Worcester Recovery Center and Hospital (WRCH), with 260 adult, 30 adolescent beds is a public psychiatric hospital that opened in October 2012, replacing a state hospital that began in Worcester in 1838. WRCH receives patients from general hospitals; private, forensic, and other public psychiatric hospitals; and courts, jails, and prisons. WRCH has no say over its admissions and cannot transfer patients with high levels of violence or predatory sexual behavior elsewhere. WRCH has the sole inpatient program for mentally ill deaf patients in New England.
WRCH itself is our innovative program. With patients from the sources above, and with most patients in the schizophrenia-schizoaffective-bipolar spectrum, WRCH has nonetheless become a person-centered, recovery-oriented and evidenced-based program. WRCH is highly respectful of patients’ perspectives and rights. Most patients keep their cell phones. Patients can have any electronics and use them without restrictions.
No program is simply dismissed as impossible. WRCH may be the only public psychiatric hospital with an in-house hospice services provided on the unit the patient is familiar with.
WRCH is a model of medical-psychiatric care integration. While Health Homes, ACO’s and Academic Centers are struggling to implement integrated care, they can look at how this is achieved at WRCH.
Many hospital and community settings report using evidence based practices. For many, this is only an aspirational goal. WRCH provides a wide range of evidence based practices demonstrating this can be done for the most functionally limited patients. What we do:
The Recovery Perspective
Motivational Enhancement Therapy (MET)
Person Centered Approach (PCA)
Cognitive Enhancement and Restructuring Therapy (CERT)
Family Support and Treatment
Illness Management & Recovery (IMR)
Wellness Recovery Action Plan (WRAP)
Relapse Prevention Planning (RPP)
CBT for Psychosis (CBTp)
Cognitive Therapy for Psychosis (CT-R)
Dual Recovery Interventions
Dialectical Behavior Therapy (DBT)
Cognitive Restructuring for PTSD (CR for PTSD)
Good Lives for Sexual Behavior and for Fire-Setting Problems
Readiness for Change
These interventions are fully integrated with psychopharmacologic treatment. All interdisciplinary treatment teams include the patient as the key member of that team.
WRCH’s leaders believe in simultaneous bottom-up and top-down change. WRCH functions through its own homegrown LEAN methodology.
Creativity and innovation require leaders to be an active presence throughout the hospital. The COO is on the hospital’s units daily. The Medical Director (MD) does holiday coverage to know staff on all units across three shifts. The MD and discipline chiefs carry caseloads, thus being embedded in day-to-day operations of the hospital.
Patients have a patient counsel. Input from the counsel to hospital leadership occurs biweekly.
Any staff can drop in on the COO and MD. Patients have access to them by phoning directly. Each leader gets scores of calls each week.
Leadership models, encourages, praises, participates, supervises. Leaders come in early and leave late. Leaders know and care about WRCH’s workforce. Knowing who you work with and caring about their contribution and their well-being laid the foundation for WRCH’s successful innovations.
Creativity and innovation fall short if they cannot live beyond the participation of the innovators. WRCH has changed its culture and that culture is not dependent on current leadership. The culture is honored by both staff and patients. It is clear in the hospital’s table of organization, its signage, and the interactions taking place every day.
Sustainability can be facilitated by modifying the workforce. One innovation WRCH embraced early on is including peer specialists in its workforce. Among their functions, peer specialists lead debriefings after episodes of restraint.
WRCH is one of the Massachusetts Department of Mental Health (DMH) public psychiatric hospitals. DMH has embraces what WRCH is doing and is quite supportive. This has been sustained through a change in the party of the governor.
An effort in innovation can be sustained through the receptivity the change accrues. WRCH has received global visitors looking at what we do.
WRCH’s innovative and changes did not require infusion of unusual resources. While it is true WRCH occupies a newly built structure, change did not require a new building. And the hospital, while impressive in its appearance, has many features that inhibit innovation.
The number of staff is not outside national norms. The hospital-community interface is not an outlier. Thus, replicability does not require resources states do not have.
Any state hospital, and many private psychiatric hospitals, can replicate WRCH’s innovative changes within their current budget. There is no reason why every psychiatric inpatient facility cannot have features of WRCH’s person-centered recovery-focused, evidence-based practices, and many could achieve all of them.
WRCH is available as a resource to all – to visit, to consult, to teach, and to do so with follow-ups to achieve replicability nationwide and beyond.
In collaboration with researchers from University of Massachusetts Medical School, a study was designed and implemented involving data collection at 3 points in time: immediately prior to transition to WRCH (October 2012); 6 months (May 2013) and 18 months post-transition (May 2014). The study involved standardized measures and semi-structured interviews, with patients and staff, to evaluate implementation of the new, patient-centered, recovery model.
- At both 6 and 18 months post-transition patients were overall positive about treatment by clinical staff
- Many patients reported overwhelmingly positive interactions with Peer Specialist.
- At both 6 and 18 months post-transition most patients felt they were active participants in their treatment planning.
- Some patients reported being involved in the Advisory Group and feeling administration was interested in and responded to their concerns and requests
- On the Recovery Self-Assessment Scale, Global scores were higher at 18 months post-transition than prior to transition or at 6 months.