IPS: The mental health service conference Oct. 8-11, 2015. New York City Presenta'on: HIC Name: Tom van Mierlo N one (Poten'al) Conflict of interest None Sponsoring or research
www.hic-psy.nl �
'You never leave ill patients alone' � (2011) �
IPS: The mental health service conference Oct. 8-11, 2015. New York City Presenta'on: HIC Name: Joris Hendrickx N one (Poten'al) Conflict of interest None Sponsoring or research
High and Intensive Care J Hendrickx, psychiatrist Jfm.hendrickx@ggze.nl
Recovery means learning to deal with symptoms and vulnerability, winning back self-confidence, and, despite persis'ng symptoms, par'cipa'ng in life. (Plooy 2009).
Pa'ent Professional Family Evidence Beste Based prac'ces Care Consensus High and Intensive Care
Extra HIC Model Safety Room Intensive Care Preven'on Unit Seclusion Care Coördina'on Conversa'on Healing Environment Preven'on Hospitality Seclusion High Care Unit Outpa'ent care = leading Outpa'ent Triade Care
HIC Model HIC Intensive care Units Individual Space High Care Ward High Safety Facility
Extra HIC Model Safety Room Intensive Care Preven'on Unit Seclusion Care Coördina'on Conversa'on Healing Environment Preven'on Hospitality Seclusion High Care Unit Outpa'ent care = leading Outpa'ent Triade Care
Self control
First 24 hours: 7-step model 1. Hearty Gree'ng 2. Care Conference
First 24 hours: 7-step model 3. Risk taxa'on and signalisa'on plan 4. Psychiatric examina'on 5. Physical examina'on 5. Rou'ne Outcome Monitoring 6. Treatment plan
Digital White board
1 to 1 guidance
Extra HIC Model Safety Room Intensive Care Preven'on Unit Seclusion Care Coördina'on Conversa'on Healing Environment Preven'on Hospitality Seclusion High Care Unit Outpa'ent care = leading Outpa'ent Triade Care
Intensive Care Unit
IC: control of environment
Healing Environment: single person room
Healing environment: shared facili'es
Nursing Desk
Results GGzE: seclusion
Results GGzE: admission days gemiddeld opname duur in dagen per opname 36 35 34 33 gemiddeld opname duur per opname 32 Lineair (gemiddeld opname duur per opname) 31 30 29 28 2010 2011 2012 2013 2014 2010 2011 2012 2013 2014
Results Breburg: Seclusion
Results Breburg: Admission days
Jfm.hendrickx@ggze.nl
IPS: The mental health service conference Oct. 8-11, 2015. New York City Presenta'on: HIC Name: Bram Berkvens Philips (Poten'al) Conflict of interest None Sponsoring or research
Recovery Supportive Care in High & Intensive Care IPS APA Conference New York Oktober 2015 Bram Berkvens �
� � � � Introduction � Bram Berkvens Certified peer support specialist � Manager Recovery center � Mental Health institute GGz Breburg � Tilburg, The Netherlands � Board member HIC Foundation, the Netherlands �
A new development! �
"You will not abandon a mentally ill client” �
The High & Intensive Care model has some significant recovery elements in it: Recovery supportive care • Empowerment Experience and knowledge • Self Directed Care •
What is Recovery Supportive care? Recovery Supportive care means that treatment is entirely focused on the four domains of recovery: health • daily functioning • full citizenship • Identity • (Strangles & Plooy, 2010)
Peer support specialists is a must! create hope (clients and family) • belief in possibilities, not impossibilities • bridge builder • improving the quality of care • (Voskes, 2010)
Healing environment is an essential element �
Thank you very much for your attention! � b.berkvens@ggzbreburg.nl One of our new HIC units, opening next week �
IPS: IPS: The mental health service conference Oct. 8-11, 2015. New York City � Presentation: HIC � Name: Niels Mulder � N one (Poten'al) Conflict of interest None Sponsoring or research
High & Intensive Care: Research results Prof. Niels Mulder, Dr. Yolande Voskes & Laura van Melle, Msc, Dr. Eric Noorthoorn Research Programme > Quality of Care
HIC development HIC MONITOR
Research Questions Main question: how do we know whether the HIC monitor is a good instrument for assessing the HIC model? Sub questions: 1) Is the HIC-monitor valid and reliable as an indicator of HIC model-fidelity? 2) Are HIC-monitor scores associated with use of coercion?
Participating centers (N=21) Altrecht GGZ Oost-Brabant Arkin GGZ Noord-Holland-Noord Dimence Lentis Emergis Mondriaan GGZ Breburg Parnassia Bavo groep GGZ Centraal Reinier van Arkel GGZ Delfland Rivierduinen GGZ Drenthe Vincent van Gogh GGZ Eindhoven Yulius GGZ Friesland Tactus GGZ InGeest
24 auditors who did clinical audits using HIC-monitor • Geneviève van Tuijn (Vincent van Gogh) • Stijn Hagenaars (Altrecht) • Jeroen van de Sande (Vincent van Gogh) • Imre Feliks (Altrecht) • Ymke Sant (Vincent van Gogh) • Mark Hoppenbrouwer (Arkin) • Gerrit Kroes (Tactus) • Koos Klungers (Dimence) • Co Engelsman (Dimence) Oud auditoren: • Eveline Duimelaar (GGZ Breburg) • Yvette Huige (Delfland) • Harold Oole (GGZ Centraal) • Jolanda Damsma (Yulius) • Lydia Dijkshoorn (GGZ Delfland) • Richard Weening (GGZ Drenthe) • Karin Lorenz-Artz (GGZ Eindhoven) • Esther Pols (GGZ Eindhoven) • Caspar Lam (GGZ Friesland) • Bouke Bijnsdorp (GGZ inGeest) Coördinatie audits: • Martijn Kemper (GGZ inGeest) • Jurgen van der Meijs (GGZ Breburg) • Annette Hornbach (GGZ inGeest) • Ton Dominicus (GGZ Oost Brabant) Secretariële ondersteuning • Patricia Sterken (GGZ Oost Brabant) • Marrie Venderink (Lentis) • Linda van Dorp (GGZ Breburg) • Paola Geijselaers (Mondriaan) • Yvonne Winkelmolen (Rivierduinen)
HIC Monitor: 61 items, 11 scales – Team structure – Team process – Diagnostic tools – Care organisation – Care monitoring – Professionalization – Law implementation – Electronic dossier – Architectural features – Safety measures – Coercive measures feedback
Data collection • 38 Audits • 38 Focus groups (feedback of HIC monitor scores) • 41 Interviews • 4 Intervisions met auditoren • Data on coercion 2014
Validation process HIC-monitor Developing Adjustment Valid and Testing: Analysing the HIC of HIC reliable audits data Monitor Monitor Monitor
How did the auditors score? • 65 items, 5-point scale, 11 dimensions – Minimum score: 65 – Maximum score: 325 Mean score: 188 Lowest score: 126 Highest score: 258
Remarkeble scores High scores (>4) Low scores (<2) Amount of staff Variety of disciplines Direct comprehensive assessment Digital whiteboard Conflict management and Dual diagnosis treatment personal safety Facilities: outer space, variety of Facilities: meeting rooms ICU, appropriate seclusion room, open work space No waiting list Team spirit
Quality of the HIC-monitor • Validitity 1. Constructvalidity 2. Contentvalidity • Reliability 3. Interrater reliability
1) Constructvalidity Does the monitor discriminate between wards that were expected to score high versus wards that were expected to score low? p = <.001.
2) Content validity: using focus groups Items and scales were well recognized – Team structure – Team process – Diagnostic tools – Care organisation – Care monitoring – Professionalization – Law implementation – Electronic dossier – Architectural features – Safety measures – Coercive measures feedback
3) Interrater reliability Interrater reliability of two independent raters? • Aim: minimal 80% identical, with max 1 point difference allowed • HIC monitor: 79% • After removal of five troublesome items: 82%
SCORES ON HIC MONITOR AND USE OF COERCION
Sample • 7414 patients • 11426 admissions • 19 mental health institutes • 32 intensive care wards • 80% of all institutes in the Netherlands • 82% catchment area of the Netherlands • 79% of the Dutch beds within mental health institutes • Excluded: • Psychiatric wards at general hospitals • Forensic Hospitals • Admission wards in addiction mental health institutes • Admission wards in child mental health institutes • (Admission) wards in hospitals for patients with learning disabilities
Sample • Male 57% • Mean age 42 years • Diagnoses: – No diagnosis (admitted to short): 19% – Adjustment disorders: 7% – Anxiety disorders 5% – Mood disorders: 10% – Bipolar disorders 9% – Psychotic disorders 26% – Organic disorders 1% – Drug abuse 24%
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