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Deaddictive Mechanisms
Published in Albert A. Kurland, S. Joseph Mulé, Psychiatric Aspects of Opiate Dependence, 2019
Albert A. Kurland, S. Joseph Mulé
All of these have as their goal the utilization of natural social relationships arising from the organization of the program as the primary source of therapeutic change. In the structuring of the setting (milieu), there is an active utilization of the social and psychological elements of the treatment program in a manner that will add to their therapeutic impact – milieu therapy. Thus, each – the therapeutic community, therapeutic milieu and milieu therapy – utilizes social psychological forces in a treatment setting, but in a variety of different ways and, depending on how these are structured, may yield various types of interaction.
The Role of the Psychologist in Life Care Planning
Published in Roger O. Weed, Debra E. Berens, Life Care Planning and Case Management Handbook, 2018
Milieu therapy uses therapeutic environments to facilitate the functional capacities of its participants. Neurobehavioral treatment programs (Eames & Wood, 1989) serving individuals with significant behavioral sequelae following brain injury use specially trained staff and modified environments to help moderate triggers to behavioral dysfunction while facilitating other capacities. Substance abuse programs may use milieu approaches involving explicit guidelines, modeling by staff or more senior patients, and supports for adaptation to more effective coping strategies. Short-term milieu programs can also help people to test out new skills, perceptions, or coping skills within realistic but supportive environments.
Mountain Manor Treatment Center: Residential Adolescent Addictions Treatment Program
Published in Sally J. Stevens, Andrew R. Morral, Adolescent Substance Abuse Treatment in the United States, 2014
Marc Fishman, Philip Clemmey, Hoover Adger
On admission all patients undergo a comprehensive multidimensional biopsychosocial assessment to determine a level of severity and to confirm appropriateness of placement utilizing the adolescent section of the American Society of Addiction Medicine Patient Placement Criteria for the Treatment of Substance-Related Disorders (Mee Lee et al., 2001). In addition, this assessment is used to facilitate development of an individualized care plan. MMTC is probably best categorized as short- to medium-term residential treatment, with average length of stay of about thirty days (range: ten to sixty). It provides levels of residential care that span both Levels III.7 (medically monitored high-intensity inpatient/residential) and III.5 (clinically managed medium-intensity residential) of the ASAM criteria. The specific treatment approach (discussed in this chapter) is based on a milieu therapy approach, utilizing both medical model elements and therapeutic community (TC) elements. Patients are referred from the juvenile justice system, other government agencies, outpatient treatment providers, schools, parents, and a variety of other sources. More than half (54 percent) of the participants in the ATM study were referred to treatment by the courts, and two-thirds (66 percent) have been in detention or jail within the ninety days prior to admission. The primary funding source is Medicaid, followed by commercial insurance. state agencies (such as juvenile justice) for adolescents in their care and custody, and a small state program that provides supplemental funding for uninsured or underinsured “gray area” adolescents.
Metyrosine treatment in a woman with chromosome 22q11.2 deletion syndrome and psychosis: a case study
Published in International Journal of Developmental Disabilities, 2019
Maria Hagen Engebretsen, Arvid Nikolai Kildahl, Iver Harald Hoy, Trine Lise Bakken
A long-term psychiatric inpatient was studied, (period 2), in the setting of a specialized psychiatric inpatient unit (period 3) — see Table 1. The patient pathway through the psychiatric services covered more than five years and involved one outpatient unit and four different inpatient units. The patient was assessed for a syndrome, mental illness, and global functioning. A number of conventional and atypical antipsychotics were tried out, including clozapine, and different milieu-therapeutic regimes. The milieu therapy differed in the general inpatient unit (period 2) from the specialized unit (period 3). In the general unit, the patient was provided with basic nursing, including provision of medication and seclusion, when she showed aggressive behavior. In the specialized unit, the milieu therapy was adjusted to the patient’s lack of communicative skills. The milieu therapy especially emphasizes facilitated nurse–patient communication and task sustenance, which have both proved to be effective in severely disturbed patients with psychosis and ID (Bakken et al. 2008). Non-verbal validation was emphasized (Bakken et al. 2017). In this paper, results from clinical observations, PANSS, and the ABC will be presented.
Preventing COVID-19 Infection in Mental Health Units: Recommendations for Best Practices
Published in Issues in Mental Health Nursing, 2020
Narciso Quidley-Rodriguez, Lila de Tantillo
Gunderson (1978) conceptualized containment, support, structure, involvement, and validation as five therapeutic functions that exist in a multitude of milieus regardless of size, length of stay, staffing, and philosophy. Milieu therapy provides a stable social organization to foster inpatient treatment including the physical design of the unit and patient activities. Gunderson’s concepts are integral to nursing mental health care in an inpatient unit. Containment suggests that a milieu provides for the physical well-being of a patient including food and shelter. Support highlights clinician efforts to improve a patient’s well-being and self-esteem. Structure denotes that milieu activities are predictable. Involvement indicates that patients are an active part of their treatment, attending treatment team and therapy groups. Validation emphasizes the individuality and value of each patient. Gunderson maintained that these five functions can provide guidelines on how to structure a milieu and that all five functions would be incorporated in an ideal milieu. However, Gunderson acknowledged that it is highly unlikely that a milieu could optimally utilize all five functions simultaneously, in part due to the variability of patient needs. For example, the needs of a patient with psychosis will be different than the patient who is depressed. Gunderson proposed that milieus offer specialized care to accommodate particular patient needs or milieus remain flexible, allowing for the five functions to be used reasonably well, if not at an optimal level. As shown in Figure 1, these five functions may be used to guide inpatient care protocols in response to the pandemic.
Specialized psychiatric services: patient characteristics, referral practice and length of stay in a representative clinical sample 2010–2016
Published in International Journal of Developmental Disabilities, 2019
Trine Lise Bakken, Siv Helene Hoidal
Patients with ID and mental health problems may present with complicated symptoms and suffer from high symptom burden (Bakken and Martinsen 2013; Lake et al. 2016), which again elicit high costs, especially if the patients’ problems remain unrevealed and untreated (Bakken et al. 2014b). Specialized psychiatric services for patients with ID may therefore bring about not only improved mental health for the actual patient group, but also more cost effective services. Research on treatment finds that for the most part treatment strategies developed for patients in the general population also work when the patients have ID. However, these treatment strategies must be adapted to each patient’s level of intelligence, speech ability, and eventual idiosyncratic language and behavior. Also knowledge about how psychiatric phenomenology covariates with level of ID and eventual neuropsychiatric conditions like autism premise this use of commonly used strategies from general psychiatry (Bakken and Sageng 2016). Hence, skills required in such specialized psychiatric services include being capable of interpreting behavioral equivalents of mental illness symptoms, responding adequately to unusual utterances, and occasionally communicating in a predominantly non-verbal way (Bakken et al. 2017). Another factor that may favor specialized services is that such services may be interested in clinical improvements, and thereby initiate research. Treatment strategies including psychosocial interventions are only sparsely studied. The most studied treatment is medication (Tyrer et al. 2008; Matson and Mahan 2010). However, psychotropic medication and especially antipsychotics have been widely used to reduce behavior problems in patients with ID, which is a questionable practice (Tyrer et al. 2008; Matson and Mahan 2010). Beside medication, an increasing number of studies on psychotherapy are published. Milieu therapy on the other hand, is understudied (Bakken and Sageng 2016), although milieu therapy is the only psychosocial intervention that can be provided patients within all cognitive levels. As treatment is understudied, it is interesting to investigate if treatment strategies match the diagnoses provided according to treatment strategies recommended for patients in the general population (Bakken et al. 2016).