The Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF) provides mental health and substance use evidence-based training, customized technical assistance and resources to certified Medicare and Medicaid nursing facilities who care for residents with a variety of behavioral health conditions at absolutely no cost. To submit a request for assistance, complete the online request form at nursinghomebehavioralhealth.org.
 

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In this issue: 

Register for Upcoming COE-NF Trainings
Substance Use Disorders: Definition, Treatment & Recovery
Nursing Facility Guidance Updates: Substance Use Disorders 
Did You Know?
Evidence-Based Substance Use Screening Tools
You Matter

Register for Upcoming COE-NF Trainings

The COE-NF invites you to register to attend upcoming trainings.  Some trainings have seating capacity limits, so early registration is recommended. 

Mental Health 101

Duration: 30 minutes

Mental Health 101 is an introductory training to help identify, understand, and respond to signs of mental health disorders. Join us as we address some of the common causes contributing to the onset or exacerbation of mental health symptoms among nursing home residents, and share common warning signs and practical strategies on how staff can support improving resident mental wellness. This training will also assist nursing facility staff develop skills to more effectively help residents with mental health disorders.

Audience: All nursing facility staff

Virtual Session Date:
Wednesday, April 12, 2023 from 2 - 2:30 p.m. EST - Click HERE to register


Question, Persuade, Refer (QPR)

Duration: 90 minutes

Certification Details: This session provides QPR certification for two years. 
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​QPR is an evidence-based suicide prevention training that teaches 3 simple steps, anyone can learn, to help save a life from suicide. QPR is the most widely taught Gatekeeper training in the world. 

Audience: All nursing facility staff
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Virtual Session Dates - *Each session has a limit of 30 people.*

Click a link below to register for a QPR session.

• ​Friday, April 14, 2023 from 1-2:30 p.m. EST - Click HERE to register
• Friday, April 14, 2023 from 3:30 - 5 p.m. EST - Click HERE to register
• Wednesday, April 19, 2023 2 - 3:30 p.m. EST - Click HERE to register

The same content will be provided at each session. 


Mental Health First Aid 

Duration: Two-hour independent study and a 5.5. hour instructor-led session
Certification Details: This session provides certification for three-years

This Mental Health First Aid training will provide you with skills on how to appropriately connect with and provide initial help and support to someone who is developing a mental health or substance use challenge or experiencing a crisis.  

Audience: All nursing facility staff

Virtual Session Dates - *Each session has a limit of 15 people.*

Wednesday, April 19, 2023 from 11:30 a.m. - 5 p.m. EST
Friday, April 28, 2023 from 11:30 a.m. - 5 p.m. EST 

To register for Mental Health First Aid, please send: your name, email address, agency and desired training date to coeinfo@allianthealth.org two weeks prior to the date of interest.
 

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Substance Use Disorders: Definition, Treatment & Recovery

Thanks to your responses to the poll in the February COE-NF newsletter, this month's newsletter focuses on substance use disorders (SUD) and nursing facilities. In the 2022 CMS nursing facility guidance updates, guidance related to residents with substance use disorders was expanded and facilities may benefit from learning more about SUD and conducting a review of their SUD practices. 


Definition of SUD, Treatment, and Recovery 

What is a Substance Use Disorder (SUD)?
A substance use disorder (SUD) is a treatable mental disorder that affects a person’s brain and behavior, leading to a person’s inability to control their use of substances such as legal or illegal drugs, alcohol, or medications. Symptoms can range from moderate to severe. NIH: Substance Use and Co-Occurring Mental Disorders

Treatment and Recovery Options
SUD is a treatable, chronic disease. Overcoming a SUD is not as simple as resisting the temptation to take drugs. Like many other chronic conditions, treatment is available for SUD. While no single treatment method is right for everyone, recovery is possible, and help is available for residents with SUDs.

What does treatment look like?
​​​​​Depending on the type of SUD, treatment may include:

• Outpatient and intensive outpatient counseling– Helps people understand addiction, triggers, and reasons for using drugs. This form of treatment can be done at a doctor’s office or via telehealth appointment.  
• Medications for opioid use disorder (MOUD) – Specific conditions like opioid use disorders may require medication as the first course of treatment. MOUD can help with cravings and withdrawal symptoms. 
• Inpatient rehabilitation – A full-time facility provides a supportive environment to help people recover without distractions or temptations. 
• Behavioral health care- Trained providers who help with mental health and substance use concerns. 

https://www.cdc.gov/drugoverdose/featured-topics/recovery-SUD.html 

To find mental health treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357), click HERE, or text your ZIP code to 435748 (HELP4U). 

 

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Nursing Facility Guidance Updates: Substance Use Disorders

Effective October 2022, CMS expanded F tag guidance on substance use disorders (SUD) in nursing facilities in the State Operations Manual.  Based on that guidance, there are many areas to be reviewed when evaluating your facility’s practices related to residents with substance use disorders:  

• Facility assessment to address SUD needs
• Staff skills/competencies in identifying signs/symptoms of SUD and implementing person centered interventions 
• Opioid overdose policies: Assessing for signs of potential overdose and availability of Naloxone
• Managing planned and unplanned leaves of absence
• Appropriate use of behavioral contracts; considerations to ensure no conflicts with abuse prevention and admission/discharge policies
• Legal property/room search protocols
• Ensuring appropriate recreational activities are offered
• Connecting residents with appropriate SUD treatment services such as individual/group counseling, Alcoholics Anonymous, or Medication Assisted Treatment

What can you do today?

• Identify a team member to review the full guidance available in the CMS Appendix PP State Operations Manual.
• Review your facility’s current policies and practices to ensure that they are complaint with the new updates.  For example, do you have naloxone available in the facility? If yes, have staff been trained to administer the medication? 
• If there are gaps, develop a plan to align with the updated guidance. 

The COE-NF is available to support your facility in any of these guidance areas. Click HERE to request the assistance you need. 
 

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Evidence-Based Substance Screening Tools
The goal of substance use screening is to identify residents who have or are at risk for developing alcohol-or drug-related problems, and within that group, identify residents who need further assessment to diagnose their substance use disorders and develop plans to treat them. National Institute of Health (see Chapter 4).

Nursing facilities routinely screen for pain, mood, and cognition. The same practice should be applied to SUD screening. Once identified, care planning for residents can take place. SUD screening tools can easily be incorporated into the nursing or social work assessment process.  

Here are some tools that can be useful in SUD screening:
  
CAGE & CAGE Adapted to Include Drug Use
The CAGE and CAGE Adapted to Include Drug Use (CAGE-AID) is a screening tool medical professionals use often to identify individuals likely to have substance use disorders. Administering the CAGE takes less than one minute, requires no training, and can be in written form or performed verbally. 

Screening, Brief intervention and Referral to Treatment for substance use (SBIRT) Tools
Screening, Brief intervention and Referral to Treatment for substance use (SBIRT) does not require extensive education or training. It can be implemented by a variety of healthcare providers, including nurses, social workers, and health educators. It can also be applied throughout the continuum of care and for a variety of patient populations. This pre-screening form can be administered to all residents. It rules out residents who are at low or no-risk using one pre-screening question for alcohol and one pre-screening question for drugs.

Alcohol Use Disorders identification test (AUDIT)
The Alcohol Use Disorders identification test (AUDIT) is a simple 10 item screening tool, effective in detecting unhealthy alcohol use. It can be administered to residents who screen positive on the SBIRT pre-screening for alcohol use (above). 

What can you do today?

All of these SUD screening tools are quick and effective.  

• You can get started by identifying who in the facility will do the screening (consider social worker or nursing staff).
• Ask them to start by screening 10 residents. 
• After the first 10 screenings, meet to review the findings and how to implement facility wide.
• Once you are comfortable with the screening, develop a plan to screen all residents.
• Finally, identify how to incorporate the screening into routine assessments completed by social work or nursing.

If you would like training on how to administer any of these screening tools, please click HERE to submit a request to the COE-NF.
 

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You Matter

Mindfulness is the practice of being in the moment aware of your thoughts, feelings, surroundings and bodily sensations. Mindfulness is a great tool to use when feeling overwhelmed, anxious, or stressed. Check out the flyer for some simple steps that anyone can take to practice mindfulness.

Click HERE to share flyer with staff or posting in the facility break room. Mindfulness can also be a helpful technique for residents.               

 

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Join our text message list!

Scan the QR code below or click HERE to sign-up and receive text notifications from COE-NF. Stay up-to-date on news about this new support for your facility.   

Contact us: 

For more information, we can be reached by phone at 
1-844-314-1433 or by email at coeinfo@allianthealth.org.  

                                                      

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Alliant Health Solutions (AHS) was awarded a three-year cooperative agreement from the Substance Abuse and Mental Health Services Administration (SAMHSA) to create a Center of Excellence for Behavioral Health in Nursing Facilities (COE-NF). Alliant has over 50 years of experience working with nursing homes and behavioral health in nursing homes.

Interested in learning more? Download the FAQs about the Center of Excellence, click HERE.
 

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