Residential Treatment for Patients in Crisis
Douglas Dolnak, DO
Mark Rapaport, MD
William Hawthorne, PhD

This prospective pilot study, which evaluated changes in functioning from admission to discharge, was published in February 1998 (Dolnak, D., Rapaport, M. H., & Hawthorne, W. (1998). Residential treatment for patients in crisis. Psychiatric Services, 49 (2), 246). The study included 50 adults (29 male and 21 female) who agreed to participate in interviews and signed an informed consent form. Participants' diagnostic categories included 48% major depression, 38% schizophrenia, and 14% bipolar disorder. The mean length of stay was 12 days (SD=7).

The initial interview consisted of collection of an extensive psychosocial history by clinical staff and a structured DSM-IV diagnostic interview by a psychiatrist. At admission and again at discharge, a single rater with extensive training administered the Scale of Functioning, a well-validated 15-item scale assessing social functioning in such areas as orientation, appointment compliance, socialization, financial management, and independence of living arrangements. Scores on the scale range from 15 to 60, with higher scores indicating higher functioning. In addition, clinical staff independently completed the Global Assessment of Functioning (GAF) Scale when subjects were admitted to and discharged from the crisis facility. Scores on the GAF range from 0 to 100, with higher scores indicating higher functioning.

Subjects' mean SOF scores were 29.7 at admission and 36 at discharge, a statistically significant difference (p<.001). Although both males and females showed improvement between admission and discharge as measured by both the SOF and the GAF, for females the improvement was statistically significant. SOF scores increased from 30.2 to 38.6 (p<.01), GAF scores from 35.5 to 48 (p<.04). On the SOF, diagnosis influenced the degree of improvement between admission and discharge. For clients with major depression, SOF scores increased from 32.6 to 40.2, (p<.001); for bipolar disorder, from 29.4 to 37 (p<.002); and for schizophrenia, from 26 to 30.4 (p<.001).

Short-term residential crisis treatment programs may be a cost-effective alternative to inpatient hospitalization. They offer clients crisis psychiatric treatment, a supportive network of clinicians to facilitate life skills training, housing support, and placement into transitional living programs. This pilot study suggests that residential crisis treatment was associated with significant improvement in clients' psychosocial functioning as measured by the SOF and GAF scales. Changes between admission and discharge on the SOF reflected a 21 percent improvement in functioning and a 28 percent improvement on the GAF.

This was a report of an uncontrolled study, and our results should be interpreted cautiously. Further comparative research investigating the utility of residential crisis treatment is needed, with specific emphasis on its impact on symptomatology, functioning, quality of life, and social adjustment.