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Parker S, Arnautovska U, Korman N, Harris M, Dark F. Comparative Effectiveness of Integrated Peer Support and Clinical Staffing Models for Community-Based Residential Mental Health Rehabilitation: A Prospective Observational Study. Community Ment Health J 2023; 59:459-470. [PMID: 36057000 PMCID: PMC9981709 DOI: 10.1007/s10597-022-01023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022]
Abstract
This observational study compared the outcomes of consumers receiving community-based residential mental health rehabilitation support in Australia under a clinical staffing model and an integrated staffing model where Peer Support Workers are the majority component of the staffing profile. Reliable and clinically significant (RCS) change between admission and discharge in functional and clinical assessment measures were compared for consumers receiving care under the clinical (n = 52) and integrated (n = 93) staffing models. Covariate analyses examined the impact of known confounders on the outcomes of the staffing model groups. No statistically significant differences in RCS improvement were identified between the staffing models. However, logistic regression modelling showed that consumers admitted under the integrated staffing model were more likely to experience reliable improvement in general psychiatric symptoms and social functioning. The findings support the clinical and integrated staffing models achieving at least equivalent outcomes for community-based residential rehabilitation services consumers.
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Affiliation(s)
- Stephen Parker
- School of Medicine, The University of Queensland, Brisbane, Australia. .,Metro South Addiction and Mental Health Services, Woolloongabba, Australia. .,Metro North Addiction and Mental Health Service, Chermside, Australia. .,The Prince Charles Hospital, Chermside, QLD, 4032, Australia.
| | - U Arnautovska
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - N Korman
- School of Medicine, The University of Queensland, Brisbane, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, Australia
| | - M Harris
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - F Dark
- School of Medicine, The University of Queensland, Brisbane, Australia.,Metro South Addiction and Mental Health Services, Woolloongabba, Australia
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Korman N, Ng J, Gore-Jones V, Dark F, Parker S. Examining the outcomes of the first one hundred residents in a community based residential rehabilitation unit for people affected by severe and persistent mental illness. Australas Psychiatry 2023; 31:213-219. [PMID: 36857441 DOI: 10.1177/10398562231157599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
OBJECTIVE Community-based residential rehabilitation for people experiencing severe and persistent mental illness (SPMI) is increasingly available as an alternative to psychiatric inpatient care. Understanding who accesses these services and their outcomes will inform the optimal allocation of limited public mental health resources. METHOD This retrospective cohort study explored the outcomes of the first 100 consumers supported by a new Australian Community Care Unit (CCU). The primary outcome focus was acute mental health service use (emergency department presentations, acute mental health inpatient admission days), and secondary outcome foci were accommodation independence and substance use. RESULTS When the 365 days before and after CCU support were compared, significant reductions in acute mental health bed days were observed (22 days, W = 3.373, p = .001); greater reductions were noted for those staying >182 days (31 days, W = 3.373, p = .001). Additionally, significant improvements in accommodation independence were found, (W = 3.373, p = .001). CONCLUSION CCU consumers experienced reductions in acute mental health inpatient service use and improved accommodation independence. These observations are consistent with the intended functioning of the residential rehabilitation service.
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Affiliation(s)
- Nicole Korman
- Metro South Addiction and Mental Health Services, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Joanna Ng
- Metro South Addiction and Mental Health Services, Brisbane, QLD, Australia
| | | | - Frances Dark
- Metro South Addiction and Mental Health Services, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Stephen Parker
- Metro South Addiction and Mental Health Services, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia; The Prince Charles Hospital, 157827Metro North Mental Health Services, Chermside, QLD, Australia
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Caqueo-Urízar A, Ponce-Correa F, Semir-González C, Urzúa A. Latent Profiles of Premorbid Adjustment in Schizophrenia and Their Correlation with Measures of Recovery. J Clin Med 2022; 11:jcm11133840. [PMID: 35807125 PMCID: PMC9267748 DOI: 10.3390/jcm11133840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 02/05/2023] Open
Abstract
Premorbid adjustment (PA) has classically been defined as psychosocial functioning in the areas of education, occupation, social and interpersonal relationships prior to evidence of characteristic positive symptomatology. It is a concept which possesses ample evidence regarding its predictive nature for the course of Schizophrenia. The study aimed to analyze the latent profiles of premorbid adjustment and their relationship with symptomatology, functionality, subjective recovery, stigma resistance and years of untreated psychosis. Latent class analysis (LCA) was used to elaborate a solution of three premorbid adjustment profiles in a sample of 217 patients diagnosed with Schizophrenia from Public Mental Health Centers in the city of Arica, Chile. The results show that premorbid adjustment was significantly correlated with recovery indicators and that latent profiles of better premorbid adjustment predict better outcomes in subjective recovery and stigma resistance. The results show that premorbid adjustment not only has implications for the severity of the disorder, but that psychosocial functioning prior to psychosis affects the patient’s subjectivity, the representation of the disorder and the recovery process.
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Affiliation(s)
- Alejandra Caqueo-Urízar
- Instituto de Alta Investigación, Universidad de Tarapacá, Arica 1000000, Chile
- Correspondence:
| | - Felipe Ponce-Correa
- Programa Doctorado en Psicología, Escuela de Psicología y Filosofía, Universidad de Tarapacá, Arica 1000000, Chile;
| | - Carla Semir-González
- Escuela de Psicología y Filosofía, Universidad de Tarapacá, Arica 1000000, Chile;
| | - Alfonso Urzúa
- Escuela de Psicología, Universidad Católica del Norte, Antofagasta 1270709, Chile;
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Cross-Sectional Comparison of Treatment Provided Under the Clinical, Integrated, and Partnership Staffing Models for Community-Based Residential Mental Health Rehabilitation. Community Ment Health J 2022; 58:907-916. [PMID: 34591218 DOI: 10.1007/s10597-021-00898-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
In Queensland (Australia), community-based residential mental health rehabilitation services have three distinct staffing profiles. The traditional 'clinical' staffing model has nursing staff occupying most staff roles. The 'partnership' approach involves collaboration between the health service and a Non-Government Organisation. Under the 'integrated' staffing approach, Peer Support Workers reflect the majority staffing component. This study compares the treatment received by consumers (N = 172) under these staffing models using cross-sectional administrative data. Staffing models were generally comparable on demographic, diagnostic, and symptomatic/impairment measures. However, statistically significant differences were present on a range of treatment variables. Differences mainly occurred between the clinical and integrated approaches, with the integrated staffing model having lower rates of involuntary treatment, antipsychotic polypharmacy, depot use, and chlorpromazine dose equivalence levels. These findings indicate the need to carefully examine the impact of staffing configuration on rehabilitation processes to understand whether differences in approaches are likely to impact rehabilitation outcomes.
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Nikbakht-Nasrabadi A, Mardanian-Dehkordi L, Taleghani F. Abandonment at the Transition from Hospital to Home: Family Caregivers' Experiences. Ethiop J Health Sci 2021; 31:525-532. [PMID: 34483609 PMCID: PMC8365482 DOI: 10.4314/ejhs.v31i3.9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 11/23/2020] [Indexed: 11/20/2022] Open
Abstract
Background People with concurrent chronic conditions face different situations that lead to frequent transferring between the hospital and home. Despite the use of different strategies for improving transitional care, these transferring is associated with different challenges. This article aims to explore family caregivers' experiences of transitional care in diabetes with concurrent chronic conditions. Methods This descriptive explorative study was done at university hospitals in two big cities (Isfahan and Tehran) of Iran. The data collection was conducted from November 2018 to February 2020 using deep, semi-structured, and face-to-face interviews which are focused on family caregivers' experiences of transitional care. The researchers continued the sampling until the data saturation. Finally, 15 family caregivers were selected through purposive sampling. Data collection and data analysis were performed concurrently. Data were analyzed through the conventional content analysis method. Results Two main themes were identified: unsafe transition (unplanned discharge, inappropriate communication, lack of patient center care, and unavailable healthcare team) and erosive effort (financial burden, psychological stress, physical exhaustion, and lack of supportive sources). Conclusion The findings point to the importance of designing a discharge plan and preparing family caregivers before being discharged by healthcare providers. It appears to be essential for health managers and policymakers to pay attention to safe transitional care planning. The establishment of transitional care centers will help to ensure continuity of care. Future research focusing on the design and implementation of an appropriate transitional care model is recommended.
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Affiliation(s)
- Alireza Nikbakht-Nasrabadi
- Department of Medical Surgical, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Mardanian-Dehkordi
- Department of Medical Surgical, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.,Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariba Taleghani
- Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
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Parker S, Wyder M, Pommeranz M, Newman E, Meurk C, Dark F. Consumer experiences of community-based residential mental health rehabilitation for severe and persistent mental illness: A pragmatic grounded theory analysis. Int J Ment Health Nurs 2021; 30:733-746. [PMID: 33533196 DOI: 10.1111/inm.12842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2021] [Indexed: 11/29/2022]
Abstract
Semi-structured interviews were used to explore the consumer experience of community-based residential mental health rehabilitation support at Community Care Units in Australia. These clinical services provide recovery-oriented residential rehabilitation to people affected by severe and persistent mental illness. Typically, nurses occupy the majority of staff roles. However, two of the three sites in the study were trialling a novel integrated staffing model where the majority of staff were people with a lived experience of mental illness employed as peer support workers (PSWs). The interviews explored consumers' experiences of care 12-18 months after admission. Fifteen interviews were completed with an independent interviewer. Most participants were diagnosed with schizophrenia or a related psychotic disorder. The analysis followed a pragmatic approach to grounded theory. Consumers viewed the CCU favourably, emphasizing the value of the relationships formed with staff and co-residents. No major differences in consumers' experience under the traditional versus integrated staffing models were identified; however, those from the integrated staffing model sites valued the contributions of the peer support workers. The understanding of the consumer experience emerging through this study aligned with their expectations of the service at the time of commencement.
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Affiliation(s)
- Stephen Parker
- Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, Queensland, Australia.,School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Marianne Wyder
- Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, Queensland, Australia.,Griffith University, Nathan, Queensland, Australia
| | - Matthew Pommeranz
- Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, Queensland, Australia
| | - Ellie Newman
- Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, Queensland, Australia.,Alfred Mental and Addiction Health (AMAH), Melbourne, Victoria, Australia
| | - Carla Meurk
- School of Public Health, The University of Queensland, Herston, Queensland, Australia.,Forensic Mental Health Group, Queensland Centre for Mental Health Research, Wacol, Queensland, Australia
| | - Frances Dark
- Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, Queensland, Australia.,School of Public Health, The University of Queensland, Herston, Queensland, Australia
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Parker S, Arnautovska U, McKeon G, Kisely S. The association between discontinuation of community treatment orders and outcomes in the 12-months following discharge from residential mental health rehabilitation. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2021; 74:101664. [PMID: 33316696 DOI: 10.1016/j.ijlp.2020.101664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/29/2020] [Accepted: 11/26/2020] [Indexed: 06/12/2023]
Abstract
To compare the post-discharge outcomes of people admitted to community-based residential mental health rehabilitation facilities subject to a Community Treatment Order (CTO) who do and do not have this order discontinued prior to discharge. People subject to a CTO who were admitted across five Community Care Units (CCUs) in Queensland, Australia between 2005 and 2014 (N = 311), were grouped based on involuntary treatment status at the time of their discharge. Individuals whose status changed to voluntary (n = 63; CTO > VOL) were compared with those whose treatment remained involuntary (n = 248; CTO-CTO) on demographic, clinical and treatment-related characteristics. Group-level and individualised changes were assessed between the year pre-admission and the year post-discharge. The primary outcome measure was change in mental health and social functioning (Health of the Nation Outcome Scale). Secondary outcomes included disability (Life Skills Profile-16), service use, accommodation instability, and involuntary treatment. Logistic regression was completed to examine predictors of CTO discontinuation during CCU care. Potential predictors covered service-, consumer-, and treatment-related characteristics. Compared to the CTO-CTO group, the CTO > VOL group had significantly longer episodes of CCU care, more frequent primary diagnoses of schizophrenia spectrum disorders, and were more likely to be female. Following discharge, CTO > VOL subjects had more frequent reliable and clinically significant improvement in HoNOS scores, as well as more frequently demonstrated reliable improvement in hospital bed use and accommodation instability than the CTO-CTO subjects. CTO discontinuation was predicted by longer duration of CCU care, being a female, and having a smaller number of psychiatry-related bed use prior admission. Our findings suggest that CCU care of sufficient duration may lessen the need for subsequent compulsory treatment in the community.
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Affiliation(s)
- Stephen Parker
- Staff Specialist - Psychiatry Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, Australia; Faculty of Medicine, University of Queensland, School of Public Health, Herston, Australia.
| | - Urska Arnautovska
- Senior Research Officer PA Foundation, Princess Alexandra Hospital, Brisbane, Australia
| | - Gemma McKeon
- Clinical Neuropsychologist and Clinical Psychologist Child and Youth Mental Health Group, QIMR Berghofer Medical Research Institute, Australia; Psychosis ACU, Metro South Addiction and Mental Health Services (MSAMHS), Brisbane, Australia
| | - Steve Kisely
- Faculty of Medicine, University of Queensland, School of Public Health, Herston, Australia
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