QIOs in Action: New England QIN-QIO Responds to Nursing Home Staff Need for Behavioral Health Education

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Across the country, nursing homes and skilled nursing facilities face a two-pronged challenge: They’re working to reduce the over-prescription of antipsychotic medications, while also dealing with a growing population with behavioral health needs. 

After analyzing data obtained through their antipsychotic-reduction work in nursing homes, the New England Quality Innovation Network-Quality Improvement Organization (QIN-QIO), the QIN-QIO for Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island and Vermont, quickly realized that some of its Rhode Island-based nursing homes struggling with reductions also had high rates of residents under 65 years old with psychiatric diagnoses, compared with state and national averages. 

Further inquiries to these nursing homes revealed a desperate interest in having education for their staff who are not prepared to manage this growing population of younger patients with mental illness and/​or substance use disorders,” according to Kathy Calandra, Rhode Island program director for the New England QIN-QIO.

In response to this, the New England QIN-QIO created a special training program targeting those homes with the highest rates of residents with psychiatric diagnoses who were also under age 65. The Rhode Island Special Innovation Project (SIP): Nursing Home Behavioral Health Education, which began in September 2017 and continues through September 2019, focuses on behavioral health training for nursing home staff to improve their ability to serve residents with needs beyond dementia treatment. 

Although nursing home staff members are highly skilled in caring for elders, a critical need has been identified by the long-term care community and state regulators for additional skills-based training and education on caring for younger individuals with behavioral health concerns.

The New England QIN-QIO collaborated with the Rhode Island College Institute for Education in Healthcare and the Substance Use and Mental Health Leadership Council of Rhode Island to offer the training.

They didn’t stop there. Continuous monitoring of the program led to adjustments along the way. As a result of feedback from participants and brainstorming among the New England QIN-QIO team and partners, they modified the curriculum to be more interactive as the program continued. The revised curriculum included case studies, role-playing and practical tips for staff to use in their day-to-day work.


The results show marked improvement in understanding how to deal with nursing home residents under age 65 with psychiatric diagnoses. The New England QIN-QIO measured this through assessments that included several questions measuring knowledge of behavioral health and substance use disorders, as well as questions evaluating confidence in caring for patients with these illnesses and diseases.

Immediately following the paraprofessional training for providers such as certified nursing assistants and other nursing-home staff, 93% of participants had increased knowledge scores and 79% had increased confidence scores in assessments. Similarly, for the professional training for staff such as doctors and nurses, 89% had increased knowledge scores and 77% had increased confidence scores immediately after training.