An Alternative to Inpatient Care
In the early 1960s, a small group of clinicians who were involved in the relatively new treatment approach of “day hospitals” began meeting on a regular basis to discuss their problems and experiences. They shared a basic dissatisfaction with the restrictive traditional ways in which mental health treatment was organized and delivered. They also shared a belief in the common sense notion that individuals with acute mental illness had a better chance of recovery and healthy functioning if they were allowed to pursue their treatment in the same communities where they worked, went to school, or maintained their family relationships. By the late 1960s, this group was already sufficiently organized to have a name and a more formal structure: they called themselves the Partial Hospitalization Study Group (PHSG).
The Purpose of the Modality
Partial hospital or day programs have always tended to share a number of characteristics that distinguish them from inpatient settings, although their programming is designed to treat many of the same kinds of acute populations that have traditionally been assigned to inpatient psychiatric treatment. Partial programs differ from inpatient in being more flexible, more tailored to the individual patient treatment needs, and more focused on maintaining the important community ties of their clients. They are run by relatively egalitarian multidisciplinary teams, with treatment centered around group therapy and psychoeducation modules. They draw on a number of client rights movements of this century, including the community mental health and deinstitutionalization movements; they also take advantage of the revolution in psychopharmacology and build on core group approaches such as family systems theory, the psychosocial rehabilitation movement and therapeutic milieu concepts of Irvin Yalom, Maxwell Jones, and others.
As the Partial Hospitalization treatment modality began to amass a research base and to be generally recognized within the mental health community, the first group (located mostly in the northeast) was joined by others in other parts of the country. Members organized a regular annual conference, hosted in turn in various cities where regional groups were active. In 1975, the original study group and other similar regional groups formed a national network for the purpose of exploring, sharing, and addressing concerns which were both national and regional in scope. They gave this group the name Federation of Partial Hospitalization Study Groups, Inc (FPHSG).
By 1979, this national network had proved itself so useful to members that they voted to adopt a new name: the American Association for Partial Hospitalization (AAPH). It continued to operate through the volunteer services of program directors, psychiatric nurses, social workers, activity therapists and counselors in hundreds of partial hospital programs across the country. In 1985, the research, publication, conference and training activities of the association were extensive enough to warrant the establishment of a national headquarters office in Washington DC and the hiring of an executive director.
Partial Makes Its Name Known
In the early days, the most common topic a PHSG or AAPH member discussed with an outsider was “What, exactly, is a partial hospital?” That changed dramatically during the 1980s, as the effectiveness, cost savings, and client support of partial hospital programs were demonstrated over and over again. Advocacy efforts expanded recognition of the modality among other clinicians, as well as by third party payers such as CHAMPUS, Medicare, and the insurance community. But during this same period, the partial hospital pioneers continued to apply the same kind of common sense approaches to a broader and broader range of treatment issues, leading to the translation of partial hospitalization concepts to other types of community-based services and the forming of connections to the pioneers of other flexible care alternatives, who also found themselves constrained by an increasingly rigid reimbursement system.
Growth of the Ambulatory Continuum
For almost two years, the AAPH Board of Directors worked to consciously expand the association’s mission and services in response to member needs. This was influenced by the extremely rapid development of a broad new diversified array of ambulatory services, and by the widespread extension of our members’ service delivery programs into new modes or types of care. This expansion of services has occurred as part of a movement towards diversified ambulatory care solutions going on throughout the healthcare delivery industry, and not just within our association’s membership. The careful broadening of the AAPH scope prompted discussion about a name change throughout this two year period. A member opinion poll was conducted during April 1995 which showed that most AAPH members already offered an expanded range of ambulatory services, and strongly supported the association’s movement to better define and support the understanding of ambulatory approaches within the healthcare delivery community. In August 1995 the membership voted to change the organization’s name to its current one: the Association for Ambulatory Behavioral Healthcare.
The Future of Ambulatory Care
Today’s healthcare environment is experiencing dizzying change, rapid evolution, and tremendous levels of confusion, as the tension between consumer pressures for greater access to healthcare and taxpayer pressures for greater cost containment lurches toward resolution. Within this confusing framework, ambulatory solutions are being adopted right and left, both by those who understand them and by those who don’t. AABH finds itself square in the middle of exciting times. Our goal - more flexible healthcare solutions to bring quality results to greater numbers of people - lends itself well to these times.