Showing papers in "Psychiatric Services in 1976"
TL;DR: In this article two of the program's developers briefly describe the results of one year of research on the effectiveness of their community treatment model.
Abstract: Editor's note: Frequently we have wondered what happens to innovative treatment programs for mental patients. Do they continue to grow and flourish, or eventually fade from the scene? To shed some light on that question, H & CP plans to publish occasional follow-up reports on the Training in Community Living program at Mendota Mental Health Institute in Madison, Wisconsin, a 1974 winner of an achievement award from the Hospital & Community Psychiatry Service. In this article two of the program's developers briefly describe the results of one year of research on the effectiveness of their community treatment model.
67 citations
TL;DR: The methodology was used to project costs and benefits over a ten-year period for 52 clients successfully placed in the community through the project, called Service Integration for Deinstitutionalization (SID).
Abstract: As part of a project to develop a model procedure for returning residents of institutions to the community, the Commonwealth of Virginia contracted with a consulting firm to develop a methodology for conducting a cost-benefit analysis of institutional versus community living. The methodology was used to project costs and benefits over a ten-year period for 52 clients successfully placed in the community through the project, called Service Integration for Deinstitutionalization (SID). The results showed an average net saving for each client of $20,800 over a ten-year period, mostly to the state government. The authors describe the methodology used in the analysis, the cost and benefit elements considered, and the adjustments made for economic factors that could not be measured directly.
52 citations
TL;DR: How staff from a mental hospital were retrained to work in the Training in Community Living program is described, which after two years of operation has had almost no staff turnover.
Abstract: Editor's note: This article describes another aspect of the Training in Community Living program at Mendota Mental Health Institute in Madison, Wisconsin. Hospital & Community Psychiatry plans to publish occasional follow-up reports on this program to shed light on how an innovative treatment program evolves over time. Here the authors describe how stafffrom a mental hospital were retrained to work in the program. After two years of operation the program has had almost no staff turnover.
27 citations
TL;DR: In this article, the authors describe weekly group meetings in which newly diagnosed cancer patients talk with the hospital staff, co-authors from a psychiatric institute, and more experienced cancer patients about problems in adjustment, misconceptions about cancer, reactions of family and friends, and problems in relating to their physician.
Abstract: A patient wit/s cancerfrequently experiences significant stress in adjusting to his disease, The authors feel that cancer patients who are receiving physical care in a general hospital may benefit from psychiatric techniques used regularly by mental health professionals. They describe weekly group meetings in which newly diagnosed cancer patients talk with the hospital staff, coiisultantsfrom a psychiatric institute, and more experienced cancer patients about problems in adjustment, misconceptions about cancer, reactions of family and friends, and problems in relating to their physician. To date approximately 2000 patients have attended the meetings. in most cases their anxiety has decreased as they talk with other cancer patients who have learned to live with their disease, and as they see alternative methods for dealing with their problems.
20 citations
TL;DR: It was shown that patients discharged against medical advice had a poorer response to treatment than those discharged in the traditional manner, and factors that contributed to the poor response and were related to the discharge were identified.
Abstract: About one in every six voluntary mental patients discharges himself against medical advice. But despite the high rate of AMA discharges, the authors found the literature on the subject to be sparse and oflittle help in explaining why patients leave the hospital against medical advice. They examine the approaches that have been used thus far to study the phenomenon. They also report the findings of their own study, which showed that patients discharged against medical advice had a poorer response to treatment than those discharged in the traditional manner. The study identified factors that contributed to the poor response and were related to the discharge.
18 citations
TL;DR: The authors believe that underuse of the day center was due as much to doctors' inexperience, personal biases, and unfamiliarity with the facilities as it was to psychopathology and financial realities.
Abstract: Observations of 392 women admitted to a psychiatric hospital indicated that 24 were well suited to treatment in a day center and that 208 could feasibly be treated there. However, only 59, or 28 per cent of those for whom day care was feasible, were able to take advantage of that alternative. The others were excluded by financial limitations, refusal to accept the day center option, administrative delays, and inaccurate classification of treatment setting. The authors believe that underuse of the day center was due as much to doctors' inexperience, personal biases, and unfamiliarity with the facilities as it was to psychopathology and financial realities. They found that many clinicians were not aware of the factors that affect their decisions about the use of a partial hospitalization setting.
17 citations
16 citations
TL;DR: A study conducted by independent researchers over the initial two-year period indicates that the homes are more effective in certain respects than a psychiatric hospital in providing intensive care.
Abstract: For the past four years Southwest Denver Community Mental Health Services, Inc., has had a system of alternative families who take one or two psychiatric patients who need intensive treatment Into their homes; the clients' average stay is ten days. Thus far approximately 220 client placements have been effectively carried out in a network of five homes. Clients who receive psychotropic medication have its effects monitored by a staff psychiatrist, medical nurse coordinator, and nurse cliniclan. A study conducted by independent researchers over the initial two-year period Indicates that the homes are more effective In certain respects than a psychiatric hospital in providing intensive care.
14 citations
TL;DR: The author discusses the source of referral, psychiatric diagnosis, and treatment of 539 inmates who were referred for psychiatric treatment in two metropolitan jails, highlighting the importance of a close working relationship with the custody staff to facilitate identifying inmates who need psychiatric treatment.
Abstract: The author discusses the source of referral, psychiatric diagnosis, and treatment of 539 inmates who were referred for psychiatric treatment in two metropolitan jails. Almost one-third of the patients were evaluated within 24 hours of their being booked into jail. Manifestly disordered and violent behavior accounted for 50 per cent of the referrals; almost half the patients were diagnosed as schizophrenic or manic. The author emphasizes the importance of a close working relationship with the custody staff to facilitate identifying inmates who need psychiatric treatment.
14 citations
TL;DR: Questions revealed that respondents placed research on prevention at the top of a list of needed research areas, and that the most useful NIMH service to agencies was person-to-person assistance such as consultation and workshops.
Abstract: The director, one other professional, and one paraprofessional in 515 community mental health centers and 193 state hospitals throughout the United States were asked to rate 57 critical issues in mental health services as to their importance now andfive years from now. Issues judged most important now are services for children and for adolescents; five years from now children's services still top the list. Answers to two other questions revealed that respondents placed research on prevention at the top ofa list ofneeded research areas, and that the most useful NIMH service to agencies was person-to-person assistance such as consultation and workshops.
13 citations
TL;DR: The authors point out the shortcomings of American residency programs for foreign trainees and describe how a program was developed to meet their special needs.
Abstract: Foreign medical graduates entering psychiatric residency programs in the United States must cope with cultural, language, educational, and status barriers during their crucial first year of training. The authors point out the shortcomings of American residency programs for foreign trainees and describe how a program was developed to meet their special needs. It includes a more authoritarian form of instruction patterned after the educational structure the students were used to in their native countries and courses in American culture, English language, and problem-solving techniques.
TL;DR: An approach that uses an educational model to teach patients the basic skills of everyday living is described, which can save mental health funds and further the patients' integration into the community.
Abstract: Establishing rehabilitation programs for long-term mental patients outside mental health settings can save mental health funds and further the patients' integration into the community, the author declares. He describes an approach that uses an educational model to teach patients the basic skills of everyday living. As "students," they enroll in a course taught by a creden-tialed teacher and sponsored by the adult education department of the local high school. Mental health professionals are used only for consultation, and the cost to the local mental health program is minimal. A key element in the course is having the students participate in planning the curriculum.
TL;DR: The authors describe a specific redesign for a 32-bed psychiatric ward of a large federal hospital constructed in the early 1950s and review current theory about the effects of the physical environment on behavior.
Abstract: Since funds for the construction of new treatment facilities are scarce, outmoded wards must be redesigned to meet the current needs of users. The authors feel the redesign must integrate modern therapeutic concepts, humanistic patient requirements, and pragmatic budgetary limitations. They review current theory about the effects of the physical environment on behavior, and they discuss such questions as to what extent the need for security should govern ward design and how pleasant the environment should be. They also describe a specific redesign for a 32-bed psychiatric ward of a large federal hospital constructed in the early 1950s.
TL;DR: Clinical impressions indicate that the children have made substantial gains in developing social and interpersonal skills and in their academic acievement.
Abstract: The authors describe the parent-therapist program, an innovative alternative to residential treatment for emotionally disturbed children. In the program, which is based on the extended family model, couples not only provide a residential milieu for a child placed with them, but also are trained to be therapists who can deal with specific emotional and behavioral problems. The parent-therapists work together in three treatment teams, each consisting of five couples. Education and supervision are ongoing. A total of 27 children have been treated in the program since it got under way in May 1972. Clinical impressions indicate that the children have made substantial gains in developing social and interpersonal skills and in their academic achievement.
TL;DR: Rights of staff include having sufficient resources to provide adequate care, participating in the allocation of resources and the setting of priorities, being accountable for clinical matters to the highest governing authority, having clinical practice reviewed by peers, and practicing without excessive and unnecessary regulation.
Abstract: If we accept the premise that adequate health care is the right ofevery individual, itfollows that the provider of health care must, as a basic right, have the opportunity and the conditions necessary to provide such care. The author defines and describes a set ofstaff rights that bear directly on tile treatment process. Rights of staff include having sufficient resources to provide ade-quate care, participating in the allocation of resources and the setting of priorities, being accountablefor clinical matters to the highest governing authority, having clinical practice reviewed by peers, and practicing without excessive and unnecessary regulation.
TL;DR: A survey of community mental health centers to assess the extent to which they have applied technological innovations found that 54 per cent of the 220 centers collected a standard data base, 34 per cent used structured process records, and 55 per cent developed outcome measures.
Abstract: UMental health service delivery was characterized as “ essentially pre-technological” as recently as 1971.’ However, current literature suggests there has been a dramatic increase in the application of technology in the field. For example, entire issues of widely disseminated psychiatric journals have been devoted to cornputer applications2’3 and to the development of structured treatment process recording.4 Whether the increased volume of publication reflects implementation of new techniques has not been studied previously. This paper reports the results of a survey of community mental health centers to assess the extent to which they have applied technological innovations. The survey consisted of questions on the center’s use of business technology, program evaluation, structured process recording, standardized data bases, and cornputer equipment. In April 1974 the survey questionnaire was mailed to 500 community mental health centers listed by the National Institute of Mental Health. By June 1, 1974, a total of 44 per cent (220) of the centers had responded. Results are based on that group. Initial attempts to use technology for the improvement of a process or procedure depend on the development of a structured and quantified data base. The study found that 54 per cent of the 220 centers collected a standard data base, 34 per cent used structured process records, and 55 per cent developed outcome measures. Thus approximately half of the mental health
TL;DR: In December 1972 the family psychiatric unit opened at Royal Jubilee Hospital in Victoria for the treatment of children under age 15 with emotional disturbances or behavior problems.
Abstract: In December 1972 the family psychiatric unit opened at Royal Jubilee Hospital in Victoria for the treatment of children under age 15 with emotional disturbances or behavior problems. Each child is admitted to the unit on a predetermined date for a pre-established period of five weeks, during which time the child's family is also involved in treatment. After the child is released from the unit, therapy continues for an additionalfive weeks in the family's home and then contact is terminated. To date more than 350 children have been admitted to the unit; a second admission has been required in only 21 cases.
TL;DR: The adult development program is an intensive, shortterm program for individuals who want to change their behavior based on an educational model; participants, who are called students, set their own behavior-change goals, and a multidisciplinary staff teach them techniques for reaching those goals.
Abstract: The adult development program is an intensive, short-term program for individuals who want to change their behavior. It is based on an educational model; participants, who are called students, set their own behavior-change goals, and a multidisciplinary staff teach them techniques for reaching those goals. The program curriculum consists of about 20 seminars and workshops, which give the students an opportunity to learn and to practice new behaviors. Students pay fees that vary from $40 to $500 per month depending on the number of classes they take. Approximately 1750 students have participated in the program since it began six years ago.
TL;DR: The author describes several kinds of visual, auditory, olfactory, and other stimuli that lead to distorted perceptions of oneself and others and of time and space.
Abstract: Administrators and others responsible for the design of environments for the mentally ill must be aware that what might be considered irrelevant minutiae of design can have traumatic effects on patients. Because of patients' heightened sensitivity to sensory stimuli and their lessened ability to filter out or adjust to the effects of such stimuli, they are much more likely to be affected by their surroundings than are healthier people, and their social relationships are correspondingly affected. The author describes several kinds of visual, auditory, olfactory, and other stimuli that lead to distorted perceptions of oneself and others and of time and space. He recommends not a bland and stimulus-free environment, but one whose elements are unobtrusive and unambiguous.
TL;DR: The authors point out that collaboration is often strained by lack of trust and conflicts of interest and study design may fail to consider neighborhood values, with the result that the provision of services is impeded, consumers are frightened or coerced, and the consumer board's responsibilities to the neighborhood are ignored.
Abstract: Neighborhood mental health programs are challenged with the scientific and fiscal necessity of evaluating their services Since most such programs are joint endeavors of neighborhood residents (usually a consumer board) and nonneighborhood professionals, such evaluative efforts require the sanction and collaboration of both groups to be maximally effective However, the authors point out that collaboration is often strained by lack of trust and conflicts of interest Study design may fail to consider neighborhood values, with the result that the provision of services is impeded, consumers are frightened or coerced, the role of paraprofessionals is threatened, and the consumer board's responsibilities to the neighborhood are ignored The authors discuss those four issues and suggest ways of resolving them
TL;DR: The authors describe the changing trends in psychiatric care over the last quarter century, which includes a marked shift from inpatient to outpatient care, and more individuals with diagnoses other than psychoses are being treated today.
Abstract: The authors describe the changing trends In psychiatric care over the last quarter century. Whereas In 1950 state and county mental hospitals were the principal site for psychiatric care, by 1974 community mental health centers and other types of mental health facilities had an important role in providing such care. There has been a marked shift from inpatient to outpatient care, and more individuals with diagnoses other than psychoses are being treated today.
TL;DR: The author describes a program in which he used collage-making to help a group of schizophrenic women improve interpersonal relationships, reality-testing, and self-image as well as to help them express problems and develop feelings of autonomy.
Abstract: The author reviews literature relating to the use of activities in the treatment of chronic schizophrenia, citing several programs that combined activities and psychotherapy to produce effective mo...
TL;DR: A system for psychiatric peer review developed by a peer review committee in a general hospital is described, which requires the physician to specify diagnosis, reasons for hospitalization, and major symptom complexes, as well as laboratory work and treatment and discharge plans.
Abstract: The author describes a system for psychiatric peer review developed by a peer review committee in a general hospital. At the heart of the system is aform called the peer review check sheet, which requires the physician to specify diagnosis, reasons for hospitalization, and major symptom complexes, as well as laboratory work and treatment and discharge plans. Minimal criteria have been established to verify the diagnoses and to justify the need for hospitalization. Each month the check sheets are removed from the charts of patients who have been discharged and sent to committee members for evaluation. Those that are incomplete or unsatisfactory signal the need to examine the patient's chart.
TL;DR: The author illustrates how nonprofessional staff can help patients achieve a more satisfactory adjustment by using certain behavior modification techniques, by roleplaying, and by identifying feelings responsible for porblem behaviors and helping patients ventilate them.
Abstract: Professional as well as nonprofessional staff who work with the elderly in nursing homes must be reminded repeatedly that most problem behaviors are symptoms of such underlying problems as unresolved conflicts, the loss of normal, appropriate life roles, and the anticipation of illness and death. The author describes how those problems are reflected in such "senile" behaviors as incoherence, incontinence, ritualism, and inappropriate sexual behaviors. She believes the concept of personality regression under stress is a useful frame-work for helping staff understand and manage such behaviors. She illustrates how nonprofessional staff can help patients achieve a more satisfactory adjustment by using certain behavior modification techniques, by role-playing, and by identifying feelings responsible for problem behaviors and helping patients ventilate them.
TL;DR: The author reports on a study of 67 young children who had been treated and discharged, including their psychiatric diagnoses and psychological status at intake and discharge, family characteristics, and treatment outcome an average of two years and seven months after discharge.
Abstract: An Illinois mental health center operates a day treatment program for young children who have severe emotional disturbances, often accompanied by profound functional retardation or neurological impairment or both. The primary therapists are child-development specialists; most of the treatment is provided in a classroom setting, through small groups. The author reports on a study of 67 young children who had been treated and discharged, including their psychiatric diagnoses and psychological status at intake and discharge, family characteristics, and treatment outcome an average of two years and seven months after discharge. At that time all but four of the children were living at home. Fifty-two of them attended public school, most in regular classes, and the rest were in therapeutic day schools.
TL;DR: The author describes several low-cost deisgn techniques for giving a more stimulating and personalized atmosphere to large, existing institutions and describes the implementation of her design ideas on a unit for blind retarded clients at the Mansfield Training School in Connecticut.
Abstract: An environment that stimulates the auditory, visual, and tactile senses increases appropriate behavior among mentally retarded clients and thereby reinforces their learning activities. The author describes several low-cost design techniques for giving a more stimulating and personalized atmosphere to large, existing institutions; discusses design requirements for group homes for retarded and handicapped clients in the community; and summarizes design ideas to be incorporated in new facilities built for retarded clients. She describes the implementation of her design ideas on a unit for blind retarded clients at the Mansfield Training School in Connecticut.