Psychodynamic day treatment program for borderline personality disorder: factors that predict outcome and dropout: An observational study.

ABSTRACT: The objective of this study was to ascertain changes in symptoms of patients with borderline personality disorder undergoing psychodynamic day treatment with a duration of 9 months and the factors that predict clinical outcome or dropouts from the program.In an observational study, demographic characteristics (age, number of psychiatric hospitalizations, number of suicide attempts, current involvement in work or study activities), day doses of antipsychotic and antidepressant medication, psychiatric symptoms, and social functioning (Health of the Nation Outcome Scales), and symptoms of dissociation (Dissociative Experiences Scale) were assessed in patients at the beginning of treatment (N = 105). Further, psychiatric symptoms and social functioning were assessed at 3 stages: beginning of the program, end of the program, and 1-year follow-up. To study the differences between baseline values and values at the end of the treatment and follow-up values, the Wilcoxon signed-rank test was used. To discover baseline factors related to the effect of the treatment, Spearman correlation coefficients were calculated. To evaluate the differences between patients who completed the program (N = 67) and patients who dropped out (N = 38), differences in baseline factors between both groups were compared, using the Mann-Whitney test for independent samples.Improvement in symptoms (Health of the Nation Outcome Scales - version for external evaluators) at the end of the therapy (N = 67, P < .001) and at the 1-year follow-up (N = 46, P < .001) was found. Experience of an intimate relationship was positively related to clinical improvement at follow-up examinations (P < .001). Predictors of dropout included a higher number of psychiatric hospitalizations (P = .004), suicide attempts (P = .004), more severe pretreatment symptoms (P = .002), and symptoms of dissociation (P = .046).The results indicate that a psychodynamic day treatment is feasible for the treatment of less clinically disturbed patients with a history of intimate relationships. Patients with a higher number of previous psychiatric hospitalizations, more suicide attempts in the past, more severe pretreatment symptoms, and symptoms of dissociation are more likely not to complete the program.

Development of a Child and Adolescent Tele-Partial Hospitalization Program (tele-PHP) in Response to the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic prevented a group-based partial hospitalization program (PHP) from running in-person care due to social distancing guidelines. However, the crisis also simultaneously increased stress on families while decreasing their desire to hospitalize youth for a nonmedical issue. Hence, the need for a PHP remained high. Health care organizations worked diligently to create a secure telehealth platform (tele-PHP) to be delivered to patients in their home environments. This article describes the development and implementation of child and adolescent tele-PHPs in response to the COVID-19 pandemic. These new programs were started in mid-March 2020, and changes were implemented over the next 3 to 4 weeks. Overall, patients and families have been receptive to behavioral health services delivered through telemedicine. While tele-PHPs are the most plausible solution to continue behavioral health care for these patients, some challenges were observed during this process. Besides procedural and technological challenges associated with creating a virtual setup, other difficulties include variable patient engagement, specific treatment-related challenges, and system-related changes. These challenges are addressed through psychoeducation, provision of online measures to assess treatment outcomes, and efforts to optimize parent engagement prior to treatment initiation for better treatment adherence. Initial experiences during a time of crisis suggest that tele-PHP services can be a viable long-term treatment option in the future during both a disaster and routine times to improve access for those who otherwise cannot take advantage of such services. Long-term effectiveness of these interventions still needs to be explored.

Exploring the costs, consequences and efficiency of three types of palliative care day services in the UK: a pragmatic before-and-after descriptive cohort study.

BACKGROUND: Palliative Care Day Services (PCDS) offer supportive care to people with advanced, progressive illness who may be approaching the end of life. Despite the growth of PCDS in recent years, evidence of their costs and effects is scarce. It is important to establish the value of such services so that health and care decision-makers can make evidence-based resource allocation decisions. This study examines and estimates the costs and effects of PCDS with different service configurations in three centres across the UK in England, Scotland and Northern Ireland. METHODS: People who had been referred to PCDS were recruited between June 2017 and September 2018. A pragmatic before-and-after descriptive cohort study design analysed data on costs and outcomes. Data on costs were collected on health and care use in the 4 weeks preceding PCDS attendance using adapted versions of the Client Service Receipt Inventory (CSRI). Outcomes, cost per attendee/day and volunteer contribution to PCDS were also estimated. Outcomes included quality of life (MQOL-E), health status (EQ-5D-5L) and capability wellbeing (ICECAP-SCM). RESULTS: Thirty-eight attendees were recruited and provided data at baseline and 4 weeks (centre 1: n = 8; centre 2: n = 8, centre 3: n = 22). The cost per attendee/day ranged from £121-£190 (excluding volunteer contribution) to £172-£264 (including volunteer contribution) across the three sites. Volunteering constituted between 28 and 38% of the total cost of PCDS provision. There was no significant mean change at 4 week follow-up from baseline for health and care costs (centre 1: £570, centre 2: -£1127, centre 3: £65), or outcomes: MQOL-E (centre 1: - 0.48, centre 2: 0.01, centre 3: 0.24); EQ-5D-5L (centre 1: 0.05, centre 2: 0.03, centre 3: - 0.03) and ICECAP-SCM (centre 1:0.00, centre 2: - 0.01, centre 3: 0.03). Centre costs variation is almost double per attendee when attendance rates are held constant in scenario analysis. CONCLUSIONS: This study highlights the contribution made by volunteers to PCDS provision. There is insufficient evidence on whether outcomes improved, or costs were reduced, in the three different service configurations for PCDS. We suggest how future research may overcome some of the challenges we encountered, to better address questions of cost-effectiveness in PCDS.

Assessment of a Day Hospital Management Program for Children With Type 1 Diabetes.

Importance: A shift in the setting of care delivery for children with a new diagnosis of type 1 diabetes led to a reorganization of treatment. Objective: To determine whether a new diagnosis of pediatric diabetes can be successfully managed in a day hospital model. Design, Setting, and Participants: This quality improvement study used retrospectively collected data on pediatric patients with a new diagnosis of diabetes who completed an inpatient program for education and insulin titration prospectively compared with patients completing a diabetes day hospital program. Baseline data were collected over 12 months (January-December 2015) and intervention data collected over 14 months (March 2016-May 2017). The study was conducted at a single institution and judged as a nonhuman participant project. The referral local base included a 100-mile radius. Patient inclusion was a new diagnosis of diabetes, age 5 years or older, and no biochemical evidence of diabetic ketoacidosis. Ninety-six patients completed the day hospital program and 192 patients completed an inpatient program. Exposures: All patients received 2 consecutive days of insulin titration and education in either a day hospital or inpatient setting. Main Outcomes and Measures: Primary outcomes included the mean length of stay, patient charge, and insurance denial/reimbursement rates. The hypothesis was that a day hospital program would be associated with a reduced length of stay, which would directly affect patient charges and insurance denials. Results: Among the 96 day hospital patients, the mean (SD) age was 12.2 (4.7) years (range 5-20.3), with no patients experiencing diabetic ketoacidosis or hypernatremia. Among the 192 inpatient patients, the mean (SD) age was 9.4 (4.7) years (range, 1.6-20.1). The mean (SD) length of stay reduction in the day hospital was 46 (14.1) to 14 (5.1) hours. The mean day hospital patient charge was $2800, compared with a mean (SD) baseline carge of $24 103 ($9401). Within the first year, there was a cumulative reduction in patient charges of more than $2.1 million. Conclusions and Relevance: This study's findings suggest that a diabetes day hospital setting was associated with reductions in length of stay and patient charges, with an increase in insurance reimbursements and a decrease in insurance denials. This study demonstrates an effective way to streamline new-onset diabetes education, which may reduce length of stay and patient charges. Reimbursement rates for patients with a new diagnosis of diabetes increased from 52% to 72% and reimbursement denial rates decreased from 80% to 0%.

Early weight gain predicts treatment response in adolescents with anorexia nervosa enrolled in a family-based partial hospitalization program.

OBJECTIVE: Improved treatment outcome in family-based treatment (FBT) for anorexia nervosa (AN) is predicted by weight gain occurring early in the course of treatment (i.e., about 4 lbs by week 4). Although prior work suggests that early weight gain in higher levels of care (e.g., partial hospitalization programs [PHP]) predicts weight restoration at discharge, no study has examined the specific rate of gain within FBT-informed PHP programs that best predicts treatment response. METHOD: This study examined rate of weight gain in pounds and percent expected body weight (EBW) that predicts positive outcome in 70 patients (M age = 15.49 years, SD = 2.56) with AN who were enrolled in a family-based PHP. RESULTS: Receiver operator characteristic analyses demonstrated that changes in %EBW during weeks 2-5 were more useful than changes in weight in predicting positive outcome. Gaining at least 8.9 pounds or over 8% of EBW in the first 4 weeks of treatment significantly predicted positive outcome. DISCUSSION: Findings suggest that positive outcome in an FBT-informed PHP is predicted by rapid weight gain in the initial weeks of treatment. Research is needed to identify specific family and patient characteristics that facilitate weight gain and to develop corresponding interventions to improve outcome.

Naturalistic outcomes for a day-hospital programme in a mixed diagnostic sample of adolescents with eating disorders.

Despite initial data suggesting positive treatment outcomes for adolescent eating disorder day-hospital programmes (DHPs), existing studies have included limited follow-up, small samples, and a focus on restricting-type eating disorders. To address these gaps, we explored naturalistic outcomes for an adolescent eating disorders DHP. Adolescent participants (N = 265) completed measurements at treatment admission, discharge (n = 170), and various lengths of follow-up (n = 126; Mfollow up = 278.87 days). Results from multilevel models indicated significant increases in body weight for the anorexia nervosa group throughout treatment and maintenance of increased body weight from discharge to follow-up. In bulimic spectrum disorders, binge eating and purging significantly decreased from intake to discharge and did not change from discharge to follow-up. Across the entire sample, eating disorder symptoms decreased from intake to discharge and did not change from discharge to follow-up. Further, anxiety and depression decreased over the course of treatment and continued to decrease over the follow-up period. The current investigation represents the first study to explore longitudinal DHP outcomes within adolescent bulimic spectrum eating disorders. Our findings also highlight many challenges inherent in conducting naturalistic research; it is critical that the field continue to develop solutions to the barriers inherent in conducting longitudinal research on eating disorder treatment.

From Urges to Action: Negative Urgency and Nonsuicidal Self-Injury in an Acute Transdiagnostic Sample.

Urgency-rash action during strong emotion-is a robust correlate of nonsuicidal self-injury (NSSI). This study tested whether urgency is associated with time between NSSI urges and NSSI, and sought to replicate the finding that urgency is associated with NSSI history. Participants attending a partial hospitalization program (N = 669) completed self-report measures of urgency, NSSI history and latency, and psychiatric symptoms. Consistent with previous research in clinical samples, rates of lifetime engagement in NSSI were high. Using logistic regression to predict short vs. long latency between urges and NSSI, no significant relationship emerged between negative urgency and latency to self-injure. Negative urgency more than doubled the likelihood of NSSI history (p < .001, OR = 2.39). In addition, exploratory analyses revealed several links between NSSI latency and negative urgency. Results confirm that urgency is robustly related to NSSI, yet also suggest that more research is needed to understand how urgency relates to the parameters of NSSI within those who self-injure. Use of retrospective self-report measures may limit the ability to test links between urgency and latency of NSSI.

Combining day treatment and outpatient treatment for eating disorders: findings from a naturalistic setting.

BACKGROUND: Day treatment programs for individuals with eating disorders (ED) have been the subject of research and are promoted as an alternative to inpatient treatment due to their therapeutic and economic advantages, but have not regularly been implemented in regular care. PURPOSE: We investigated the long-term effectiveness of a transdiagnostic combined eating disorder treatment program which consisted of an 8-week day treatment phase followed by an average of 19 sessions of outpatient treatment over an average of 39 weeks in a naturalistic setting. METHODS: We accepted 148 patients with different diagnoses of eating disorders into our combined treatment program. We assessed weight, behavioral eating disorder symptoms and eating disorder related cognitions and attitudes at the beginning and the end of the day treatment phase and after 6, 12 and 26 months. RESULTS: Over the course of the 8-week day treatment phase, patients with initial binge eating, purging and/or fasting behavior reduced these symptoms by 91%, 90% and, 86%. Patients who were underweight at baseline gained on average 1.05 BMI points (d = 0.76). In addition, eating disorder related cognitions and attitudes of all patients significantly improved with large effect sizes (d = 1.12). On average, all improvements remained stable during the follow-up period. CONCLUSIONS: Our findings add to the existing studies on day treatment and support previously found encouraging effects of treatment programs that combine day treatment and consecutive outpatient treatment for eating disorders. LEVEL OF EVIDENCE: Level III, longitudinal cohort study.

Adapting treatment in an eating disorder program to meet the needs of patients with ARFID: Three case reports.

Avoidant/restrictive food intake disorder (ARFID) was introduced in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. Three different subtypes of ARFID are described: individuals who seem disinterested in eating, those who avoid certain foods because of a sensitivity to specific characteristics of the food, and those who are concerned about an aversive experience associated with eating. There is currently no first-line treatment for ARFID. Three case studies are presented of patients with ARFID who participated in a family-based partial hospitalization program/intensive outpatient program for eating disorders. A description of the course of treatment is included, as well as ways in which the eating disorder program adapted treatment to more closely meet the unique needs of these patients. An approach with emphasis on parental involvement seems promising, although research is needed to investigate this more fully.

Categorizing Cannabis and Alcohol Use Patterns of Emerging Adults in Psychiatric Partial Hospitalization Treatment.

BACKGROUND: Emerging adulthood is a common and problematic time for alcohol and cannabis use. Emerging adulthood also represents a vulnerable time period for anxiety and depression. Substance use and mental health issues are highly comorbid, yet substance use is commonly neglected in psychiatric care. OBJECTIVE: The goal of this study was to categorize the cannabis and alcohol use patterns of emerging adults in psychiatric care and to evaluate relationships with use-related problems, psychiatric symptomatology, and motives for use. METHODS: Participants were emerging adults who were consecutive admissions to a young adult psychiatric partial hospital program from 2017 to 2018. Of 318 participants who completed questionnaires, 244 (76.7%) reported cannabis and/or alcohol use in the previous month. Cluster analyses and analysis of variance tests were conducted to categorize and differentiate between participants who reported use. RESULTS: Results from cluster analyses identified 4 categories of use: low cannabis/high alcohol (35.7%), low cannabis/low alcohol (17.6%), high cannabis/low alcohol (29.1%), and high cannabis/high alcohol (17.6%). Individuals in categories with the highest rates of use and co-use reported more alcohol problems (F=24.31, P<0.001), cannabis problems (F=36.75, P<0.001), depression (F=3.60, P=0.01), and motives: social (F=6.12, P<0.001), coping with anxiety (F=20.43, P<0.001), coping with depression (F=17.80, P<0.001), enhancement (F=7.85, P<0.001), and conformity (F=4.92, P<0.01). CONCLUSIONS/IMPORTANCE: Clear categories of substance use emerged. Participants who were heavier users were more likely to use to alleviate psychiatric symptomatology, yet they also reported greater psychiatric symptomatology and use-related problems. Among a psychiatric sample of emerging adults, cannabis and alcohol use was common and problematic. Thus, substance use should be evaluated for and, if present, targeted with interventions during psychiatric care.

Nudging Immunity: The Case for Vaccinating Children in School and Day Care by Default.

Many parents are hesitant about, or face motivational barriers to, vaccinating their children. In this paper, we propose a type of vaccination policy that could be implemented either in addition to coercive vaccination or as an alternative to it in order to increase paediatric vaccination uptake in a non-coercive way. We propose the use of vaccination nudges that exploit the very same decision biases that often undermine vaccination uptake. In particular, we propose a policy under which children would be vaccinated at school or day-care by default, without requiring parental authorization, but with parents retaining the right to opt their children out of vaccination. We show that such a policy is (1) likely to be effective, at least in cases in which non-vaccination is due to practical obstacles, rather than to strong beliefs about vaccines, (2) ethically acceptable and less controversial than some alternatives because it is not coercive and affects individual autonomy only in a morally unproblematic way, and (3) likely to receive support from the UK public, on the basis of original empirical research we have conducted on the lay public.

Aspectos evolutivos del trabajo en equipo en el hospital de dia de la comarca del bages (1997-2019) / No disponible

La atención sanitaria en la salud mental de Cataluña define la existencia de los recursos de hospitalización parcial en su cartera de servicios, y específicamente en la comarca del Bages. La evolución de las políticas sanitarias en materia de salud mental, con la incorporación de recursos en la comunidad, así como la introducción de estrategias asistenciales centradas en el paciente ha determinado cambios en la forma de intervenir de la Unidad de Hospitalización Parcial en la comarca del Bages en sus treinta dos años de funcionamiento. En este sentido se redefinen los modelos de intervención, pasando inicialmente de un sistema unidireccional, estrictamente clínico y centrado en el recurso, a un esquema polidireccional, que se define como multidisciplinar, con implicación directa del paciente y enmarcado en un modelo integral más allá del dispositivo

The partial hospitalización was defined into the services who attend the people with mental health. The aim of this study was to identify how the changes about community policies and the new strategies specifically focused of the patient lead to changes in the mode to threat the patients admitted in the partial hospitalización of the Bages' región. The result was define in a polidyrectional system with three basic principles: multidisciplinary team, direct involvement of the patient and integral plan

Experiencia del abordaje multidisciplinar aplicado en el hospital de día de neuropsiquiatría del hospital mare de déu de la mercè (años 2016, 2017 y 2018) / Multidisciplinary approach experience of the neuropsychiatry day hospital of the hospital mare de deu de la merce (period 2016 to 2018)

Introducción: El hospital de día de Neuropsiquiatría es un dispositivo sanitario especializado que atiende a personas adultas que presentan sintomatología cognitiva derivada de un daño cerebral sobrevenido, trastorno por uso de sustancias, enfermedad de Huntington y demencias degenerativas de inicio precoz. Se presenta la experiencia del abordaje multidisciplinar entre los años 2016 y 2018. Métodos: La información ha sido obtenida a partir de las valoraciones realizadas según los protocolos de evaluación multidisciplinar del hospital. Se ha realizado una estadística descriptiva y se ha utilizado la prueba t para medias de dos muestras emparejadas para evaluar diferencias significativas entre las valoraciones al ingreso y al alta. La muestra es de 179 pacientes, con una media de edad de 50.47 años, de las cuales 75 (41.90%) son mujeres. Como instrumentos de medida se han utilizado pruebas de despistaje cognitivo, de evaluación de la conducta, del equilibrio y funcionalidad, y un cuestionario de calidad de vida. Resultados: Se objetiva una mejoría significativa de las pruebas de despistaje cognitivo, de valoración de la conducta y de la sobrecarga del cuidador. En los pacientes con trastorno por uso de sustancias hay también una mejoría significativa del equilibrio. En los pacientes con enfermedad de Huntington hay una mejoría significativa de la apatía. Conclusiones: La intervención multidisciplinar del hospital de día de Neuropsiquiatría parece ser válida para mejorar las habilidades cognitivas, la conducta y disminuir la sobrecarga del cuidador. Hay que destacar la mejoría de la apatía en los pacientes con enfermedad de Huntington dado que es un síntoma refractario al tratamiento farmacológico. Se propone incluir grupos de rehabilitación física en otros recursos de la red de tóxicos

Introduction: The Neuropsychiatry day hospital is a specialized health care service that attends adults who present cognitive symptoms in the context of acquired brain damage, substance use disorder, Huntington's disease and early onset dementias. The manuscript exhibits the multidisciplinary approach experience from the period 2016 to 2018. Methods: The information has been obtained from the assessments made according to the multidisciplinary evaluation protocols of the hospital. A descriptive statistic has been performed and the t-test for means of two paired samples has been used to assess significant differences between admission and discharge assessments. A sample of 179 patients, with an average age of 50.47 years, of which 75 (41.90%) were women, is presented. As measuring instruments, tests of cognitive screening, behavioral assessment, balance and functionality, and a quality of life questionnaire have been used. Results: There is a significant improvement in the tests of cognitive screening, behavior assessment and caregiver burden. In patients with substance use disorder there is also a significant improvement in balance. In patients with Huntington's disease there is a significant improvement in apathy. Conclusions: The Neuropsychiatric day hospital intervention seems to be effective to improve cognitive abilities, behavior and caregiver burden. It is noteworthy the improvement of apathy in Huntington' disease patients, because it is a pharmacological refractory symptom. It is proposed to include physical rehabilitation groups in substance abuse programs

Can brief telephone interventions reduce caregiver burden and depression in caregivers of people with cognitive impairment? - long-term results of the German day-care study (RCT).

BACKGROUND: Day-care and telephone counseling have been discussed as effective support measures for caregivers of people with cognitive impairment. METHODS: In a two-arm cluster-randomized trial involving multicomponent therapy for cognitively impaired persons in day-care centers and telephone counseling for their caregivers versus treatment as usual (TAU), we investigated long-term effects on caregivers' burden and depressiveness. Person-caregiver dyads involving home-dwelling persons with MCI, mild dementia, or moderate dementia were eligible. Day-care centers were randomized into an intervention group (IG) or a control group (CG). Outcome assessors were blinded. Out of 359 caregivers who had completed a 6-month intervention phase (nIG = 205, nCG = 154), a total of 304 of them were available at the 12-month follow-up (nIG = 173, nCG = 131). Instruments for assessing were the Burden Scale for Family Caregivers - short version (BSFC-s) (caregiver burden) and the Well-Being Index Score (WHO-5) (depressiveness). Mixed ANOVAs were used for the main analyses; descriptive statistics and subgroup analyses were additionally performed; secondary analyses involved multiple linear regressions for the main outcomes that were significant in the unadjusted main analysis. RESULTS: At follow-up, crude mean differences showed a nonsignificant advantage for the IG in caregiver burden [IG: -.20 (SD = 5.39) vs. CG: .76 (SD = 5.49), p = .126, d = .177] and depressiveness (reverse scored) [IG: -.05 (SD = 5.17) vs. CG: -.98 (SD = 5.65), p = .136, d = .173]. For caregiver burden, a mixed ANOVA resulted in significant main effects of group (F (1, 302) = 4.40; p = .037) and time (F (1.88, 568.96) = 3.56; p = .032) but not a significant interaction. The largest effects were found for the "mild dementia" subgroup (d = .443 for caregiver burden and d = .520 for depressiveness). DISCUSSION: Positive long-term effects of a combined intervention involving telephone counseling for caregivers and multicomponent activation for patients were observed especially for mild dementia. However, the treatment effects washed out after the intervention ended. TRIAL REGISTRATION: ISRCTN16412551 (date: 30 July 2014, retrospectively).

Updates in the treatment of eating disorders in 2018: A year in review in eating disorders: The Journal of Treatment & Prevention.

Current evidence suggests that the majority of patients with eating disorders will not fully recover during treatment, and little doubt can exist around the urgent need for improved treatment outcomes across the field of eating disorders. While empirical efforts are underway to optimize outcomes, this article reviews treatment-related research findings published in Eating Disorders: The Journal of Treatment & Prevention during 2018. Importantly, this review encapsulates research addressing (i) barriers to access and the uptake of empirically supported treatments, (ii) research assessing the delivery of empirically supported treatments across the full spectrum of patient care, and (iii) research aiming to isolate treatment mechanisms and optimize treatment outcomes across a transdiagnostic array of eating disorders. Ultimately, while much ground has been covered in 2018, further research is needed to enhance the accessibility and uptake existing treatments, since only a fraction of those with eating disorders are currently engaged in treatment. Further, with the expanding scope of non-outpatient eating disorder treatment settings, further research is required to adapt and assess the implementation of empirically supported treatments in higher levels of patient care. Lastly, in aiming to optimize patient outcomes, treatment outcome research must seek to identify (i) mechanisms that underlie illness eating disorder psychopathology, and (ii) the active mechanisms of existing treatments.

Turning the UPPS down: Urgency predicts treatment outcome in a partial hospitalization program.

BACKGROUND: Impulsivity in response to negative mood (negative urgency) and positive mood (positive urgency) is common in psychiatric disorders. The aims of this study were to test if urgency predicts treatment response during partial hospitalization in a transdiagnostic sample, and if urgency is malleable over the course of brief treatment. METHOD: Participants (N = 348, 55% female, M age = 32.9) were patients presenting to a CBT-based partial hospitalization program. Urgency and a range of symptoms were assessed with self-report measures during treatment. RESULTS: Higher negative urgency scores predicted worse outcome for depression and anxiety symptoms. Negative urgency (p < .001, Cohen's dz = 0.61) and positive urgency (p < .001, Cohen's dz = 0.39) significantly decreased during treatment. DISCUSSION: Findings suggest that participants report decreases in urgency during brief partial hospitalization treatment. Higher negative urgency predicted poorer treatment response for symptoms of depression and anxiety, demonstrating the need for novel treatments for urgency.

Adult Day Services Outcomes: Delphi Review of an Integrated Participant Assessment System.

Adult day services (ADS) aim to help elders age in place, but evidence of impact on participants lags behind caregiver research. To play a larger role in the continuum of care, ADS participant outcomes should regularly be documented with standard measures. We conducted a Delphi review of one integrated participant assessment system. Capturing physical, mental, and cognitive health indicators and activity engagement of typical ADS participants (i.e., frail elders eligible for nursing home placement), experts evaluated the system on instrument validity, relevance, and application. Practitioners and researchers completed multiple assessments of the system's instruments and alternatives. Finally, panelists addressed the potential benefits and challenges of system adoption by ADS providers. Panelists concurred that such a system would benefit individuals, families, and providers; concerns related to cost and staffing requirements and appropriateness for distinct client populations. A refined system can reveal best practices to enhance ADS service delivery and participant outcomes.