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Sheppard Pratt Admission Criteria

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Figured this might be useful to others

This is from page 104 of "textbook of Hospital Psychiatry where the current director has written the guidelines they use on there unit.

It reads as follows

Admissions to the TDU must be referred by a treating mental health professional. The Admissions Coordinator reviews an extensive questionnaire submitted by the referring clinician and discusses the prospective patient with the clinician. Then all potential admissions are reviewed with an attending psychiatrist for suitability for TDU admission., including medical necessity criteria for inpatient level of care. Currently, the TDU accepts both male and female patients, ages 18-65, with a history of psychological trauma. Male patients are screened carefully for their ability to manage in, and not be disruptive to, a mostly female hospital milieu. Given the realities of modern hospital reimbursement, most admissions must meet inpatient "medical necessity" criteria: imminent dangerousness to self or others and/or a catastrophic inability to function due to disabling, post traumatic and/or dissociative symptoms.

Because patients must be motivated to participate actively in a demanding treatment program, we generally do not accept involuntary patients or court-mandated treatment. Trauma patients with extensive histories of perpetrating childhood abuse, violence towards others, or sexual assaults or with significant antisocial personality features usually are excluded due to their potential negative impact on the TDU milieu and the difficulty in treating these problems in a milieu focused on recovery for abuse survivors. Not uncommonly, however, previously unknown histories of perpetrating child abuse or violence are revealed during TDU hospitalization.

Patients admitted to the TDU must be medically stable. Psychotic and/or manic patients are excluded because of the potential disruption to the TDU milieu and difficulty participating in the treatment program. It has been our experience that patients with severe substance and/or alcohol abuse or dependence usually do not respond to the treatment milieu of the TDU until they have achieved sobriety and are motivated to maintain recovery. It goes on more about substance abuse not worth repeating. But is followed by: because we do not have the resources to provide intensive specialized eating disorders treatment during a TDU stay, trauma patients with histories of eating disorders can be admitted only when sufficiently stabilized to manage their eating disorder symptoms.

Unlike what they say on SVU: they get to pick the vic. They get to choose the easy patients, it would seem that anyone who is too damaged they won't help. Kind of goes against being on of the best units around when you take into consideration they don't help those who have too much abuse history or problems from it.
 
It seriously sounds like you're talking this way because you think you're going to be rejected from their program and you want to brace yourself for the bad news. How far along are you in the admissions process now? I'm not sure how they work, but I know with my other programs it took some time to determine if the program was right for me, along with financial considerations.

I don't think that any trauma program picks "easy patients" because dare I say most of us aren't "easy" especially if we need hospitalization or a program.

Don't lose hope. In sure you'll get in.
 
Trauma patients with extensive histories of perpetrating childhood Abuse, violence towards others, or sexual assaults or with significant antisocial personality features usually are excluded due to their potential negative impact on the TDU milieu and the difficulty in treating these problems in a milieu focused on recovery for abuse survivors.
So, this means that they generally do not admit:
  • people who have abused children (perpetrators)
  • people who violently attack others
  • people who have sexually assaulted others
  • people who have significant antisocial (sociopath) traits.

And this is a problem, because...?

That's not laziness. I think that's pretty reasonable, given the kind of work they do - work with people suffering from the after-effects of trauma (PTSD and Dissociative Disorders)

because we do not have the resources to provide intensive specialized eating disorders treatment during a TDU stay, trauma patients with histories of eating disorders can be admitted only when sufficiently stabilized to manage their eating disorder symptoms.
If you are actively bulimic or anorexic, and cannot control your symptoms (are going to binge/purge, or will refuse to eat), they don't have the ability to help you right now. You need to stabilize those first. They actually have a separate unit for eating disorders.

I don't think that's just 'taking the easy patients' either. It's realistic and responsible. I suspect you misread their first statement as meaning that they do not take survivors of childhood abuse, etc. It's the opposite.

@Lucycat - TDU is Trauma Disorder Unit. SVU is Special Victims Unit, which is a reference to the US television show: Law and Order (Special Victims Unit), which is a police procedural drama about a department that investigates sex crime.
 
Having been in a TDU here just recently, I think these guidelines sound pretty realistic.

It was a lot of hard, hard work in the TDU I was at. It was a full-time, trauma-focused therapy program, and if I'd been in a place where I wasn't able to manage my comorbid issues, it would have been disastrous. The confroting work really demanded that you be in a really good space to keep yourself grounded and motivated. It was a working unit, as opposed to a standard mental health unit for acute admissions.

We had a patient come in during the last of my 3 week admission who was not in a good space. She was very depressed, and had what appeared to be completely unmanaged BPD. The impact on the group was huge, and her instability actually caused the group to breakdown and be unable to continue the scheduled programming on several occasions. She was removed from the group on my last day for that reason.

There was an ex-anorexic who was self-managing a good diet (which was monitored, and for her own sake, she would have been removed if she relapsed), as well as at least 2 ex-addicts. Given the strain on them (like all of us) from the program, it would simply be inviting relapse if they were not stable enough before they began the program.

Guidelines about addicts and people with eating disorders or mania etc were, in my view, essential and responsible. It's not saying "You can't participate", it's saying that you need to be ready to handle it.

Acute issues from ptsd, in my view, are much better handled in acute facilities. Trauma work like this? To get benefit from it, get to a good space first. They are recognising that addiction and eating disorders are commonly cormorbid with PTSD, they're just saying that they aren't placed to treat those issues while the problem is still unstable.
 
Thanks you all for confronting my on my negative attitude, that the defeatist trait I am working to get rid of.

Part of my worry was in my records up to 20 years ago, there is one reference where I became violent when they tried to put me in seclusion for my safety and had to be put in a straight jacket. I was concerned that might nix things, I am not that same person, back then I was in hospital about 2 times a year almost every year since 17.

The fact that I am needing pratt speaks to how far I have come.

But my therapist the other day help get straight on that, non of my past record is being looked at, they info they have is where I am now.
And the delay could be a good thing. I some ways it has as I have already been forced to use some of the coping skills they taught in PHP, and have been having to come up with some new ones now.

The fact that I have sometimes SI and don't act says a lot. This time around it has to be about me in control of my needs and getting the right help, not somebody else taking the control from me to make me safe. 20 Years ago, I would have been TDO'ed in a heartbeat.
 
It seriously sounds like you're talking this way because you think you're going to be rejected fr...

My therapist set me straight on that too. That they are trying to decide if the program is right for me, and me for it. Monday it will be 10 days since the referral, I seriously don't think they will take weeks to decide, I suspect they will decide early next week.

Being in limbo with this makes me batty sometimes, I just want to move forward so I can get what i need and move on with life.

Again my therapist got me regrounded, as I was freaking out over stuff I have no control over.
 
@hurtingbadly - then do it. It was hard, and stirred up a lot of painful stuff for me, but was really really helpful.

If you have these other issues on board, it's helpful if the staff know about it. They've seen all this stuff before, they understand that ptsd doesn't exist in a vacuum and that a lot of us develop other issues along the way. They can help you keep an eye out for your triggers, step in when they see you struggling. My exprience was that once you were in the unit, they actually bent over backwards to help you stick with it. They genuinely wanted to see people get something positive out of the experience, and for a lot of us, that means keeping the other demons under control enough for us to get through the therapy process.

To me, these guidelines don't sound like "If you're too hard you can take a hike". Quite the opposite. It would concern me if the crowd at S Pratt were running the unit as though these other issues don't exist.

For what it's worth, I used this forum to help get myself ready, and to help me get through it. I think this is potentially a really great opportunity, and I've got my fingers crossed that your experience will be as helpful as mine was.
 
@hurtingbadly - then do it. It was hard, and stirred up a lot of painful stu...

I am sort of doing the same, but also to cope, this is the one place where people truly understand, and I know it will be hard, maybe ever harder than what I am going thru now. But I kept this stuff behind a solid wall of distrust for so long, that I am getting what I never allowed myself to feel all at once. I think that's why pratt is so important to me. I am finally at a point where not only is this stuff out in the open instead of locked up and turned inward, I am willing, ready and prepared to face it head on so I can move past it, and move on with life without this stuff controlling my life and making me unhappy.
 
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