1
|
Leone L, Giunta G, Motta G, Cavallaro G, Martinez L, Righetti A. An Innovative Approach to the Dismantlement of a Forensic Psychiatric Hospital in Italy: A Ten-year Impact Evaluation. Clin Pract Epidemiol Ment Health 2023; 19:e174501792212201. [PMID: 37275438 PMCID: PMC10156024 DOI: 10.2174/18740179-v18-e221221-2022-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 10/14/2022] [Accepted: 10/28/2022] [Indexed: 06/07/2023]
Abstract
Aims This study aimed to evaluate the impacts of a pilot project concerning the closure of a Forensic Psychiatric Hospital (FPH) inspired by Human Development Theory and the Capability Approach. Background The dismantlement of the FPH of Barcellona Pozzo di Gotto (Sicily Region in Italy) began in 2010 with the pilot project Luce é Libertà and ended in 2017. With the closure of six FPHs, Italy officially became the first country worldwide to close such institutions. After the closure of FPHs, some critical issues emerged, and the debate shifted to developing small-scale facilities and residences for the execution of security measures (RESM). However, few studies have provided results on the cohort of patients discharged from FPHs. Objective Following are the objectives of this study: a) Assessing the effectiveness of the pilot project in terms of better functioning accordingly to the Classification of Functioning of Disability and Health (ICF) framework, social and labour insertion, health conditions, level of dangerousness to other, rate of readmission in forensic services, b) cost analysis, and c) describing how the CA has been applied and translated into methodological and administrative devices and concrete intervention strategies. Methods A pre-post evaluation design was performed with a comparison between the intervention and the control group for the healthcare cost analysis. Data were collected from 2010 to 2019 at three points: T0) as a baseline, T1 and T2) for the follow-up. The instruments are a structured questionnaire, the Scale HoNOS Secure, 4 sub-scales of ICF (Activity and participation dimensions: sociality, culture, and knowledge, daily life, income, and work) (Cronbach's Alpha from 0.76 to 0.94), and n.20 interviews with key stakeholders and beneficiaries. Results Main results include a) the discharge of 55 patients through the use of a person-centered approach and the Personal Capability Budget (PCB), b) the expansion of substantial freedom of choice and the improvement of ICF score (t-test Sig. <, 02), c) the reduction of the risk for others and themselves (Mean Diff. -2,15 Sig. .000), d) at T2 42% of beneficiaries achieved a job placement and 36% were living in one's own home, e) at T2 the need of security measures has reduced from the initial 70% to 6.8%, and f) reduction of the healthcare costs from the fourth year onwards. Conclusion Indications emerge to support processes of deinstitutionalisation and capabilities expansion through innovative models, a person-centered approach supported by PCBs, social finance, and social impact investments.
Collapse
Affiliation(s)
- Liliana Leone
- CEVAS Centre of Research and Evaluation, Roma, Italy
| | - Gaetano Giunta
- Community Foundation of Messina o.n.l.u.s., Messina, Italy
- Department of Secretary General, Fondazione di Comunità di Messina O.n.l.u.s., Italy
| | | | | | - Lucia Martinez
- CEVAS Centre of Research and Evaluation, Roma, Italy
- Istat Italian National Institute of Statistics, Roma, Italy
| | - Angelo Righetti
- Scientific Committee- Community Foundation of Messina o.n.l.u.s., Messina, Italy
| |
Collapse
|
2
|
Krupa T, Lysaght R, Yehuala YS, Aldersey HM, Adugna MB, Kessler D, Batorowicz B, Montagnese J, Kolomitro K. Activity and participation experiences of people with disabilities in Ethiopia. Afr J Disabil 2022; 11:1002. [PMID: 36246483 PMCID: PMC9558741 DOI: 10.4102/ajod.v11i0.1002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/29/2022] [Indexed: 11/01/2022] Open
Affiliation(s)
- Terry Krupa
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Yetnayet S. Yehuala
- Institute of Public Health, University of Gondar, Gondar, Ethiopia
- School of Kinesiology and Health Studies, Queen’s University, Kingston, Canada
| | - Heather M. Aldersey
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
- International Centre for the Advancement of Community Based Rehabilitation, Queen’s University, Kingston, Canada
| | | | - Dorothy Kessler
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Beata Batorowicz
- School of Rehabilitation Therapy, Queen’s University, Kingston, Canada
| | - Jasmine Montagnese
- International Centre for the Advancement of Community Based Rehabilitation, Queen’s University, Kingston, Canada
| | | |
Collapse
|
3
|
van der Veen S, Evans N, Huisman M, Welch Saleeby P, Widdershoven G. Toward a paradigm shift in healthcare: using the International Classification of Functioning, Disability and Health (ICF) and the capability approach (CA) jointly in theory and practice. Disabil Rehabil 2022:1-8. [PMID: 35732595 DOI: 10.1080/09638288.2022.2089737] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE Over the past two decades, healthcare systems have shifted to adopt a more holistic, patient-centered care system. However, operationalization in practice remains challenging. Two frameworks have contributed substantially to the transformation toward more holistic and patient-centered care: the International Classification of Functioning, Disability and Health (ICF) and the capability approach (CA). Using these frameworks jointly can contribute to improved patient-centered care in clinical practice. METHODS This article explores the strengths and weaknesses of the use of the two frameworks in care and investigates whether using them jointly might contribute to more appropriate and patient-centered care. We will present a practical example of this integration in the form of a novel e-health application. RESULTS The exploration indicated that if the frameworks are used jointly, the individual weaknesses can be overcome. The application, used to exemplify the joint use of the frameworks, contains all categories of the ICF. It offers a unique tool that allows a person to self-assess, record, and evaluate their functioning and capabilities and formulate related goals. CONCLUSIONS Using the ICF jointly with the CA can foster holistic, patient-centered care. The e-health application provides a concrete example of how the frameworks can be used jointly. Implications for rehabilitationUsing the International Classification of Functioning, Disability and Health jointly with the capability approach can foster holistic, patient-centered care.The joint use of the frameworks is demonstrated by an e-health application which enables users to evaluate their functioning in relation to their own goals, provides them with the opportunity to increase control over their health and have a more active role in their care.Tools to record both functioning and goals from a patient's perspective can support professionals in offering patient-centered care in daily practice.Individual recording, monitoring and evaluation of functioning, capabilities and goals regarding functioning can provide a basis for research and quality improvement.
Collapse
Affiliation(s)
- Sabina van der Veen
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Natalie Evans
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Patricia Welch Saleeby
- Department of Sociology, Criminology and Social Work, Bradley University, Peoria, IL, USA
| | - Guy Widdershoven
- Department of Ethics, Law and Humanities, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
4
|
de Beer J, Heerkens Y, Engels J, van der Klink J. Factors relevant to work participation from the perspective of adults with developmental dyslexia: a systematic review of qualitative studies. BMC Public Health 2022; 22:1083. [PMID: 35642026 PMCID: PMC9158268 DOI: 10.1186/s12889-022-13436-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background This review is focused on workers with developmental dyslexia (DD). In this review DD is considered an expression of neurodiversity, a consequence of a natural variant of the brain. Evidence was synthesized to explore which factors workers with DD consider relevant for their participation in work and whether these factors reflect shifts in the concepts of health and sustainable employability. The factors were classified according to the International Classification of Functioning, Disability and Health (ICF), adapted for occupational health. Methods A systematic review of qualitative studies was performed. Two search strings were used to determine the population and the context of work. The factors were classified using a recently proposed rearrangement of the ICF scheme that places participation in a central position and incorporates preliminary lists of work-related environmental factors and personal factors. Results Fifty-one factors were found that appeared in 35% or more of the included studies and that were relevant to work participation according to the workers themselves. These factors were dispersed over all ICF categories. In the category Functions and Structures (11 factors), most of the factors had negative connotations. In the category Activities (9 factors), all the factors cause difficulties, except speaking (which is ambiguous). In the category Participation (4 factors), the formal relationships are important for the degree of participation. Overall, more than half of the factors are environmental (18) or personal (9) and they both hinder and facilitate work participation. Conclusions The results of this review give an indication for the importance of the biopsychosocial model as a relevant approach for people with a disability in the world of work. This review also adds data for the usefulness of the proposals for the reconsideration of the ICF scheme. The data has not (yet) returned any visible trends revealing that the concept of neurodiversity is common in organizations.
Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13436-x.
Collapse
Affiliation(s)
- Joost de Beer
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands. .,Department Occupation & Health, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Yvonne Heerkens
- Department Occupation & Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Josephine Engels
- Department Occupation & Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Jac van der Klink
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands.,Optentia, North-West University of South Africa, Vanderbijlpark, South Africa
| |
Collapse
|
5
|
van Druten VP, Bartels EA, van de Mheen D, de Vries E, Kerckhoffs APM, Nahar-van Venrooij LMW. Concepts of health in different contexts: a scoping review. BMC Health Serv Res 2022; 22:389. [PMID: 35331223 PMCID: PMC8953139 DOI: 10.1186/s12913-022-07702-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/23/2022] [Indexed: 01/07/2023] Open
Abstract
The rationale of our study was that the World Health Organization's (WHO) definition of health from 1947 which includes "… complete physical, mental and social wellbeing…" does not fit the current societal viewpoints anymore. The WHO's definition of health implies that many people with chronic illnesses or disabilities would be considered unhealthy and complete wellbeing would be utopian and unfeasible for them. This is no longer uniformly accepted. Many alternative concepts of health have been discussed in the last decades such as 'positive health', which focusses on someone's capability rather than incapability,. However, the question remains whether a general health concept can guide all healthcare practices. More likely, health concepts need to be specified for professions or settings. The objective of our study was to create a structured overview of published concepts of health from different perspectives by conducting a scoping review using the PRISMA-ScR guideline. A literature search was conducted in Pubmed and Cinahl. Articles eligible for inclusion focussed on the discussion or the conceptualisation of health or health-related concepts in different contexts (such as the perspective of care workers' or patients') published since 2009 (the Dutch Health Council raised the discussion about moving towards a more dynamic perspective on health in that year). Seventy-five articles could be included for thematic analyses. The results showed that most articles described a concept of health consisting of multiple subthemes; no consensus was found on one overall concept of health. This implies that healthcare consumers act based on different health concepts when seeking care than care workers when providing care. Having different understandings of the concepts of health can lead to misunderstandings in practice. In conclusion, from every perspective, and even for every individual, health may mean something different. This finding stresses the importance that care workers' and healthcare consumers' meaning of 'health' has to be clear to all actors involved. Our review supports a more uniform tuning of healthcare between healthcare providers (the organisations), care workers (the professionals) and healthcare consumers (the patients), by creating more awareness of the differences among these actors, which can be a guide in their communication.
Collapse
Affiliation(s)
- V P van Druten
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital Jeroen Bosch Ziekenhuis, PO Box 90153, Henri Dunantstraat 1, 's Hertogenbosch, 5223 GZ, the Netherlands. .,Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, Professor Cobbenhagenlaan 125, Tilburg, 5000 LE, the Netherlands.
| | - E A Bartels
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, Professor Cobbenhagenlaan 125, Tilburg, 5000 LE, the Netherlands.,TiSEM Department of Management, Tilburg University, Tilburg, the Netherlands
| | - D van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, Professor Cobbenhagenlaan 125, Tilburg, 5000 LE, the Netherlands
| | - E de Vries
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital Jeroen Bosch Ziekenhuis, PO Box 90153, Henri Dunantstraat 1, 's Hertogenbosch, 5223 GZ, the Netherlands.,Tranzo Scientific Center for Care and Wellbeing, Tilburg University, PO Box 90153, Professor Cobbenhagenlaan 125, Tilburg, 5000 LE, the Netherlands
| | - A P M Kerckhoffs
- Department of Nephrology, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands.,Department of Geriatric Medicine, Jeroen Bosch Hospital, 's Hertogenbosch, the Netherlands
| | - L M W Nahar-van Venrooij
- Jeroen Bosch Academy Research, Jeroen Bosch Hospital Jeroen Bosch Ziekenhuis, PO Box 90153, Henri Dunantstraat 1, 's Hertogenbosch, 5223 GZ, the Netherlands
| |
Collapse
|
6
|
Examining the Availability and Accessibility of Rehabilitation Services in a Rural District of South Africa: A Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094692. [PMID: 33924910 PMCID: PMC8125304 DOI: 10.3390/ijerph18094692] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 01/21/2023]
Abstract
Introduction: Rehabilitation services aim to optimise individuals’ functioning and reduce disability. However, people with disabilities, who represent a key population of users of rehabilitation services, continue to have unmet needs for rehabilitation services that include the provision of assistive devices. This paper examines the availability and accessibility of rehabilitation services in a rural district of South Africa in order to explore why unmet needs for rehabilitation services persist. Methods: All nine district hospitals in a rural district of South Africa were included in the study. Rehabilitation services capacity was assessed by examining the available assistive devices, consumables and human resources at the level of the health facility. Data collection was conducted using the Global Co-operative Assistive Technology [GATE] Assistive Products List, AT2030’s ATScale priority list and the South African National Catalogue of Commodities for Primary Health Care Facilities. Descriptive statistics were then used for the analysis. For the qualitative component, semi-structured interviews were conducted with adults with physical disabilities at household level to explore barriers to accessing assistive device inclusive rehabilitation services and the consequences thereof in the same rural district. An interview guide based on the WHO health system building blocks was used. Thematic content analysis guided the analysis of the interview transcripts. Findings: The findings of the research demonstrate that rehabilitation service capacity in the district was constrained as a result of low availability of assistive devices [2–22%] and consumables [2–47%], as well as, possibly, a shortage of rehabilitation providers [n = 30] with an unequal distribution across health facilities [n = 9]. In addition, people with physical disabilities reported poor referral pathways, financial constraints, transport and road consideration and equipment unavailability as barriers to accessing rehabilitation services. Moreover, these barriers to access predisposed individuals to finance-, health- and person-related harm. Conclusion: Rehabilitation service availability is constrained by a lack of service capacity in rural South Africa. In addition, the rehabilitation services in district hospitals are not adequately accessible because of existing barriers to enable key populations to achieve optimised functioning.
Collapse
|
7
|
Sykes CR, Maribo T, Stallinga HA, Heerkens Y. Remodeling of the ICF: A commentary. Disabil Health J 2020; 14:100978. [PMID: 32863192 DOI: 10.1016/j.dhjo.2020.100978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Abstract
Since its publication in 2001 the International Classification of Functioning, Disability and Health (ICF) has attracted debate about the content and the model presented. After almost 20 years use, regular updating since 2008 and with the prospect of a new edition in 2020 there is increasing interest in the ICF as a tool to meet contemporary information requirements. Information on functioning is important across not only health systems, but all areas where change in functioning is important: education, employment, and social welfare for example. This commentary responds to the issues raised in a commentary by Mitra & Shakespeare in 2019 and supports review of the ICF in the current context by informing users and providers of data on human functioning how they might engage in the maintenance, updating, and modernisation of the ICF.
Collapse
Affiliation(s)
- Catherine R Sykes
- University of Sydney, 75 East Street, Lidcombe, NSW, 2141, Australia.
| | | | | | - Yvonne Heerkens
- Dutch Institute of Allied Health Care (NPi), Amersfoort, the Netherlands; HAN University of Applied Sciences, Nijmegen, the Netherlands
| |
Collapse
|
8
|
Capability deprivation of people with Alzheimer's disease: An empirical analysis using a national survey. Soc Sci Med 2016; 151:56-68. [DOI: 10.1016/j.socscimed.2015.12.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 12/07/2015] [Accepted: 12/21/2015] [Indexed: 11/17/2022]
|