Timothy G. Kuehnel

Maintaining Nursing Staff Performance on an Intensive Behavior Therapy Unit.

Abstract The establishment and maintenance of high quality behavioral programs within a hospital setting are complex and time consuming tasks. Suggestions for maintaining nursing staff performance in such a setting are provided based on the experiences of the authors. The central thesis is that such intensive programs require a combination of factors including high staff morale, consistency of effort, teamwork, staff training and reinforcement. The procedures responsible for the successful 12 year maintenance of the Camarillo State Hospital/UCLA Clinical Research Unit (CRU) include standard patient treatment programs; observation and data collection procedures; a flexible credit economy system; a cohesive, interdisciplinary professional staff; and attentiveness to political currents

Treatment Strategies That Promote Deinstitutionalization of Chronic Mental Patients

Our task in this chapter is threefold: first, to define the scope of deinstitutionalization for the chronic mentally ill; second, to review briefly factors that aid effective deinstitutionalization of this group; and third, to describe examples of validated models for deinstitutionalization. In this chapter, we will refer to deinstitutionalization as a process that optimizes the normalization of the chronic mentally ill. This definition includes (1) the prevention of unnecessary or harmful admission to and retention in institutions; (2) locating and developing appropriate alternatives in the community for housing, treatment, education, and rehabilitation of the mentally disabled who do not need to be in institution; and (3) improving conditions, care, and treatment for those who require institutional care (U.S. General Accounting Office, 1977).

The Zeitgeist of Innovation The Road Ahead

There are those who believe that we are already doing all that is necessary in knowledge transfer, or that publications in academic journals will take care of the problem. Some even express alarm and concern lest knowledge be disseminated too rapidly or prematurely. Some of us, however, were led, encouraged, and stimulated by Howard Daviss vigor and enthusiasm to conceptualize this as a problem to be investigated and assessed in a scientific manner, and, further, as a social necessity and a responsibility, even as a challenge to channel our natural rebelliousness into developing a methodology for dealing with resistance to change and innovation.

The Behavioral Analysis and Modification Project for Community Mental Health

The confluence of two innovative streams in psychology and psychiatry —the delivery of mental health services through comprehensive, community-based centers, and the development of behavioral analysis and therapy—led to an applied research project aimed at demonstrating the applicability of behavioral approaches to the needs of clients and clinicians in a typical community mental health center (CMHC). The Behavior Analysis and Modification (BAM) Project in CMHCs began slowly in 1970 with the building of a clinical-research foundation in the Ox-nard, California CMHC; accelerated during 1972–1975 when an NIMH research grant permitted the establishment and evaluation of systematic behavior therapies; and concluded in 1975–1979 with dissemination of six of the therapeutic methods that were experimentally validated to 40 other CMHCs across the nation. This chapter summarizes the procedures and results of the 9-year BAM Project.