Determinants of the treatment climate in psychiatric and substance abuse programs: implications for improving patient outcomes.
This study examined determinants of the treatment climate in 89 psychiatric and substance abuse programs. Clearer policies giving patients more control, and more health and treatment services, were related to more supportive, autonomous, expressive, and practically oriented milieus. In contrast, more policy choice and daily living assistance were associated with less support, personal expression, and practical orientation. Programs in which staff had more paraprofessionals and better team functioning, and in which patients had more social resources and better mental functioning, tended to be more supportive and to have more emphasis on autonomy, personal expression, and practical orientation. Based on these results, we suggest some guidelines on how to change the treatment milieu to benefit patients' adjustment.
Timko
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Center for Health Care Evaluation, Veterans Affairs Health Care System, Palo Alto, California, USA.
Moos
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D000203:Activities of Daily Living; D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D006801:Humans; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D010348:Patient Care Team; D010358:Patient Participation; D011050:Policy Making; D015397:Program Evaluation; D011787:Quality of Health Care; D012114:Residential Treatment / Q000458:organization & administration / Q000592:standards*; D012944:Social Support; D016320:Substance Abuse Treatment Centers / Q000592:standards; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome