Partial Hospitalization: A Current Perspective PDF
Preview Partial Hospitalization: A Current Perspective
Partial Hospitalization A Current Perspective APPLIED CLINICAL PSYCHOLOGY Series Editors: Michel Hersen and Alan S. Bellack University of Pittsburgh, Pittsburgh, Pennsylvania PARTIAL HOSPITALIZATION: A Current Perspective Edited by Raymond F. Luber A Continuation Order Plan is available for this series. A continuation order will bring delivery of each new volume immediately upon publication. Volumes are billed only upon actual shipment. For further information please contact the publisher. Partial Hospitalization A Current Perspective Edited by Raymond F. Luber Western Psychiatric Institute and Clinic School of Medicine University of Pittsburgh Pittsburgh, Pennsylvania Plenum Press . New York and London Library of Congress Cataloging In Publication Data Main entry under title. Partial hospitalization. Includes index. 1. Psychiatric hospital care. 2. Partial hospitalization. I. Luber, Raymond F. [DNLM: 1. Day care. 2. Community mental health services. 3. Mental disorders-Rehabilitation. WM29. 1 P273] RC439.2.P37 616.8'91 78-31915 ISBN-13: 978-1-4613-2966-4 e-ISBN-I3: 978-1-4613-2964-0 DOl: 10.1007/978-1-4613-2964-0 © 1979 Plenum Press, New York Softcover reprint of the hardcover 1s t edition 1979 A Division of Plenum Publishing Corporation 227 West 17th Street, New York, N.Y. 10011 All righ ts reserved No part of this book may be reproduced. stored in a retrieval system, or transmitted, in any form or by any means. electronic, mechanical, photocopying, micro11iming, recording, or otherwise, without written permission from the Publisher To Janice, Marty, and Jenna Contributors Marguerite Conrad, R. N., Ed.M., M.P.H., Late Assistant Professor of Nursing for Partial Hospitalization and Aftercare, Clinical Assistant Professor, Boston University School of Nursing, Boston, Mas sachusetts Thomas Detre, M.D., Professor and Chairman, Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Thad A. Eckman, Jr., Ph.D., Camarillo-UCLA, Neuropsychiatric Insti tute and California Lutheran College, Thousand Oaks, California V. DeCarolis Feeg, R.N., M.A., Division of Biological Health, The Pennsylvania State University, University Park, Pennsylvania F. Dee Goldberg, M.P.H., Deputy Commissioner, Program Support Service, Division of Mental Health, Columbus, Ohio Michel Hersen, Ph.D., Professor of Clinical Psychiatry, Director, Re socialization Treatment Center, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania David L. Kupfer, B.A., Department of Psychology, University of Geor gia, Athens, Georgia Benjamin B. Lahey, Ph.D., Assistant Professor, Department of Psychology, University of Georgia, Athens, Georgia vii viii Contributors Paul M. Lefkovitz, Ph.D., Director, Partial Hospitalization, Gallahue Mental Health Center, Community Hospital of Indianapolis, In dianapolis, Indiana Raymond F. Luber, M.Div., Assistant Professor of Clinical Psychiatry, Director, Partial Hospitalization, Department of Psychiatry, West ern Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania John T. Neisworth, Ph.D., Associate Professor of Special Education, Department of Special Education, The Pennsylvania State Univer sity, University Park, Pennsylvania Joan Perrault, B.S.N., M.P.H., Lecturer in Nursing, George Mason University, Consultant, Mental Health Program Development, Fair fax, Virginia Samuel M. Turner, Ph.D., Assistant Professor of Psychology, Depart ment of Psychiatry, Western Psychiatric Institute and Clinic, Uni versity of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Stephen Washburn, M.D., Chief, Partial Hospitalization Service, Mc Lean Hospital, Belmont, Massachusetts; Assistant Professor of Psychiatry, Harvard Medical School, Cambridge, Massachusetts Foreword There was a time, not long ago, when the only treatment options considered to be worthwhile for patients requiring psychiatric care were the 50-minute hour on the one hand, or full-time hospitalization on the other. Most of us were convinced in those days that treatment could, and indeed should, take place with a minimum of involvement by the patient's family. Nor did we really consider that the community in which a patient lived was a significant contributor to either his illness or its cure. These naive assumptions were strongly challenged, of course, be ginning with the questions of social psychiatrists in the 50s and con tinuing with the quiet growth of the patients' rights movement. Thus it is no mere coincidence that when the community psychiatry movement emerged in the mid-60s as a powerful force for profound change in our traditional practice, the concept of partial hospitalization, which can be traced back at least 30 years, became a symbol of the new social psychiatry. Partial hospitalization had singular advantages well attuned to the times: it did not force a separation between the patient and his family; it cost far less to deliver than inpatient care; and it avoided the stigma of institutionalization while still providing far more care than the traditional psychotherapeutic hour. In a few years' time, several well controlled studies documented that virtually all patients who were cus tomarily treated on an inpatient basis could be effectively managed and treated in a day hospital. Like so many of their counterparts in other modes of health care delivery, the advocates of day hospitals and other partial hospitalization programs have often been somewhat reluctant to expose their innova tive methods of patient care to the time-consuming process of close critical scrutiny, and as a result several important issues remain unre solved. Some of these issues bear upon the treatment itself, but others, ix x Foreword just as important, involve the cost of such treatment to our society as a whole and to the members of the patients' families in particular. While we readily assume that what is good for the patient and protects his or her rights is what should be done, we do not know what effect, if any, a severely depressed or schizophrenic patient living at home has on children or other relatives living in the same household, nor can we measure at this stage whether or not or under what cir cumstances the advantages of partial hospitalization are outweighed by the disadvantages caused by the patient's presence in the family. It is also an historical truism that health care delivery systems rarely make an effort to address the question of efficacy until forced to do so hurriedly because time - or funding - is running out. As our in creasingly cost-conscious society begins to demand proof, it becomes clear that amazingly little has been done to define specific uses of partial hospitalization or to identify what programs and applications within partial hospitalization are best suited to a specific group of patients. We still have no data to tell us whether a specific group of patients, such as ex-inpatients about to be discharged into the community, are best served by a partial program, or whether the improvement of patients' social skills or work habits attempted in partial hospitalization programs is maintained over time. As a result, while the cost of treatment in these settings is at most half of what it would cost to admit the patient to a full-time inpatient unit, lacking guidelines and proof of efficacy, third party payers have never developed a consistent policy of reimbursement. Some, recog nizing that patients can get care as effective as inpatient care for half the price, have shown willingness to underwrite the expenses, but there are many states where the reimbursement schedule is barely sufficient to provide a baby-sitting service for adults, which was very far from the aim of partial hospitalization programs. This volume is among the first to take a long step forward toward bridging the gap between treatment planning and assessment data. THOMAS DETRE, M.D. Preface This book is the result of several converging influences. One influence has been my own personal experience. In varying capacities over the past several years I have been associated with partial hospitalization. During this time, several changes (many of them unplanned and im posed by outside forces) have made their impact on partial hospitaliza tion. Some of these changes have been provincial in nature while others have been the direct result of changes in national mental health care policies. Some changes were welcomed, others were met with violent opposition. Through it all, however, I have been impressed with and at times astonished by the resiliency and dedication of those affiliated with partial programs. It has been obvious that professionals in the field have considered the treatment modality to be utilitarian and worthwhile. It is gratifying that we are beginning to substantiate this "clinical impression" with empirical data. A second influencing factor has been the obvious need for some at tempt to integrate the available material related to partial hospitaliza tion. The last 3 to 5 years have seen a marked increase in clinical and research publications related to partial hospitalization as well as a growth in professional organizations primarily concerned with this treatment modality. This has been an encouraging and long-needed development. Unfortunately, these efforts have had little unity and even less exposure. In this period of time I have received numerous requests from professionals, students, and other interested individuals for infor mation about partial hospitalization; at times the requests were as simple as supplying a bibliography of resources. Unfortunately, even this minimum request was difficult to meet. It is hoped that this book will, therefore, meet two needs: (1) to provide a comprehensive survey and integration of the most significant clinical, conceptual, and research de velopments in the field of partial hospitalization; and (2) to provide an xi
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