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PubMed1988

[AIDS epidemiology and prevention in i.v. drug addicts].

The incidence of AIDS cases in intravenous drug abusers is growing faster than in other risk groups, in Switzerland as well as in Europe in general. By end of May 1988, 27% of all AIDS cases registered nationally were injecting drugs. The prevalence of HIV antibodies is known from selected samples only, on the basis of voluntary testing. In 1986, among all intravenous drug users in residential treatment nation-wide, 90% were tested and thereof 55% seropositive. In a sample of drug abusers in out-patient treatment in Zurich in 1987, seropositivity was documented for 42% of male and 63% of female patients. According to registered AIDS cases, there is no differential risk for both sexes. Duration of intravenous drug abuse is the only relevant risk factor so far. Preventive change in risk taking behaviour is a minimalization of utilizing contaminated syringes/needles and a minimalization of unprotected sex (safer sex by regular use of condoms). An analysis of published data demonstrates that dissemination of information and availability of syringes/condoms are a pre-requisite for behaviour change, but by no means sufficient in order to elicit behaviour change. Drug abusers engaged in out-patient/residential treatment are available in high proportions for voluntary testing and for the intended behavioural changes. It is therefore of primary preventive interest to engage as many intravenous drug abusers as possible in treatment. Apart from drug-free residential treatment, out-patient treatment using Methadone provides positive results, whereas compulsory measures are considered to be of doubtful value.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Effectiveness and cost of specific treatment elements in a program for homeless mentally ill veterans.

OBJECTIVES: The study examined relationships between specific treatment elements and their costs and ten outcome measures using data from a longitudinal outcome study of a Veterans Affairs program for homeless mentally ill veterans. METHODS: Baseline and outcome data over an eight-month period were analyzed for 406 homeless veterans with psychiatric and substance use disorders who were treated in VA's Homeless Chronically Mentally Ill Veterans Program. Multivariate techniques were used to examine the relationship between ten measures of outcome and six treatment elements: program entry via community outreach, the number of contacts with program clinicians, the number of referrals for other services, duration of program involvement, number of days of residential treatment, and increased public support payments. RESULTS: Each of the six treatment elements was significantly related to improvement on at least one of the ten outcome measures. The number of clinical contacts with program staff and the number of days in residential treatment were associated with improvement in the greatest number of outcome domains. However, improvement associated with residential treatment was far more costly than improvement related to other treatment elements. CONCLUSION: This study provides evidence of the effectiveness of a multimodal approach to the treatment of homeless mentally ill persons. However, results indicate that special attention should be paid to to differences in the cost of improvement associated with various treatment elements.

Adult↗
PubMed1975

Current and emerging models of residential psychiatric treatment, with special reference to the California situation.

The author reviews the steps that have led to the progressive deemphasis of psychiatric hospitalization in California and surveys the empirical basis for rejecting the usefulness of hospitalization. He discusses the four alternative residential models that have emerged in California as substitutes for state mental hospitals--general hospital psychiatric units, board and care homes, private psychiatric facilities available through vendor contracts, and convalescent hospitals. The author also touches briefly upon some important problems, including the possible fate of public general hospital psychiatric units, community mental health services, and the commitment law in California.

California↗
PubMedDate not supplied

Admission variables as predictors of completion in an adolescent residential drug treatment program.

PROBLEM: Understanding of the pretreatment characteristics of drug-dependent adolescents to better match clients to treatment models that serve their needs for successful recovery. METHODS: A random sample of (N = 91) clients records were selected for this outcomes pilot. Chi-square analysis examined differences between groups and multivariate logistic regression analysis determined which variables best predicted completion status. FINDINGS: Several admission variables were associated with noncompletion and included: fire setting, sex for drugs, or addicted parents. Variables associated with completion included: first time admission to treatment or referral to treatment by peer. CONCLUSIONS: Findings suggest that adolescents admitted to treatment with preexisting major depression might have unique treatment needs. Peer education treatment referral systems may be viable ways to encourage adolescents with drug-dependency problems to seek treatment.

Adolescent↗
PubMedDate not supplied

The success of therapeutic communities for substance abusers in American prisons.

Residential treatment provides opportunities for intensive interventions and support that may not be present in outpatient settings. In the area of substance abuse treatment, the therapeutic community (TC) has become synonymous with residential treatment. A growing body of prison TC outcome research has led to recent acceptance of prison TCs as a major innovation in American correctional institutions. An overview of prison TC outcome research is provided and the emergence of the TC as the primary substance abuse treatment modality in prison is described. The self-help orientation that provides the basis for both residential and 12-Step substance abuse treatment programs is described and contrasted with the relapse recovery model. The theoretical principles of the TC model are discussed and two main variants of the prison TC model are described and contrasted. Finally, recommendations are offered for expanding the TC approach and increasing its effectiveness by treating comorbid problems that are prevalent among prison inmates with substance abuse problems.

Humans↗
PubMed1995

Civilian Health and Medical Program of the Uniformed Services (CHAMPUS); mental health services--DoD. Final rule.

This final rule is to reform CHAMPUS quality of care standards and reimbursement methods for inpatient mental health services. The rule updates existing standards for residential treatment centers (RTCs) and establishes new standards for approval as CHAMPUS-authorized providers for substance use disorder rehabilitation facilities (SUDRFs) and partial hospitalization programs (PHPs); implements recommendations of the Comptroller General of the United States that DoD establish cost-based reimbursement methods for psychiatric hospitals and residential treatment facilities; adopts another Comptroller General recommendation that DoD remove the current incentive for the use of inpatient mental health care; and eliminates payments to residential treatment centers for days in which the patient is on a leave of absence.

Day Care, Medical↗
PubMed1993

Demographic and diagnostic characteristics of inmates receiving mental health services in state adult correctional facilities: United States, 1988.

The demographic and diagnostic characteristics of inmates in State adult correctional facilities who received 24-hour hospital mental health care, residential treatment care, and counseling/therapy in 1988 are reported by State and by type of administrative auspices under which the services are provided. Rates under treatment for 24-hour hospital mental health care were highest for the youngest (under 18) and oldest (65 and over) age groups, for females, and for whites. For counseling/therapy, rates were also highest for the youngest, for females, and for whites, but they declined with age. Rates in residential treatment were highest for the young and old and for whites, but about equal for males and females. Primary diagnoses of major psychoses predominated in 24-hour hospital mental health care. In residential treatment, a comparatively small proportion of the caseload had major psychotic disorders and a comparatively large proportion had substance abuse and mental retardation diagnoses. In counseling/therapy, personality disorders predominated. Individual State figures vary widely on these characteristics, both within and between service auspice types.

Adolescent↗
PubMed1997

Clients entering drug abuse day treatment: 18-month outcomes.

Clients who entered and remained in day treatment for at least 2 weeks (N = 66) were interviewed at 6, 12, and 18 months after baseline. Follow-up rates for each time point ranged from 58% to 68%, and 30 clients (45%) were interviewed at every time point. Those who were consistently followed (N = 30) did not differ from those who were not consistently followed (N = 36) on demographics or on outcome variables measured at baseline. Comparison of mean outcome scores across time using MANOVA indicated significant changes from baseline to 6 months in the areas of alcohol, drug, legal, and social problem severity, and these changes were maintained up to 18 months postadmission. Outcomes reflecting psychiatric symptoms and employment also changed over time, but exhibited different patterns of change. Results are confounded by treatment received, since many respondents also participated in residential treatment during follow-up. Day treatment can serve clients having a range of substance abuse problems, and can act as a bridge to traditional residential treatment. Randomized clinical trials, where clients receive only one or the other type of treatment, are needed to assess the effectiveness of day treatment alone.

Adult↗
PubMed2002

Improved health and self-esteem among patients with AIDS in a therapeutic community nursing program.

This study followed up 41 clients (26 males and 15 females) admitted into a modified therapeutic community (TC) nursing home for substance abusing clients with AIDS at 3 points in time (admission, 8 months into treatment, and after completing residential treatment, 16-18 months post baseline) using the Tennessee Self-Concept Scale and other biological and social indicators, such as CD-4 cell count, body weight, and number of close friends. Analyses of repeated measures found significant linear increases on total self-esteem, CD-4 cell count, and body weight biological indicators, and number of close friends social indicator. Discussion focused on the pertinence of the TC nursing home treatment on clients' internalized behavior self-concept change, as well as positive physical and social change indicators.

Acquired Immunodeficiency Syndrome↗
PubMed1982

The need for adolescent units: general issues.

There is a growing demand for psychiatric services for adolescents in Australia. The provision of residential treatment units as part of such a service raises a number of issues. This paper examines the questions whether such units are effective, whether justified, and what the optimal numbers of beds and staff are. A facilitative treatment model for the majority of disturbed adolescents is briefly described. The case for providing residential treatment units for adolescents is reaffirmed.

Adolescent↗
PubMed1999

Antisocial behavioral syndromes among residential drug abuse treatment clients.

We compared residential addictions treatment clients meeting full criteria for antisocial personality disorder (ASPD+) with those reporting syndromal levels of antisocial behavior only in adulthood (AABS+) on demographics, antisocial symptomatology, drug history, axis I comorbidity and characteristics of index treatment episode. We examined these issues in the sample as a whole, as well as separately in male and female respondents. Among both men and women, ASPD+ initiated their antisocial behavior earlier, met more ASPD criteria and endorsed more violent symptoms, than AABS+. Male ASPD+ also met criteria for more lifetime axis I diagnoses and reported more years of drug involvement than male AABS+. Trends were observed toward poorer retention in treatment among ASPD+ than among AABS+ participants of both genders randomized to a planned duration of 180 days, but retention did not differ between ASPD+ and AABS+ randomized to a planned duration of 90 days. Our findings, which replicate and extend previously published results, carry potential implications for treatment programming and for the nosology of ASPD.

Adult↗
PubMed1998

Antisocial behavioral syndromes among residential drug abuse treatment clients.

We compared residential addictions treatment clients meeting full criteria for antisocial personality disorder (ASPD+) with those reporting syndromal levels of antisocial behavior only in adulthood (AABS+) on demographics, antisocial symptomatology, drug history, axis I comorbidity and characteristics of index treatment episode. We examined these issues in the sample as a whole, as well as separately in male and female respondents. Among both men and women, ASPD+ initiated their antisocial behavior earlier, met more ASPD criteria and endorsed more violent symptoms, than AABS+. Male ASPD+ also met criteria for more lifetime axis I diagnoses and reported more years of drug involvement than male AABS+. Trends were observed toward poorer retention in treatment among ASPD+ than among AABS+ participants of both genders randomized to a planned duration of 180 days, but retention did not differ between ASPD+ and AABS+ randomized to a planned duration of 90 days. Our findings, which replicate and extend previously published results, carry potential implications for treatment programming and for the nosology of ASPD.

Adult↗
PubMed2003

Aggressive behavior in abused children.

Our objective was to investigate the relationship between a lifetime history of traumatic stress, defined as physical and/or sexual abuse and aggression and psychosocial functioning in a sample of clinically referred and nonclinically referred children and adolescents. This is a retrospective case comparison study. Three groups of children were identified, assessed, matched for age, and partially matched for gender. Children clinically referred to residential treatment with a history of abuse (N = 29) were compared with children clinically referred to residential treatment without a history of abuse (N = 29), and a nonclinical group of children residing in the community (N = 29). Variables investigating specific types of aggression, IQ, and psychopathology were assessed across the three groups. Clinically referred children scored worse on all measures compared with nonclinical community children. Clinically referred abused children scored higher on measures of aggression and significantly higher on measures of reactive aggression and verbal aggression than clinically referred nonabused children. Clinically referred abused children had significantly lower verbal IQ scores than clinically referred nonabused children, but no difference in psychopathology. Results support the importance of assessing specific types of aggression in samples of traumatized youths. Verbal information processing may be especially vulnerable in abused children and adolescents and enhance vulnerability to aggressive responding.

Adolescent↗
PubMed1991

Availability and distribution of psychiatric beds, United States and each state, 1988.

The total number of non-Federal and Department of Veterans Affairs (VA) inpatient and residential treatment psychiatric beds in mental health organizations in the United States increased by almost 2 percent between 1986 and 1988, from 267,613 to 271,923. Excluding VA psychiatric beds in both years, the number of beds increased from 240, 739 in 1986 to 246,181 in 1988 (2.3 percent). This was in contrast to a 3 percent decrease observed nationally in all non-Federal hospital beds (psychiatric and other) during the 1986-88 period. As a result, non-Federal psychiatric beds comprised 21 percent of non-Federal hospital beds in 1988, compared to 20 percent in 1986. The overall growth in psychiatric beds between 1986 and 1988 was due to increases in number of psychiatric beds in private psychiatric hospitals, separate psychiatric services of non-Federal general hospitals, residential treatment centers for emotionally disturbed children, (RTCs), and multiservice mental health organizations, which more than offset decreases in psychiatric beds in State and county mental hospitals and VA mental health services. Between 1986 and 1988, the national pattern of an increase in psychiatric beds was reflected in 30 States, while the remaining 20 States and the District of Columbia showed decreases in psychiatric beds. Among the States, the availability of psychiatric beds, measured by bed rates per 100,000 civilian population, varied considerably in 1988. Thirty States and the District of Columbia had 100 or more beds per 100,000 civilian population, while 6 States had rates of fewer than 75 beds. Although the number of State and county mental hospital beds decreased between 1986 and 1988, these organizations accounted for the largest percentage of all psychiatric beds in 1988 (39 percent). The separate psychiatric services of non-Federal general hospitals ranked second in number of psychiatric beds in 1988, with 18 percent of the total followed by private psychiatric hospitals, with 16 percent; VA mental health services, with 10 percent; residential treatment centers for emotionally disturbed children with 9 percent; and multiservice mental health organizations, with 8 percent.

Hospital Bed Capacity↗
PubMed1978

Crisis induction and parental involvement: a prerequisite of successful treatment in an inpatient setting.

In residential treatment programs, oftentimes the relevance of the procedures and methods utilized in situations encountered on the outside are lost sight of. The utilization of a stress induction model in conjunction with parental consultation within an inpatient setting makes it a great deal easier to conceptualize the relationship between problems the child has in the program, how they are handled and the way problems are dealt with at home. Involving the parents in dealing with program "crises" allows one to see firsthand how the family interacts under conditions of stress and permits systematic interventions into this system. If the goal is to return the child home, the parents and the child must be convinced that changes in behavior are a result of their methods of interacting with each other and not merely a result of "magic" or contact with new sympathetic adults outside the home.

Acting Out↗
PubMed2001

Impact of efforts to reduce inpatient costs on clinical effectiveness: treatment of posttraumatic stress disorder in the Department of Veterans Affairs.

BACKGROUND: There have been major reductions in the availability of inpatient psychiatric care in the United States in recent years. OBJECTIVE: The objective of this study was to evaluate the clinical impact of cost-cutting changes in the delivery of inpatient psychiatric care. DESIGN: This was a nonequivalent control group pre/post design. SUBJECTS: Outcome data on 6,397 veterans treated between 1993 and 2000 at 35 specialized VA inpatient and residential programs for posttraumatic stress disorder (PTSD) were used to compare changes in effectiveness (measured as patient improvement from admission to 4 months after discharge) at programs that either shortened their average length of stay or converted from a hospital-based program to a low-cost residential rehabilitation program. For comparison, outcome data are also presented over the same years from both inpatient PTSD programs and residential PTSD programs that did not experience program change. MEASURES: Measures addressed baseline characteristics and 4-month postdischarge outcome measures of PTSD symptoms, substance abuse, violent behavior, and employment. RESULTS: Analyses of covariance showed no significant change in outcomes at inpatient programs that either reduced their length of stay or did not change at all. However, effectiveness declined on some measures at inpatient programs that converted to residential treatment during this period but improved at residential treatment programs that had been established before this period of change. CONCLUSIONS: Although there was no deterioration in effectiveness related to reduced length of inpatient stay, programs that converted to a residential model showed decreased effectiveness.

Aged↗