the family, who agreed to accept the volunteer as a supportive friend and helper. The volunteer and the family set up a regular visiting time, usually once a week, that was convenient for both. The volunteers made it clear that they also were on call in case of an emergency or if a crisis occurred. The volunteers serve as advocates for the families in dealing with various agencies and help them take advantage of services they had not used previously. The volunteers assist the families with problems such as establishing eligibility for public assistance, initiating school conferences with teachers and counselors, investigating vocational testing and training placements, contacting landlords about renovation of living quarters, assisting with planning, budgeting, and buying, and providing transportation to and from medical appointments. The case clinician provides regular supervision. The volunteers are required to submit written reports about each meeting with the family, which become part of the family’s permanent medical record at the center. Volunteers are encouraged to consult their case supervisors about specific problems. They meet biweekly with the original planning group for problem-solving and information-sharing sessions. The involvement and dedication of the volunteers have been outstanding. They have demonstrated their ability to facilitate positive changes in the families they work with. In many cases, they have fulfilled a need not met by the various agencies in contact with the family in the past. The program has not been without problems. Sometimes the volunteer has been the only person involved with a multiproblem family that needed other systems of support as well. Also, a few of the referrals have been inappropriate. Some families, who had received intensive treatment but had not shown improvement, were dumped on the volunteers as a last resort. The staff recruited a new group of volunteers to expand services on a limited basis. Recruitment was opened to the public, and screening procedures were intensified. However, staff accepted all the eight women who applied. By June of 1974 they were actively involved with cases. We now have nine active volunteers in the program. Three of the other volunteers moved from the city, and three took full-time jobs or entered graduate school. The nine remaining serve 11 families. Future expansion of the program is contingent on the availability of staff supervision; however, we plan to recruit more volunteers in the spring of 1975. Carefully selected volunteers, when given appropriate training and professional support, can play a significant role in the treatment of child-abusing families. The families have been accepting of the services and feel that the advocative and supportive services are especially beneficial. The program has demonstrated its viability without the need for additional staffing or a significant increase in spending.
AN ATTITUDE HELPS REDUCE OF PHYSICAL Charles
Ellen
THERAPY PROGRAM THE USE RESTRAINTS
E. Sneligrove,
L. Flaherty,
Ph.D.
R.N.
UStaff began a program using attitude therapy on a four-ward psychiatric unit at the Veterans Administration Hospital in Knoxville, Iowa, in January 1971. Attitude therapy is a milieu treatment approach that involves restructuring the ward environment so that treatment team members are consistent in their attitudes toward a particular patient. One of five basic attitudes is prescribed by the treatment team, based on the patient’s behavior, and all staff use that attitude in their contacts with the patient. The attitudes are active friendliness, passive friendliness, matter-of-fact, no demand, and kind firmness.’ A basic assumption underlying the approach is that most mental illness is a pattern of maladaptive responses learned by the individual that impairs the effectiveness of his communication with, and adaptation to, his environment.2 The goal of the program was, very broadly, the remission of psychiatric symptoms. Staff considered a number of ways to assess the effectiveness of the program, including selective psychological testing, behavior rating scales, and disposition statistics. It was fortuitous that during a regular administrative review of nursing service activities for a three-month period we found that the number of times physical restraints were used each month had decreased markedly since the attitude therapy program was implemented. The following excerpts from the head nurse’s reports highlight aspects of the program’s progression: . The attitude therapy program was initiated on January 20 on the admissions ward. At that time nearly all new patients were being admitted to the closed ward. Admissions are now being taken on all four wards of the building. The multidisciplinary team interviews the patient and prescribes an attitude; patients are included in any treatment planning that is done. Therapeutic progress is assessed intermittently. We ‘have found that patients generally show a marked change in behavior within 24 hours after attitude prescription. There have been dramatic changes in patients who previously had not responded to other approaches, including medication and individual and group psychotherapy. In one case, a patient exhibited hyperactivity, irritability, interpersonal conflicts, destruction of propDr. Snellgrove is a clinical psychologist at the Veterans Administration Hospital in Salisbury, North Carolina; he formerly was clinical psychologist at the VA Hospital in Knoxville, Iowa. Ms. Flaherty is head nurse at the VA Hospital in Knoxville. ‘L. B. Lamm and J. C. Folsom, “Attitude Therapy and the Team Approach,” Mental Hospitals, Vol. 16, November 1965, pp. 307-320. J. C. Folsom, “Attitude Therapy as a Communication Device,” Transactions, Vol. 1, Spring 1969, pp. 19-26.
(Continued
VOLUME
26
NUMBER
3 MARCH
1975
on page
140)
137
(Continuedfroni
page
137)
erty, and self-destructive behavior. After we used attitude therapy for three days, he became manageable and responded more appropriately to nursing personnel, He began to participate in hospital programs and expressed satisfaction with his activities. The improvement in the patient’s behavior was so great that his parents, who had been quite critical of other treatment approaches, commended the program in a letter to the staff. In addition to improving patient care, the program has led to more effective multidisciplinary communication and higher staff morale. . A review of the number of incidents where cuffand-belt restraints were necessary to prevent the patient from injuring himself or others showed that there has been a substantial decrease in the number of such incidents since the program began. In January restraints were used 28 times; in February there were ten uses, and in March only two uses were recorded, In April the number increased to seven, but dropped to two in May. No physical restraints were used in June and August, and only one use was shown for July. The increase in April was due to the admission of a hyperactive patient who had been in the organicpsychiatric unit. Staff had to use cuff-and-belt restraints until they found the proper attitude to use. The decrease in use of physical restraints reflects fewer expressions of severe psychiatric symptoms. The only systematic change in procedure during that time was the introduction of attitude therapy as the treatment
approach.
a
LITCHFIELD,
Place
CONNECTICUT
THE COUNTRY PLACE is a residential treatment the emotionally disturbed person over I 8 years old to leave the hospital but needs an intermediate rejoining the outside community. THE COUNTRY PLACE offers a home where he is understood a work place where he can cope a community where he can find
center for who is ready place before
with the demands a social identity,
THE
COUNTRY PLACE helps toward in socially useful projects to college experimenting with outside jobs. THE COUNTRY PLACE maintains a well staff for individual and group therapy. sports and games, and vocational training. teamwork return
WEEKEND WORKSHOPS terested in studying our in creating a new identity. Address
inquiries
are method
of
offered helping
trained creative for the
professional therapies,
professionals disturbed
inperson
to.’
RENEE NELL, ED,D. THE COUNTRY PLACE Litchfield, Conn, 06759 Telephone: (203) 567-8763
‘Psychiatrist-Director”
COUNTY OF ROCKLAND, New York-Director of Community Mental Health Services needed for attractive suburban area with easy access to Manhattan (less than 30 miles to New York City) . Person will be responsible for New York State’s first Unified Services System, including serving as Director of one of nation’s leading Community Mental Health Centers and for the supervision of State facility and contract agency services for 255,000 residents of the County; including mental retardation, developmental disabilities, alcoholism, and drug abuse. Must have three years of post residency experience in psychiatry, one year of which included major administrative responsibilities, Board Certification and New York State license. Salary Open. Contact Ms. Judith Starker, Health & Social Services Complex, Pomona, New York 10970. Telephone 914-354-0200.
Equal
The Country
Opportunities
Employer
Psychiatrists The New Hampshire Hospital (the State’s only psychiatric hospital) operates on the unit principle, each clinical geographic unit having close ties with the community mental health center (s) of its catchment area. There are special clinical units including Neurology, Child and Adolescent Care, Forensic, and Medically Infirm Care. Board certified or eligible physicians who have a strong interest in community psychiatry and a competence in leading therapeutic teams with a high degree of clinical independence are invited to consider joining the staff. Salary up to $34,000. New Hampshire licensure required. For further information please Superintendent M. W. Wheelock, Hampshire Hospital, 105 Pleasant Concord, New Hampshire 03301.
contact: New Street,
AN ATTITUDE HELPS REDUCE OF PHYSICAL Charles
Ellen
THERAPY PROGRAM THE USE RESTRAINTS
E. Sneligrove,
L. Flaherty,
Ph.D.
R.N.
UStaff began a program using attitude therapy on a four-ward psychiatric unit at the Veterans Administration Hospital in Knoxville, Iowa, in January 1971. Attitude therapy is a milieu treatment approach that involves restructuring the ward environment so that treatment team members are consistent in their attitudes toward a particular patient. One of five basic attitudes is prescribed by the treatment team, based on the patient’s behavior, and all staff use that attitude in their contacts with the patient. The attitudes are active friendliness, passive friendliness, matter-of-fact, no demand, and kind firmness.’ A basic assumption underlying the approach is that most mental illness is a pattern of maladaptive responses learned by the individual that impairs the effectiveness of his communication with, and adaptation to, his environment.2 The goal of the program was, very broadly, the remission of psychiatric symptoms. Staff considered a number of ways to assess the effectiveness of the program, including selective psychological testing, behavior rating scales, and disposition statistics. It was fortuitous that during a regular administrative review of nursing service activities for a three-month period we found that the number of times physical restraints were used each month had decreased markedly since the attitude therapy program was implemented. The following excerpts from the head nurse’s reports highlight aspects of the program’s progression: . The attitude therapy program was initiated on January 20 on the admissions ward. At that time nearly all new patients were being admitted to the closed ward. Admissions are now being taken on all four wards of the building. The multidisciplinary team interviews the patient and prescribes an attitude; patients are included in any treatment planning that is done. Therapeutic progress is assessed intermittently. We ‘have found that patients generally show a marked change in behavior within 24 hours after attitude prescription. There have been dramatic changes in patients who previously had not responded to other approaches, including medication and individual and group psychotherapy. In one case, a patient exhibited hyperactivity, irritability, interpersonal conflicts, destruction of propDr. Snellgrove is a clinical psychologist at the Veterans Administration Hospital in Salisbury, North Carolina; he formerly was clinical psychologist at the VA Hospital in Knoxville, Iowa. Ms. Flaherty is head nurse at the VA Hospital in Knoxville. ‘L. B. Lamm and J. C. Folsom, “Attitude Therapy and the Team Approach,” Mental Hospitals, Vol. 16, November 1965, pp. 307-320. J. C. Folsom, “Attitude Therapy as a Communication Device,” Transactions, Vol. 1, Spring 1969, pp. 19-26.
(Continued
VOLUME
26
NUMBER
3 MARCH
1975
on page
140)
137
(Continuedfroni
page
137)
erty, and self-destructive behavior. After we used attitude therapy for three days, he became manageable and responded more appropriately to nursing personnel, He began to participate in hospital programs and expressed satisfaction with his activities. The improvement in the patient’s behavior was so great that his parents, who had been quite critical of other treatment approaches, commended the program in a letter to the staff. In addition to improving patient care, the program has led to more effective multidisciplinary communication and higher staff morale. . A review of the number of incidents where cuffand-belt restraints were necessary to prevent the patient from injuring himself or others showed that there has been a substantial decrease in the number of such incidents since the program began. In January restraints were used 28 times; in February there were ten uses, and in March only two uses were recorded, In April the number increased to seven, but dropped to two in May. No physical restraints were used in June and August, and only one use was shown for July. The increase in April was due to the admission of a hyperactive patient who had been in the organicpsychiatric unit. Staff had to use cuff-and-belt restraints until they found the proper attitude to use. The decrease in use of physical restraints reflects fewer expressions of severe psychiatric symptoms. The only systematic change in procedure during that time was the introduction of attitude therapy as the treatment
approach.
a
LITCHFIELD,
Place
CONNECTICUT
THE COUNTRY PLACE is a residential treatment the emotionally disturbed person over I 8 years old to leave the hospital but needs an intermediate rejoining the outside community. THE COUNTRY PLACE offers a home where he is understood a work place where he can cope a community where he can find
center for who is ready place before
with the demands a social identity,
THE
COUNTRY PLACE helps toward in socially useful projects to college experimenting with outside jobs. THE COUNTRY PLACE maintains a well staff for individual and group therapy. sports and games, and vocational training. teamwork return
WEEKEND WORKSHOPS terested in studying our in creating a new identity. Address
inquiries
are method
of
offered helping
trained creative for the
professional therapies,
professionals disturbed
inperson
to.’
RENEE NELL, ED,D. THE COUNTRY PLACE Litchfield, Conn, 06759 Telephone: (203) 567-8763
‘Psychiatrist-Director”
COUNTY OF ROCKLAND, New York-Director of Community Mental Health Services needed for attractive suburban area with easy access to Manhattan (less than 30 miles to New York City) . Person will be responsible for New York State’s first Unified Services System, including serving as Director of one of nation’s leading Community Mental Health Centers and for the supervision of State facility and contract agency services for 255,000 residents of the County; including mental retardation, developmental disabilities, alcoholism, and drug abuse. Must have three years of post residency experience in psychiatry, one year of which included major administrative responsibilities, Board Certification and New York State license. Salary Open. Contact Ms. Judith Starker, Health & Social Services Complex, Pomona, New York 10970. Telephone 914-354-0200.
Equal
The Country
Opportunities
Employer
Psychiatrists The New Hampshire Hospital (the State’s only psychiatric hospital) operates on the unit principle, each clinical geographic unit having close ties with the community mental health center (s) of its catchment area. There are special clinical units including Neurology, Child and Adolescent Care, Forensic, and Medically Infirm Care. Board certified or eligible physicians who have a strong interest in community psychiatry and a competence in leading therapeutic teams with a high degree of clinical independence are invited to consider joining the staff. Salary up to $34,000. New Hampshire licensure required. For further information please Superintendent M. W. Wheelock, Hampshire Hospital, 105 Pleasant Concord, New Hampshire 03301.
contact: New Street,
