The Kiva project.

The treatment program for patients involved in the Kiva Project was individualized. Growth was reinforced and regression was accepted as a natural part of the treatment process. Discharge was never discussed until the patient indicated readiness to leave the hospital and willingness to undertake a particular placement opportunity in the community. Rehospitalization, if it occurred was considered a part of the process and the staff continued to be supportive of the patient regardless of whether or not they remained in the Department of Mental Health system. As of March, 1993, 21 patients had been successfully discharged to the community. Eleven of these patients have been out of the hospital for more than a year, and three for as long as six years. In financial terms, this means a savings in the long-term institutional care of these patients as opposed to more cost-effective outpatient services. The Project currently serves 17 patients. It continues to be a viable treatment modality for the Division of Psychiatric Rehabilitation.

A habilitation center for individuals with a dual diagnosis of mental retardation and mental illness.

The ICF/MR provides services to individuals with a dual diagnosis of mental retardation and mental illness. These services prepare these individuals to the least restrictive environment analogous to the norms and patterns of the mainstream of society. The individuals served are more than 22 years of age and have behavioral problems associated with mental retardation and/or mental illness. In addition, they have multiple medical problems which are related or unrelated to their physical or mental disabilities. These individuals have multiple changing needs which are addressed by an interdisciplinary team. The team develops a unified Individual Program Plan which is the framework for a comprehensive care for these individuals. This is to enable them to live a normal life as possible and to achieve gainful occupational pursuits like any other citizen in the State of South Carolina.

Efficacy of behavioral versus triazolam treatment in persistent sleep-onset insomnia.

OBJECTIVE: This study compared differential effects of behavioral therapy and triazolam in a clinical population with sleep-onset insomnia. Triazolam was hypothesized to decrease sleep latency and frequency and duration of awakening, with some effects during the first night's administration. But at follow-up, sleep measures were predicted to return to baseline levels. Behavioral treatment was hypothesized to effect sleep after 2 or more weeks of training which persisted at follow-up. METHOD: Thirty patients with average sleep latencies of 81.48 minutes, who reported chronic insomnia for an average of 2.6 years, were randomly assigned to one of two treatment groups: behavioral stimulus control/relaxation training and triazolam. RESULTS: Both treatments decreased sleep latency but differentially. Triazolam was effective immediately but maintained only some gains at follow-up. Behavioral treatment decreased sleep latency beginning the second week, when subjects expected no improvement, with gains maintained at follow-up. Comparisons showed that triazolam group latencies returned toward baseline, while behavioral group gains were maintained at follow-up. CONCLUSIONS: Triazolam treatment showed superior immediate treatment effects, while behavioral treatment showed superior treatment effects at follow-up, effects that accrued during the training period and differentially persisted at follow-up. One treatment strategy implied by these results would be to combine these two interventions concurrently. This would seem to use the immediate effects produced by the medication until the behavioral skills were learned, at which point medication would be terminated. This strategy could offer immediate relief and sustained effects at drug termination.