Inpatient Behavior Therapy for Children and Adolescents

Transcription

1 Inpatient Behavior Therapy for Children and Adolescents

2 Inpatient Behavior Therapy for Children and Adolescents Edited by VINCENT B. VAN HASSELT Center for Psychological Studies Nova University Fort Lauderdale, Florida AND DAVID J. KOLKO Western Psychiatric Institute and Clinic University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania SPRINGER SCIENCE+BUSINESS MEDIA, LLC

3 Library of Congress Catalog1ng-1n-PublIcatIon Data Inpatient behavior therapy for children and adolescents / edited by Vincent B. Van Hasselt and David J. Kolko. p. cm. Includes bibliographical references and Index. ISBN Behavior therapy for children. 2. Behavior therapy for teenagers. 3. Child psychotherapy Residential treatment. 4. Adolescent psychotherapy Residential treatment. I. Kolko, David J. II. Van Hasselt, Vincent B. [DNLM: 1. Behavior Therapy 1n adolescence. 2. Behavior Therapy- -1n Infancy & childhood. 3. Behavior Therapy methods. 4. Institutionalization. WS ] RJ505.B4I * dc20 DNLM/DLC for Library of Congress CIP ISBN ISBN (ebook) DOI / Springer Science+Business Media New York 1992 Originally published by Plenum Press, New York in 1992 Softcover reprint of the hardcover 1st edition 1992 All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher

4 To the memory of my grandparents-helen and Rudolph -WH To my grandparents - Esther, Reuben, Ada, and Hyman -DJK

5 Contributors ROWLAND P. BARRETT, Department of Psychiatry and Human Behavior, Brown University School of Medicine, Emma Pendleton Bradley Hospital, East Providence, Rhode Island CHRIS BRADEN, Department of Psychiatry and Human Behavior, University of California, Irvine Medical Center, Orange, California OSCAR G. BUKSTEIN, Department of Psychiatry, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, Pennsylvania GABRIELLE A. CARLSON, Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook, Stony Brook, New York WALTER P. CHRISTIAN, The May Institute, Inc., 100 Sea View Street, Chatham, Massachusetts JOHN F. CURRY, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina c. J. DAVIS, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana vii

6 viii CONTRIBUTORS MICHAEL J. DOLGIN, Children's Hospital of Los Angeles, and University of Southern California, Los Angeles, California ERICH G. DUCHMANN, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana CARL FEINSTEIN, Department of Psychiatry and Human Behavior, Brown University School of Medicine, Emma Pendleton Bradley Hospital, East Providence, Rhode Island GRETA FRANCIS, Department of Psychiatry and Human Behavior, Brown University School of Medicine, Emma Pendleton Bradley Hospital, East Providence, Rhode Island JACK FUNDANISH, Attention and Conduct Evaluation Service, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, Pennsylvania KATHLEEN J. HART, Department of Psychology, Xavier University, Cincinnati, Ohio YIFRAH KAMINER, Center for Alcohol and Addictions Studies, Brown University, and Adolescent Substance Abuse Intervention Center, Emma Pendleton Bradley Hospital, East Providence, Rhode Island MARGARET KLITZKE, Department of Psychiatry and Human Behavior, Brown University School of Medicine, Emma Pendleton Bradley Hospital, East Providence, Rhode Island DAVID J. KOLKO, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, Pennsylvania LINDA 1. LOAR, Association for Children and Adults with Learning Disabilities, 4900 Girard Road, Pittsburgh, Pennsylvania JOHN E. LOCHMAN, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710

7 CONTRIBUTORS ix STEPHEN C. LUCE, The May Institute, Inc., 100 Sea View Street, Chatham, Massachusetts JOHN J. MCGONIGLE, Department of Psychiatry, Allegheny Neuropsychiatric Institute, 7777 Steubenville Pike, Oakdale, Pennsylvania ARTHUR F. MERCURIO, Department of Psychiatry and Human Behavior, Brown University School of Medicine, Emma Pendleton Bradley Hospital, East Providence, Rhode Island CAROLY S. PATAKI, Department of Psychiatry and Behavioral Science, State University of New York at Stony Brook, Stony Brook, New York MARK D. RApPORT, Department of Psychology, University of Hawaii, Honolulu, Hawaii RICHARD R. RUMER, Department of Psychiatry, Duke University Medical Center, Durham, North Carolina LAWRENCE J. SIEGEL, Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York JOSEPH STRAYHORN, Medical College of Pennsylvania, Allegheny General Hospital, Early Childhood Clinic, Pittsburgh, Pennsylvania VINCENT B. VAN HASSELT, Center for Psychological Studies, Nova University, Fort Lauderdale, Florida JAMES W. VARNI, Orthopaedic Hospital, and University of Southern California, Los Angeles, California GARY A. WALCO, Schneider Children's Hospital of Long Island Jewish Medical Center, and Albert Einstein College of Medicine, New Hyde Park, New York 11042

8 x CONTRIBUTORS ANNE S. WALTERS, Department of Psychiatry and Human Behavior, Brown University School of Medicine, Emma Pendleton Bradley Hospital, East Providence, Rhode Island KAREN J. WHITE, Department of Psychology, University of Notre Dame., St. Joseph, Indiana DONALD A. WILLIAMSON, Department of Psychology, Louisiana State University, Baton Rouge, Louisiana

9 Preface Behavior therapists on child and adolescent psychiatric inpatient units have played an increasing role in the treatment of a wide range of disorders. Indeed, behavioral assessment and treatment strategies in these settings have been applied to a diversity of problems, including depression, mental retardation, autism, conduct disorders, attentiondeficit hyperactivity disorder, anorexia, and bulimia. More recently, the heuristic value of behavioral methods with substance abuse, pediatric pain, and child maltreatment has been documented as well. Because of the multifaceted and complex challenges posed by children and adolescents who reach inpatient units, behavioral clinicians have worked closely with other professionals (e.g., psychiatrists, social workers, psychiatric nurses) in an effort to provide broad-spectrum, comprehensive intervention. However, as a burgeoning body of clinical research attests, the significant contribution of behavior therapy to successful treatment outcome is now indisputable. Yet, surprisingly few texts have been published concerning inpatient treatment of children and adolescents. The few extant efforts in this area have not covered the broad array of issues and diagnostic populations treated, nor have they considered the pragmatic day-to-day difficulties encountered by behaviorally oriented practitioners working in child and adolescent inpatient settings. This text is an attempt to remedy such shortcomings by providing a comprehensive yet practical approach to the functions of behavior therapists on inpatient psychiatric services for children and youth. The book is divided into four parts, with Part I (General Issues) consisting of a historical overview, an analysis of staff training and conxi

10 xii PREFACE sultation, and a description of the medical aspects of care. Parts II and III deal with the treatment of children and adolescents, respectively. Each of the nine chapters in these sections includes a precise clinical description of the disorder, a discussion of how to evaluate it behaviorally and psychiatrically, presentation of behavioral treatments and their frequent integration with psychopharmacologic approaches, case illustrations, and a discussion of specific problem areas. Finally, Part IV (Special Topics) considers the topics of child abuse, academic and educational a s ~ pects of inpatient treatment, and the role of social and family work, all of which cut across the disorders covered in the previous two parts. Many people have contributed their time and effort to the development and production of this volume. We would first like to thank our colleagues who agreed that this book was needed and who willingly contributed chapters. Next, we would like to extend our appreciation to Tracey Eck, Jane A. Null, and Maria Smith for their technical assistance in preparation of the volume. Finally, we thank our friends at Plenum for their willingness to undertake this project and for their assistance and skill in all aspects of production. Vincent B. Van Hasselt, Ph.D. Fort Lauderdale, Florida David J. Kolko, Ph.D. Pittsburgh, Pennsylvania

11 Contents PART I: GENERAL ISSUES CHAPTER 1: HISTORICAL OVERVIEW David J. Kolko Introduction The Growth in Inpatient Psychiatric Units Current Functions and Practices Specialized Assessment/Evaluation Management: Consistent Exposure to Corrective Contingencies... 9 Brief Treatment of Psychiatric Disorders Protection and Respite Disposition and Placement Challenges: Practical and Programmatic Considerations Staff Training and Consistency Time Pressures Constraints of a Controlled Setting Concurrent Treatments Multiple Service Agency Involvement Suggestions and Future Directions References CHAPTER 2: STAFF TRAINING AND COMMUNITY CONSULTATION 23 John J. McGonigle Introduction The Social Environment of an Inpatient Psychiatric Facility xiii

12 xiv CONTENTS Staff-Training Procedures in Inpatient Settings Group Inservice Training.... Verbal and Written Instruction/Direct Feedback.... Case Observation/Video Tape Sessions.... Hands-on Training.... Methods of Evaluation.... Staff/Parent Training and Consultation/Liaison in the Community.... Group Inservice Training.... Role-Playing.... Case Observation.... Hands-on Training.... Staff Training and Consultation across Settings: An Illustration Facilitating the Transition from the Hospital to Other Settings.... Needs Assessment.... Case Histories Summary References CHAPTER 3: MEDICAL ASPECTS OF PSYCHIATRIC TREATMENT OF CHILDREN Joseph Strayhorn The Nature of Medical Decision Making Diagnosis of Psychiatric Syndromes Drug Side Effects Medical Problems That Can Masquerade as Psychiatric Symptoms Differentiill Diagnosis Toxic: Lead Toxicity Toxic: Toxicity from "Recreational" Drugs Toxic: Side Effects of Prescribed Drugs Traumatic: Subdural Effusions Infectious: Rocky Mountain Spotted Fever Infectious: Brain Abscess Infectious/Toxic: Reye Syndrome Neoplastic: Brain Tumors Hereditary: Wilson's Disease Hereditary: Tourette's Disease Endocrine: Hypothyroidism, Hyperthyroidism Endocrine: Diabetes

13 CONTENTS XV Other Endocrine Illnesses Multiple Causes: Epileptic Seizures, Especially Complex Partial Multiple Causes: Hearing Problems Multiple Causes: Vision Problems Multiple Causes: Anemias Multiple Causes: Sleep Apnea Syndromes Multiple Causes: Constipation as a Cause of Encopresis Degenerative: Multiple Sclerosis The Review of Systems Interpretation of Frequently Used Laboratory Tests Drug Treatment of Violent Behavior References PART II: TREATMENT OF CHILDREN CHAPTER 4: DEPRESSION AND SUICIDE Greta Francis and Kathleen J. Hart Introduction Clinical Description Behavioral and Psychiatric Assessment Diagnostic Interviews Self-Report Instruments Family Assessment Medical Assessment Behavioral Observations Cognitive-Behavioral Treatment Activity-Increase Strategies Social Skills Training Cognitive Therapies Parent-Focused Treatment Treatment Specific to Suicidality Combination of Behavioral and Pharmacological Intervention Case Histories Case Case Case Problem Areas Summary References

14 xvi CONTENTS CHAPTER 5: MENTAL RETARDATION AND PSYCHIATRIC DISORDERS Rowland P. Barrett, Anne S. Walters, Arthur F. Mercurio, Margaret Klitzke, and Carl Feinstein Introduction Program Description and Statement of Philosophy Overview Staffing and Organizational Structure Statement of Philosophy Clinical Service Areas Intake and Referral Service Outpatient Services Day Patient Services.. ; Inpatient Services Behavior Therapy in the Inpatient Setting Overview Behavioral Assessment Behavior Therapy Time-in and Time-out Compliance Training Visual Screening Individual and Group Psychotherapy: Social Skills Training Behavior Therapy in Combination with Pharmacotherapy Monitoring of Patient Care Intake, Referral, and Discharge Meeting Pediatric Rounds Medication Review Treatment Review Meetings Administrative Quality Improvement Meeting Behavior Clinic Summary References CHAPTER 6: INPATIENT BEHAVIOR THERAPY WITH AUTISTIC youth Stephen C. Luce and Walter P. Christian Introduction Diagnosis Behavioral Deficits Behavioral Excesses Normally Developing Behaviors

15 CONTENTS xvii Etiology Parents of Autistic Youth Characteristics of Autistic Youth in Need of Inpatient Services The Role of Inpatient Treatment with Autistic Youth Behavioral Assessment Previous Findings An Assessment of the Previous Environment Future Environment Survey Direct Observation Specifying Transitional Priorities Preparing the Inpatient Facility Preparing the Staff Providing Adequate Supervision Maintenance of Client Rights Normalized Environments Implementing Effective Procedures Events Preceding the Behavior Reinforcing Stimuli Suppressive Strategies Evaluating Behavioral Treatment Measurement Reliability Conducting Applied Research Summary References CHAPTER 7: PEDIATRIC PAIN Gary A. Walco, Lawrence J. Siegel, Michael J. Dolgin, and James W. Varni Introduction Procedural Pain and Acute Iatrogenic Distress Postoperative Pain Assessment of Postoperative Pain Postoperative Pain Management Pain Associated with Chronic Diseases Hemophilia Juvenile Rheumatoid Arthritis Sickle-Cell Disease Sickle-Cell Disease and Chronic Pain Summary References

16 xviii CONTENTS CHAPTER 8: CONDUCT DISORDER David J. Kolko Introduction Oinical Description of the Disorder Behavioral and Psychiatric Assessment Cognitive-Behavioral Treatments Conceptual Model of Aggression Contingency Management Child Skills Training Parent, Marital, and Family Skills Training Case History Background Assessment Conditions and Outcome Conclusions Problem Areas Contingency Management Child Skills Training Parent, Marital, and Family Skills Training Discharge Planning and Community Outreach Summary References CHAPTER 9: A'ITENTION-DEFICIT HYPERACTIVITY DISORDER Mark D. Rapport, Caroly S. Pataki, and Gabrielle A. Carlson Introduction Clinical Description of the Disorder Current Diagnostic Criteria and Essential Features of the Disorder Secondary Features of the Disorder Coexisting Disorders Psychosocial Stressors Behavioral and Psychiatric Assessment Behavioral Treatment The Inpatient Management Program: An Overview Structure of the Inpatient Management Program The Inpatient Management Program Unit Point System Organization and Use of the Inpatient Management Point System Case History Developmental, Educational, Familial, and Medical History

17 CONTENTS xix Admission for Inpatient Care Behavioral and Pharmacological Treatment Discharge Planning Problem Areas Summary References PART III: TREATMENT OF ADOLESCENTS CHAPTER 10: ANTISOCIAL BEHAVIOR John E. Lochman, Karen J. White, John F. Curry, and Richard R. Rumer Introduction Clinical Description Psychiatric and Behavioral Assessment Behavioral Checklists and Rating Scales Behavioral Interviews Behavioral Observation Standardized Testing and Assessment of Other Cognitive Factors Treatment Approaches Contingency Management and Token Economy Programs Cognitive-Behavioral Therapy and Social Skills Training Challenges to Implementation of and Research on Behavior Therapy in Inpatient Settings Case History Conclusions Summary of Findings Foci for Future Research Acknowledgments References CHAPTER 11: INPATIENT BEHAVIORAL AND COGNITIVE THERAPY FOR SUBSTANCE ABUSE IN ADOLESCENTS Yifrah Kaminer and Oscar C. Bukstein Introduction Clinical Description of the Disorder Diagnosis Behavioral and Cognitive Factors Modeling Tension Reduction

18 xx CONTENTS Cognitive Social Learning Theory... " 317 Self-Awareness Model... " 318 Marlatt's Expectancy Model Self-Handicapping Theory... " 318 Behavioral and Psychiatric Assessment Antecedents Target Behaviors... " 322 Consequences of Substance Abuse Behavioral Treatments Inpatient Programs The Therapeutic Environment and Process Behavioral and Cognitive Elements in Chemical Dependency Treatment Modalities Case History Background Assessment Treatment FolloUJ-up Problem Areas Definition and Measurement of the Disorder Treatment Using Behavioral or Cognitive Modalities or Techniques... " 333 Summary References CHAPTER 12: ANOREXIA AND BULIMIA NERVOSA.. " 341 Donald A. Williamson, C. J. Davis, and Erich G. Duchmann Introduction Oinical Descriptions Anorexia Nervosa Bulimia Nervosa Behavioral and Psychiatric Assessment Clinical Interview Self-Report Inventories Body Image Assessment Self-Monitoring Behavioral Observation Assessment of Family Problems Assessment of Secondary Psychopathology Behavioral Treatment Strategies Meal Planning and Behavioral Contracting

19 CONTENTS xxi Exposure with Response Prevention Cognitive Restructuring Temptation Exposure with Response Prevention Body Image Therapy Family Therapy Psychopharmacological Approaches Behavioral Treatment Outcome Research Special Problems Denial Resistance to Treatment Case History Process Model of Treatment Summary References PARr IV: SPECIAL TOPICS CHAPTER 13: CHILD ABUSE Chris Braden and Vincent B. Van Hasselt Introduction Assessment Medical Assessment Behavioral Assessment Treatment Case History Summary and Conclusions References CHAPTER 14: ACADEMIC AND EDUCATIONAL ASPECTS Linda L. Loar Introduction Educational Setting Educational Program The Treatment Team School Liaison Child Advocacy Summary Appendix 1: School History Form Appendix 2: Treatment Team Report

20 xxii CONTENTS Appendix 3: Educational Liaison Form Appendix 4: Home School Information Form Appendix 5: Medication Treatment Form References CHAPTER 15: SOCIAL AND FAMILY WORK Jack Fundanish Introduction Overview of Services and Functions Intake Admission Managing Resistance Liaison Work with Families Liaison with Outpatient Resources Discharge Summary and Conclusions Appendix: Intake Information Form References AUTHOR INDEX SUBJECT INDEX