Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Butler Hospital

Name of Innovative Program: 
ACT for inpatients
Sponsoring Organization
Butler Hospital
Name of Innovative Program Lead: 
Brandon Gaudiano
E-mail Address of Innovative Program Lead: 
brandon_gaudiano@brown.edu
Project Description: 
This project is collaboration between nursing leadership, occupational therapy and the psychosocial research department in a university affiliated free-standing psychiatric hospital.ACT-IN stands for Acceptance and Commitment Therapy for INpatients.  The treatment has been developed specifically for inpatients with psychotic disorders including schizophrenia.  ACT-IN is based on Acceptance and Commitment Therapy adapted for a group format for patients with short-term inpatient stays.  The aim of ACT-IN is to improve functioning and quality of life by helping individuals work toward  goals that are consistent with their core values. To facilitate this, patients are taught acceptance and mindfulness-based strategies to cope with distressing symptoms, including hallucinations and delusions.   The therapy is designed to be delivered by hospital staff in an open/rolling format in which different content themes are rotated across sessions. 
Creativity and Innovation: 
  Brandon Gaudiano PhD developed ACT-In, the IN standing for inpatients from his own and others research in using ACT. This model adapts ACT to a group format that can be delivered by the routine unit staff once trained. This is creative and innovative in several ways. First of all this project takes an individual therapy model and adapts it to a  group format that can be used in the inpatient setting.   Basing unit programming on ACT principles or core processes enables a shift in focus to empowering the patient, promoting recovery and obtaining functioning.  Patients are instructed through stories and metaphors. They engage in mindfulness practices and are reminded that they can make choices based on their value system.  . In addition, this project represents a unique collaboration between disciplines to incorporate a research based treatment into the milieu that can be administered by unit staff of all skill levels.
Leadership: 
This project is still in the early design and implementation phase. It a funded research project that will span several years.   Ultimately, our goal is to transform the basis of the milieu treatment and create a cohesive unit program that can be replicated.  We plan to then expand it to other inpatient units, using what we learned to further inform the process. The potential for other organizations to adopt a similar model is great. As we proceed in the roll out of the research intervention, we will refine a process and manual  for other hospital units and organizations to implement this intervention. Opportunities exists for this project and its results to be presented to national nursing, occupational and psychology organizations as well as for publication. Finally, although this particular project is aimed toward individuals with psychotic symptoms, ACT has been demonstrated to be effective for other  symptoms/diagnoses. 
Sustainability: 
This is a funded research project and there is support within the organization for it to continue, the advantage being that the implementation has a muti-disciplinary focus. In addition , because the intervention can be deliverd by line staff it is very sustainable as it does not require years of training as a therapist to become competent.
Replicability: 
The replicability has not been tested completely for this project. The potential is there  and defining the method of replicability is one of the project aims. One of our goals is to create a group model that can be taught to and effectively deliverd by unit staff. As we procees we will be outlining the process and refining the manual that guides the treatment intervention.
Results/Outcomes: 
Research on ACT therapy, even in short sessions on an inpatient unit has shown positive patient outcomes such as reduced re-admission rates and less distressed experienced from symptoms. We will be monitoring re-admission rates but also measures of the patient's experience of care and hospitalization to further evaluate the benefits of this intervention.
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