Advancing Care Within an Adult Mental Health Day Hospital: Program Re-Design and Evaluation

  • Marlene Taube-SchiffEmail author
  • Adrienne Mehak
  • Sandy Marangos
  • Anastasia Kalim
  • Thomas Ungar


Day hospital mental health programs provide alternate care to individuals of high acuity that do not require an inpatient psychiatric stay. Ensuring provision of best practice within these programs is essential for patient stabilization and recovery. However, there is scant literature to review when creating such a program. This paper provides an overview of the steps an acute care hospital took when designing and implementing new programming within a day hospital program. Qualitative data was collected following initial program rollout. This data helped to inform the ongoing modification of groups offered, group scheduling and content, as well as ensuring patient satisfaction and adequate skill delivery during the rollout period and beyond. The goal of this paper is to inform health service delivery for other programs when attempting to build or re-design a day hospital program.


Day hospital Partial hospitalization program Program development Program evaluation Qualitative research 



The authors wish to acknowledge the valuable guidance and support from Drs. Karen Fergus and Sanjeev Sockalingam throughout the completion of this work. Thank you also to the staff of the Day Hospital Program at North York General Hospital and to our patients, for sharing your stories and helping us to understand your experiences.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Kallert TW, Priebe S, McCabe R, et al. Are day hospitals effective for acutely ill psychiatric patients? A European multicenter randomized controlled trial. The Journal of Clinical Psychiatry. 2007;68(2):278–287.CrossRefGoogle Scholar
  2. 2.
    Priebe S, Jones G, McCabe R, et al. Effectiveness and costs of acute day hospital treatment compared with conventional in-patient care: randomised controlled trial. The British Journal of Psychiatry. 2006;188:243–249.CrossRefGoogle Scholar
  3. 3.
    Marshall M, Crowther R, Almaraz-Serrano A, et al. Systematic reviews of the effectiveness of day care for people with severe mental disorders: (1) acute day hospital versus admission; (2) vocational rehabilitation; (3) day hospital versus outpatient care. Health Technology Assessment. 2001;5(21):1–75.CrossRefGoogle Scholar
  4. 4.
    Rosie JS, Azim HF, Piper WE, et al. Effective psychiatric day treatment: historical lessons. Psychiatric Services. 1995;46(10):1019–1026.CrossRefGoogle Scholar
  5. 5.
    Yanos PT, Vreeland B, Minsky S, et al. Partial hospitalization: compatible with evidence-based and recovery-oriented treatment? Journal of Psychosocial Nursing and Mental Health Services. 2009;47(2):41–47.CrossRefGoogle Scholar
  6. 6.
    Horvitz-Lennon M, Normand SL, Gaccione P, et al. Partial versus full hospitalization for adults in psychiatric distress: a systematic review of the published literature (1957-1997). Americal Journal of Psychiatry. 2001;158(5):676–685.CrossRefGoogle Scholar
  7. 7.
    Institute of Medicine. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.Google Scholar
  8. 8.
    Kern D, Thomas PA, Hughes MT. Curriculum developmeny for medical education: a six-step approach. Baltimore, MD: The John Hopkins University Press; 2009.Google Scholar
  9. 9.
    Calley NG. Program development in the 21st century: an evidence-based approach to design, implementation, and evaluation. Los Angeles, CA: Sage Publications; 2011.Google Scholar
  10. 10.
    Association for Ambulatory Behavioral Healthcare. (2015). Standards and guidelines: partial hospitalization programs and intensive outpatient programs. Portsmouth, VA: Association for Ambulatory Behavioral Healthcare.Google Scholar
  11. 11.
    Creswell JW. Research design: qualitative, quantitative and mixed methods approaches. 4th ed. Thousand Oaks, CA: Sage Publications; 2013.Google Scholar
  12. 12.
    Braun V, Clarke V. Successful qualitative research. London: SAGE Publications; 2013.Google Scholar
  13. 13.
    Francis JJ, Johnston M, Robertson C, et al. What is an adequate sample size? Operationalising data saturation for theory-based interview studies. Psychology & Health. 2010;25(10):1229–1245.CrossRefGoogle Scholar
  14. 14.
    Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007;19(6):349–357.CrossRefGoogle Scholar
  15. 15.
    Dimidjian S, Hollon SD, Dobson KS, et al. Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting Clinical Psychology. 2006;74(4):658–670.CrossRefGoogle Scholar
  16. 16.
    Dimidjian S, Barrera M, Jr., Martell C, et al.. The origins and current status of behavioral activation treatments for depression. Annual Review of Clinical Psychology. 2011;7:1–38.CrossRefGoogle Scholar
  17. 17.
    Martell CR, Dimidjian S, Herman-Dunn R. Behavioral activation for depression: a clinician's guide. New York: Guilford Press; 2010.Google Scholar
  18. 18.
    Jacobson NS, Dobson KS, Truax PA, et al. A component analysis of cognitive-behavioral treatment for depression. Journal of Consulting and Clinical Psychology. 1996;64(2):295–304.CrossRefGoogle Scholar
  19. 19.
    Martell C, Addis M, Jacobson N. Depression in context: strategies for guided action. New York, NY: Norton; 2001.Google Scholar
  20. 20.
    Hopko DR, Lejuez CW, LePage JP, et al. A brief behavioral activation treatment for depression. A randomized pilot trial within an inpatient psychiatric hospital. Behavior Modification. 2003;27(4):458–469.CrossRefGoogle Scholar
  21. 21.
    Gollan JK, Hoxha D, Hanson B, et al. A comparison of a milieu-based Behavioural Activation Communication with treatment as usual for acute psychiatric inpatients. Journal of Psychiatric Intensive Care. 2013:1–10.Google Scholar
  22. 22.
    Folke F, Hursti T, Tungstrom S, et al. Behavioral activation in acute inpatient psychiatry: a multiple baseline evaluation. Journal of Behavior Therapy and Experimental Psychiatry. 2015;46:170–181.CrossRefGoogle Scholar
  23. 23.
    Gollan J. Behavioral activation patient guide. In. Chicago Illinois: The Stone Mental Health Center, Northwestern Memorial Hospital Department of Psychiatry and Behavioral Sciences Northwestern University’s Feinberg School of Medicine; 2013:1–37.Google Scholar
  24. 24.
    Hanson B, Hoxha D, Roberts P, et al. The checklist of unit behaviours (CUB): psychometric properties of a measure of patient milieu engagement on an acute inpatient psychiatric unit. Journal of Psychiatric Intensive Care. 2013:1–9.Google Scholar
  25. 25.
    Lariviere N, Melancon L, Fortier L, et al. A qualitative analysis of clients’ evaluation of a psychiatric day hospital. Canadian Journal of Community Mental Health. 2009;28(1):165–179.CrossRefGoogle Scholar
  26. 26.
    Lariviere N, Desrosiers J, Tousignant M, et al. Revisiting the psychiatric day hospital experience 6 months after discharge: how was the transition and what have clients retained? The Psychiatric Quarterly. 2010;81(2):81–96.CrossRefGoogle Scholar
  27. 27.
    Kazantzis N, Whittington C, Zelencich L, et al. Quantity and quality of homework compliance: a meta-analysis of relations with outcome in cognitive behavior therapy. Behavior Therapy. 2016;47(5):755–772.CrossRefGoogle Scholar

Copyright information

© National Council for Behavioral Health 2017

Authors and Affiliations

  • Marlene Taube-Schiff
    • 1
    Email author
  • Adrienne Mehak
    • 1
  • Sandy Marangos
    • 1
  • Anastasia Kalim
    • 1
  • Thomas Ungar
    • 1
  1. 1.North York General HospitalMental Health ProgramTorontoCanada

Personalised recommendations