A goal list and a treatment methods index in an automated record system.

In conjunction with the development of a computerized goal-oriented record system at Forest Hospital Des Plaines, Illinois, research staff developed a psychiatric goal list from goal statements most frequently used at the hospital. Treatment methods written by hospital staff were also reviewed and classified under the goal statement for which they were most frequently written. The result is the Treatment Methods Index, which currently contains more than 500 goal statements and 1500 treatment method statements, and also lists all drugs and activity therapies used in the hospital. The index is stored in a computer, and a comprehensive treatment plan can be generated by entering the numbers of selected goals and treatment methods. The authors emphasize the advantages of the system in writing and updating treatment plans and its importance in peer review and other medical-care evaluations.     

The effect of deinstitutionalization on a general hospital's inpatient psychiatric service.

As a result of the deinstitutionalization movement, increasing numbers of former state hospital patients are being rehospitalized in general hospital psychiatric units. Because of this change in patient population, the general hospital has had to adjust its treatment strategy to emphasize meticulous review of previous psychiatric history, including medications; plans for meeting the patients' posthospital housing, vocational, and social needs; and development of plans with community care-givers for continuing care. General hospital staff members have to be educated to develop competence in working with the new patient population and a tolerance for chronicity; that can be done through several forums ranging from large staff meetings to individual supervision.     

Medicine court, II: Rivers in practice

The authors conducted a retrospective study of the initial impact (1986-1987) of the Rivers v. Katz decision involving patients' right to refuse treatment at New York State's largest forensic psychiatric hospital. Of 18 petitions submitted, 15 cases were adjudicated. All 15 patients were found incompetent, and all treatment plans submitted were approved by the court. Most patients selected for Rivers hearings were diagnosed as having chronic schizophrenia and/or were older than the hospital population. A comparison of the implementation of the Rivers decision with that of Rogers v. Commissioner of Mental Health in Massachusetts showed Rogers to be significantly more expensive in human resources, time, and money.     

Therapeutic Contracting: An Effective Strategy for Competency-Based Treatment

Abstract

The therapeutic contracting program represents a comprehensive cognitive-behavioral treatment system for persons with serious mental illness. This article introduces therapeutic contracting principles and procedures through a case study format. Specific methods are described for engaging clients in the development, evaluation, and continuous reformulation of competency-based treatment plans. Organizational structures which serve to coordinate staff members' efforts around person-centered recovery goals and interventions are discussed. Finally, the therapeutic contracting model is presented as a meaningful framework for structuring long-term therapy across inpatient, partial hospital, and outpatient treatment settings.     

Behavior treatment programs,readability, and treatment outcomes

Reading grade level and readability are rarely considered as important variables in the implementation and outcome of behavior treatment plans. In the first of two studies, we analyzed the reading level and readability of 20 behavior treatment plans developed by certified behavior analysts. We found that the behavior plans were written at college reading level-well above the reading level of the average frontline staff member. On a test of readability, none of the behavior plans met criterion on all 12 critical readability variables. To test if there was a correlation suggestive of a relationship among reading grade level, readability, and treatment outcomes, we divided the behavior treatment plans into two groups; 10 that had relatively high readability levels and 10 that had relatively low readability levels. A comparison of the two groups indicated that the average reading level of the behavior plans in both groups was about the same, and the higher readability had somewhat better treatment outcomes. In the second study, we used a multiple baseline design across four individuals to directly assess the effects of manipulating reading grade level and readability of behavior treatment plans on treatment outcomes. Results showed that these manipulations greatly enhanced treatment outcomes of all four individuals. Our data suggest that reading grade level and readability of behavior treatment plans are important variables that directly affect treatment outcomes.     

Randomized evaluation of a web-based tool for designing function-based behavioral intervention plans

Challenging behaviors are prevalent in children with autism and can have a negative impact on a variety of child outcomes. The creation of good-quality behavior intervention plans is critical to decreasing challenging behaviors but little previous research has developed or evaluated practical tools for designing intervention plans. This study consisted of a randomized evaluation of a web-based tool designed to aid clinicians in choosing treatment procedures for inclusion in behavior intervention plans. The effects of the tool were assessed on the inclusion of three types of intervention components that likely contribute to the quality of intervention plans: (1) function-based intervention components, (2) evidence-based intervention components, and (3) non-punishment-based intervention components. Use of the web-based behavior intervention plan builder produced a statistically significant increase in the inclusion of function-based intervention components but no statistically significant effect was observed on the other two measures. Results are discussed in terms of the implications for improving the quality of behavior intervention plans, as well as the dissemination of knowledge of best practices in behavioral intervention.     

A computerized psychiatric treatment planning system

The authors describe a computer-assisted psychiatric treatment planning system developed at the Jerry L. Pettis Memorial Veterans Hospital in Loma Linda, California. Using the File Manager, a VA-developed data base management system, they have developed a comprehensive, flexible system for writing, retrieving, and analyzing psychiatric treatment plans. The system permits rapid entry and retrieval of required treatment plans and produces a document that is clinically expressive and readable. It stores clinical data that may be analyzed for research, quality assurance, and management purposes. The authors discuss design philosophy, practical aspects of implementation, staff acceptance, and future applications to structured medical records.     

A typology of advance statements in mental health care

Advance statements documenting mental health service consumers' preferences for treatment during a future mental health crisis or period of incapacity have gained currency in recent years in the United States and some European countries. Several kinds of advance statements have emerged -- some as legal instruments, others as treatment planning methods -- but no formal comparison has been made among them. This article reviews the literature in English and German to develop a comparative typology of advance statements: joint crisis plans, crisis cards, treatment plans, wellness recovery action plans, and psychiatric advance directives (with and without formal facilitation). The features that distinguish them are the extent to which they are legally binding, whether health care providers are involved in their production, and whether an independent facilitator assists in their production. The differing nature of advance statements is related to the diverse models of care upon which they are based and the legislative and service contexts in which they have been developed. However, there is recent convergence between the United Kingdom and the United States with respect to research interventions that facilitate the production of advance statements, as evidence emerges for the effectiveness of facilitated psychiatric advance directives and joint crisis plans. Different types of advance statements can coexist and in some cases may interact in complementary ways. However, the relationship of advance statements to involuntary treatment is more problematic, as is their effective implementation in many mental health service settings.     

Planning community treatment for sex offenders

In California and in Great Britain plans are being made to move the treatment setting for many sex offenders from large state hospitals to community sites. The most useful aspects of the state hospital programs can be adapted to the community setting. In the proposed treatment centers, graded levels of security may include inpatient, half-way house, and outpatient facilities. The therapist will coordinate social and educational programs as well as psychiatric care. Optimally, the community treatment center will have university support so as to facilitate training in forensic psychiatry and research into the etiology and management of sexually aggressive behavior.     

Definition of partial hospitalization. The National Association of Private Psychiatric Hospitals and the American Association for Partial Hospitalization

The National Association of Private Psychiatric Hospitals (NAPPH) recently joined with the American Association for Partial Hospitalization (AAPH) to provide mental health professionals with a clear, industry-supported definition of psychiatric partial hospitalization, an option on the continuum of care used by clinicians to treat mental illnesses. In 1988, Congress approved a major benefit change for the Title XVIII Medicare program by including reimbursement for partial hospital programs that meet a strict definition and provide a series of treatment services. As defined by Congress, partial hospitalization means an outpatient program specifically designed for the diagnosis or active treatment of a serious mental disorder when there is a reasonable expectation for improvement or when it is necessary to maintain a patient's functional level and prevent relapse or full hospitalization. That definition and the service components are endorsed by NAPPH and AAPH, and they offer a model for other insurers or employers considering the addition of this highly specialized program to healthcare benefit plans. Partial hospital programs are usually furnished by a hospital as a distinct and organized intensive ambulatory treatment service of less than 24-hour daily care. Partial hospitalization is not a substitute for inpatient care. For some patients, the availability of partial hospitalization may shorten the length of stay of full hospitalization or serve as a transition from inpatient to outpatient care. It may allow some patients to avoid hospitalization. Placement in a partial hospital program is a clinical decision that can be made only by a physician thoroughly knowledgeable about the patient's illness, history, environment, and support system.     

Recent developments in the Grenada mental health program

The activities of a multidisciplinary team of mental health professionals during their initial year of work to upgrade the mental health system in the English-speaking Caribbean nation of Grenada are described. Improvement of services at the islands only psychiatric hospital received top priority. The team helped Grenadian staff to sharpen basic techniques of active treatment, which included assessment of psychiatric symptoms, development of treatment plans, and intervention with patients. Maintenance of medical records was improved, procedures for medication and seclusion were standardized, weekly ward rounds were routinized, and regular staff meetings were urged. Among the obstacles faced by the team in implementing these changes were staffs delayed acceptance of collaborative interdisciplinary team-work, as well as shortages of money and personnel.     

佛山市急性脑血管病住院患者糖代谢异常调查

目的 调查佛山地区急性脑血管疾病住院患者糖代谢异常的情况,以帮助医生制定更合理的诊断和治疗方案,改善预后.方法 选取2007年6月至2008年4月在我院神经内科住院的符合急性脑血管病诊断纳入标准的患者为研究对象,共收集有效病例557例,记录患者性别、年龄、高血糖史、吸烟情况,测量身高、体重、血压、腰围及随机血糖、空腹血糖,对未确诊糖尿病的患者进行口服75 g葡萄糖耐量试验(OGTT)检测空腹和餐后2 h血糖,以判断糖代谢状况.结果 脑血管病住院患者中发现糖代谢异常368例(66.1%),其中糖尿病185例(33.2%),糖调节受损183例(32.9%),正常糖耐量189例(33.9%),若不进行OGTT试验仅依靠空腹血糖,则有89.1%(189/368)的糖调节受损患者和14.1%(26/185)糖尿病患者被漏诊.结论 佛山地区急性脑血管疾病患者大多数合并糖代谢异常,通过OGTY可以及时准确地发现这些合并糖代谢异常的患者,有利于我们下一步制定更合理的治疗方案.     

Hospitalized pregnant psychotic women: characteristics and treatment issues

The medical records of 35 pregnant women hospitalized for nonorganic, psychotic symptoms were reviewed to determine their demographic and psychosocial characteristics as well as patterns of assessment, treatment, and disposition. The review showed that the majority of the women had been hospitalized five times or more and lacked social and economic supports. Almost two-thirds had had two or more pregnancies, but only two were living with their children. The review also showed that the basic issues of birth control methods and infant custody rights were not addressed by the hospital treatment program. The authors urge that discussions of birth control methods be included in the treatment plans of pregnant psychotic patients and that recommendations regarding infant custody be recorded in the patients' charts.     

The Myrtle Cottage Project: testing resettlement groupings

A small flat in the grounds of a hospital was used to look at possible groupings of hospital residents, as a stage in planning their resettlement. Almost all of the residents stayed for 10 days in the flat. The exercise helped to crystallise plans, was enjoyed by most of the residents, and boosted staff morale.     

A Home-Based Program for the Treatment of Acute Psychosis

There is evidence that home treatment is an effective alternative to hospital admission for patients with acute psychiatric illnesses. This report describes processes necessary to establish and disseminate home treatment programs as well as the impact and comparative cost of a home treatment program developed in Metropolitan Toronto. Organizational analysis revealed a number of essential structures and interactions necessary to facilitate smooth functioning for home treatment programs involving several agencies. Attitudes towards home treatment were positive, symptoms were reduced, family burden decreased, satisfaction was high and home treatment was preferred to hospital admission. Economic data indicate that home treatment is less costly than hospitalization.     

Examples of implementation and evaluation of treatment fidelity in the BCC studies: Where we are and where we need to go

Treatment fidelity plays an important role in the research team's ability to ensure that a treatment has been implemented as intended and that the treatment has been accurately tested. Developing, implementing, and evaluating a treatment fidelity plan can be challenging. The treatment fidelity workgroup within the Behavior Change Consortium (BCC) developed guidelines to comprehensively evaluate treatment fidelity in behavior change research. The guidelines include evaluation of treatment fidelity with regard to study design, training of interventionists, delivery and receipt of the intervention, and enactment of the intervention in real-life settings. This article describes these guidelines and provides examples from four BCC studies as to how these recommended guidelines for fidelity were considered. Future work needs to focus not only on implementing treatment fidelity plans but also on quantifying the evaluations performed, developing specific criteria for interpretation of the findings, and establishing best practices of treatment fidelity.     

The mental hospital revisited: a proposal.

Mental hospital treatment stresses an overcaring, humanistic approach that tends to foster a passive role dependence of patients on institutions and people. The author proposes a treatment concept of an "active, self-participatory involvement" by patients. This approach allows patients to experience an active role by participation in various tasks and assumption of responsibilities in running the ward. Staff gradually delegates decision-making processes, implementation of plans, and even a certain administrative authority to patients.     

Child abuse in Winnipeg: hospital and community together

The Winnipeg Children's Hospital Child Protection Centre program for helping physically, sexually and emotionally abused children and their families is presented. The Protection Centre strongly advocates and works within a multidisciplinary approach which includes the hospital, child welfare agencies, the police and the justice system in case management and in carrying out intervention strategies and treatment plans. This approach is considered a most effective means of ensuring the care and protection of children.     

Psychiatric Rehabilitation Services in Turkey

The first rehabilitation therapy in Turkey was performed in Bakirkoy State Mental Hospital in the late 1930s by Mazhar Osman, the chief of the psychiatry hospital. He achieved the first steps of occupational therapy. In the 1960s, increased attention was paid to occupational therapies, and the long-term inpatients were provided with courses and sheltered workshops. A day hospital, community mental health clinics, sheltered workshops, supervised work placement, and half-way homes were integrated into the treatment. In the 1990s, delays in rehabilitation occurred, and the day hospital was closed. Since then, medication has dominated treatment. Rehabilitation programs are not well coordinated, and the patient accessibility is limited. In late 2005, a day hospital was reestablishment at Bakirkoy State Training and Research Hospital for Psychiatry, Neurology and Neurosurgery to carry out a psychosocial rehabilitation program and psychosocial rehabilitation for outpatients, acute inpatients, chronic inpatients, and their relatives. Future plans include social skill training groups, family training groups, case management, and improvement of occupational and vocational therapies. Other rehabilitation services are also reemerging: Kocaeli University Hospital has a day hospital, and the State Hospital of Manisa for Psychiatry recently added a rehabilitation. In addition, half-way houses are being built for patients receiving treatment at the State Hospital of Elazig. There is an increasing interest in rehabilitation in Turkey requiring new models and attempts at improvement.