intervention

                         TREATMENT INTERVENTIONS
           (All Information from Surgeon General Report on Mental Health)

OUTPATIENT TREATMENT

- Covers a broad range of therapeutic approaches (such as Interpersonal,
   Psychodynamic, and Behavioral Psychotherapy)

- Offered to individuals, groups, or families, usually in a clinic or private office.

- Lasts 6-12 sessions to a year or longer.

- Outpatient Psychotherapy is the most common form of treatment for children
   and adolescents; it is utilized by an estimated 5 to 10 percent of children and their
   families in the US.

- Research states that the improvements with outpatient therapy are greater than
   those achieved without treatment.

- Outpatient treatment is highly effective (in research settings). In the real world,
   it was found to be less effective than that provided through a research protocol.

The reasons are:

- Less attention in real-world settings to careful matching of patients with
   treatments
- Less adherence to a treatment protocol
- Less follow up care.

PARTIAL HOSPITALIZATION/DAY TREATMENT

- Research on partial hospitalization as an alternative to inpatient treatment
   generally finds benefit from a structured daily environment that allows youth to
   return home at night to be with their family and peers.

- An integrated curriculum combining education, counseling, and family
   interventions is the most frequently used day treatment.

- The setting could be a hospital, school or clinic.

     Partial hospitalization has been used as a transitional service after either psychiatric hospitalization or residential treatment, at the point when the child no longer needs 24-hour care but is not ready to be integrated into the school system. It also is used to prevent institutional placement.

     Day treatment programs are not being used as frequently as they might be because third-party payers are reluctant to support this form of treatment. They claim that the modality is ambiguous, that it induces demand among those who would not otherwise seek treatment, and that its length, treatment outcomes, and costs are unpredictable. More research is needed.

RESIDENTIAL TREATMENT CENTERS

     A Residential Treatment Center (RTC) is a licensed 24-hour facility (although not licensed as a hospital), which offers mental health treatment. Settings range from structured ones, resembling psychiatric hospitals, to those that are more like group homes or halfway houses. While formerly for long-term treatment (e.g., a year or more), RTCs under managed care are now serving more seriously disturbed youth for as briefly as 1 month for intensive evaluation and stabilization.

Concerns about residential care primarily relate to:

- criteria for admission
- the costs of such services
- the possibility of trauma associated with the separation from the family
- difficulty reentering the family or even abandonment by the family
- victimization by RTC staff
- learning of antisocial or bizarre behavior from intensive exposure to other
   disturbed children.

- Used by 8 percent of treated children

- Nearly one-fourth of the national outlay on child mental health is spent on care in
   these settings.

- There is only weak evidence of their effectiveness.

INPATIENT TREATMENT

Most restrictive type of care:

- Based on the latest estimate available, inpatient care consumes about half of child
   mental health resources, but is the clinical intervention with the weakest research
   support.

- Some children with severe disorders do require a highly restrictive treatment
   environment, thus hospitals are expected to remain an integral component of
   mental health care

Home Based Services

- Provide very intensive services within the homes of children and youth with
   serious emotional disturbances.

- The main goals of Home Based Services are to prevent an out-of-home
   placement (i.e., in foster care, residential, or inpatient treatment); keep families in
   touch with community agencies and individuals; and to strengthen the family�s
   coping skills and capacity to function effectively in the community after crisis
   treatment is completed.

- The specific services provided most often include evaluation, assessment,
   counseling, skills training, and coordination of services.