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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.

Examination of a social-learning program implemented in a maximum-security state hospital setting.

“…In one study, the rates of aggressive and self-injurious behaviors were found to decrease on an SLP ward over time such that these behaviors were significantly lower than the rates found on traditional care wards (Bellus et al, 1999). Another report from the same facility found significant improvements over time among clients admitted into an SLP in self-care skills and treatment engagement, as measured by rates of attendance and successful participation in groups and classes (Bellus et al, 2003). That same report revealed that clients who did not achieve discharge were more likely to refuse to attend treatment groups and were more likely to engage in nonviolent problematic and dangerous behaviors (Bellus et al, 2003).…”

Cognitive behavior therapy.

“…a few studies used a treatment as usual comparison (owen, Sellwood, Kan, Murray, & Sarsam, 2015;rosner, Lumbeck, & geissner, 2011;veltro et al, 2008;Wykes, parr, & Landau, 1999). the rest compared before and after measurements to show positive results (Bellus et al, 2003;Chadwick et al, 2000;hodel & West, 2003;Long et al, 2016;Lynch, Berry, & Sirey, 2011;Manning, hooke, tannenbaum, Blythe, & Clarke, 1994;Mcinnis, Sellwood, & Jones, 2006;newton et al, 2005;pinkham, gloege, Flanagan, & penn, 2004;Wykes et al, 1999). Most were admittedly pilot programs.…”

“…the scope of symptom acuity that responded positively to CBt group ranges from first break adolescents (newton et al, 2005) to chronic psychotic patients hospitalized for more than 2 years (Bellus et al, 2003). the studies suggested that a broad array of realistic goals is accomplished in CBt group.…”

“…With both acute and chronic patients, increases in attendance, selfcare, and participation have been found (Bellus et al, 2003;raune & Daddi, 2011). Several studies have demonstrated that CBt group improves knowledge and awareness of the illness (Long et al, 2016;Mcinnis et al, 2006).…”

“…For patients with chronic schizophrenia in longer term care, CBt group has been shown to have some positive effect for sessions that range from seven (Chadwick et al, 2000;pinkham et al, 2004) to as many as 50 (Bellus et al, 2003). one study found that there was no additional benefit to increas ing the number of sessions from seven to 20 (pinkham et al, 2004).…”