International journal of partial hospitalization最新文献

Traditional models of group psychotherapy have become less applicable in inpatient and partial hospital programs as the lengths of stay in these programs have decreased. Shorter lengths of stay are associated with rapid changes in group membership and high levels of symptoms among group members. The clinical objectives and clinical techniques suggested by traditional group models are simply less relevant under these conditions. In this paper the authors outline a model of group psychotherapy designed to meet the needs of acutely ill patients and accommodate to the demands of the short-term acute-care setting. Drawing on previous research that has identified the therapeutic factors that operate in these groups, the authors offer specific recommendations regarding group structure, therapist role, and clinical technique.

Many psychiatric outpatients need maintenance psychotropic medication, but noncompliance remains a major problem. One-half of psychiatric outpatients do not take their medications as prescribed. Medication compliance can be increased by proper and timely education regarding the psychiatric illness and the need for medication. A medication group in a day hospital setting is described which encourages the patient to take an active role in ensuring his best possible health. The goals of this group are to increase compliance by increasing understanding of psychiatric illness, actions and side effects of medications, how to cope with side effects, and how to avoid drug interactions. Fears and myths regarding use of medication are dealt with. Ongoing and repetitive discussions regarding medication use have been found to be useful and increase compliance.

How does a child and/or adolescent partial hospitalization program structure care for patients who are suicidal, assaultive, or combative or using drugs? Special treatment procedures designed for use in child and adolescent partial hospitalization programs must adequately address the issue of safety and involve the family and the community, while maintaining the patient in the least-restrictive environment. This paper deals with management of child and adolescent partial hospitalization patients whose behavior and level of impulsivity have escalated to the point where they require special programs. Special treatment procedures for dealing with patients displaying aggressive, acting-out behaviors, noncompliance with program rules, suicidal or runaway ideation, and drug usage are described.

This article reflects the first major revision in the standards for adult partial hospitalization which were developed by the American Association for Partial Hospitalization and initially published in Volume 1, Number 1 of this journal. They are intended to guide the development of quality treatment programs.

This article describes standards and guidelines for the treatment of children and/or adolescents in partial hospitalization programs. Developed through the Child and Adolescent Special Interest Group of the American Association of Partial Hospitalization, they are intended to aid in the establishment of quality treatment programs.

As the trend toward community-based treatment of the seriously mentally ill has continued, partial hospital programs have admitted an increasing number of highly symptomatic individuals. As a result, patient crises occur more often in these programs, and staff have had to develop novel crisis intervention strategies that do not rely on standard hospital care. One such strategy involves the use of "overnight hospitalization" or a "backup bed" to provide temporary safety and clinical management with the goal of returning the patient to the partial hospital within 24 hr. Given the lack of data on this intervention the present study was designed to provide further information about the implementation and effectiveness of this clinical strategy. The authors outline the rationale and procedures for a backup bed system and provide data on outcome that is drawn from an examination of backup bed utilization in a public-sector mental-health setting over a 1-year period. Clinical implications of the findings for future use of overnight hospitalization with partial hospital patients are reviewed.

Child and Family Outreach Services have been an important adjunct to urban community child and adolescent mental health treatment. The Child and Family Outreach Services Program was developed as an extension of a child and adolescent outpatient and child partial hospitalization program to provide a comprehensive continuum of treatment. The Child and Family Outreach Program generalizes and links traditional therapeutic services to the patient's and family's environment through in-home, in-school, and community intervention. The latter treatment model enables the mental health service provider comprehensively to treat and effect positive change with high-risk patients and their families. Outreach service involvement has increased treatment compliance and reduced out-of-home placements.

Results of a follow-up study of 50 adolescents treated in a day-hospital program are reported. The program admits seriously disturbed adolescents, over two-thirds with a personality diagnosis. Patients are treated in the day hospital for an average of 3 to 9 months. Outcome results are two-thirds adaptive outcome and one-third poor outcome as measured on a level of function scale in the areas of peer and social functioning, occupational functioning, and family relationships. Variables that were significantly related to outcome were significant relationships to peers and staff at discharge, diagnosis, learning disabilities, age at admission, family substance abuse, and type of discharge. These findings are explained in the context of the treatment philosophy.

The author addresses the historical antecedents of three important aspects of partial hospitalization: (1) therapeutic use of the milieu, (2) decentralization of hospital-based care, and (3) a pluralistic view of the human organism. In the process, a tour d'horizon of Western psychiatry from the period of Phillipe Pinel to that of Adolf Meyer is provided. Such an excursion into history permits a greater appreciation of the partial hospital setting and the relevance of history in the evolution of psychiatric thinking.

In 1988 a questionnaire was sent to all institutional members of the American Association for Partial Hospitalization to gather information concerning their program and staffing characteristics as well as information concerning the recruitment of staff psychiatrists for these programs. A total of 388 questionnaires was mailed out, yielding 209 responses representing 230 programs. This paper presents the survey findings as well as their implications for day-hospital programs.