Physical characteristics of residential psychiatric and substance abuse programs: Organizational determinants and patient outcomes

Described the Physical and Architectural Characteristics Inventory (PACI), which assesses the physical characteristics of hospital- and community-based psychiatric and substance abuse residential treatment programs for adults. Developed using data from 94 representative programs, the PACI has 7 dimensions that assess community accessibility, physical features that add convenience, aid recreation, and provide support for patients, and space for patient and staff functions. In comparison to community-based programs (n=63), hospital programs (n=31) had more social-recreational and prosthetic aids, safety features, staff facilities, and space. The PACI dimensions were also related to other organizational features, such as facility ownership and program size and staffing level. Programs with more physical amenities had patients who were more involved in self-initiated and community activities and were more likely to successfully complete the program and be discharged to independent living situations and paid jobs. Programs with more social-recreational and prosthetic aids, space, and access to community resources also had better patient outcomes. In addition, PACI dimensions were related to observers' ratings of facility attractiveness. Potential applications of the PACI and the full inventory of which it is a part are discussed.     

Prevalence of traumatic brain injury in an inpatient psychiatric population

This study investigated the prevalence of traumatic brain injury (TBI) in an inpatient psychiatric population. We hypothesized increased prevalence of TBI relative to the general population due to a variety of risk factors observed in psychiatric patients. One hundred (mean age = 34) psychiatric inpatients completed the revised Head Injury Questionnaire. Chart review of 17 subjects reporting injuries established whether injuries were documented in medical records. Sixty-eight percent of this psychiatric population reported one or more injuries in which they were unconscious or dazed. This number is higher than the prevalence in the general population. Injuries were generally of mild to moderate severity; multiple injuries were common. Chart review of 17 subjects reporting TBI indicated that histories of TBI had not been noted in the medical record. Finally, 63% of TBI subjects reported that their injury predated the onset of their psychiatric symptoms. These results suggest a possible role of TBI in psychiatric symptomatology and have implications for psychiatric treatment in this population.     

THE BEHAVIOR OBSERVATION INSTRUMENT: A METHOD OF DIRECT OBSERVATION FOR PROGRAM EVALUATION1

The background and development of a multicategory direct observation system, the Behavior Observation Instrument (BOI), is described. This time-sampling procedure for recording the behavior of persons is demonstrated in several treatment settings and the results applied to issues of program evaluation. Elements that have prevented direct observation from being widely adopted, such as costs, manpower, and training requirements, are systematically analyzed. A basic psychometric analysis of the instrument is used to determine optimum frequency and duration of observation intervals as well as observer agreement. The results imply that direct observation methods, once assumed by some to belong to the special province of the single-subject design, can be used to assess the effects of programs on groups of psychiatric clients in an efficient and economic manner.     

INCREASING EXTENDED CARE FACILITY RESIDENTS' ATTENDANCE AT RECREATIONAL ACTIVITIES WITH CONVENIENT LOCATIONS AND PERSONAL INVITATIONS1

Residents of extended care facilities generally exhibit a low level of attendance at recreational and therapeutic activities. Spatial arrangement of rooms, prompting, snacks, and small prizes have been suggested as factors that affect attendance. The present study examined the effects of an extensive system of prompts and the location of activity areas on the attendance of residents at a variety of activities. Twenty-six subjects were randomly selected from the ambulatory population of the facility. The first time each subject entered the activity room during the first 6 min of an activity session their name was recorded. Reliability measures were taken at 10 sessions, with a 95% mean agreement between observers. The variables examined were the amount of individualization of subjects (experimental group I: names announced versus experimental group 2: names not announced), room location (central or peripheral), use of names in announcements (activity only versus activity and group I names), and mode of announcement (PA system only versus PA system and in-person). A counter-balanced group design with repeated measures was used, with a randomly determined order of application of experimental treatments. An analysis of variance split plot 2.222 (Kirk, R. E. Experimental Design: Procedures for the Behavioral Science. Belmont, Ca.: Brooks-Cole, 1968.) of the level of subject attendance yielded significant main effects for room location, F(1, 24) = 5.47, p < 0.05, and type of announcement, F(1, 24) = 9.10, p < 0.01, and significant interactions for Individualization × Use of Names in Announcements, F(1, 24) = 5.57, p < 0.05, and Room Location × Mode of Announcement, F(1, 24) = 7.90, p < 0.01. The results indicate that using a centrally located room and announcement of resident names increases attendance at a variety of activities. The increased social and environmental interaction generated by activity attendance has potential therapeutic benefits for the residents involved. Furthermore, the kind of information reported here and by others should be taken into consideration by planners of a variety of group living facilities, ranging from nursing homes to residential treatment cottages.     

What is happening in the world of therapeutic communities?

This overview of the contributions to the special edition illustrates something of how the collection of papers reflects the marginal nature of therapeutic communities, and makes parallels as to how they are forever struggling to survive, yet generate a passion of ideas and intellectual resilience that no project-managed health service can extinguish. It briefly describes the theoretical and geographical terrain covered, and signals how the cross-disciplinary incorporation of congruent ideas can be added to the traditional bedrock of therapeutic community practice. It ends by stating the context of the new, and seemingly successful, organization which assembled these contributions into its inaugural conference – and suggests that the journey could, and ultimate should, go further.     

Staff and Administrators’ Perceptions of Music Therapy with Acute Care Mental Health Inpatients: A Qualitative Investigation

The purpose of this qualitative study is to understand staff members’ and administrators’ perceptions of group-based music therapy in an acute care mental health setting. The researcher conducted semi-structured interviews with six experienced administrators and unit staff who were familiar with music therapy. Using an inductive approach to thematic analysis, the author identified six themes: (a) music constitutes an important role in patients’ lives, (b) patient-centricity and competence of the music therapist, (c) music therapy uniquely engages the patient with music, the music therapist, and peers, (d) music therapy shifts patients’ focus from internal to external, (e) music therapy is a normalizing experience that facilitates interaction, and (f) music therapy provides optimal conditions for cognitive, affective, and behavioral change. Implications for clinical practice, suggestions for future research, and limitations of the study are provided.     

Occupational Therapist,Biomedical Science Corps Officer and Former Firefighter

Abstract

What the literature reports that adolescents need within their parent-adolescent relationships, as well as what adolescents with serious emotional disturbances may experience within their parent-adolescent relationships are discussed. A framework for providing parent-adolescent group intervention for psychiatrically hospitalized adolescents and their parents to promote positive interaction and co-occupation are provided. Summaries of the parent-adolescent activity group experiences of three families are provided to illustrate how different adolescent psychiatric issues and family dynamics might be addressed in a parent adolescent activity group.     

Animal-Assisted Therapy with Farm Animals for Persons with Psychiatric Disorders: Effects on Anxiety and Depression,a Randomized Controlled Trial

This study examined the effects of Animal-Assisted Therapy with farm animals during a 12 weeks' intervention on anxiety and depression among psychiatric patients by using a randomized controlled trial with a follow-up investigation at 6 months. Ninety adult patients were included, with 41 completers in the treatment group and 28 in the control group. Anxiety measured using Spielberger State Anxiety Inventory did not decrease significantly during the intervention for the treatment group but was significantly lower at follow-up compared with baseline (p = 0.002) and with the end of the intervention (p = 0.004). There was no significant change for the control group. Depression measured using Beck Depression Inventory was significantly lower at follow-up compared with baseline for both groups, but there were no significant differences between the groups.     

APP conference summary

This is an account of the extended assessment of a 22-year-old man who was initially sent for a court report, having been accused of setting fires. He had a history both of delinquency and, importantly, of childhood asthma. Although he proved unable to engage in psychotherapy, some management was provided, such as Winnicott advocates in cases of delinquency. This paper explores the symbolic meanings and functions of the patient's delinquent acts, drawing upon theoretical concepts from Freud, Aichhorn, and Deutsch. Of particular importance is the link between this patient's delinquency, his asthma, and the unresolved mourning for his dead mother which he carried not simply for himself but for his whole family.