Organizational change in an adolescent inpatient unit

This paper describes a two-year process of evolution toward a more open, yet more structured therapeutic orientation in a large adolescent inpatient psychiatric unit. The rationale for alterations in structural organization, therapeutic modalities, and staff development are discussed. Issues of treatment team leadership, physical organization of the treatment center, integration of family, group and individual therapy, continuity of care and staff training are examined. Assessment of the impact of the changes were accomplished by administration of the Moos Ward Atmosphere Scale to clients and staff prior to and two years following the implementation of the changes. Adolescents perceived the ward environments as engendering more involvement, being more oriented toward personal problems, and encouraging less anger and aggressiveness. In addition, they saw the program as increasing in clarity, and the staff as being in greater control. Staff's perceptions, shifted in a more positive direction on nine of ten WAS subscales. Implications for the direction of change and its relationship to the organizational changes is discussed.