In This Issue

• National Minority Mental Health Awareness Month 
• Nursing Facility Guidance: Prioritizing Resident Behavioral Health Care and Services-F740 
• SME Article: Cultural Competence in Health Care: Bridging Gaps for Behavioral Health Equity
• Research Article: Severe Behavioral Health Manifestations in Nursing Homes: Associations with Service Availability
• Office Hours
  • Managing Substance Use Disorder in Nursing Facilities 
  • CARES® Serious Mental Illness™
• COE-NF Resources
  • Overcoming Stigma in Mental Health
  • Advancing Behavioral Health Equity
  • Advancing Behavioral Health Equity Bite-Sized Learning
• Did You Know?
• Save the Date: Upcoming Trainings
• You Matter – Occupational Wellness

July is recognized as National Minority Mental Health Awareness Month. It is a time when organizations across the United States come together to bring awareness to the unique challenges that Black, Indigenous, and People of Color (BIPOC) communities face when it comes to mental illness. It is a time to help close the treatment gap and eliminate disparities. Download Mental Health America’s 2024 BIPOC Mental Health Toolkit

Get Your Facility Involved
Here are ways nursing facilities can bring awareness to the impact of mental health today and beyond:  

1. Discuss, post and share the COE-NF educational flyer on Overcoming Stigma in Mental Health. Download here 
2. Use graphics from the BIPOC toolkit to post information on social media and your networking platforms. 
3. Use discussion worksheets from the BIPOC toolkit to start meaningful conversations with residents, staff, and volunteers.
4. Assist residents in taking a mental health screening. The screenings are free and confidential. Residents can use the results to start a conversation with their physician. Click Here To Access the Screening

Ftag 740 is an important regulatory component in nursing homes that emphasizes the importance of behavioral health care and services. Each resident must receive care that promotes the highest practicable physical, mental, and psychosocial well-being. 

Behavioral health care is an integral part of a person-centered environment. It involves an interdisciplinary approach, with staff demonstrating the necessary competencies and skills to care for residents. Behavioral health care should be individualized and directed towards understanding, preventing, reducing, and accommodating a resident’s distress or loss of abilities. 

Key components include ensuring person-centered care, promoting mental well-being through staff interaction, providing meaningful activities, creating a conducive recovery environment, and using pharmacological interventions only when necessary. 

The facility is responsible for creating an environment that promotes emotional and psychosocial well-being, meeting each resident’s needs, and including individualized approaches to care. 

Deficient practice at F740 is cited when the facility fails to identify, address, or obtain necessary services for the behavioral health care needs of residents. Strive for excellence in care delivery, keeping Ftag 740 at the forefront of practices.  

What you can do TODAY to ensure necessary behavioral health care and services are provided to residents.

• Use the Behavioral and Emotional Status Critical Element Pathway to determine if your facility is meeting residents' behavioral health care needs. Surveyors use this pathway to determine whether the facility is providing necessary behavioral, mental and/or emotional health care and services to residents. 
• Request no-cost assistance from the COE-NF to mitigate any identified gaps. 

Nursing facilities provide care to diverse demographics, and recognizing the unique challenges faced by minority communities regarding behavioral health is critical. Key aspects of addressing behavioral health equity include understanding common mental health disparities among minority communities, understanding one’s cultural impact on communication, and utilizing cultural competency standards and resources to improve resident outcomes in the long-term post-acute care (LTPAC) setting.

Here are some common factors that contribute to mental health disparities among minority communities:

Access to Mental Health Care:
Minorities in long-term care facilities often face challenges accessing mental health services due to limited resources, language barriers, and lack of culturally competent care. 

Environmental Factors:
Minorities in long-term care may experience environmental stressors such as institutional racism, isolation, and lack of social support, which can exacerbate mental health disparities.

Cultural and Linguistic Barriers:
Minorities often encounter challenges due to language differences, cultural norms, and unfamiliarity with mental health terminology. These barriers can hinder effective communication with health care providers and limit access to appropriate care. While cultural and linguistic barriers exist across all populations, the general population has more diverse resources and may find it easier to navigate these challenges.

Stigma:
The stigma surrounding mental health persists, especially among minorities. Fear of judgment, shame, and misconceptions can prevent individuals from seeking help or openly discussing their mental health concerns. Stigma affects everyone, but public awareness campaigns and education have gradually reduced its impact on the general population. 

Mistrust:
Historical mistreatment, discrimination, and systemic biases have led to mistrust of health care systems among minorities. This mistrust can deter them from seeking or participating in mental health services. For example, this has been a significant factor for decades within the Native American/Alaskan Native (NA/IA) population. The legacy of colonization, forced assimilation, and loss of cultural identity has profoundly affected NA/AI communities. NA/AI communities have the highest rates of suicide among minority groups in the United States. 

Improving Cross-Cultural Communication:
Nursing facilities must understand their own culture’s impact on communication. Building teams that reflect resident diversity improves communication and cultural knowledge sharing. 

The US Department of Health and Human Services (HHS) Office of Minority Health created the National Standards for Culturally and Linguistically Appropriate Services (CLAS) to provide guidelines to help advance equity, improve quality and eliminate disparities.

The Substance Abuse and Mental Health Services Administration collaborated with the OMH to develop the Behavioral Health Implementation Guide. This guide emphasizes the critical role of the national CLAS Standards in transforming behavioral health care. 

These standards pave the way for improved access, quality programs, and reduced disparities in mental health and substance use treatment for underserved minority communities. 

Let’s work together to bridge gaps and promote mental health equity for all! Submit a request for training on CLAS Standards from the COE-NF today.
 

Article written by Whitney O’Donnell, MBA, BSN, RN, CPHQ

1.  U.S. Department of Health & Human Services. (n.d.). Think Cultural Health. CLAS Standards - Think Cultural Health
2.  Shippee TP, Fabius CD, Fashaw-Walters S, et al. Evidence for Action: Addressing Systemic Racism Across Long-Term Services and Supports. J Am Med Dir Assoc. 2022;23(2):214-219. doi:10.1016/j.jamda.2021.12.018
3. Key Data on Health and Health Care by Race and Ethnicity. KFF. Link
4. Addressing Disparities by Diversifying Behavioral Health Research. SAMHSA. Link
5.  Indian Health Service (IHS). Behavioral Health Fact Sheets. Link

Research Article: Keeping you up-to-date with the latest research, advancements, and best practices in managing and addressing behavioral health conditions in nursing facilities.

In 2020, the Journal of the American Geriatrics Society published the first national study linking severe behavioral health manifestations to a nursing facility’s behavioral service availability. When describing the study's results, researchers were careful not to generalize them to all nursing facilities and to keep them reflective of the nursing facilities that responded to the surveys to minimize response bias.

The study looked at responses from nursing facilities to a three-question survey. Questions were as follows:

1. Is the level of behavioral health education among staff an issue in your ability to provide good behavioral health services?
2. Is there inadequate coordination between facility staff and community providers?
3. Does the facility lack adequate infrastructure to make referrals or transport residents to services?

The researchers then looked at the Aggressive Behavior Scale, and the Patient Health Questionnaire (PHQ-9) results for residents from the facilities that responded to assess the number of behavioral health manifestations. 

Researchers found several links between a nursing facility’s behavioral health services and the behavioral health manifestations in its residents, including the fact that residents in nursing facilities who reported inadequate behavioral health services were more likely to have severe depression, suicidal ideations, and severe aggressive behaviors. The study noted that the odds of a resident having severe depression were 21% higher when the nursing facilities reported inadequate behavioral health education for their staff. It also found that residents in nursing facilities with more psychiatrically trained RNs, Nurse Practitioners, and Physician Assistants had 17% to 14% lower odds of severe aggressive behaviors. 

This study highlights the importance of staff behavioral health training. Adequate staff training can help optimize resident mental health outcomes and reduce stigma that could negatively impact behavioral health management at a nursing facility. 

The COE-NF would like to hear from you. Take our 60-second survey. Click Here to answer the questions used in this research. Your responses are anonymous. 

What can you do TODAY?

• Complete an assessment of your facility’s behavioral health services to identify its current strengths and weaknesses.
• Enhance behavioral health education for your staff. Request assistance to work with a Behavioral Specialist from the COE-NF to personalize your facility’s training based on your behavioral health needs assessment.

Sources: 
Orth, J., Li, Yue, Y., Simning, A., Temkin-Greener, H. (2020). Severe Behavioral Health Manifestations in Nursing Homes: Associations with Service Availability? Journal of the American Geriatrics Society. 68(11) 2643-2649. https://doi.org/10.1111/jgs.16772

Have mental illness and substance use questions? We have the answers! Join us for office hours to talk with the experts.

Managing Substance Use Disorder in Nursing Facilities

Interested in receiving expert answers to substance use challenges you are facing in your nursing facility? Join Dr. Jen Azen and Dr. Swati Gaur, Subject Matter Experts, as they answer questions related to your complex cases. No question is too big or too small!   
  
Join our monthly office hours on the third Friday of each month from 1-1:30 p.m. ET to get answers directly from the experts working in nursing facilities!  
  
Audience: Appropriate for clinicians, nurses, administrators, and social workers. 

CARES® Serious Mental Illness™   
 
The COE-NF is making the CARES® Serious Mental Illness™ Online Training Program available to CMS-certified nursing facilities at no cost. CARES® Serious Mental Illness™ focuses on how to develop care strategies for individuals diagnosed with a Serious Mental Illness (SMI) and how an SMI differs from dementia.  
 
Interested in learning more about CARES® Serious Mental Illness™ before committing, or have general questions about the program?  
 
Join our ongoing monthly office hours meeting on the fourth Wednesday of each month from 2:30-3 p.m. ET for an open discussion on implementation, benefits, case studies, and successes. 
 
Audience: Appropriate for staff at all levels of care  

The COE-NF developed the following resource that nursing facilities can use to educate the team about behavioral health conditions.

Overcoming Stigma in Mental Health
This resource provides helpful tips to stop mental health stigma. Download Resource

Advancing Behavioral Health Equity in Nursing Facilities-Promoting Healthy Pathways for All
This resource provides ten actionable steps to advance behavioral health equity. Download Resource

Advancing Behavioral Health Equity in Nursing Facilities Bite-Sized Learning
This video defines behavioral health equity, identifies barriers to behavioral health equity, and demonstrates actionable steps nursing facilities can take to advance behavioral health equity. Watch Video

Data related to minority behavioral health has traditionally been an under-researched and under-reported area. However, many organizations have recognized this, and there are now concerted efforts to gather data on minority behavioral health. The Substance Abuse and Mental Health Services Administration Office of Behavioral Health Equity released its Behavioral Health Equity Fact Sheet in April that outlined the activities undertaken to advance behavioral health equity. Learn More

• Explain the rationale for implementing the Safety Planning Intervention.
• Describe how utilizing a systemic best practice intervention results in improved client outcomes, which ultimately saves lives.
• Learn the steps to completing the Safety Planning Intervention with clients.

• To educate nursing facility staff about de-escalation strategies to effectively manage challenging behaviors among residents.
• To provide nursing facility staff with the knowledge and skills of trauma-informed care principles when delivering care and implementing de-escalation interventions.
• To equip nursing facility staff with practical skills to effectively implement de-escalation techniques when encountering escalated situations with residents, fostering a safe and supportive environment.
• To assist nursing facility staff in enhancing their communication and engagement skills, including active listening, empathy, and non-verbal communication, to effectively interact with residents and prevent escalation of behaviors.

• Understand PTSD. 
• Learn the symptoms of PTSD.
• Discover ways to support individuals with PTSD.

• Define trauma and trauma-informed care. 
• Learn what happens to the traumatized body and why trauma behavior is misunderstood.
• Discover the basic concepts of trauma-informed care.

Occupational wellness means finding ways to make our employment meaningful and reflect our personal values, interests, and beliefs. Consider one or two ways your facility can better support occupational wellness for staff.

Ideas for optimizing occupational wellness in your facility:

• Find ways that allow each person to contribute their talents, gifts, and knowledge to their work.
  • Examples: Host a talent show for staff, residents, and their families at the facility.
• Use tools that help communicate feelings about the workload and provide opportunities to ask for help without judgment if the workload becomes overwhelming.
  • Examples: Use the traffic light system at daily huddles. Green means you’re feeling “focused, relaxed, energized, ready for the day, and can help others.” Red means you’re “distracted, distressed, overwhelmed, or exhausted, and need help.” Yellow is somewhere in between.
• Celebrate each other’s accomplishments. 
  • Examples: Create an achievement board somewhere in the facility where everyone passes by daily. Regularly post accomplishments made by staff (e.g., career/education or family milestones) for all to see and congratulate each other.

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