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| Dan Squires, Ph.D., MPH, is the director of the Addiction Technology Transfer Center of New England, located at Brown University. The center will receive $2.5 million over five years to treat substance abuse. (photo by Tom Croke) | |
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By Nan Shnitzler
The Substance Abuse and Mental Health Services Administration (SAMHSA) this past September announced funding to continue two programs that affect New Englanders. Connecticut and Vermont will each get $650,000 over three years to promote alternatives to seclusion and restraint in mental health facilities. The Addiction Technology Transfer Center of New England (ATTC-NE), based at Brown University, will get $2.5 million over five years to support the workforce that treats substance abuse disorders.
Entering its fifteenth year of funding, ATTC-NE (attc-ne.org) coordinates services to the addiction treatment community through New England's six single-state drug and alcohol agencies. ATTC-NE can serve some 2,500 individuals annually through 65 activities such as learning interventions, technical assistance, training and workshops.
"That's pretty standard for us," says Dan Squires, Ph.D., MPH, director of ATTC-NE.
The center has announced four focus areas in the five-year funding cycle that will build on past success: rapid assimilation of evidence-based practices, recovery-oriented care, leadership development and advanced credentialing opportunities.
Conceived in 2003, the center's Science to Service Laboratory helped establish evidence-based practices in more than 50 community treatment agencies across New England and is a model across the national ATTC network. Further initiatives will explore organizational capacity to integrate change and improve fidelity to evidence-based practices by treatment providers and supervisors.
Another first is a distance-learning program for continuing education in substance abuse treatment that will be expanded through Brown's medical school. It will offer psychology continuing education units through the American Psychological Association.
To overcome such workforce challenges as high turnover and aging, the center has collaborated with the New England Institute for Addiction Studies in Maine to come up with a program called the Leadership Development Institute to identify and develop emerging leaders in the substance abuse treatment field.
Finally, the center is working with higher education to create degree-granting and credentialing programs, such as the Bachelor of Science program in chemical dependency at Rhode Island College.
Squires, a clinical psychologist in private practice, says that while substance abuse often co-occurs with mental health problems, psychologists and psychiatrists don't tend to focus on it.
"I think there's a tremendous opportunity for psychologists who want to learn more about treating substance abuse disorders to network and interface with the variety of training programs and opportunities we offer," Squires says.
SAMHSA has established seclusion and restraint (S/R) as a priority area and launched a national action plan in 2004 with grants awarded to eight states including Massachusetts, which has reported reductions in restraint events, people restrained and restraint duration. Another eight states in the 2007 grant round include Connecticut and Vermont; both have been cited by the Department of Justice for abuses at state hospitals.
"At Connecticut Valley Hospital, we had already begun a process to reduce the use of restraint and seclusion, and restraint was reduced by 65 percent in fiscal year 2007 compared to 2006. We saw similar reductions with seclusion," says Jim Siemianowski, MSW, LICSW, a spokesman for the Connecticut Department of Mental Health and Addiction Services. "So these funds will help us leverage and build on what we've already done to further reduce restraint and seclusion."
Connecticut will embark on a strategic planning and implementation process to reduce and ultimately eliminate use of S/R among young adults 18 to 25. An advisory board of stakeholders from hospitals, the community and consumers will look at the training and technical assistance resources needed and develop a plan for data collection and outcomes, Siemianowski says. The plan will apply to psychologists, public safety personnel and even food service workers.
"Clearly, we're looking at extending this to all direct service workers to help expand the repertoire available when we intervene," Siemianowski says.
Vermont will use the grant to focus on two populations: adults at Vermont State Hospital and children and adolescents at Retreat Healthcare. Both facilities have experienced spikes in S/R, says Michael Hartman, mental health commissioner at the Vermont Department of Health.
"We have started new training processes and S/R has gone down to the low end of the national range," Hartman says. "We're trying to reduce instances of coercion and be a trauma-informed system at the same time, and recognize that use of S/R is one of primary issues for inpatients who already have some exposure to trauma."
The long-range plan is to staff full-time positions at the state hospital and at Retreat Healthcare to focus on reducing S/R. The state is also looking at environmental factors that can aggravate behavior that brings on restraint. As such, the grant will fund consultation with Tina Champagne, a Massachusetts-based occupational therapist who pioneered sensory relaxation environments for S/R reduction.
The target is the two institutions. But the promise of the grant is to establish new protocols in all the areas where S/R occurs and to propagate them statewide to the benefit of all involved, Hartman says.
"We hope that during the three years, it becomes positively systemic," he says.
States receiving these Alternatives to Restraint and Seclusion Infrastructure Grants don't have to go it alone. Also awarded funding continuation is the National Technical Assistance Center, an arm of the non-profit National Association for State Mental Health Program Directors (NASMHPD).
The center helps states implement core strategies around leadership, data transparency and consumer involvement that emerged from a broad coalition of stakeholders and that have the highest likelihood of reducing S/R, says Joan Gillece, Ph.D., the NASMHPD project director. The approach is recovery-based and more about partnership than control because S/R does nothing therapeutic for the patient and is traumatic to the person doing the restraining, she says.
"We're not simply saying, 'Stop restraining.' We're working on a prevention model to identify triggers and teach strategies for clients to calm themselves down," Gillece says. "We're about getting at the stimulus versus just responding. It's a huge radical culture change."
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