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Evolution of OSH treatment mall leads to enhanced patient care


From the moment patients arrive at Oregon State Hospital, staff help them understand that, ultimately, they're in charge of their own recovery. Through their actions and willingness to fully participate in treatment, patients determine which path they follow through the hospital.

OSH Treatment Mall

Herschel Underwood (foreground), a mental health specialist at Oregon State Hospital, uses a ball labeled with various legal concepts and questions to engage patients in one of his legal-skills classes. The ball is rolled around the table and as it comes to each participant, the person must discuss a topic. Here, Tyler Cleverly, a patient in Oregon State Hospital's admissions and stabilization program, talks with Underwood about the definition of contempt of court.

Wherever their paths eventually lead, all patients spend much of their journey toward recovery working with staff and other patients on one of the hospital's six treatment malls. Each treatment mall is geared toward a specific patient population and offers a variety of therapeutic groups. According to Gareth Page, one of the treatment mall managers, the key is to offer groups that meet patients' treatment needs while being driven by patient preference.

"During the past year, we've done an excellent job of engaging people and getting them off of the units and onto the treatment mall," Page said. "But now we're at the point in our evolution where we need to go further and take a closer look at the way we approach the development of our groups."

Adopting a more businesslike approach, treatment mall staff are now using a variety of measures to ensure they're taking advantage of all the tools they have available to offer effective groups that will help their patients meet their treatment care plan goals.

Using staff-skills matrices, staff can easily identify the strengths and expertise of each individual staff person and determine how and where these attributes can be used most effectively on the treatment mall. Following each 10-week treatment mall session, staff are now conducting a thorough evaluation to gain feedback, critiques and suggestions from both group leaders and patients to determine if the groups are meeting their desired goals. Perhaps the biggest changes, though, have come from an increase in good old face-to-face communication.

Last year, each mall's staff began meeting as a group before an upcoming treatment mall session to plan the next 10 weeks. Over time, this has evolved from a meeting for staff to come with pre-planned groups and discuss scheduling, to a forum for cross-discipline brainstorming. This increased collaboration among staff from different disciplines has significantly improved communication and teamwork throughout Harbors and, as a result, has enhanced the types of groups being offered to patients.

Now more and more groups are being co-created and co-facilitated by individuals from different backgrounds with different professional training, each of whom brings a different skill set and approach to therapy.

"It's tremendous. I'm sitting there with a social worker, a treatment care plan specialist and a nurse manager, and just the creativity that comes from getting those different perspectives is unbelievable," Herschel Underwood, a mental health specialist, said. "In about 20 minutes, I scratched down five or six ideas that I'm really excited about."

Recently, Underwood teamed with Bruce Bell, a rehabilitation therapist, to create the curriculum for a group called "Legal Skills in Motion." The idea was to offer a different way of teaching these important and, in some cases, required skills to patients who have difficulty learning in a traditional classroom environment.


Instead of sitting at a table and going through a workbook, patients in this group spend most of their time focusing on movement by participating in various activities that incorporate teachings and concepts about the legal system.


"We teach them the legal skills they need, but, at the same time, we also focus on other skills they'll need in court — following directions, focusing, communicating and cooperation," Underwood said. "These are all skills they'll need to participate in their defense and work with a lawyer, and I learn more about people's readiness in that group than the more traditional groups."


Page said he's seen a growing excitement among his staff as they've been given creative license in how they develop groups. All of this has added up to more innovative treatment options that both patients and staff find more engaging and beneficial.


"We're getting away from saying, ‘I want to lead this group on Tuesdays at 2 o'clock,' and moving toward, ‘we have a set of patients who need this type of group on Tuesdays at 2 o'clock—who has the skills and abilities to lead it?'," Page said. "It's part clinical thinking and part business thinking—is this an efficient use of our resources that is effecting change in our patients' conditions and supporting them moving through the hospital."