Table Of ContentDOCUMENT RESUME
ED 475 588
CG 032 353
AUTHOR Oxman, Elaine B.; Chambliss, Catherine
Tailoring Treatments for Diverse Inpatient Populations.
TITLE
2003-00-00
PUB DATE
NOTE
11p.
Reports Descriptive (141)
PUB TYPE
EDRS Price MF01/PC01 Plus Postage.
EDRS PRICE
DESCRIPTORS
Counseling Effectiveness; *Counseling Techniques; Evaluation
Methods; *Group Therapy; *Individual Needs; *Outcomes of
Treatment; Patients; *Psychiatric Hospitals
Solution Focused Counseling
IDENTIFIERS
ABSTRACT
Individualizing treatment to accommodate the diverse needs of
patients has long been a priority among psychologists. In the inpatient
realm, where heterogeneous client groupings are often common, individualizing
treatment is an ongoing challenge for therapists compelled to rely
increasingly on cost-effective group treatment modalities. This paper
proposes that streamlined assessment techniques, group sessions tied
explicitly to elements of the treatment plan, and incorporation of solution-
focused treatment methods will help to facilitate individualization of
inpatient treatment.
(GCP)
Reproductions supplied by EDRS are the best that can be made
from the original document.
Tailoring Treatments for Diverse
Inpatient Populations
by
Elaine B. Oxman
Catherine Chambliss
U.S. DEPARTMENT OF EDUCATION
PERMISSION TO REPRODUCE AND
Office of Educational Research and Improvement
DISSEMINATE THIS MATERIAL HAS
EDUCATIONAL RESOURCES INFORMATION
BEEN GRANTED BY
CENTER (ERIC)
This document has been reproduced as
received from the person or organization
originating it.
Minor changes have been made to
improve reproduction quality.
TO THE EDUCATIONAL RESOURCES
Points of view or opinions stated in this
INFORMATION CENTER (ERIC)
document do not necessarily represent
1
official OERI position or policy.
AVAILABLE
16EST COPY
2
Tailoring Treatments for Diverse Inpatient Populations
Elaine B. Oxman, Ph.D.
Norristown State Hospital
Catherine Chambliss, Ph.D.
Ursinus College
SUMMARY
Individualizing treatment to accommodate the diverse needs of
Research
patients has long been a priority among psychologists.
examining how diagnostic and personality variables mediate the
importance
of
established
the
has
interventions
effects
of
tailoring care to the specific requirements of particular client
The differential strengths and weaknesses of clients
groups.
treatment
optimizing
operate;
techniques
helping
how
affect
influences requires sensitivity to how each client best learns how
to change.
In the inpatient realm, where heterogenous client groupings
is an ongoing challenge
are often common, individualizing treatment
for therapists compelled to rely increasingly on cost-effective
3
3
group treatment modalities.
Assembling groups of clients that are
homogenous with respect to all the relevant client dimensions is a
flexible ways
must develop
therapists
rarity.
Instead,
of
accommodating within
diverse their
needs
those
the
of
heterogeneously comprised therapy groups.
group
tied
techniques,
sessions
Streamlined
assessment
explicitly to elements of the treatment plan, and incorporation of
methods facilitate
were
found
solution-focused
treatment
to
individualization of inpatient treatment, despite reliance on group
treatment modalities. Findings from this state hospital setting,
severely mentally
heterogeneous
ill
needs
the
serving
of
a
population, suggest that the demand for individualized treatment
planning can be reconciled with the need to provide group therapy.
I. Brief Problem Identification Testing
assist
Testing
can
Identification
Problem
Brief
(BPIT)
for
objectives
treatment
specific
clinicians clarifying
in
On units where turnover is rapid and staff in
individual patients.
not
evaluations
are
psychological
complete
short
supply,
Focused assessments based on structured
universally available.
can describe key psychological
interview and historical data
The BPIT
concerns that must be addressed on the treatment plan.
impulse
form addressed cognitive, psychoeducational, affective,
control, interpersonal, substance abuse, posttraumatic, and other
problems.
4
4
Following a two hour inservice training program, samples of
able to complete the
psychology intern trainees were on average
more experienced
fifteen minutes;
BPIT form in approximately
The BPIT can expedite
clinicians had a mean time of ten minutes.
assignment process by summarizing
the treatment planning and group
(see sample).
the patient's focal difficulties
II. Goal Group Techniques
focused on
Five years of experience with conducting groups
objectives suggests
familiarizing patients with their treatment
many severely
helps
that regular rehearsal of therapy goals
patients
Goal group participation requires
mentally ill patients.
in concrete, behavioral terms,
to think about their treatment
optimism.
clarifies staff expectations for them, and encourages
support and establishes
Discussing goals in group encourages peer
Leading goal groups also orients
a sense of shared hopefulness.
and facilitates
objectives,
clinicians to measurable treatment
patients regarding goal
their provision of timely feedback to
attainment.
data by
Centralized collection of weekly behavioral progress
disciplines facilitates
representatives of individual treatment
team members. Goal
communication about patients' improvement among
this information and share it with
group leaders can integrate
patients to recognize how their
patient goal group members to help
all staff members.
progress is being noted by
5
5
III. Solution-Focused Group Techniques
While much of the treatment process involves articulation of
deficits and maladaptive behavior, expanding the strengths within
inpatients
a patient's repertoire is clearly a priority. Orienting
to instances of their effective coping with difficult stressors can
help to increase perceived self efficiency.
When inpatients complain about feeling overwhelmed, inquiring
about recent times when they did not experience these difficulties
can provide clues
for future
in closely related situations,
Distinguishing between the contextual elements that
solutions.
facilitate coping and those associated with distress, can help
Emphasizing
make more
"what
choices.
constructive
patients
foster
sometimes works" can alert patients to their strengths,
brainstorming, and improve optimism.
(including
Even patients with treatment-resistant problems
dissociative identity disorder, borderline personality disorder,
have been found to benefit from
and refractory schizophrenia)
constructive refocusing on strengths. Rather than focus on episodes
interfered with goal
these
attainment,
during which symptoms
patients can be encouraged to learn about the circumstances which
promote their more effective functioning.
Determining how certain members of their support network can
help patients to make more appropriate choices was associated with
Developing a list
of
improved success during weekend visits.
employ during periods
of
positive self-calming strategies
to
6
6
exacerbating stress also was linked to more successful community
visits. Feedback from other group members about the efficacy of
patients to
these self-management strategies helped motivate these
make continued use of these techniques.
Focusing more on patients' optimal periods of functioning
psychotropic
role
the
of
of
examination
an
to
leads
often
medication in the treatment of severe mental illnesses. Group
discussion of the value of medication compliance, and collaborative
between
review of relevant recent research on the relationship
compliance and discharge success, has helped to transform many
resistant patients' attitudes toward psychotropic medication.
Davis,
Work reported by Haywood, Kravitz, Grossman, Cavanaugh,
(1995)
and Lewis (1995) and Sullivan, Wells, Morganstern, and Leake
attitudes
proved to be especially influential in shifting patients'
constructively. Preparation of copies of research abstracts of
was
wallets
their
carry
in
patients
to
for
studies
these
attending
particularly helpful for dually diagnosed patients also
that
substance abuse programs. Several of these patients reported
them to
being able to reference the treatment literature enabled
anti-drug
explain to peers (who frequently adopted a strong, global
that for these patients psychotropic medication was an
stance)
exception to the "drug free is always best" rule. Many patients
reported the belief that helping peers and family members to
break
understand their medication needs better would help them to
their cycle of multiple hospitalizations.
7
7
Discussion of unwanted side effects, and behavioral strategies
exercise regimes,
for compensating for these effects (e.g., use of
use of
social
attention to diet and sleep hygiene,
careful
willingness- to abide
supports), has been found to improve patients'
conscientious use of
by medical recommendations. Those making more
during community
their medications were also more successful
visits.
a
Brief Problem Identification Testing
Female /Male
Sex:
DOB:
Patient Name:
Date of Admission:
Building/Unit:
Diagnosis:
History of Behavioral Problems:
Current Behavioral Problem Areas:
Cognitive:
Psycho-educational:
Affective Functioning:
Impulse Control:
The Elderly
A Specific Case
Reminiscence groups for the elderly in state hospitals may
need to modify some of the tradition of reminiscence groups
Elderly patients in state mental hospitals may have
elsewhere.
The common
spent most of their lives in a hospital setting.
backgrounds that members of other reminiscence groups often
child-rearing, may
share- such experiences as work, marriage, and
In addition, the patient may
have been brief or non-existent.
the
have limited cognitive skills, a short attention span, or
which may preclude extended
presence of hallucinations, any of
discussions.
Even with these handicaps, reminiscence groups can be used
Patients frequently
to strengthen and help these patients.
remember, and enjoy talking about, their school days- even when
Some of
attendance at school was no more than five or six years.
praise
their few successes in life may have come at this time-
being
from a teacher; participation in a school play, or simply
Other frequently relished topics of
part of a class.
The hospital
conversation are pets and childhood friends.
experience itself can be used as a basis for reminiscence- for
from other
example, the staff members that the patients remembers
buildings or the holiday celebrations in other words.
10
