The impact of deinstitutionalization on California's state hospital population.

Deinstitutionalization has dramatically reduced the state psychiatric hospital population in California from 37,000 in 1955 to only 2,500 at the present time. In 1980 and 1982 the California Department of Mental Health conducted two surveys to assess demographic characteristics, psychiatric diagnosis, health status, and behavioral traits of state hospital patients. The results indicate that most patients are young, male, and diagnosed as schizophrenic and frequently engage in dangerous behaviors. The various patient subpopulations exhibited few differences in diagnostic distribution, although Hispanics did have a significantly higher rate of substance use. The author posits that the current hospital population constitutes a "hard core" of patients who may be difficult to place in community treatment facilities.

The Behavior Observation Instrument: a method of direct observation for program evaluation.

The background and development of a multicategory direct observation system, the Behavior Observation Instrument (BOI), is described. This time-sampling procedure for recording the behavior of persons is demonstrated in several treatment settings and the results applied to issues of program evaluation. Elements that have prevented direct observation from being widely adopted, such as costs, manpower, and training requirements, are systematically analyzed. A basic psychometric analysis of the instrument is used to determine optimum frequency and duration of observation intervals as well as observer agreement. The results imply that direct observation methods, once assumed by some to belong to the special province of the single-subject design, can be used to assess the effects of programs on groups of psychiatric clients in an efficient and economic manner.

The Credit-Incentive system: motivating the participation of patients in a day hospital.

The Credit-Incentive System, a modified token economy, is a means of motivating the participation of day hospital patients in therapeutic activities through the use of contingent rewards. Credits are earned by patients for engaging in a wide variety of prosocial tasks and activities and can be spent for coffee, a free lunch, special time with professional staff, recreational events, and time off from the treatment centre. The receipt of credits is accompanied by social approval and recognition from the staff and other patients. Evaluations have shown that the credit system doubles the participation rate of patients in a partial hospitalization programme. The system also enhanced group cohesiveness, provides practice and feedback for cognitive re-integration, and offers opportunities of learning self-management. The results of two experiments suggest that the symbolic and social rewards mediated by the credits are the most important components of their effectiveness.

A comparative evaluation of two day hospitals. Goal attainment scaling of behavior therapy vs. milieu therapy.

Previous attempts at program evaluation of partial hospitalization programs have consisted largely of descriptive and anecdotal reports of programs and patient characteristics. There have been no comparative or experimental studies of the effectiveness of differing day treatment programs. In the current study, Goal Attainment Scaling, a goal-oriented program evaluation system, was used with 56 randomly selected partial hospitalization patients who attended two day hospitals: one program was based on behavioral-educational methods, and the other was an eclectic program based on the concepts of a therapeutic community. Patients attending the behavioral-educational program showed greater attainment of their therapeutic goals than did the patients involved in the eclectic program. The greater effectiveness of the behavioral-educational day program increased from the 3-month follow-up to the 2-year follow-up.