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PLACE ll RETURN BOX to roman this checkout from your record.
TO AVOID FINES Mum on or bdon dd. duo.

DATE DUE DATE DUE DATE DUE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

MSU Is An Afflrm‘tlvo Action/Equal Opponunny Institution
Wanna-m

 

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m mmamom STUDY 01" TH" RILAII ans-HIP Rama-m
socmx. smmce: Pun-mm: m3 TRIAL VISIT
mmnmm op ”Trams AT VIII-2. m
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by

Oscar Cecil Parker
A PROECT REPORT

Submitted to the School or Social Work
fiichigan Stata university
in Partial Fulfillment of the
Requiraments for the Degree
of

MSSTER OF SOCIAL'WORK

Approved:

    

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Wfié’éwwr of‘szzhool ‘ “‘

 

ACKNOWLEDGMENTS

The triter wishes to express his sincere appreciation
for the lid and encouragement given him by Dr. H; Bruck in
tho writing of this project. fippreciation is also duo
Mr. A. Gurin and Mr; H. Gluckin for thoir valuable aseis~
tancc and suggestions.

Grateful acknowledgment is also extended to the entire
staff of the Battle Creek veterans Administration Hospital
for their cooperation in the project. fipprociation is
expecially extended to Hr. T. Blakely of tho Trial‘Viait
Statistical section for his help and encouragement. My
most sincere thanks goes to Mrs. Jewel S. Barry, Hrs.
Hargrurito Douglas of the Registrar's Office, and Miss Ann
l“ Boll the Closed File Section for assisting the writer in

loathing the necessary records for this project.

11

TEBLE OF CONTENTS

ACKEOWLEDGMERTS¢ c , a e c . . o .
LIST OF TLBLES . I . . ¢ . . . . .

Chapter
1. PURPOSE PHD BfiCKGROUND OF STUDY 0
Trial Visit. 0 c o‘ o c c
The PPOblema o I c I
II. REVIEW OF THE LIngfi 333 . . ¢
III. FRIED}? OF STUDY 0 c o 9 c c
IV} PRESENTfiTION AND fiNALYSIS OF DATA
The Findings . . . . . .
Dig-8110313 o o I c o c O
Lengt of Hospitalization . .
Status Of Admission n o O o
Marital StatuS. c o. c c 1!
A33 0 a c o a o o o 0
'V. CONCLUSIOHS.' . . . . . . .
fiPPENDIX . o o . c o c c c o o o
BIBLIOGRAPM. o o o c c o a o o o

111

mkm H

11
13
1

16
17

20
23
2%

33

wars
1.

2.

3.

9.

10.

11.

LIST OF TABLES

Comparison of Number of Patients on Trial

V1311; StatU-Sa o c a c 0

Diagnosis of Patients Who Stayos Out and

Patients Who Returned. . 0

Diagnosis of Patients Who Received or Did

not Receive Social Service

Length of Hospitalization of Patients Who‘

0

O

O

reparation .

Returned and Patients Who Stayed Out.

Status of Admission of Patients Who Stayed

Out and Patients Who Returned .

Status of fidmission of Those Patients Who‘
Received or Did Not Receive Social

Service Preparation -. . .

Experience of Committed Patients on Trial
Visit in Relation to Social Service-

Preparation 0 c o 'c o 0

Marital Status of Patients who Stayed Out

and Patients Who Returned .

Marital Status of Patients We Did or Did
Not Receive Preparation by Social Service

Age of Patients Who Stayed and Patients Who

Returned . . . . . . .

Age of Patients Who Did or Did Not Receive

Social Service Preparation .

iv

0

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13

1h

15

16

17

18

18

19

20

22

Cfi-‘PTSR 1’.
PURPOSE ABE) BACI‘TGROUID 0F STE?

This was sn excloratory study of the relationship
between social. service planning and trial visit comment
at 'Vctcrtnn Minietration Hospital. Battle Creek. fliohixcn.
It was in sttonpt to investigate whether prcpmtion for
trill visit by Social Service is s. factor mien contribute:
positively to I patient's trial visit adjustment. Trial
visit an ken defined as "the status of s patient rm- c
nempsycbistrio hospital who is at home. or in the emu
it: for the purpose of determining his adjustability to
living outside the hospital.“

The hospital in I 2,055 had neuropeychiitric tmstnent
cantor loostcd at Fort Custer, approximately six miles west
of Battlo Crock, nichigan. Social Service is composed of
s Chief. an Assistant Chief who is also Supervisor of
Student Training Program. Supervisor of Continuous Treat-
moat, Supervisor of Acute Intensive Treatment, Supervisor
of Funny Cm Program, six professionally trained social
workers, and graduate social work students from Atlanta
Univeraity, lichigan State University, and the University

__..__. ___._ #
——rv W

J‘V‘oto'mnc fidfigietgation Technical limitiretinJL T34010-
5. may 1. IWT‘ISW fivendix E]. ‘ "

1

 

ot’flichisan. Social workers participate in treatment on
all wards, in diagnostic staff conferences, and in the
work-up of cases considered by tho Family Care Screening
Boar-é, and the Trial Visit Board.

In thb student training and staff fiovelopmont pro-
grams thorn are special educational lectures and collabor-
ation with other agencies on profesoional matters. These
are supplemented by staff case presentations as well as
by visits to other agencies. Th5 Department has I soplrate
library operated in conjunction with the hoapital library
to obtain current books and literature. Recently. in
order to lend support to staff'mombers, a research program
was instituted in collaboration with the Psychology Dopart-
ment.

The team approaoh of psychiatrist, psychologist. and
social worker is utilized. The Social Service Department
also has a working rolationship with other services, such
an the following: Special Services Division; Registrar
Division; Physical, medical, and Rehabilitation Service;

and Nursing Service.

TTial'ViSit

 

The ”trial visit" procedure is used for patients

1

with a psychotic diagnosis. Its purpose is to evaluate

the patient'a strengths, weaknesses, and readiness to

__‘..._ _‘L _ _. _._.._-

13ee Ippendix c.

3

roturn to society through t test visit to his family.
friends, and home community. It represents a.¢radual
transition for the psychotic patient from the protective
environment of the hospital community to the outside com-
munity, with assistance in this trancition being given
through supportive efforts of both the hospital and the

home community.

Preparation for eventual return to the community
is, theoretically, continuous from the patient's admission
to the hospital until his release on trial visit. Patients
can be released on trial visit either by action of the
recponsiblo physician or by action of a staff group known
as the Trial'Vicit Board. Social Service participates in
the preparation of all patients processed through the Trial.
‘Vicit award. This participation includca contacts and
planning with relatives or those who are to assume respon-
sibility for the patient at home. It includes periodic
conferences with other hospital staff, and contacts and
planning with resources in the home community.

A patient may be granted a ninety or thirty day trial
visit or leave of absence extending from one to fifteen'
dayc.1 The fifteen day leave of absence may be extended
to a thirty day trial visit. Where trial visit evaluation
indicates that the patient has improved he may be discharged
“maximum hospital benefits," after completion of the trial

A...
_~_ w..— W

189- Appendix C.

visit period. Patients discharged in this way any or any
not‘hnvc had contact with Social Service, depending on
whether they were released by the Trial Visit Board or by
the responsible physician directly.

A decision to select a patient for consideration by
the Trial Visit Board may be made at any pointty physicians,

social workers, or both.

The Probleg
The writer was a "Social Work Aide“ during the answer

 

of 1958, in the Social Service Department at‘Veterans
fidministrstion Hospital, Battle Creek. Michigan. During
a Social Service Staff’meeting the problem of the frequent
rate of re~admiseions to the hospital was raised. Concern
was expressed as to whether or not these re—admitted
patients had been prepared for trial visit by Social Service
staff. It was also stated that in those instances where
patients had been prepared for trial visit by Social Service
there was no data to show what positive contribution, if
any, was*made toward trial visit adjustment. The staff
suggested that an exploratory follow~up study be made of
all patients who had been granted trial visit during the
' first three months of 1958 so that some data could be
obtained about this problem.

The hypothesis upon which this study was based in as

follows: Patients who are active with Social Service and

who receive trial visit planning prior to discharge make
a better adjustment than those pahients who are not active
with Social Service and who receive no planning prior to

their trial visit tram the hospital.

QJ

CHfPTER II

315711232} OF 1.1%" WW

Luau":- ‘ AU;Li—d

An extensive search of the litérature revealed that
thsrs were no studies directly rclatcd to this investi-
gation. The few studies which were found were concerned
with auch'prcblcms as the following: evaluation of the
rcls of dependency as it related to rs-hospitalization,
determination of the factors related to community rs~
adjustment and rc~hcspitalixation, and social factors
associated with rs~admission to the hospital. These
studies were related to the present study in that they were
concerned with the exploration of factors which may or may
not contributc to the psychotic patient's failure to adjust
while on trial visit status.

1

Janie Francis Gray studied a group of twenty

patients who Ware admitted at least three times to neuro~
psychiatric hospitals in order to evaluate the role of
dependency as it relates to ra~hospitalization. The
following areas wars investigated: (1) ages of patients.
(2) marital status, (3) voluntary or involuntary admissions,

A

“A...
‘w— m

lJanic Francis Gray, "Veterans Admitted to‘a Naurcw
psychiatric Hospital for at Least the Third Time" (unDUD~
lished Master's thesis, Smith College, School of Social
Work, 1953 ) c

6

7

(4) nature of tho illness for'which hospitalized. and (5)
reason for re~hoopitalization as verbalizod by the patient.

The findings revealed that patients returned because
of inadequate economic adjustment and somatic complaints,
because they acted out in the community and were threats
to self or others, or because of’zroaa psychotic behavior.

Dorothy flankinol made a study in which.she lttanwtad
to determine the factors related to the oatiafnatory com~
munity readjustment or twenty patients while twenty othor
comparable patients were unable to adjust.

Hist Hookina found that: (l) prognooia for readjust-
ment was best in those patients who had adequate treatment
relatively soon after the onsot of the diaoaoo; (2) the
freguoncy of visitors to the patient, indicative of the
warmth of feeling of the family and friends for hin was
a factor in the success of the trial visit period: (3) 1f
the patient secured employment while on trial visit he
won in tho best position to remain out of tho hoapittlz
(t) the amount of pressure induced by atreoa and strain
within the family circle contributed to tho return.ratei
and (5) contact with a social agency contributed to the
pationt'o ability to moot stress and strain and he thus had
a better chance of getting along at home. Kins Hafikina

A...- A.
.— v . ‘— , w iv.

1Dorothy Rankina, ”Some Factors in the Rehospital-
ination of Sohizophrenio Patients" (unpublished lister'l
thesis, university of Michigan, School of Social Work,
1954 .

8

momeadad the relieving: (1) intensive 91min; with
the ”that, family. and commity prior to placement on
trial visit) (2) increased mmis on involvmnt of
mum. in the treatment program (3) additional consid-
eration, a! the matter of employment: and (4) tin adherence
to the beat imam psychiatric tmatment practinna.

Len Lavenhargl conducted 3 study of the seam tutor-a
in remnant: to I. mental hospital. m: study an t
follow-up of flu: pmvieualy done by Hi“ War man-
ber; chose 0. group of patterns: the had bean readmitted to
the: hospital 81min the period from July 1‘, 1953. to J'm 3.
1954.; Then were twenty patients with I. Magma. of
”schizophrenia. mdifferentnted type" and mat: of an;
“anxiety reaction.” Such factors a religion, m. and
mm status were considered. The study untied that
patients return to the hospital for the rouom‘ mm:
(1) difficulty in forming poaibive minimum” nth flair
{with (2) inability t0 cope with the mama of ovary-
din living. (3) sundae“). acting out in tho Why.
Ind (13) "satiation or symptoms in the tom of 3th
owl-int... 8m nomad! early and more intend" mark
with puma, commity, 1nd future employers, and
providing my additional social services beyond th- period

“1—... _._..__.__ ._ A._ ,
V, _.._v, *7 —vv w

A

Rental Hoopital“ unpublished Hunter's then-13. Smith

1L“ Livenbirg, "Secial Factors in Remissionm 3.
college, School a Social Work, 1955).

‘0’

9

or hospitalization in order to help these patients function
adequately outside the hospital.

In spite of all careful and detailed planning by
Social Service with the patient, family, friends, and
community, not all patients are able to make the transition
from the hospital. This has become the concern of all thoee
who plan with the patient and particularly so with Secill
Service which carries a aizetblo responsibility in this
area. This problem was of sufficient magnitude to motivate
the Social Service Staff of‘Veterane #dministrntion Center,
Shreveport, Louisiana, to re—examine the responsibility of
social service in this area.1

The Shreveport study resulted in the following can»
clueiona: (1) In making referrals to the regional social
Service Offiee. it is essential that the hospitnl worker
be aware of the entire service available and that he include
in his referral.all information pertinent to the regional
office ease worker's part of the total Job. Referrals
should contain the following,informationa (a) date. of
admission Ind discharge, (b) the pationt's course in the
hospital, (a) his response to the hospital Social Services.
(d) recommendations regarding work activity, (9) his atti-
tude towlrd going home, and (r) the final diagnosis; (2)
It is helpful for the regional office worker to know what

‘

1300181 Service Starf,‘veterans Administration Center,
Shereveport, Louisiana, ”Trial'Vieit Service: Principles and
Practice," v1 Department otknedioine and Surgery_1n§ormation

Bulletin, Inlo—a9”(béfiaber, 195a). fi37"lfiii7.

 

 

1...)"

10

the hospital has learned about family relationships, atti~
kudos, living conditions, patient's plans, ambitions, and
the degrea of recovery which may be expected; (3) Both

the patient and his family should be prepared for the
regional office workcr's visit. The hospital workers should
explain the regional office worker's role and prepare the
patient for the service he may expect. The patient should
be cndouraged_to ask questions about this. Ho may need
help to recognize tho regional office worker's role as

one of servica and support to himself} (a) The patient
should be advised that reports of hic progress and wolfare
will bc sent back to the hospital, which maintains its
interact in him; (5) In all cases of service-connected
disability the availability of Social Service after hoavital
discharge should be pointed out; (6) There should be a
definite understanding with the patient, his family, the
hospital finance officer, and guardian about financial
arrangements to be made during the time the patient is at
home, and clarification of responsibility for arrangements
and cost of transportation.

The Social Service Department in Battle Creek vctoran
Administration Hospital tries to follow those suzgcsted
procedures. This is reflected in the form which is used
for trial visit referra1.1

m A. 4‘“ .A__ __‘

18cc Appendix A.

CHAPTER III
METHOD OF STUDY

The study included all patients granted trial visit
during the first quarter period from January 1, 1958 to
March 1, 1958. There were sixty-five patients in this
group divided as follows: (1) Group I. thirty-seven
patients granted ninety day trial visit and prepared by
Social Service; (2) Group II, fourteen patients granted
ninety day trial visit and not prepared by Social Service;
and (3) Group III, thirteen patients granted thirty day
trial visit and not prepared by Social Service.

One patient died while on trial visit and, therefore,
was not included in the follow-up study.

Information concerning these patients was obtained
from the Social Service "Trial Visit" Information form and
from the clinical records. Information concerning their
experience on trial visit was obtained from reports which
are sent from the agency in the home community to the
hospital. The out off date for the follow-up study was
chosen 85 March, 1959. This allowed a period of between
one year and fifteen.montna to evaluate the patientb adjust-
ment on trial visit. Each of the three groups listed above

was divided into thoee who "stayed out“ and those who had

11

12

"returned" to the hospital by March, 1959.

Tho study involved a coaparieon between those patients
who had been prepared and who had not been prepared by
Social Service in order to determine the effect which such
preparation might have had on their ability to adjust
during trial visit. In order to evaluate what other factors
may or may not have contributed to trial visit adjuotment,
the two groups were compared in relation to a variety of
other identifying characteristics. Groups II and III were
combined in these comparisons, since bothgroups had received

no proparation from Social Service.

CHfiPTSR IV

PRESENTRTION END fiNfiLYSIS CF DPTh

The FinQings

 

The major finding of the study was that more of those
patients who werc prepared by Social Service "stayed out"
after twelve to fifteen months than of those patients who
had not been prepared by Social Service.

Table 1 shows that of the thirty-seven patients pre-
pared by Social Service, twenty—seven or seventy—three per
cent "stayed out" as compared to a combined total of seven

out or twenty~seven, or thirty—seven per cent in Groups I

 

 

and III.
TEBLE l
COMPARISON 0? NUMBER OF PATIENTS 0N TRIAL VISIT STfiTUB
an: “1: “W
Trial Visit
Status Group I Group II Group III Total
Total 37 13 13 65
Stayed out 27 4 3 3h
Returned 10 10 10 30

m A A‘

After arriving at this finding, the next step was to

evaluate certain common characteristics of the sixty-four

13

1h

patients included in.the study in an effort to detorline
what other factors may have influenced the adjustment of
patients on trial visit. Such factors as age, diagnosis.

marital status, at cotcra, were analyzed.

21mm

Since only those patients with a psychotic diagnosis
may be concidcrod for trial viait, it acamed relevant to
in uirc whether different types or psychoses were factors
relating to success of trial visit adjustment.

to can be seen from Tabla 2 the diagnoses foil into
two major categories: ”schizofihrenic reaction. uncllnsificd"
and "schizophrenic reaction, paranoid." A larger proportion
of ”paranoids" stayed out than "unclascified." The propor-

tion 13 sixty—eight per cent compared with fifty per cent.

wow: 2

DIAGNOSIS OF PfiTIENTS WHO STSYZD OUT END
PSTIEETS WHO RETURNED

 

 

 

 

 

 

:z::==x:==:x=r**~z_ ~A~xxzzzé *_ i; _
Number of Patients

Diagnosis 'J‘Jfl-‘:*' ' 4".“ t; ##L

Stayed Out Returned Total

Tbtal 3h 30 6h
Schizophrenia reaction,

unclassified 20 20 no
Schizophrenic reaction,

paranoid 12 7 19

Other 2 3 5

u ._..4. __. A...‘ AA .4...‘ h “__ _‘ _A ‘_ ~— __.__ __- A A A...‘

15

Since "paranoida" seemed to do better, the next ques-
tion was whether the prepared group had c larger proportiaa
or paranoid: than.the unprepared group.

Table 3 shows that twelve, or thirty-two per cent
were ”paranoids" as compared to seven, or twenty-six per
cent of those patients not preparcd by Social Service.

This m a mall difference compared with the much greater
parcentagc difference in success or trial visit found in

the total group, at thoaa who received preparation and

those who did not. It may, thereforc. be concluded that.
although the prepared group had a slightly higher proportion
of “paranoida," this alone cannot explain theirbcttar

experience on trial visit.

3 BER 3
DIAGHOSIS OF PATIENTS WHOIRECEIVED OR'DID NOT
RECEIVE SOCIAL SERVICE PREPARATION
34—“ .4 j +44 ‘1“. 'v‘ - W
_*__ figmber of Patienta
Prepared Not Prepared

 

 

 

 

”WM“ by Social by Social
Service Service Total
Total 37 27 61‘:
Schizophrcnic reaction,
unclassified 22 18 ho

Schizophrenic reaction,
paranoid 12 7 19

Othar 3 2 5

A... ‘— M A—‘- __._ -_ _¥ ——-—-——
*— V W w.

16

Longth¥of Hospitalization

 

The next question that was explored tee whether or
not the length of hospitalization prior to release on
trial visit was a differentiating factor between a success-
ful and unsuccessful trial visit experience. This question
seemed important since many people believe that patients
with long periods of hospitalization may be expected to
find it difficult to adjust in the community.

Table 3 shows that there wee little difference
between those who had been hospitalized under six months
and those who had been hospitalized over one year in raznrd
to their relative success on trial visit. About htlf of
each group stayed out. The group hospitalized between
six and twelve months showed a higher proportion of success.

but the numbers involved were very email.

TEBLE u

LENGTH OF HOSPITALIZATION OF P‘TIEHTS WHO
RETURNED AND PfiTIENTS WHO STfYED OUT

 

 

 

 

Length of g; #» unmber of Patients
Hosgétfiigzggion Stayed Out Returned ‘I‘fcitolww
Six months Tm“ 31’ 30 5“
or less 15 15 30
Six to twelve

One your or more 10 ll 21

M _.. A A A _“.‘_

17

§ta§ua of fldmlssiog

Status of admission was evaluated to see if it was
a factor in trial visit adjustment. #dmission status or
patients in either ”committed” or “non-committed,‘ depending
upon whether he entered the hospital voluntarily or by
legalization. The "committed" patient is usually more
seriously ill and rated "incompetent." In some instances
it was necessary to institute committment procedures for
tho patiant'a protection. UBually the "non-committed”
patient is rated "competent” and may not be as 111 as tho
"committed" patient.

Table 5 shows that the largest proportion or aixty~
nine per cent of those who returned wore ”committed" Ind
aixty~rive per cent of those who stayed out were "non-

committed.“

TABLE 5

STATUS OF ADMISSION or PATIENTS WHO STAYED
our 1* ND P MEN-Ts WHO marumrw

’— j,

i AA Number of Patieg§g_: A
Stayed Out Returned Total

 

Status of Admission

 

 

Tbtfil 3h 26 60
Committed 12 13 30

Hon-oammittod 22 8 30

18

Table 6 shows that Social Service prepared an approxi~
natal: equal number of ”committed" and ”non-omitted"
patients. Thin difference was. therefore, not important.

TABLE 6

STfiTUfi OPADMISSION OF THOSE PfiTIENTS WHO RECEIVED
OR.DID HOT RECEIVE SOCIAL SERVICE PREPARATION

 

 

 

 

3;" l - w“: 75* ““ *“x ‘wizx‘fv r m
Number of Potion“ “
Status of Prepared by Not Prepared
Admission Socill by Sociul
Service Service Tom
Total 37 27 6h
Omitted 19 ll 30

Non-comittcd 18 16 34

.— WV 1.— w w .__7 W

me am picture is shown even more strikingly by
Table 7, which analyses the 'comittcd" patients in relation
to success on trial visit Ind whether they had 30cm
Service preparation. Although the majority of the to“).
“emitted" group remix-nod, those who received Social
Sonic. prcpmtion did much better.

TABLE 7

EXPERIENCE OF COMMITTED PATIENTS ON TRIAL‘VISIT
IH'RELATION TO SOCIAL SERVICE PREPARATION

Rumbar of Patients

 

#-

 

 

Stntun of 1'me by Not Prepared by
____ Adiniicaio‘n Social Simicc Social Service Total
Total 19 11 30
Stayed out 10 2 15
:ljetumed , M 9 9 1 V

19

floggt 31 Status
Fifty-three per cent or those patients who stayed out
were married as compared to only thirty per cent of the
group who returned. This ceeme to be an important dir~
forencc, indicating that married pereone do better, perhaps,

because of“more stable home situations.

mm 8

MfiRITAL STfiTUS OF P."-’1‘IE?T1‘S WHO 8151531) OUT
fiND PATIENTS WHO RET'RNBD

 

 

Number of Patients

 

Marital Status

 

k“ _M_#_ Stewed“0ut ‘_ Returned
Total 34 30
Married 18
Separated 1
Divorced O 3

Single 15 16

This difference suggested an exadination of the
Vmarricd“ category to determine whether Social Service
may have prepared a larger proportion in this group.

Tibia 9 shows that ”married" patients accounted for
forty per-tent or the group as compared to forty~rour per
cent of those not prepared by Social Service. The percenu

tagc are thus approximately the same.

20

TABLE 9

MfifiITAL STATUS OF FATIENTS WHO DID OR DID NOT
ECEI‘VE PREPARETION BY SOCIfiL SERVICE

 

“Number of Patient: #

 

 

 

Martial Status Prepared by fiuot Prepared by

' Soc 19.]. Service Social Service
Total 37 27
Married 15 12
Separated 1 2
Divorced 1 2
Single 20 11

In an attempt to evaluate what otnor factors may or
may not have contributed to trial visit success, the final
causation was, whether or not age was a factor.

on Roman trawl studies a. group or one—mmdred-and~
thirty~eenn patients in order to detemxino whether or not
use was a factor in adjustment of patients placed in
Family Cm Program. He found that men placed titer they
mm forty. (stowed 1n Fanny Care homes longer and that Q
great” proportion of thosa placed before they were forty
did not remain but had to return to the hospital. Dr. am:
also pointed out that older patients seem to be stnbilized

WA

in their illness and are accepted by society while younger

“ L. ”A“ #

1Dr. Roman Graft, ”Pgnily Cm Program): Progress and

21

patients are more active and are not accepted by society.
Title 10 shows that twenty—four,or eeventy per cent of
those patients who stayed out were over thirty as compared
to fifteen, or fifty per cent of those who returned. This

proportion seemed important.

T “BLT. 10

ACE OF PATIENTS WHO STAYED AND PATIENTS
WHO RETURNED

829‘? gm r L- : vrmw . a “‘n W

number of Patient!

 

 

 

 

___._‘__-

 

Age in Years

 

i. o__ *4, _;geayed Out Returned
Total 33 30
Less than 30 10 15
Over 30 24 15

This finding suggested the quottion as to-whether
Social Service might have prepared a larger proportion of
older patients.

Table 11 shows that twenty~five, or sixty~f1ve per
cent of those patients prepared by Social Service were
over thirty as compared to fourteen, or fifty-one per cent
of those who were not prepared by Social Service. In this

respect, there was some selectivity in favor of the group

“A _— AA A‘—

and Research Notes," Psychology Department,‘veterant Adm1n~
istration flospital, Battle Creek, Michigan (December 1,

1958).

receiving preparation. The difference in regard to age,
however, was much smaller than the over-all difference in

success between those prepared and those not prepared.

TfiBLE 11

ms or PPTIEN’I‘S mo DID on DID nor 122mm
socIr-L SERVICE Parspwxnon

r 3 hr

 

 

Number of Patients

Prepared by Not Prepared by

 

 

:ge in‘Yeara
Social Service Social Sortioc
Total 37 27
tees than 30 12 13

Over 30 25 1h

czr PTER v
3mm! mm CONCLUSIONS

The maJor finding of the study was that more of those
patients who were prepared by Social Service stayed out I
after twelve to fifteen months than those patients who had
not been preptred by Social Service. Seventy~thrcc per
cent or the thirty~ecven patients prepared by Socicl service
remained out as compared to thirty-ccvcn per cent or the
twenty-coven who were not prepared by'Socili Service. This
finding supported the hypothesis of the study.

A variety of factors such an age, diagnosis, length
of hospitalization, marital status, et cetera, were
nnnlyzed to determine whether they were associated with
success on trial visit. D

It Inc found that greater success was experienced by
patients with a."perenoid" diagnosis compared with ”cchizo~
phrenic unclassified,“ by married compared with single,
by those over thirty compared with those under thirty.

Each of these factors was checked further to dctcr~
mine whether Social Service had prepared an undue proportion
of patients in these categories, where the success achieved
could be due to the patients' characteristics rather than

to Social Service preparation.

23

24

It was found that no such selective factor existed.
except for age. In each or the other characteristics studied,
differences between the group prepared by Social Service and
the grow not prepared were either small or non-existent.

In the case of age. a seemingly important difference
was noted between the groups who stayed out successfully and
those who did not. A greater nmnber of patients over thirty
years of no made a better adjustment than those under thirty,
years of Ice. when the relationship betwocn up of populo-
tion prepared by Social Service and those not prepircd by
Social Service was compared, no perceptible differed“ was
found between the group over and under thirty who were not
prepared by Social Service. The case of the population pro-
pared by Social Service, (I significantly greater percentage
of the population studied was over thirty years and c signifi-
cantly lower percentage was under thirty year“ While this
data. represented some Social Service selectivity in relation
to use, the difference was much smaller when the over—all dir-
ferencc in success was compared between the group who was pre-
pared and the group who was not prepared by Socinl Service.

It was, therefore, concluded that the greater degree of sum-
cesa achieved by the group prepared by Social. Service was re-
lated more to the preparation itself than the age factors,

Although this study applied to Battle Creek, Michigan.
Veterans Administration Hospital, the -:Z.m::>1icationc from these
data suggested that all patients selected for trial visit
should have Social Service preparation prior to trial visit.

’C‘f.‘
1i PPEE'mlcdq

25

fiPPENDIX r
gamma: D P m x T

FWfiISSION Dfi-TE:

 

mmzm INFOTMATIGN :

 

 

 

 

 

 

 

 

 

Nana-e: - m *0. Number:- 4 __
Trial Visit Address:_u_ . + Phone:
Birthdate: w W A Birthplace: w _
Occupation: W wMari-tal Statusz‘ M
Next of Kin:w_

"“ ' (Name) . TReIatIonshipI ’ {hadron}
Serum Dates!“ Bmchzw

 

 

RWERRAL:
fiction Requested of 3.0.:

__.__. 4“ __.‘ ;__. 7 __L._ _.A A

Trial Visit Dates:

‘v—v “—

!«iay We Have Your Report By:__ #
DIAGNOSIS xv
mam AND FINmi‘CIAL STATUS:

‘4‘ 7 A A_‘ L —..

Guardian x

 

 

 

'x-faxrz‘e) _ TRJlati on :3pr , I ah
Competent: Incompetent: SC: NSC: _ _ A
Amt.-
Amount on Deposit at Hospital: A Apportionment“

 

Pmom’xt Given Patient on Departare:_
Financial Planning. While on Tim:
Voluntary Admissionzw _ Or comitted;__“
micanomfiw

W . w

 

27

FflMILY ACTIVITY WITH OR REFERR1L TO COIfivTUNITY ‘. EIICY:

W

PHYSICAL AND EMOTIONPL DESCPJP’PIOII:__

 

_ A. .._‘_. ‘____- A
w V .- . —-— v. _ _,,. '_,_v

HIST RY 01? ILLIQSSL

—_ A

masons FOR HOSPITF-LIZA‘I‘ION:_

__ __‘A A
.7“ w.— __ f

PPTIENT'S USE OF HCSDITALEM

WV _ . r“-

__ A , A

50cm, SERVICE ACTIVE"! mm PATIENT AT Hes-91mm (Include

persona seen by social worker)

A A “w ___.__I

F’I’IILY RELATIONSHIP mm PMIENT:_ “_

 

PATIEEI’B'S ATTII‘UDIIS I‘m-mm T.V.=_I I

 

T59 (if :11 Fe Oi‘ke‘r‘.

Encloaure(a)

PPENDIX B

TB~COlO—8
VETERANS fiDMINISTRhTION'ERTNCH OFFICE NUMBER SIX -
Columbus 8, Ohio Tnchnical Bulletin
May 1. 19%?

SOCIAL SERVICE RTSPOHSIBILITY'FOR TRI’L VISIT PITIENTS

Paragraph

G€NERAL PURPOSE 1
DIFISITIOM OF "TSIrL VISIT" 2
REASONS FOR REFERRIL T0 SOCIAL SERVICE V g
PROCEDURE FOR SECURING FEE-TRIflL VISIT STUDY

UTILZATION a? How-Va AGENCIES 5

1. general_§u3pose. The object of this bulletin 15

 

to clarify the responsibility of the Social Service Section
rzgarding those patients within the Branch Area who are on
Trial Visit status from a‘VA hospital.

2. nglnition cf Trial Visit. The term ”trial visit”

 

refers to the status of a patient from an NP hospital who
is at home, or in the community for the purpose at deter-
mining his adjustability to living outside the hospital.
(See a. n P. 6167 (a) and 6938).

3. finason fog

R;ferrgl to Socialޤervioe. Upon the
reedmmendation of the ward physician, the patient may be
coneiderdd ready for trial visit. When such a recommend-
ation is contemplated by the ward physician, referral Should
be made promptly to the hospital Social Service Section in
order to:

28

29

a. Determine and evaluate the adequacy of
the home and environment.

b. Psepare the family and community for the
patient's return by: (l) helping them understand
the patient'S present condition; and (2) giving
them the necessary information conccring VA
regulations governing patients on trial visit.

c. Help the patient in his adjustment at home
by means of referral to the Social Service Section
in the regional office area to which he will return.

6. Maintain close supervision of the patient
while at home and thereby provide the ward phy—
sician with complete reports and evaluation of
the patient'e trial visit experience.

#. Erocedure for Segurin§;Pre—Tri§l_Vitit Stagi.

 

When a patient hen been recommended for trial vilit and has
been rcterrcd to the hospital Social Service Section. the
following steps will be taken:

a. The patient will be interviewed. as soon as
possible, by a hospital social worker.

b. On the basis of prior reading by the medical
chart and discussion with the ward physician, the
social work Should obtain information pertinent
to the patient'a situation and help him with prob-
lems he may have in relation to the proposed trial
Vilith

0. Hospital Social Service should request a
prc~trial visit study from the social service section
in the particular regional office having isolation,
following the provisions of R. & P. 6787 D).

l. The request to the regional office should cover
in detail not only the types of information needed, but also
facts and recommendations concerning the patient which will
be of value to the regional office.

In those instances where the hospital Social Service

Section has had extensive contact with the patient and his

relatives, sufficient information may have been acquired to
afford a basis for determination of the feasibility of trial
visit. The referral to the regional office in these cases
should include an adcuuate summary of this information in
order that effective follow~up supervision and assidtance
may be provided:

d. As soon as the pro-trial visit study has been
prepared and submitted to the Social Service Section
making the recuest, the original copy will be sent
to the ward physician.

0. Before he leaves the hospital, the patient
will be prepared for his relationship with Social
Service during the trial visit with the information
that he will be contacted by a social worker after
his arrival home. The regional office will be noti-
fied promptly when the patient leaves the hospital.

I. The Social Service Section in the regional
office will get in touch with the patient as soon
no possible after his arrival home, preferably
within two weeks. A definite appointment will be
lid. for him to be seen in the office or at home,
whiover seems appropriate. R gular interviews with
the patient, his family, and if absolutely necessary,
with members of the community, should be held during
hhe trial visit period. This will enable the Social
Service Section to submit reports within the time _
specified by the hospital. Recording should include
information which may be useful to the Chief Attorne.

8. Social Service in the hospital and the regional
office will consider the individual patient's need
for neuropsychiatric guidance or treatrcnt, and will
be guided by the recommendation of the hospital
medical staff in taking the necessary action.

5. gfiilization of Ncn~Va ’gencics. a. In some in~

 

stances it will become necessary to refer individual patients
or their families to other agencies in the community. It
will be the responsibility of the regional office Social

Service Section to maintain complete liaison and active

31

cooperation in these cases. If cooperation of non-VA
agencies is required or desirable, this will be requested
by the regional office. In this way one unit can offer
consistent interpretation to the community agencies, devel~
op understanding between‘VA and those agencies in the
regional office territory. and evaluate the relative
usefulness of the various agencies which offer assistance.
The report from the cooperating agency will be incorporated
in the final report to the hospital Social Service Section:

1. An exception to the above procedure:may

exist when I hospital has developed good working
relationships with the agencies in its immediate
community. Where necessary, direct contacts with
such agencies may be made by the hospital.

2. When a hospital and a regional office or

sub~regional office have social service faciliticl
are located in the same community, a Joint agree-
mont subject to Branch Office approval should be
reached on the procedure for utililation of NOH;VA
resources in that community.

b. ‘Where a need for social service by a non-service-
connected veteran can be anticipated to exist heyond the
date of final discharge from the hospital, consideration
should be given to arranging for referral to a nonJVa
agency during the trial visit period in order to avoid
an abrupt transfer when eligibility for Vi service tennin~
ates 0

Ralph H. Stone
Deputy Administrator

EPPENDIX C

VETERANS ADMINISTRATION HOSPITAL
FORT cusm, IICHIGAN December 12 , 1952

Excerpts from Medical Memorandum. No. 12

Subject: Passes, Lnavea of Absence,
and Trial Visits.

1. Trial Visits are encouraged but are only sruntad
to psychotic pttients, and extend for period tram 30 to
90 days, and are subject to extension up to a.maxflmu| period,
beyond which recommitment unuld be required under state law.
Generally, Trill Visit will not be longer than 33.: math...

2; Approval for trial visit will be granted following
presentttion of the case to Trial‘V131t Board, In outltned
in previous namormdm from the manger.

(as) A. L. Olsen, M D.
Chief. Professional
~ Services

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BIBLIOGRAPHY

Graft, Norman. ”Family Care Program: Progress and
Research Notes," The Department of Psychology Re search
Section, V<‘:teranc Administration Hospital, Battle
Creek, Hie: igan.

Gray, Janie Francis. "VEterans ”emitted to a Neurc-psychiatric
Hospital for at Least the Third Time." Uhpubliahed
Master's thesis, Smith College, School of Social Work,
June, 1953.

Hawkins, Dorothy, "Some Factors in the Echospitaliz&tion
of Schizophrenic Patients." unpublished Master's
Thesis, university of Michigan, School of Sooia
wel'k. 1955 '

Lanenberg, Lea. "Social Factors in Readmissicn in a.Mental
Hospital.” Unpublished Master's thesis, Smith College,
School of Social Work, 1955.

Sylvester, Lorna. "Casewoxk in a Psychiatric Setting,"
Jogrpal ofwf%z§§ mic ric Social Work, XXIV, no. 3
{5;}? {Tr—1955 p.155 a

veterans Admfinictration. Technical Bulletin, TB-COlO—B,
yay 1’ 1957‘ pp. 16‘18.

 

Veterans nominiotration C nter, Social Services Staff.
'Trial Visit Service: Principles and Practices,"
chorcna Administration D nir‘o nt of Moiicine and
52335 info:- nacicm mBull-c tin IB~10~ ”chmcr, I952),
Emevgyp't’fh' LUQj—Sialla‘ L’po 1‘1’17Q

 

 

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