Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 4 Treatment Settings and Therapeutic Programs

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment Settings Inpatient hospital treatment –Rapid assessment, stabilization of symptoms, discharge planning Client-centered multidisciplinary approach to brief stay –Short inpatient stays

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment Settings (cont.) Inpatient hospital treatment –Long-stay clients (severe, persistent mental illness requiring acute care services) –Case management –Discharge planning Partial hospitalization programs –Day treatment programs –Eight broad categories of goals (see Box 4.1)

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment Settings (cont.) Residential settings –Vary in structure, level of supervision, services provided Group homes Supervised apartments Board, care homes Adult foster care Crisis resolution/respite care

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment Settings (cont.) Residential settings (cont.) –Evolving consumer household Group-living situation Residents make transition from group home to residence where they fulfill own responsibilities and function without onsite supervision. Transitional care –Peer support –Bridging staff

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Board and care homes are an example of a partial hospitalization program.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: A board and care home is an example of a residential treatment setting. –A day treatment program is an example of a partial hospitalization program.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychiatric Rehabilitation Programs Services to promote recovery process (see Box 4.3) –Emphasis on recovery, going beyond symptom control and medication management; includes personal growth –Reintegration into community –Empowerment, increased independence –Improved quality of life

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychiatric Rehabilitation Programs (cont.) Clubhouse model –Four guaranteed rights of members A place to come to Meaningful work Meaningful relationships A place to return to (lifetime membership) –Physician–client relationship as key –Focus on health, not illness

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychiatric Rehabilitation Programs (cont.) Assertive community treatment (ACT) –One of most effective approaches (see Box 4.4) –Problem-solving orientation No problem is too small –Direct provision of service rather than referral –Services intense; no time constraints

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? In the clubhouse model, the relationship between clients is most important.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: With the clubhouse model, the physician– client relationship is most important.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Populations: Homeless Mentally Ill In comparison to homeless not mentally ill: –Spend more time in jail –Are homeless longer –Spend more time in shelters –Have less family contact –Face greater barriers to employment PATH program ACCESS demonstration project

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Populations: Prisoners 13% of those jailed with mental illness Factors for placement in criminal justice system –Deinstitutionalization –More rigid criteria for civil commitment –Lack of adequate community support –Economization of treatment for mental illness –Attitudes of police, society

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Special Populations: Prisoners (cont.) Criminalization of mental illness Barriers to successful community reintegration –Poverty –Homelessness –Substance use –Violence –Victimization, rape, trauma –Self-harm

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Interdisciplinary Team Pharmacist (see Box 4.5) Psychiatrist Psychologist Psychiatric nurse Psychiatric social worker Occupational therapist Recreation therapist Vocational rehabilitation specialist

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Interdisciplinary Team (cont.) Core skills –Interpersonal skills (tolerance, patience) –Humanity (warmth, acceptance, empathy) –Knowledge base –Communication skills –Personal qualities (consistency, assertiveness, problem solving) –Teamwork skills –Risk assessment, risk management

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following disciplines most likely would be included as part of the interdisciplinary team? –A. Physician’s assistant –B. Physical therapist –C. Pharmacist –D. Dietician

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Pharmacist Rationale: The pharmacist would be a member of the interdisciplinary team when medication, management of side effects, and/or interactions with nonpsychiatric medications are complex. –A physician’s assistant, physical therapist, and dietician are not typically involved as members of the psychiatric interdisciplinary team.

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychosocial Nursing in Public Health and Home Care Primary prevention: stress management education Secondary prevention: early identification of mental health problems Tertiary prevention: monitoring, coordinating psychiatric rehabilitation services Clinical practice issues such as substance abuse, domestic violence, child abuse, grief, depression, and many others

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Self-Awareness Issues Evolution of care away from inpatient settings into community Nontraditional settings such as jails or homeless shelters Empowering clients to make their own decisions Frustration of working with clients having persistent and severe mental illness