Research suggests that individuals may benefit from participation in a partial hospital program (PHP) following discharge from inpatient psychiatric hospitalization. Indeed, PHPs are designed to facilitate further stabilization and skill-building before discharge to the community. As a result, our hospital-located in a large metropolitan area in the Northeastern United States-has long maintained a commitment to providing this critical level of care. However, during the COVID-19 pandemic, these in-person PHP services were discontinued in response to public health recommendations and to ensure the safety and well-being of patients and staff. To maintain this important point along the psychiatric care continuum, hospital leadership encouraged our PHP team to pursue an alternative approach to treatment delivery: video-based telepsychotherapy. This article describes the development of a virtual PHP that serves acute psychiatric patients stepping down from inpatient hospitalization. First, we provide an overview of the original in-person PHP and then discuss the process of its transition to a virtual format. Next, we describe in detail the components of our newly developed virtual PHP, highlighting adaptations necessitated by patients and staff being remote from our physical hospital. Finally, we present preliminary evidence of our virtual PHP's acceptability and feasibility, based on experiences with our 23 patients to date; discuss lessons learned from this program development effort; and recommend future directions for research and clinical practice. Information provided herein aims to guide the development of other virtual PHPs and telepsychotherapy programs that similarly strive to offer intensive treatment to an acute psychiatric population.
This article introduces the therapeutic contracting program as a comprehensive treatment system for persons with serious mental illness. Therapeutic contracting offers a promising framework for integrating medical, psychological, and social therapies in a manner that fosters clients' active involvement in treatment. This article outlines a multistage therapy program that mobilizes clients' adaptational resources through experimental interventions, structured goal-setting exercises, and skills-building experiences. Data illustrate the effectiveness of therapeutic contracting for (a) securing clients' treatment compliance, (b) promoting positive clinical outcomes, (c) reducing overall treatment costs. The therapeutic contracting model is discussed as a potential vehicle for expanding the professional role of psychologists in psychiatric settings, particularly in areas of clinical and administrative decision making.
Few empirical data address naturalistic outcomes of residential eating disorder (ED) treatment. Study aims were to evaluate course, effectiveness, and predictors of outcome in a residential treatment program. We evaluated 80 consecutively admitted female adolescents with the SCID-IV. Primary outcomes were treatment completion, subsequent readmission, clinical global impressions, and changes in body weight. Mean length of stay was 51 days, and 80% of patients were discharged according to treatment plans. Mean expected body weight (EBW) for AN patients increased from 80% to 91%. Patients reported significant improvements in ED symptoms, depression, and quality of life. Low admission %EBW and previous psychiatric hospitalizations were associated with premature termination. Overall, findings support that residential treatment is largely acceptable to patients, and that residential care may provide an opportunity for substantive therapeutic gains.
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