No abstract

Objective:The transition after inpatient psychiatric care is a critical time with increased risk. This brief report evaluates Veterans Engaged in Treatment, Skills, and Transitions for Enhancing Psychiatric Safety (VETSTEPS), a program designed for this critical time. Method: Three "bridging" strategies were employed: (a) using inpatient-outpatient care collaboration; (b) four phone calls within seven days of discharge; and (c) a 4-week, evidence-based intervention that provided safety planning, coping skills, and triage services for postdischarge needs. Using retrospective data from 219 military veterans, VETSTEPS impact on treatment follow-up rates and veteran readmissions was examined. Results: Group participation was associated with significantly sooner mental health follow-up access, for both first and second follow-up appointments. Greater group participation was associated with lower rates of 12-month readmission, with more attended sessions associated with fewer readmissions when controlling for length of stay and previous readmissions. Following a hospital-wide strategy to implement VETSTEPS team phone calls, exploratory analyses indicate the facility's mental health care follow-up rate significantly improved from 55% to 79%, with sustained gains above 80% for two years. Conclusions and Implications for Practice: Program evaluation data suggest that bridging critical time interventions may improve outcomes for veterans recently discharged from psychiatric hospitalization. Impact and ImplicationsThis study offers some preliminary yet promising news for clinicians serving veterans recently discharged from a psychiatric hospitalization. Innovative "bridging" programs where veterans receive critical time intervention utilizing inpatient-outpatient care collaboration can improve continuity of care. Additionally, efficient modalities such as telephone calls and therapeutic groups can be effective ways to mitigate risk during this critical time. Safety planning and skills-based group treatment may serve to provide needed psychoeducation and support among this high-risk demographic. Lastly, although 7-day postdischarge appointments are a critical first step, continued access to care beyond the first week of discharge may be particularly important in reducing hospital readmission.

Eight outpatients, four from the V.A. and four from a University counseling center, were seen by eight different counselors in the two different settings. Predictions for patient gain in interpersonal functioning were generated by the differential between tape rating assessments of the counselor's level of functioning (empathy, respect, genuineness, concreteness, self-disclosure) in his initial session with the client and tape assessments of patients cast as counselors in the helping role with standard clients. In general, the inventory ratings were in the predicted direction for all dimensions for all indices of interpersonal and gross behavioral functioning by all of the following sources: experts; therapists; patients; standard interviewee; objective tape ratings.

Previous research ( I ' 2 -4 . 3 . 6 , iiiclicates t,hat valid clinical juclgiiieiits iiiade froni interviews are priniarily based upon the content of the client's responses, while the affect of responses rarely assists and can iiiislead judgnients. Studies ( 4 * 6 , comparing clinical judgnients iiiade froni content cues, in the form of typescripts, with voice cues, in the form of recordings, have been improperly controlled since rate of presentation has riot been controlled for. Specifically, judges have been free to read typescripts at their own pace, while recordings have been presented in continuous fashion, In addition, possible differences in inforniat,ion processes via the two inodes of presenttation have not been controlled for.Research (* ) also indicates t.hat different inodes of presentation could lead to greater or less accuracy of predict'ion relative to various areas of functioning. Evaluat.ion of various areas should be attempted under the different modes of interview presentation. Finally, there has been no direct investigation of the effect of retention of factual inforiliation contained in interviews upon the validity of clinical judgments.This study exaiiiiries these considerations through : (1) A controlled coiiiparison of the use of voice and content cues. (2) A comparison of the validity of judgments of self-reference adjectives of intcllect, eniotions, interpersonal relations and work efficiency froin content,, verbal and affect cues.(3) A test of which of these modes of interview presentation allows for the best retention of the factual inforiiiation the client presents. (4) A test of whether the aiiiount of factual information recalled is related to the accuracy of t,he prcdict,ions of self-descriptions. METHODTen-iiiinutc sc1ect)ioiis froiii tape recorded iiitervicws of three niale psychiatric patients at, a Veterans Administration hospital were selected on the basis of the clients' expressed affect, without, stress on specific et8iological material. Each of thc three clients' inherviews was then prepared under three conditions : (a) Thc original tape-recorded selections, (b) an exact typescript of the interview selections, and (c) t hc select,ion with the clie~it's responses read i n a iiioiiotone voicc.Prior tjo the iiiterviews, the dietits were presented with four groups of tell adjectives taken from the Gough Adjcct,ivc Chcck t.0 be clcscriptive of iutelligcnce, iritcrpcrsoiial rclatio~is, eiiiotioiis or work cfhciciicy. The clieiits wcre instructed to "choose thc four adjeot'ivcs out of each group of ten that dcscribc you best."The pool of di~iical judges was voiiiposctl of 18 1)h.D. cliiiical psychologists, 9 graduate st.udent trairiccs in diriictal psychology aiitl 3 social Each judge was raiitloiiily assigned t,o oric of thrcc cxperinient,al groups. The Ph.L).s, trainees aiid social workers were disl,ribul,cd evcrily aiiiong t,hc three groups. Each group of judges was first prcscritcd the original rccordiiig of one aliciit's intcrview, the typescript of ariothcr client's iritcrv...

The published results of readministering the Therapist Orientation Questionnaire to a group of “low experience” therapists (N = 60) 4 years after an initial administration were recalculated due to scoring errors. Ss had been classified into Freudian, Sullivanian, and Rogerian schools. Differences present among schools on several TOQ factors were present initially and were mostly still there at the readministration. Although relative to each other the groups were stable, many scores shifted, essentially, away from a Freudian philosophy.