International journal of partial hospitalization最新文献

In this paper, three treaters from three different psychiatric hospitals delineate specific criteria for developing a mutually beneficial, interactive relationship between day hospitals and halfway houses. Ideas for setting up such a cooperative venture are based on the strengths of these three existing programs at the Menninger Clinic, Timberlawn Psychiatric Hospital, and Harding Hospital. Potential problem areas are discussed such as admission and discharge criteria, communication between separate program components, treatment responsibility, staff roles, and program goals and boundaries.

This paper presents the demographic and clinical data necessary to define the population of children and adolescents served in a model day treatment program. On the day of admission, patients (N = 204) and parents complete a batter of instruments designed to measure reliably characteristics of the patient's system at three levels: individual, parental, and family. Design of the assessment establishes comparisons among self-report, parent/other report, and clinician report measures at each subsystem level. Results of the CBCL, YSR, PIC, Piers-Harris, MCMI, DAS, and FES indicate moderate levels of disturbance, usually consistent with norms reported on referred or clinical populations. Patients are being treated for a wide variety of childhood disorders within systems demonstrating dysfunction at parental, marital, and familial levels.

In order to identify the distinguishing characteristics of patients with unplanned discharges from day hospital, the author reviewed 96% of all 1987 admissions. Unplanned discharges included precipitous in-patient hospitalization, discharge before 30-day program completion, and discharge against medical advice. Forty-three percent of reviewed admissions ended by unplanned discharge. Psychiatric patients with recent and/or remote substance abuse, and patients with multiple day-hospital admissions were especially vulnerable to unplanned discharge. Use of a backup bed during admission and being referred from the general-hospital emergency room or parent mental-health facility were associated with high rates of unplanned discharge. Patients with multiple admissions were more likely than those with a single admission to have personality disorders and to be female and white. Using logistic regression analysis, the author found that when patients had several characteristics increasing their risk for unplanned discharge, the odds of leaving before program completion were considerable.

Past studies examining the dropout from treatment phenomenon have failed to identify comparable populations or a standardized definition of the term "patient dropout." Although the phenomenon is widespread, few investigators have studied the problem within day-treatment programs serving subacutely disturbed clients in need of socialization or prevocational services. The primary purpose of the present study was to determine the reasons for brief Day Treatment Center (DTC) stays of 10 sessions or fewer and to ascertain implications of these findings for admission screening processes. Analysis of demographic information revealed that the average brief-stay patient was in his mid-thirties, was single (65%), was schizophrenic (39%) or suffering a mood disorder (27%), and had attended up to 4 days (63%) before leaving treatment. A retrospective review of 122 brief stay records revealed six categories of reasons for leaving the DTC: (1) a desire to return to work, (2) exacerbation of psychiatric symptoms, (3) resistance to treatment recommendations, (4) negative reaction to the treatment milieu, (5) a desire for less intense treatment, and (6) a belief that problems were resolved during the brief stay. The authors concluded that admission screening interviewers would benefit from complete past school and work records. Strategies for reducing dropout rates should include (1) longer transition periods for newly referred patients, (2) obligatory meetings with the patient and his family and therapist before inpatient discharge, and (3) improved orientation to the DTC program.

Jefferson Evening Program (JEP) is an evening partial hospital in operation for 14 years treating higher-functioning adults. This paper describes the benefits and problems in engaging and treating a broad population mix in a partial hospital and programmatic solutions to these clinical challenges.

This is a paper about doing systems therapy in a day-treatment facility for children identified as severely emotionally disturbed. Children's emotional problems are seen and treated as aspects of family and larger-system problems. An intervention process has been articulated. Information management is a central team task. All staff are team members. While many theories and therapies inform the intervention process, there is no attempt to integrate approaches. Rather, a consultation process serves as a clearinghouse for information management. The managers of the information process think in systems terms and that thinking is "meta" to other positions. In this paper the thinking, the organization of the workplace, and some of the processes which people experience are explored.

Although its history in Netherlands is a short one, day treatment for children and adolescents is in great demand and an increase in the number of centers throughout the country has been planned. It serves as both a primary and a secondary treatment modality. While the theoretical frames of reference among day units vary, psychoanalytic and systems thinking are the leading orientations. All day units operate with a multidisciplinary staff who work intensively and therapeutically with the children and their families. The day unit at Sophia Children's Hospital in Rotterdam is described as an example of an existing program.

Day-treatment programs for children in Sweden are described from the perspective of the author during her fellowship year under the auspices of the World Rehabilitation Fund, Inc.

Day-treatment programs for children in The Netherlands are described from the perspective of the author during her fellowship year under the auspices of the World Rehabilitation Fund, Inc.

Day-treatment programs for children in France are described from the perspective gained by the author during her fellowship year under the auspices of the World Rehabilitation Fund, Inc.