International journal of partial hospitalization最新文献

A survey process was begun in 1983 collecting and examining state statutes governing Partial Hospitalization programs. Data were collected from 37 states and the Country of Canada, which were then analyzed into the categories of definition, goals, target population, length of stay, frequency of patient participation, duration of a program day, program services, staffing, and documentation and quality assurance. The results revealed a great diversity of the operationalization of the treatment modality of partial hospitalization through state statutes. There is a clear need for increased levels of clarity and uniformity of this treatment mode.

Inspiration for the modern-day hospital comes from two sources, the hospital-based work of D. Ewen Cameron and the community-oriented approach of Joshua Bierer. Examination of their respective viewpoints sheds light on the baffling diversity which partial hospitalization, at the interface of hospital and community, has manifested over the last four decades. Such an intellectual history offers insights into the provision of more rational day programming.

Data were collected from a study of 28 patients in 1988 and 18 patients in 1989 admitted into Camelback Vista Treatment Center. Camelback Vista is a free-standing 64-bed residential center under Camelback Behavioral Health Services in Phoenix, Arizona. The tool used in this study was the Camelback Vista Self Assessment and Management Scale. This scale was specifically designed to provide a monitoring tool for a more acute patient population than has been treated in residential settings in the past. The 1988 study cited improvement in 72% of the patients studied. The 1989 study cited improvement in 78%. Both studies monitored four areas: personal skills, social skills, financial skills, and emotional skills.

While recent studies have investigated the relationship between patient characteristics and immediate treatment outcome in day-hospital treatment, none have investigated the relationship between these variables and long-term outcome. the present study attempts to expand upon previous research by including long-term follow-up variables based on posttreatment psychiatric hospitalization. A total of 96% of the admissions to a DVAMC Day Hospital Program in 1985 was reviewed retrospectively and for a 4-year follow-up. As with previous studies, the only consistent predictor of both immediate and long-term treatment outcome in day-hospital treatment was the number of pretreatment psychiatric hospitalizations. Immediate treatment and long-term treatment outcomes were also significantly associated, but variables which predicted the former did not necessarily predict the latter.

In this keynote address, Dr. Zimet discusses two issues. She reviews the accomplishments and future efforts of the Child and Adolescent Special Interest Group in AAPH. And she presents research findings that attempt to answer the question posed in the title.

Outcome in children's day treatment has been studied infrequently. There is little information available to suggest which types of children may or may not benefit from day treatment services. In an earlier study, Gabel et al. (1988) found that preadmission factors related to parental/family dysfunction (i.e., suspected child abuse/maltreatment and parental substance abuse) and preadmission factors related to child dysfunction (i.e., suicidality and severe aggressive/destructive behavior) correlated with poor outcome in day treatment by the criterion of a recommended out-of-home placement on discharge. Of these factors, severe aggressive/destructive behavior was most important in predicting outcome. In this study, discharges from two additional centers were reviewed to determine if these findings could be generalized. There is support for the earlier results when the three centers' discharges are considered as a whole but not when the two new centers' discharges are considered separately. Reasons for these findings are discussed. Further study of these preadmission variables, especially severe aggressive/destructive behavior, as possible predictors of poor outcome in children's day treatment, seems warranted.

The four roles of quality assurance within a partial-hospital program are discussed, along with suggestions for integrating clients into the 10-step quality assurance model recommended by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

This paper discusses three interrelated organizational models relevant to partial hospitalization. Such a management perspective can play an important role in the planning of effective mental health-care delivery structures.

The course of treatment in a time-limited day-hospital setting can be usefully understood in terms of three phases. Close examination of the treatment goals, difficulties, benefits, and tasks for both patients and staff for each phase provides a greater understanding of the curative process. These observations are based upon clinical work in a Veteran Administration Day Hospital and are reinforced with clinical examples from that work. Identification of these phases of treatment can be put to practical use. Knowing in which phase a patient is working helps staff members focus their thinking. Such an awareness can also help staff members cope with "burnout" over the frustrations that come with a particular phase. Information about these phases has been valuable to patients and their families in helping them understand the course of their treatment.

Partial hospitalization has taken on an increasingly important role in the treatment of violence-prone patients. In response to the 1976 Tarasoff decision in California and its progeny widening the scope in many jurisdictions of a therapist's duty to protect endangered third parties from the violent acts of such individuals, strategies relevant to the day hospital need to be formulated. Treaters can provide beneficial containment through the use of informed consent, the therapeutic contract, and reality-based work which involves the patient and significant others. Nevertheless, the partial-hospital team must not lose sight of the limits of such interventions and should consider inpatient care as a serious option.