Woolston J L, Berkowitz S J, Schaefer M C, Adnopoz J A
Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA.
Child Adolesc Psychiatr Clin N Am. 1998 Jul;7(3):615-33, x.
The authors introduce the Yale Intensive In-Home Child and Adolescent Psychiatric Service, a model of home-based care for children with severe psychiatric disturbances. This model synthesizes the principles and method of the wrap-around paradigm and in-patient child psychiatric practice within the reality of the managed care system. A clinical team, under the direct supervision of a child psychiatrist, works directly within the family to understand and address the multilevel transactions that have affected the child's ability to function in various domains and resulted in recommendations for intensive intervention, including psychiatric hospitalization. This article suggests that if the psychiatrist is to provide the highest level of care, cognizance of and involvement in the child's ecology are as essential for the child and adolescent psychiatrist as other aspects of the child's world and life. In the days of ever shortening patient lengths of stay, this model of care offers promise for both clinical and fiscal effectiveness.
作者介绍了耶鲁大学强化家庭儿童和青少年精神科服务项目，这是一种针对患有严重精神障碍儿童的居家照护模式。该模式在管理式医疗系统的实际情况下，综合了全方位照护模式和住院儿童精神科实践的原则与方法。一个临床团队在儿童精神科医生的直接监督下，直接深入家庭，了解并处理影响儿童在各个领域功能的多层次互动关系，并据此提出强化干预建议，包括精神科住院治疗。本文指出，如果精神科医生要提供最高水平的照护，那么认识并参与儿童的生态环境，对于儿童和青少年精神科医生而言，与儿童世界和生活的其他方面同样至关重要。在患者住院时间不断缩短的当下，这种照护模式在临床和财务效益方面都颇具前景。
