NEW YORK -- The implementation of a comprehensive cognitive-behavioral therapy model as treatment paradigm for inpatient psychiatry can help hospitals balance the competing demands of providing effective care and limiting lengths of stay, Dr. Jean Kim said at the American Psychiatric Association's Institute on Psychiatric Services.
"Cognitive-behavioral therapy [CBT] is well suited to the inpatient milieu," said Dr. Kim, inpatient attending psychiatrist at New York-Presbyterian Hospital's Westchester Division and unit chief of the women's inpatient psychiatry program at Payne Whitney Westchester. "By definition, cognitive-behavioral therapy is a short-term, time-limited type of therapy, and the psychoeducational aspects provide a structure and framework for achieving patient goals." In this era when inpatient psychiatric care is often driven by a focus on acute stabilization and the need to move patients in and out quickly, "there is a lot of empirical evidence suggesting that CBT is a reasonable, effective option for optimizing patient outcomes," she said.
The transition to a fully CBT-focuscd model in the women's program at Payne Whitney, beginning in 2002, has not only improved patient care and minimized recidivism, but it has boosted staff morale, said Dr. Kim. "There is a sense among staff that we are all working toward the same goal and that we have the tools and training to achieve that goal."
When Payne Whitney administrators initially conceived of the women's program in 2002, "the idea was that we would be using it to treat postpartum and fertility cycle types of diagnoses, but reality being reality, to maintain financial viability, we started seeing patients with a wide array of diagnoses and acute psychiatric illnesses," said Dr. Kim. To handle the diverse diagnoses, "the administration decided to develop a comprehensive CBT focus for the unit, with the thought that such an approach would complement the existing sense of camaraderie and communication in the all-female unit, she said.
Unlike many inpatient psychiatric settings that offer adjunct CBT programs that are peripheral to the primary patient care team, the Payne Whitney program was built around a CBT focus. 'All levels of staff--nurses, social workers, mental health workers, psychologists, and psychiatrists attended workshops and programs on CBT," said Dr. Kim. In addition, "the administrators hired a consultant who used the principles of CBT to shift the unit philosophy from a conventional approach to a more collaborative CBT approach. These efforts helped to establish a sense of trust and enthusiasm among staff."
The CBT programming that was established for the unit comprises a core set of group sessions that occur daily, during which the basic principles of CBT are taught to patients. …