CORE (Community of Respect and Empowerment) Plan
Strategic Plan #1: Consumer Involvement
Goal: Further increase consumer's meaningful involvement in all aspects of treatment, decision making and operations facilitating a sense of hope and personal vision for their future.
- More activities to inspire hope (for example, showing inspirational videos, discussions of hopes and dreams and increasing the number of small groups for clients to begin to tell their stories and personal testimony)
- Have clients select the FRS staff to be with them in the team meeting and treatment planning team
- More involvement in treatment planning and attendance at treatment planning meetings
- Increase opportunities for client voices to be heard (for example, have them write a topic for the FORUM)
- RESPECT Institute - increase involvement - create more mechanisms for RESPECT speakers to interface with staff
- Consumer councils to address issues of internal and external stigma
- Hire more Peer Specialists
Strategic Plan #2: Training Recruitment and Retention.
Goal: To develop and support a competent, skilled, stable team of individuals to provide services.
- Ongoing continued use of new technology such as videos of people doing things the right way
- Building a team by allowing all staff on a team and within a program and all shifts to go to training together
- Increased frequency of training (for example, at shift change)
- Evaluate training
- Increased employee morale and employee recognition and apprecitaion across campus
- A campaign to put forth that each staff member is a leader and putting forth that each and every job is important
- Just Culture
- Look at our hiring practices
- Train supervisors
Strategic Plan #3: Safety
Goal: To provide a safe environment for the Fulton State Hospital community
- Update current physical plant
- Just Culture
- Improved supervision for staff/supervisors
- Training for the role of supervisor
- Boundary awareness and training
- Increase security awareness
Strategic Plan #4: Sense of Community
Goal: To improve and strengthen positive community relationships in our role as neighbor, employer, service provider and consumer
- Branching out to local newspaper - creating articles "Getting to know FSH" and talk about mission goal projects
- Consumers create activities to give back to community members - i.e., plants, cds, artwork
- Add consumer driven elements on the website
- Inviting community meetings to RESPECT institute seminars
- Invite community/newspaper to Mission Goal Projects Ceremony
- Have Community Outreach Committee
Strategic Plan #5: Trauma-Informed Care/Culture
Goal: Create a culture of trauma-informed care for the Fulton State Hospital community
- Create an outreach program for staff that are injured
- Help them ease back into the work community, if needed
- Increase training regarding trauma and being trauma informed
- Incorporate trauma-informed care into treatment planning
- Improve the physical environment (the visual environment, the audio environment, the temperature, crowded conditions - basically we need a healing environment)
- Use the tools regarding being a trauma-informed organization
- CISM Staff Assist vs. Staff Support
- The Employee Health Nurse
- The brief trauma assessment and the personal safety plan
- Increase the opportunities for staff and clients to learn about stigma and recovery (internal/external)
Strategic Plan #6: Effective Treatment/Staffing
Goal: To provide a full array of effectiv evidenced-based treatment services for all clients with adequate numbers of qualified staff
- Training teams and entire wards together
- Increased training opportunities on the ward
- Enhance and improve program training
- Anti-stigma training
- Strategies for staff remaining out of the office and the desk area and out among the patients
- Staff Development educators available on the units for education
- Quality treatment space
Ethics Fulton State Hospital has an ethical responsibility to the individuals and community it serves. Our hospital philosophy, through our mission, vision, and values provides a consistent and ethical framework for our consumer care and business practices. To support ethical operations and fair treatment of individuals, Fulton State Hospital has and operates according to a policy of ethical behavior. The policy addresses ethical practices regarding marketing, admissions, transfers, discharge, and billing and resolution of conflicts associated with patient billing. Our policy ensures that the hospital conducts its business and consumer care practices in an honest, decent, and proper manner.
Consumers Fulton State Hospital is a 341 bed, Medicare-Certified, Joint-Commission accredited, long-term inpatient facility. We serve primarily an adult (18 years old and older) population which has been committed to the state facility through the following admission categories: pretrial evaluation, incompetent to proceed, not guilty by reason of mental disease or defect, voluntary, adult court order, criminal sexual psychopath, Circuit Court, and Department of Corrections transfers.
The number of admissions in these classifications has remained relatively stable over the past several years. However, changes in state and federal statutes related to commitment status, and the rapidly increasing number of inmates in the Department of Corrections requiring mental health services may have a dramatic impact on the number of individuals we serve, their length of stay, the level of security we provide and the type of treatment offered.
Consumer satisfaction and input is an important element in any strategic plan. While FSH has in the past and will in the future continue to perform and analyze the results of consumer satisfaction surveys, and has assisted in the development of Consumer Councils in each of our units to allow individual input, it must be realized that the data reflected from these processes will be somewhat skewed because the majority of the individuals are involuntarily committed and in many cases receiving treatment they do not believe they need. We do take seriously the information garnered from this process and try to improve living and treatment environments based on this information.
Active Treatment FSH provides a wide variety of treatment modalities for the individuals served. This would include prescribing the most recently released medications for schizophrenia, depression, and substance abuse addiction. Active treatment also includes the use of rehabilitation programs that have been publicized as having an impact on individuals previously thought of as treatment resistive. These programs include Social Learning, Boston University model, Dialectical Behavior Therapy, Cognitive Behavioral Therapy and treatment for problematic sexual behaviors. Other important programs include residential substance abuse programs, competency restoration, aggression management, and a work skills programs.
The recognition that these programs and medications have had a dramatic effect on the individuals we serve is important. In the future more medications with higher level efficacy and fewer side effects will become available; however, we are finding the cost of these medications may create barriers to their use or require the reduction in other service areas to save funds to purchase the new medications. Continuation of increased funding is dependent on the economic health of the state. Also, to operate high-quality programs in psychosocial rehabilitation requires expertise in the specialty program areas. This requires FSH to search out and retain the highest quality clinicians available.
Services Provided FSH has a long history of providing care to individuals with mental illness dating back to the days when most state psychiatric facilities were fully self contained. These facilities were able to provide for their individuals any service possible without going to the community for support. Over the years many of these services have been discontinued, such as the acute hospital and dairy farm. FSH still provides many services, i.e., dietary, laboratory, environmental services, and maintenance to name a few. These services must operate economically and efficiently as more pressure is brought onto the hospital due to limited financial resources and the challenges of managed care.
Physical Plant An assessment of the FSH physical plant reveals that most of the structures housing clients and staff are old and deteriorating. Functional buildings (approximately 40) date from 1860 to the most recent addition to the Biggs building which was completed in 1988. Our consumers currently reside in Biggs, original building 1938; first addition, 1968; second addition, 1988; Guhleman, original building, 1952; Adult Psychiatric Services, original building, 1952; and Hearnes Complex, original building, 1970. The Hearnes Complex was originally built for children and adolescents. Most of these buildings are requiring capital individual population, the physical separation between support services, administration and the individual care areas is too great. Ground crews must currently maintain 96 acres of land. While over the past several years over 800 acres have been transferred to other state agencies and municipalities or sold, the need still exists to reduce the size of the campus, consolidate some support and administrative functions closer to the individual care areas, and upgrade individual living areas to a more therapeutic environment.
Human Resources Our most important resource is our staff. Unlike acute general hospitals where a large amount of money is tied up in high-technology equipment, psychiatric facilities are bound only by the competence, training, education, and expertise of the staff providing care and support services to the individual. FSH has attempted over the past 10 years to recruit the highest quality medical and professional staff available within the United States. We have been successful in recruiting much-needed psychiatrists by supporting adjustments in pay scales to be competitive. FSH like the rest of the country is realizing difficulty in recruiting nurses. It is anticipated that recruitment of most disciplines over the next several years could be problematic as state salaries continue to fall behind the private sector.
One serious area of concern is in the classification of Forensic Rehabilitation Specialists. For the first time in the past 10 years FSH has had to advertise for applicants for these positions. This is partly due to the high level of job availability within the Mid-Missouri area and partly due to the low entry-level salaries of these positions. These positions have in past been predominantly filled by males; however, now there are a majority of female applicants. This situation is also creating a problem for staffing patterns, in that as the number of female aides increase, we have more problems in providing for the privacy of our predominantly male client population. However, the quality of staff in these positions cannot be underestimated. Creative and innovative hiring and interviewing processes have been developed, such as peer selection, to improve the quality of those hired.
Retaining highly sought after and trained staff is of paramount importance. Having to constantly recruit and retrain staff is not economically feasible. Retaining staff requires a dedication by leadership to listen to employee suggestions, to provide appropriate training, and to determine the level of employees satisfaction with their work and work environment.
Changing Environment In the last several years, the health care environment has changed significantly. The emergence of Managed Care organizations and the replacement of typical Medicaid funding streams have everyone who works in the health care field questioning the future. These dramatic changes effect the public sector as well as the private sector. In the long-term state psychiatric setting, the impact of these changes is less certain; however, these changes will have an impact.
The political and socioeconomic environment is also undergoing significant change. There is a dramatic movement toward a more-conservative approach in dealing with social issues such as crime and welfare. These shifts will have an impact on the care provided as well as the clients served. Changes in state statutes will make commitment to state mental health facilities easier, while other law changes will make release more difficult. The increasing numbers of inmates in the Department of Corrections is increasing the need for mental health and substance abuse services. Courts are being allowed to certify youths as adults at younger ages. The need for more secure facilities for those individuals who commit violent offenses and are diagnosed with mental retardation or another developmental disability is growing. Each of these issues must be considered as we develop our plans for the future.
Public Safety As vital as our role is in providing treatment for mental illnesses, equally important is our responsibility to provide for public safety. Built into every treatment program must be a component to appropriately and adequately measure an individuals' ability to understand the consequences of their actions and behaviors. FSH clinical staff must attempt to ensure through careful assessment of each individual's current behavior that moving the individual to a less-restrictive setting places no perceived or real danger on anyone, especially the community.
Without close attention to public safety issues, the hospital's ability to provide secure environments for treatment will be jeopardized or impaired. This impairment may result in the inappropriate shifting of mentally ill individuals to other state agencies, resulting in potentially increased cost to the state and a further reduction of public safety.
Community Relations Individuals who have mental illnesses and reside in state institutions can and do suffer from a dual "stigma." The stigma of the mental illness and the additional stigma of being in a state institution.
To deal with the stigma of mental illness community education is crucial. This education must take place in our schools and service organizations. It must include community leadership, students and teachers, law enforcement, judiciary, and media. This education must be ongoing, up-to-date, and from all levels of individuals dealing with mental illness (individuals, family, professionals, and administration).
The stigma of the state institution can be as difficult to deal with as the stigma of mental illness. While the stigma of mental illness is undeserved and thrust upon individuals who are suffering from a disease like any physical ailment, the stigma of the institution comes from many years of poor environments, a lack of active treatment and overcrowded facilities. Again, it is crucial to educate all individuals to the significant changes being made in long-term-care facilities as well as the advances in medications, new treatment programs, new diagnostic technology, and better trained professionals. The past cannot and should not be forgotten, but there must be education with an emphasis on the present and the future.