Short Term Acute Residential Treatment Program - Admission/Application Essay Example

?Research Evaluation on the Community Research Foundation’s Short Term Acute Residential Treatment Program Research Evaluation Program Community Research Foundation Short Term Acute Residential Treatment 8/8/2011 Introduction The Community Research Foundation (CRF) is a San Diego based health care and research foundation that works to provide health services and rehabilitation to people with mental illness, and mental illness co-occurring with substance abuse. It is a not-for profit organization. The mission of the foundation is to provide health services in a manner that is compassionate and enthusiastic to those they work with. They deliver their services at the community level, aiming to have sensitivity to differing cultures, such as disparities in treatment requirements and use of services between Spanish-speaking Latino’s and European American’s (Barrio et al., 2003). CRF offers a number of different programs, including those aimed to help children and families, as well as individuals who suffer mental health problems, and those with mental health problems combined with substance abuse. The foundation was initiated in 1980, at which time a Residential Treatment Act had been recently been passed. The Act facilitated the development of community based health care programs, and made them financially viable. The first program that CRF produced was Turning Point Crisis Center, which was developed as an alternative method of treatment to psychiatric hospitalization in extreme cases. Turning Point Crisis Center is still in use today, located in Oceanside, San Diego. This center provided the basis for the Short Term Acute Residential Treatment (START) programs, which are now internationally recognized. CRF has continued to provide a range of mental health care services to all age groups since then as well as families, offering a number of outpatient care programs, such as psychiatric analysis, rehabilitation services, and family services as well as the residential programs. In addition to programs, CRF is also involved in research looking at different aspects of mental health care and the health care industry, with the aim of providing better treatment, and better understanding the mental conditions that they are facing. In addition, they are involved in training the next generation of health care professionals. An example of their research focus is that, the executive director of CRF in involved in publishing many research papers including one that looked at ethnic disparities in patients with schizophrenia, finding that European Americans used case management services more than other minorities, with Spanish-speaking Latinos using the services least out of all groups (Barrio et al., 2003). Short Term Acute Residential Treatment (START) is a voluntary program that is provided by the CRF as an alternative to hospitalization. Residents enter the program only at their own inclination, although they are obliged to remain for at least the first 72 hours. It equally serves people with insurance and people without, the inability to pay does not result in services being reduced or restricted at any level. An early form of the program was initially described in 1989, and has been used with varying popularity since. Repeated-measures tests indicate that the START method of treatment is significantly less expensive than hospital treatments for a similar level of patient distress. The level of improvement after discharge from START programs was also comparable to hospital treatment (Hawthorne et al., 2005). This makes it viable as an alternative to hospital treatment for adults suffering from a severe mental health breakdown, who do not need restraint. The length of stay within a center averages around ten days, with staff members starting to prepare residents for discharge from when they first enter the program. Residents enter a home-like environment where they are involved in meetings and therapy, as well as being required to help in taking care of the house, helping with preparing meals and cleaning. The staff works with residents to refer them to various outpatient and medication services as well as providing a safe environment for them to recover. The START programs are publically funded, with funding coming from San Diego County Mental Health Services. Each center contains 11- to 14- beds, and there are six such centers in San Diego. These are fully staffed with professionals who are fully trained in mental health (Hawthorne et al., 1999). As of 2005, the program has a total of 75 beds and all six centers are fully certified and accredited (Hawthorne et al., 2005). The focus of the centers is providing a community-based, home-like environment where residents have ample tools for recovery, and are connected to a number of support networks, and can meet with health professionals or psychologists when desired. Problem Statement The START program aims to provide a safe environment for people suffering severe mental issues, no matter what their ability to pay is or whether they have insurance, as well as to assist residents towards recovery goals. Many residents suffer substance abuse problems as well as mental problems, and the program has integrated approaches to deal with both simultaneously (Hawthorne et al., 2005) Members of the staff work to provide information for outpatient therapy, what social service resources are available, as well as providing psychiatric assessment. The program admits clients that would be at high risk otherwise, and a large proportion of admissions are combined with substance abuse (Hawthorne et al., 1999). Thus the program provides an important intermediary role for cases that would otherwise become severe. San Diego is an important place for such a program, as it is culturally diverse, with a particularly distinct Mexican culture. Research into mental health has found that there are many cultural influences to mental state, and individual cultures require different approaches (Cuellar & Paniagua, 2000). Health programs in the community are important for a number of reasons. Firstly, they provide an alternative to hospitalization for individual suffering from severe mental problems. Secondly, many of individuals that suffer these conditions will not seek hospitalization, but may seek programs like START as they are not as threatening or involve as much commitment. In addition, these types of programs have been shown to reduce hospital admissions, while being cost-effective (Gilmer et al., 2003). The START program is part of a trend that has been followed since 1950 away from reliance on long-term hospitalization, and towards community programs and shorter hospital stays. Long-term hospital stays are often expensive, especially for acute psychiatric cases, such as those that are admitted into the START program (Hawthorne et al., 2005). Keeping track of outcomes is important for such programs, especially to keep level of service high and costs low (Hawthorne et al., 1999). The primary outcome of the START program is residents leaving feeling empowered to move forward with their life and with the tools they need to do so. One measure of performance for this program is the length of stay, the average stay length is ten days, and an extended stay may indicate not being ready to leave. Length of stay may also be connected with the diagnosed mental issue, perhaps providing information as to what conditions require more attention, or where services need to be improved. Another measure of performance is the return rate of residents, if residents return to the program multiple times, then they are not being sufficiently empowered to move forward with their lives. Finally, the prevalence of negative thoughts and emotions when leaving the program as opposed to at admission is an indication of how well the program is performing. There should be a trend of negative thoughts decreasing in prevalence as time in the program increases if the program is being successful, the stronger the trend, the larger the effect the program is having. Getting data on this several months after release from the program also provides indication of the long term effects of the program. START programs are staffed 24-hours a day and all staff is fully trained in the mental health area; with psychiatric and nursing care both readily available on location. Staff in the programs generally have training at either the masters or the doctoral level, and staffing levels during the day is approximately three to four residents to one staff member, while at least two members are present on site overnight (Hawthorne et al., 1999). Evaluation Goals The aim of this evaluation is to look at how effective the program is at increasing the mental well being of residents during their stay from admission to discharge, and whether they make and follow through with plans following leaving the program. This information will be used to provide insight on the comparative advantages of the START community program and hospitalization. Information will be collected by means of survey and of data gathering. For determining how the program changes the thought processes of the residents and their planning for the future, surveys will be collected from residents at different stages during their stay at each of the treatment centers. For example, residents will be asked about their suicidal thoughts, feelings of hopelessness, plans for the future and what will happen next for them at different stages throughout their time in the program, as well as a follow up survey once they have left. To determine the levels of readmission, names (where recorded) will be looked at across all the centers. Data from the surveys will be entered as points along a scale, ranging from one to ten with one indicating low severity, five middling and ten high severity. This will be applied to a number of different thought and emotional processes, such as levels of suicidal thought, feelings of hopelessness, despair and hope for the future. This will be done for all questions asked, and the information analyzed statistically to look for trends in the data. If the program is effective at improving resident’s overall outlook, then a negative trend is expected in relation to negative thoughts, with negative thoughts decreasing as time in the program increases. This is likely to vary across different types of mental conditions, with the decrease being higher for some conditions and lower for others. Likewise, whether there is a coupled substance abuse problem will affect the trend, as the two problems interact. Information about resident readmission will also be analyzed statistically, and the level of readmission will indicate the successfulness of the program, as if there are many readmissions then the lessons that are being taught at the center are not being retained. This form of evaluation has some limitations. As the subjects participation is of their own volition there is some bias in the data collected. For example, some mental conditions, like depression can increase participation, while psychotic diagnoses may have the opposite effect (Hawthorne et al., 1999). In addition this type of evaluation does not consider the alternatives to treatment, thus while the program may not be completely successful, the outcome for the residents may still be significantly better than being institutionalized. References Barrio, C., Yamada, A. M., Hough, R. L., Hawthorne, W., Garcia, P., & Jeste, D. V. (2003). Ethnic disparities in use of public mental health case management services among patients with schizophrenia. Psychiatric Services, 54(9), 1264. Cuellar, I., & Paniagua, F. A. (2000). Handbook of multicultural mental health: Assessment and treatment of diverse populations. Academic Pr. Gilmer, T. P., Folsom, D. P., Hawthorne, W., Lindamer, L. A., Hough, R. L., Garcia, P., & Jeste, D. V. (2003). Assisted living and use of health services among Medicaid beneficiaries with schizophrenia. Journal of Mental Health Policy and Economics, 6(2), 59–66. Hawthorne, W. B., Green, E. E., Gilmer, T., Garcia, P., Hough, R. L., Lee, M., Hammond, L., et al. (2005). A randomized trial of short-term acute residential treatment for veterans. Psychiatric Services, 56(11), 1379. Hawthorne, W. B., Green, E. E., Lohr, J. B., Hough, R., & Smith, P. G. (1999). Comparison of outcomes of acute care in short-term residential treatment and psychiatric hospital settings. Psychiatric Services, 50(3), 401.  Read More