How to ensure that the money follows the patient: a strategy for funding community services.

Although the vast majority of chronic mentally ill patients now live in the community, most of the funds for mental health services have remained in the budgets of large state institutions. As a result, adequate community support systems have not been developed for chronic patients. The author developed a strategy that permits funds to follow the patients from the hospital to the community. He explains how, within a single fiscal year and without increased funds, a treatment program's budget can be divided between hospital and community services, patients can be moved into community residential settings, and institutional staff can be absorbed into existing vacancies. The strategy was implemented for a treatment program in a Louisiana state hospital, resulting in substantial savings in the per diem cost of care.

Consumer accreditation: developing a quality assurance patient evaluation scale.

The 1979 Consolidated Standards for Psychiatric Facilities of the Joint Commission on Accreditation of Hospitals are performance-oriented, with emphasis on the identification and resolution of problems interfering with treatment goals. Nearly 200 of these criteria can be rated directly by patients. Converted into questions, these items can provide the basis for simple, inexpensive, and effective measures of patient care flexible enough to meet the needs of individual agencies. When used in this way, the standards also provide a format by which a psychiatric program and the Joint Commission can focus collaboratively on quality assurance issues relevant to accreditation.

Internal control and success orientation in a token economy for emotionally disturbed adolescents.

Forty-one emotionally disturbed adolescents were tested at each of three token economy levels on Rotter's Internal-External Locus of Control Scale and Guevar's Success-Failure Inventory. Delay of reinforcement (immediate, daily, weekly) was the primary differentiation between levels. One-way analyses of variance indicated a change across levels in the direction of more perceived internal control of behavior (p less than .025) and a greater success orientation (p less than .005). Change scores were not correlated with length of time in the program. Results suggest that the token economy as an external source of control is not necessarily incompatible with increasing patient expectancies of present and future control of the environment.

Sensory reinforcement of eyeblink rate in a decorticate human.

An unusual case of hydranencephaly was reported. The child survived for 19 years and showed evidence on three occasions of an increase in eyeblink rate with tactile reinforcement. Diagnosis was confirmed by an autopsy which revealed no preserved cortex in either hemisphere.