Behavior Reduction Across the Spectrum for Seniors (B.R.A.S.S.)

Sandra Psiurski, RPC, RPN Interior Health Authority February 2013

AIM To increase frontline residential staff confidence

and ability to manage residents identified as belonging to a special population, who present with behavioural challenges which

– interfere with or inhibit others quality of life – occur repeatedly – places the resident or others at risk for injury – does not respond to routine interventions. – exhaust staff

The case that sparked the start of B.R.A.S.S.

...Looking for that magical elixir to cure our elderly woman!

(Risperdal, Loxapine, Trazodone, Ativan, Valproic, Zopiclone, mixed with a little Seroquel dust...)

over 5 days......

How are behaviors viewed? • CURRENT APPROACH: • Medicate the behavior • Admit to hospital

• WHY? • Fear • Personalizing behavior as action against us

• NEW FOCUS • Understand behavior is communication • Manage resident in the residential facility

WHY BUILDING CONFIDENCE & CAPABILITY IS IMPORTANT

IF COSTS WERE CALCULATED AS: Management - Outside counsel - Debriefing - Recruiting and training new staff - MOUNTAINS OF PAPERWORK CONSEQUENCES FOR NOT BUILDING CONFIDENCE...

• appeasing, calming, counseling or disciplining • reorganizing departments, reassigning staff • managing burnout, decreased commitment, and increased distress • addressing the media

ORGANIZATION – YOU LOSE STAFF BY DEFLATION OR DEFECTION - Impaired ability to attract the brightest and the best to work with you. •Adapted from Sutton, Robert (2007) “No Asshole Rule”.

Managing Behaviours

Features of successful management plans – Tailored to individual's needs – Explicit goals, clearly formulated – Realistic and prioritized goals – Long-term and short term goals – Attempt to reach shared expectations – Consistent and tolerant approach – Multi-disciplinary

Davison, Sophie A (2002)

3/5/2013 6

Addressing Behaviors For many staff, addressing behaviors presented by

our seniors seems as foreign as understanding shark behavior –

The fear is of the unknown Providing education has created pockets of success What gaps do we need to address to create spread

throughout the organization?

7

PROFICIENCY

You didn’t become proficient overnight, in one day, in one training, in an online session... it took repetition, making mistakes, and having support to help you improve.

CREATE A TIMELINE

10

Born 1929 – Age 83

Raised during the Dirty 30’s, dustbowl, poverty

Fought in the (forgotten) Korean War 1950 – 1953 Aged 21 - 23

Was a young adult, got married, Canada opened first TV station, TV dinners arrived, Drive in diners and theaters were the place to go…cool cars….

1940 – 1965 period of rebellion, lawlessness, prohibition, rationing didn’t end until 1954

Raised children through the 50’s & 60’s , Dr. Spock, self – esteem, different cultural focus

TV SHOWS – MORE THAN JOHN WAYNE! MUSIC – ROCK N ROLL – MORE THAN ELVIS!

You can’t know where you are going if you don’t know where you’ve been

• WE DON’T HAVE ANYONE WHO CAN PROVIDE US WITH HISTORY

• Hmmm… do what an archaeologist does – DIG FOR IT

The Archaelogical Dig 11

PILOTS

• Cottonwoods, Kelowna is an IHA Owned and operated, 254 residential care beds

• Hamlets of Penticton is a 103 residential care beds with 75 beds funded through IHA.

• Village by the station is a private partner with 100 residential care beds total: (4) 10 bed dementia cottages, 60 complex care beds

SPECIAL POPULATIONS CONSULTATION EXPANDED PROJECT SCOPE:

Consultation for all Interior Health and their private contracted residential facilities

A full time consultant will be hired

The BRASS project will also continue for a few more months to allow quantitative data collection

REFERRAL NEEDS Short term assistance: <5 contacts with facility Assist with care plan development

Connect with community services available to the facility Provide education Long term assistance: More routine contact daily, weekly or biweekly for a total of >5 contacts Staff education and support Care Plan development Possible site visits Assist in collaboration with community resources Family contact and collaboration

Types of referrals

~ 25% of referrals < 65

BEHAVIOR ISSUE RELATED TO: NUMBER DEMENTIA with Aggression 18 Acquired Brain Injury (CVA most common) 5 Personality Disorder/Components 15 Mental Illness (Depression, Anxiety, etc) 5 Neurological (Huntington, ALS, etc) 2 End of Life (EOL) 3 Developmental with behavior 1 Deceased before consult completion 1 Cancelled 3 TOTAL REFERRALS (Aug 2013 – Feb 2013) 53

DISCOVERIES • Every area of the IH Region has different

mandates for mental health services to residential facilities

• Skill set and mind set are varied from facility to facility.

• Skills need to improve in writing clear, concise care plans - too many are vague and are not individualized to be relevant to the resident

• Staff are eager to learn and will follow the process if supported by their managers

OVERALL COMMENTS • Presence of a consultant has made a difference in

the region • Staff feel hope knowing someone is here to help

them • Staff confidence levels have increased • Educational presentations have been well

received and requested more widely for acute, community and family caregiver groups

• Requests for consultation from community agencies and acute systems

BRASS SUCCESS • Based on the comments we have received we

are on our way to meeting the aim to improve confidence and capability to address behavioral challenges within our residential facilities

• BRASS project will be extended to allow collection of more quantitative data

• A special populations consultant will be hired to continue the work that was started by this project.

Questions

Sandy P Sandra Psiurski, RPC RPN Interior Health Authority 550 Carmi Avenue Penticton, BC V2A 3G6 250-492-4000 X 2684 250-488-3429 Sandra.psiurski@interiorhealth.ca