French day hospitals for children: an overview

Over the last 30 years, with the implementation of a catchment-area policy in France, a number of day hospitals have been created to replace full-time hospitalization or other residential programs as a treatment modality for child psychotics. Considered as one treatment possibility among others available in any given geographic area, day hospitals differ tremendously in how they are organized, but the approach to treatment has been, so far, inspired largely by psychoanalysis. Recently, parents favoring cognitive or behavioral techniques have begun to challenge that position. This paper contains an overview of the general situation in France and presents in greater detail methods used at the day hospital of the Rothschild Foundation, located in Paris' 13th district. Longitudinal studies going back to 1973 point to a need for extreme caution in establishing prognoses, as progress can occur when least expected. The authors favor a strategy of ongoing support for parents and children, devised on a case-by-case basis, rather than preestablished treatment plans applied according to symptoms.