Health, 2013a) Australians reporting a history of a mental and behavioural health condition has increased to over 3 million (Australian Bureau of Statistics, 2013) Project aims Determine whether the TIC education provided to ED nurses can lead to practice change To identify elements of the TIC education that

can support a reduction in the use of restrictive interventions in EDs Increase awareness of the need for care to be trauma-informed when mental health consumers present to the ED TIC pilot development Co-design & Co-delivery by consumers, carers' and nurses Three Victorian EDs invited to participate as a pilot site One rural & one metropolitan pilot site planned as an 8 hour workshop (8 modules over 1 day)

One pilot planned over 4 days (45 minute modules delivered during in-service times) Pre/Post education questionnaires developed to measure effectiveness of pilot Focus groups scheduled three months post training Modules 1. Introduction to Trauma Informed Care 2.

Neurobiology 3. Social consequences of trauma 4. Cognitive model of trauma 5. Self fulfilling prophecy 6. Responding to stories 7. Trauma and the workforce

8. Where to from here *All run for 45 minutes Participants Trials completed: 52 Metropolitan participants 17 Rural participants Total: 69 Participants demographics: All Emergency Department nurses Average age group: 25-30 Average years of experience in an ED: 5-10 Evaluation Pre/Post questionnaires were used prior to and at the completion of training Questionnaires were used to identify and measure changes in two areas: 1. Knowledge

2. Confidence Focus groups were scheduled three months post education Questionnaire evaluation Allowing nurses to talk about trauma in an informed way Nurses identified this education as one way to understand and possibly prevent occupational violence Beneficial to the mental well being of staff

Consumer project officer identified as one of the most valuable components of the day Data reflected 100% of attendees would recommend this training to their colleagues Nurses suggested TIC education be extended to all acute care and emergency services staff Module 7- trauma and the workforce identified as one of the favourite modules Focus group evaluation: three months post training

Participants reported: Increased knowledge about trauma informed care Desire for more education involving consumer consultants Increased capacity to build more therapeutic relationships with patients Circumstances where restrictive interventions have been avoided using skills learned during this training Desire for permanent and accessible TIC education within their workplace References State of Victoria Department of Health. (2013b). Reducing restrictive interventions: literature review and document analysis. Melbourne: State of Victoria Department of Health

National Executive Training Institute (NETI). (2005). Training curriculum for reduction of seclusion and restraint. Draft curriculum manual. Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD), National Technical Assistance Center for State Mental Health Planning (NTAC) State of Victoria Department of Health. (2013a). Providing a safe environment for all: framework for reducing restrictive interventions. Melbourne: State of Victoria Department of Health Australian Bureau of Statistics. (2013). Australian Social Trends: (cat. no. 4125.0 ). Retrieved from www.abs.gov.au on May 10th 2015.

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