v gig: 5?: f: 2,, , 2;; I'r - , 9.."f_‘; ‘ ,3: ~-:.~.?'. ifft‘jrert _ ‘2' V1 ‘1'. V’- " o ‘, . T‘ Th1?!“ru‘f '.¢’ I *u s ‘v 9N», ) "l su¢m umm-rrm g ' l\\\\\\\\ \\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\\|u * 3 1293 10500 4547 NW 1V1£3I_] SETURNING MATERIALS: ace in book dro to LIBRARIES remove this checkgut from .—,—. your record. FINES will be charged if book is returned after the date stamped below. ‘ .I I. L'! v, - we iflfi A STUDY IN THE APPROPRIATENESS OF PATIENT REFERRALS TU UTHER STAFF, AND THE APPRMPRIATENESS OF USE UF SELF IN PATIENT'S TREATMENT PUNTIAC STATE HOSPITAL CHILDREI‘l'S PRUGRAM PONTIAC, M CHIGAN presented by Barbara A. Anderson MICHIGAN STATE UNIVERSITY East Lansing, Kichigan J.W. Heffernan Assistant Professor May 27, 1964 {mum \\\ e T 9 TABLE OF CU”"E"TS -‘u' UL} Pare outline.0000......0.00.00.00.00...0..OOOOOOOOIOOOOOCOOOO. ii Cliapter IOOOOOOOOOOO...00......OOOOCOOOOOOOOOOOOOOOOOOOO. l PUI'pOse and BaCkgI‘Ound50000000000coco-00000coo... Cllap’ter 1:00.000...0.0...0.0....0OOOOOOOOOOOOOOOOOOOOOOO. 14' A. COllCCtiOn and. .AflalySis of Dataooooooooooooo' B. RGSLIltS of the 3401161,]...OOOOOOOOOOOOOOOOOOO... 8 Cllapter IIIOOOOOOOOO0.0..OOOOOOOOOOOOOOOCOOOO00.0.0.0.... 12 Recommendations and. ApplicationSooo0000000000000. AppendiI'Cooooooooooooooooooooooo00000.0000000000000000...O 15 A. Appendix Aooooooooooooooooooooooooooococo-0.0 16 B. Appendj—X BOO0......O.OOOOOOOOOOOOOOOOOOOCOOOO %‘ .l ,r I _, _. . K. I r r',v'| ..~-- - BibliograEDE-EIYOOOOOOO...0..00......OOOOOOOOOOOOOOOOOOO0.... :P'IZ OUTLINE I. The introduction includes a description of the study and the forces behind it. A. The purpose of the study will be given. I. The study focus will be described. 2. The motivations behind the study will be stated. 3. The derivations of the study, which were hoped for, will be described. 8. Background material related to the study will be given and appended. II. The body includes a description of the research methodology and the findings of the study. A. The methodology of data collection will be described. B. The analysis of the data will be discussed. C. The results of the study will be discussed. III. The conclusion includes recommendations and applications of the findings of the study. A. Recommendations for a new study will be suggested. u)O B. Conclusions will be drawn for practical application of the study. IV. An Appendix will be added for elaboration of the project report. A. :Appendix "A": includes the Historical DevelOpment of the Children's Program. . :Appendix ”B": includes a copy of the Pontiac State Hospital Questionnaire used in the research project. V. A bibliography will be appended for further reference and elaboration of the study. CHAPTER I PURPOSE AND BACKGROUND The purpOSe of this study was to determine how one staff member used another staff member and how they used themselves within the Children's Program in the Pontiac State Hospital, Pontiac, Michigan. Factors such as jOb class, education, training, experience and background factors were to be associated with the staff member's ability to make apprOpriate referrals to other staff and to themselves. The study served as an evaluative study of one aspect of the Children's PrOgram, as it is now in Operation, and the entire staff of the Program, employed under the State of Kichigan Civil Service COde, was canvassed by questionnaire. The aspect evaluated was that of the staff members' tendencies to make use Of other staff and themselves in providing treatment methods and techniques for the mentally ill child. The reSpondents were compared on the basis of questions concerning patients and staff. The study was motivated by the belief that precise treat— ment methods and techniques used with mentally ill or emotionalLy disturbed children are expedited by staff members who have a thorough understanding and working knowledge of their own and other staff members' reles. By providing a current picture of how staff members see the utilization of other staff members and how they see themselves involved in obtaining treatment for patients -2- in the Children's Program at Pontiac State Hospital it was hOped that the staff would be enabled to more effectively utilize appropriate services for more effective treatment of the individual child. Secondary to the major focus of the study were observations concerning the staffs' feelings about inservice training programs and the 'team' approach in the Hospital setting. This information was meant to provide general consensus of opinions and was not analytically oriented. The future of the Children's PrOgram is challenging and stimulating when one thinks in terms of how slowly it has deveIOped and what giant steps it seems to be taking in recent years. Throughout the history of the institution, children have been housed on adult wards and no special facilities or programs were designated for them. Staff were assigned to treatment plans for both children and adults. But with the establishment of the Children's PrOgram, about two (2) years ago, a gradual separation of duty assignments and hospital facilities has been made, and when the new multi-unit building is constructed about three (3) years hence, the children's facilities and staff will be quite separate. This seems to make it extremely important that the Children's Program be scrutinized from many different aspects now, and within the next three years, to help achieve maximum prOgram effectiveness. The historical development 0f the Children's PrOgram is indeed interesting and it has been appended for the interest and information of the reader. (See Appendix). -3- Opinions as to how staff should go about treating the mentally ill and emotionally disturbed are diverse, from a 'team' approach consisting of a psychiatrist, psychologist and a social worker; to a nursing approach which states that nursing is the hub of patient care and thus treatment is channeled through them in a nursing team approach; to a 'unified team' approach, involving all staff groups including such examples Of groups as psychiatrists, social workers, psychologists, nursing staff, occupational and recreational therapists, as well as the teaching staff and other groups}’ 'Other' groups consist of such peOple as volunteers, etc. The staff of the Pontiac State Hospital Children's PrOgram appear to be engaged in treatment from the 'unified team' approach methOd, since all staff groups are engaged in various degrees 0f activities and routines with the patients included in the prOgram. However it was questioned as to how each staff member saw other staff, including themselves, being used in the program as a part Of the clinical course Of treatment for the individual patient. lKathleen Cliggett, "Nursing Staff Functions in a Treatment Setting," Journal of the Hillside Hogpital, X, No. 1-2, (April 1961), pp. 88-93. See by other authors: Jules D. Helzberg, "The Historical Traditions 0f the State Hospital as a Force 0f Resistance to the Team," American Journal Of CrthOpsychiatny, XXX, No. l, (1960), pp. 88-94. Robert L. Kahn, "Staff Attitudes Toward Psychiatric Treatment in a VOluntary Hospital," Journal Of the Hillside Hospital, X, No. 2 (April 1961), pp. 97-106. JOhn Hann, "Studies Of Role Performance," Genetic PsychOlogical HonOgraphs, N0. 64, (1961), pp. 220-279. Nicholas E. Stratas and K.T. Schmidt, "A Children's Unit in a State Hospital," American Journal Of ngchiatry, V01. 11?, (July 1960) pp. 34—36. Angie F. Waldrum and G.L. Jones, "Present Day Concepts in Nursing Service Administration in Hospitals for the Mentally Ill," American Journal Of Pgrchiatry, V01. 117, (OctOber 1960) Pp- 329-335- -4- The better a staff member could make apprOpriate referrals, (that is "set apart for, and assign tO, a particular person"2), patients with whom they actually worked, Or with whom they might be ex- pected to work, the quicker a particular child would get well. CHAPTER II HOW THE RESEARCH WAS DUKE AND HE RESULTS A. COllectiOn and Analysis Of Data A questionnaire was distributed to the staff after it was pre-tested and revised. The questionnaire was delimited to certain questions in order to focus on the study question more precisely, and the data page was revised to some extent. Although the study repOrts to have surveyed the entire staff of the Children's PrOgram there were some groups, Or classes Of peOple who were not included in the survey. The 'staff' was defined as all staff employed by the Pontiac State Hospital who had.Hichigan State Civil Service status, and who were associated with the Children's PrOgram in sOme capacity. This definition excluded such groups as VOlunteers, students in training at the Hospital (including thOSe in psychOlogy, social work, teaching-special education, occupational therapy, Or nursing), Or Others associated with the Children's PrOgram but not having Civil Service status. COOperation among the staff in completing the questionnaires, and returning them prOmptly seemed very gOOd and no follow-up appeared to be necessary. 2 , webster's New COllegiate Dictionary,(Springfield, Kass: G. c. I-Ierriam COmpany,) Second Edition, (19597, pg. 53. -5- The rate Of return On the questionnaires was 74 per cent, that is, 45 Of the 61 staff included in the universe. Forty-four (44) Of the 45 questionnaires were used for tabulating purposes since one (1) Of the forms was returned with a blank data page and the information was judged meaningless without it. The questions themselves ranged into four categOries Of infOrmation: 1) General Observations concerning the pOsitive or negative feelings concerning the broad overall Operational goals such as feelings about whether or not the 'team' approach existed, or if feelings about staff meetings were differential, and what attitudes were concerning in-service training prOgrams; 2) Particular patients now inVOlved in the prOgram Of treatment were sighted as examples for which the respondent was to choose a 'team' Of not more then three staff members to work with each Othhem; 3) Each jOb classification fOund within the Children's PrOgram was listed to determine knowledge 0f minimum basic requirements, needed by a staff member to begin the jOb listed, regardless Of the respondents Own jOb class; 4) Education, experience, and background factors were asked to help formulate a picture frOm which answers in particular cases or groups might justify certain responses. This approach was suggested thrOugh the writings Of Ronald Taft who studied the ability 0f peOple to 3 make accurate analytic judgements about their peers. He found 3Rona1d Taft, "A Study of Some Characteristics of GOOd Judges of Others," British J0urna1 Of PsychOIng, V01. 47, (1956), pp. 19-29. -6- this ability to have a positive correlation with certain background factOrs such as urban origin, previous working experience, sibling and orientation to either the natural or SOCial sciences. The returned questionnaires were initially tabulated on raw data sheets and pertinent infOrmatiOn frOm the variOus cate- gories was assigned to statistical tables. The statistical test for significance, using the methOd 0f chi square, was made between the jOb classifications and their ability to make apprOpriate referrals. Table l demOnstrates the data used in the chi square test fOr associatiOn and the result was thattthere was no significant association between position and appropriateness of referral. (See next page). After c103ely scrutinizing the remaining data it appeared there would be no statistical tests Of signficance 0r correlations which wOuld be significant. There was little variation between either individuals 0r grOups in terms Of how successfully they responded to the questions or in terms 0f the information on the data sheets. That is, there were so many respondents who fell into the same educatiOn and experience categories that very little discriminatiOn could be made by statistical methOds. Added to this factOr was the small variation in the core data -- apprOpriateness 0f referrals -- that no inferences could be drawn concerning the relationships between the factOrs Of educatiOn, experience, background, knowledge of job requirements, and apprOpriateness of referrals. TABLE I ASSOCIATION BETWEEN JVB CLASS THE Attendant Nurses (19 RespOndents) Nurse (5 Respondents) Occupational Therapists (2 Respondents) Psychologists (2 Respondents) Psychiatrists (3 Respondents) RecreatiOnal Therapists (4 Respondents) Social Workers (3 RespOndents) Teachers (6 Respondents) AHD 233R 9? APPROPRIATE REFERRALS Appropriate (InapprOpriate 136 204 48 56 19 17 13 11 28 25 43 46 28 31 51+ 54 369 w. X2 = 8 D a L 0.50 104 36 24 53 108 (Y) }__1 \O B. Results of the tudg Some interesting observatiOns were made in the study which have implicatiOns for certain program recOmmendatiOns. A high consensus of opinion was expressed among the staff on all questions, regardless of the nature of the question. Figure 1 illustrates the findings of the first five questions concerning broad and general attitudes towards the Program. The Bar Chart demonstrates that 35 out of the 43 people who responded indicated that they felt the staff of the Children's Program works in a team effort to restore patients to mental health. Thirty-two (32) people indicated they felt that the 'team' approach does work effectively in practice, while eleven (11) did not. All but one group, for the most part, indicated they did attend staff meetings; the group which had a significant number of people who responded that they did not attend staff meetings were the Attendant Nurses, who had fifteen (15) out of nineteen (l9) respond negatively. The reason given most often, for non-attendence to staff meetings, was that of "not being asked" to attend. The sample universe, taken by individual was almost evenly dividEd into three major groups in their opinions about the number of staff meefings: Sixteen (16) felt there were not (enough staff meetings; eleven (11) felt there were enough; and twelve (12) were uncertain as to how they felt about the number of staff meetings. A fourth;é&35group, consisting of three (3) people indicated they were of the opinion that there were too many staff meetings. There was a complete consensus of Opinion (100%), about staff meetings being helpful in the sharing of information” "THE CHAMPION LINE" NO CROSS SFCTION - IO SOU BIO-3 ARES TO INCH ............ ’buestion‘ E #2. .I . I I I “W““Izuegtion 7 i I V... .-.._..W_ -_. I I I I I ___i1_ 1 Question I t. NmtBER or s ,., . I , 1 ? m, TAFFiRESPoMS ...... . , . . o 7 . . . . . I . . . ....... .._._.__. —I ..._.—,. .._ w -_...‘_._._.. ..—.--.-‘—o ..... _ _.L.w‘__,.a—-u—_—4~ ..---—-. ._.. —_—._-__ __1,_-—._.- I I I U“M%§§)‘ Encartaan) , (Strong And H1I§ ree Agree) I 'l I ‘I A I ‘ O ‘ I q ' '. s I I 1 E I .I I « I I_— I— . ; l : g I I I I I . I . I . I i. I I l 1 ’ I I I I I ' fl»... I -10. about patients, but this was expected. There were forty-two (42) of the staff who said they strongly agreed or mildly agreed that there should be an 'In-service Training Program'. Two (2) staff disagreed with this opinion. It can be seen from Figure 1, that positive responses to all questions predominated. Figure 2 illustrates the staff's overall knowledge of job requirements concerning the various types of positions included in the Children’s Program. Information concerning the requirements for these jobs was derived from the Personnel Office, Pontiac State Hospital, in their 'Job Description' file. The two (2) positions most well known as to education and experience requirements were those of the Registered Nurse, called Graduate Nurse, and Psychiatrist, with a third position close behind, that of the Special Education Teacher. The positions which were least well known in regards to qualifications were Attendant Nurse and Occupational Therapist. The Attendant Nurse was most often over- rated in terms of education. There are no educational requirements for this position, or the position of Nursing Service Supervisor. The two (2) positions differ in respect to the latter position, Nursing Service Supervisor which requires particular experience. On the other hand, the Occupational Therapist, as Figure 2 demonstrates, was the most often under-rated position in regards to education and experience requirements, with the position of Clinical Social Worker following fairly close behind. "THE CHAMPIO‘I LINE-" .N‘C) (Hid) SECTION -1v’» SQUAHLU '5) Mn“)! -11- KNOWLEDGE 0F JOB REQUIREIENTS .K.. If I ....... I . ' 1* 1-? :f:::i:::: ,.Li. .1 EIoUmzz; 'I;:,',‘;“ iiiilil ........... . ,. ... .n-rTr-— ,. . - . 1:41-, .. é I WEE on REBSPPNISES BILSIIAFF:,L,,';,,,;-‘ $114-4; _ ........ . . .I ... ,, L-..'-..Ili.. 1., ...... , .. ..§. . 10. ..I.. ..I0 ....... IO 1.... 1.40 ........ TT’ ....... Nursing.5erffce ’7 ‘.ii: fT‘SUPoI'ViSPI‘iQIQ iTILj'L" L ‘ ' Attendant NTrse /., .. ii Iiili’ , I II :IIII ‘ H ”""'Ilicensed"Praotical" I Nurse _ g = .IRegistered Nurse - I ...... '" "oEcupat"onal Therapis ...... 1 .. , ‘ . . . ... I LLLIIf Z ..... fII. . .. I i ...l ......... II 1 ¥. . .. Arts & Craf s. .. ..1... . ... -"';I -.. .. .EInstmctor!.. ......... —_ ..... i H IPsychologis ..... . I (Psychomet st) "' ‘“ ..fi LIIIT . ..... . , . ,, I .I Psychiatris . III IIIIII ‘; . . ' . . - Q h] - i .................... 1 3 Psychiatric Resident ._ "III ,I . .......... ‘ 1 IIII iii . I ............. I RecreationalITherap1st ........... .' I.. ' ._ ‘ ........ ,. I I ........ . I .‘Recreationalilnstructor .. ..I. I ..... g 1 """ " 'i Iiffi ""' .k .L. - .............. .,.iI linical Soci a1 workerI .... ..... ILIf IIIL, _.. , . I , . IITIT III II: IIIIII II ISpeEial Edufation I .[S'upemisor‘ ............ ,. ..I ., I , I .. , ...... Spec1al Education . “;::: ;;; (Teacher).iI :::"“ ":1::: ;::t:::" ChildITheribIE ’ 'II“ ’ I (Teacher). ' _. ,..., "III ......... I I - ...... ‘IKn wledgeI'II .Ov r—estimate edge ~ -12- Occupational Therapists require five (5) years of higher education and training and Social Workers require six (6) years of college and field experience. Six years of experience was the average amount of experience which staff members had had in the field of their work Or related job experience. Although the average length of experience was six (6) years, it is also significant to point out that half of the staff members fell below four (4) years experience. The average educational level for staff members fell at the three (3) year higher educational level, while half the staff fell above the four (h) year college level. In terms of numbers it was possible to break the staff into thirds, one-third fell at the twelth grade level or below, the second third fell into the one to four year college group, and the last third fell into the bracket of having five years to seventeen (17) years of higher education and training. Background and income facters were not tabulated because this information was purposeful in providing a rationali- ation for certain answers given on the questionnaire. Because the data to which these factors were to be correlated had no significance for research findings there seemed to be little value in summarizing it. CHAPTER III RECOMMENDATIONS AXD APPLICATIONS To repeat the study with more discrimination, it is suggested that questions geared toward selection of staff to work with patients be focused more sharply toward specific functions . ji“ 4'1v/L'r'1j-‘va' "r-- /"' . .2 Al“- _‘~'I I' i ' "’- I I Of particular jOb classes.} In evaluating questions asked on this -13- particular questionnaire there were several Observations made for improvements: there was a significant lack 0f clarity on the directiOns fOr certain questiOns evidenced by the lack 0f adequate respOnse 0r inapprOpriate respOnses. In attempting to draw discriminatiOns from the respOndents in making staff assignments to particular patients, it is suspected that better response would have been obtained if staff functions had been clearer to the respondent. Part of the difficulty in choosing the apprOpriate staff person might be alleviated by describing the patient briefly and then choosing one characteristic Of the patient to be worked with by a staff person the respondent chOOSes. It is also suggested that observatiOns be made on an inter-disciplinary peer basis, so that correlations between job classes may be more discrimiating. QuestiOns could be more narrOwly f0cused on finer points of diagnosis and referral; or patient prOblems and their handling or referral. In addition to these suggestions the questiOnnaire included in this repOrt (See Appendix), pOints Out sOme significant problems in scoring, which w0uld need to be mini- mized in another study. For example, the respondent did not follow directiOns for question number six (6), and he made more then the desired or asked for number of responses. And in question number seven (7) there were some indefinite replies. For example, the question-mark response on the item "Arts & Crafts Instructor" leads one to believeTthe respondent wasn't sure if it required over or under the high school level of education in addition to _14- the required work experience. This lowers the accuraqy of the scoring technique. There are several suggestions to be made as a result of indications derived from this study, which can be practically applied to the program as it is now in Operation. SOme inter- departmental cOmmunications both up and down cOuld be implemented to increase staff knowledge COncerning qualifications Of Other staff to ensure effective use of each other. Seminars and in- service training programs are viewed positive1y by staff and a follow-up On the kinds of programs suitable should be done. Evaluations Of other aspects Of the Children's PrOgram shOuld fOllow up this study to ensure effective utilizatiOn Of the new facilities to be built soon. Areas such as staff communications to other staff shOuld be explOred; policies concerning rules and regulatiOns regarding the staff's handling of children, and regarding their behavior should be explored in terms of consistency and degree of enforcement desirable, to clarify staff roles and increase communication and cooperation among staff; in addition to these it might be helpful to evaluate the program from the viewpoint of the patients in terms of enabling staff to focus more precisely on treatment methods and techniques. Some considera- tions and follow-up should be made in the area of whether or not Attendant Nurses, including afternoon and night shifts should be included in staff meetings and In-Service Training Programs. The most positive aspect of the entire study seems to be the 'finding' of such a high degree of cooperation from the s-aff to participate in an evaluative study and respond so well. ~16- HISTORICAL DEVELOPI-EI‘I OF Tim CHILDREN'S PRoch-z PUNTIAC STATE HUSPITAL In the 1962-1963 Pontiac State Hospital Program Statement its%m: ' "In 1878, the Pontiac State Hospital was established for the care and treatment of the mentalb'ill...By 1911, something more than custodial care was deemed advisable for the mentally ill." J . Facilities were enlarged and a degree of emphaSis was placed upon treatment of the mentally ill. The hospital was also renamed. The first name given the hospital was Eastern Michigan Asylum and its new name was Pontiac State Hospital. Throughout the history of the institution children have been housed on adult wards and no special facilities or programs were designated for them. According'b the severity of the disturbance and nature of their illness they were placed on relatively confortabie wards or on disturbed wards. Prior to the actual establishment of the Chidren's Program at Pontiac State Hospital, the staff were assigned to treatment plans of both children and adults. With the establishment of the program a gradual separation of duty assignments have been made. Some change in living arrangements have been made in that there is now one ward where only boys under 18 years of age are assigned and another where both boys under 18 years of age and adult patients are housed. Some sorting out of girls under 18 has been done, but there are no wards specifically designated for them. The Children's Program originated about two (2) years ago and it is set up to handle about eighty (80) children under the age of eighteen (18) years of age. The unit has its own director, a psychiatristfwho has had prior expeience in working with children. Several types of staff meetinfs are held in which the only patients considered are the children, including admisssions staff (when a child is first admitted to the EOSpital he is diagnosed in this staff; ) school staff in whieh behavior problems as well as academic problems are resolved; and special staffs are held to discuss behavior and treatment problems and progress of the chfldren. The development of the program as a separate unit from the adult program has been slow and a tedious process, but the future appears somewhat brighter in terms of the possibilities for progress and planning for treatment and handling of the emotionally disturbed youth. APPENDIX B s‘" } -17- PONTIAC STATE HOSPITAL RESEARCH PROJECT Introduction Periodically it is helpful to evaluate HOSpital programs from many different aSpects. It is especially important, since the Children's Program is relatively new, that we pause for a moment and look at the program's Operation from many different viewpoints. Your help is essentially necessary in making an adequate and helpful evaluation of the Program in Operation. To View the overall functioning of the Program from one aSpect, which might be helpful to us, other staff, and yourself, we would like to have your vieWpoints and opinions. You are urged to do your best in answering this questionnaire because it is an evaluation of the Program's functioning from the staff's viewpoint; however, you may not be able to answer all the questions as well as you might like to. In a study such as this it is extremely important for you to express your true Opinions and not what you feel is "wanted." THERE ARE NO RIGHT OR WRONG ANSWERS. Please do not Show your questionnaire to anyone or talk about it until after you have returned it. The infor- mation is confidential and will not be discussed with anyone. If you have any questions regarding any of the items please feel free to call: Barbara Anderson, extension 260, on Wednesday, Thursday, or Friday. The findings of this study will be available in the Pontiac State HOSpital Medical Library for your information and interest when it has been written into a paper (about June, 1964). May we express our appreciation to each of you for your COOperation in completing and returning the ques- tionnaire, and for taking Special part in this research project. RETURN TO: Dr. Alatur Attention: Barbara Anderson Social Service Department PLEASE RETURN THIS FORM AS SOON AS POSSIBLE AND NO LATER THAN MAY 6, 196A W36: “18' /}/L20 * (3L4 ¥ \ PONTIAC STATE HOSPITAL PROGRAM OPERATION'S QUESTIONNAIRE DIRECTIONS: Although it is difficult to answer all questions "yes‘r orVno,” we would like you to check one or the other. Specific directions for some questions are included where they are needed. We would also appreciate any comments you may wish to add in explaining your answers or concerning any- thing which was not clear to you. NOTE: All references to ”patients” concern only children in the Children's Program. 1. a. The staff of the Children's Program works in a team effort to help the patients become mentally healthy. 94 yes no b. Do you think the team idea works effectively in practice? §$~ yes no 2. Staff meetings are helpful to bring about the sharing of information about patients. ET“ yes no 3. Do you attend any staff meetings? UK yes no 4. Would you say the number of staff meetings are: too many EA. enough too few uncertain -19- ,//' Pontiac State Hospital Questionnaire 2 5. An "In—Service Training Program" would be helpful. I strongly agree I mildly agree I mildly disagree I strongly disagree ‘Ok Uncertain CN§L ‘ 95b --+\ Using the following patients as example , please eck the types of staff members, who in your Opinion could work best, or most apprOpriately with them. 23y.£2.bg realistic in terms 9: the staff now assigned £2,222 Children's Program and try to choose staff members who might actually be assigned to the individual or who might, for the most part, be most helpful in working with the child. Using the following choices (select not more than 3 staff members), list the degree Of intensity which you feel is warranted: l..Work closely with the patient on an individual basis. ‘2..Work with the patient's behavior or acting out problems. 3..Work with the patient in a group, or group activity. 03 A 13 year Old boy has the following characteristics: ) He is quiet and passive, becomes moody and disagreeable. ) He is quite hostile to parental or authoritative figures. ' ) He has a history of repeated incidents of break- ing and entering private homes. ) He enjoys playing a musical instrument—-the clarinet. ) He completed the fifth grade and has low average intelligence. ) He is hostile towards female nurses and it is known that he resents and feels hostile towards his step-mother--”she never let's his father get close to him." 3-.Q Attendant Nurse Psychologist Practical Nurse 1 5 Psychiatrist Medical Doctor § Recreational Therapist Nurse (R.N.) Social Worker Occupational Therapist Teacher -20- Pontiac State Hospital 3 Questionnaire 6. l..Work closely with the patient on an individual basis. 2..Work with the patient's behavior or acting out problems. 3..Work with the patient in a group, or group activity. b. An ll year old girl has the following characteristics: (1) She is moderately mentally retarded. She feeds and dresses herself. (2) She is friendly towards everyone but becomes extremely aggressive in a hostile way towards these same people; she is easily frustrated. (3) She appears to be shy and does not enter' many activities. (A) She is overly active and much of the time can't sit still. 5) She attended ungraded-Special education classes. 6) Her vision is normal but she has trouble focusing on objects. Attendant Nurse Psychologist \- 2i Practical Nurse '§ § Psychiatrist _Medical Doctor Recreational Therapist g ——Nurse (R.N.) '——-—Social Worker Occupational Therapist Teacher c. A l6 year old boy has the following characteristics: (1) He experiences no deep emotional reactions or feelings. 2 He does not seem to profit from experience. 33 He has no regard for laws or social standards. A He makes no close friends and forms no close relationships. (5) He completed the 10th grade in school, seems to have a high normal level of intelligence. (6) He appears aloof and withdrawn, at least he seems wrapped up in his thoughts. \-:l Attendant Nurse Psychologist Practical Nurse Psychiatrist Medical Doctor j; Recreational Therapist Nurse (R.N ) Social Worker Occupational Therapist Teacher d. A 12 year Old patient, diagnosed in the Court Commit- ment papers as schiZOphrenic is newly admitted to the ward. During the first two weeks which staff members would work with the patient? \-2~{3Attendant Nurse Psychologist {2E§:§Practical Nurse Psychiatrist Medical Doctor Recreational Therapist Nurse (R.N.) Social Worker ‘V\) A -21.. Pontiac State HOSpital A Questionnaire 6. l..Work closely with the patient on an individual basis. 2..Work with the patient's behavior or acting out problems. 3..Work with the patient in a group, or group activity. f. A 17 year Old girl has the following characteristics: (1) She seems to be clear and logical in her thinking but has strong fears about ”getting fat." She is overly concerned with her menstrual period. (2) She is extremely thin due to her refusal to eat, although she hoards food on the sly. (3) At meal time she will threw her food away, because "her mother used to stare at her during meals.” éhg She has temper tantrums. 5 She completed the 11th grade. 6 She constantly reads books on how to control her weight. Attendant Nurse Psychologist \..g IWectical Nurse Psychiatrist Medical Doctor fig Recreational Therapist Nurse (R.N.) Social Worker Occupational Therapist Teacher A l5 year old girl has the following characteristics: 1) She behaves in a COOperative manner. 2) She periodically becomes quite depressed when upset and has suicidal tendencies. (3) She has difficulties in forming apprOpriate relationships with men, especially in the area of sexual relationships. (A) She periodically becomes silly, laughs hysterically, and seems to be unconcerned about anything. (5) She completed the 7th grade and has average intelligence. (6) She is suSpicious of women and feels she cannot trust them, but she can trust men. Attendant Nurse Psychologist Q 3-.g Practical Nurse Psychiatrist Medical Doctor E Recreational Therapist S-§Nurse (R.N.) Social Worker Occupational Therapist Teacher Pontiac State HOSpital n )\ (1o \Tl Questionnaire 7. Please indicate, as nearly as possible, what you feel are the general requirements for the following job classifi— cations, by checking the proper blanks as provided: Attendant Nurse a. Nursing Service Supervisor Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. 2 years (or less) Higher Education and/or Training. A year College Degree. Graduate Education beyond a College Degree. How many years . IHII b. Attendant Nurse Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. 2 years(or less) Higher Education and/or Training. A year College Degree. Graduate Education beyond a College Degree. How many years . HHI Practical Nurse t Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. 2 years (or less) Higher Education and/or Training. A year College Degree. Graduate Education beyond a College Degree. How many years . Medical Doctor a. Psychiatrist 7< 'Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. 2 years (or less) Higher Education and/or Training. A year College Degree. 2 Graduate Education beyond a College Degree. HOW many years . -23- Pontiac State Hospital 6 Questionnaire Nurse (R.N.) a. Graduate Nurse :1 Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. 2 years (or less) Higher Education and/or Training. 4 year College Degree. Graduate Education beyond a College Degree. How many years . IH‘H Occupational Therapist a. Occupational Therapist \\ Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. :g 2 years (or less) Higher Education and/or Training. ' A year College Degree. Graduate Education beyond a College Degree. How many years Arts and Crafts Instructor 3 'Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. 2 years (or less) Higher Education and/or Training. A year College Degree. Graduate Education beyond a College Degree. How many years . Hill Psychologist a. Psychometrist Z: Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. 2 years (or less) Higher Education and/or Training. A year College Degree. 2 Graduate Education beyond a College Degree. HOW many years Ag u.ukg “\e-nttly ‘—£E“‘ \ Pontiac State HOSpital 7 Questionnaire Psychiatrist a. Psychiatrist Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. A year College Degree. Graduate Education beyond a College Degree. ‘ How many years . b. Psychiatric Resident Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. 4 year College Degree. 2 Graduate Education beyond a College Degree. How many years . Recreational Therapist a. Recreational Therapist \( Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). §£ High School Diploma. 2 years (or less) Higher Education and/or Training. A year College Degree. Graduate Education beyond a College Degree. How many years . b. Recreational Instructor 5 lflork experience beyond required level of education, necessary to begin job. 8th Grade (or less). A year College Degree. Graduate Education beyond a College Degree. How many years . High School Diploma. *i 2 years (or less) Higher Education and/or Training. 2 years (or less) Higher Education and/or Training. 2 years (or less) Higher Education and/or Training. 6 5-5;) -25- I -9/ Pontiac State Hospital 8 Questionnaire Social Worker a. Clinical Social Worker :X Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. 2 years (or less) Higher Education and/or Training. A year College Degree. 3 Graduate Education beyond a College Degree. ' How many years . Teacher 8. Special Education Supervisor Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. 2 years (or less) Higher Education and/or Training. A year College Degree. 3 Graduate Education beyond a College Degree. How many years 1 Special Education Teacher \K WOrk experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. 2 years (or less) Higher Education and/or Training. A year College Degree. Graduate Education beyond a College Degree. How many years . EHIH Therapist Work experience beyond required level of education, necessary to begin job. 8th Grade (or less). High School Diploma. 2 years (or less) Higher Education and/or Training. A year College Degree. Z Graduate Education beyond a College Degree. How many years . Hi -26- PONTIAC STATE HOSPITAL DATA QUESTIONNAIRE Although we do not want your name on this questionnaire, we would like to have some relevant data concerning your position (job title) to help in tabulating the information you have so kindly contributed. POSITION (Job) TITLE: HOW long have you worked in your kind of work or had similar experience? years. How long have you worked in your present job classification? ' years. ’ ' " ‘. i How long have you worked with the Children's Program? years. FORMAL EDUCATION OR SPECIAL TRAINING: Check the appropriate blanks as they apply to you. 8th Grade or less Years of High School Years of Higher Education or Special Training As a Pontiac State HOSpital Staff member do you also have some connection of work assignments with the Adult Program as well as the Children's Program? yes no _— What did your father do for a living What was your father's income (or wage)? Were you raised: on a farm in a rural area in a suburban area in the city Your COOperation in this study is most appreciated. Please return this form to: Dr. Alatur Attn: Barbara Anderson THANK YOU -27- BIBLIOGRAPHY Books Hall, C.S., and Lindzey, G. Theories of Personality. New'Yomx: EIIile‘ ’ 1957’ pg. Viiio . Webster's New Collegiate Dictionary. Springfield, Kass.: G.C. Merriam Co. Second Edition, 1959. LES ND PERIODICALS Cliggett, Kathleen. "Nursing Staff Functions in a Treatment Setting." Journal of the Hillside Hospital. X. No. l-2. (April 19617. 88-93. Holzberg, Jules De. "The Historical Traditions Of the State Hospital as a Force Of Resistance to the Team." American Journal of Orthopsychatgy. XXX. NO. 1 (1960). 88-9o. Kahn, RObert L. "Staff Attitudes T0ward Psychiatric Treatment in a Voluntary Hospital." JOurnal of the Hillside HoSpital. x. NO. 2. (April 1961). 97-1061 Mann, John. "Studies of Role Performance." Genetic Psychological Honographs, No. 64. (1961). 220—279. Stratas, Nicholas E. and Schmidt, K.T. "A Children's Unit in a State Hospital." American Journal of Psychiatry. v01. 117. (July 19607T*3A-36. Taft, Ronald. "A Study of Some Characteristics of Good Judges of Others." British Journal of Psychology. No. 47. (1956). 19-29. waldrum, Angie F. and Jones, G.L. "Present Day Concepts in Nursing Service Administration in Hospitals for the Rentally Ill." American Journal of Psychiatry. Vol. 117. (Oct. 1960). 329-335-