Reducing the Use of Seclusion and Restraints in Psychiatric Facilities
Centers for Medicare and Medicaid Services (CMS)
Satellite Broadcast and Webcast
Friday, September 23, 2005
1:00 PM –3:00 PM EDT
PLEASE ADJUST TIMES FOR YOUR TIMEZONE
This live satellite broadcast and Webcast will present Six Core Strategies to Reduce the Use of S/R
© in inpatient mental health facilities that serve children and adults Recent changes in law and regulations regarding the use of S/R have created an impetus for service providers to reduce and even eliminate the use of these high risk interventions. Largely preventative, best practices that are effective and replicable have been identified but are not yet widely used on the local level.
The presentation will include a brief overview of the history of this initiative, emerging findings on effectiveness, a brief review of the core theories and literature that added support to the development of the six core strategies and recommendations for administrative and practice change.
.

Inpatient mental health service providers have largely been left to their own devices in reducing the use of S/R. In many cases providers have continued to focus on how to use S/R interventions more safely. This session will provide an overview of Six
Core Strategies
© to reduce the use S/R in the first place. Provide overview of current
CMS regulations and policies regarding seclusion and restraints in inpatient and residential settings.
After viewing this program, participants will be able to:

Become familiar with the historical and current national and state efforts to reduce the use of seclusion and restraint.

Understand the literature based theories and principles that provide the approach and foundation for the identification of the Six Core Strategies
© to reduce and even eliminate S/R use.

Give an overview of the Six Core Strategies
© proven effective in reducing use including practical recommendations for administrative and clinical practice change.
This will include a specific focus on the inclusion of child and adult service recipients in their own care.

Understand the steps in developing a facility specific S/R Prevention Plan.

Hear from two mental health facility providers on their experiences in reducing seclusion and restraint.
1

Mental Health Service Providers
CMS Regional Office and State Agency Psychiatric Facility Surveyors
National Mental Health Provider Associations
Kevin Ann Huckshorn, RN, MSN, CAP, ICADC
National Technical Assistance Center (NTAC) for State Mental Health Planning
Jennifer Jones, RN, BSN
CMS PRTF program lead
David W. Eddinger, RN, MPH
CMS lead hospital survey and certification analyst.
Joan B. Gillece, Ph.D.
Project Director for the National Coordinating Center for the Seclusion and Restraint
Reduction Initiative.
Tom Lane
Vice President of the Recovery Supports Division for New Horizons of the Treasure Coast.
Anthony J. Riccitelli
Chief Operating Officer of Worcester State Hospital
Dr. Malini Patel
Medical Director of Community Psychiatric Services/Metro Suburban Network, Elgin
Mental Health Center, Elgin, Illinois
Raul S. Almazar
Hospital Administrator of Elgin Mental Health Center.
Individual and Site registration is available today. To obtain CEUs for viewing the training program you must go to the CMS website. For individual and site registration and viewing instructions go to: http://cms.internetstreaming.com
This program will have a live Webcast and will be available for viewing up to one year following September 23 at http://cms.internetstreaming.com
This broadcast will be available on C and Ku Digicipher bands. Specific satellite technical specifications will are available at http://cms.internetstreaming.com
or can be obtained by calling 1-800-401-9387.
2

Handouts for this broadcast will be available at the following website after September 9,
2005 at http://cms.internetstreaming.com
JOIN THE CMS LIVE WEBCAST AND SATELLITE CONFERENCE!
Reducing the Use of Seclusion and Restraints in Psychiatric Facilities
Webcast and Satellite Broadcast
Friday, September 23, 2005
1:00 PM –3:00 PM EDT
On Thursday September 23, 1:00-3:00 p.m. EDT, the Center for Medicaid and State
Operations/Division of Continuous Care Providers will sponsor a live webcast and satellite broadcast entitled “ Reducing Seclusion and Restraints in Psychiatric Facilities.”
This broadcast is designed to provide a brief overview of the history of this initiative, emerging findings on effectiveness, a brief review of the core theories and literature that added support to the development of the six core strategies and recommendations for administrative and practice change.
Time (EDT) Topic Presenter
1:00 – 1:15 p.m.
1:15 – 1:30 p.m.
1:30 – 2:00 p.m.
Welcome and Introduction
Overview
Theoretical Foundation for S/R
Interventions
1.
Myths & Assumptions Regarding
S/R
2.
The Public Health Prevention
Approach Applied to S/R
Reduction Efforts
3.
Trauma Informed Care
4.
The Principles and Practice of
Recovery
Stan Stovall, Moderator
Thomas Hamilton, Director, Survey
& Certification Group, CMSO
Kathryn Power, Director, CMHS,
SAMHSA)
Jennifer Jones, RN, PRTF Program
Lead
Capt. David Eddinger, RN, Acute
Care Services
Kevin Ann Huckshorn, RN, MSN,
CAP, ICADC
Joan Gillece, PhD
3

2:00- 2:30 p.m.
2:30 – 2:25 p.m.
2:25 – 2:50 p.m.
2:45 – 3:00 p.m.
Creating a Comprehensive S/R
Prevention Plan (Six Core Strategies for
Reducing S/R)
1.
Leadership Toward Organizational
Change
2.
Use of Data to Inform Practice
3.
Workforce Development
4.
Use of S/R Prevention Tools
5.
Supporting Consumer and Advocate
Roles in Inpatient Settings
6.
Use of Debriefing Tools
Findings & Results
Provider Testimonials
Question & Answer Session
Kevin Huckshorn, RN, MSN
Tom Lane, Consumer Advocate
Kevin Huckshorn, RN, MSN
Raul Almazar RN, MA,.
Administrator and Dr. Patel, Medical
Director, Elgin Mental Health
Anthony Riccitelli, CEO
Worchester State Hospital
Panel Members
Kevin Huckshorn, RN, MSN
Jennifer Jones, RN, PRTF Program
Lead
3:00 p.m. Conclusion
Faculty Biographical Information
Kevin Ann Huckshorn, RN, MSN, CAP, ICADC
Stan Stovall, Moderator
Ms. Kevin Ann Huckshorn, RN, MSN, CAP, ICADC, is the Director of the Office of Technical
Assistance at the National Association for State Mental Health Program Directors (NASMHPD) and the new National Coordinating Center for Seclusion and Restraint Reduction. Ms. Huckshorn is a licensed and certified mental health nurse and substance abuse clinician with practical knowledge from 24 years of professional frontline experience working in a variety of public and private mental health organizations and substance abuse programs.
Ms. Huckshorn has extensive experience in both in-patient and outpatient program development including consumer run projects; psychiatric rehabilitation treatment programs for persons with serious mental illness; and recovery-based mental health and substance abuse services. In her current role she manages multiple technical assistance projects, organizes state and national meetings, and monitors all services and products, from action plans to pragmatic tools and training for applying evidence-based practices. Ms. Huckshorn is a frequent speaker at national conferences related to behavior health. She also represents the state mental health agencies on the JCAHO Professional
Advisory Committee for Behavioral Health and is on the editorial boards of two peer reviewed mental health publications.
4

Jennifer Jones, RN, BSN
Jennifer Jones transferred to the Centers for Medicaid and State Operations/Survey &
Certification/Division of Continuing Care Providers from the Atlanta Regional Office’s Survey &
Certification Review Branch where she surveyed nursing homes and ICF-MR facilities as well as conducted Federal Oversight/Support Surveys (FOSS) of state agency survey staff. Prior to entering federal service, Jennifer worked for BlueCross BlueShield (BCBS).
She was a Nurse Audit Specialist with CareFirst BCBS in Washington, DC in their Special
Investigations Unit, where she investigated suspected provider fraud and over-utilization issues. She was a Medical Management Nurse with WellPoint BCBS of Georgia in their Preauthorization
Division, where she conducted medical reviews and rendered pre-certification decisions. Jennifer’s clinical background is as an emergency room nurse who has worked in several emergency departments in the Washington DC Metro and Atlanta Metro areas. Jennifer is completing her
Master’s degree in Public Health (MPH) at Emory University.
David W. Eddinger, RN, MPH
David W. Eddinger is a Captain in the United States Public Health Service. He received his BSN from the University of North Carolina at Greensboro and his Masters of Public Health from Tulane
University.
At CMS he serves as the lead hospital survey and certification analyst. In this role he works daily with issues related to hospital compliance with the CMS Hospital Conditions of Participation. Part of his duties include coordinating the development of the interpretive guidelines for the hospital
Conditions of Participation including the Interpretive Guidelines for the Patients’ Rights Condition of
Participation. He has over 25 years of experience in healthcare including:
 forensic psychiatric nursing
 oncological nursing
 medical surgical nursing
 community health nursing

 school nursing health promotion and disease prevention
 hospital safety & security management, and
 regulatory affairs.
Joan B. Gillece, Ph.D.
Project Director, National Coordinating Center for the Seclusion and Restraint Initiative
National Association of State Mental Health Program Directors/
National Technical Assistance Center for State Mental Health Planning
66 Canal Center Plaza, Suite 302
Alexandria, VA 22314
Phone: 703-739-9333, ext. 157
Fax: 703-548-9517
Email: joan.gillece@nasmhpd.org
Dr. Gillece is new Project Director for the National Coordinating Center for the Seclusion and
Restraint Reduction Initiative. The Coordinating Center works with the eight state grantees to implementing best practice alternatives to seclusion and restraint in facilities serving adults, child and forensic populations. Prior to coming to National Association of State Mental Health Program
Directors, Dr. Gillece was the Director of Special Needs Populations for Maryland’s Mental Hygiene
5

Administration. She was responsible for developing and sustaining services for Maryland citizens who have serious mental illness and may also be incarcerated in local detention centers, homeless, suffering form a co-occurring substance abuse disorder or be deaf. She has been successful in obtaining private, state, local, and federal funding to create a patchwork pf services for Special Needs
Populations.
Dr. Gillece also recently obtained funding to develop a program for pregnant, incarcerated women and their newborns. This program, Tamar’s Children, is designed to break the intergenerational cycle of despair, poverty, addiction, and criminality. She has spoken extensively on developing model systems of care through partnerships across agencies. Dr. Gillece has provided consultation to numerous states on developing innovative institutional and community based systems of care for individuals with co-occurring disorders in the justice system via GAINS Center and the National
Institute of Corrections.
Thomas Lane
Vice President, Recovery Supports & Forensic Services
New Horizons of the Treasure Coast
4500 Midway Road
Ft. Pierce, FL 34981
Phone: 772-468-5600
Fax 772-468-5633
Email: tlane@nhtcinc.org
Mr. Thomas ‘Tom’ Lane serves as the Vice President of Recovery Supports and Forensic Services at
New Horizons of the Treasure Coast. Before joining the National Alliance for the Mentally Ill
(NAMI) as director of the Office of Consumer Affairs, Mr. Lane worked as director of the Forest
Park Drop In Center, a peer-run project at South Florida State Hospital. He also served as vice chair and chair of the NAMI National Consumer Council.
While living in New Mexico, he founded, worked in, and advocated for the first independent, consumer-run drop-in center in Albuquerque in collaboration with NAMI New Mexico. Other achievements include the design and implementation of a statewide outreach campaign, the Consumer
Involvement Project , and the initiation of a Peer Bridger program at the University of New Mexico’s
Mental Health Center. Mr. Lane is particularly interested in the intersection of law enforcement, justice systems, and mental health systems and is a nationally recognized consumer expert in this area. Mr. Lane is a consumer living with bi-polar disorder, and a recovered substance abuser. In addition to serving the NAMI national office, he is active in the NAMI Broward County affiliate and serves on the NAMI Florida Board of Directors.
Anthony J. Riccitelli
Chief Operating Officer
Worcester State Hospital
305 Belmont Street
Worcester, MA 01604
Phone: 508-368-3461
Fax: 508-363-1515
Email: Tony.Riccitelli@state.ma.us
Mr. Riccitelli is currently the Chief Operating Officer of Worcester State Hospital. He has led his executive team to reducing use of restraint and seclusion at their hospital by over 75% in a two-year period. He is a member of the Massachusetts Department of Mental Health’s committee on Restraint
6

and Seclusion Reduction and Violence Free Hospitals and Technical Expert Panel. Prior to this appointment, Mr. Riccitelli was the Superintendent of the John C. Corrigan Mental Health Center and the Director for the Department of Mental Health’s Fall River Case Management Site Office.
He has also worked for the Department of Mental Health’s Division of Forensic Mental Health
Services, as Southeast Area Forensic Director with oversight of the Department’s Court based forensic evaluation clinics and inpatient forensic programs. Preceding his tenure with the Department of Mental Health, Mr. Riccitelli worked in the private sector and was the Director of the Secure Care
Program, providing inpatient forensic evaluation and treatment.
Dr. Malini Patel
Dr. Malini Patel is the Medical Director of Community Psychiatric Services/Metro Suburban
Network, Elgin Mental Health Center, Elgin, Illinois and is also Clinical Associate Professor of
Psychiatry and Behavioral Sciences at Rosalind Franklin University of Medicine and Science/the
Chicago Medical School, North Chicago, Illinois. She is board certified with added qualifications in
Addiction Psychiatry and serves as an examiner for the American Board of Psychiatry and
Neurology.
Dr. Patel is a Distinguished Fellow of the American Psychiatric Association. She serves on the
Illinois
Psychiatric Society Governmental Affairs Committee and is a councilor on the Illinois Psychiatric
Society Executive Committee and the American Association of Psychiatric Administrators
Committee. Dr. Patel has published regularly in peer reviewed journals and has presented nationally and internationally on topics related to addictions, administrative+ restraints.
Raul S. Almazar
Raul S. Almazar is the Hospital Administrator of Elgin Mental Health Center. Mr. Almazar holds a
Bachelors Degree in Nursing and Masters of Arts Degree in Psychology. Prior to joining Elgin
Mental Health Center, Mr. Almazar served as Director of Nursing at Chicago-Read Mental Health
Center, another state operated facility. Mr. Almazar has extensive Psychiatric management experience, having held positions as Director of Patient Services, Director of Clinical Services,
Director of Nursing and Clinical Nurse Manager. Mr. Almazar also has held business positions as
Associate Administrator and President of his own behavioral health company.
7

TECHNICAL FACT SHEET
DATE: September 23, 2005
TEST TIME: 12:30 – 1:00 p.m. EDT
11:30 – 12:00 p.m. CDT
10:30 – 11:00 a.m. MDT
9:30 – 10:00 a.m. PDT
PROGRAM TIME: 1:00 – 3:00 p.m. EDT
12:00 – 2:00 p.m. CDT
11:00 – 1:00 p.m. MDT
10:00 - 12:00 p.m. PDT
WEBCAST
TROUBLESHOOTING
NUMBER:
SATELLITE TROUBLE
NUMBER:
703-812-8816
410-786-3618
CMS Digital Network: Channel 712
Individuals and Sites outside of the CMS satellite network who wish to set up a site for this program or view this broadcast via webcast should go to http:// cms.internetstreaming.com to register. Handouts can also be found at that website
In general, there are 2 major formats for satellite transmission - digital and analog. CMS uses both analog and digital formats, CMS’s Digital network is a closed network which can only be viewed by its ten regional offices and several State survey agencies in regions VIII, IX, and X. The Digital format that CMS uses is called Digicipher. CMS is also capable of transmitting and receiving programs in KU-band and C-band analog. Ku-band and C-band have been in use for many years, can be received by thousands of ‘steerable’ analog dishes nationwide. C-band is the oldest transmission signal and the most widely used. NOTE: This is NOT ‘video conferencing,’ which is carried by telephone lines.
8

Potential Analog Downlink Sites: There are thousands of steerable analog downlink dishes nationwide at public schools, colleges, libraries, hotels, television stations, restaurants, private residences, etc. A few calls should locate one near you.
Here are some places to start calling:

Your Local Cable and Satellite Television Provider: Contact your local cable/satellite television distributor, which is probably listed under “Television -- Cable &
Satellite.” Ask to speak with the programming staff and inquire about their willingness to simulcast the broadcast on your area's public access channel. Advise them that this broadcast is free of charge. Satellite television distributors may be able to provide you with a list of public institutions such as libraries, community centers, health care centers, and public schools that subscribe to their services. You may also wish to contact your local public TV station and ask that they download and air the program on their station.

Public Libraries: Larger public libraries are a good place to check for satellite downlink facilities. Check library listings in the local government section of the blue pages of your local telephone directory.

Educational Institutions: Universities, community colleges, and large public high schools often have satellite downlink capabilities.

Hotels and Business Centers: Large hotels that frequently host conventions in business districts, may be able to receive satellite broadcasts. These hotels may charge a fee for viewing.

Health Care Facilities: Many hospitals and health maintenance organization (HMO) offices have satellite reception capabilities.

Copy Centers: Commercial office supply centers may also have satellite capabilities.
When you contact an analog site, you will need to give the contact person the satellite coordinate information. The coordinates for the broadcast should be made available from the
Central Office contact approximately 30 days prior to the broadcast. Here is the information you will need to provide:

Transmission Type:

Satellite:

Orbital Location:

Transponder:

Polarity:
 Downlink Frequency:

Satellite Help Hotline:

Broadcast Schedule:

Test Signal:

Broadcast Title:
9

You will need to know what to ask the person who answers the phone, who may or may not be the best person at that organization to help.
If the facility has an analog satellite:
You are interested in viewing a satellite C-band and/or KU band analog broadcast and you understand that this facility may have that capability. You should have the satellite coordinates for reference. Some satellite dishes can’t be pointed to all satellites.
You should also ask:

If the facility can receive the broadcast, is the viewing room open to the public and not reserved for another use at the time of the broadcast?

If the viewing room is available, how many people will it hold, and is there any fee for its use?

Will the facility let you phone or fax your questions in to a toll free number?

You should point out that this broadcast is open to the public and employees of the hosting facility with an interest in the topic are welcome.

As a courtesy, you should offer the hosting facility a list of the people who will attend.

Are there any special arrangements necessary for entry to the site?

It is your responsibility to arrange for sign language interpretation if you anticipate that individuals with hearing impairments will attend.
If you find a site, you should be prepared to perform as site coordinator.
Typically, site coordinators will:

Locate a suitable location.
 Promote the event locally.

Direct individuals to register if necessary

Download material (e.g., sign-in sheet, evaluation, participant guide) if available

Ensure that participants sign in on the day of the event.

Distribute copies of the participant guide and handouts to participants the day of the broadcast.

Assist participants with the use of the distance learning equipment.
 Receive instructions from the broadcast director regarding any activities they may be asked to facilitate.

Encourage active participation in event activities.

Record the broadcast for office use.

Encourage participants to complete the evaluation form (included in the handout).

Mail/fax the sign-in sheet and completed evaluation form to Central Office following the event.
10