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Assessment of Co-occurring Disorders, Levels of Care, and ASAM Requirements
Published in Tricia L. Chandler, Fredrick Dombrowski, Tara G. Matthews, Co-occurring Mental Illness and Substance Use Disorders, 2022
Elizabeth Reyes-Fournier, Tara G. Matthews, Tom Alexander
Persons with co-occurring disorders may receive treatment from an array of service providers at differing levels of care. One of the primary goals of health-care professionals is to establish effective treatment that is provided at the least restrictive level of care. When lower levels of care like outpatient counseling, medication management, intensive outpatient, and partial hospitalization will not meet the treatment needs of a person with co-occurring disorders, alternate and higher levels of care are considered. Two of the higher levels of care are residential treatment and inpatient hospitalization. The following content explores variations in residential and inpatient levels of care and their subsequent application to the treatment of persons with co-occurring psychiatric and substance use disorders. The specific levels of care are guided by the American Society of Addiction Medicine (ASAM) criteria, edited by Ries et al. (2014). Prior to discussing the variations in levels of inpatient and residential treatment, it is imperative to fully outline the six dimensions utilized by ASAM to determine the appropriateness of each level of care.
Freud on the Ward
Published in Paul Ian Steinberg, Psychoanalysis in Medicine, 2020
Most clinicians who had assessed Mrs. W diagnosed depression. This does not consider the contribution of her personality. The current diagnostic label that might best describe Mrs. W is self-defeating personality disorder; the older term, masochistic personality disorder (Lingiardi & McWilliams, 2017) better describes her, although it is now considered politically incorrect by some. Mrs. W appeared to accept that, for her, attachment inevitably involved suffering. She behaved in a manner that fulfilled this unconscious expectation, and ensured that others would suffer with her. The treatment team’s job is to disengage from relating with Mrs. W in this fashion, showing her different ways of interacting in their relationships with her. That is, the enactment needs to be identified and then discussed, first among staff, and then with Mrs. W, rather than continue to be acted out with her. Unfortunately, this type of work with this type of patient may only be possible in an inpatient unit stay of some weeks, or an intensive partial hospitalization program lasting several months, and so currently is available (when it exists) in most jurisdictions only in private hospitals for those who can pay. Nevertheless, applying the principles listed below will help avoid many destructive interactions on the ward, and foster growth among patients (and staff). These principles also can be applied in the psychiatric management of outpatients by psychiatrists and family physicians, whether or not these patients receive formal psychotherapy.
Treatment of anorexia nervosa
Published in Stephen Wonderlich, James E Mitchell, Martina de Zwaan, Howard Steiger, Annual Review of Eating Disorders Part 2 – 2006, 2018
There are no adequate RCTs to determine the efficacy of initial treatment intensity or type for AN patients. Some partial hospitalization programs have been found to be effective in direct relation to their intensity; that is, programs with 12 hour, 6 days a week treatment may approach inpatient programs in their effectiveness, whereas programs with fewer hours and fewer days of the week lose effectiveness (Zipfel et al. 2002; Olmstead et al. 2003).
Child and Adolescent Psychiatric Inpatient Care: Contemporary Practices and Introduction of the 5S Model
Published in Evidence-Based Practice in Child and Adolescent Mental Health, 2022
Casey D. Calhoun, Elizabeth A. Nick, Kyrill Gurtovenko, Aaron J. Vaughn, Shannon W. Simmons, Rebecca Taylor, Eileen Twohy, Jessica Flannery, Alysha D. Thompson
Send-off includes determining when the patient is ready for discharge as well as the services and support they will need following discharge. Determinations of LOS and post-discharge services go hand-in-hand, as inpatient clinicians will often wait to discharge a patient until outside services are arranged. Clinicians should track progress, both qualitatively and quantitatively, to determine the level and type of care that will be needed following discharge. For some patients, acute distress may fade quickly, and they may show increased signs of safety and readiness for outpatient therapy. Others may present with more sustained or fluctuating levels of risk that require services that are more intensive than outpatient therapy (e.g., partial hospitalization, residential care). Safety plans should be created for all patients with a history of risk and should be specific to safety risks post-discharge.
Symptoms of anorexia nervosa and bulimia nervosa have differential relationships to borderline personality disorder symptoms
Published in Eating Disorders, 2021
Alexia E. Miller, Sarah E. Racine, E. David Klonsky
Participants were 208 adolescent patients from a psychiatric inpatient or partial hospitalization unit of a hospital in the northeastern United States. Participants were admitted for short-term treatment for a range of severe psychopathology (i.e., mood disorders, anxiety disorders, substance-related disorders, and suicidality). Inpatient stays were typically one week or less, and partial hospitalization treatment typically lasted for one to two weeks. Most patients transitioned from inpatient to partial hospitalization treatment. The participants were recruited for a larger study on non-suicidal self-injury and related constructs over a period of two years (June 2008 to October 2010; Glenn & Klonsky, 2013a). Of these 208 adolescents, 181 completed the structured interview assessing BPD criteria, 135 completed the questions on BN symptoms, and 157 completed questions on AN symptoms. Participants ranged in age from 12 to 18 years (M = 15.13; SD = 1.64) and were mostly female (76.3%). Most participants identified as Caucasian (63%), with 10.6% identifying as African American, and 25% identifying as another race. Participant’s body mass index (BMI) ranged from 16.44 to 48.09 (M = 24.51; SD = 6.00). The research was approved by the Institutional Review Board, and informed consent/assent was provided by the parent and adolescent.
EPCAMH Call for Papers: Special Issue on Acute, Intensive, and Residential Mental Health Services for Youth
Published in Evidence-Based Practice in Child and Adolescent Mental Health, 2020
The prevalence of children receiving hospital-based care for mental health conditions continues to rise with over 10% of pediatric patients having a mental health diagnosis as the primary reason for admission. Intensive acute psychiatric care for youth focuses on crisis stabilization, assessment, safety monitoring, and longer-term treatment planning. Residential treatment services are typically of longer duration and may be accessed when day treatment and acute treatment options have not been effective. Additionally, intermediate levels of mental health-care such as intensive outpatient and partial hospitalization programs are designed to be time limited and focused on assisting with treatment intervention following inpatient or residential services, or to provide intervention for youth who need more than outpatient level treatment. Current practice guidelines strongly recommend access to evidence-based psychological therapies across these settings. However, limited evidence exists for how to provide psychology services in acute, intensive, and residential mental health settings as well as the effectiveness of those services and related interventions. Further, the variability across and within these treatment setting creates unique challenges in implementing evidence-based care. Limitations in the evidence-base of effective interventions, demonstrated strategies for successful implementation of those interventions, and the role of psychological services in implementation impede the generalization, dissemination, and associated improvement of care currently needed.