Eastern State Hospital team makes great strides in competency restoration program

Dr. Bryan Zolnikov led the creation of the DSHS Behavioral Health Administration’s Breaking Barriers Program in 2015–2016, a process that required the Washington’s state psychiatric hospitals to alter treatment for competency restoration patients. At Eastern State Hospital, the implementation of the program was an arduous process complicated by staffing issues.

Many of those issues were resolved in mid-2020, and under the guidance of Dr. Jennifer Henderson and her team, Eastern’s Breaking Barriers Competency Restoration Program has made considerable improvements in the implementation. “Compliance with the program exploded within six months” of the department becoming staffed with people who can implement aspects of the program, Zolnikov said.

Intake psychological assessments, treatment group progress notes and forensic evaluation referrals are areas in which Eastern has shined, Zolnikov said.

“Transitioning from treatment as usual to a competency restoration focus was difficult,” he said. “Now they are doing it with excellence.”

Henderson joined the hospital as director of psychology in May 2020. Around this time, psychologists Dr. Maureen Nickerson and Dr. Lisa Mathews also came on board. The trio then zeroed in on getting the Breaking Barriers program into compliance.

The first step was analyzing the issues — beyond staffing — that had prevented the program from being implemented. The key needs were to create a more holistic approach to treatment planning and encourage collaboration among the medical staff, social workers, recreation and occupational therapists, and psychology staff.

“One of the things we’re so used to in our roles as psychologists is not necessarily being the primary care provider, but being a consultant able to get all of the people at the table in an interdisciplinary manner,” Henderson said. “Between myself, Lisa, and Maureen we’ve really prioritized stakeholder engagement, breaking down silos and collaborating to provide solutions.”

The Breaking Barriers program requires a treatment team to individualize competency restoration treatment plans for each patient based on that person’s barriers to competency. Nickerson and Mathews have led the way by shepherding the collaboration among disciplines.

“Lisa and I play off one another’s strengths,” Nickerson said. “We started by talking to the staff and the social workers in particular who have been here a while.”

With the key players from all treatment disciplines collaborating together, the interdisciplinary team began the challenging work of identifying obstacles toward implementation, finding creative solutions, and turning improvement strategies into reality.

“Really, all the credit goes to the entire competency restoration team. I am particularly proud of every member of my psychology staff, including our psych associates Kenzie Bush, Amanda Saunders and Rachel Giddings,” Henderson said. “I tell my team ‘You are empowered to be awesome. Tell me what you need and I’ll make it happen.’”