Kevin Martin, Steve Robson, Joan B. Beasley,Thomas A. Dailey, Kathryn duPree
US Public Policy Update
A challenge often faced by policy planners is how to assist individuals with intellectual disabilities and mental health needs who no longer require a psychiatric inpatient stay, but are not yet ready to return home. In some states transitional housing has improved both outcomes for individuals and collaborative efforts between service systems.
The Woodbridge Center currently has six beds and will soon expand to twelve, and is a short term facility operated by the Connecticut Department of Mental Retardation (DMR). The first floor of the program has a kitchen, living, laundry, medication, exercise room as well as a separate living room/bedroom for one individual who needs specialized services. The backyard has an enclosed grassy area with a fish pond and picnic tables. The second floor has individual bedrooms with semi private bathrooms, a shared "family" room and a quiet area for individuals who need some time alone.
Visits range from 30-90 days, renewable every 30 days. A request for extension of a stay requires an approved transition plan outlining actions taken to assure community placement within a reasonable period of time. The primary purpose of the Center is to successfully transition individuals discharged from acute psychiatric settings back home. The population most often served at the Center includes individuals with mental retardation and severe behavioral challenges, autism, substance abuse and/or serious and persistent mental illness. Guests must be at least 18 years old. Planning for discharge begins at the time of admission.
The Center utilizes Milieu Therapy to help guests succeed in a group environment. As stated by Focus Alternative Learning Center, Inc (Retrieved May 22, 2006 from www.focus-alternative.org/milieu.htm, page 1) "Milieu Therapy is a planned treatment environment in which everyday events and interactions are therapeutically designed for the purpose of enhancing social skills and building confidence." The milieu requires "immediate feedback from caring staff" as well as consistent rules, routines and activities. The primary goal is "to teach [adults] 'how' to 'fit in' socially and emotionally in their world without changing 'who' they are." A key aspect in fulfilling this goal is ensuring that interactions between all staff and residents are respectful, non-threatening and done in a manner that will encourage confidence and independence.
The Center follows a structured and consistent routine. Guests are expected to participate to their fullest potential. Independence is a primary goal. Activities include household responsibilities, recreational activities, and community involvement. Volunteer work at "Meals on Wheels" plays a major role allowing guests to have a sense of accomplishment, self-worth and to assist others. Therapies at the Center include music, speech and occupational therapy with therapists coming into the house to provide services.
The Woodbridge Center's clinical support services include psychiatry, psychiatric nursing, psychology, occupational therapy, physical therapy, speech therapy and clinical nursing coordination. Team meetings are held at least weekly. The Woodbridge team works cooperatively with public and private agencies including discharging facilities. To promote success, the Center emphasizes training and supervision provided to direct support professionals with frequent information sharing and team meetings as a centerpiece of the project.
The Center has strong support from administrators on local, regional and state wide levels. This helps the program maintain its mission to provide quality services to individuals with serious challenges and to limit lengths of stay to ensure availability to as many as possible following an acute psychiatric inpatient stay.
Policy planners must consider remedies to limits in the provision of inpatient mental health services and how to best serve individuals with intellectual disabilities who often require more than is provided in generic psychiatric inpatient settings. In many cases individuals are not yet ready to return home but no longer require an inpatient stay according to current practices. The Woodbridge Center is one example of the effective use of a transitional clinical setting to ensure a successful return home.
For more information on the Woodbridge Center contact:
Thomas Dailey, North Region Director of Public Residential and Day Supports