International journal of partial hospitalization最新文献

This article describes a discharge survey of patients who were preparing to leave a day treatment program. It developed out of staff interest in patients' beliefs about their preparedness for discharge and patients' view of their experience at the end of their treatment.

Children with disruptive behavior disorders often show deficits in peer relations and self-esteem, putting them at risk for later life psychiatric disorders. The prevalence of poor peer relations and low self-esteem in behavior-problem children, as well as the efficacy of an intensive day treatment program in addressing these deficits, was evaluated. Twenty-five normal-population (NP) children were matched sequentially by age and sex to 25 behavior-problem (BP) children who received day treatment. Groups were compared on measures of self-esteem and peer relations. Pre-/posttreatment comparisons were made for the BP group on the same variables. Mann-Withney U tests showed that the BP group had significantly more problems in self-esteem and peer relations than the NP group. Their scores significantly improved with day treatment and were no longer different from those of the control group. The study indicates that children with behavior disorders present with more problems in peer relations and self-esteem. Intensive multimodal day treatment is an efficient approach for treating these difficulties.

A study of 82 Psychiatric Day Hospital patients was undertaken to identify the program's specific effects on individuals with longer standing (i.e., chronic) psychiatric disability. Sociodemographic information and self-ratings, staff ratings and significant-other ratings were used to identify changes in functioning during the 3-week treatment as well as during the period 3 months after treatment. Findings suggest (1) that the Day Hospital patients were as seriously psychiatrically impaired as psychiatric inpatients, (2) that, as a group, they demonstrated a significant improvement in symptoms and functioning, and (3) that the more chronic patients displayed a distinctive pattern of decreased hostility and increased anxiety over the course of treatment. Findings are discussed in relation to the proposition that mobilizing the chronic patient's affect is an important factor in reengaging the therapeutic process.

This article undertakes two interrelated tasks in order to illustrate the business plan as a dynamic part of the day treatment planning process. To ensure an understanding of basic concepts, it walks the day treatment program planner through the elements of a generic business plan. Building upon this foundation, the paper provides the day treatment program planner with detailed information regarding the various uses to which the material gathered for the business plan may be employed.

This paper discusses the role of a partial hospital program for neurologically impaired children and adolescents on a continuum of service delivery. The effectiveness of a partial program in assisting transitions across treatment and community settings is critical in establishing and maintaining treatment gains. This innovative approach and model are reviewed and discussed within the context of an integrated system of care.

This study explored the use of the Interpersonal Behavior Survey (IBS) with a day hospital population. The patients completed the IBS in such a way as to suggest potential deficits in a variety of assertiveness skills and potential excesses in two areas of aggressiveness. Moreover, the IBS was correlated with measures of psychological distress, suggesting the relevance for training in social skills for this population.

This clinical study explored the use of the Global Assessment of Functioning Scale (GAF Scale) in a day hospital setting. In general, the GAF Scale was found to be of use in categorizing patients and in detecting change from admission to discharge. However, changes in GAF Scale scores may lack clinical significance, and moreover, there was little evidence of concurrent validity. Implications for the use of the GAF Scale in day hospitals were discussed.

A 3-year follow-up study was conducted with 73 psychiatric patients in a Finnish day treatment program. The treatment outcome for these patients, who carried a wide range of diagnoses, was measured using psychiatric rehospitalization as a criterion. There were a large number of patients who were disabled and had been receiving social security benefits during the 3 years following discharge from the day treatment program. The rehospitalized cases involved mainly patients with a diagnosis of schizophrenia or personality disorder; use of neuroleptic medication was significantly associated with poor results. The numbers of psychiatric hospitalizations before treatment in the day treatment program in 1985 was found to be independent of hospitalizations during follow-up years. The results of the study support the claim that day treatment does not increase the likelihood of rehospitalization. Day treatment may reduce the length of stay during rehospitalization, but it is also clear that it cannot stop the rehospitalization of patients with severe diagnoses.

In an ever-changing health care field, an organization must be willing to change to meet the needs and demands of its patients. With continuity of care as the impetus for change, the Harold E. Fox Center at St. Joseph Mercy Hospital experienced a significant change in the delivery of child/adolescent psychiatric services. To improve patient outcomes and patient, family, staff, physician, and community satisfaction, the partial hospitalization program and the inpatient unit were integrated. A treatment team model was adopted for the integrated program. This program consisted of a teacher, social worker, nurse, and activity therapist. Physicians supervised the team in the delivery of treatment for their patients. These patients were placed on a treatment team upon admission and were maintained in the team until discharge. A survey was completed analyzing patient, parent, and staff satisfaction with the new model of service delivery. The results indicated favorable support for the concept of the integrated program; however, the operation of such a program still requires refinement.

The number of individuals incarcerated in penal institutions in the United States has increased dramatically in recent years. Children of incarcerated parents have been studied infrequently. They appear to be at high risk for present and future behavioral disorders, although their rate of utilization of mental health services is not known. This study compares a group of behaviorally disturbed children in day hospital treatment who have had incarcerated parents with a group of children without this history who were treated in the same facility at the same time. Children with histories of incarcerated parents account for almost 40% of those treated. They are more likely than their peers without histories of having had an incarcerated parent to have had substance abusing parents and to have been involved in at least one report of suspected child abuse/maltreatment. These variables together are taken as signs of severe family disorganization or dysfunction. In previous studies they have also been associated with poor outcome in mental health treatment. Clinical and social implications of these findings are discussed.