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OBJECTIVE: The authors describe a self-assessment training program for multidisciplinary mental health teams that was developed in a public multihospital system, the process of implementing the training at a state psychiatric hospital, and a measurement instrument, the Scale for Leadership Assessment and Team Evaluation (SLATE), which they have used for self-assessment of multidisciplinary teams and which is currently being studied. They assessed whether changes in team self-assessments could be seen after the training program. METHODS: A total of 102 mental health professionals from 12 inpatient units representing the disciplines of psychiatry, psychology, nursing, social work, and occupational and activity therapy completed the SLATE before and after participation in a training program that consisted primarily of team self-assessment in the context of treatment planning sessions. The training program included structured feedback, didactics, consultation, and videotaping of sessions. Aggregate data were used to compare mean item scores for the SLATE overall and for its four subscales (team, psychiatrist, participation, and treatment plan) at baseline and after the training. RESULTS: Scores increased significantly for the overall SLATE and for all four subscales, indicating improved team functioning in the areas addressed. The increase in mean score was greatest for the subscale that assessed the leadership of the psychiatrist. CONCLUSIONS: Treatment planning sessions can be used successfully by multidisciplinary mental health teams to examine team functioning in various areas in a self-assessment model. Participation in a training program that included videotaping of sessions, consultation, and structured attention to team functioning was associated with improved ratings of team functioning.

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Leadership is an important consideration at many levels within behavioral healthcare systems. The authors developed a training program in a large public hospital system that focused on psychiatric leadership and clinical team functioning. In a learning laboratory format, they used videotaped patient simulations as a stimulus for multidisciplinary treatment planning sessions. Structured self-assessments were performed using a preliminary Scale for Leadership Assessment and Team Evaluation (SLATE). Videotaping the sessions provided an additional team self-assessment tool. Other educational activities supplemented the sessions, and teams proposed steps for transferring their learning to other units. The authors emphasize that leadership must foster team learning, which involves developing adaptive capacities and applying them to new clinical situations.

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Unique roles of the professional psychologist are outlined with respect to increasingly restrictive utilization practices of managed care. Suggestions of how to develop less traditional venues of practice, the types of instruments to use, and report formats, along with ways to persuade primary care physicians (PCPs), managed care organizations, and facilities to utilize psychological assessment services are provided. Medical cost offsets, cost-efficient quality of care, and models of practice are also discussed.

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A primary characteristic of Attention Deficit Hyperactivity Disorder (ADHD) is an inability to establish and maintain sustained attention, which is speculated to reflect frontal lobe involvement. The Knight Verbal Fluency measure was administered to 19 ADHD inpatient boys and to a cohort group of 7 children who were matched for mean age, psychiatric diagnosis (depression), treatment facility, and examiner but were without the diagnosis of ADHD. Analysis indicated that ADHD children performed significantly lower than expected and lower than the similar non-ADHD children. These findings lend support to the hypothesis that frontal lobe dysfunction is involved in attentional process disorders and suggests the potential clinical usefulness in the diagnostic screening of ADHD children of a simply administered measure amenable to interpretation of frontal lobe function.

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The perceptions, knowledge, and opinions of 104 teachers of students with learning disabilities regarding medication used with their students were investigated. The students' doctors were perceived as the professionals primarily responsible for making the decision to have the student either placed on or taken off medication. The teachers indicated that global impressions and direct behavioral observations were used to assess the effects of medication but that they would prefer to use behavioral observations and rating scales. Hyperactivity and delusions/hallucinations were perceived as the problems most likely to lead to medication. Less than 15% of the teachers indicated that their professional preservice training had provided them with sufficient information on the use of medication for children with behavior problems, and less than 20% had a similar opinion regarding their inservice training on the same topic.

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An acute care psychiatric hospital faces the dilemma of maintaining a safe and secure environment for its patients while gradually providing them with enough independence to assume responsibility for the management of their own behaviors. When patients leave the hospital building, grounds, or an off-ground activity without prior authorization from the attending physician or if they do not adhere to restrictions during a medical/therapeutic pass, they are placing themselves, the hospital, and others in a high-risk situation. An analysis and review of the closed medical records of patients who had eloped were conducted to determine if a pattern existed among them. The medical records studied included clinical notes, assessments, physician's orders, precautions and restrictions, lengths of stay, notes on the hospital environment, and patient-specific demographic data. The findings suggest that there are some consistent factors related to patient elopements that, when recognized, may help clinicians decrease this highly disruptive behavior.

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Natural disasters do not always lead to post-traumatic stress disorders (PTSD) for their victims, although stress-related symptoms are commonly reported as results of such disasters. The impact of a natural disaster on the treatment of a hospitalized psychiatric population has never been systematically evaluated. In the fall of 1986, severe river flooding caused evacuation of a 160-bed psychiatric facility. One hundred and twenty-one hospitalized patients were taken to nearby hospital facilities, and many were separated from their primary therapists, fellow patients or both. A mail survey two months post-evacuation assessed stress-related symptoms, the patients' opinions of the impact of the flood on their treatment and functioning, and the patients' views of the evacuation procedures. Patients also responded to questions about their cognitive and affective reactions during each phase of the disaster. Clear evidence of PTSD was not found with this population; however, the findings underscore the importance of keeping patients with familiar staff and peers when possible. Differences between this study and previous disaster studies are noted, and suggestions for coping with natural disasters in inpatient or residential psychiatric facilities are offered.

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Response-contingent small-step treatment is a structured clinical methodology developed for use in the management of brain-injured communication-disturbed adults. Treatment planning includes the determination of target behavior hierarchies, criterion levels of patient performance, and planned response contingencies. Treatment forms are employed to enable ease in scoring patient response, systematic treatment planning, and objective data retrieval for charting.

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