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CONTENTS Foreword Steven S. Sharfstein Preface Acknowledgments Introduction The Goals of this Book PART I: THE PLACES Chapter 1. What Is a Residential Care Facility? Infrequently Asked Questions Chapter 2. The Problem of the Problem The Problem of Data Collection Chapter 3. The History Residential Care Facilities in San Francisco Personal History The Pioneers Chapter 4. The Facility The Evolution Of Residential Care Facilities Case Histories Specialized Referral Patterns PART II: THE PEOPLE Chapter 5. Who Should Do It ? Psychotherapeutic Considerations The Advantages of a Sense of Humor Behavioral Therapy Applications Group Psychotherapy Considerations Chapter 6. The Job Description Chapter 7. The Cast The Patient The General Medical Physician The Social Worker The Psychologist The Administrator The Pharmacist The Case Manager Relatives The Modern Residential Care Psychiatric Team PART III: THE PROBLEMS Chapter 8. How It Should Be Done: Space, Time, and Techniques Space Constraints Time Constraints The Techniques Chapter 9. The Problems of Frequency and Duration Visitation Frequency in Relation to the Unpredictability of Adverse Events The Standard of Care in the Community The Problem of Duration The Effects of Offsite Work on Onsite Visits A Typical Day in the Life of A Residential Care Facility Psychiatrist Chapter 10. Why Do It? The Value of Onsite Visits by Psychiatrists and the "Continuity Of Care" Issue Clinical Examples of the Advantage of Onsite Encounters The Effect of Onsite Visits on the Administrator Chapter 11. The Residential Care Facility First-Aid Paperwork Reduction Kit Chapter 12. The Legal Problems Recent Changes in Residential Care Psychiatry The Impact of HIPAA The Problem of Medical Necessity Redefining Medical Necessity For Psychiatry Computers and the Medicare Audit Computers and the Medicaid Audit Audits and Health Care Fraud Chapter 13. The Medicare Audit Process Chapter 14. Progress Note Problems Examples of Progress Notes Medicare Policies Regarding Progress Notes Chapter 15. Special Problems The Poorly Organized Facility with Substandard The Well-Organized Facility with Regular Visits The Well-Organized Facility with No Regular Visits The Nonemergency Emergency Professional Services by the MRCPT by the MRCPT The Problems That Occur When MRCPT Members Do Not Visit Regularly Chapter 16. Suicide Chapter 17. IM Medications--How To Do It and Why The Technique of IM Administration Clinical Examples of the Use of Long-Acting IM Depot Injections PART IV: REMEMBRANCES OF THINGS PAST Chapter 18. School Days Chapter 19. How To Fail in Psychology Without Really Trying Chapter 20. Life in the Prechlorpromazine Era of Nongeological Time PART V: ISSUES IN PSYCHOPHARMACOSOCIOECONOMICS Chapter 21. How Antipsychotic Drugs Have Changed the World Chapter 22. The Cost of the Treatment of Schizophrenia for Society Chapter 23. The Costs of the Treatment of Schizophrenia for the Patient Chapter 24. How Onsite Services Can Reduce the Costs of Treatment Chapter 25. Residential Care Facilities and the Cost Savings Associated with Rehospitalization PART VI: SUMMING UP Chapter 26. Of Wind and Gravity Chapter 27. Summary and Recommendations The Evolution of Psychiatric Treatment in Residential Care Facilities The Scope of the Problem Goals and Recommendations PART VII: APPENDIXES Appendix A. The Problem of Competing Acronyms Appendix B. A List of Psychiatric Medications Appendix C. Metabolic Monitoring Recommendations Appendix D. The Problem of Rare Side Effects Appendix E. The California Code of Regulations Appendix F. The Federal Nursing Home Reform Act (OBRA) Appendix G. A Brief History of Medicare Appendix H. The Twenty-Five Warning Signs of Poor Documentation Notes Index
Library of Congress Subject Headings for this publication: Mentally ill Institutional care United States, Mentally ill Long-term care United States, Mental health facilities United States, Mental health personnel United States, Psychiatry Practice United States, Psychoses Treatment, Schizophrenia drug therapy, Patient Care Team, Psychiatry methods, Residential Facilities, Socioeconomic Factors