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PubMed2001

Evolution of symptom severity during residential treatment of females with eating disorders.

OBJECTIVES: The overall objective of this study was to measure the evolution of symptom severity in a residential programme based on a multidimensional approach to treatment that includes cognitive-behavioural, interpersonal, experiential and family therapies. The specific aims of the study were: 1) to evaluate changes in symptom severity in bulimic and anorexic patients between admission and discharge; 2) to compare the severity of these symptoms with those of non-patient college females (control group); and 3) to monitor the progression of symptom changes six months after discharge. METHODS: The evolution of symptom severity was measured by comparing the mean raw scores of the Eating Disorder Inventory (EDI original inventory, 1983 version), which was administered at the beginning and end of the residential treatment. A subgroup of patients was also administered the EDI six months after discharge. The study involved 99 females: 47 with bulimia and 52 with anorexia as diagnosed by means of a clinical interview using DSM-IV criteria. The mean raw EDI scores in the control group (FC1, female college students) were obtained from the EDI manual. The population means were compared using the t-test for paired data (Microsoft Excel, version 2000). RESULTS: The overall results for the population as a whole show that the eight subscales of the EDI improved significantly with treatment (<0.001). The subscales with the largest numerical improvements were drive for thinness, ineffectiveness and interoceptive awareness. When divided on the basis of diagnosis, the mean feelings of perfectionism score of the bulimic patients was less than that of the control female college sample; the symptoms of bulimia in the anorexic patients were similar to those found in the control group. The fact that the mean follow-up scores for a number of the ED1 subscales remained similar to those recorded at the time of discharge suggests that some of the improvements in symptoms remained for at least six months. CONCLUSIONS: The results of our study show that multidimensional residential treatment leads to statistically significant changes in the severity of the symptoms manifested by females with eating disorders.

Adolescent↗
PubMed1995

The relationship of patients' cognitive status and therapists' ratings of psychological distress among psychoactive substance users in long-term residential treatment.

Patients in a long-term residential substance abuse treatment program (N = 168) were asked to complete the Symptom Checklist-90-Revised (SCL-90-R), a brief inventory that measures psychological distress in nine symptom areas. Using the Symptom Checklist-90 Analogue (SCL-90 Analogue), which allows raters to assess patients along the same dimensions measured by the SCL-90-R, therapists also estimated the degree of psychological distress they observed in their patients. Significantly larger discrepancies were found between therapists' ratings of their patients and patients' ratings of themselves when patients were cognitively impaired (N = 57) than when patients did not display these decrements (N = 111). Furthermore, these patient-therapist assessment differences were negatively related to measures of patients' participation in treatment and length of stay in the program. Clinical and research implications of these findings are discussed.

Adaptation, Psychological↗
PubMedDate not supplied

Changing care staff approaches to the prevention and management of aggressive behaviour in a residential treatment unit for persons with mental retardation and challenging behaviour.

The impact of a new training procedure aimed at improving staff skills in the preventative and reactive management of severely challenging behaviours was investigated within a six-place residential treatment unit. The results showed that there was some evidence to support the notion that the training reduced the number of behavioural incidents for most residents. The rates of major reactive strategy use (restraint and emergency medication) also declined over time, as did rates of staff and resident injury. Although only a limited number of these changes showed statistically significant correlations with time, it is argued that they were clinically significant when viewed against the complexity of the client group under study.

Activities of Daily Living↗
PubMed2006

Programme factors that influence completion of residential treatment.

The aim of this study was to predict retention in residential rehabilitation (RR) services for drug users, focusing on service provider factors. A national postal survey of RR services in England and Wales was carried out and information was obtained from 57 of 87 services identified (65.5%). Service managers were asked to complete a questionnaire asking about treatment philosophy, treatments provided, staff characteristics and staffing levels, as well as overall service size and funding. Services also provided information on the number of clients admitted and the number who had completed, dropped out and been asked to leave in the past year. Completion rates varied widely, from 3% to 92%, with an average of 48%. Higher completion rates were associated with lower counsellor caseloads, fewer beds, single rooms, shorter scheduled treatment durations, higher fees per client and provision of what could be termed a balanced treatment programme containing adequate amounts of individual counselling and programme-free time, and with only moderate demands for domestic duties. Programmes with more drug than alcohol users had lower completion rates, but the proportion of dual diagnosis or criminal justice referred clients did not appear to affect retention. Completion rates varied as a function of a number of service factors that are amenable to manipulation. To retain clients successfully, programmes should not be too large and should have adequate levels of therapeutic staff, a well-developed treatment schedule which is not too demanding for the client in terms of duties or overall time spent in structured activities, and which incorporates sufficient levels of individual counselling. [Meier PS, Best D. Programme factors that influence completion of residential treatment. Drug Alcohol Rev2006;25:349 - 355].

Demography↗
PubMed2004

Effects of alcohol and drug use on inpatient and residential treatment among youth with severe emotional disturbance in Medicaid-funded behavioral health care plans.

This study examined the use of alcohol and recreational drugs among 875 youth with severe emotional disturbance (SED) enrolled in Medicaid-funded behavioral health care plans, and whether co-occurring SED and substance use affected the subsequent likelihood of receiving inpatient and/or residential treatment. Youth at five sites nationwide were interviewed about their use of drugs and alcohol, while interviews with their caregivers elicited information about youths' service utilization, degree of functional impairment, and a series of demographic and environmental variables. Results indicated that half of the youth (52%) reported lifetime use of alcohol, street drugs, or over-the-counter medications for recreational purposes, while 18% reported use in the past 30 days. Among those reporting recent use, 32% reported using drugs only, 34% alcohol only, and 33% reported use of both drugs and alcohol. In multivariate logistic regression analyses, the effect of recent use was stronger than that of lifetime use; however, the largest effect occurred for those reporting recent use of both drugs and alcohol, versus either alone, or none. Differences remained significant when controlling for managed care versus fee for service enrollment as well as child, family, and environmental characteristics including study site. These results mirror those of prior studies that found an association between substance use and greater likelihood of inpatient services, even in managed care settings.

Adolescent↗
PubMed2005

An economic evaluation of inpatient residential treatment programs in the Department of Veterans Affairs.

The Veterans Health Administration (VA) established psychosocial residential rehabilitation treatment programs (RTPs) to treat eligible veterans who have psychiatric and substance use disorders in a less intensive and more self-reliant inpatient setting. Forty-two (25 percent) VA medical centers adopted RTPs in 1995. Panel regression models using data from 1993 through 1999 indicated that RTPs were associated with 8.6 and 24.4 percent decreases in the average cost per day for inpatient psychiatry and substance use care, respectively. During this time, VA transitioned much of the inpatient mental health care to ambulatory services. Yet medical centers with RTPs had smaller decreases in the number of inpatient patient days than those without RTPs. Because medical centers with RTPs provided more services, this offset the per diem savings, resulting in no significant differences in total costs between medical centers with and without RPTs.

Costs and Cost Analysis↗
PubMed2005

Building a residential treatment program for dually diagnosed women with their children.

The epidemic of drug and alcohol abuse in our nation impacts millions of women, mothers, and children. Addicted mothers with complex problems and numerous co-morbidities present unique treatment challenges. This intergenerational cycle of abuse and addiction is difficult to stop. Arkansas CARES (Center for Addictions Research Education and Services, referred to in this article as CARES) initially was created to treat addicted pregnant and postpartum women and their infants. CARES evolved into a residential treatment program for dually diagnosed mothers with their children. This paper is a synopsis of a presentation delivered at the North American Society for Psychosocial Obstetrics and Gynecology. It shares a glimpse inside the treatment program and lessons learned along the way in an effort to assist others who are interested in building treatment programs for addicted women with their children.

Adult↗
PubMed1999

Residential treatment for dually diagnosed homeless veterans: a comparison of program types.

This study compared two types of residential programs that treat dually diagnosed homeless veterans. Programs specializing in the treatment of substance abuse disorders (SA) and those programs addressing both psychiatric disorders and substance abuse problems within the same setting (DDX) were compared on (1) program characteristics, (2) clients' perceived environment, and (3) outcomes of treatment. The study was based on surveys and discharge reports from residential treatment facilities that were under contract to the Department of Veterans Affairs Health Care for Homeless Veterans program, a national outreach and case management program operating at 71 sites across the nation. Program characteristics surveys were completed by program administrators, perceived environment surveys were completed by veterans in treatment, and discharge reports were completed by VA case managers. DDX programs were characterized by lower expectations for functioning, more acceptance of problem behavior, and more accommodation for choice and privacy, relative to SA programs after adjusting for baseline differences. Dually diagnosed veterans in DDX programs perceived these programs as less controlling than SA programs, but also as having lower involvement and less practical and personal problem orientations. At discharge, a lower percentage of veterans from DDX than SA programs left without staff consultation. A higher percentage of veterans from DDX than SA programs were discharged to community housing rather than to further institutional treatment. Program effects were not different for psychotic and non-psychotic veterans. Although differences were modest, integration of substance abuse and psychiatric treatment may promote a faster return to community living for dually diagnosed homeless veterans. Such integration did not differentially benefit dually diagnosed veterans whose psychiatric problems included a psychotic disorder.

Adult↗
PubMed1988

Rearrest following residential treatment for repeat offender drunken drivers.

Multiple offenders are at high risk for continued drunken driving. Massachusetts, therefore, mandated that individuals convicted of a second drunken driving offense either be committed for a minimum of 7 days in a house of correction or enter a 14-day residential alcoholism treatment program for second offenders. A 2-year follow-up study of arrest rates assessed the impact of the two sentencing options on subsequent arrests for driving under the influence of liquor (DUIL). The incarcerated sample (N = 190) was slightly younger, had more prior DUIL charges and exhibited greater criminality than those who entered treatment (N = 199). Offenders admitted to the 14-day program were significantly less likely to be rearrested for drunken driving (10 vs 20%). A summary odds ratio suggested that when adjusted for differences in prior arrests, the risk of rearrest was 1.9 times greater among incarcerated offenders. Although a 2-year follow-up is insufficient to assess the complete impact of the 14-day program, the two-fold difference in the risk of rearrest suggests that mandated short-term residential treatment may provide an effective intervention among repeat offender drunken drivers.

Adult↗
PubMed1987

HTLV-III antibody prevalence among young delinquent drug abusers in long-term residential treatment at a North-German drug clinic.

To date, long-term intravenous drug users studied at regional European centers of illicit drug use have had a high number of LAV/HTLV-III infections. Among 200 patients remanded by court or referred from prison to a special clinic in northern Germany for young delinquent drug abusers, 26 (17%) of 157 IV drug abusers were HTLV-III seropositive. With 40% seropositive, female patients showed a significantly higher prevalence of HTLV-III infection than males. The results of longitudinal serological, immunological, and clinical observations over periods of 12 months and 2-3 years indicate that under conditions of continuous medical surveillance, sound preventive counseling, and steady therapeutic care during long-term coeducative residential treatment of drug abusers, neither detectable HTLV-III transmission nor definite progression of HTLV-III induced impairment of immune regulatory functions must ensue.

AIDS-Related Complex↗
PubMed2002

Continuity of care and clinical effectiveness: outcomes following residential treatment for severe substance abuse.

BACKGROUND: Continuity of care (COC) has often been viewed as a crucial indicator of treatment quality for patients with severe psychiatric or addictive disorders. However, the relationship between COC and clinical outcomes has received little empirical evaluation. RESEARCH DESIGN: This study used hierarchical linear modeling to examine the relationship between six indicators of COC and seven outcome measures addressing symptoms, substance abuse, and social functioning. SUBJECTS: Patient interviews were conducted with 1576 veterans 3 months after their discharge from one of 22 residential work therapy programs for the treatment of severe substance abuse. RESULTS: Few significant relationships were found between COC and outcome measures in analyses conducted at both the client and program level and fewer than half of these show better outcomes with greater COC. When a Bonferroni corrected P level of P <0.0012 was used, none of the relationships were statistically significant. CONCLUSION: Although there were significant relationships between outcomes and measures of services received during residential treatment, postdischarge COC does not seem to be related to improved outcomes, at least when examined following long term intensive residential treatment. Thus, our results are specific to the context of aftercare following long-term residential rehabilitation and indicate that the value of standard performance measures may vary by treatment context.

Adult↗
PubMed1983

Residential treatment centers in Europe for children and youth with diabetes mellitus.

Residential centers for children with diabetes in Germany, Netherlands, Scotland, and Denmark were visited during 1979 and 1980 to determine applicability of this approach to North American needs. Information was updated in 1982 and data from France added. Duration of patient stay was from one month to many years. All of the centers sought to involve the family in rehabilitation. Direction varied from full-time physician to nonmedical; and involvement of nurses, psychologists, and social workers ranged from nil to intense. Professional staffing appeared to have no direct relationship to success of the houses; rather, good results depended upon a committed staff providing love and even-handed discipline. No comparative studies are available to evaluate the cost-effectiveness of these houses, which had a per diem cost, excluding capital investment, of +31 to +90 per patient.

Adolescent↗
PubMed1981

Process research data on a potent, feeling-evoking residential treatment program for the simultaneous counseling of alcohol abusers and drug users.

There are four goals in this study: (1) to describe an innovative counseling program (called CARE, Chemical Abuse Rehabilitation Effort) tailored to treat both alcohol abusers and drug abusers simultaneously, (2) to report process data on 156 residents treated in a program that emphasized the use of three potent treatment modalities, (3) to describe the clinical use of and consequences of the scream-evoking group therapy modality within a military residential program, and (4) to determine the utility of the scream-evoking group therapy procedure (that is, specify differences between clients who screamed versus those who did not) in facilitating successful program completion according to three criteria. A rating scale was specifically designed to assess the nature, intensity, and consequences of the "scream experiences." Interobserver reliability coefficients were computed for all data involving clinical judgements and/or decisions. A total of 103 alcohol abusers and 53 drug abusers were treated from August 25, 1975 to January 7, 1977. For each of the five stages (A through E), five types of process data were used to measure the immediate impact of the treatment program: (1) response to psychodrama groups, (2) response to scream-oriented group sessions (SGSs), (3) unauthorized chemical use, (4) premature exits, and (5) clinical evaluations as to whether a client was clinically progressing upon discharge. Overall, alcohol abusers and drug abusers responded similarly to the intensive, emotion-evoking residential treatment as measured by each of the five process variables. However, more alcohol abusers than drug abusers met three combined "success" criteria for program completion. The innovative aspect of this residential treatment program is the integration of three potent groups, and structured and spontaneous confrontations--that have been combined for the first time in this program. This is the first of only two programs in the military which utilize the scream-oriented group therapy methods. Fifteen methods of treatment are used to facilitate changes in problematic behaviors, attitudes, and/or feelings. The theoretical rationale for the use of these modalities is described. The SGSs are hypothesized to facilitate cathartic experiences via the scream experiences. The theoretical rationale for the use of abreactive/cathartic techniques is discussed from psychoanalytic, behavioral, and rational-emotive points of view.

Adult↗