Caring for the Mentally Ill Behaviorally Impaired

1. Caring for the Mentally Ill Behaviorally Impaired By: Evelyn W. Stone RN.,BSN.,M.Ed.

2. 4 Levels of Need and Care • Dangerous • Serious Major • Minor

3. Level I • Dangerous - serious and persistent behavioral symptoms • Danger to self and others • Behavioral symptoms are ongoing & UNPREDICTABLE • Behavior interferes with client’s ability to live safely in traditional settings • Complex interactions between physical and mental

4. Level I (continued) f.)Requires expertise in diverse specialties making care complex and costly. g.)Demand specialized care provided by trained professionals to assure basic safety and minimal function. h.)Requires long term care in the most restrictive, safe environment.

5. Level II a.)Serious and persistent symptoms that do not respond to traditional medication and therapy b.)At risk for harming self or others c.)Requires ongoing assessment and intervention… • To assure ongoing stability • Acceptability to live in a group setting • Community placement/independent living is marginal

6. Level II cont. • Need higher level of care. 1:1 until re-stabilized • Responds well to treatment for awhile, then later for reasons unknown or known, no longer respond to therapy • Exhibit dangerous symptoms that require a different/higher level of care

7. Level III a.)Major symptoms, intermittent and/or occasional frequency effectively managed. b.)Medication compliant.

8. Level IV a.)Minor behavior symptoms, intermittent, and/or occasional frequency. b.)Viewed as “competent” who occasionally have a problem.

9. Placement Options2:1 1:1GH GH

10. Level I - Dangerous • Placement in “most restrictive” environment • Not in a group setting • Individualized setting with 2:1 • Inpatient in long term hospital

11. Level II - Serious • 3 incidents of serious behavior • Harm to self • Harm to others • Damage to property • managed in a group setting with 1:1 • No unsupervised time.

12. Level III - Major • Manageable in a traditional group setting • May have 1-2 hours of unsupervised time if able to manage it safely • No injurious behavior

13. Level IV - Minor • Manageable in a traditional setting • May have unsupervised time per physicians order and Tx plan • Candidate for “Independent living”

14. Conclusion: • Know the levels • Document & report behavior • Maintain safety • Know your crisis plan • Notify the supervisor/director/owner • Call 911 prn

15. Contact Instructor: Evelyn Stone, RN., BSN., M.Ed 1008-F Big Oak court Knightdale, NC 27545 (919) 266-7050 Phone (919) 266-7050 Fax www.qprofessionalmentalhealthservice.com Email: stn_vlyn@yahoo.com

16. Services