Journal of Communiry Psychology Volume 12, January, 1984

EVALUATING DAY-CARE FOR CHRONIC PSYCHOTICS: GOAL ATTAINMENT VERSUS SYMPTOM-ATTITUDE CHANGE

GARY BLAIR A N D MARVIN W. KAHN

University of Arizona

Research evaluation of the effectiveness of day-care treatment for the mentally ill is sparse and has been criticized for being largely descriptive and anecdotal (Austin, Lieber- man, King, & De Risi, 1976). This study evaluated the effects of a 90-day day-care program for chronic psychotic patients from lower socioeconomic backgrounds. The program provided socialization, support, group therapy, and used a goal attainment ap- proach. Goals were set and recorded, and MMPI and an attitude measure were ad- ministered just prior to the start of the program. Posttests were given at the program’s conclusion.

No significant changes in self-report measures of the degree and type of psy- chopathology, or in attitude toward mental illness and treatment were found. Changes represented by attainment of goals were obtained, but the goals were so simplistic that they hardly represented a meaningful behavior change. Did this mean that the 90-day program of day-care was a wasted effort?

We concluded the contrary. Efforts to evaluate day-care by the measures used here stemmed from an assumption that significant reduction in psychopathology and major changes in social behavior were to be expected in response to the “right” treatment in a population of chronically mentally ill patients. We thought that such a view was not realistic.

While certain improvements .in functioning and behavior have been demonstrated with chronically mentally ill patients, the evidence is that chronically mentally ill patients remain chronically mentally ill, despite the best efforts at treatment (Bleuler, 1978; Wing, 1981). It is true that chronic patients, as well as others, deteriorate to institutional syndromes when in purely custodial settings (Barton, 1976; Goffman, 1959). It has also been amply demonstrated with medication, support, and with the involvement of family and community resources including day-care, many chronic patients can function much more satisfactorily than they would in an institution or out on their own (Hertz, 1971; Washburn, 1976). But they remain chronically mentally ill. That is what we believe our data demonstrated.

The purpose that the day-care center serves for such patients is not that of curing the chronic mental disorder. Patients attending such a program can be contrasted to those deinstitutionalized mentally ill persons who live in isolation and poverty, sleeping in cheap hotel rooms, or gutters and doorways, drifting from jail to alcohol-drug abuse programs, to brief hospitalization and then back on the streets for another cycle. Day- care can provide some antidote to deterioration, some support and socialization, and a more humane way of living.

81

a2 GARY BLAIR AND MARVIN W. KAHN

REFERENCES AUSTIN, N., LIEBERMAN, R. , KING, L., & DE RISI, W. (1976).

BARTON, R. (1976). BLEULER, M. (1978).

GOFFMAN, E. (1959). HERTZ, M., ENDICOTT, J., & SPITZER, R. (1971).

WASHBURN, S., VANNICELLI, M., LONGABAUGH, R. , & SCHEFF, B. (1976).

A comparative evaluation of two day hospitals. The Journal of Nervous and Mental Disease, 163, 253-262.

Institutional neurosis. Bristol, England: John Wright and Sons. The long-term course of schizophrenic psychoses. In L. C. Wynne, R . L. Cromwell, &

The moral career of the mental patient. Psychiatry, 22, 123-142. S. Matthysse (Eds.), The nature of schizophrenia. New York: Wiley.

Day vs. inpatient hospitalization: A controlled study. American Journal of Psychiatry, 127, 1371-1381.

A controlled comparison of psy- chiatric day treatment and inpatient hospitalization. Journal ojConsulting and Clinical Psychology, 114,

Institutional to community care. Psychiatric Quarterly, 52, 139-152. 328-334.

WING, J. K . (1981).

All New From Springer New in our Behavior Therapy Series ’

Counseling Adults in Transition: Punishment and Its Alterna- Linking Practice a n d Theory. Nancy K. tives: A New Perspective for Behavior Schlossberg, Ed.D. This text and handbook Modification. Johnny L. Matson, Ph.D. and features a practical new model for applying Thomas M. DiLorenzo, M.A. Describes the solidly grounded knowledge of adult devel- methods, advantages, and limitations of us- opment tocounseling skillsand thecounsel- ing therapeutic punishment in behavior ing process. 224ppl 1984 I pre-pub: $19.95 modification with various types of clients.

288pp (est.) I 1983 I pre-pub: $22.95

Child Obesity: A New Frontier of Be- k e : An Activities Handbook. Ira Heilveil, havior Therapy. Michael D. LeBow, Ph.D. Ph.D. A practical guide to over 100 tested and innovative activities for using video in Discusses the state of the art and future

forms of psychotherapy, 224pp I directions in research and treatment of obesity in children with detailed therapeutic regimens, obstacles to their administration, 1983 I soft $17.95

and useful tables. 272pp I 1983 1$27.95 11111111111111111111111111=I

Please send ___ I

thereafter. NY residents add tax.)

Name _ _ _.

Address

CitylStatelZip

Springer Publishing Company

Video in Mental Health Prac=

Enclosed is $ (Add postage: $1.30 first book, 40a f The Binge-Purge Syndrome: Di- p.l I agnosis, Treatment, and Research. Raymond

f Hawkins, Ph.D., William Fremouw, Ph.D. and I Pamelia Clement, Ph.D., eds. Discusses the 8 state of theart indiagnosis,assessment and f treatment of bulimia, as well as research and I theory from cognitive-behavioral and other f perspectives. 320pp I 1983 I pre-pub: $24. Park Ave. South, New York, NY 10003