News & Notes

In 2003 the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a national action plan that called for the reduction and ultimate elimination of the use of seclusion and restraint in behavioral health care settings. As part of this plan the agency has recently released a training curriculum based on the latest information on prevention strategies and alternative approaches. The training package provides background materials, lecture points, and PowerPoint slides necessary for facilitators to implement seven training modules.

Roadmap to Seclusion and Restraint Free Mental Health Services emphasizes the importance of creating cultural change within organizations. The training manual's preface quotes Albert Einstein: "It is not possible to solve a problem with the same consciousness that created it." Accordingly, the curriculum materials are designed to help direct care staff work from a consumer-based philosophy. The recovery-based materials, which draw on the research and writings of consumer leaders in the recovery movement, were developed with the assistance of the National Association of Consumer/Survivor Mental Health Administrators. Consumers from around the country provided insight derived from their experiences of seclusion and restraint and offered guidance for the elimination of these practices. The curriculum also draws on the knowledge of direct care staff. A steering committee, made up of representatives from most stakeholder organizations in the mental health system, provided technical assistance and insight. The training was pilot tested with direct care staff and administrators at two hospitals.

The curriculum is designed for use in a variety of settings. Prior training for facilitators is not necessary; however, facilitators must be familiar with consumer perspectives to effectively teach the curriculum. The manual recommends that at least one facilitator be a mental health consumer. It notes that a team of staff and former consumers acting as joint facilitators is a particularly effective training format.

The training, which takes approximately 21 to 24 hours to complete, is divided into seven modules. Each module requires approximately three hours, but modules can be shortened to meet the needs of the training group.

• Module 1 increases participants' understanding of the personal experience of seclusion and restraint by presenting perspectives of consumers and direct care staff.

• Module 2 discusses the impact of trauma on consumers and staff.

• Module 3 describes the steps needed to ensure cultural change, including the role played by staff, and outlines a model for reform.

• Module 4 explores the concepts of resiliency and recovery from the consumer perspective.

• Module 5 uses consumer and staff perspectives to identify strategies that will lead to reduction and elimination of seclusion and restraint.

• Module 6 discusses sustainable change through both consumer and staff involvement.

• Module 7 presents a review of the first six modules and involves participants in developing both personal and workplace action plans.

An extensive resources section lists Web sites and contact information for advocacy organizations and reprints policy and position statements of several organizations and agencies, including the American Nurses Association, the National Alliance on Mental Illness, and the Commonwealth of Pennsylvania Office of Mental Health and Substance Abuse Services.

The curriculum can be ordered free of charge from SAMHSA's National Mental Health Information Center (800-789-2647 or www.men talhealth.samhsa.gov).

SAMHSA co-occurring disorders series: The Co-Occurring Center for Excellence of the Substance Abuse and Mental Health Services Administration (SAMHSA) has released the first three of a series of brief publications for treatment professionals: Overarching Principles to Address the Needs of Persons With Co-Occurring Disorders, Definitions and Terms Relating to Co-Occurring Disorders, and Screening, Assessment, and Treatment Planning for Persons With Co-Occurring Disorders . The series of ten papers will cover topics such as epidemiology, treatment, workforce and systems issues, prevention and early intervention, and evaluation and monitoring. The documents are designed for substance abuse treatment counselors and mental health care providers who usually treat one or the other of the two disorders. However, they will also be useful for primary care providers, criminal justice staff, and other health care and social service workers. Copies are available free of charge from the National Clearinghouse for Alcohol and Drug Information (800-729-6686) or on the SAMHSA Web site at www. coce.samhsa.gov.

Bazelon Center report on school-wide positive behavior support: A report from the Bazelon Center for Mental Health Law outlines a new direction for child mental health linked to a recent movement in education—positive behavior support (PBS). The 130-page report, Way to Go: School Success for Children With Mental Health Care Needs, documents how school districts have successfully combined PBS with mental health services to create school environments that are safer, more respectful, and better suited to learning. The approach is three tiered. For the 80 percent of students in the first tier, PBS creates "a social environment that reinforces positive behavior and discourages unacceptable behaviors." A second tier of students benefits from additional services, often provided coordination with the mental health system. Students in the third tier, who have the greatest needs, can be provided intensive services through partnerships between the school, the mental health system, other child-serving agencies, and the child's family. The report describes policy steps for local, state, and federal governments and presents information about funding sources for schoolwide PBS-mental health initiatives. The report and fact sheets can be purchased on the Bazelon Center's Web site at www.bazelon.org for $29 plus shipping. Two checklists for use by advocates working to promote such initiatives can be downloaded at www. bazelon.org/issues/education.

SAMHSA report on PASRR screening in nursing facilities: Medicaid regulations require states to maintain a Preadmission Screening and Resident Review (PASRR) program to screen nursing facility applicants and residents for serious mental illness. The program's intent is to ensure that individuals are placed in the most appropriate setting and have access to specialized mental health services. Recent studies have questioned the efficacy of the PASRR process. The Substance Abuse and Mental Health Services Administration (SAMHSA) conducted a national survey to determine how states organize and administer federal PASRR requirements. Site visits were made to 24 facilities in four states, where interviews were conducted with administrators and residents and medical records were reviewed. Results of these efforts are presented in an 85-page report, PASRR Screening for Mental Illness in Nursing Facility Applicants and Residents . The survey found wide variation in how PASRR programs are organized and administered. Medical records indicated that few residents receive in-depth level II screening, which is required when level I screening indicates potential mental illness. Lack of oversight was the most frequently cited weakness of PASRR programs, and lack of resources was cited as the chief barrier to effective implementation. The report is available on the SAMHSA Web site at www.mentalhealth.samhsa.gov.

Training package for therapeutic community staff: Therapeutic communities have evolved to serve a range of special populations with substance use disorders, including women with children, older adults, adolescents, and individuals with co-occurring disorders or HIV-AIDS. The Center for Substance Abuse Treatment has developed a curriculum and training package to help supervisors provide new staff members with an understanding of the therapeutic community model and an appreciation that they are part of a long tradition of community as a method of treatment. The package contains a trainer's manual and a CD with PowerPoint slides for the curriculum's 11 modules. A participant's manual includes orientation materials, resource sheets, module summaries, and a module review that functions as a learning assessment. The training package is designed to be used by either experienced trainers or program supervisors who have limited training experience. Curriculum materials are available free of charge from the National Clearinghouse for Alcohol and Drug Information (800-729-6686) and can be downloaded from the Knowledge Application Program Web site at www.kap.samhsa.gov.

Treatment Improvement Protocol on detoxification: The Substance Abuse and Mental Health Services Administration (SAMHSA) has released a new Treatment Improvement Protocol (TIP 45) Detoxification and Substance Abuse Treatment . The 245-page TIP, which was developed by an expert consensus panel, provides information about the physiology of withdrawal, pharmacologic advances in the management of withdrawal, patient placement procedures, and management of detoxification services within comprehensive systems of care. Special considerations are outlined for individuals from diverse cultural and ethnic backgrounds or with co-occurring mental or medical disorders. The primary audiences include substance abuse treatment counselors, administrators of detoxification programs, state agency directors, psychiatrists and other physicians, nurses, and psychologists. A secondary audience includes primary care providers, staff of managed care and insurance carriers, and others involved in planning, evaluating, and delivering services. TIP 45 is available free of charge from the National Clearinghouse for Alcohol and Drug Information (800-729-6686). It can be downloaded from the Clearinghouse Web site at http://ncadi.samhsa.gov.

New NMHA president and CEO: The board of directors of the National Mental Health Association (NMHA) has appointed David L. Shern, Ph.D., a leading mental health researcher, as the organization's new president and chief executive officer. Dr. Shern, who will begin his official duties on a full-time basis in September, is dean of the Louis de la Parte Florida Mental Health Institute at the University of South Florida. During his 30-year career, Dr. Shern has helped reengineer mental health care systems in Colorado, New York, and Florida. "I am honored to join NMHA and excited to be part of its long-standing legacy of promoting mental health and ensuring access to quality mental health services," Dr. Shern stated in a press release announcing his appointment. "Our science base has never been stronger, and NMHA will be instrumental in translating this science into action. Communities are the bedrock of lasting change. With its 340 affiliates nationwide, NMHA is in a key role to create lasting change in the nation's response to mental health and mental illness every day and in times of crisis."