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Wednesday, July 30, 2014

Citizens Advisory Board updated on MHI, CCUSO

Wednesday, November 4, 2009

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Dr. Daniel Gillette (standing) , Superintendent of the MHI at Cherokee, led off Friday's meeting with the Citizens Advisory Board. Photo by Dan Whitney
The Citizens Advisory Board met on Friday at the Cherokee Human Resource Center for their quarterly meeting, and board members were updated on activities at the Cherokee Mental Health Institute and Civil Commitment Unit for Sexual Offenders (CCUSO).

MHI Superintendent Dr. Daniel Gillette reviewed the visit of the MHI Task Force. He stated that the Task Force is expected to make its report to the Department of Human Services around December 15 of this year. After they report their findings, the DHS will then make a recommendation to the state legislature sometime after the first of the year. That recommendation may be to close one of the state's four MHIs, or they may even possibly recommend keeping all four MHIs open.

Dr. Gillette suggested that anyone present who wished to contact their legislators and "put in a good word" for keeping the Cherokee MHI open would certainly not be discouraged from doing so.

Dr. Gillette also spoke about a different Task Force, an Acute Care Task Force, which is advocating keeping all four MHIs open, but turning them all into sub-acute care facilities. He said that he has not spoken to this group, but his own personal preference would be to retain the MHIs, but then re-work the current reimbursement system, making it more appealing for private entities to create more residential care facilities, like the Plains Area RCF, which would be less expensive for funders, like the county or insurance companies, than either general hospitals or MHIs. This would also create a larger number of placement choices for discharged MHI patients.

Dr. Gillette also mentioned several "good news" items of which he had become aware in recent weeks:

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Director Dr. Jason Smith discussed the CCUSO Program at Friday's Citizen's Advisory Board Meeting at the MHI. Photo by Dan Whitney
1) The Joint Commission on the Accreditation of Hospitals (JCAHO) recently put out a publication citing the Cherokee MHI's recent switch to an electronic medical records system and things that the MHI staff had done to correct and rectify problems they encountered.

2) The American Heart Association has interviewed MHI staff and are planning an article on things that the MHI staff has done to eliminate confusing medical abbreviations.

3) Someone from the state of New Hampshire called the Cherokee MHI for recommendations on developing treatment plans, at the suggestion of a chart reviewer who informed them that Cherokee MHI had "the best treatment planning (he had) seen."

CCUSO Director Dr. Jason Smith spoke next, and he refreshed CAB members on the history of the CCUSO facility. The CCUSO was created by a 1198 legislative act and opened in 1999. Though it is housed on the MHI grounds, and they share some services, CCUSO is a separate entity of the Department of Human Services.

CCUSO has 94.5 full-time employees, providing 24/7 coverage. CCUSO has two employees working on each residential ward and one who is stationed in the ward office. They currently have 80 residents, all of whom were commited to the CCUSO Program. They receive an average of eight new admissions a year, and their current population ranges in age from 25 - 81 years old, with an average age of 48.5.

Thirteen CCUSO residents have been released back into a community, all through court action. Dr. Smith stated that they do currently have one resident who they feel they may be able to recommend for community release, feeling that he will probably have met the criteria for this disposition soon.

Dr. Smith concluded his presentation by showing some slides of the interior rooms of the CCUSO building.

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MHI Social Worker Rashel Nixon (second from left) discussed the MHI's Pro-Act Training program with members of the Citizen's Advisory Board on Friday. Photo by Dan Whitney
The program concluded with a presentation by Rashel Nixon, LBSW, who is a Social Worker at the MHI. Nixon is in charge of training MHI employees about restraint and seclusion. She said that the MHI now uses the Pro-Act method, developed in 1975, and it focuses more on verbal de-escalation of patient behavior, crisis intervention and problem solving. Though they also include the use of mechanical restraints and seclusion as part of the training, it is a minor part, and restraint and seclusion are now used only as a last resort. The use of restraint and seclusion at MHI has gone down dramatically over the last decade.

MHI employees undergo 16 hours of mandatory training in verbal de-escalation and another eight hours in the use of restaraint and seclusion, and have to display their competence before being certified. They then undergo a mandatory 12-hour refresher course every three years with full training in order to be re-certified.

A modified version of the course is also provided for support staff, who are also required to attend and be certified.

Nixon stated that the Pro-Act course is really a kind of "Human Behavior" course, helping staff understand patient needs and why they are at the MHI, and also helping staff better prepare for work, taking a look at such things as their own attitude, the way they dress, appropriate ways to effectively react to situations, and exercising self-control and not always immediately acting on their feelings.



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