Adolescent students with psychiatric disorders who are educated in day treatment school classrooms manifest cognitive limitations, maladaptive behaviors, and social functioning deficits that often lead to academic failure, impeding their productivity when they become adults and causing them to run afoul of the criminal justice system. Informed by their students' interests and perspectives, day treatment schoolteachers can individualize existing curricular and behavioral interventions, or develop alternatives so that unwanted classroom behaviors decrease and academic performance improves. This qualitative case study used Roland Barthes' (1981, 1985) theory of semiotics as a conceptual framework for answering how an analysis of photographs taken by adolescent day treatment school students who have psychiatric disorders provide insight into the students' interests and perspectives. The photography of seven adolescent participants, who were placed in a day treatment school and involved in its photography elective, was found to have communicated their interests and perspectives. A semiotic analysis was conducted of the photographs they took, observation notes made at the time the photographs were taken, and questionnaires collecting their reflections on taking the photographs. Should school-wide photography programs be implemented in day treatment schools and in schools with similar student populations nationwide, those programs could generate more effective curricula informed by their students' interests and perspectives. This could lead to a larger percentage of their graduates becoming productive members of society, thus prompting positive social change.

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Thesis (MOccTher)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Background: The high number of mental health care users requiring care, the quick turnover in psychiatric hospitals and the scarcity of community-based mental health services are some of the factors that have led to a dramatic increase in the number of high frequency users of in-patient psychiatric services. In an attempt to address these issues, an occupational therapy-led day treatment centre was established at Stikland Hospital in the Western Cape province of South Africa. The aim of this study was to determine whether attendance at an occupational therapy-led community day treatment centre for mental health care users affects the use of in-patient services in the Western Cape Province of South Africa. Methods: A pre-test/post-test quasi-experimental study design was used to determine the benefits of the occupational therapy-led day treatment centre. Total population sampling was used. Forty four mental health care users participated in the study. The number of admissions and number of days spent in hospital before and after occupational therapy intervention were compared using statistical analysis. Results: The analysis showed a significant difference in the number of admissions (p = .00) and the number of days spent in hospital (p = .00) before and after the occupational therapy intervention. There was a decrease in the number of admissions of 62.3% after intervention. Twenty-five participants (56.8%) had fewer admissions after intervention than before. Total days spent in hospital for the group showed a decrease of 74.6% after intervention. Days spent in hospital became shorter by up to 7 months after occupational therapy intervention. This indicated a medium effect size (r = .436) for number of admissions and a large effect size (r = .504) for number of days spent in hospital after intervention. The frequency of attending the day treatment centre had no influence on number of admissions (p = .410) or on the number of days spent in hospital (p = .579) after intervention. Conclusion: The findings suggest that an occupational therapy-led day treatment centre is effective in reducing the use of in-patient services within the Western Cape, South Africa. In addition providing a range of opportunities for meaningful participation may be more important than the intensity of treatment when promoting recovery. / AFRIKAANSE OPSOMMING: Agtergrond: Die groot hoeveelhied persone wat psigiatriese sorg benodig, die vinnige omset in psigiatriese hospitale asook die tekort aan gemeenskaps psigiatriese dienste is van die faktore wat lei tot ‘n toename in persone wat gereëlde heropname benodig. As moontlike oplossing vir die probleem is ‘n dagbehandelingsentrum geopen by Stikland Hospitaal in die Wes-Kaap provinsie van Suid Afrika. Die doel van die studie was om vas te stel of ‘n dagbehandelingsentrum, onder leiding van ‘n arbeidsterapeut, effektief is in die Wes-Kaap provinsie van Suid Afrika vir persone met psigiatriese siektes. Metode: ‘n Voortoets-natoets kwasi-eksperimentele studie metode is gebruik om die voordele van ’n arbeidsterapie gedrewe dagbehandelingsentrum te bepaal. Totale bevolking steekproef is gebruik. Vier en veertig persone met ‘n psigiatriese diagnose het deelgeneem aan die studie. Die hoeveelheid opnames asook hoeveelheid dae spandeer in die hospitaal voor en na die arbeidsterapie intervensie is vergelyk. Resultate: Resultate het getoon dat daar ‘n beduidende verskil was tussen die hoeveelheid opnames (p = .00) en die hoeveelheid dae in die hospital (p = .00) voor en na arbeidsterapie intervensie. Die groep se hoeveelheid opnames het met 62.3% gedaal na intervensie. Vyf en twintig deelnemers (56.8%) het minder opnames gehad na intervensie as voor intervensie. Data toon ‘n medium effekgrootte (r = .436). Die totale dae in die hospitaal vir die groep het met 74.6% afgeneem na intervensie. Dae spandeer in die hospitaal het met tot 7maande verkort na arbeidsterapie intervensie. Dit toon‘n groot effekgrootte (r = .504). Die frekwensie van bywoning het geen invloed getoon op die hoeveelheid opnames (p = .410) of hoeveelheid dae in die hospitaal (p = .579) nie. Gevolgtrekking: Die studie het gevind dat, in die Wes-Kaap, ‘n arbeidsterapie gedrewe dagbehandelingsentrum ‘n effektiewe en uitvoerbare opsie is om die druk op binne-pasiënt dienste te verlig. Die studie het verder getoon dat betekenisvolle deelname aan aktiwiteite moontlik belangriker is vir herstel na ‘n psigiatriese siekte as intensiteit van behandeling.

Therapeutic Day Treatment (TDT) is a community-based mental health treatment program regulated and funded by the Department of Medical Assistance Services (DMAS) in the Commonwealth of Virginia. This case study sought to understand how DMAS regulatory changes impacted the implementation of the TDT program in the Commonwealth between fiscal years 2004 and 2011. In an effort to respond to this question, sources of qualitative and quantitative data were collected including: TDT fee-for-service data, regulations in the Community Mental Health and Rehabilitative Services manual guiding the implementation of the TDT program, and structured interviews with eight key stakeholders who interface with the TDT program. The fee-for-services analysis found that there was a 269% increase in fee-for-service expenditures between fiscal years 2007 and 2011. The analysis of the regulations found DMAS added language to provide greater clarity to the existing regulators. Some of these changes include the implementation of the PA process with KePRO as well as the VICAP process. Additionally, staff requirements changed and paraprofessionals were no longer able to provide TDT programming. Caseload limits were also set for TDT programming. Four themes emerged through the analysis of the structured interviews. These themes include: 1) fraudulent practices and misuse of TDT services, 2) regulatory oversight, 3) cost containment, and 4) evaluation. Implications focused on the areas of policy, practice, and research by suggesting further research studies focusing on TDT and policy, offering the foundation of a more comprehensive theory focusing on policy implementation, and lastly the researcher provided a logic model for the TDT program in an effort to propel evaluation research forward.

Promoting Alternative Thinking Strategies (PATHS) is an intervention program for children with behavioral and emotional deficits, designed for use, and shown to be effective when used in the classroom a minimum of 3 times per week. However, in some settings, as in the current study, PATHS is being used just once per week. The purpose of this quantitative study was to determine whether PATHS was beneficial in helping elementary school aged children improve their behavioral and emotional health when implemented once per week in a group therapy setting. PATHS was developed based on cognitive behavioral theory, which focuses on improving internalizing symptoms of mental health disorders (thoughts) as well as the externalizing symptoms (behaviors). A one-way, repeated measures ANOVA was utilized to analyze archival data of 193 scores, collected over a single school year. Results indicated that elementary school aged children who received PATHS once per week in a group setting showed a decrease in aggression and disruptive behaviors, and an increase in concentration and attention as well as social and emotional competence. Social change implications could involve the results of the study informing how we might promote overall emotional and behavioral well-being in children. At the organizational level, the expansion of the use of PATHS at reduced costs and time within other settings will extend these benefits to more children with behavioral and emotional deficits. Future studies are suggested to examine further the effectiveness of PATHS when implemented in other programs and alternative ways.

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The purpose of this study was to compare and measure the long term effectiveness of the rehabilitative day treatment program at San Bernardino County's Department of Mental Health. This current study was completed in 2005 and is a follow up study tracking the long term effectiveness of the program.