| October 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. | | | | October 10, 2024, is recognized as National Depression Screening Day. Making depression screening a part of general health screenings provides a quick and easy way for early identification and referral to treatment for residents with depressive symptoms. | | | | This time can also be used to increase the understanding of depression and other mental health illnesses while intentionally addressing stigma through advocacy and education.
Depression is a chronic mental health condition that causes a persistent low mood and loss of interest in activities that last for at least two weeks. It can affect all aspects of life, such as sleeping, eating, working, and even family, friends, and community relationships.
Some findings show that depression is relatively frequent in residents of long-term care facilities, with up to 35% of residents experiencing major depression or clinically significant depressive symptoms. (Journal of the
American Medical Directors Association (JAMDA), 2008) | | | Do the following to improve depression awareness in your nursing facilities: - Screen all residents: Nursing facilities should routinely screen all residents for depression using the Patient Health Questionnaire PHQ 2 to 9 screening tools. Review the PHQ 9
- Provide staff training: Training staff in recognizing depressive symptoms and best care practices is a first step in reducing stigma, increasing empathy, and providing treatment options other than just medication. Share this bite-sized learning to educate your team on nonpharmacological approaches to managing depression. View Bite-Sized Learning
- Provide resident education: Educating residents about depression helps improve treatment compliance, encourages active participation, and leads to better overall outcomes.
Encourage non-pharmacological interventions, including individual and group therapies, light therapy, physical activity, recreation, and rehabilitation activities. For additional
nonpharmacological strategies, download the resource below. | | |
| The COE-NF is dedicated to providing mental health and substance use education for nursing facilities by equipping them with the knowledge and tools to recognize and address mental health and substance use challenges residents might face daily. Learn how we have helped nursing facilities across the country
transform care and how we can support your facility in achieving the same results. | | | A vice president of recreation and life enrichment reached out to COE-NF for support in enhancing care quality across 40 skilled nursing facilities, citing the need for a stronger trauma-informed care approach.The COE-NF suggested trauma-informed care training for the staff, specifically designed for facility activity directors, and developed a two-part training program with specific learning objectives:
- Understand what happens to the traumatized body
- Learn why trauma behavior is misunderstood
- Recognize the benefits of social engagement in decreasing trauma responses
- Understand the basic concepts of trauma-informed care
Twenty-five activity directors participated in the training, demonstrating a 36% knowledge gain from the pre-test to the post-test. The feedback was overwhelmingly positive, with participants expressing gratitude for the valuable training and the tools provided to better meet the needs of residents affected by traumatic situations.
Click below to learn more about the COE-NF’s dedication to fostering better care for residents impacted by trauma in nursing facilities. | | | | The COE-NF partners closely with medical directors and leading mental health and substance use experts to enhance education and awareness within nursing facilities. Through these collaborations, we work to provide specialized training and insights for long-term care settings. | |
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| Click below for an episode of PALTtalk, where the COE-NF joins PALTmed to discuss pain management for patients with substance use disorder. | | |
| Nursing Facility
Guidance: Requirements for Using Psychotropic Medications | | | F758 of the CMS State Operations Manual (SOM) Appendix PP offers guidance to surveyors for long-term care (LTC) facilities on the use of psychotropic medications. It includes a broader definition of
psychotropics and provides additional guidance on other medications used for psychotropic purposes.
The guidance specifying the requirements for psychotropic medication use applies to antipsychotics, antidepressants, antianxiety, and hypnotic medications, without exception. It further clarifies that any medication affecting brain activity is subject to these requirements if it appears to be given in place of another psychotropic medication (such as antihistamines, anti-cholinergic medications, and central nervous system agents). Surveyors are directed to screen for medications prescribed for an inadequate indication to determine if they were used to sedate or restrict movement or cognition.
According to the SOM, if antipsychotic medications are prescribed, documentation must clearly show the indication for the antipsychotic medication, the multiple attempts to
implement care planned, non-pharmacological approaches, and ongoing evaluation of the effectiveness of these interventions. It is important to keep in mind that diagnoses alone do not necessarily warrant the use of an antipsychotic medication.
Antipsychotic medications may be indicated if: - Behavioral symptoms present a danger to the resident or others.
- Expressions or indications of distress are of significant distress to the resident.
- Multiple
non-pharmacological approaches have been attempted (if not clinically contraindicated) but did not relieve the symptoms that are presenting a danger or significant distress.
- Gradual dose reduction (GDR) was attempted, but clinical symptoms returned.
The requirements underlying this guidance emphasize the importance of seeking an appropriate dose and duration for each medication and minimizing the risk of adverse
consequences. The purpose of GDR is to find an optimal dose or to determine whether continued use of the medication is benefiting the resident. Tapering may be indicated when the resident’s clinical condition has improved or stabilized, the underlying causes of the original target symptoms have resolved, and/or non-pharmacological approaches have been effective in reducing the symptoms. | | | What you can do TODAY to help maintain compliance with antipsychotic medications:
- Establish a schedule to review all residents who are taking antipsychotic medication.
- Prioritize residents who show signs and symptoms of side effects or have PRN (as needed) orders for medication review, discontinuation, or schedule routinely.
- Share the review findings with the interdisciplinary team to prioritize medication reviews and determine the next steps for residents with negative responses.
- Keep track of and report any trends, such as the number of PRN orders, to the facility's Quality Assurance and Performance Improvement (QAPI) committee.
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| The COE-NF stands ready to support your facility in these guidance areas. Contact us today: | | | | New Podcast: Unpacking the Behavioral Health Equity Concept | | | | | | Explore how behavioral health equity is not just a concept but can be a guiding principle within long-term care facilities, from ensuring fair access to mental health and substance use treatment to addressing systemic barriers that impact racial and ethnic populations. Discover strategies around this concept to drive change within the walls of nursing facilities. | |
| | Have mental illness and substance use questions? We have the answers! Join us for office hours to talk with the experts. | | |
Managing Substance Use Disorders 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 SMI differs from dementia.
Interested in learning more about CARES® Serious Mental Illness™ before committing, or have general questions about the program?
Join our upcoming monthly office hours meeting on Wednesday, October 16, 2024, from 3–3:30 p.m. ET for an open discussion on implementation, benefits, case studies, and successes.
Audience: Appropriate for staff at all levels of care |
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| | Major Depressive Disorder: Myths vs. Facts
Learn the myths vs. facts of depression. Download Resource |
| | | | Depression Zone
Tool
Use the Depression Zone tool created by Alliant Health Solutions to help residents manage symptoms of depression. Download Resource | | | | | The Power of Empathy: Bite-Sized Learning
In this five-minute video, explore effective ways to connect with residents by understanding and empathizing with
their emotions. Discover simple techniques for showing empathy and how it can support residents with mental health disorders. Watch Video | | | | | Identifying and Supporting Residents with Major Depressive Disorder: Module
This module provides effective support tools for residents living with major depressive disorder. Watch Video | | | |
Interested in accessing additional COE-NF resources for your facility?
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| Major depression is one of the most common mental disorders in the United States. Click Here to learn more. | | | |
| Unlock vital mental health skills and join our October training events to gain essential knowledge in suicide prevention, mental health first aid and trauma-informed care. Each evidence-based session is led by expert speakers and offers ACCME & NAB
credits.
Seize the opportunity to expand your expertise and contribute to mental health care in your facility.
Register Today! | | | Assessment and Initial Management of Suicidal Ideation Across Long-Term Care Settings |
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| Tuesday, October 15, 2024
2-3 p.m. ET 1.0 ACCME & 1.0 NAB
credits will be offered.
This session will assist members of the interdisciplinary team to gain confidence and competence in screening and assessing long-term care residents with suicidal ideation and/or suicidal behavior. With a lack of availability of behavioral health clinicians across many long-term care settings, it is imperative for front-line clinicians and staff to have the skills to assess a resident for suicidal ideation and to initiate appropriate interventions to keep the resident safe in the least restrictive environment. The epidemiology of suicide in long-term care settings, risk factors, and protective factors will be discussed. Best practices for suicide screening,
comprehensive assessment, and early intervention will be described and applied to a case study.
Learning Objectives: - Describe at least two risk factors and protective factors for suicidal ideation in long-term care settings.
- Discuss best practices for screening and comprehensive assessment of suicidal ideation in long-term care settings.
- Develop an initial management plan for a long-term care resident who is
experiencing suicidal ideation.
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An Introduction to Co-Occurring Disorders | | | | Thursday, October 17, 2024
2-3 p.m. ET 1.0 ACCME & 1.0 NAB credits will be offered.
This training will equip nursing facility staff with the knowledge and skills necessary to recognize, assess, and respond effectively to co-occurring disorders (mental health and substance use disorders) among residents,
ultimately enhancing the quality of care provided in the facility.
Learning objectives: - Define co-occurring disorders.
- Recognize the prevalence and common types of co-occurring disorders among elderly populations.
- Identify signs and symptoms of co-occurring disorders in nursing facility residents.
- Understand the importance of holistic care and interdisciplinary collaboration in managing co-occurring disorders.
| | | | | An Introduction to Trauma-Informed Care | | | | Tuesday, October 22, 2024
2-2:30 p.m. ET 0.5 ACCME & 0.5 NAB credits will be offered.
In this brief 30-minute training, nursing facility staff will explore the principles of trauma-informed care and learn techniques for creating a safe environment where
both residents and staff can thrive.
Learning objectives: - Define trauma and trauma-informed care.
- Understand what happens to the traumatized body
- Learn why trauma behavior is misunderstood
- Understand the basic concepts of trauma-informed care
| | | An Easy Pill to Swallow: Nonpharmacological Interventions for Long-Term Care Residents | | |
| Tuesday, October 29, 2024
2-2:30 p.m. ET 0.5 ACCME & 0.5 NAB credits will be offered.
While psychotropic medications can be valuable for mental wellness, there are many effective nonpharmacological interventions available. This presentation will introduce various non-drug approaches for residents in nursing facilities. Attendees will learn about a comprehensive biopsycho-spiritual approach to mental health, illustrated with real-life case examples. The session will also cover the development of person-centered
strategies to address mental illness, aiming to improve symptoms and reduce the need for PRN (as-needed) medication requests or emergency hospitalizations.
Learning objectives: - Understand and apply person-centered care principles in geriatric populations.
- Recognize the presence and impact of mental illness on nursing facility residents.
- Develop and implement a comprehensive approach to mental illness
using nonpharmacological interventions.
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Working in a nursing facility can be incredibly rewarding, but it can also be physically and emotionally demanding. It is invaluable to recognize the significance of self-care as a component of your overall well-being.
Take a moment to complete the Mental Health of America’s quick online mental health test to gain awareness of your mental health. This screening tool is an easy way to determine whether you are experiencing symptoms of a mental health condition. Remember - You Matter! | |
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| | Join our text message list!
Scan the QR code or click the button below to sign up and receive text notifications from COE-NF.
Stay up-to-date on COE-NF news and events. | | |
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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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| | | 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 the COE-NF. AHS has over 50 years of experience working with nursing facilities and behavioral health in nursing facilities. | | | | | 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. | | | | | | |
