CLINICAL HANDBOOK OF SCHIZOPHRENIA

348 V. SYSTEMS OF CARETypes of Residential ProgramsAlthough there are many modalities of community residential treatment facilities, wepresent some of the more commonly available types of programs.Crisis Residential Treatment ServicesCrisis residential models of acute care offer examples of community mental health practicesthat place emphasize patient integration into the community, with the least restrictiveenvironment possible and at low cost. With rising costs of psychiatric hospitalization,crisis residential treatment program models have become popular in some areas as an alternativeto inpatient admission for certain patients. Without compromising outcome (infact, there may be better outcome for patient satisfaction), the cost for having a patient ina crisis residential program can be as little as one-third the cost of a comparable inpatienthospitalization (Hawthorne et al., 2005).These programs focus on psychosocial rehabilitation of patients who need crisis interventionfor situations such as deterioration of psychiatric symptoms, which is oftendue to adherence problems or recent changes in medication regimens. Patients may alsoneed intervention because of safety issues, such as passive suicidal and homicidal ideationin the absence of any plan of harm, and with the ability to “contract for safety” (anagreement between the patient and staff that the patient will contact staff before engagingin any behaviors harmful to themselves or others). A crisis might also be related to a relationshipproblem, homelessness, substance abuse, or medical problems that contribute toworsening of the psychiatric condition but are not significant enough to require hospitalizationor skilled nursing care.Admission to these programs is voluntary, and the patient should be able to participatefully in the program to receive maximum benefit. Program size ranges from a fewbeds to over 10 beds, and each program is generally located in a house within a neighborhood.Programs are fully staffed, 24 hours a day, 7 days a week, by mental health professionalsand provide extensive services based on the biopsychosocial model, with an interdisciplinaryteam approach that addresses every patient’s unique situation. Patientsreceive rehabilitation and therapeutic services such as psychotherapy, medication management,and education by therapists, psychiatrists, and nursing staff members in a structuredenvironment. The services support individuals in their efforts to restore, maintain,and apply interpersonal and independent living skills, and to access community supportsystems.Crisis residential programs provide patients with opportunities to reintegrate intothe community, and they also facilitate continuation of outpatient management for bothpsychiatric treatment and substance rehabilitation programs. Also, these programs helppatients find stable housing and financial resources, such as state and Social Security Disability.Patients are usually admitted to these programs for a period that ranges from afew days to 30 days, with length of stay determined by degree of improvement.Adult Residential Treatment ServicesAdult residential treatment programs are generally oriented toward rehabilitation andprovide services in a noninstitutional, residential setting. Adult residential treatment programsoffer a range of activities and services for individuals who would otherwise be atrisk of hospitalization or other institutional placement. These services are available and