Aftercare

After 24 h the grid is removed. Following removal of the grid, the mask comes off the face almost with no effort, since the skin exudate lifts the tape. Analgesia is not required, since the procedure is almost painless. Occasionally some physicians remove the mask at 48 h, but we find it unnecessary and more troublesome for the patients, since while the tape mask is on, the eyelids are frequently swollen shut. We feel that this inconvenient period must be minimized. 

After the tape mask removal the exudate is cleaned by sterile saline. Spot peeling and retaping may be done if the skin looks underpeeled, particularly in areas with severe wrinkling. It is usually accompanied by a short-duration burning sensation. The tape is left for an additional 4-6 h and then removed by the patient. We cover the face with bismuth subgalate antiseptic powder for 7 days (Fig. 8.10). Other options include occlusive moisturizers, antibiotic ointments, and biosynthetic occlusive dressings such as Meshed Omiderm. 

At this stage we recommend using regular pain killers every 4 h for the first 2 days. Some physicians administer systemic corticoids to reduce the swelling and inflammation after the peel. Neck swelling is expected after deep peel. It disappears within 4-6 days. 

After the procedure, the patient is advised to use water-based creams and potent sunscreens. The erythema is extremely intense in the first 2 weeks, and gradually resolves over a period of about 2 months. During this time, the use of makeup with a green foundation is encouraged to assist the patient in resuming daily activities. 

In cases of patients with olive skin (Fitzpatrick skin type 3 or 4), the application of Kligman preparation is recommended to prevent reactive hyperpigmentation. 

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Netherlands (high ground water level, soft soil), a price of some 50 per tonne is enough to realise a controlled landfill (including aftercare systems). The gate fee of mechanical recycling processes depends very much on the type of plastic and type of mechanical recycling and cannot be specified here. 

Provides prevention, treatment, rehabilitation and aftercare programmes (in partnership with other... 

Hogarty GE and Goldberg S (1973). Drug and sociotherapy in the aftercare of schizophrenic patients One year relapse rates. Archives of General Psychiatry, 28, 54-64. 

Sustainable solutions minimise the burden of aftercare. Endless pump and treat solutions or containment walls that require control and maintenance forever may be less desirable in view of the amount of aftercare required [4],... 

Aftercare. A treatment modality that comes after and is less intensive than outpatient or inpatient therapy. The focus is usually on relapse prevention. Behavior chain analysis. Assessing how one behavior leads to another, which leads to another, and so on. 

Aftercare goals are almost always the same as treatment goals. True or False ... 

Counselors and therapists have to determine when the client has made sufficient progress to move into this next phase of therapy. The decision whether the client is ready to be moved from formal treatment into aftercare is determined by client progress on the treatment plan. The counselor or therapist uses clinical judgment to ascertain whether the client has made sufficient progress on the plan to warrant movement from formal treatment into aftercare and whether the client is sufficiendy stable in his or her recovery to take this next step toward autonomous recovery. The next section covers factors that counselors and therapists should consider when making the decision to graduate clients from treatment into aftercare. In addition, this chapter provides an overview of what can be expected during this final phase of treatment and therapy for professionals, and for clients and their families. 

Suggested Criteria for Discharging From Treatment Into Aftercare... 

For both counselors and therapists, the treatment plan provides an excellent way to determine when a client is ready for aftercare. As you may remember, the treatment plan includes various types of problems that are prioritized by the relative threat to the recovery and well-being of the client (see Chapter 4, especially Research Frontiers on page 166. Counselors and therapists can also use the tier system to guide their determination of when a client is ready for a taper in treatment or therapy. For example, counselors and therapists will most certainly want clients to be stable before referral to aftercare, which suggests that all Tier 1 and... 

Tier 2 problems should be resolved before such referrals are made. The resolution of Tier 3 problems becomes more a matter of clinical judgment, but certainly a counselor or therapist will want to determine whether enough progress on Tier 3 problems has been made that the client can begin to direct his or her own treatment out in the real world. I would recommend that significant progress has been made on most, if not all, Tier 3 problem items on the treatment plan prior to discharge into aftercare. 

Aftercare represents the ideal forum for addressing Tier 4 problem items, so it is expected that many of these will not have been addressed in treatment. Therefore, it is not necessary to have made progress on Tier 4 problems before a referral to aftercare. Many of these problems, as mentioned in Chapter 4, will require clients to develop their own plans for how to address them in everyday life. The aftercare counselor or therapist can serve as a guide in this effort to find new life pathways, but clients must do the actual walking when the trails are chosen. 

The continuing care plan, developed prior to discharge from treatment into aftercare, is constructed with the different spheres and zones of recovery in mind. The ultimate goal of the continuing care plan is to help the client move into this new phase of recovery as seamlessly as possible. So, like the treatment plan (remember Chapter 4), the continuing care plan should be comprehensive but not overly intrusive, should be simple enough to follow, and should be developed collaboratively with the client prior to discharge. 

Just as with treatment, the appearance of aftercare may vary according to the therapeutic model. For example, Minnesota-model aftercare usually operates in groups that meet weekly. The format of these weekly sessions usually involves psychoeducation around relapse prevention, often related to an issue germane to specific members of the group. Sometimes the psychoeducation topic is predetermined by the outline of a relapse prevention manual (see Chapter 7). 

Before aftercare begins, a client will likely meet with the aftercare counselor. This counselor may be different than the one he or she works with in treatment. However, the client likely will know the aftercare counselor from treatment groups even if that person was not her or his primary individual counselor. This first... 

Darien is a 24-year-old finishing treatment and preparing for aftercare. 

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