The plan of care and treatment for the patient begins prior to admission to the hospital with the information supplied by the community agencies that refer the patient for admission. The care, treatment, and rehabilitation planning process is designed to ensure that care is appropriate for the patient's specific needs and the severity level of the patient's other disease, condition, impairment, or disability.
Biopsychosocial rehabilitation is the treatment approach adopted by Logansport State Hospital. The treatment team provides interventions that focus on mental and physical health as well as psychosocial environments. It is our goal to assist the patient in reaching maximum independence in order to return to the least restrictive environment. Treatment teams made up of a psychiatrist, nurse, behavior clinician, social service specialist, rehabilitation therapist, and attendant staff.
Each patient's assessment is integrated to identify strengths and problems needing care and treatment. Interdisciplinary treatment teams meet with the patient, family, and/or healthcare representative, as appropriate, to formulate an individual treatment plan to address needs and problems identified through the assessment process. The plan includes goals and objectives with measurable outcomes for each identified problem and need. The plan also consists of treatment interventions to be provided by staff that will assist the patient in achieving their objectives.
Discharge criteria and a discharge plan are also formulated in order to judge the outcome of the treatments determined for each specific patient.
Treatment plans are reviewed on a regular basis by the treatment team and the patient, family, guardian, and/or healthcare representative, as appropriate. Gatekeepers are also encouraged to participate.
Logansport State Hospital’s treatment interventions are provided for mental and physical health and in the psychosocial environments of working, living, leisure, and socialization based upon the assessed needs of the patient. Mental and physical health issues include: medication, nutrition, dental, physical ailments, hallucinations, delusions, depression. Psychosocial issues include personal hygiene, academic education, vocational skills, legal issues, communication, and recreation. Programs are developed to meet the needs of the patient in these areas. Leaders strive to ensure that best practices are implemented in a recovery-oriented environment.
Logansport State Hospital uses the framework in the Risk-Need-Responsivity model (RNR model) of dangerous behavior including criminal and offending for the hospital's overall programming principles guide interventions in the following ways:
- Risk: The patients with the most risk receive the most access to treatment. Patients are not removed from the group unless they represent an imminent threat of violence to someone in the immediate environment. High-risk patients who refuse groups are provided with individual treatment on the unit. The focus of this individual treatment may include covering materials from core groups that address the specific risks presented. Patients who have engaged in dangerous behaviors need more (not less) frequent access to individual time with treatment team members.
- Responsivity: Programming includes integration of key interventional strategies found to increase patient engagement and motivation. Individual responsivity factors might be addressed through therapeutic tasks. Response to interventions is communicated more openly/frequently to the patient (daily observations, weekly treatment team feedback forms, etc.). Interventions found to increase motivation are used on all units: acceptance and commitment therapy, core mindfulness training, motivational interviewing techniques, and stages of change/recovery principles. The RNR model targets for change include dynamic risk/need factors closely linked with the recurrence of dangerous behavior. For this reason, the identification of the following information becomes key to assessment:
- Escalation behaviors toward violence/self-harm/sexual aggression
- Cycle(s) of offending behaviors (build-up, planning, offense/dangerous behavior, justification)
- Protective factors including learned and practiced de-escalation strategies and responsivity factors
- Destabilizing factors which potentially keep the cycle of offending going
- Specific treatment targets across all groups include the following:
- attitudes that support crime/abuse/hostility,
- response to help-seeking/treatment/supervision,
- decision making/problem solving,
- impulse management,
- trouble maintaining healthy relationships with healthy (noncriminal/deviant) others, vocational/leisure development, and time management problems.
- The therapeutic climate associated with the RNR model is shaped by the following principles:
- Change is possible.
- Hope is necessary for change to happen.
- The real message is delivered by showing your own empathy, objectivity, ability to validate others, to work with others, and to be flexible.
- Get patient feedback when they are able to honestly give it – do they feel respected, heard, and understood? These are the necessary conditions to encourage hope and change (see Miller et al., 2008).
Programming offered at LSH includes but is not limited to:
- Dialectical behavior therapy
- Service Outreach and Recovery (SOAR)
- Mindfulness-based stress reduction
- Risk discovery and management
- Aggression replacement training
- Managing deviant sexual arousal
- Acceptance and commitment training
- Epictetus Club; non-violent communication
- Good lives model using the LEAD workbook
- Behavior support plans
- Transition recovery
- Substance abuse education
- Legal education series based on the knowledge base
- Neuropsychological Education Approach to Cognitive Remediation (NEAR)
- Slater method for individuals with intellectual and developmental disabilities through Intensive legal education and focus on legal education.