Residential and Inpatient Treatment of Children and Adolescents

375 Pages·1989·41.34 MB·English

by  Robert D. Lyman

Residential and
I n patient Treatment of
Children and Adolescents
Residential and
Inpatient Treatment of
Children and Adolescents
Edited by
Robert D. Lyman and Steven Prentice-Dunn
University of Alabama
Tuscaloosa, Alabama
and
Stewart Gabel
Cornell University Medical College
The New York Hospital-Cornell Medical Center
White Plains, New York
Springer Science+Business Media, LLC
Library of Congress Cataloging in Publication Data
Residential and inpatient treatment of children and adolescents / edited by Robert D.
Lyman and Steven Prentice-Dunn, and Stewart Gabel.
p. cm.
Inc1udes bibliographies and index.
ISBN 978-1-4899-0929-9 ISBN 978-1-4899-0927-5 (eBook)
DOI 10.1007/978-1-4899-0927-5
1. Child psychotherapy. 2. Adolescent psychotherapy.
[DNLM: 1. Mental Disorders - in adolescence. 2. Mental Disorders - in infancy &
childhood. 3. Mental Disorders-rehabilitation. 4. Residential Treatment-in
adolescence. 5. Residential Treatment - in infancy & childhood. WS 350 R4315]
RJ504.R46 1989
618.92'8914-dc20
DNLM/DLC 89-8393
for Library of Congress CIP
© Springer Science+Business Media New York 1989
Originally published by Plenum Press, New York in 1989
Softcover reprint of the hardcover 1s t edition 1989
Ali rights 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, microfilming,
recording, or otherwise, without written permission from the Publisher
To my parents, Dorothy and George; my wife, Kathleen;
and my daughter, Meghan
-RDL
To my parents, Kathleen and Lee
-SP-D
To my wife, Joan
-SG
Contributors
Stephen Barcia Bacon • Outward Bound USA, Greenwich, Connecticut
06830
Brian S. Bassuk • White Plains Public Schools at The New York Hospital
Cornell Medical Center, White Plains, New York 10605
Karen A. Blase • William Roper Hull Child and Family Services, Calgary,
Alberta T2W 2Z8, Canada
Larry K. Brendtro • Department of Education, Augustana College, Sioux
Falls, South Dakota 57197
Sheila Cooperman. Four Winds Hospital, Katonah, New York 10536
Carol S. Drolen • School of Social Work, University of Alabama, Tusca
loosa, Alabama 35487-0314
Dean L. Fixsen • William Roper Hull Child and Family Services, Calgary,
Alberta T2W 2Z8, Canada
Richard J. Frances • Department of Psychiatry and Mental Health Science,
University of Medicine and Dentistry of New Jersey, Newark, New
Jersey 07103-2757
Kim Freeborn. William Roper Hull Child and Family Services, Calgary,
Alberta T2W 2Z8, Canada
Stewart Gabel • Department of Psychiatry , Cornell University Medical Col
lege, The New York Hospital-Cornell Medical Center, Westchester Di
vision, White Plains, New York 10605
Carol J. Garrett. Colorado Division of Youth Services, Denver, Colorado
80236
Diane Jaeger • William Roper Hull Child and Family Services, Calgary,
Alberta T2W 2Z8, Canada
Jeffrey M. Jenson. Graduate School of Social Work, University of Utah,
Salt Lake City, Utah 84112
Richard Kimball • Santa Fe Mountain Center, Santa Fe, New Mexico 87501
vii
viii Contributors
Edward A. Konarski, Jr .• ProgramAdministration, Western Carolina Cen
ter, Morganton, North Carolina 28655
Beverly L. Lewis. Middle Tennessee Mental Health Institute, Nashville,
Tennessee 37204
Wilbert W. Lewis. Middle Tennessee Mental Health Institute, Nashville,
Tennessee 37204
Robert D. Lyman. Department of Psychology, University of Alabama, Tus
caloosa, Alabama 35487-0348
Betty K. Marler. Colorado Division of Youth Services, Denver, Colorado
80236
Richard T. Monahan. Hall-Mercer Center for Children and Adolescents
of McLean Hospital, Harvard Medical School, Belmont, Massachu
setts 02178
David R. Parker. The Group for Neuroscience Research and Education,
Inc., Winter Park, Florida 32789
Richard Perry • Bellevue Hospital Center and Department of Psychiatry,
New York University Medical Center, New York, New York 10016
Cynthia Pfeffer. Child Psychiatry Inpatient Unit, Department of Psychia
try, Cornell University Medical College, The New York Hospital-Cor
nell Medical Center, Westchester Division, White Plains, New York
10605
Steven Prentice-Dunn. Department of Psychology, University of Alabama,
Tuscaloosa, Alabama 35487-0348
Mae Sokol. Child Psychiatry Inpatient Unit, Department of Psychiatry,
Cornell University Medical College, The New York Hospital-Cornell
Medical Center, Westchester Division, White Plains, New York 10605
Arthur M. Small • Department of Psychiatry, New York University Medical
Center, New York, New York 10016
Ira Stamm. The Menninger Clinic, Topeka, Kansas 66601
George E. Taylor, Jr .• Brewer-Porch Children's Center, University of Al
abama, Tuscaloosa, Alabama 35487
William Wasmund. The United Methodist Children's Home, Worthington,
Ohio 43085
James K. Whittaker. School of Social Work, University of Washington,
Seattle, Washington 98195
David R. Wilson. Private Practice, Salem, Virginia 24153
Preface
Residential and inpatient treatment of children and adolescents is a field that
is still in the process of defining itself and of demonstrating its effectiveness.
Because of the continuous nature of the field's development, it is especially
important that a broad range of its theoretical orientations and therapeutic
techniques be considered and critically appraised. Residential and inpatient
treatment is unique in its potential for both positive and negative outcomes.
No other interventions can bring about the major changes in all aspects of
a child's environment that inpatient hospitalization or residential treatment
can. These changes may result in rapid and significant improvements in a
child's condition, or they may conceivably lead to additional maladaptive
behavioral patterns or inappropriate emotional and cognitive responses.
Therefore, the obligation to consider the entire range of treatment alterna
tives and to empirically determine the effectiveness of specific interventions
is particularly great. Residential and inpatient treatment is also an expensive
and limited resource, and our wise utilization of it should be guided by a
comprehensive understanding of its benefits and limitations.
We intend this volume to be of value to both academicians and prac
titioners. We have attempted to delineate the differences between various
theoretical models and to describe the relationship between theory and prac
tice. We believe that further theoretical refinement is a necessary step in
the evolution of residential and inpatient treatment and that this information
may assist the refinement process. Because of the complex and intense char
acter of its services, residential and inpatient treatment is, of necessity, a
multidisciplinary endeavor, with the strengths and weaknesses inherent to
multidisciplinary approaches. We hope that this fact is conveyed by the
chapters themselves, as well as by the diverse nature of the contributor list.
The text provides considerable clinical detail regarding specific treat
ment approaches and special populations so as to aid practitioners in eval
uating and modifying their own treatment programs. A reality of residential
and inpatient treatment is that it is self-contained in nature. Many practi
tioners working within one setting have little or no information as to alter
native approaches or orientations. We hope that this book will broaden their
base of knowledge and lead to greater treatment effectiveness.
ix
x
Preface
We also hope that students will be able to benefit from this information
and will begin to understand the unequaled promise and challenge that work
ing with children and adolescents in residential and inpatient settings pro
vides, and how such work differs from outpatient treatment. These students
will become the next generation of inpatient and residential treatment prac
titioners and will need to build on our efforts rather than duplicate them.
For this reason, we have not, in this book, attempted to resolve all
theoretical differences between chapter authors. We believe that such dif
ferences are, for the most part, healthy and integral to the dialogue that
results in further scientific progress. We invite the readers of this book to
become part of that dialogue.
Robert D. Lyman
Steven Prentice-Dunn
Stewart Gabel
Tuscaloosa, Alabama
White Plains, New York
Contents
I. Issues
1. Issues in Residential and Inpatient Treatment
Robert D. Lyman, Steven Prentice-Dunn, David R. Wilson, and
George E. Taylor, Jr.
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
The Least Disruptive Setting .......................... 3
Outpatient Treatment .............................. 4
Residential Treatment Centers ....................... 6
Maximum Effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Matching Child and Treatment Environment . . . . . . . . . . . . . . . 8
The Psychoanalytical Model ......................... 8
The Behavioral Model ............................. 9
The Medical Inpatient Model ........................ 10
The Psychoeducational Model. . . . . . . . . . . . . . . . . . . . . . . . 10
The Peer Culture Model ............................ 11
The Wilderness Therapy Model . . . . . . . . . . . . . . . . . . . . . . . 11
Physical Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Staffing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Characteristics of Children Served .................... 14
Involvement of the Child in Treatment ................. 15
The Role of Psychotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . 15
The Role ofthe Group ............................. 16
Specific Skill Training. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Behavior Management and Control. . . . . . . . . . . . . . . . . . . . 16
Parental Involvement in Treatment .................... 17
Community Linkages .............................. 18
Cost Effectiveness .................................. 18
Summary......................................... 19
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
xi