Unit 2 Treatment Settings Chapter 4 Flashcards
The continuum of Psychiatric Mental Health Treatment
Least Restritive to Most Restrictive
Primary Care
Specialty Care Patient-Centered Medical Homes Community Mental Health Centers Psychiatric Home Care Assertive Community Treatment Intensive Outpatient Programs Partial Hospitalization Programs Emergency Care
Crisis Stabilization/Observation Units
General and Private Hospitals State Hospital
Movement along the continuum is fluid and can go in either direction. For example, patients discharged from the most acute levels of care (e.g., hospitalization) may need intensive services to maintain their initial gains. Failure to follow up with out- patient treatment increases the likelihood of rehospitalization and other adverse outcomes.
Inpatient Setting Goals/Interventions
*24-Hour supervision
*Therapeutic milieu with hospital-/staff-supported healing environment( Calm, Safe, Secure, Structured
*Stabilization of symptoms and return to community
Develop short-term therapeutic relationship
Administer medication
Unit Design
Promotes calming safe environment
Treatment Team (Multidisciplinary)
Psychiatrist, PMH-APRN, Therapist, Counselors, Occupational therapy,
Recreational Therapy
Plan for discharge with family/significant other with regard to housing and follow-up treatment
Outpatient Setting Goals/Interventions
Intermittent supervision
Independent living environment with self-care, safety risks
Stable or improved level of functioning in community
Encourage adherence with medication regimen
Communicate regularly with family/support system to assess and improve level of functioning
IOP- Intensive Outpatient Programs regulation and schedule
Intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs) function as intermediate steps between inpatient and outpatient care
STRUCTED MULTIDISCPLINARY
while IOPs meet anywhere from three to five times each week for sessions lasting around 3 hours.
3- 5 times a week for 3 hours a day
Partial Hospitalization Programs (PHP)regulation and schedule
Intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs) function as intermediate steps between inpa- tient and outpatient care
STRUCTED MULTIDISCPLINARY
PHPs meet Monday through Friday and have longer hours (about 6 hours because they are “partially hospitalized”),
(Monday-Friday 6 hours a day)
What is the difference between Intensive Outpatient Programs and Partial Hospitalization Program?
A. Access to high quality care with Partial Hospitalization Programs.
B. The amount of time patients spend in them.
C. Partial Hospitalization Programs doesn’t allow visitors while Intensive Outpatient Program does.
D. Intensive outpatient programs provide less of an interdisciplinary care.
B. The amount of time patients spend in them.
STRUCTED MULTIDISCPLINARY
They provide(IOP AND PHP) structured activities along with nursing and medical supervision, intervention, and treatment. These programs tend to be located within general hospitals, psychiatric hospitals, or community mental health facilities.
A multidisciplinary team facilitates group therapy, individ- ual therapy, other therapies (e.g., art and occupational), and medication management. Coping strategies learned during the program can be applied and practiced between sessions, then later explored and discussed. Patients admitted to IOPs and PHPs are closely monitored in case of a need for readmission to inpatient care.
A psychiatric patient has been admitted to the hospital. He is displaying acute Super manic behavior continuously, and threatening to kill himself and his family throughout the arrival of getting to the hospital. Which treatment setting is the best for this patient?
A. Intensive Outpatient Program
B. Primary Care Provider
C.Emergency Care
D. Specialized Care
C.Emergency Care
Patients and families seeking emergency care range from the worried well to those with acute symptoms. The primary goal in emergency services is to perform triage and stabilization.
Emergency Care regulation and goals
Patients and families seeking emergency care range from the worried well to those with acute symptoms. The primary goal in emergency services is to perform triage and stabilization.
Triage refers to determining the severity of the problem and the urgency of a response.
Stabilization is the resolution of the immediate crisis.
Primary Prevention
Before any problem occurs
Primary prevention occurs before any problem manifests and seeks to reduce the incidence or rate of new cases. Primary pre- vention may prevent or delay the onset of symptoms in genet- ically or otherwise predisposed individuals. Coping strategies and psychosocial support for vulnerable young people are effec- tive interventions in preventing mood and anxiety disorders.
Secondly Prevention
Screening , medication
Reducing the prevalence
Early Identification and effective treatment are hallmarks of this level
While it does not stop the actual disorder from begin- ning, it is intended to delay or avert progression.
Tertiary Prevention
Tertiary
Tx of disease with focus on preventing deterioration
Rehab
Tertiary prevention is closely related to rehabilitation, which aims to preserve or restore functional ability.
example; In the case of treating major depressive disorder, the aim is to avoid loss of employment, reduce disruption of family processes, and prevent suicide.
Crisis Stabilization/Observation Units- inpatient
Care models that prioritize rapid stabilization and short length of stay have become more prevalent in medical and psychi- atric settings. Overnight short-term observation, often 1 to 3 days, is designed for individuals who have symptoms that are expected to remit in 72 hours or less. This observation is also helpful for individuals who have a psychosocial stressor that can be addressed in that timeframe, maximizing their stability and allowing them to rapidly return to a community treatment setting.
State Psychiatric Inpatient hospital
Care has improved over the years
Serve the most seriously ill patients
In most states, state hospitals provide forensic (court-related) care and monitoring as part of their function. The state or county system also advises the courts as to a defendant’s sanity. In some criminal cases, defendants may be judged to have been so ill when they committed the criminal act that they cannot be held responsible but instead require treatment. These judgments are termed “not guilty by reason of insanity” (NGRI). One tragic example is that of Andrea Yates, the Texas woman who, in 2001, drowned her five young children under the delusional belief she was saving them from their sinfulness. She was found NGRI and was committed to a Texas state psychiatric facility.
Patient items
A safe environment is an essential component of any inpatient setting. Protecting the patient is essential, but equally import- ant is the safety of the staff and other patients. Safety needs are identified, and individualized interventions begin on admis- sion. Staff members check all personal property and clothing to prevent any potentially harmful items (e.g., medication, alcohol,or sharp objects) from being taken onto the unit or left in their immediate possession. Some patients are at greater risk for sui- cide than others, and psychiatric-mental health nurses are skill- ful in evaluating this risk through questions and observations.
Visitor regulation
Monitoring visitation is an important aspect of patient well- being and safety. Although visitors can contribute to patients’ healing, visits may be overwhelming or distressing. Also, visitors may unwittingly or purposefully provide patients with unsafe items. Staff should inspect bags and packages. Sometimes, the unsafe items take the form of comfort foods from home or a favorite restaurant and should be monitored because they may be incompatible with diets or medications.
