Abstract
Economic and political pressures have led state governments to shrink and close long-term psychiatric inpatient units in favor of community-based treatment. These pressures present inpatient clinicians with an opportunity to examine their clinical practices and question whether the focus of treatment addresses the behaviors most relevant to helping patients achieve discharge and maintain community tenure. The social learning approach of Gordon Paul is the empirically validated treatment of choice for long-term psychiatric inpatients. In this study, we compared changes in daily functioning of sixty-four chronic psychiatric inpatients treated in two rehabilitation programs based extensively on Gordon Paul's social learning approach. Half of the participants were successfully discharged from the hospital. Analysis found both similarities and differences in behavioral improvements between the groups. These results provide some clarity to the relationship between selfcare skills, participation in programs, maladaptive behaviors, and achieving hospital discharge for chronically hospitalized individuals.
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REFERENCES
Deane FP, Huzziff R, Beaumont G: Discharge planning: Levels of care and behavioural functioning in long-term psychiatric inpatients transferred to community placement. Community Mental Health in New Zealand 9:18-26, 1995.
Aviram U, Minky S, Smoyak SA, et al: Discharge-ready patients who remain hospitalized: A re-emerging problem for mental health services. Psychiatric Quarterly 66:63-85, 1995.
Selig MJ, Johnson GW: A bridge to the community for extended-care state hospital patients. Hospital and Community Psychiatry 41:180-183, 1990.
Gannon M, Meagher D, Watters L: New long-stay patients—Two years later. Irish Journal of Psychological Medicine 14:24-25, 1997.
Woods PA, Higson PJ, Tannhill MM: Token-economy programmes with chronic psychotic patients: The importance of direct measurement and objective evaluation for long-term maintenance. Behavior Research and Therapy 22:41-51, 1984.
Paul GL, Lentz R: Psychosocial Treatment of Chronic Mental Patients: Milieu Versus Social Learning Programs. Cambridge, MA, Harvard University Press, 1977.
Paul GL, Stuve P, Menditto AA: Social-learning program (with token economy) for adult psychiatric inpatients. The Clinical Psychologist 50:14-17, 1997.
Ayllon T, Azrin N: The Token Economy—A Motivational System for Therapy and Rehabilitation. New York, Appleton-Century-Crofts, 1968.
Kazdin AE: Response cost: The removal of conditioned reinforcers for therapeutic change. Behavior Therapy 3:533-546, 1972.
Beck NC, Menditto AA, Baldwin L, et al: Reduced frequency of aggressive behavior in forensic patients in a social learning program. Hospital and Community Psychiatry 42:750-752, 1991.
Menditto AA, Baldwin LJ, O'Neal LG, et al: Social-learning procedures for increasing attention and improving basic skills in severely regressed institutionalized patients. Journal of Behavior Therapy and Experimental Psychiatry 22:265-269, 1991.
Menditto AA, Beck NC, Stuve P, et al: Effectiveness of clozapine and a social learning program for severely disabled psychiatric inpatients. Psychiatric Services 47:46-51, 1996.
Paul GL, Menditto AA: Effectiveness of inpatient programs for mentally ill adults in public psychiatric facilities. Applied & Preventive Psychology 1:41-63, 1992.
Bellus SB, Kost PP, Vergo JG: Preparing Long-term Inpatients for Community Re-entry. Psychiatric Rehabilitation Journal 23:359-363, 2000.
Corrigan PW: Behavior therapy empowers persons with severe mental illness. Behavior Modification 21:45-61, 1997.
Deegan PE: The Independent Living Movement and people with psychiatric disabilities: Taking back control over our lives. Psychosocial Rehabilitation Journal 15:3-19, 1992.
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Bellus, S.B., Donovan, S.M., Kost, P.P. et al. Behavior Change and Achieving Hospital Discharge in Persons with Severe, Chronic Psychiatric Disabilities. Psychiatr Q 74, 31–42 (2003). https://doi.org/10.1023/A:1021189505212
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DOI: https://doi.org/10.1023/A:1021189505212