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Model of Care
Richmond State Hospital has served persons with mental illness since 1890. Care centers around the Residential Treatment Center (RTC), the Clinical Treatment Center (CTC) and AIT building. The Residential Treatment Center has 3 wings, each containing 2 patient units with a common living area and activity rooms on each wing. There is a central dining room and a variety of central activity rooms and a medical clinic. The Clinical Treatment Center, emphasizes active treatment using the treatment mall concept with multipurpose classrooms, social areas, living skills kitchen and arts/crafts areas, gymnasium, dental clinic, pharmacy and a large multimedia training area. The AIT Building offers patient living areas with activity rooms, a central dining room, special occupational and crafts programming areas and gymnasium. There are three houses for transitional housing and several guest houses for families. During late 2010 and early 2011, RSH has been moving towards the Division of Mental Health and Addiction Transformation Plan which focuses on the care of two populations: patients with severe mental illness and co-occurring disorders of mental illness and substance abuse. Patients with substance abuse disorders are now referred to 2 community mental health systems who have a contract with the DMHA for residential substance abuse treatment. In addition, there has been significant placement into the community of patients with developmental disabilities and mental illness.
Richmond State Hospital has maintained accreditation from the Joint Commission since 1986. The requirements set forth by the Joint Commission focus on hospital systems critical to the safety, quality of care, treatment and services provided. The most recent survey was August 2010. Accreditation is reviewed every 3 years with periodic required updates. Joint Commission accreditation also has gained the hospital deemed status with The Center for Medicare and Medicaid Services (CMS). The hospital was surveyed January of 2009 and CMS found the organization to be in compliance with both required Conditions of Participation.
Richmond State Hospital’s model of care is based primarily on SAMHSA’s National Consensus Statement on Mental Health Recovery, the principles of trauma-informed care, with an emphasis on person first language. The 10 Principles of Recovery were adopted and adapted by the Clinical Administration Team of Richmond State Hospital (February 2008) to include evidence-based practices and system accountability—or the 10+2 Model of Recovery. The components are:
3. Individualized and person centered
6. Non linear
8. Peer support
11. Evidence based practices
12. System accountability
For patients with co-occurring disorders of substance abuse and mental illness, the model of care has adapted an eclectic integrated dual diagnosis approach based upon SAMSHA’s model “Tip 42.”
The care for patients is individualized based upon their identified needs through discipline specific assessments and an overall multidisciplinary team approach using case managers at the unit level. Care includes activities and classes on (1) healthy lifestyles, (2) leisure skill education, (3) medical and nursing needs, (4) psychopharmacology, (5) interpersonal and family relationships, (6) resolving legal issues, (7) developing coping skills that include symptom management and wellness recovery action planning, (8) group psychotherapy, and (9) individual therapy based on specific needs or target skills. Recovery Specialists, as a new classification of employee, have been very instrumental in these efforts.
Trauma-informed care principles were formally introduced through the “Roadmap to Seclusion and Restraint Free Mental Health Services.” Trauma, unfortunately, has been prevalent throughout the history of most of the people who come to the hospital for treatment. In recognizing their needs, changes have been made in assessments and programming has shifted to address specific issues and to be more sensitive to the overall care environment to avoid re-traumatizing practices. The goal is to have safety plans that recognize triggers, warning signs, and personalized strategies that help consumers cope. Learning is fundamental to recovery.
Richmond State Hospital recognizes that the culture of our hospital is shifting towards partnering and collaborating with consumers. As part of the “Roadmap to Recovery”, a modularized program from SAMSHA that was first offered in 2008, RSH has continued to build on this base and focus on trauma-informed care, improving communication skills and teaching techniques to work more effectively with persons with major mental illnesses and/or addictions. These efforts have culminated into the core values of the hospital: Recovery, Strength and Hope.
Richmond State Hospital primarily serves 2 populations with severe mental illness and co-occurring substance abuse and mental illness.
• Serious Mentally Ill: 60 co-ed admission beds (located on 420A/B units in RTC) are dedicated to patients who have severe and persistent mental health problems.
• Integrated Dual Diagnosis: 60 co-ed admission beds (located on 421A/B units in RTC) that specializes in the care of patients with both a major mental illness and a substance abuse/dependency problem using established best practices as a framework for recovery as outlined by SAMSHA’s “Tip 42.”
• Serious Mentally Ill/Geriatric/Medical: 60 bed co-ed continuing stay beds (located on 422A/B in RTC) that focuses on recovery programming with consumers whose return to the community requires adaptive skills for residual impairments, partial symptom control and/or persistent mood dysregulation.
• Mentally ll/Developmentally Disabled/Fluid Management/Transition: Provides recovery services on a 23 bed co-ed unit (located on 417a in AIT building) for adults with developmental disabilities and mental illnesses and patients with severe mental illness with polydipsia who require specialized medical/nursing care. The fluid management program focuses on the medical protocol required to stabilize and prevent electrolyte imbalance and learn the skills needed to prevent medical crises. The focus includes social skills, self care, behavioral regulation, and symptom management in preparation for community and family living. There are also 3 houses on grounds that are used to transition patients into the community by concentrating on the living and vocational skills necessary for successful re-integration.
Members of the team, based on the consumer’s needs, include a psychiatrist/physician, psychologist or behavioral clinician, social service specialist, dietitian, rehabilitation therapy staff, nurses, psychiatric attendants and substance abuse counselors.
Treatment is individualized through interdisciplinary assessments and interventions that are designed to improve functional capacity. Treatment is based on a person’s strengths and choices within a collaborative framework with staff and family members to build the skills for a rich productive life in the community. Interventions may include psychopharmacology, management of medical problems, individual and group therapy, consumer and family education, rehabilitation and recreation therapy, academic and vocational skills training and supported employment, and social skills development. The multidisciplinary treatment team oversees the consumer’s care.