March 2024 Newsletter
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 that 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 by clicking HERE.
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In This Issue
- Bipolar Disorder Awareness
- Article: Communicating with Residents Diagnosed with Bipolar Disorder
- Nursing Facility Guidance Updates: Coordinating Care under FTag 644 for residents with Serious Mental Illness (SMI)
- Office Hours
- CARES® Serious Mental Illness™ Office Hours
- Managing Substance Use Disorders in Nursing Facilities
- COE-NF Resources for Bipolar Disorder
- Bite-Sized Learning
- Module
- Fact Sheet
- Making Health Care Better Podcast
- Did You Know?
- Register for Upcoming COE-NF Training Sessions
- You Matter – Emotional Wellness
- Poll: Your Opinion Matters
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Bipolar Disorder Awareness
Each year, World Bipolar Day is observed on March 30. It is organized by the International Bipolar Foundation in collaboration with the Asian Network of Bipolar Disorder and the International Society for Bipolar Disorders. The vision of World Bipolar Day is to bring awareness to bipolar conditions and eliminate social stigma through education and understanding of the condition.
According to the Substance Abuse and Mental Health Services Administration, bipolar disorder is a brain disorder that causes unusual shifts in energy, activity levels, sleep and mood. These shifts range from extreme highs (mania or hypomanic episodes) to lows (depressive episodes).
Bipolar disorder symptoms can significantly disrupt a person’s life and ability to function. When depressed, the individual may feel sad and hopeless, and lack interest in activities once found pleasurable. When the mood shifts to mania or hypomania (less extreme than mania), there are feelings of euphoria, over-excitement, increased energy, and irritability. While bipolar disorder is a lifelong illness, it is treatable with medication and psychological counseling (psychotherapy).
A few celebrities you might know who are living and managing bipolar disorder:
Register to attend the March 26, 2024, An Overview of Bipolar Disorders training and use the resources provided to educate, reduce stigma, and spread awareness about bipolar disorder.
According to the Substance Abuse and Mental Health Services Administration, bipolar disorder is a brain disorder that causes unusual shifts in energy, activity levels, sleep and mood. These shifts range from extreme highs (mania or hypomanic episodes) to lows (depressive episodes).
Bipolar disorder symptoms can significantly disrupt a person’s life and ability to function. When depressed, the individual may feel sad and hopeless, and lack interest in activities once found pleasurable. When the mood shifts to mania or hypomania (less extreme than mania), there are feelings of euphoria, over-excitement, increased energy, and irritability. While bipolar disorder is a lifelong illness, it is treatable with medication and psychological counseling (psychotherapy).
A few celebrities you might know who are living and managing bipolar disorder:
- Demi Lovato
- Mariah Carey
- Jean-Claude Van Damme
- Selena Gomez
- Catherine Zeta-Jones
Register to attend the March 26, 2024, An Overview of Bipolar Disorders training and use the resources provided to educate, reduce stigma, and spread awareness about bipolar disorder.
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Article: Communicating With Residents Diagnosed With Bipolar Disorder
Bipolar means “two poles” or “two extremities.” Residents diagnosed with bipolar disorder may experience shifts in mood (known as cycling) that can include deep, depressive lows or peaks with high, intensive mania. As a resident moves through the cycle, you may observe changes in function impacting thinking, behavior, and motivation. Their ability to problem-solve, process information, and make choices can fluctuate.
You may find that your communication style also needs to change and adjust throughout the cycle. Science and experience have shown that positive rapport contributes to improved quality of care and outcomes in all aspects of health care. Your ability to communicate with residents plays a tremendous role in building that rapport.
Consider these points in adapting communication for a resident moving towards the low pole (depression):
You may find that your communication style also needs to change and adjust throughout the cycle. Science and experience have shown that positive rapport contributes to improved quality of care and outcomes in all aspects of health care. Your ability to communicate with residents plays a tremendous role in building that rapport.
Consider these points in adapting communication for a resident moving towards the low pole (depression):
- Speak slower and take longer pauses to allow them to process what you’ve said.
- Acknowledge how they feel with empathy in your voice and facial expression.
- Consider using touch to help them feel connected with you and orient to the present.
- Allow for thoughtful silence at times. It may feel awkward, but this can help them feel safe and willing to continue talking versus shutting down due to feeling rushed.
- Make eye contact to help them feel connected to you, but don’t force it if they seem reluctant.
- Acknowledge that feelings of depression are difficult to discuss and express gratitude for trusting you.
- Maintain a calm, even pace of speech, even if the resident is talking rapidly. People like to communicate at the same basic energy level, which may help the resident slow down.
- Use short sentences to reflect their statements and ensure your understanding. This happened. And they said this. Then you felt this way.
- Allow more physical space between you and the resident to prevent them from feeling cornered. This can also help you feel less overwhelmed.
- Avoid too much eye contact during mania. Too much eye contact could intensify the situation and cause you to get swept up in the resident's elevated mood.
- Establish boundaries (without arguing or being disrespectful) as needed. A good rule of thumb is to ask yourself: Am I talking to this resident like they’re an adult? Or am I talking to them like they’re a child?
- Express gratitude for shifts towards calmer behavior and for giving you grace as you try to understand their needs in the face of the rapid-fire information they provide.
This article was contributed by Jean Horton, a licensed mental health counselor and geriatric mental health specialist, trainer for the COE-NF Behavioral Health Action Network and a consultant for the Residential Care Services Behavioral Health Support Team (RCS BHST) for the Washington State Department of Social and Health Services.
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Nursing Facility Guidance Updates
Coordinating Care under FTag 644 for residents with Serious Mental Illness (SMI)
In the landscape of nursing facility care, FTag 644 addresses the coordination of assessments with the Pre-Admission Screening and Resident Review (PASRR) program under Medicaid. Residents with a serious mental illness (SMI), such as bipolar disorder, can present with complex needs. This regulation, under the Nursing Home Reform Act, helps to ensure the quality of care for these residents.
Coordination under FTag 644 requires a multidisciplinary approach. All residents require a Level 1 screening. Upon completion of the Level 1 screening, if triggered, Level 2 screening is required. Recommendations from the PASRR Level 2 should be incorporated into a resident’s assessment, care planning, and transitions of care. Many residents with an SMI require completion of the Level 2 PASRR and coordination of personalized care plans. This means involving a team of professionals - including psychiatrists, nurses, social workers, and occupational therapists - to coordinate and begin care planning to provide holistic care.
The key to managing bipolar disorder lies in the care plans, which should be comprehensive and coordinated. They should encompass regular psychiatric evaluations, medication management, and therapeutic interventions tailored to the resident’s needs. The care plan should also include a detailed schedule, clear roles for each care team member, and a process for monitoring progress.
FTag 644 is vital to ensuring that residents diagnosed with bipolar disorder receive the specialized care they require. By adhering to this regulation and effectively coordinating care plans, nursing homes can significantly enhance the quality of life for these residents, promoting their overall well-being.
Coordination under FTag 644 requires a multidisciplinary approach. All residents require a Level 1 screening. Upon completion of the Level 1 screening, if triggered, Level 2 screening is required. Recommendations from the PASRR Level 2 should be incorporated into a resident’s assessment, care planning, and transitions of care. Many residents with an SMI require completion of the Level 2 PASRR and coordination of personalized care plans. This means involving a team of professionals - including psychiatrists, nurses, social workers, and occupational therapists - to coordinate and begin care planning to provide holistic care.
The key to managing bipolar disorder lies in the care plans, which should be comprehensive and coordinated. They should encompass regular psychiatric evaluations, medication management, and therapeutic interventions tailored to the resident’s needs. The care plan should also include a detailed schedule, clear roles for each care team member, and a process for monitoring progress.
FTag 644 is vital to ensuring that residents diagnosed with bipolar disorder receive the specialized care they require. By adhering to this regulation and effectively coordinating care plans, nursing homes can significantly enhance the quality of life for these residents, promoting their overall well-being.
What Can You Do TODAY?
Audit resident PASRR Level 1 screenings: Conduct regular audits of the current residents’ medical records to ensure compliance with FTag 644. This involves reviewing PASRR Level 1 screening and confirming whether a PASRR Level 2 is needed and/or has been completed. This also includes assessing care plans to ensure plans are individualized and comprehensive and verifying that they are being implemented as written. Any discrepancies found during the audit should be addressed immediately to ensure the well-being of residents.
PASRR screening procedures differ from state to state. Nursing facilities should know their state’s PASRR policy on referral to the state mental health or intellectual disability (SMH/ID) authority so that these authorities may determine when a Level 2 evaluation is needed.
Audit resident PASRR Level 1 screenings: Conduct regular audits of the current residents’ medical records to ensure compliance with FTag 644. This involves reviewing PASRR Level 1 screening and confirming whether a PASRR Level 2 is needed and/or has been completed. This also includes assessing care plans to ensure plans are individualized and comprehensive and verifying that they are being implemented as written. Any discrepancies found during the audit should be addressed immediately to ensure the well-being of residents.
PASRR screening procedures differ from state to state. Nursing facilities should know their state’s PASRR policy on referral to the state mental health or intellectual disability (SMH/ID) authority so that these authorities may determine when a Level 2 evaluation is needed.
The COE-NF is available to support your facility in any of these guidance areas. Contact the COE-NF today:
CARES Serious Mental Illness (SMI) Office Hours
The COE-NF is making the CARES® Serious Mental Illness™ Online Training Program available to CMS-certified nursing facilities at no cost. CARES SMI focuses on how to develop care strategies for individuals diagnosed with a serious mental illness and how it differs from dementia.
Interested in learning more about CARES SMI before committing or have general questions about the program? Join our 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.
Interested in learning more about CARES SMI before committing or have general questions about the program? Join our 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.
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Managing Substance Use Disorders in Nursing Facilities
Interested in receiving expert answers to substance use challenges you are facing in your nursing facility? Our subject matter experts, Dr. Jen Azen and Dr. Swati Gaur will answer questions related to your complex cases. No question is too small or too big!
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!
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!
Managing Substance Use Disorders in Nursing Facilities Office Hours begins Friday, April 19, 2024!
Who should attend: Clinicians, nurses, administrators and social workers.
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COE-NF Resource
The COE-NF developed the following resource that nursing facilities can use to educate the team about behavioral health conditions.
Understanding and Recognizing the Signs and Symptoms of Bipolar Disorder: Bite-sized Learning
This five-minute bite-sized learning video can be used to educate staff on bipolar disorder and how to identify common symptoms. The examples shown in the video will help staff learn to recognize the extreme highs and lows associated with bipolar disorder. Watch Video
This five-minute bite-sized learning video can be used to educate staff on bipolar disorder and how to identify common symptoms. The examples shown in the video will help staff learn to recognize the extreme highs and lows associated with bipolar disorder. Watch Video
Recognizing and Treating Bipolar Disorder in Nursing Facilities: Module
This 20-minute in-depth learning module educates staff on the definition of bipolar disorder, how to identify common symptoms and treatment options. It consists of pre- and post-test questions. After completing the post-test, a participation certificate is provided. Watch Video
This 20-minute in-depth learning module educates staff on the definition of bipolar disorder, how to identify common symptoms and treatment options. It consists of pre- and post-test questions. After completing the post-test, a participation certificate is provided. Watch Video
Bipolar Disorder Fact Sheet
This fact sheet provides nursing facility staff with the knowledge to better understand and care for residents diagnosed with bipolar disorder. Download Factsheet
This fact sheet provides nursing facility staff with the knowledge to better understand and care for residents diagnosed with bipolar disorder. Download Factsheet
Interested in accessing additional COE-NF resources for your facility?
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Approximately 5.7 million Americans have been diagnosed with bipolar disorder. A journal article published by the Annals of Long-Term Care found that as many as 10% of skilled nursing facility residents are diagnosed with bipolar disorder.
Source: Understanding Bipolar Disorder. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/sites/default/files/understanding-bipolar-disorder.pdf;Manasterski, M. J., Cruz, C., MD, Leach, C. L., MD, Sullivan, G. A., MD, Whiting, W. L., DO, FAPA, & Stewart, J. T., MD, DFAPA, AGSF (2016). Bipolar Disorder in Long-Term Care. Annals of Long-Term Care. https://www.hmpgloballearningnetwork.com/site/altc/articles/bipolar-disorder-long-term-care
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This March, seize the opportunity to enhance your expertise and enrich resident care by participating in our professional training sessions tailored just for YOU!
These sessions are being held at no cost to you.
Click the REGISTER HERE buttons below each training to sign up.
See you there!
These sessions are being held at no cost to you.
Click the REGISTER HERE buttons below each training to sign up.
See you there!
Tuesday, March 19, 2024
2-3 p.m. ET
*ACCME credits will be offered.*
*ACCME credits will be offered.*
Nursing facility residents are impacted by historical and intergenerational trauma that goes deep and wide for many racially minoritized groups in the United States. Whether the trauma is recognized openly or tucked deeply into the subconscious, it is often characterized by emotional, physical, and psychological wounds that bleed through generations and across one’s lifespan. In this session, nursing facility staff will gain awareness to consider, generations later, the mental health effects of African American slavery, the Jewish Holocaust, the Native American Indian experience, and Latinx immigration trauma that residents may have experienced.
Learning Objectives:
- Explain the concepts of historical, race-based, and intergenerational trauma.
- Consider the intergenerational and historical trauma experiences of Black, Latinx, and Native Americans.
- Discuss how the biology of trauma can negatively impact trust in caregivers.
Wednesday, March 20, 2024
12-1:30 p.m. ET
*ACCME & NAB credits will be offered.*
Key Components Covered in the Training:
- How to Question, Persuade and Refer someone who may be suicidal.
- How to get help for yourself or learn more about preventing suicide.
- The common causes of suicidal behavior.
- The warning signs of suicide.
- How to get help for someone in crisis.
Thursday, March 21, 2024
1-1:30 p.m. ET
*ACCME credits will be offered.*
With current trends in opioid overdose, residents in skilled nursing facilities may also be at risk. It is important to train staff to recognize opioid overdose and respond quickly to save a life. In this training, attendees will review opioid overdose signs and symptoms. We will help to provide a framework for developing a process to respond to an overdose with naloxone, a lifesaving medication. We will also review processes that can help prevent opioid overdose with education.1-1:30 p.m. ET
*ACCME credits will be offered.*
Learning Objectives:
- Become competent in assessing for opioid overdose.
- Review trends in opioid overdose.
- Understand how naloxone is administered in an emergency overdose.
- Review how to establish facility training and overdose prevention within skilled nursing facilities.
Friday, March 22, 2024
11 a.m.-4:30 p.m. ET
7.75 NAB credits and 5.5 ACCME credits will be offered after completing the live training.
11 a.m.-4:30 p.m. ET
7.75 NAB credits and 5.5 ACCME credits will be offered after completing the live training.
Mental Health First Aid (MHFA) training provides skills to engage and provide initial help and support to someone developing a mental health or substance use challenge or experiencing a crisis.
This session provides a MHFA certification for three years.
The training covers:
- Common signs and symptoms of mental health and substance use challenges.
- How to interact with a person in crisis.
- How to connect a person with help.
- Expanded content on trauma, substance use and self-care.
Part 1 starts AFTER initial registration has been APPROVED by the instructor. Approved registrants will be emailed instructions on how to create an online profile using MHFA Connect and complete a pre-survey/quiz followed by a two-hour self-paced online course. Registrants MUST complete Part 1 no less than 48 hours (two business days) prior to the scheduled Part 2 session.
Part 2 is a 5.5-hour live instructor-led virtual training. Participants are required to be on camera the entire time.
Part 3 participants will return to MHFA Connect to complete the post-test and evaluation, which is required to receive a certificate of participation.
To register for the Mental Health First Aid training, please send your name, email address, agency and training date to coeinfo@allianthealth.org by Friday, March 15, 2024.
Tuesday, March 26, 2024
2-2:30 p.m. ET
*ACCME & NAB credits will be offered.*
2-2:30 p.m. ET
*ACCME & NAB credits will be offered.*
This half-hour training will introduce staff to a basic understanding of bipolar disorder, its onset, symptoms, and treatments. Participants will leave with an understanding of this mood disorder and will be able to identify its symptoms and approaches to help residents experiencing challenges from bipolar disorder.
Learning Objectives:
- Participants will gain an understanding of bipolar disorder.
- Participants will be able to recognize and understand the signs and symptoms of mania and depression.
- Participants will learn appropriate responses of engagement with residents.
Thursday, March 28, 2024
1-2 p.m. ET
*ACCME & NAB credits will be offered.*
1-2 p.m. ET
*ACCME & NAB credits will be offered.*
Participants will gain an understanding of the Stages of Change model in the context of substance use disorders (SUD). Learn effective communication and motivational strategies to support the resident’s journey to recovery.
Learning Objectives:
- Define and explain the Stages of Change Model.
- Identify and assess the stages of change in residents with SUD.
- Discuss how to apply appropriate interventions tailored to each stage of change.
- Understand the challenges and dynamics associated with each stage.
- Explain relapse prevention strategies for residents in the maintenance stage.
- Describe how to foster effective communication and motivation throughout the change process.
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You Matter:
Emotional Wellness
Emotional Wellness
Emotional wellness means being able to express one's feelings, cope with daily stressors, and enjoy life. Consider one or two ways your facility can better support emotional wellness for staff and residents.
Ideas for optimizing emotional wellness in your facility:
- Dedicate time to activities that help express and process thoughts and feelings.
- Examples: Writing in a journal, listening to music, and talk therapy.
- Incorporate mindfulness practices into daily schedules and routines to remain calm and centered throughout the day.
- Examples: Yoga, mindful breathing, and meditation.
- Cultivate a culture of self-love by posting positive self-affirmations around the facility for everyone to read and repeat to themselves daily.
- Examples: “I am enough.”, “I can do hard things.”, and “I am grateful for another day of life.”
Source: Creating A Healthier Life: A Step-By-Step Guide to Wellness | SAMHSA Publications and Digital Products. (2016, April 1).
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Contact us:
For more information, please call 1-844-314-1433 or email coeinfo@allianthealth.org.
To submit a request to inquire about substance use and/or mental health training options for your facility, complete the inquiry form.
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For more information, please call 1-844-314-1433 or email coeinfo@allianthealth.org.
To submit a request to inquire about substance use and/or mental health training options for your facility, complete the inquiry form.
Was this email forwarded to you? If so, please subscribe HERE.
Want to opt-out from receiving news from us? Click HEREto unsubscribe.
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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), in collaboration with the Centers for Medicare & Medicaid Services (CMS), to create a COE-NF. AHS has over 50 years of experience working with nursing homes and behavioral health in nursing homes.
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This newsletter was made possible by grant number 1H79SM087155 from the Substance Abuse and Mental Health Services Administration (SAMHSA). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Substance Abuse and Mental Health Services Administration.
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