4 TREATMENTSETTINGS ANDTHERAPEUTICPROGRAMS 75
Creating successful discharge plans that offer op-
timal services and housing is essential if people with
mental illness are to be integrated into the commu-
nity. Gibson (1999) wrote that a holistic approach to
reintegrating persons into the community is the only
way to prevent repeated hospital admissions and im-
prove quality of life for clients. She maintains that
community programs after discharge from the hospi-
tal should emphasize social services, day treatment,
and housing programs. These services must be geared
toward survival in the community, compliance with
treatment recommendations, rehabilitation, and in-
dependent living. Gibson identified assertive com-
munity treatment (ACT)programs as providing
most of the services that are necessary to stop the re-
volving door of repeated hospital admissions punctu-
ated by unsuccessful attempts at community living.
ACT programs are discussed in detail later in this
chapter.
Partial Hospitalization Programs
Partial hospitalization programs (PHPs)are de-
signed to help clients make a gradual transition from
being an inpatient to living independently and to pre-
vent repeat admissions (Pittman et al., 1990). In day-
treatment programs, clients return home at night;
evening programs are just the reverse. The services
that different PHPs offer vary, but most programs in-
clude groups for building communication and social
skills, solving problems, monitoring medications, and
learning. Individual sessions are available in some
PHPs as well as vocational assistance and occupa-
tional and recreation therapy.
Each client has an individualized treatment plan
and goals, which the client develops with the case man-
ager and other members of the treatment team. Eight
broad categories of goals usually addressed in PHPs
(Swearingen, 1987) are summarized in Box 4-1.
Clients in PHPs may complete the program after
an inpatient hospital stay, which is usually too short
to address anything other than stabilization of symp-
toms and medication effectiveness. Other clients may
come to a PHP to treat problems earlier, thus avoid-
ing a costly and unwanted hospital stay. Others may
make the transition from a PHP to longer-term out-
patient therapy. Wilberg et al. (1999) reported that
completion of a day-treatment program was effective
in stabilizing symptoms and improving daily func-
tioning, and it encouraged poorly functioning clients
with personality disorders to participate in outpatient
therapy. Pittman et al. (1990) found that day treat-
ment for clients with severe and persistent mental ill-
ness prevented hospital admission and improved the
quality of clients’ lives with respect to socialization,
structure, and support.Residential Settings
Persons with mental illness may live in community
residential treatment settingsthat vary according
to structure, level of supervision, and services pro-
vided (Box 4-2). Some settings are designed as transi-
tional housing with the expectation that residents will
progress to more independent living. Other residential
programs serve clients for as long as the need exists,
sometimes years. Board and care homes often provide
a room, bathroom, laundry facilities, and one common
meal each day. Adult foster homes may care for one
to three clients in a family-like atmosphere including
meals and social activities with the family. Halfway
houses usually serve as a temporary placement that
provides support as the client prepares for indepen-
dence. Group homes house six to ten residents who
take turns cooking meals and sharing household
chores under the supervision of one or two staff per-
sons. Independent living programs are often housed in
an apartment complex, where clients share an apart-
ment. Staff members are available for crisis interven-
tion, transportation, assistance with daily living tasks,
and sometimes drug monitoring. In addition to on-site
staff, many residential settings provide case manage-
ment services for clients and put them in touch withBox 4-1
➤ PARTIALHOSPITALIZATION
PROGRAMGOALS- Stabilizing psychiatric symptoms
- Monitoring drug effectiveness
- Stabilizing living environment
- Improving activities of daily living
- Learning to structure time
- Developing social skills
- Obtaining meaningful work, paid employment,
or a volunteer position - Providing follow-up of any health concerns
Box 4-2
➤ RESIDENTIALSETTINGS
Group homes
Supervised apartments
Board and care homes
Adult foster care
Respite/crisis housing