Time and Crisis: A survey of 98 Planned Short-Term Treatment Programs

This was an exploratory-descriptive survey of planned short-term crisis-oriented programs in 44 child psychiatric clinics and 54 family service agencies. The general study questions concerned the common and special characteristics of these programs, the extent to which formulations about the crisis approach and the structuring of the time dimension were utilized, and the feasibility of developing a scoring-instrument to profile certain important program features. Specific study questions dealt with theoretical formulations, practice processes, and administrative procedures. Planned short-term treatment (PSTT) was defined to mean that certain cases were designated during the intake period, or shortly thereafter, to be seen for (a) a more or less limited number of in-person interviews and/or (b) a more or less limited period of time. The "crisis approach" included attention to the stress-crisis configuration (the precipitating event, the perception of and response to the event, and the resolution of the ensuing problems) as well as emphasis on the prompt availability and accessibility of treatment. Major findings were: The proportion of clinics with PSTT services was much greater than that of the agencies. PSTT was viewed as a treatment of choice rather than expediency. The goals of PSTT were generally focused on the client's "presenting" rather than his "underlying" problem. The primary reason for initiating PSTT was to meet the needs of clients in crisis situations. Treatment techniques were thought to require special adaptations in PSTT. The clinics--as compared to the agencies--were more likely to (1) have longer waiting lists; (2) use an application form as a screening device; (3) have centralized or specialized intake services; (4) have a longer time laps betwen the application for help and the initial interview; and (5) use a larger number of exploratory interviews before the case was assigned to PSTT. In terms of these administrative factors, clinics seemed less accessible for early crisis intervention than agencies. Only 21 clinics and agencies reported the use of a specific predetermined number of interviews or weeks of treatment for PSTT cases; the remaining 77 respondents used an approximate range of interviews or weeks as a way of flexibly structuring the time dimension. PSTT, as typically used by the respondents in this sample, encompassed up to 12 interviews which were offered over a period of up to three months. Staff opinions about the professional advisability of PSTT were overwhelmingly positive, and when they changed--after PSTT services were initiated--they did so in a significantly positive direction. A preliminary Program Assessment Scale (PAS) was developed to profile differences among respondents with a strong, moderate, or minimal investment in crisis-oriented PSTT. The PAS included 10 cross-validated items (for clinics and agencies) related to crisis formulations, time factors, intake procedures, staff training, and research. Further study will be needed to test this instrument. The study suggests that continued careful experimentation with crisis-oriented PSTT programs in a variety of mental health services shows promise of (1) reducing the number of unplanned terminations by offering families under stress a meaningful ans definitive type of brief service; and (2) serving--through the redeployment of available professional resources--an increasing number of individuals and families in stressful situations. Such programs might well be the treatment of choice for large numbers of families and thus deserve an important place in the spectrum of community mental health services