IPS: The mental health service conference Oct. 8-11, 2015. New York - - PowerPoint PPT Presentation

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IPS: The mental health service conference Oct. 8-11, 2015. New York - - PowerPoint PPT Presentation

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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)

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(Poten'al) Conflict of interest

None

Sponsoring or research None

IPS: The mental health service conference Oct. 8-11, 2015. New York City Presenta'on: HIC Name: Tom van Mierlo

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www.hic-psy.nl

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'You never leave ill patients alone' (2011)

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(Poten'al) Conflict of interest

None

Sponsoring or research None

IPS: The mental health service conference Oct. 8-11, 2015. New York City Presenta'on: HIC Name: Joris Hendrickx

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High and Intensive Care

J Hendrickx, psychiatrist Jfm.hendrickx@ggze.nl

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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).

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High and Intensive Care

Consensus Beste prac'ces Evidence Based Care

Professional Family Pa'ent

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Extra Safety Room

Healing Environment Hospitality Triade

Intensive Care Unit

Outpa'ent Care Preven'on Seclusion Preven'on Seclusion Care Coördina'on Conversa'on Outpa'ent care = leading

HIC Model

High Care Unit

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HIC Model

HIC

High Care Ward Intensive care Units Individual Space High Safety Facility

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Extra Safety Room

Healing Environment Hospitality Triade

Intensive Care Unit

Outpa'ent Care Preven'on Seclusion Preven'on Seclusion Care Coördina'on Conversa'on Outpa'ent care = leading

HIC Model

High Care Unit

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Self control

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First 24 hours: 7-step model

  • 1. Hearty Gree'ng
  • 2. Care Conference
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First 24 hours: 7-step model

  • 3. Risk taxa'on and

signalisa'on plan

  • 4. Psychiatric

examina'on

  • 6. Treatment plan
  • 5. Rou'ne Outcome

Monitoring

  • 5. Physical examina'on
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Digital White board

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1 to 1 guidance

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Extra Safety Room

Healing Environment Hospitality Triade

Intensive Care Unit

Outpa'ent Care Preven'on Seclusion Preven'on Seclusion Care Coördina'on Conversa'on Outpa'ent care = leading

HIC Model

High Care Unit

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Intensive Care Unit

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IC: control of environment

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Healing Environment: single person room

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Healing environment: shared facili'es

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Nursing Desk

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Results GGzE: seclusion

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Results GGzE: admission days

28 29 30 31 32 33 34 35 36 2014 2013 2012 2011 2010

gemiddeld opname duur in dagen per opname

gemiddeld opname duur per opname Lineair (gemiddeld opname duur per opname)

2010 2011 2012 2013 2014

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Results Breburg: Seclusion

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Results Breburg: Admission days

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Jfm.hendrickx@ggze.nl

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(Poten'al) Conflict of interest

Philips

Sponsoring or research None

IPS: The mental health service conference Oct. 8-11, 2015. New York City Presenta'on: HIC Name: Bram Berkvens

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Recovery Supportive Care

in High & Intensive Care

IPS APA Conference New York Oktober 2015 Bram Berkvens

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Introduction

Bram Berkvens

Certified peer support specialist

  • Manager Recovery center

Mental Health institute GGz Breburg Tilburg, The Netherlands

  • Board member HIC Foundation, the Netherlands
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A new development!

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"You will not abandon a mentally ill client”

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The High & Intensive Care model has some significant recovery elements in it:

  • Recovery supportive care
  • Empowerment Experience and knowledge
  • Self Directed Care
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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)

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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)

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Healing environment is an essential element

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Thank you very much for your attention!

b.berkvens@ggzbreburg.nl

One of our new HIC units, opening next week

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(Poten'al) Conflict of interest

None

Sponsoring or research None

IPS: IPS: The mental health service conference Oct. 8-11, 2015. New York City Presentation: HIC Name: Niels Mulder

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Quality of Care Research Programme >

High & Intensive Care: Research results

  • Prof. Niels Mulder,
  • Dr. Yolande Voskes & Laura van Melle, Msc,
  • Dr. Eric Noorthoorn
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HIC development

HIC MONITOR

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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?

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Participating centers (N=21)

Altrecht Arkin Dimence Emergis GGZ Breburg GGZ Centraal GGZ Delfland GGZ Drenthe GGZ Eindhoven GGZ Friesland GGZ InGeest GGZ Oost-Brabant GGZ Noord-Holland-Noord Lentis Mondriaan Parnassia Bavo groep Reinier van Arkel Rivierduinen Vincent van Gogh Yulius Tactus

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24 auditors who did clinical audits using HIC-monitor

  • Stijn Hagenaars (Altrecht)
  • Imre Feliks (Altrecht)
  • Mark Hoppenbrouwer (Arkin)
  • Koos Klungers (Dimence)
  • Co Engelsman (Dimence)
  • Eveline Duimelaar (GGZ Breburg)
  • Harold Oole (GGZ Centraal)
  • 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)
  • Martijn Kemper (GGZ inGeest)
  • Annette Hornbach (GGZ inGeest)
  • Ton Dominicus (GGZ Oost Brabant)
  • Patricia Sterken (GGZ Oost Brabant)
  • Marrie Venderink (Lentis)
  • Paola Geijselaers (Mondriaan)
  • Yvonne Winkelmolen (Rivierduinen)

Oud auditoren:

  • Yvette Huige (Delfland)
  • Jolanda Damsma (Yulius)

Coördinatie audits:

  • Jurgen van der Meijs (GGZ Breburg)

Secretariële ondersteuning

  • Linda van Dorp (GGZ Breburg)
  • Geneviève van Tuijn (Vincent van Gogh)
  • Jeroen van de Sande (Vincent van Gogh)
  • Ymke Sant (Vincent van Gogh)
  • Gerrit Kroes (Tactus)
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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

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Data collection

  • 38 Audits
  • 38 Focus groups

(feedback of HIC monitor scores)

  • 41 Interviews
  • 4 Intervisions met auditoren
  • Data on coercion 2014
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Validation process HIC-monitor

Developing the HIC Monitor Testing: audits Analysing data Adjustment

  • f HIC

Monitor Valid and reliable Monitor

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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

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Remarkeble scores

High scores (>4) Low scores (<2) Amount of staff Variety of disciplines Direct comprehensive assessment Digital whiteboard Conflict management and personal safety Dual diagnosis treatment Facilities: outer space, variety of meeting rooms Facilities: ICU, appropriate seclusion room,

  • pen work space

No waiting list Team spirit

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Quality of the HIC-monitor

  • Validitity

1. Constructvalidity 2. Contentvalidity

  • Reliability

3. Interrater reliability

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1) Constructvalidity

p = <.001. Does the monitor discriminate between wards that were expected to score high versus wards that were expected to score low?

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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

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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%
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SCORES ON HIC MONITOR AND USE OF COERCION

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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
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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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Coercion outcome

HIC score N wards Seclusion hours Number

  • f

Incidents Hours per admission hours** Enforced medication Medication Events per adm days*

High > 184 17 40476 hours 690 0.0258 538 0.0162 Low < 184 16 76847 hours 1404 0.0420 1030 0.0207

**Significant differences student t test p<0.001 *Significant differences student t test p<0.05

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Conclusions

  • The content-, and construct validity and interrater

reliability of the HIC monitor are acceptable

  • Some adjustments need to be made to the

monitor

  • Wards showing relatively high HIC monitor scores

use less seclusion and less enforced medication

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Future

  • Control for patient characteristics
  • Collecting data on patient, relatives and staff

satisfaction and study its association with HIC monitor scores

  • Study association with duration of admission
  • International use of HIC model and monitor
  • Certification of HIC model
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www.hic-psy.nl