0
0

Chapter 62. Milieu TreatmentInpatient, Partial Hospitalization, and Residential Programs

Theodore A. Petti, M.D., M.P.H.
DOI: 10.1176/appi.books.9781585623921.479503

Sections

Excerpt

Inpatient hospital units (IU), partial hospital (PH) or day treatment (DT) programs, and residential treatment centers (RTCs) (sometimes grouped as "restrictive" or "intensive" services) play a critical role for children and adolescents (youth) with severe and/or persistent mental illness requiring extensive or intensive health and psychiatric services. Federal reports sometimes combine residential and inpatient statistics, while PH/DT is now pooled with outpatient treatments. A common set of values and expectations allows these programs to be considered together. A therapeutic milieu is central to each. This chapter describes common features across these milieu treatments (MTs) and considers each modality by defining the intervention and describing its structure, clinical role, and related issues.

Your session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Table Reference Number
TABLE 62–1. Essential milieu factors for patient assessment, safety monitoring and assurance, and transition to community
Table Reference Number
TABLE 62–2. Comparative criteria for milieu treatment programs
Table Reference Number
TABLE 62–3. Risk factors for suicidal behavior warranting admission and conditions for safe discharge
Table Reference Number
TABLE 62–4. Recommendations for assuring effective milieu treatment
Table Reference Number
TABLE 62–5. Acute inpatient psychiatric unit functions
Table Reference Number
TABLE 62–6. Frequency of presenting problems to acute specialty mental health inpatient programs

References

Alliance for the Safe, Therapeutic and Appropriate use of Residential Treatment: A START Factsheet. Available at: http://astart.fmhi.usf.edu/AStartDocs/factsheet.pdf. Accessed June 16, 2009.
 
American Academy of Child and Adolescent Psychiatry: Practice parameters for the assessment and treatment of children and adolescents who are sexually abusive of others. J Am Acad Child Adolesc Psychiatry 38(suppl):55S–76S, 1999
 
American Academy of Child and Adolescent Psychiatry: Practice parameters for the assessment and treatment of children and adolescents with suicidal behavior. J Am Acad Child Adolesc Psychiatry 40(suppl):24S–51S, 2001
 
American Academy of Child and Adolescent Psychiatry: Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint. J Am Acad Child Adolesc Psychiatry 41(suppl):4S–25S, 2002
 
Ash P, Nurcombe B: Malpractice and professional liability, in Lewis's Child and Adolescent Psychiatry: A Comprehensive Textbook, 4th Edition. Edited by Andres M, Volkmar FR. Philadelphia, PA, Lippincott Williams & Wilkins, 2007, pp 1018–1032
 
Blader JC: Symptom, family, and service predictors of children's psychiatric rehospitalization within one year of discharge. J Am Acad Child Adolesc Psychiatry 43:440–451, 2004
[PubMed]
 
Blader JC: Which family factors predict children's externalizing behaviors following discharge from psychiatric inpatient treatment? Arch Gen Psychiatry 47:1133–1142, 2006
[PubMed]
 
Blader JC, Foley CA: Milieu-based treatment: Inpatient and partial hospitalization, residential treatment, in Lewis's Child and Adolescent Psychiatry: A Comprehensive Textbook, 4th edition. Edited by Andres M, Volkmar FR. Philadelphia, PA, Lippincott Williams & Wilkins, 2007, pp 865–878
 
Burns CD, Cortekk MA, Wagner BM: Treatment compliance in adolescents after attempted suicide: a 2-year follow-up study. J Am Acad Child Adolesc Psychiatry 47:948–957, 2008
[PubMed]
 
Carman GO, Dorta N, Kon D, et al: Special education in residential treatment. Child Adolesc Psychiatr Clin N Am 13:381–394, 2004
[PubMed]
 
Case BG, Olfson M, Marcus SC, et al: Trends in the inpatient mental health treatment of children and adolescents in US community hospitals. Arch Gen Psychiatry 64:89–96, 2007
[PubMed]
 
Centers for Medicare and Medicaid Services: Medicare and Medicaid programs; hospital conditions of participation: patients' rights; final rule. Fed Regist 42 CFR Part 482, Dec 8, 2006, pp 71377–71428
 
Cohen P: Chemical dependency program, in Community Child and Adolescent Psychiatry: A Manual of Clinical Practice and Consultation. Edited by Petti TA, Salguero C. Washington, DC, American Psychiatric Publishing, 2006, pp 205–218
 
Colton D: Leadership's and program's role in organizational and cultural change to reduce seclusions and restraints, in For Our Own Safety: Examining the Safety of High-Risk Interventions for Children and Young People. Edited by Nunno MA, Day DM, Bullard LB. Washington, DC, Child Welfare League of America, 2007, pp 143–166
 
Cuellar AE, Libby AM, Snowden LR: How capitated mental health care affects utilization by youth in the juvenile justice and child welfare systems. Ment Health Serv Res 3:61–72, 2001
[PubMed]
 
Curry JF: Future directions in residential treatment outcome research. Child Adolesc Psychiatr Clin N Am 13:429–440, 2004
[PubMed]
 
Daily S, Reddick C: Adolescent day treatment: an alternative for the future. Adolesc Psychiatry 19:523–540, 1993
[PubMed]
 
Dale N, Baker AJL, Anastasio E, et al: Characteristics of children in residential treatment in New York State. Child Welfare 86:5–27, 2007
[PubMed]
 
Day DD: A review of the literature on the therapeutic effectiveness of physical restraints with children and youth. in For Our Own Safety: Examining the Safety of High-Risk Interventions for Children and Young People. Edited by Nunno MA, Day DM, Bullard LB. Washington, DC, Child Welfare League of America, 2007, pp 27–44
 
Dean AJ, McDermott BM, Marshall: PRN sedation-patterns of prescribing and administration in a child and adolescent mental health inpatient service. Eur Child Adolesc Psychiatry 15:277–281, 2006
[PubMed]
 
Embry LE, Evens C, Stoep AV, et al: Risk factors for homelessness in adolescents released from psychiatric residential treatment. J Am Acad Child Adolesc Psychiatry 39:1293–1299, 2000
[PubMed]
 
Epstein RA Jr: Inpatient and residential treatment effects for children and adolescents: a review and critique. Child Adolesc Psychiatr Clin N Am 13:411–428, 2004
[PubMed]
 
Friedman RM, Pinto A, Behar L et al: Unlicensed residential programs: the next challenge in protecting youth. Am J Orthopsychiatry 76:295–303, 2006
[PubMed]
 
Fujita M, Arnold V: Community residential programs, in Community Child and Adolescent Psychiatry: A Manual of Clinical Practice and Consultation. Edited by Petti TA, Salguero C. Washington, DC, American Psychiatric Publishing, 2006, pp 219–230
 
Greene RW, Ablon JS, Martin A: Use of collaborative problem solving to reduce seclusion and restraint in child and adolescent inpatient units. Psychiatr Serv 57:610–612, 2006
[PubMed]
 
Grizenko N: Outcome of multimodal day treatment for children with severe behavior problems: a five-year follow-up. J Am Acad Child Adolesc Psychiatry 36:989–997, 1997
[PubMed]
 
Henggeler SW, Rowlan MD, Randall J, et al: Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: clinical outcomes. J Am Acad Child Adolesc Psychiatry 38:1331–1339, 1999
[PubMed]
 
Huey SJ Jr, Henggeler SW, Rowlan MD, et al: Multisystemic therapy effects on attempted suicide by youths presenting psychiatric emergencies. J Am Acad Child Adolesc Psychiatry 43:183–190, 2004
[PubMed]
 
Katz LY, Gunasekara S, Miller AI: Dialectical behavior therapy for inpatient and outpatient parasuicidal adolescents. Adolesc Psychiatry 26:161–178, 2002
 
Katz LY, Cox BJ, Gunasekara S, et al: Feasibility of dialectical behavior therapy for suicidal adolescent inpatients. J Am Acad Child Adolesc Psychiatry 43:276–282, 2004
[PubMed]
 
Kiser L, Heston JD, Paavola M: Day treatment center/partial hospital setting, in Community Child and Adolescent Psychiatry: A Manual of Clinical Practice and Consultation. Edited by Petti TA, Salguero C. Washington, DC, American Psychiatric Publishing, 2006, pp 189–203
 
Kolko DJ: Short-term follow-up of child psychiatric hospitalization: clinical description, predictors, and correlates. J Am Acad Child Adolesc Psychiatry 31:719–727, 1992
[PubMed]
 
Kutash K, Rivera VR: Effectiveness of children's mental health services: a review of the literature. Education Treatment Children 18:443–477, 1995
 
Leichtman ML, Leichtman ML: Short-term residential treatment and its limits. Treatment Today Spring:12–14, 1996
 
Leichtman ML, Leichtman ML, Barber CC, et al: Effectiveness of intensive short-term residential treatment with severely disturbed adolescents. Am J Orthopsychiatry 71:227–235, 2001
[PubMed]
 
Leon SC, Snowden J, Bryant FB, et al: The hospital as predictor of children's and adolescents' length of stay. J Am Acad Child Adolesc Psychiatry 45:322–328, 2006
[PubMed]
 
Lieberman RE: Future directions in residential treatment. Child Adolesc Psychiatr Clin N Am 13:279–294, 2004
[PubMed]
 
Lyons JS, McCulloch JR: Monitoring and managing outcomes in residential treatment: practice-based evidence in search of evidence-based practice. J Am Acad Child Adolesc Psychiatry 45:247–251, 2006
[PubMed]
 
Lyons JS, Schaefer K: Mental health and dangerousness: characteristics and outcomes of children and adolescents in residential care. J Child Fam Stud 9:67–73, 2000
 
Lyons JS, Libman-Mintzer LN, Kisiel CL, et al: Understanding the mental health needs of children and adolescents in residential treatment. Prof Psychol Res Pr 29:582–587, 1998
 
Lyons JS, Terry P, Martinovich Z, et al: Outcome trajectories for adolescents in residential treatment: a statewide evaluation. J Child Fam Stud 10:333–345, 2001
 
Manderscheid R, Atay JE, Male A, et al: Highlights of organized mental health services in 2000 and major national and state trends, in Mental Health in the United States, 2002. DHHS Publ No SMA-3938. Edited by Manderscheid RW, Henderson MJ. Rockville, MD. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2004, pp 243–279
 
Masters KJ: A CBT approach to inpatient psychiatric hospitalization. J Am Acad Child Adolesc Psychiatry 44:708–711, 2005
[PubMed]
 
Masters KJ: Modernizing seclusion and restraint, in For Our Own Safety: Examining the Safety of High-Risk Interventions for Children and Young People. Edited by Nunno MA, Day DM, Bullard LB. Washington, DC, Child Welfare League of America, 2007, pp 45–66
 
Milazzo-Sayre LJ, Henderson MJ, Manderscheid RW, et al: Persons treated in specialty mental health programs, United States, 1997, in Mental Health, United States, 2000. Edited by Manderscheid RW, Henderson MJ. Rockville, MD, Center for Mental Health Services, 2000, pp 172–217
 
Mohr WK: Physical restraints: are they ever safe and how safe is safe enough? in For Our Own Safety: Examining the Safety of High-Risk Interventions for Children and Young People. Edited by Nunno MA, Day DM, Bullard LB. Washington, DC, Child Welfare League of America, 2007, pp 69–86
 
Mohr WK, Martin A, Olson JN, et al: Beyond point and level systems: moving toward child-centered programming. Am J Orthopsychiatry 79:8–18, 2009
[PubMed]
 
Nunno MA, Day DM, Bullard LB (eds): For Our Own Safety: Examining the Safety of High-Risk Interventions for Children and Young People. Washington, DC, Child Welfare League of America, 2007
 
Pappadopulos E, MacIntyre JC, Crismon L, et al: Treatment recommendations for the use of antipsychotics for aggressive youth (TRAYY), part II. J Am Acad Child Psychiatry 42:145–161, 2003
[PubMed]
 
Parmelee DX, Nierman P: Transitions from institutional to community systems of care, in Community Child and Adolescent Psychiatry: A Manual of Clinical Practice and Consultation. Edited by Petti TA, Salguero C. Washington, DC, American Psychiatric Publishing, 2006, pp 249–257
 
Petti TA: Future directions, in Community Child and Adolescent Psychiatry: A Manual of Clinical Practice and Consultation. Edited by Petti TA, Salguero C. Washington, DC, American Psychiatric Publishing, 2006, pp 269–275
 
Petti TA, Somers J, Sims LA: Chronicle of seclusion and restraint in an intermediate-term care facility. Adolesc Psychiatry 27:83–116, 2003a
 
Petti TA, Stigler K, Gardner-Haycox J, et al: Perceptions of PRN psychotropic medications by hospitalized child and adolescent recipients. J Am Acad Child Adolesc Psychiatry 42:434–441, 2003b
 
Petti TA, Blitsch M, Blix S, et al: Deliberate foreign body ingestion in hospitalized youth: a case series and overview. Adolesc Psychiatry 29:249–287, 2005
 
Pottick K, Warner L, Isaacs M, et al: Children and adolescents admitted to specialty mental health care in the United States, 1986 and 1997, in Mental Health in the United States, 2002. DHHS Publ No SMA-3938. Edited by Manderscheid RW, Henderson MJ. Rockville, MD, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2004, pp 314–326
 
Sanislow CA, Grilo CM, Fehon DC, et al: Correlates of suicide risk in juvenile detainees and adolescent inpatients. J Am Acad Child Adolesc Psychiatry 42:234–240, 2003
[PubMed]
 
Schur SB, Sikich L, MacIntyre JC, et al: Treatment recommendations for the use of antipsychotics for aggressive youth (TRAYY), part I: a review. J Am Acad Child Psychiatry 42:132–144, 2003
[PubMed]
 
Snowden JA, Leon SC, Bryant FB, et al: Evaluating psychiatric hospital admission decisions for children in foster care: an optimal classification tree analysis. J Child Adolesc Psychol 36:8–18, 2007
[PubMed]
 
Stroup A, Witkin M, Atay J, et al: Residential Treatment Centers for Emotionally Disturbed Children 1983 (Mental Health Statistical Note No 188). Rockville, MD, National Institute of Mental Health, 1988
 
Subramaniam GA, Stitzer MA, Clemmey P: Baseline depressive symptoms predict poor substance use outcome following adolescent residential treatment. J Am Acad Child Adolesc Psychiatry 46:1062–1069, 2007
[PubMed]
 
Sukhodolsky DG, Cardona L, Martin A: Characterizing aggressive and noncompliant behaviors in a children's psychiatric inpatient setting. Child Psychiatry Hum Dev 36:177–193, 2005
[PubMed]
 
Teich JL, Ireys HT: A national survey of state licensing, regulating, and monitoring of residential facilities for children with mental illness. Psychiatr Serv 58:991–998, 2007
[PubMed]
 
Tse J: Research on day treatment programs for preschoolers with disruptive behavior disorders. Psychiatr Serv 57:477–486, 2006
[PubMed]
 
Whittaker JK: The reinvention of residential treatment: an agenda for research and practice. Child Adolesc Psychiatr Clin N Am 13:267–278, 2004
[PubMed]
 
Whitted BR: Legal issues in residential treatment. Child Adolesc Psychiatr Clin N Am 13:295–307, 2004
[PubMed]
 
+

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
Which of the following statements regarding the historical perspective of milieu treatments is false?
2.
Which of the following components is essential for providing effective milieu treatment?
3.
In determining whether a patient warrants an inpatient admission for suicidality, which of the following factors is considered to be least risky?
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Books
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 1.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 2.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 3.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 4.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 5.  >
Topic Collections
Psychiatric News
PubMed Articles
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation