Posts Tagged ‘recovery’

State Hospital Becoming a National Model

August 7th, 2013

Operating any type of medical or behavioral health facility is a balancing act.  It’s especially delicate at the Arizona State Hospital because we deal with patients who suffer from the most severe symptoms of mental illness.  Treatment practices at ASH has changed through the years to reflect contemporary approaches.  Decades ago, people with mental illness were heavily medicated and expected to stay in an institution for the rest of their lives.  Now we know that most mental illnesses are like other chronic diseases… and that with good medication management, therapy, and lifestyle changes, people can live healthy, productive lives.

Which brings me to the topic of the changes we made in the last couple of years at ASH to improve outcomes.    We converted from a 911-style response to an impending or active crisis to a system that uses more direct care staff who are all trained to help de-escalate the situation immediately.  It’s called Non-Violent Crisis Intervention.  As you might expect, we used evidence to drive our decision-making before we moved to this new model.   We researched the system before we changed and are tracking the results – and the results have been very good. 

In the first few months, we noticed a difference in patient outcomes – there were fewer times a crisis escalated into a major incident and when they did, fewer patients had to be restrained. That’s another benefit of having more direct patient care staff – teams build rapport with patients which helps prevent situations from escalating in the first place. It also provides teaching moments for patients.  Early in a developing situation, teams work with patients to help them understand the consequences before something happens – a principle of Recovery.

We’re now entering the 2nd full year of the Culture of Care and the response from patients and staff is encouraging.  Since it started, we’ve trained 748 staff on Non-Violent Crisis Intervention including on-going practice activities.  One of the ways that we track the success is the number of injuries to staff and patients.  Injuries happen in every business, so we focus on injuries that are tied to interactions with patients – everything from a push, shove or scratch to spitting or more serious injuries is counted. 

For example, the number of workers’ compensation claims we have from staff dropped from 311 in 2011 to 101 in the first six months of 2013.  That trends out to a one-third drop in claims… something any business would be proud to report.  Our increased and more robust effort to capture each incident- no matter how minor- means the raw number of reports are a little higher, but about 90% of the time when an incident report is generated, staff require no medical attention or simple first-aid like a Bandaid.  At the end of the day, safety is a priority at the hospital.  The Joint Commission  considers safety as part of the stringent review it does before accreditating a hospital; The Joint Commission accredited ASH in November of 2011.

As a result of our progress in establishing our Culture of Care, the Arizona State Hospital has been invited by the National Council of Behavioral Health to become a Trauma Informed Care Community.  I know that the transition to the evidence-based Non-Violent Crisis Intervention approach hasn’t been easy, and I really appreciate the work our excellent staff at ASH does for our patients and residents in their path to Recovery.  Well done.

ASH CEO Position

May 15th, 2013

Now that Cory Nelson has officially been appointed as our Deputy Director for Behavioral Health, we’re moving full steam ahead to recruit for the Chief Executive Officer of the Arizona State Hospital.  The CEO is a critical member of our team and has the responsibility of managing the day-to-day operations of the civil, forensic and sex offender units located on the campus.  This is a great opportunity for someone interested in being part of some of the most exciting changes happening at the hospital in years.  

Recently the hospital hit ten-month lows in the use of seclusion, restraint and patient falls… all as a result of new efforts that have been put in place to create culture change that engages patients and staff in the overall success of treatment.  The focus on Recovery, Trauma Informed Care using evidenced-based are all coming into full swing and present opportunities to even further improve the lives of patients on the campus.  Anyone interested in applying of for the position should submit an application through the State of AZ Jobs Site and look under the Department of Health in the agency section.


Recovery WORKS Newsletter

April 17th, 2013

In our April issue of Recovery WORKS you’ll find inspiring recovery stories, behavioral health news, resources, and information from our community. Our featured peer success story this month is about MedHat Zekri, a peer who’s been able to overcome severe depression, anxiety and stress and is being very successful in achieving his life’s goals.  In our “Healthy Living” section you’ll find information and tips for enjoying a healthy lifestyle with focus on eye safety. In our “Dimensions of Wellness” section you’ll see information about the “Financial Dimension of Wellness”.

Each issue explores one of the 8 dimensions of wellness and provides ideas and resources to help address that particular dimension of wellness in your life. We hope you’ll continue to find inspiration, encouragement, and practical knowledge through this publication.  Here’s how to sign up to get future issues.

Helping Kids Recover

February 26th, 2013

Our Vision at the Arizona Department of Health Services is, ”Health and Wellness for all Arizonans.”  Part of our mission includes helping individuals with substance abuse issues achieve and maintain self-reliance and independence.  To get there, some individuals simply need occasional outpatient services.  Some need wrap-around, community or home-based services.  Others require more intensive treatment in a residential setting.  Our goal is to provide the most effective kind of treatment to suit every individual’s unique needs. While no two paths to recovery will ever be identical, we do know this: young people recover better in settings as close to home as possible. 

Over the past two years, we’ve taken that knowledge to heart – and our actions have paid dividends. We’re matching more people with effective wrap-around services like in-home counseling, high-needs case management, home-care training, peer support, respite, family support and skills training.  In turn, we’ve reduced the need for care in licensed high-level Residential facilities by 75% in Maricopa County. However, outpatient treatment, home and community-based services can’t always provide the level of treatment people need.  Some individuals require more intensive treatment that only a licensed and regulated residential facility can provide.  

A series of reports in The Republic this week suggests that some juvenile residential treatment facilities in our state are substandard.  While no facility is perfect, our inspectors are well-trained and highly-motivated to ensure each of our licensed residential treatment facilities meets State standards. Those that fail to meet these standards must implement an immediate corrective action plan. 

We inspect residential treatment facilities at least once a year — more often when we receive complaints. When we inspect facilities, our teams make decisions based on evidence. We talk to the residents and the staff; we look at patient and personnel records (including video records); we observe facility practices and examine physical evidence. This helps us separate legitimate complaints and concerns from those that are baseless or intentionally fabricated.  We receive dozens of incident reports every day, which we carefully and promptly evaluate. It’s unusual that a report poses a health or safety problem. But when a situation that does is brought to our attention, we immediately send staff to the facility. 

Successful residential treatment facilities are pro-active, follow their policies and procedures without fail, are meticulous in reporting and documentation and seek ongoing education. They’re not afraid to admit a mistake. Our job is to ensure that facilities comply with our standards and maximize their effectiveness. That’s why our licensing teams also focus on ways to improve our licensed facilities and our Behavioral Health team focuses on the evidence-based treatment that’s best for the patient. Additionally, we’ve been overhauling many regulations to ensure our standards focus on the most important components of care. 

Our actions as an agency must be based in fact and rooted in the evidence demonstrated by a comprehensive review of the facility in question. You can view factual information about the more than 7,400 facilities we license by visiting


Outcomes: Public Health’s Lighthouse

October 16th, 2012

One of our primary objectives over the last couple of years has been to shift the focus of our performance measures away from process and procedures toward actual outcomes.  In other words, we don’t want to measure our success on whether someone’s paperwork is right, but on whether the services we provide actually help folks achieve their recovery goals.  That’s why it’s so exciting to see the system continue to develop easy-to-use behavioral health outcomes dashboards as a new performance tool and to inform consumer choice. 

Outcome Dashboards are like a scorecard- allowing folks to easily review performance and outcomes information (employment, housing, staying out of crisis centers, abstaining from substance abuse, avoiding arrests, etc.) at the at the tip of a finger by region of the state.  Links are also included so the user can then visit dashboards developed by each Regional Behavioral Health Authority, where provider-level performance can be reviewed. 

Our updated Behavioral Health System Performance Framework and Dashboard provides an easy to read outcomes summary including dials for Quality of Life, Access to Services, Service Delivery, and Coordination/Collaboration metrics.  Each category includes demographic data provided by clients, audits of client records, analysis of claims and survey data reported by the Regional Behavioral Health Authorities.

Acting Deputy for Behavioral Health

August 5th, 2012

Thanks for your patience as we developed our continuity plan for leadership in our Division of Behavioral Health.  I know you’re  all anxious to hear the transition plan for after Dr. Nelson leaves on August 24.  Fortunately, we are very lucky to have so many strong leaders here at the agency, including a really great team of DBHS Branch Chiefs and Bureau Chiefs.  Many of you will be key in helping to make this time period a success, and we’ll be looking to you to keep our great momentum going!

We’ve already posted the Deputy Director position and have had interviews underway for the Assistant Director position.  I think we’ll move smoothly with filling both of these positions permanently in the near future.  In the interim, I’ve asked Cory Nelson, AZ State Hospital CEO to serve as the Acting Deputy Director- and he’s agreed to help out.  Cory will spend the next three weeks working closely with Dr. Nelson and the rest of the team and should have no problem getting up to speed- as he’s a quick study.  This plan will offer a great opportunity to further strengthen our important link between the Hospital and the community-based behavioral health system.  It’ll also bring in additional people-power to DBHS during this incredibly busy time.  Cory has a great team at the Hospital as well and they’re up to the task of picking up some of Cory’s day-to-day work there.  Donna Noriega will be leading the team at the hospital as Acting CEO and will be working closely with the rest of the leadership team to make sure the great things happening there keep moving forward.

Some may ask why Bob Sorce, our fearless Assistant Director, has not been asked to serve as Acting Deputy Director. While Bob is very capable and no doubt would do a good job in that role, his current assignment in managing the Maricopa County RBHA RFP project is at a critical stage with the expected release of the RFP next month. Given the importance of this project, I am not willing to disrupt the positive momentum that has been building over the last several months by reassigning him to a different position.   Bob, along with the rest of the RFP Core Team must continue to spearhead  this important work as well as prepare for the monumental changes to health care that are expected on January 1, 2014 when federal healthcare reform is set to kick in.  Bob will also serve as back-up to Cory and assist whenever needed.  As I have previously said, we’ll continue with our mission as a team and I feel good about the team we have in place.

It’s nice to know that we have a strong team in place throughout the Agency- which gives me comfort that we’ll make it through this transition effectively.

Recovery Works Newsletter

July 13th, 2012

Check our our July Recovery WORKS Newsletter.  It’s full of excellent inspirational stories about Recovery and is a great source of news and other community information.

Public Health Budget

May 9th, 2012
 The Governor signed the budget this week – here’s a look at how some of it affects public health:

Behavioral Health Services for folks that don’t Qualify for Medicaid

The budget that was just signed includes about $39M in new funding for services for folks with a serious mental illness that don’t qualify for Medicaid.  With it, we’ll be able to provide some services like supported employment and housing, peer and family support, living skills training, and health promotion to help folks along their Recovery journey.  We’ll also be expanding the list of medications for the folks with a serious mental illness so it matches the list for folks that qualify for Medicaid.  Our behavioral health team has already begun working closely with the RBHAs, providers, and members/families to plan for the most effective use of this funding.

Newborn Screening

Our newborn screening program has been running in the red for the last couple of years- despite the fact that we’ve squeezed just about every efficiency out of the program and are collecting more than 95% of our service fees.  The current screening fee is $30 for the 1st (hospital) screen and $40 for the 2nd (which happens in the pediatric office a couple of weeks after birth).  These fees haven’t been raised in several years- meanwhile the instruments and reagents we use have become increasingly expensive.  We’ve been supplementing the program with Title V funds that really should be used for other more effective purposes. The budget that was just signed allows us to set new fees for the 2nd screen in Rule…  and we’ll be starting that process shortly.

County Contribution toward Hospital Patients and Residents

The “Budget Reconciliation Bill” or BRBs included specific instructions regarding how much counties are obligated to pay (50%) for the patients and residents at the Hospital and ACPTC (the sexually violent person’s unit).

ASH Administration building

Hospital Operating Fund

Despite all our efforts to reduce overtime, cut shift overlap, streamline services and other efficiency measures- our hospital operating fund was headed for big trouble next fiscal year- partly because the Hospital Fund (which had provided funds to operate the Hospital) went dry. The state budget that was just signed rescued us from needing to cut our staffing ratio’s to below Licensing standards (which would have put us in jeopardy of losing Medicare and Medicaid funds).  Whew.

100 Years (actually more) of the AZ State Hospital

February 16th, 2012

Check our excellent new web page about the history of the AZ State hospital. The stuff on the new hospital history page is fascinating. One of the things that struck me is that the issues of concern to the Superintendent of the Hospital 100 years ago were remarkable similar to today. The 100 year old documents we have talk about things like staff shortages, salaries, budget shortfalls and building maintenance and renovation. All of these are still relevant today! Of course, we’ve made huge strides in treatment, patient therapy techniques and implementation, overcrowding, patient quality of life and community reintegration- so in those respects today’s hospital is nothing like it was 100 years ago. The hospital continues to be innovative leaders in mental health for the state of Arizona. We anticipate the next 100 years to be filled with hope and promise.

Hospital Visitation Refresh

November 18th, 2011

Over the last few weeks, we’ve been working on ways to engage family members in the treatment of patients- as part of our continuing efforts to promote a culture of care at the hospital that reflects recovery and resilience.  One of those ways is to make sure that our policies make it easier for family members to visit the hospital… and our teams have been working on a new visitation policy for the last few weeks.  It may sound like an easy task to just change a policy- but there are actually lots of details that need to be worked out before the changes can occur.  Things like…  Do we have the right number of staff on at the right time?  How do we make it work so that family members can enjoy a meal at the hospital?  Are there any new safety and security issues we need to take into consideration? 

Our hospital team worked through those kinds of questions- and Monday we’ll be rolling out our new expanded visitation hours including a more friendly visitation protocol with more flexible criteria for food and gifts.  We think it’ll help create a more therapeutic environment for the patients and will make it easier for family members to participate in the Recovery process.  Here are some answers to frequently asked questions about the new visitation policy and hours.