The Day CENTER is a focused program designed to serve patients in need of an intensive structured environment. It is a specialized service that addresses acute symptoms associated with posttraumatic and other psychiatric conditions and/or the exacerbation of ongoing symptoms and dysfunction. The treatment day is organized around a sequence of specialized groups that teach specific coping and self-management skills and that address issues of past and current trauma as they contribute to the patient’s destabilization. The group format and process are used to stimulate the discussion of core issues that maintain the patient’s symptoms. Patients are assisted in the development of coping skills (e.g. daily coping, self-management, impulse control, emotional regulation, and interpersonal interaction and negotiation), safety plans, and relapse prevention plans, individually and in group modalities.
Each patient is assigned a case manager who meets individually with him/her on a once a week basis. The case manager also provides ongoing coordination of care with the patient’s outpatient providers. Consultation on psychopharmacology related to the patient’s posttraumatic symptoms is also provided on as-needed basis.
The Day CENTER offers two levels of intensity:
1. The Partial Hospitalization Program consists of treatment 4-5 days a week. It is used to offset the need for an inpatient admission or to shorten the length of an acute inpatient stay.
2. The Intensive Outpatient Program is designed for patients who are struggling with more chronic and/or intermittent work and social dysfunction. Patients in this component attend two to three days a week.Both programs involve individualized treatment plans that encourage maximal levels of functioning away from the treatment setting and are designed to expedite transition to less intensive levels of treatment. Both programs also provide flexibility of scheduling to accommodate other therapies, transition to work, and/or other structured activities. The treatment philosophy of the Day CENTER is based on a trauma-responsive model that takes past and present trauma into account with the specific goal of promoting improvement in present day coping and in symptom management and resolution.
Four treatment groups are part of the daily schedule:
1. Assessment, Goals, and Motivation orients patients each day by focusing them on problems and tasks of daily functioning and by motivating them to work on their individualized treatment goals.
2. Group Psychotherapy encourages patients to address issues of personal safety and effective expression and management of feelings within a forum designed to help them learn and practice interpersonal skills. Group is also focused, in part, on the processing of trauma-related issues and emotions and addresses symptoms associated with other psychiatric conditions.
3. Psych-Education/Life Skills provides information about trauma recovery and life skills by teaching coping skills for symptom management and emotional regulation along with problem solving skills for daily living.
4. Expressive Therapy provides a forum for the safe and contained expression and management of emotion using art therapy and writing modalities in a context of peer support and discussion.
Typical symptoms indicating a need for treatment at a Partial Hospital or Intensive Outpatient level of care:
- Marked deterioration in an individual’s ability to function independently and carry out day-to-day activities.
- Active or transient suicidal and/or homicidal ideation without imminent risk for harm to self or to others.
- Behavior that reflects poor impulse control and limited judgement.
- Distress due to overwhelming flashbacks and other intrusive or numbing trauma symptoms and/or compromised reality-testing.
- Distress due to severe symptoms of associated psychiatric conditions such as depression and anxiety.
- Treatment complicated by substance abuse or medical conditions for which 24 hour monitoring is not indicated.