The relationship of illness management and recovery to state hospital readmission

The Relationship of Functioning and Life Satisfaction with Illness Management and Recovery in Patients with Bipolar Disorder: A Cross-Sectional Study

The aim of this study was to determine relationship between functioning and life satisfaction with illness management and recovery, and determinants of illness management and recovery in patients with bipolar disorder. This descriptive and correlational study was conducted with 152 participants between August 2022 and February 2023. "Personal Information Form", "Illness Management and Recovery Scale", "Functioning Assessment Short Test" and "Adult Life Satisfaction Scale" were used to collecting data. In study, a positive relationship was found between illness management and recovery and total functionality, autonomy, cognitive functionality, interpersonal relationships, and life satisfaction. Gender, marital status, educational status, employment status, total functioning, autonomy, cognitive functioning, interpersonal relationships, and life satisfaction were found to be effective in illness management and recovery. Being female, single, primary school graduate, unemployed, having low functioning (autonomy, cognitive functioning, interpersonal relationships) and having low life satisfaction were found to be determinants of illness management and recovery.

Applying implementation science in mental health services: Technical assistance cases from the Mental Health Technology Transfer Center (MHTTC) network

OBJECTIVE

Critical gaps exist between implementation of effective interventions and the actual services delivered to people living with mental disorders. Many technical assistance (TA) efforts rely on one-time trainings of clinical staff and printed guidelines that alone are not effective in changing clinical practice. The Mental Health Technology Transfer Center (MHTTC) Network uses implementation science to accelerate the use of evidence-based practices (EBPs), improve performance, and bring about systems-level change.

METHOD

Four case examples illustrate how MHTTCs employ the Exploration-Preparation-Implementation-Sustainment (EPIS) implementation framework and intensive implementation strategies to educate clinicians, manage change, and improve processes. These examples include implementing motivational interviewing, cognitive-behavioral therapy for people with psychosis, strategies to decrease the no show rate for virtual appointments, and school mental health systems development.

RESULTS

From Preparation through Sustainment, MHTTCs successfully employed implementation strategies including learning communities, audit and feedback, and coaching to bring about change. Each project attended to inner and outer contexts to eliminate barriers. The examples also show the benefit of integrating process improvement alongside implementation.

CONCLUSIONS

The MHTTCs are a model for using implementation science to design technical assistance that leads to more successful practical execution of EBPs; thus reducing the gap between research and practice.

Implementation of recovery-oriented practice in hospital-based mental health services: A systematic review

Recovery-oriented practice has become the dominant paradigm of practice in mental health services internationally. The exception is hospital-based mental health services where the biomedical model continues to prevail, in this context defined by high acuity and safety concerns. This review aims to identify the approaches to, and feasibility of, implementing recovery-oriented practice in hospital-based mental health services. A systematic review of the literature (2010-2019) identified seventeen studies of recovery-oriented practice implementation in hospital-based mental health services. One study was excluded based on quality assessment. Of the remaining studies, seven reported on staff training initiatives, four reported service user programmes facilitated by staff, and five were implementations of models of care. The findings indicate that it is feasible, albeit challenging, to implement recovery-oriented practice in hospital-based mental health services. More successful approaches are multimodal, applied over several years and have organizational support. The main barriers to implementation include resistance to change from the embedded, biomedical model, staff attitudes towards recovery, and an absence of consumer involvement in the implementation of recovery-oriented practice.

Clinical and brain structural effects of the Illness Management and Recovery program in middle-aged and older patients with schizophrenia

AIMS

In this study, we implemented the Illness Management and Recovery (IMR) program for middle-aged and older patients with schizophrenia hospitalized for long periods and assessed the effect of the IMR program on psychiatric symptoms and psychosocial function. The effects of the IMR program on brain structure were also evaluated.

METHODS

The IMR program was implemented for 19 patients with schizophrenia; 17 patients with schizophrenia receiving treatment as usual (TAU) were also recruited as controls. In all patients, mean age was 61.4 years (range, 50-77 years) and mean hospitalization duration was 13.1 years (range, 1-31 years) at enrollment. Structural magnetic resonance images and Positive and Negative Syndrome Scale (PANSS) and Global Assessment of Functioning (GAF) scores as clinical variables were obtained at the beginning and end of the IMR program. Longitudinal analyses were performed to compare the effects of the IMR program on clinical symptoms and cortical thickness in the superior temporal gyrus (STG) between the IMR and TAU groups.

RESULTS

Significant improvements in GAF scores and the total, Insight and Judgment, and Positive components of the PANSS were found in the IMR group compared with the TAU group. Cortical thickness in the left STG was preserved in the IMR group compared with the TAU group.

CONCLUSIONS

This is the first report demonstrating the effectiveness of the IMR program for improving psychotic symptoms and psychosocial function and protecting brain structure in middle-aged and older inpatients with schizophrenia hospitalized for long periods.

Tools for Moving On: Adapting an Evidence-Based Housing Curriculum for Individuals Receiving Services in an Inpatient Psychiatric Setting to Prepare for Community Living

Individuals with serious mental illness transitioning from state psychiatric hospitals to community living need specialized skills to enter community housing programs. There are few examples of best practice hospital group programs to improve community living skills. To address this gap, the authors developed a community skills training and discharge readiness program, Tools for Moving On (TFMO), adapted from materials from the Substance Abuse and Mental Health Services Administration Permanent Supportive Housing: Tools for Tenants toolkit. The new program uses facilitator and participant handouts, implementation recommendations, and covers four topics, including housing choices, housing preferences, tenancy skills, and support needs. Adapting existing evidence-based practices for individuals in state psychiatric hospitals may aid in successful discharge and community living and support nurses in their efforts for discharge. [Journal of Psychosocial Nursing and Mental Health Services, 57(8), 23-29.].

Cultural Change: Implementation of a Recovery Program in a Veterans Health Administration Medical Center Inpatient Unit

INTRODUCTION

The Freedom Commission's recommendations, Substance Abuse and Mental Health Services Administration's framework, and policy directives on recovery-oriented services have fueled the recovery transformation. Mental health recovery services have been implemented in a broad range of outpatient settings. However, psychiatric inpatient units remained embedded in the traditional model of care.

AIMS

The purpose of this article is to describe an ongoing quality improvement implementation of recovery services in a Veterans Health Administration acute psychiatric inpatient unit.

METHOD

An interprofessional Partnership for Wellness delivered 4 to 6 hours per day of evidence-based recovery and holistic population-specific health programs. Veteran, system, and program indicators were measured.

RESULTS

Preliminary indicators over a 2-year period suggest that Veterans rated group content and relevance high, pre-post psychiatric rehospitalization rates decreased by 46%, and fidelity to recommended strategies was high.

CONCLUSIONS

The project success reflects strong leadership, a partnership of committed staff, effective training, and an organizational culture exemplifying excellence in Veteran services and innovation.

Patient Characteristics Associated with Inpatient Psychiatric Re-admissions and the Utility of the READMIT Clinical Risk Index

In response to the problem of frequent 30-day readmissions to inpatient psychiatric facilities, Vigod and colleagues (2015) developed the READMIT clinical risk index to identify risk factors for psychiatric inpatient readmissions. The purpose of this descriptive retrospective study was to examine the effectiveness of the READMIT clinical risk index to identify patients that are at high risk for a 30-day inpatient psychiatric readmission at a state psychiatric hospital in the southeastern US. Data were extracted from the discharge summaries of patients discharged between September 2013 and December 2014. Data collected included patient demographic variables (age, gender, race/ethnicity, primary diagnosis, housing status at discharge, employment, long-acting injectable at discharge, substance abuse, education, and insurance status) and study variables from the READMIT clinical risk index (repeat admission, emergent admission, age, diagnosis and discharge, medical comorbidity, intensity, and time in hospital). The inclusion criterion was age 18 and above. There were no exclusion criteria. Findings indicated that age, insurance status, previous lifetime admissions, 'diagnoses and discharge' scores, and higher READMIT clinical risk index scores were associated with 30-day readmissions. Future research should include a prospective study of the READMIT clinical risk index to assess its predictability of 30-day readmissions and explore possible use of the minimum clinical risk index score to trigger evaluation of patient need for enhanced transitional care services posthospital discharge.

Rapid realist review of the evidence: achieving lasting change when mental health rehabilitation staff undertake recovery-oriented training

AIM

The aim of this study was to identify the factors contributing to lasting change in practice following a recovery-based training intervention for inpatient mental health rehabilitation staff.

BACKGROUND

Staff training may help nurses and other staff groups in inpatient mental health rehabilitative settings to increase their recovery-oriented practice. There are no published reviews on the effectiveness of such training and few long-term evaluations. This review informed a realist evaluation of a specific intervention (GetREAL).

DESIGN

Rapid realist review methodology was used to generate and prioritize programme theories.

DATA SOURCES

ASSIA, CINAHL, Cochrane Library, Medline, PsycINFO, Scopus, Web of Science and grey literature searches were performed in September 2014-March 2015 with no date restrictions. Stakeholders suggested further documents. GetREAL project documentation was consulted.

REVIEW METHODS

Programme theory development took place iteratively with literature identification. Stakeholders validated and prioritized emerging programme theories and the prioritized theories were refined using literature case studies.

RESULTS

Fifty-one relevant documents fed into 49 programme theories articulating seven mechanisms for lasting change. Prioritized mechanisms were: staff receptiveness to change; and staff feeling encouraged, motivated and supported by colleagues and management to change. Seven programme theories were prioritized and refined using data from four case studies.

CONCLUSION

Lasting change can be facilitated by collaborative action planning, regular collaborative meetings, appointing a change agent, explicit management endorsement and prioritization and modifying organizational structures. Conversely, a challenging organizational climate, or a prevalence of 'change fatigue', may block change. Pre-intervention exploration may help identify any potential barriers to embedding recovery in the organizational culture.

Illness management and recovery in community practice

OBJECTIVE

To examine provider competence in providing Illness Management and Recovery (IMR), an evidence-based self-management program for people with severe mental illness, and the association between implementation supports and IMR competence.

METHOD

IMR session recordings, provided by 43 providers/provider pairs, were analyzed for IMR competence using the IMR Treatment Integrity Scale. Providers also reported on receipt of commonly available implementation supports (e.g., training, consultation).

RESULTS

Average IMR competence scores were in the "needs improvement" range. Clinicians demonstrated low competence in several IMR elements: significant other involvement, weekly action planning, action plan follow-up, cognitive-behavioral techniques, and behavioral tailoring for medication management. These elements were commonly absent from IMR sessions. Competence in motivational enhancement strategies and cognitive-behavioral techniques differed based on the module topic covered in a session. Generally, receipt of implementation supports was not associated with increased competence; however, motivational interviewing training was associated with increased competence in action planning and review.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

IMR, as implemented in the community, may lack adequate competence and commonly available implementation supports do not appear to be adequate. Additional implementation supports that target clinician growth areas are needed. (PsycINFO Database Record