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PubMed2001

Medication supervision and adherence of persons with psychotic disorders in residential treatment settings: a pilot study.

BACKGROUND: Little is known about risk factors for and predictors of medication nonadherence within residential facilities. This pilot study examined the association between medication adherence and level of supervision and other environmental and clinical variables among patients with schizophrenia and related psychotic disorders living in supported housing. METHOD: A convenience sample of 74 adult residents with schizophrenia and related psychotic disorders (DSM-IV criteria) living in 4 supported housing facilities in New York City were assessed by their treating psychiatrist for medication cessation during the previous month. Demographic characteristics, medications, supervision, global function as measured by the Global Assessment of Functioning (GAF), and substance abuse were also assessed. A priori hypotheses were that regimen complexity would be directly and medication supervision would be inversely related to medication nonadherence. RESULTS: In multivariate models, lack of direct medication supervision, negative medication attitude, and lower GAF score were associated with increased medication nonadherence in the recent past. CONCLUSION: This pilot study suggests that direct supervision of medication is associated with better adherence in residential treatment settings. This finding is relevant for mental health service planners and clinicians working in these settings.

Adult↗
PubMedDate not supplied

Accountability in public short-term adult AOD residential treatment. Fontainebleau Treatment Center.

Fontainebleau Treatment Center provides short-term public residential AOD treatment and primary health care to a lower-socioeconomic adult population. The multimodal focus of treatment includes interactive group therapy, behavioral contracting, relapse prevention, and 12-step involvement. Research funded by the National Institute on Drug Abuse indicated both positive treatment outcome and significant cost efficacy. These results may be in some contrast to prevailing assumptions about public sector, government-operated behavioral health-care delivery to high-risk populations. Multiple variables for consideration in future outcome research are discussed, with potential for database inclusion toward standardization of treatment and cost protocols.

Behavior Therapy↗
PubMed1977

Divorced parents in family therapy in a residential treatment setting.

Divorced parents are required to participate together in the family therapy of their child placed in a residential treatment center. Different sources of resistance and treatment techniques are identified and discussed through a theoretical analysis and case study material. The therapy of these fractured families contributed to an elimination of recidivism and, according to followup reports, to significant and sustained improvement in the children's functioning in school, home, and community activities.

Adult↗
PubMed2002

Home away from home: factors associated with current functioning in children living in a residential treatment setting.

OBJECTIVE: While recent research has focused on the impact of abuse and other interpersonal traumas in childhood, little attention has been given to the experiences of children who have been removed from their homes. In addition to trauma, these children are likely to have had a number of experiences that may impact their current functioning. The purpose of this study was to provide descriptive information pertaining to the unique characteristics of children in residential treatment centers, and to examine preliminary factors believed to be associated with current functioning. METHODS: Participants included 41 children, aged 7-12, recruited from two treatment centers in the rural Midwest. Children were administered the Trauma Symptom Checklist for Children (TSCC) and participated in a brief interview. Each child's primary caregiver at the facility completed the Child Behavior Checklist (CBCL). RESULTS: Results of the descriptive analyses painted a picture of chaotic childhood marked by significant stress and trauma. Gender, child's satisfaction with current discharge plan, and multiple traumatic experiences were found to be associated with variations in symptomatology. CONCLUSIONS: Findings may assist service providers and caregivers in understanding the unique experiences of this population.

Anxiety↗
PubMed1980

Time-limited residential treatment: issues and evaluation.

The trends toward deinstitutionalization and community care have increased the need for short-term residential programs, and the literature supports their effectiveness as an alternative to longer-term care. The authors describe an innovative short-term residential treatment program at Florida Mental Health Institute. Called the Early Intervention Project and limited to nine weeks, it uses a combination of behavioral and psycho-educational techniques for building skills in younger patients who have not received extensive prior treatment. It includes training modules in assertiveness, communication, problem-solving, managing anxiety and depression, medication, relaxation, and nutrition, and also incorporates a peer-managed token economy. A series of research studies have demonstrated the program's effectiveness in changing patient behavior.

Adolescent↗
PubMed1990

[Differential results of treatment in pedagogic-therapeutic long-term intervention in residential treatment centers for children].

In a longitudinal evaluation study the developmental progress of 223 children, who have been treated between 1968 and 1987 in a residential facility for psychiatric care, was explored from referral until time of discharge. Initial state and state at discharge were defined multidimensionally according to MAS. Comparisons between children with different initial clinical diagnosis met expectations, that introversive disturbances recover more frequently than autistic as well as conduct disorders or hyperactivity. Associations between recovery and initial cognitive-intellectual state did not reach statistical significance, when type of disorder was controlled for. But rate of recovery appeared to be throughout higher for children with learning disabilities than for children without such deficits. Age at onset and age at referral were apparently rather irrelevant for the state at discharge. But rate of recovery was in general clearly reduced, when length of time between onset and referral had been above average. The relation between duration of treatment and state at discharge depended on the type of disorder. For children with conduct or autistic disorders the rate of recovery increased with longer duration of treatment, whereas for children with introversive disturbances the contrast was true. This could suggest confounding effects of severity of disorder. When the treatment in the facility had been precociously terminated, rate of recovery in general was remarkably lower than in case of a planned termination. Analysis on effects of alternative methods of treatment was only with restrictions possible and did not suggest a general or differential superiority of a special type of treatment.

Adolescent↗
PubMedDate not supplied

Drug use patterns of adult crack users in street versus residential treatment samples.

Studies of treatment samples have long been the primary source of generalizations about drug users, especially for drugs with very low prevalence rates in the general population, such as heroin and crack. Sample selection bias is briefly discussed, and a 1988-1990 study of 699 cocaine users in Miami is described. The drug patterns of the 387 adult crack users interviewed in that study are compared by sample type--residential treatment versus street, controlling for gender. Some similarities between sample types were found, but differences were more numerous. Notably, street respondents started cocaine at a younger age; had used crack regularly for a longer period of time; were more likely to have used pills, heroin, and freebase cocaine; were much more likely to be using crack (but only crack) on a daily basis; and were more likely to obtain crack by being paid in it, especially for drug dealing. Treatment respondents were more likely to use multiple forms of cocaine, to use cocaine in a binge pattern and with high per-day dosages, and to pay for cocaine with cash they got from a job.

Adolescent↗
PubMed2005

Effectiveness of intensive residential treatment (IRT) for severe, refractory obsessive-compulsive disorder.

OBJECTIVE: The aim of this study was to determine the effectiveness of an innovative Intensive Residential Treatment (IRT) program for severe refractory Obsessive-Compulsive Disorder (OCD). No formalized OCD IRT outcome studies have been completed to date in North America. METHOD: Subjects admitted to the Massachusetts General Hospital/McLean OCD Institute (OCDI) between February 1997 and June 2003 comprised the intent-to-treat sample. Measures of OCD severity, depression severity and psychosocial well-being were determined at admission, interim and discharge points, and were subsequently compared via t-tests using a last-observation-carried-forward approach. Initial OCD severity subgroups and treatment length subgroups were created and analyzed. Correlations and stepwise linear regressions were conducted to determine treatment length predictors. RESULTS: The sample of 403 individuals (58.7% male) had an average 66 day treatment length. Mean YBOCS scores decreased by 30.1%, from 26.6 (SD 6.1) at admission to 18.6 (SD 7.2) at discharge, reflecting a clinically meaningful improvement (p<0.001). Psychosocial functioning, depression severity scores and self-report global functioning ratings also indicated significant improvement. Subgroups with longer treatment lengths tended to have earlier ages of OCD onset and increased OCD severity scores at admission. CONCLUSION: IRT deserves recognition as a therapeutic approach for severe, refractory OCD. In the largest study to date for IRT significant improvements of OCD severity, depression severity and quality of life were determined. IRT should be considered prior to more invasive approaches for severe refractory OCD.

Adult↗
PubMed2000

Risk factors for homelessness in adolescents released from psychiatric residential treatment.

OBJECTIVES: To measure the incidence of homelessness among youths discharged from an inpatient facility as well as to identify factors that place these youths at risk for homelessness. METHOD: Reports of homelessness during 5 years of follow-up interviews with 83 adolescents consecutively discharged from an inpatient facility were used in conjunction with chart reviews. RESULTS: One third of youths experienced at least one homeless episode after discharge. Youths who had a history of substance use, physical abuse, running away, or being in state custody were more likely to become homeless than those without such factors. Having a thought disorder, however, was inversely related to becoming homeless after hospital discharge. CONCLUSIONS: Youths discharged from a residential treatment facility are at high risk for becoming homeless. Interventions to prevent homelessness among adolescent inpatients should be targeted to those with a history of substance abuse, physical abuse, running away, and being in state custody.

Adolescent↗
PubMed2001

Vagus Nerve Stimulation for Patients in Residential Treatment Facilities.

THIS ANALYSIS COMPARED THE EFFECTIVENESS OF VAGUS NERVE STIMULATION (VNS) THERAPY AMONG PATIENTS WITH INTRACTABLE SEIZURES: a group living in residential treatment facilities (RTF) with a group not living in RTFs (non-RTF). Among a constant cohort of patients with baseline, 3-month, and 12-month data, the RTF group had significantly (P < 0.05) larger numbers of patients with generalized seizures, previous callosotomy, psychiatric disorders, behavioral problems, and Rett's syndrome. Median seizure reductions after 3 months were 33% in the RTF group and 49% in the non-RTF group (P < 0.001); after 12 months, 50% (RTF) and 56% (non-RTF). After both 3 and 12 months, alertness, mood, postictal recovery, and cluster seizures improved in more than a third of patients in both groups. Because VNS therapy does not interact with medications and is delivered automatically, it should be seriously considered for patients with intractable epilepsy who reside in RTFs.

Journal Article↗
PubMed1996

Effectiveness of a specialized women's intervention in a residential treatment program.

"Time Out! For Me," a specialized psychoeducational treatment found to be effective with women in an outpatient methadone clinic, was tested for generalizability to a residential drug user treatment program. The 6-session module was first given to an experimental group (n = 11) and compared to a control group (n = 10). The treatment was associated with increases in knowledge of human sexuality, assertiveness and communication skills, more positive attitudes toward being assertive and practicing safer sex, and increased self-esteem. Thus, "Time Out" appears to be an effective treatment enhancement for women in residential treatment.

Adult↗
PubMed2005

Sexual fantasies of adolescent male sex offenders in residential treatment: a descriptive study.

An attenuating sample of 87 male adolescent sexual offenders logged sexual fantasies during their entire time in therapy. These patients were attending residential treatment and kept a log recording all normal and deviant sexual fantasies which they experienced. Patients recorded which fantasies were interrupted and which fantasies were accompanied by masturbation. Typically, at the beginning of treatment, the reported rate of normal fantasies was maximal, the occurrence of deviant fantasies was minimal, and there was little effort to interrupt the deviant fantasies. The reported frequency of deviant fantasies increased substantially (about 380%) during the first 5 months of treatment and then steadily declined (approximately 47%) over the remaining months in therapy. Following an initial decline in the early months of treatment, an increase in the rates of normal fantasies was reported. Additionally, over the course of treatment, the frequency of deviant fantasies decreased relative to all fantasies. While deviant fantasies remained predominant to normal sexual fantasies and were more frequently paired with masturbation, patients reported substantial changes in the proportion of deviant fantasies that were interrupted (from about 20% to 70%). Implications of the results for juvenile sex offender treatment are discussed.

Adolescent↗
PubMed1990

The severely disturbed adolescent: indications for hospital and residential treatment.

Certain groups of preadolescent and adolescent children suffer from developmental and adaptive problems serious enough that they become candidates for full-time hospital or residential treatment. The author reviews the diagnostic criteria that justify such placement and describes these groups of children and adolescents, with particular attention to borderline and narcissistic personality disorders. He concludes by emphasizing the need for a psychodynamic, rather than merely symptom-focused, approach to milieu treatment.

Adolescent↗
PubMed1999

Verbal ability predicts abstinence from drugs and alcohol in a residential treatment population.

Measures of cognitive ability, depression, anxiety, antisocial personality, as well as length, type and severity of addiction were obtained from 122 substance abusers enrolled in residential treatment programs. Over a subsequent 6-mo. monitoring period, relapse to substance use was detected in 46 subjects. 17 subjects withdrew from treatment for other reasons and their relapse status was unknown. The remaining 59 maintained abstinence from alcohol or drug use throughout the monitoring period. The only variables to differentiate the groups significantly on outcome were IQ and the Verbal subtest from the Shipley Institute of Living Scale. Stepwise discriminant function analysis indicated that the Verbal component alone correctly identified 64.4% of patients who would successfully remain abstinent.

Adult↗
PubMed1998

In whose 'best interests'? Ethical issues involved in the moral dilemmas surrounding the removal of sexually abused adolescents from a community-based residential treatment unit to a locked, forensic adult psychiatric unit.

This study scrutinizes the ethical and moral dilemmas surrounding the removal of sexually abused adolescents from a community-based residential treatment unit to a locked, forensic adult psychiatric unit. Adolescent victims of sexual abuse exhibit a plethora of psychopathological symptomatology which can lead in many cases to the adolescent resorting to self-injurious behaviours in an attempt to relieve feelings of tension, anxiety and guilt. Because the unit in which the writer is involved is an open, community-based treatment centre with limited staffing levels, a completely secure environment may be compromised. Consequently self-injurious adolescents may become so disturbed that a more secure environment must be sought. The limited resources for disturbed adolescents in Northern Ireland means that occasionally the only option available to health care professionals who find themselves in this situation is to utilize the services of the psychiatric adult, forensic unit in Belfast which is contained within a large psychiatric hospital. Many would agree that such a placement for a disturbed adolescent seems inappropriate but is at the same time unavoidable. This study will examine the ethical and moral minefield that only recently has become a dilemma for health care professionals and particularly for nurses endeavouring to adhere to the code of professional conduct.

Adolescent↗
PubMed2005

A randomized trial of short-term acute residential treatment for veterans.

OBJECTIVE: A variety of alternatives to acute psychiatric hospital care have been developed over the past several decades. including San Diego's short-term acute residential treatment (START) program, now comprising a certified and accredited network of six facilities with a total of 75 beds. This study compared outcomes, patient satisfaction, and episode costs for a sample of 99 veterans who received acute care either at an inpatient unit at a Department of Veterans Affairs (VA) hospital or at a START facility. METHODS: Consenting participants were randomly assigned to one of the two treatment settings. Follow-up was conducted at two months. During the follow-up period, participants received treatment as usual. Multiple standardized measures were used to maximize validity in assessing symptoms, functioning, and quality of life. RESULTS: Participants who were treated in either a hospital or the START program showed significant improvement between admission, discharge, and two-month follow-up, with few statistically significant differences between the groups in symptoms and functioning. There was some evidence that START participants had greater satisfaction with services. Mean costs for the index episode were significantly lower for START participants (65 percent lower) than for those who were treated in the hospital. CONCLUSIONS: The results of this study suggest that the START model provides effective voluntary acute psychiatric care in a non-hospital-based setting at considerably lower cost. Efforts to replicate and evaluate the model at additional locations merit attention.

Acute Disease↗
PubMed2000

Attachment theory and residential treatment: a study of staff-client relationships.

This qualitative study examines residential child care workers' styles of engaging adolescent clients. Analysis focuses on staff practices and behavior that facilitate a treatment context conducive to healthier client attachments. Findings demonstrate the complexity inherent in residential treatment and illuminate barriers to optimal staff-client relationships. Suggestions are offered for improvement of agency policies and for future research.

Adolescent↗