Preparing to Handle the Worst
COA has several ongoing initiatives, covering areas as diverse as adult guardianship, disaster services, juvenile justice services, and after-school programs. COA is working with a number of accredited organizations that are very involved with guardianship, including Catholic Charities USA and Jewish Family & Children's Service, to develop adult guardianship standards for organizations that serve adults only, expected to be published in January.
“As the country becomes increasingly older, there's a greater need to protect vulnerable senior citizens,” says COA President and CEO Richard Klarberg. “Because we have such a mobile nation, older people are left on their own and find it difficult to cope, and they become potential victims for unscrupulous individuals, so the guardianship standards look to protect the rights of seniors.”
COA also was involved in developing standards for disaster-relief case management, which are about to be published. In concert with a large group of other organizations, COA worked with the National Voluntary Organizations Active in Disaster (NVOAD) to develop the standards.
“As we saw with Katrina, there was definitely a void in how the needs of people [displaced by disasters] were being managed and how they were being literally tracked,” says Klarberg. “So we developed these standards…that will allow agencies to be identified as having in place standards that will help in the area of case management in the event of natural disaster and of course, sadly, in the event of a man-made disaster.”
Calling this an exciting and important initiative, Klarberg says that COA wants to ensure that people's needs are being met beyond the immediate situation to help them rebuild their lives. “What we want to put in place through disaster relief case management is that agencies have the capacity to be responsive in a very structured and systematic way to deal with the needs of these people,” he says.
The standards evaluate an organization's ability to go beyond being a first responder, at which point it becomes a much more difficult task to identify individuals' and families' needs, notes Klarberg. While this includes basic needs (e.g., food and shelter), it also includes people's ability to cope with what has just happened in their lives, he explains.
“We've seen in many instances, whether it was 9/11 or Katrina, that there are heroic deeds done by men and women, both professionals and volunteers, and then at a certain point, the support systems, if they don't disappear, they become substantially diminished,” says Klarberg. It then becomes increasingly difficult to meet the needs of those impacted, he adds.
Brion P. McAlarney is a freelance writer. Photo of Nikki Migas by Steven Meckler.
Joint Commission moves forward with HBIPS measure set
The Joint Commission has decided to implement the Hospital-Based Inpatient Psychiatric Services (HBIPS) measure set while it waits for the measures' endorsement by the National Quality Forum (NQF) and approval by the Hospital Quality Alliance (HQA). The measure set evolved out of a partnership between the National Association of Psychiatric Health Systems (NAPHS), National Association of State Mental Health Program Directors (NASMHPD), and NASMHPD's Research Institute (NRI) that began in 2002, and later involved the American Psychiatric Association and the Joint Commission. According to the Joint Commission's Web site, specifications for the following measures have been completed:
Admission screening for violence risk, substance use, psychological trauma history, and patient strengths completed
Hours of physical restraint use
Hours of seclusion use
Patients discharged on multiple antipsychotic medications
Patients discharged on multiple anti-psychotic medications with appropriate justification
Post-discharge continuing-care plan created
Post-discharge continuing-care plan transmitted to next level of care provider upon discharge
The HBIPS measure set will be available starting with October 1 discharges for freestanding psychiatric hospitals and acute-care hospitals with psychiatric units. Until the Joint Commission receives the nod from NQF and HQA, data on the measures will not be publicly available through QualityCheck.org and will not be included in the Joint Commission's Priority Focus Process (PFP) or Strategic Surveillance System (S3). Yet the data will be available to Joint Commission surveyors and will be in each hospital's ORYX Performance Measurement Report (available via secure extranet site).
To read about some of the history of the HBIPS measure set, visit http://www.behavioral.net/mccann0906. For the latest updates on the set, visit http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Hospital+Based+Inpatient+Psychiatric+Services.htm.
—Douglas J. Edwards
Behavioral Healthcare 2008 August;28(8):27-28