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Rouhi M, Linden T, Doherty D, Prior SJ. Environmental Risk Assessment in Community Care: A Scoping Review. Healthcare (Basel) 2024; 12:859. [PMID: 38667621 PMCID: PMC11050427 DOI: 10.3390/healthcare12080859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/09/2024] [Accepted: 04/14/2024] [Indexed: 04/28/2024] Open
Abstract
Community care encompasses inherent risks for both clients and healthcare providers. Maintaining a safe environment for the delivery of care services ensures that any risk of unintentional or intentional personal harm is minimised. The aim of this scoping review is to (a) provide an overview of existing knowledge by summarising the current literature and (b) identify gaps pertaining to understanding and managing environmental risk in community care settings. Guided by the Population/Concept/Context approach and PRISMA guidelines, this paper used two questions to answer how a score-based tool for assessing client suitability in community care is developed and how an environmental screening tool assists with reducing risk to community care workers. Literature searches of CINAHL, PubMed (Medline), Web of Science and PsychINFO databases were conducted between September 2023 and November 2023. We included full text articles published from 2018 to 2023. The following four broad areas were identified as key components in the structure of an environmental screening tool: environmental factors, health factors, socioeconomic factors and cultural factors. The results of this review provide valuable information which can be utilised by care organisations to develop and/or refine tools to ensure the safety and wellbeing of workers within the community care sector.
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Affiliation(s)
- Maryam Rouhi
- Tasmanian School of Medicine, University of Tasmania, Burnie, TAS 7320, Australia; (M.R.); (T.L.)
| | - Tanya Linden
- Tasmanian School of Medicine, University of Tasmania, Burnie, TAS 7320, Australia; (M.R.); (T.L.)
| | - Douglass Doherty
- Family Based Care Association North West Inc., Burnie, TAS 7320, Australia;
| | - Sarah J. Prior
- Tasmanian School of Medicine, University of Tasmania, Burnie, TAS 7320, Australia; (M.R.); (T.L.)
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Martinelli A, D'Addazio M, Zamparini M, Thornicroft G, Torino G, Zarbo C, Rocchetti M, Starace F, Casiraghi L, Ruggeri M, de Girolamo G. Needs for care of residents with schizophrenia spectrum disorders and association with daily activities and mood monitored with experience sampling method: the DIAPASON study. Epidemiol Psychiatr Sci 2023; 32:e18. [PMID: 37039434 PMCID: PMC10130736 DOI: 10.1017/s2045796023000124] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 01/24/2023] [Accepted: 03/12/2023] [Indexed: 04/12/2023] Open
Abstract
AIMS Care needs represent an essential paradigm in planning residential facility (RF) interventions. However, possible disagreements between users and staff are critical issues in service delivery. The Experience Sampling Method (ESM) tracks experiences in the real world and real time. This study aimed to evaluate the care needs of patients with schizophrenia spectrum disorder (SSD) in RFs and its association with daily activities and mood monitored using the ESM. METHODS As part of the DIAPASON project, 313 residents with SSD were recruited from 99 Italian RFs. Sociodemographic and clinical characteristics were recorded. Care needs, the severity of symptomatology and negative symptoms were assessed. Fifty-six residents were also assessed for 7 consecutive days using the mobile ESM. Descriptive, agreement, predictor and moderator analyses were conducted. RESULTS The staff rated a higher number of total and met needs than service users (p < 0.001). Only a slight agreement between users and staff on unmet needs was found in self-care (k = 0.106) and information (k = 0.100) needs, while a moderate agreement was found in accommodation (k = 0.484), food (k = 0.406), childcare (k = 0.530), physical health (k = 0.470), telephone (k = 0.458) and transport (k = 0.425) needs. Older age (-0.15; p < 0.01), longer SSD diagnosis (-0.16; p < 0.01), higher collaboration (-0.16; p < 0.01) and lower symptomatology (-0.16; p < 0.01) decreased the number of unmet needs, while being a female (0.27; p < 0.05) and a shorter length of stay in an RF (0.54; p < 0.001) increased the number of unmet needs. A higher number of unmet needs was associated with a lower amount of time spent in leisure activities or reporting a positive mood: on the contrary, more unmet needs were associated with a greater amount of time spent in religious or non-productive activities. The associations between unmet needs rated by staff and users and momentary mood as assessed using the ESM were not moderated by the severity of symptomatology. CONCLUSIONS Although care needs are fundamental in planning residential activities aimed at recovery-oriented rehabilitation, RF interventions did not fully meet users' needs, and some disagreements on unmet needs between users and staff were reported. Further efforts are necessary to overcome Italian RF limits in delivering rehabilitative interventions defined by real users' needs to facilitate users' productivity and progress towards personal recovery.
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Affiliation(s)
- Alessandra Martinelli
- Unit of Clinical Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Miriam D'Addazio
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Manuel Zamparini
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Gabriele Torino
- Department of Psychology, Clinical Psychology, Catholic University of the Sacred Heart, Milan, Italy
| | - Cristina Zarbo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Matteo Rocchetti
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Fabrizio Starace
- Department of Mental Health and Dependence, AUSL of Modena, Modena, Italy
| | - Letizia Casiraghi
- Department of Mental Health and Dependence, ASST of Pavia, Pavia, Italy
| | - Mirella Ruggeri
- Section of Psychiatry, Verona Hospital Trust, AOUI, Verona, Italy
| | - Giovanni de Girolamo
- Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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McDonald KL, Hoenig JM, Norman CC. Identifying profiles of need among psychiatric inpatients approaching discharge in New York City: a latent class analysis. Soc Psychiatry Psychiatr Epidemiol 2021; 56:63-73. [PMID: 31897580 DOI: 10.1007/s00127-019-01817-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 12/13/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Understanding the needs of individuals transitioning to the community following a psychiatric hospitalization can inform community service planning. This study is among the first to examine the needs of a sample of psychiatric inpatients approaching discharge in a large urban area in the USA. METHODS Representative data were drawn from 1129 acutely hospitalized psychiatric inpatients from eight New York City hospitals. Descriptive statistics were used to estimate patient needs at discharge across nine domains: housing, employment, income, transportation, education, time use, social support, and help accessing medical and mental health care. Latent class analysis (LCA) was applied to identify subgroups of patients based on needs profiles. Multinomial logistic regression was used to investigate socio-demographic associations with class membership. RESULTS Respondents were most likely to have needs related to income (50.7%), housing (49.2%), and employment (48.7%). Results from the LCA suggested a five class solution of patient needs: three domain-specific classes whose members endorsed needs for 'housing and employment' (22.5%), 'social support and time use' (15.0%) and 'access to care' (6.4%) and two classes where overall member needs were high ('high needs,'18.4%) or low ('low needs,' 37.7%) across all needs. Compared to the 'low needs' class, members of the 'high needs' class had significantly greater odds of being black or Latino, male, uninsured, and parents of a child under 18 years. CONCLUSION Patients have unique profiles of need that are significantly associated with the socio-demographic characteristics. These findings may help practitioners and policymakers improve mental health services.
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Affiliation(s)
- Kate L McDonald
- NYC Department of Health and Mental Hygiene, NYC Department of Health and Mental Hygiene, Bureau of Mental Health, 42-09 28th Street, 19th floor, Queens, New York, 11101-4132, USA.
| | - Jennifer M Hoenig
- NYC Department of Health and Mental Hygiene, NYC Department of Health and Mental Hygiene, Bureau of Mental Health, 42-09 28th Street, 19th floor, Queens, New York, 11101-4132, USA
| | - Christina C Norman
- NYC Department of Health and Mental Hygiene, NYC Department of Health and Mental Hygiene, Bureau of Mental Health, 42-09 28th Street, 19th floor, Queens, New York, 11101-4132, USA
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Zhao Y, Hoenig JM, Protacio A, Lim S, Norman CC. Identification of risk factors for early psychiatric rehospitalization. Psychiatry Res 2020; 285:112803. [PMID: 32035374 DOI: 10.1016/j.psychres.2020.112803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 11/24/2022]
Abstract
Identifying risk factors for early psychiatric rehospitalization (EPR, rehospitalization within 90 days) can inform strategies to reduce rehospitalization rates. Random forest (RF), a tree-based classification algorithm, can be useful for identifying potential risk factors for EPR from a large number of patient factors. Patient characteristics were collected from 519 psychiatric inpatients at eight New York City hospitals. RF was used to identify potential risk factors for EPR. Multiple logistic regression was performed to assess the association between the identified risk factors and rehospitalization. Top risk factors identified by RF were previous psychiatric hospitalizations, number of post-discharge needs, social isolation, and sense of belonging in one's community. Follow-up analyses confirmed the significant association between EPR and number of previous psychiatric hospitalizations, number of endorsed post-discharge needs, and social isolation after adjusting for demographic variables. Understanding the contributors to EPR can better inform mental health service planning, policies, and programs that promote recovery.
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Affiliation(s)
- Yihong Zhao
- NYC Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA; Center of Alcohol & Substance Use Studies, Department of Applied Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, 607 Allison Road, Piscataway, NJ, 08854, USA
| | - Jennifer M Hoenig
- NYC Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA
| | - Angeline Protacio
- NYC Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA
| | - Sungwoo Lim
- NYC Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA
| | - Christina C Norman
- NYC Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY, 11101, USA.
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Norman CC, McDonald K, Schneider AE, Malinovsky I, Goldmann E, Blauschild MK, Driver C. The New York City Mental Health Needs Assessment Study (MHNAS): Objectives, design, and methods. Int J Methods Psychiatr Res 2018; 27:e1606. [PMID: 29392814 PMCID: PMC6877271 DOI: 10.1002/mpr.1606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 12/05/2017] [Accepted: 12/13/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This paper describes the objectives, design, and methods of the Mental Health Needs Assessment Study (MHNAS). The objective of the MHNAS was to assess the needs of individuals transitioning to the community following psychiatric hospitalization and again 3-5 months later to inform community service planning. Needs were defined broadly to include domains like housing, employment, treatment, and social support. METHODS The MHNAS used a 2-stage clustered sampling approach where the primary sampling units were hospitals and secondary sampling units were patients. The study included an in-person patient interview, an assessment of need from a key hospital worker, and a follow-up telephone interview 3-5 months after discharge. RESULTS One thousand one hundred twenty-nine patients from 8 randomly selected hospitals participated. The overall response rate was 54.3% with a cooperation rate of 71.8%. The sample was similar to the overall population of psychiatric patients with respect to several key demographics. CONCLUSION The MHNAS demonstrates the feasibility of conducting a needs assessment with a random sample of psychiatric inpatients in a large urban setting. Results from this study may improve community service planning to better meet individuals' needs, with the ultimate goal of reducing rehospitalization and promoting recovery.
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Affiliation(s)
| | - Kate McDonald
- NYC Department of Health and Mental Hygiene, New York, NY, USA
| | | | - Igor Malinovsky
- NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Emily Goldmann
- New York University College of Global Public Health, Queens, NY, USA
| | | | - Cynthia Driver
- NYC Department of Health and Mental Hygiene, New York, NY, USA
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