Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Services Interventions
Treatment Interventions
Partial Hospitalization/Day Treatment
Partial hospitalization, also called day treatment and partial care, has been a
growing treatment modality for youth with mental disorders. Research on partial
hospitalization as an alternative to inpatient treatment generally finds benefit
from a structured daily environment that allows youth to return home at night to
be with their family and peers.
Partial hospitalization is a specialized and intensive form of treatment that is
less restrictive than inpatient care but is more intensive than the usual types
of outpatient care (i.e., individual, family, or group treatment). The most
frequently used type of partial hospitalization is an integrated curriculum
combining education, counseling, and family interventions. The setting, be it a
hospital, school, or clinic, may be tied to the theoretical orientation of the
treatment, which ranges from psychoanalytic to behavioral. Partial
hospitalization has also been used as a transitional service after either
psychiatric hospitalization or residential treatment, at the point when the
child no longer needs 24-hour care but is not ready to be integrated into the
school system. It also is used to prevent institutional placement.
Overall, the research literature points to positive gains from adolescent use of
day treatment, but most of the studies are uncontrolled. Gains relate to
academic and behavioral improvement; reduction in, or delay of, hospital and
residential placement; and a return to regular school for about 75 percent of
patients (Baenen et al., 1986; Gabel & Finn, 1986). Day treatment programs are
not being used as frequently as they might be because third-party payers are
reluctant to support this form of treatment. They claim that the modality is
ambiguous, that it induces demand among those who would not otherwise seek
treatment, and that its length, treatment outcomes, and costs are unpredictable
(Kiser et al., 1986). Research is needed to address these issues.
To date, the only controlled study of partial hospitalization compared outcomes
for young children (ages 5 to 12) with disruptive behavior disorders who
received intensive day treatment with children who received traditional
outpatient treatment services (in fact, a waiting list control) (Grizenko et
al., 1993). The results at 6 months favored day treatment in reducing behavior
problems, decreasing symptoms, and improving family functioning.
Findings from uncontrolled studies of partial hospitalization are informative,
although not conclusive. Based on approximately 20 studies, multiple benefits
have been reported even over the long term (see reviews by Kutash & Rivera,
1996; Grizenko, 1997). In general, child behavior and family functioning improve
following partial hospitalization. Findings for improved academic achievement
are mixed and possibly suggest that implementation of school-based models should
be considered. About three-fourths of youth are reintegrated into regular
school, often with the help of special education or other school- or
community-based services. Several uncontrolled studies found that day treatment
could prevent youth from entering other costly placements (particularly
inpatient and residential treatment centers), which suggests that partial
hospitalization may reduce overall costs of treatment (Kutash & Rivera, 1996).
Finally, family participation during and following day treatment is essential to
obtaining and maintaining results (Kutash & Rivera, 1996).
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