International journal of partial hospitalization最新文献

The pilot study at Charter Kingwood was designed as an integral part of continuous quality improvement. Research focused on patient appropriateness and outcome treatment results. The Day Therapy Appropriateness Scale was administered along with pre and post tests of the Index of Self Esteem (ISE) and General Contentment Scale (GCS). Other instruments included a Patient Satisfaction Survey and alumni quarterly follow-up checklist letter. The outcome study demonstrates that patients were appropriately placed in treatment and improved with treatment. Results showed that patients improved 20% after 2 weeks of intensive group therapies. The Patient Satisfaction Survey had 17 items and 4 categories to select degrees of satisfaction or dissatisfaction with the overall program, staff, therapy groups, and individualized treatment goals. Results supported a 90% overall satisfaction with services provided. An alumni quarterly follow-up emphasizing postdischarge planning and aftercare verified that 96.3% of participants benefited from the program, 82% participated in aftercare, and 98.3% would recommend significant others for treatment.

Responding to an increase in the number of acutely and severely ill patients being treated in partial hospital programs, this paper addresses the treatment of aggressive patients in acute partial hospital settings. The authors review the limited conceptual literature published in this area and then suggest concrete strategies of intervention that fit the day-to-day life of a day hospital. They take as a guiding principle for these interventions an extension of the tenet of deinstitutionalization that patients be treated in the least restrictive manner possible and offer a variety of possible interventions for managing aggressive acts, ranging from least to most restrictive. Six issues which arise in applying less restrictive controls in the partial hospital treatment of aggressive patients are then identified, and illustrations of the principles employed in each of these areas are provided through reflection on two representative clinical vignettes. Taken together, these principles and interventions suggest ways for staff to intervene with aggressive patients, with each other, and with the significant others in patients' lives, in a manner which respects and fosters patients' autonomy and individual responsibility for their own behavior while maintaining a safe environment.

This article describes a partial hospitalization program for seriously emotionally disturbed children and adolescents in a public mental health setting. The article focuses on the integration of cognitive and behavioral treatment strategies in a group and family therapy based program. The literature on recent advances in the application of cognitive techniques in treating child and adolescent behavior problems is briefly reviewed. Specific cognitive and behavioral interventions that have proven useful with typical behavior problems in a partial hospitalization setting are outlined.

Services to perpetrators of child sexual abuse have been located primarily in larger urban centers. There has been a relative lack of services to family violence offenders, in general, and sex offenders, in particular, in rural Canada. This paper presents a model for sex offender treatment which has emerged out of a collaboration between federal and provincial justice agencies and a day hospital based in a rural mental health center. A preliminary group process evaluation is also included.

Data were collected from a study of 49 patients in 1990 and 106 patients in 1991 admitted into Country View Treatment Center and Green Country Counseling Center. Country View is a 30-bed chemical dependency residential center operating under St. John Medical Center in Tulsa, Oklahoma. Green Country is an evening partial hospital chemical dependency program operating under St. John Medical Center in Tulsa, Oklahoma, The tools used in this study were the Country View Patient Self-Reporting Questionnaire, the global Rating Scale, and the Model of Recovering Alcoholics Behavior Stages and Goal Setting (Wing, 1990). These assessments were specifically designed to measure the patient's perceptions of goal setting and the patient's perspective on treatment outcome. The study outcome resulted in program improvement (Green Country evening partial hospital program) and the development of the Country View Substance Abuse Intermediate Link (SAIL) Program (day partial hospital).

The Connecticut Mental Health Center Day Hospital instituted a no-smoking policy at the time of relocation to a new building. The attitudes of staff and patients were surveyed before and after the move. Despite the concern and anxiety shown in anticipation of the change in policy, the patients were not affected in a significantly adverse manner. The importance of providing a safe environment for patients and staff includes measures to prevent the inhalation of cigarette smoke. This paper supports the implementation of smoke-free policies in psychiatric settings.

Patient perceptions can contribute significantly to partial hospitalization program evaluation. A retrospective study of patients' satisfaction ratings and comments concerning a day treatment program using a discharge questionnaire yielded high degrees of satisfaction. This may reflect a priori selection biases toward patients who formed a working alliance within the program. Comparison with a group of patients admitted to the program who did not complete a discharge questionnaire failed to differentiate the two groups on the basis of demographic or clinical characteristics. Attendance by males admitted to the program who completed a questionnaire was significantly (p less than .01) more frequent than by males who did not complete the questionnaire. Consistency in individual component ratings with overall satisfaction with the program suggests nonspecific benefits, with group psychotherapy evoking polarized perceptions. The latter observation suggests the need for careful matching of patients with specific treatment modalities employed in a day treatment setting. Suggestions are made regarding the administration and construction of a patient satisfaction questionnaire as well as for the application of this measure in enhancing program efficacy.

This paper is the first in a series of papers which discuss the many necessary ingredients that combine to produce a quality day treatment program. The theme of this article is the assessment of market needs. Included are (1) an introduction to the concepts of needs, (2) a discussion of the movement from need to change in society, (3) an examination of the process of quantifying needs, and (4) a brief description of several different types of needs assessments. The conclusion provides a description of each salient point and indicates its use in day treatment program development.

Two rating scales were administered to 44 consecutive admissions to a day treatment program. The anticipated length of stay was 6 months. Better patient outcome was expected where the clinician's Global Assessment Scale (GAS) correlated with the patient's Self Assessment Scale (SAS). Data did not support the congruence of clinician and patient ratings. However, low GAS scores at the point of initial assessment seemed to "predict" early dropout. A follow-up inquiry showed that those who completed the program were in higher-functioning placements than those who dropped out early. Hence, those who benefited most were those who completed the program. Also observed was the fact that males had significantly higher SAS scores. How this contributed to length of stay is discussed.

This paper addresses the efforts made by the managed care industry to cut costs in the spending of the health-care dollar. It focuses on what appears to be disproportionate attention being paid to the dollar at the expense of appropriate patient care. It examines the effects of cuts in the mental health-care dollar as this relates to shorter lengths of stay in more expensive settings and not effectively utilizing a continuum of care. It also shows how managed care has impacted medical liability and the legal implications thereof.