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Tuesday, July 19, 2016
What is Socail Anxiety Disorder and How do you Cure It?
What is Separation Anxiety and How do you Cure It?
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Symptoms of Depression and Tips to Cure It
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What are the Symptoms of Depression?
· feeling extremely sad most of the day nearly every day
· diminished pleasure in previously enjoyable activities
· difficulty sleeping or falling asleep
· feeling slow and heavy
· feeling irritable
· fatigue and loss of energy nearly every day
· feelings of worthlessness
· difficulty concentrating
· withdrawal from interactions with others
Tips for Managing Depression:
No Down Time
o Make a full schedule and stick to it
o Make a full schedule and stick to it
Spend Time Helping Someone
o High Self Focus = Low Self Esteem
o High Self Focus = Low Self Esteem
Eat Healthy
o The body needs the right building material to heal the mind
o The body needs the right building material to heal the mind
Adequate Sleep
o The body needs adequate sleep to manage daily stressors
Exercise
o Exercise burns out feelings of stress and anxiety
o Exercise burns out feelings of stress and anxiety
Finish unfinished projects
o Cluttered mind = Depressed mind
o Cluttered mind = Depressed mind
Note: Depression requires a jump start. Like a cold motor, it’s hard to start the initial crank,
but once started your body will run on its own.
Follow us on Facebook, Instagram, and Twitter!
@TherapyPhD
Contact Info:
2800 N. 2nd St.
Rogers, Ar. 72756
479-561-0174
Fax # 479-755-3581
ericchristianjohnsonphd.com
ericchristianjohnsonphd@gmail.com
#counselor #Therapist #AnxietyDoctor
2800 N. 2nd St.
Rogers, Ar. 72756
479-561-0174
Fax # 479-755-3581
ericchristianjohnsonphd.com
ericchristianjohnsonphd@gmail.com
#counselor #Therapist #AnxietyDoctor
The Environmental Effects of Children's Psychiatric Inpatient Hospitalization Stays Abstract
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Abstract
Background: Children have been shown to have a positive treatment effect from psychiatric
inpatient stays. Objective: The purpose of this study was to determine why the treatment effect
occurs. Hypothesis: The hypothesis was that if the children do demonstrate a change in
behavior, the behavior will be in response to the inpatient environment and that after a two week
period, no significant change would occur. Results: No significant difference from combined
two week post admission scores to combined two week prior discharge scores was found (t(13) =
.119, p.>.05). Conclusion: If change did occur, it occurred within the first two weeks as a
response to a change in the environment. Before inpatient is considered, children should be
referred to family therapists who focus on environmental changes that can be made in the home.
Keywords: children, inpatient, therapy, medication, primary care physician
Background: Children have been shown to have a positive treatment effect from psychiatric
inpatient stays. Objective: The purpose of this study was to determine why the treatment effect
occurs. Hypothesis: The hypothesis was that if the children do demonstrate a change in
behavior, the behavior will be in response to the inpatient environment and that after a two week
period, no significant change would occur. Results: No significant difference from combined
two week post admission scores to combined two week prior discharge scores was found (t(13) =
.119, p.>.05). Conclusion: If change did occur, it occurred within the first two weeks as a
response to a change in the environment. Before inpatient is considered, children should be
referred to family therapists who focus on environmental changes that can be made in the home.
Keywords: children, inpatient, therapy, medication, primary care physician
In a study conducted by Goodwin, Gould, Blanco, and Olfson (2001), they identified that
84.4% of psychotropic medication prescribed to children and adolescents are done so by general
practitioners or pediatricians. Goodwin et al, 2001 referred to primary care physicians as the
gatekeepers to mental health. When clients are not making progress with medication
management they are often referred by general practitioners to therapists. Studies demonstrate
that medication management combined with therapy is more effective than medication
management alone (Clarking, Carpenter, Hull, Wilner, & Glick, 1998; Craske et al., 2005;
Feeney, Connor, Young, Tucker & McPherson, 2006; Mitchell, 1999; Safren et al., 2005).
Combined medication management and psychotherapy may not always be enough either.
When outpatient therapy and medication management fails, physicians often look toward
inpatient facilities. When using pre-admission and post-discharge data, inpatient facilities have
been found to have a positive treatment effect with children (Garralda, Rose, & Dawson, 2008;
Gavidia-Payne, Littlefield, Hallgren, Jenkins, & Coventry, 2003; Mayes, Calhoun, Krecko,
Vesell, & Hu, 2001; Sourander & Piha, 1997).
Although some studies have identified variables that predict stability after discharge, it is
not yet known why inpatient facilities, for children, have a treatment effect (Dean et al., 1995;
Gavida-Payne et al., 2003; Sourander & Piha, 1997; Garralda, Rose, & Dawson, 2008). The aim
of this study is to determine why the treatment effect of inpatient stays, for children, actually
occurs.
Children have shown the ability to decrease or increase behavior quickly in
response to changes in their environment (Moore & Boniecki, 2003; Moore, Tingstrom, Doggett,
& Carlyon, 2001; Higgins, Williams, & McLaughlin, 2001). My hypothesis is that if there is a
behavior change, the change in the child’s behavior will occur within two weeks after admission
in response to the new environment of the hospital and that although the child will exhibit small
increases and decreases in behavior, there will not be a significant change in behavior following
the first two weeks of admission.
84.4% of psychotropic medication prescribed to children and adolescents are done so by general
practitioners or pediatricians. Goodwin et al, 2001 referred to primary care physicians as the
gatekeepers to mental health. When clients are not making progress with medication
management they are often referred by general practitioners to therapists. Studies demonstrate
that medication management combined with therapy is more effective than medication
management alone (Clarking, Carpenter, Hull, Wilner, & Glick, 1998; Craske et al., 2005;
Feeney, Connor, Young, Tucker & McPherson, 2006; Mitchell, 1999; Safren et al., 2005).
Combined medication management and psychotherapy may not always be enough either.
When outpatient therapy and medication management fails, physicians often look toward
inpatient facilities. When using pre-admission and post-discharge data, inpatient facilities have
been found to have a positive treatment effect with children (Garralda, Rose, & Dawson, 2008;
Gavidia-Payne, Littlefield, Hallgren, Jenkins, & Coventry, 2003; Mayes, Calhoun, Krecko,
Vesell, & Hu, 2001; Sourander & Piha, 1997).
Although some studies have identified variables that predict stability after discharge, it is
not yet known why inpatient facilities, for children, have a treatment effect (Dean et al., 1995;
Gavida-Payne et al., 2003; Sourander & Piha, 1997; Garralda, Rose, & Dawson, 2008). The aim
of this study is to determine why the treatment effect of inpatient stays, for children, actually
occurs.
Children have shown the ability to decrease or increase behavior quickly in
response to changes in their environment (Moore & Boniecki, 2003; Moore, Tingstrom, Doggett,
& Carlyon, 2001; Higgins, Williams, & McLaughlin, 2001). My hypothesis is that if there is a
behavior change, the change in the child’s behavior will occur within two weeks after admission
in response to the new environment of the hospital and that although the child will exhibit small
increases and decreases in behavior, there will not be a significant change in behavior following
the first two weeks of admission.
Method
Setting and Participants
The setting was an inpatient psychiatric hospital for children. The unit holds up to 16
children. Acute and sub-acute stays are conducted on the same unit. I examined the behavior of
the sub-acute (or long term residential) children only. All children received a diagnosis prior to
admission. Each sub-acute child was receiving outpatient therapy and medication management
prior to admission. As a requirement for admission, it was determined by a mental health
professional that outpatient services had failed. I explored the data collected from the behavior
of 45 children ages five to twelve. There were 11 females and 34 males.
Setting and Participants
The setting was an inpatient psychiatric hospital for children. The unit holds up to 16
children. Acute and sub-acute stays are conducted on the same unit. I examined the behavior of
the sub-acute (or long term residential) children only. All children received a diagnosis prior to
admission. Each sub-acute child was receiving outpatient therapy and medication management
prior to admission. As a requirement for admission, it was determined by a mental health
professional that outpatient services had failed. I explored the data collected from the behavior
of 45 children ages five to twelve. There were 11 females and 34 males.
Statistical Analysis
The combined mean of the first and last month two week scores of all of the sub-acute
children that were admitted and discharged in 2006 through 2009 was compared using a paired
measures t-test. Only clean data was utilized. Data that contained missing information resulted
in the children’s data being thrown out. The children were sometimes given passes into their
homes. The days on which passes occurred, were not counted as a day spent in the residential
center, and data was not collected from the day the child was in the home.
The combined mean of the first and last month two week scores of all of the sub-acute
children that were admitted and discharged in 2006 through 2009 was compared using a paired
measures t-test. Only clean data was utilized. Data that contained missing information resulted
in the children’s data being thrown out. The children were sometimes given passes into their
homes. The days on which passes occurred, were not counted as a day spent in the residential
center, and data was not collected from the day the child was in the home.
Dependent Measures
In this study, I utilized scores that were recorded on a form the facility uses to track
child’s behavior. The behavior was recorded by PsychTechs who are have been trained by the
nursing supervisor on how to fill out the form. Prior to filling out the form by themselves they
were also required to observe seasoned PsychTechs fill out the form for an eight hour period on
an average of 4-8 children, during the regular shift hours.
The forms were used to record the child’s behavior and points for each activity that are
conducted on the unit. There were 20 activities that behaviors were recorded for. The behaviors
that were recorded are: aggression, destruction of property, not flowing directions/unit rules,
non-compliance, non-participation, stealing, disrespectful/inappropriate behavior, bullying peers,
and instigating or lying. If a behavior was recorded within the activity slot, the child did not
receive a point for that period. If no behaviors were recorded, a point was received. It is the
daily total points that was used to measure child’s progress in this study.
An interrater reliability assessment was conducted with three spate sets of staff members.
Two sets compared the ratings of two separate therapeutic recreational therapists to the ratings of
two separate PsychTechs. One set compared the ratings of the charge nurse to a separate
recreational therapist. The interrater reliability score (.76) was moderate.
In this study, I utilized scores that were recorded on a form the facility uses to track
child’s behavior. The behavior was recorded by PsychTechs who are have been trained by the
nursing supervisor on how to fill out the form. Prior to filling out the form by themselves they
were also required to observe seasoned PsychTechs fill out the form for an eight hour period on
an average of 4-8 children, during the regular shift hours.
The forms were used to record the child’s behavior and points for each activity that are
conducted on the unit. There were 20 activities that behaviors were recorded for. The behaviors
that were recorded are: aggression, destruction of property, not flowing directions/unit rules,
non-compliance, non-participation, stealing, disrespectful/inappropriate behavior, bullying peers,
and instigating or lying. If a behavior was recorded within the activity slot, the child did not
receive a point for that period. If no behaviors were recorded, a point was received. It is the
daily total points that was used to measure child’s progress in this study.
An interrater reliability assessment was conducted with three spate sets of staff members.
Two sets compared the ratings of two separate therapeutic recreational therapists to the ratings of
two separate PsychTechs. One set compared the ratings of the charge nurse to a separate
recreational therapist. The interrater reliability score (.76) was moderate.
Results
The mean differences in pared scores were examined for adequacy of sampling. The
distribution demonstrated an adequate sample with a normal curve consisting of only a slight
skew (.33). The skew in data was toward declined scores of children. There was some kurtosis
present (2.26), within the first deviation, but the sample remains adequate.
A paired-samples t test was calculated to compare the combined mean of the first two
weeks post admission scores to the last two weeks prior discharge scores. The mean on the
combined admission scores was 747.36 (sd = 14.15) and the mean of the combined discharge
scores was 735.36 (sd = 18.63). No significant difference from admission scores to discharge
scores was found (t(13) = .119, p.>.05).
My hypothesis was that if there was a behavior change, the change in the child’s behavior
would occur within two weeks after admission in response to the new environment of the
hospital and that although the child would exhibit small increases and decreases in behavior,
there would not be a significant change in behavior following the first month of admission.
Children did exhibit small increases and decreases in behavior, but there was no significant
change in behavior following the first two weeks of admission when compared with the last two
weeks of discharge.
Discussion
Overall, if a change did occur, it occurred immediately after a change in the environment.
This indicates that behavioral changes may occur very quickly with environmental changes. It
further indicates that once a child’s behavior has changed to fit the new environment, there is
very little influence that continued residential stay will have on continued change.
There is no way of reliably using the same form that was used to collect data in inpatient,
to collect pre-admission data about the child’s behavior in the home. For this reason, this study
does not purpose to establish that inpatient treatment does indeed have a treatment effect.
Rather, this study intends to identify that if an effect did occur, the reason for the effect would be
the child’s adaptation to a new environment. Since failing outpatient medication management
and therapy is a pre-requisite to admission, it is a reasonable conclusion to assume that more of
the same would not influence the child to exhibit an increase of positive behavior. This appeared
to be confirmed by the results.
The mean differences in pared scores were examined for adequacy of sampling. The
distribution demonstrated an adequate sample with a normal curve consisting of only a slight
skew (.33). The skew in data was toward declined scores of children. There was some kurtosis
present (2.26), within the first deviation, but the sample remains adequate.
A paired-samples t test was calculated to compare the combined mean of the first two
weeks post admission scores to the last two weeks prior discharge scores. The mean on the
combined admission scores was 747.36 (sd = 14.15) and the mean of the combined discharge
scores was 735.36 (sd = 18.63). No significant difference from admission scores to discharge
scores was found (t(13) = .119, p.>.05).
My hypothesis was that if there was a behavior change, the change in the child’s behavior
would occur within two weeks after admission in response to the new environment of the
hospital and that although the child would exhibit small increases and decreases in behavior,
there would not be a significant change in behavior following the first month of admission.
Children did exhibit small increases and decreases in behavior, but there was no significant
change in behavior following the first two weeks of admission when compared with the last two
weeks of discharge.
Discussion
Overall, if a change did occur, it occurred immediately after a change in the environment.
This indicates that behavioral changes may occur very quickly with environmental changes. It
further indicates that once a child’s behavior has changed to fit the new environment, there is
very little influence that continued residential stay will have on continued change.
There is no way of reliably using the same form that was used to collect data in inpatient,
to collect pre-admission data about the child’s behavior in the home. For this reason, this study
does not purpose to establish that inpatient treatment does indeed have a treatment effect.
Rather, this study intends to identify that if an effect did occur, the reason for the effect would be
the child’s adaptation to a new environment. Since failing outpatient medication management
and therapy is a pre-requisite to admission, it is a reasonable conclusion to assume that more of
the same would not influence the child to exhibit an increase of positive behavior. This appeared
to be confirmed by the results.
Implications
In conjunction with medication management, primary care physicians should consider
referring children to family therapists. Family therapists focus on environmental changes as
opposed to processing issues. Changes in the child’s environment may lead to a change in the
child’s behavior. A referral to a family therapist that focuses on environment should be
considered before a child is admitted to a residential treatment facility.
The concept of children needing to stay at residential facilities for a period of several
months needs to be examined by the mental health community. If no significant differences in
overall scores exist over time, then there is not a need to keep the children for several months at a
time. Future studies examining inpatient residential stays need to focus on quantitatively
measuring recorded behaviors instead of perceived behaviors. This will increase the accuracy of
the measurement and decrease response bias.
If children are admitted into psychiatric facilities, careful monitoring of their behavior
with objective measures should be used to avoid unnecessary length in stays. If the child does
not show progress or demonstrates a decline in progress within over a period of weeks, then it
should be considered if the child has received maximum benefit from the residential stay.
In conjunction with medication management, primary care physicians should consider
referring children to family therapists. Family therapists focus on environmental changes as
opposed to processing issues. Changes in the child’s environment may lead to a change in the
child’s behavior. A referral to a family therapist that focuses on environment should be
considered before a child is admitted to a residential treatment facility.
The concept of children needing to stay at residential facilities for a period of several
months needs to be examined by the mental health community. If no significant differences in
overall scores exist over time, then there is not a need to keep the children for several months at a
time. Future studies examining inpatient residential stays need to focus on quantitatively
measuring recorded behaviors instead of perceived behaviors. This will increase the accuracy of
the measurement and decrease response bias.
If children are admitted into psychiatric facilities, careful monitoring of their behavior
with objective measures should be used to avoid unnecessary length in stays. If the child does
not show progress or demonstrates a decline in progress within over a period of weeks, then it
should be considered if the child has received maximum benefit from the residential stay.
References
Feeney, F. X. G., Connor P. J., Young, M. R., Tucker, J., & McPherson, A. (2006). Combined
acamprosate and naltrexone, with cognitive behavioral therapy is superior to either
medication alone for alcohol abstinence: A single centers experience with
pharmacotherapy. Alcohol and Alcoholsim, 41(3), 321-327.
Gavidia-Payne, S. Littlefield, L. Hallgren, M., Jenkins, P., & Coventry N. (2003). Outcome
evaluation of a statewide child inpatient mental health unit. Australia and New Zealand
Journal of Psychiatry, 37(2), 204-211.
Garralda, E. M., Rose, G., & Dawson, R. (2008). Measuring outcomes in a child psychiatry
inpatient unit. Journal of Children’s Services, 3(3), 6-16.
Goodwin, R., Gould, S. M., Blanco, C., & Olson, M. (2001) Prescription of psychotropic
medications to youths in office-based practice. Psychiatric Services, 52(8), 1081-1087.
Higgins, W. J., Williams, L. R., & McLaughlin, F. T. (2001). The effects of a token economy
employing instructional consequences for a third-grade student with learning disabilities:
A data-based case study. Education and Treatment of Children, 24(1), 99-106.
Mayes, S. D., Calhoun, S. L., Krecko, V. F., Vessell, H. P., & Hu, J. (2001). Outcome following
child psychiatric hospitalization. Journal of Behavioral Health Service and Research,
28(1), 96-103.
Mitchell, G. C. (1999). Treating anxiety in a managed care setting: A controlled comparison of
medication alone versus medication plus cognitive-behavioral group therapy. Research
on Social Work Practice, 9(2), 188-200.
Moore, S., & Boniecki, K. A. (2003). Breaking the silence: using a token economy to reinforce
classroom participation. Teaching Psychology, 30(3), 224-229.
Moore, W. J., Tingstrom, H. D., Doggett, A. R., & Carlyon, D. W. (2001). Restructuring an
existing token economy in a psychiatric facility for children, 23(3), 51-57.
Clarkin, F. J., Carpenter, D., Hull, J. Wilner, P., & Glick, I. (1998). Effects of psychoeducational
intervention for married patients with bipolar disorder and their spouses. Psychiatric
Services, 49, 531-533.
Craske, G. M., Golinelli, D., Stein, B. M., Roy-Byrne, P., Bystritsky, A., & Sherbourne, C.
(2005). Does the addiction of cognitive behavioral therapy improve panic disorder
treatment outcome relative to medication alone in the primary-care setting?
Psychological Medicine, 35(11), 1645-1654.
Dean, X. P., Cohen, R. Nemil, M., Best, M. Al, Cassell, S. & Dyson. F. (1995). Children and
Adolescents Discharged from Public Psychiatric Hospitals: Evaluation of Outcome in a
Continuum of Care. Journal of Child and Family Studies, 4(1), 43-55.
Safren, A. S, Otto, W. M., Sprich, S., Winett, L. C., Wilens, E. T., & Biederman, J. (2005).
Cognitive-behavioral therapy for ADHD in medication-treated adults with continued
symptoms. Behavior Research and Therapy, 43, 831-842.
Sourander, A., & Piha, J. (1997). Three-year follow-up of child psychiatric inpatient treatment.
Feeney, F. X. G., Connor P. J., Young, M. R., Tucker, J., & McPherson, A. (2006). Combined
acamprosate and naltrexone, with cognitive behavioral therapy is superior to either
medication alone for alcohol abstinence: A single centers experience with
pharmacotherapy. Alcohol and Alcoholsim, 41(3), 321-327.
Gavidia-Payne, S. Littlefield, L. Hallgren, M., Jenkins, P., & Coventry N. (2003). Outcome
evaluation of a statewide child inpatient mental health unit. Australia and New Zealand
Journal of Psychiatry, 37(2), 204-211.
Garralda, E. M., Rose, G., & Dawson, R. (2008). Measuring outcomes in a child psychiatry
inpatient unit. Journal of Children’s Services, 3(3), 6-16.
Goodwin, R., Gould, S. M., Blanco, C., & Olson, M. (2001) Prescription of psychotropic
medications to youths in office-based practice. Psychiatric Services, 52(8), 1081-1087.
Higgins, W. J., Williams, L. R., & McLaughlin, F. T. (2001). The effects of a token economy
employing instructional consequences for a third-grade student with learning disabilities:
A data-based case study. Education and Treatment of Children, 24(1), 99-106.
Mayes, S. D., Calhoun, S. L., Krecko, V. F., Vessell, H. P., & Hu, J. (2001). Outcome following
child psychiatric hospitalization. Journal of Behavioral Health Service and Research,
28(1), 96-103.
Mitchell, G. C. (1999). Treating anxiety in a managed care setting: A controlled comparison of
medication alone versus medication plus cognitive-behavioral group therapy. Research
on Social Work Practice, 9(2), 188-200.
Moore, S., & Boniecki, K. A. (2003). Breaking the silence: using a token economy to reinforce
classroom participation. Teaching Psychology, 30(3), 224-229.
Moore, W. J., Tingstrom, H. D., Doggett, A. R., & Carlyon, D. W. (2001). Restructuring an
existing token economy in a psychiatric facility for children, 23(3), 51-57.
Clarkin, F. J., Carpenter, D., Hull, J. Wilner, P., & Glick, I. (1998). Effects of psychoeducational
intervention for married patients with bipolar disorder and their spouses. Psychiatric
Services, 49, 531-533.
Craske, G. M., Golinelli, D., Stein, B. M., Roy-Byrne, P., Bystritsky, A., & Sherbourne, C.
(2005). Does the addiction of cognitive behavioral therapy improve panic disorder
treatment outcome relative to medication alone in the primary-care setting?
Psychological Medicine, 35(11), 1645-1654.
Dean, X. P., Cohen, R. Nemil, M., Best, M. Al, Cassell, S. & Dyson. F. (1995). Children and
Adolescents Discharged from Public Psychiatric Hospitals: Evaluation of Outcome in a
Continuum of Care. Journal of Child and Family Studies, 4(1), 43-55.
Safren, A. S, Otto, W. M., Sprich, S., Winett, L. C., Wilens, E. T., & Biederman, J. (2005).
Cognitive-behavioral therapy for ADHD in medication-treated adults with continued
symptoms. Behavior Research and Therapy, 43, 831-842.
Sourander, A., & Piha, J. (1997). Three-year follow-up of child psychiatric inpatient treatment.
European Child and Adolescent Psychiatry, 7(3), 153-162.
Follow us on Facebook, Instagram, and Twitter!
@TherapyPhD
Contact Info:
2800 N. 2nd St.
Rogers, Ar. 72756
479-561-0174
Fax # 479-755-3581
ericchristianjohnsonphd.com
ericchristianjohnsonphd@gmail.com
#counselor #Therapist #AnxietyDoctor
2800 N. 2nd St.
Rogers, Ar. 72756
479-561-0174
Fax # 479-755-3581
ericchristianjohnsonphd.com
ericchristianjohnsonphd@gmail.com
#counselor #Therapist #AnxietyDoctor
How to Solve the Two Major Types of Stress
View Online
How to Solve the Two Major Types of Stress
1.) Direct stress is stress that directly impacts you. For example, you have three assignments due within four hours.
2.) Indirect Stress is stress that indirectly impacts you. For example, your spouse has three assignments due within four hours.
2.) Indirect Stress is stress that indirectly impacts you. For example, your spouse has three assignments due within four hours.
Direct StressAnxiety is a sympathetic nervous system response, meaning that your adrenalin and other bodily functions are pushed into the fight or flight mode. This response is triggered by a thought and maintained by continued thoughts. The sympathetic nervous system response will subside on its own If you allow it to. Simply sit still, acknowledge the difficulty of the event and simply except it, without frantically trying to resolve it and frantically assigning blame. Do not attempt to mask it by seeking a euphoria provoking activity. Simply sit, accept, and wait calmly. Within a very short time, the sympathetic nervous system response will subside.
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Indirect Stress
Indirect Stress works the same as Direct Stress. They are both a form of Anxiety.
Follow us on Facebook, Instagram, and Twitter!
@TherapyPhD
Contact Info:
2800 N. 2nd St.Rogers, Ar. 72756
479-561-0174
Fax # 479-755-3581
ericchristianjohnsonphd.com
ericchristianjohnsonphd@gmail.com
#counselor #Therapist #AnxietyDoctor
2800 N. 2nd St.Rogers, Ar. 72756
479-561-0174
Fax # 479-755-3581
ericchristianjohnsonphd.com
ericchristianjohnsonphd@gmail.com
#counselor #Therapist #AnxietyDoctor
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