News & Views - Feb,
1995 Issue #32
APPROPRIATE SCREENING FOR HOSPITAL-BASED RESIDENTIAL TREATMENT CENTERS
by: Elaine Bruce
CPC INTERMOUNTAIN HOSPITAL
As an established medical model residential treatment center, we receive calls of interest for possible
admission into our distinct program for adolescents. The initial call is the beginning of a comprehensive clinical screening process
designed to appropriately assess the adolescent's effectual need for a locked residential treatment program vs. Other options the
family will need to thoughtfully consider before any decisions are made.
The alternatives to placement must be first explored and exhausted. Criteria being evaluated are behavioral,
medical and/or psychiatric problems, history of previous treatment, including all outpatient and hospital stays, therapeutic group
homes, schools and any other past approaches that have been tried for the adolescent. If the adolescent has not yet tried therapy
on an outpatient basis and can still be managed successfully within his home or school, this disposition must be explored if there
are signs that psychiatric symptomatology are evident. If the information we receive from the family or other referral source indicates
moderate behavioral problems and all psychiatric criteria has been ruled out, our residential program would not be the correct course
of placement in such a case. A better alternative often may be a referral to a qualified family therapist, placement to a well-structured
school, or merely a parenting class for the parents. Thorough and conscientious qualification is crucial to the needs and future of
the adolescent and is also indicative of the professionalism and ethical philosophy of any of the several adolescent programs now
available throughout the U.S. and abroad.
If the adolescent truly needs medically based residential treatment, a typical hypothetical profile would
include: a DSM-IV diagnosis indicating moderate to severe mental disorder, stabilization on a pharmacologic regime, all acute symptomatology
also stabilized (actively suicidal behavior would not be appropriate), a demonstrated need for continuous skilled psychiatric observation,
supervision, structure, high dose medication or therapeutic milieu, recent IQ testing of 75 or above, and behavioral problems which
severely impact social, familial, occupational or educational functioning.
Other criteria for admission must still be considered before the residential treatment team accepts the
adolescent. The impact upon the whole milieu of patients in the program must also be a factor of the acceptance. Any history of sexual
perpetration and other symptoms such as fire setting need to be examined and in the recentness and severity of each incident. Differentials
need to be established between a continuum of sexual experimentation considered still within normal boundaries to that of a well-established
pattern of aggressive sexual assaultive behavior. Careful examination of fire starting is also clarified as is the difference between
early age experimentation and signs of certain arsonist conduct. The extreme behaviors of perpetration and fire setting need a specialized
treatment and must have the long-term programs designed for behavior modification in a secure setting. Acceptance of either of the
two behaviors in a positive peer program with many victims of abuse is not conducive for either the adolescent needing treatment and
the other adolescents in the program.
Family involvement is essential due to the severity of the problems that the adolescent is exhibiting.
Teleconference family therapy sessions are mandatory for families coming from out-of-state and are surprisingly effective, though
long- distance. Every effort is made by the treatment team to facilitate this process. In closing, the key to success from this type
of selective screening is that the family is very clear on what the expectations of the treatment plan are, and the likelihood for
good outcomes become high at the onset.
Copyright © 1995, Woodbury Reports, Inc. (This article may be reproduced
without prior approval if the copyright notice and proper publication and author attribution accompanies the copy.)