Day Treatment for Children with Emotional Disorders, Softcover reprint of the original 1st ed. 1991 Volume 2 Models Across the Country

The life span of day treatment for children in the United States is relatively short, covering a period of about 50 years. Although the first 20 years saw little growth in the number of centers operating around the country, the concept of day treatment was recognized by the Joint Commission on Mental Illness and Health in 1961 as the most significant treatment innovation of this century. Enthusiasm for this treatment modality gained impetus from growing dissatisfaction among many mental health care providers who had no choice but to place children in a highly restrictive hospital environment. Day treat­ ment did not carry the stigma associated with inpatient placement. The children could now remain with their own families and within their own communities. The parents could be actively included in their child's treatment. This new modality avoided the short- and long-term negative effects of institutionalization, and there was a fa­ vorable cost discrepancy between day and inpatient mental health services. In more recent years, there has been growing evidence of the efficacy of day treatment as an intensive therapeutic environment for children and their parents. Despite these advantages, day treatment has continued to be underutilized in favor of inpatient treatment by both the psychiatric community and third-party payers. Only recently is it being acknowledged by some insurers as a therapeutically sound and financially advantageous alternative to inpatient services. Conse­ quently, it is showing signs of intense growth nationally.

I. How to Start a Treatment Program.- 1. Building a Statewide Program of Mental Health and Special Education Services for Children and Youth.- The Georgia Psychoeducational Program Network.- The Development of the Network.- Public and Professional Awareness about Statewide Needs.- A 13-Year Phase-In Plan.- Designing the Prototypes.- Estimating the SED Prevalence.- Determining the Service Areas.- Choosing a Central Location for Each Service Area.- Adjusting Unit Size to Populations.- Staffing Prototypes by Unit Size and Service Load.- The Funding History.- Studies of the Network.- Prevalence of Severe Emotional Disturbance.- Ratio of Direct to Indirect Services.- Characteristics of SED Children and Youth.- Recidivism.- Longitudinal Effect.- Academic Achievement and IQ.- Personnel.- Summary and Conclusion.- References.- 2. Start-Up of a Day Treatment Program in a University Medical Center.- Brief History of Our Experience.- Relationship of the University’s Goals to the Day Treatment Program.- Clinical Aspects.- Teaching Aspects.- Advantages.- Disadvantages.- Research Aspects.- Fiscal Aspects.- Using the System.- Facilities Management.- The University Bureaucracy.- Conclusion.- 3. Architectural Considerations in Planning a Day Treatment Center.- The Role of Architecture.- The Fundamental Function.- The Aesthetic Constituent.- The Planning Process.- Recommended Areas.- The Architectural Program.- Site Selection.- Site Planning.- Exterior Functional Requirements.- Building Materials.- Interior Functional Requirements.- Flexibility and Planning for Change.- Conclusion.- References.- II. Program Models.- 4. Developmental Rehabilitation Perspectives in the Day Treatment of Children with Serious Emotional Disorders.- Clinical Aspects of Chronicity.- The Prevalence and Social Status of Severely Emotionally Disturbed Children.- Prevalence.- Social Attitudes and Stigmatization.- Critique of Current Educational and Clinical Services.- Availability and Quality of Services.- Effectiveness of Special Education Services.- Effectiveness of Mental Health Services.- A Developmental Rehabilitation Perspective.- Application of a Physical Disability Model to Psychiatric Disorders.- Transitions in the Life Span.- Community Locus.- Social Networks and Their Assessment.- Skills in Dealing with the World.- Comparisons of Three Human Service Systems.- Application of the Rehabilitation Approach to Patients.- Case of Rondy.- Case of William.- Rehabilitation Perspectives.- Summary.- References.- 5. Child and Adolescent Day Treatment: A General Systems Theory Perspective.- Organizational Subsystem.- Staffing Patterns.- Organizational Structure.- Community Subsystem.- Advisory Board.- Liaison with Community Agencies.- Emergency Treatment.- Third-Party Payers.- Milieu Subsystem.- Behavioral Program.- Activities Therapy.- Educational Subsystem.- Family Subsystem.- Group Subsystem.- Individual Subsystem.- Biologic Subsystem.- Integrating Subsystems.- Conclusion.- References.- 6. A Behavioral Model of Day Treatment.- The Rationale for the Behavioral Model.- Behavioral Models.- Behavioral Interventions.- Aversive Conditioning.- Positive Conditioning.- Behavior Therapy in Day Treatment Settings.- Comprehensive Contingency Management: The Token Economy.- The Brewer-Porch Children’s Center System.- Young Children’s Program.- Adolescent Program.- References.- 7. The Application of Psychodynamic Principles to Day Treatment.- Psychodynamic Principles.- Essential Elements of Day Treatment.- Principles of Psychodynamic Day Treatment.- Unconscious Motivation.- The Structural Model, or “the Structure of the Psyche”.- Peremptory Drives.- Manifestations of Sexuality and Aggression in Day Treatment.- Ego Concepts.- Therapeutic Applications of Mental Structuring.- Self and Object Relations.- Therapeutic Applications of Self and Object Relations.- Transference and Countertransference.- Transference.- Countertransference.- Transference and Countertransference among Staff.- Specific Dynamic Significance of Day Treatment.- Conclusion.- References.- 8. Day Treatment for Disturbed Children from Socially and Economically Disadvantaged Homes.- Program Characteristics.- Diagnostic Characteristics and Standardized Assessment of Children in the CDH.- Efforts toward a Standardized Assessment.- Outcome of Children in the CDH.- Current Program Design and Planning for the Future.- Interventions with Children.- Interventions with Families.- Other Interventions.- Assessing Change.- Day Treatment for Whom.- References.- 9. An Afterschool Day Treatment Program.- Overview.- Rationale for an After-School-Hours Day Treatment Model.- Program Development.- Program Philosophy.- Program Organization.- Program Size, Staffing, and Budget.- Program Management.- Dangers of a Growing Closed System.- Program Systems (Entry to Discharge).- Program Challenges.- Staff Training and Education.- Parent Involvement.- Diagnosis.- Fee Scales.- References.- III. Appendix.- An Annotated Bibliography of Publications on the Day Treatment of Children with Emotional Disorders.