HIM 510 milestone one

Overview: This is your first opportunity to begin working on your final project, which asks you to design and develop training materials. Recall that you identified a problem early on: staff’s common practice of forgetting to log off computers in public or clinical spaces, potentially allowing unauthorized persons to access protected PHI. Now, another serious issue involving the clinical staff has arisen. Various regulatory violations have been levied against the hospital. Specifically, the violations assert that discharge paperwork is not being completed correctly, with some not being properly signed. You realize that you need to create new policies addressing these issues and train your staff to comply with them. Prompt: Conduct appropriate research to supplement your knowledge about current regulations on protecting PHI while using a computer and correctly completing discharge paperwork. If you need to, research training processes and methods. Use the Milestone One Template document to complete the steps listed below: ? Develop clear policy statements for Mercy Vale. Based on your research, write clear, comprehensive policies addressing the two issues: o Protecting PHI on public and clinical computers o Completing discharge paperwork fully and correctly ? Explain how your policies guide staff in keeping patient health information secure. ? Explain how your policies provide procedures for management to track access to patient health information. ? Explain how your policies align with appropriate health laws to further improve the organization’s compliance with standard-setting agencies. ? Explain how your training plan recommends leadership strategies that foster improved ethical practices of employees when working with health information. ? Recommend leadership strategies that encourage effective collaboration between members of the health information management team and other staff members in the organization. ? Explain how your training plan clearly demonstrates to employees the steps of new procedures that employees must now perform and follow, supporting with examples of how employees will act out procedures. ? Explain how your training plan clearly demonstrates how these new procedures will improve compliance with regulations and standard-setting agencies. ? Explain how your training plan clearly demonstrates the importance of these new procedures in terms of patient safety and security of patient information. ? Explain how your training plan recommends leadership strategies that could be used by management in disseminating and enforcing these new procedures. ? Outline a training plan to gain buy-in from staff on complying with the new policies.
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MH 101: Overview of Serious Mental Illness /
Emotional Behavioral Disorders
OFFICE OF BEHAVIORAL HEALTH
Disclaimer
• The content of this training should not be
relied upon for diagnosis or treatment of a
mental health condition.
• Resources listed in this document do not
constitute an endorsement, nor are these
resources exhaustive. Nothing is implied by
inclusion or when a resource is not
referenced.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
Learning Objectives
• To understand the differences between Serious Mental
Illness (SMI) and Emotional/Behavioral Disorders (EBD)
• To understand causes/factors that may lead to the
development of SMI/EBDs
• To identify specific needs of individuals with SMI / EBD
• To identify the Louisiana Behavioral Health Partnership
(LBHP)/Coordinated System of Care (CSoC)
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
Serious Mental Illness (SMI)
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
4
Define Serious Mental Illness (SMI)
“. . . individuals who, through no fault of their own or
their families, suffer from one of several diseases
affecting the brain, the most complex of human organs.
The causes remain unknown, but are probably multiple.”
Source: http://www.state.sc.us/dmh/clinical/chronic.htm
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
5
Define Serious Mental Illness (SMI)
“In addition to having a brain disease, people with
serious mental illness are (by definition) significantly
functionally impaired by the illness for an indefinite
period of time (diagnosis, disability, duration)…The
problems of victims and their families are compounded
by stigma…”
Source: http://www.state.sc.us/dmh/clinical/chronic.htm
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
6
SMI includes:
•
•
•
•
•
•
•
Major Depression
Schizophrenia
Bipolar Disorder
Obsessive Compulsive Disorder (OCD)
Panic Disorder
Post Traumatic Stress Disorder (PTSD)
Borderline Personality Disorder (BPD)
The good news about mental illness
is that “Recovery” is possible.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
7
Who does mental illness affect?
“… persons of any age, race, religion, or income. Mental
illnesses are not the result of personal weakness, lack
of character or poor upbringing. Mental illnesses are
treatable. Most people diagnosed with a serious mental
illness can experience relief from their symptoms by
actively participating in an individual treatment plan.”
Source:
http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/
About_Mental_Illness.htm
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
8
Current Statistics
• About 6 percent, or 1 in 17 Americans, live with a serious
mental illness.
• The U.S. Surgeon General reports that 10 percent of
children and adolescents in the United States suffer from
serious emotional and mental disorders.
• The economic cost of untreated mental illness is more than
100 billion dollars each year in the United States.
Source:
http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illnes
s/About_Mental_Illness.htm
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
9
Current Statistics
• Between 70-90 percent of individuals have significant
reduction of symptoms and improved quality of life with a
combination of pharmacological and psychosocial
treatments and supports.
• With appropriate effective medication and a wide range of
services tailored to their needs, most people who live with
serious mental illnesses can significantly reduce the impact
of their illness and find a satisfying measure of
achievement and independence.
Source:
http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illnes
s/About_Mental_Illness.htm
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
10
Symptoms of SMI
– Distorted perceptions; loss of contact with reality
– Delusions
– Hallucinations
– Disordered, disorganized and confused thinking
– Unstable and inappropriate emotions
– Bizarre behavior; impaired judgment
– Vulnerability to certain kinds of stress
– Extreme dependency (sometimes combined with hostility)
– Difficulty with interpersonal relationships
– Deficient coping skills
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
11
“Common” reactions to SMI
•
•
•
•
•
•
•
General stress response (“fight, flight, fright”)
Grief; denial and impatience (lack of acceptance)
Anger and striking out
Guilt and self-blame
Depression; hopeless, helpless feelings; demoralization
Regression to earlier levels of functioning
Preoccupation with “self” (apparent disinterest
in others)
• Interruption of normal development (immaturity)
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
12
In general, these individuals need:
• INDIVIDUALIZED treatment
• CONTINUITY of care (includes continuity of relationships
with staff as well as smooth transition between, and
coordination among, programs and treatment
components)
• PSYCHOEDUCATION about the illness and its treatment
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
13
In general, these individuals need:
• Safe and comfortable SURROUNDINGS with adequate
privacy and desired amount of contact with
others
• Contingency PLANS for crises
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
14
The Bio-Psycho-Social Approach
• BIOLOGICAL NEEDS
• PSYCHOLOGICAL NEEDS
• SOCIAL NEEDS
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
15
Biological Needs
• Psychiatric care with appropriate MEDICATION by a
physician (and treatment team) who understand
serious mental illness and its treatment
• Careful MONITORING of intended effects and side
effects of prescribed medication
• Identification of NEW physical and mental/emotional
problems as they surface
• Attention to BOTH active and deficit symptoms
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
16
Biological Needs
• ELIMINATION OF TOXIC CHEMICALS and unnecessary
drugs (alcohol, caffeine, marijuana, “cold” medicine,
etc.)
• EARLY DETECTION of warning signs and “danger
signals”–symptom monitoring by consumer and
others
• Adequate REST and some form of regular, planned
and/or aerobic EXERCISE
• A balanced, nutritional DIET
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
17
Psychological Needs
• A therapeutic ALLIANCE with a person (or “team”)
which involves “titrated” support (varying degree of
support depending on need), respect, reality
orientation
• Dealing with “NORMAL” REACTIONS to serious illness
(listed above)
• Being actively, comfortably and USEFULLY BUSY
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
18
Psychological Needs
• A BALANCE between over- and under-stimulation
(everyone has a “window” of optimal stimulation;
this tends to be constricted in serious mental illness)
• A RELAXED atmosphere
• A regular daily ROUTINE (including evenings,
weekends and holidays)
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
19
Psychological Needs
• Replacing inappropriate behavior with RESPONSIBLE
ADULT BEHAVIOR (behavioral approach using natural
consequences done in an empathic and supportive
way)
• Minimization of impairment; emphasis on strengths;
INDEPENDENCE AS TOLERATED
• If alcohol/drug use a problem, appropriate attention
to dependencies should be integrated with other
treatment.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
20
Social Needs
• Learning “SURVIVAL SKILLS”; psychosocial and
occupational rehabilitation
• COMMUNICATION and PROBLEM SOLVING skills for
individual served and significant others
• Construction of supportive SOCIAL NETWORK;
prevent or reverse social breakdown syndrome
• Instrumental HELP WITH DAILY LIVING (money
management, transportation, housing, etc.)
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
21
Emotional / Behavioral Disorders
(EBD)
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
22
What is an Emotional/Behavioral Disorder (EBD)?
“A child is said to have a specific ‘diagnosis’ or ‘disorder’
when his or her behaviors occur frequently and are
severe. A diagnosis represents a ‘best guess’ based on
a child’s behaviors that he or she has a specific mental
health disorder and not just a problem that all children
might have from time to time.”
Source: http://www.pacer.org/parent/php/PHP-c81.pdf
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
23
Groups of EBD
• Externalizing behaviors
– Hyperactivity (ADHD)
– Aggression (Conduct Disorder, Oppositional Defiant Disorder)
– Delinquency
• Internalizing behaviors
– Anorexia or Bulimia
– Depression
– Anxiety
• Low Incidence Disorders
– Schizophrenia
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
24
Common EBD
•
•
•
•
•
•
•
Adjustment Disorders
Anxiety Disorders
Obsessive-Compulsive Disorders (OCD)
Post-Traumatic Stress Disorder (PTSD)
Attention Deficit/Hyperactivity Disorder (ADHD)
Oppositional Defiant disorder (ODD)
Conduct Disorder
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
25
The term “behavior disorder”…
is currently and more frequently being used by many
professionals/parents because:
– It has greater utility for education than does the term seriously
emotionally disturbed.
– It is not associated exclusively with any particular theory of
causation and therefore with any particular set of intervention
techniques.
– It affords a more comprehensive assessment of the population.
– It is less stigmatizing than the term serious emotional disturbance.
– It is more representative of the students who are disabled by their
behavior.
Source: http://www.slc.sevier.org/emoclass.htm
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
26
Factors associated with EBD
•
•
•
•
•
BIOLOGICAL FACTORS
ENVIRONMENTAL FACTORS
FAMILY
SCHOOL
SOCIETY
Source: http://www.slc.sevier.org/emoclass.htm
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
27
Biological Factors
“There is growing evidence that behavior and emotional
health appears to be influenced by genetic, neurological,
or biochemical factors, singly or in combination.
However, even when a clear biological impairment
exists, no one has been able to say with certainty
whether the physiological abnormality actually causes
the behavior problem or is just associated with it in
some unknown way.”
Source: http://www.slc.sevier.org/emoclass.htm
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
28
Biological Factors
There are several disorders that have been related to a
biological basis. Among the most common of these
disorders are Tourette’s Disorder, Attention Deficit
Hyperactivity Disorder, Obsessive Compulsive Disorder
and depression. In addition, a group of children have
recently emerged whose behavior and learning are
biologically related to prenatal exposure to drugs and
alcohol.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
29
Biological Factors
Infants who have been prenatally exposed to drugs and
alcohol are at risk for physical and behavioral/emotional
problems. According to Williams and Howard (1993),
these children demonstrate a marked failure to adapt to
the environment; difficulties in appropriate interaction
with caregivers; and, problems in language, learning and
motor skills.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
30
Environmental Factors
Environmental factors are considered important in the
development of emotional and behavioral disorders in all
conceptual models. However, professionals and researchers view
what behavior is important and how it is analyzed differently.
Further research supports contention that these causal factors
(a) an adverse early rearing environment
(b) an aggressive pattern of behavior displayed on entering school
(c) social rejection by peers
operate in temporal sequence. The family or
school and society environments have
influence on the behavior of individuals.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
home,
major
31
Family Factors
The relationship children have with their parents,
particularly during the early years, is critical to the way
they learn to act. Interactions between parents and
their child influences the child’s opinions, behaviors
and emotions. One factor associated with emotional
problems is child abuse. Child abuse may result in poor
impulse control and poor self-concepts. Aggression and
anger are often noticed in children who have
been
abused.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
32
School Factors
School is where children spend the largest
portion of their time outside the home.
Teacher expectations and actions greatly
affect a student’s life and behavior.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
33
School Factors
Academic Characteristics of children with EBD:
•
•
•
•
•
Disrupts classroom activities
Impulsive
Inattentive, distractible
Preoccupied
Does not follow or appear to care about classroom
rules
• Poor concentration
• Resistance to change and transitions in routines
• Often speaks out with irrelevant information or
without regard to turn taking rules
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
34
School Factors
•
•
•
•
•
•
•
•
Demonstrates aggressive behavior
Intimidates and bullies other students
Regularly absent from school
consistently blames others for their dishonesty
Low self esteem
Difficulty working in groups
Demonstrate self injurious behavior
Can not apply social rules related to others
personal space and belongings
• Often manipulative of situations
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
35
Society Factors
Societal problems can impact on a student’s
emotional and behavioral status. An impoverished
environment, including poor nutrition, a disrupted
family and a sense of frustration and hopelessness
may lead to aggressive, acting-out behaviors.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
36
Best Practices for working with children
who have an EBD
• Develop consistent behavioral expectations.
• Involve the student in setting academic and personal
goals.
• Engage in role playing situations.
• Communicate with parents so that strategies are
consistent at home and school.
• Set limits and boundaries.
• Apply established consequences
immediately, fairly and consistently.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
37
Best Practices for working with children
who have an EBD
•
•
•
•
•
•
Acknowledge and reinforce acceptable behavior.
Avoid confrontation and power struggles.
Provide a highly structured classroom environment.
Clearly post rules and expectations.
Establish a quiet cool off area.
Provide and teach opportunities for
the student to use self control/self
monitoring techniques to control
behavior.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
38
Best Practices for working with children
who have an EBD
• Teach self talk to relieve stress and anxiety.
• Teach and provide time for relaxation techniques.
• Establish cues as reminders for inappropriate
behavior.
• Redirect to avoid situations that may increase anxiety
levels.
• Remain calm and aware of your body
language
when addressing the student.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
39
Best Practices for working with children
who have an EBD
• Provide a positive and encouraging classroom
environment.
• Use a study carrel.
• Use visually stimulating material for
assignments/learning presentations.
• Use specialized technology and software.
• Develop and use behavior contracts.
• Give frequent feedback.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
40
Coordinated Systems of Care
(CSoC)
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
41
Coordinated System of Care (CSoC)
• The State of Louisiana is developing a Coordinated
System of Care (CSoC) for Louisiana’s at-risk children and
youth with significant behavioral health challenges or
co-occurring disorders that are in or at imminent risk of
out of home placement.
• The current system does not allow for multiple state
agencies that may all be providing different or even
similar services to coordinate an approach
to
deliver the most effective and necessary behavioral
health services.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
42
Coordinated System of Care (CSoC)
• The CSoC is an initiative of Governor Jindal and is being
directed by executives of the Department of Children &
Family Services (DCFS), the Department of Education,
the Office of Juvenile Justice and the Department of
Health and Hospitals (DHH).
• As a result of these efforts the Louisiana Behavioral
Health Partnership (LBHP), a comprehensive system for
behavioral health services for individuals of
all ages, was designed. The LBHP includes the
CSoC
as one of its population of focus.
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
43
Coordinated System of Care (CSoC)
• The CSoC will offer an array of Medicaid State Plan and
Home and Community-Based Waiver services to:
– All eligible children and youth in need of mental health
and substance abuse services
– At-risk children and youth with significant behavioral
health challenges or co-occurring disorders in, or at
imminent risk of, institutionalization)
• For more information about CSoC, go to:
http://new.dhh.louisiana.gov/index.cfm/page/454/n/180
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
44
Sources of Information used in this presentation:
•
•
•
•
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•
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•
•
•
•
http://www.state.sc.us/dmh/clinical/chronic.htm
http://www.nami.org/Content/NavigationMenu/Inform_Yourself/About_Mental_Illness/Abou
t_Mental_Illness.htm
http://www.pacer.org/parent/php/PHP-c81.pdf
http://www.slc.sevier.org/emoclass.htm
http://www.nami.org/Template.cfm?Section=adhd
http://www.education.com/reference/article/emotional-behavioral-disorders-defined/?page
=2
http://www.education.com/reference/article/biological-disorders-emotional-behavioral/
http://www.gallaudet.edu/clerc_center/Information_and_Resources/Info_to_Go/Educate_Chi
ldren_(3_to_21)/Students_with_Disabilities/EmotionalBehavioral_Disorders.html
http://en.wikipedia.org/wiki/Emotional_and_behavioral_disorders/biophysical
http://specialed.about.com/cs/behaviordisorders/a/Behavior.htm
http://www.atriskyouthprograms.com/youth-programs/definition-of-an-qat-risk-youthq.html
http://new.dhh.louisiana.gov/index.cfm/page/454/n/180
LOUISIANA DEPARTMENT OF HEALTH AND HOSPITALS
45
HIM 510 Milestone One Template
Mercy Vale Medical Center
Two Policy Statements for Mercy Vale
Write two clear, comprehensive policy statements, explaining the reasons for the policy, the procedures (exactly
what should and should not be done), and the policy’s intended goals.
A. Protecting PHI on public and clinical computers
B. Completing discharge paperwork fully and correctly
Security of Patient Health Information
Explain how your policies guide staff in keeping patient health information secure.
Procedures for Management to Track Access
Explain how your policies provide procedures for management to track access to patient health information.
Alignment With Appropriate Health Laws
Explain how your policies align with appropriate health laws to further improve the organization’s compliance
with standard-setting agencies.
Ethical Practices
Explain how your training plan recommends leadership strategies that foster improved ethical practices of
employees when working with health information.
Effective Collaboration
Recomend leadership strategies that encourage effective collaboration between members of the health
information management team and other staff members in the organization.
Steps of New Procedures
Explain how your training plan clearly demonstrates to employees the steps of new procedures that employees
must now perform and follow, supporting with examples of how employees will act out procedures.
Improving Compliance
Explain how your training plan clearly demonstrates how these new procedures will improve compliance with
regulations and standard-setting agencies.
Importance of New Procedures
E …
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