Determinants of the treatment climate in psychiatric and substance abuse programs: implications for improving patient outcomes.

Center for Health Care Evaluation, Veterans Affairs Health Care System, Palo Alto, California, USA.
Journal of Nervous & Mental Disease (Impact Factor: 1.81). 03/1998; 186(2):96-103. DOI: 10.1097/00005053-199802000-00005
Source: PubMed

ABSTRACT This study examined determinants of the treatment climate in 89 psychiatric and substance abuse programs. Clearer policies giving patients more control, and more health and treatment services, were related to more supportive, autonomous, expressive, and practically oriented milieus. In contrast, more policy choice and daily living assistance were associated with less support, personal expression, and practical orientation. Programs in which staff had more paraprofessionals and better team functioning, and in which patients had more social resources and better mental functioning, tended to be more supportive and to have more emphasis on autonomy, personal expression, and practical orientation. Based on these results, we suggest some guidelines on how to change the treatment milieu to benefit patients' adjustment.

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    • "Settings with social climates that are more involving, offer consistent support, and help people adapt to their unique life circumstances tend to promote better outcomes (Boydell et al., 1992; Holahan et al., 1982; Moos, 2003; Timko et al., 1998). A key question is what types of recovery communities might best promote these characteristics. "
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    American Journal of Community Psychology 03/2011; 48(3-4):365-72. DOI:10.1007/s10464-011-9432-3 · 1.74 Impact Factor
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    • "The RESPPI is a multi-dimensional inventory designed to examine four sets of program characteristics, including physical and architectural features, policies and services, aggregate resident characteristics, and treatment or support climate . The RESPPI has been applied to the assessment of program environment of hospital-based and community-based residential programs in the fields of mental health, substance abuse, and gerontology (Moos & Lemke, 1994; Timko & Moos, 1998). "
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    Administration in Social Work 03/2006; 30(1):67-94. DOI:10.1300/J147v30n01_05 · 0.36 Impact Factor
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    ABSTRACT: OBJECTIVE: To identify the determinants of level and intensity of psychosocial treatment activity among staff who deliver services to the severely and mentally ill. METHODS: The study sample consisted of 769 treatment providers working in 77 units in 29 VA mental health facilities. Level of psychosocial care was measured as the number of patient contacts and total hours spent in psychosocial care over a 1 week period. Intensity of psychosocial care was measured as the average time per patient contact. We used hierarchical linear modeling (HLM) to examine the association between level and intensity of care and three categories of determinants - individual provider attributes, work characteristics and treatment setting characteristics. RESULTS: Providers' occupation is related to both the level and intensity of care. Providers with administrative responsibilities also have fewer patient contacts and lower intensity of such contacts. Providers who perceived their pay and benefits more positively had fewer patient contacts and less intensive patient contacts. Positive relationships with patients and providers were also associated with greater levels and intensity of psychosocial treatment activity among providers. Finally, statistically significant differences in psychosocial treatment activity among units were identified although such differences are not attributable to unit size, patient cohort severity or unit workload. CONCLUSIONS: Level and intensity of psychosocial treatment activity vary systematically by individual attributes of providers, characteristics of the work they perform and attributes of the treatment setting. These factors may provide the basis for designing interventions to modify provider behavior in a manner consistent with emerging financial pressures and treatment modalities for the seriously mentally ill.
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