The community residential treatment service: Developing a Continuum of prosthetic environments for the chronically disabled

Abstract

Among the many issues regarding the care of chronic mental patients, none is more pressing than the need for administrative and clinical models designed to organize and systematize the efforts of diverse community service providers. This paper describes the functioning of the Community Residential Treatment Service of the South Beach Psychiatric Center, a large‐scale project of a state facility created to respond to this issue. By blending sophisticated clinical and administrative technology, programs operated by the state, voluntary, and proprietary health care sectors have been integrated to form a balanced service delivery system. This system provides a broad continuum of inpatient and outpatient residential settings developed in accordance with social learning principles. The components of the system, with the Community Residential Treatment Service as the major integrative force, are linked together by detailed contracts as well as common behavioral clinical and behavioral administrative language. The treatment successes of this sytem have been significant enough to suggest that a positive synergistic effect is generated by this programming combination.

Prosthetic environments for high-risk adolescents: Toward a multi-dimensional model.

“…He suggested that well-chosen increases and decreases in stimulation levels and response consequences are among the significant elements of environ-Volume 13, Number 2: October, 1989 mental prosthetic design, and he distinguished between "acquisition prostheses" and "maintenance prostheses" in order to differentiate supports necessary for learning from those required for the continuance of new behaviors. Others (Lieberman et al, 1985) have applied the prosthetic concept in more global terms and have proceeded in their design work by labelling categories or clusters of behaviors that must be addressed in the design of a specific program setting. Although the term is used formally by relatively few authors (Skinner, 1983;Lieberman et al, 1985;Liberman et al, 1988), anecdotal evidence suggests that practicing program design specialists working with very impaired patients find the term useful.…”

“…Others (Lieberman et al, 1985) have applied the prosthetic concept in more global terms and have proceeded in their design work by labelling categories or clusters of behaviors that must be addressed in the design of a specific program setting. Although the term is used formally by relatively few authors (Skinner, 1983; Lieberman et al, 1985; Liberman et al, 1988), anecdotal evidence suggests that practicing program design specialists working with very impaired patients find the term useful.…”

Off-Unit Activities Programming for Long-Stay Psychiatric Inpatients

“…7. Though off-unit programs can vary in content, as in any clinical operations they work best when their clinical goals dovetail with both the institutional administrative goals and the clinical orientations of the referring units (Lieberman et al, 1985). Off-unit programming fits well with treatment approaches that encourage the shortest possible hospitalizations.…”

In defense of "restrictiveness": A critical concept in consumer-oriented treatment planning.

“…For example, proponents of the concept of prosthetic environment, neutrally defined as a milieu designed to compensate for individual biopsychosocial deficits, implicitly urge the application of the principle of least restrictiveness to select from among those potentially therapeutic environments the program setting that presents the highest level of normal life demands with which the patient can cope without endangering him- or herself or others (Byalin & Lieberman, 1989; Lieberman et al, 1985). Whether or not one adopts this terminology, it is clear that the needs of some patients cannot be met except in non-natural settings.…”