Teaching psychiatric inpatients to re-enter the community: a brief method of improving the continuity of care.
ABSTRACT The study evaluated the effects of a brief manualized treatment program that taught patients skills to re-enter the community and actively follow through with their own care.
A total of 59 recently admitted inpatients with schizophrenia or schizoaffective disorder were randomly assigned to either the community re-entry program or an equally intensive regimen of occupational therapy. The community re-entry program consisted of eight 45-minute sessions conducted with groups of six to eight patients on a continuous, twice-a-day, four-day-a-week schedule. The effects were measured by a review of the records of aftercare services that patients received in the month after discharge from the inpatient facility. Patients' knowledge and performance of the specific material taught in the community reentry program was ascertained through assessments conducted before and after training.
Results indicated that patients in the community re-entry program significantly improved their knowledge and performance of the skills taught in the sessions, compared with patients in the occupational therapy group. Community re-entry participants were also significantly more likely to attend their first aftercare appointment than were occupational therapy participants (85 percent versus 37 percent).
Not only can patients learn relatively complex material during a brief typical inpatient stay despite the acuteness of their illnesses, but they can also meaningfully improve the continuity of their own care by participating in a brief and highly structured training program. The program fits well within the time and staffing constraints of typical inpatient facilities.
SourceAvailable from: Carlos Melo-Dias[Show abstract] [Hide abstract]
ABSTRACT: This review is an update on the research evidence supporting psychosocial rehabilitation – the Community Re-Entry Program (CREP) in psychiatric inpatient settings. Method: This review is guided by the following questions: Is the Community Re-Entry Program (CREP) effective in psychiatric inpatient settings? and What are the main results and benefits of using this program in this patient population? Search strategy on Databases= MEDLINE and CINAHL (EBSCO), Cochrane Library, and SciELO, with no restriction on publication date and with the following keywords: Community Re-Entry Program OR CREP AND inpatients, in full text, in consecutive studies conducted between February, 2013, and October, 2014, in order to find all studies published that had used this program. Results: Results show that Patients with Experience of Mental Illness (PEMI) in the community re-entry program significantly improved their knowledge and performance of the skills taught in the sessions, compared to other patients. Community re-entry participants were also significantly more likely to attend their first aftercare appointment than other participants. Conclusions: The findings of the study clearly demonstrate the effectiveness of the CREP for clinical practice in psychiatric inpatient settings. From the patients’ perspective, quality of life is enhanced. By learning skills to achieve their own personal relevant goals in life, individuals with serious mental disorders are empowered to function more autonomously from mental health professionals. Our general conclusion is that the Community Re-Entry Program for psychiatric inpatients is effective in teaching them about their illness and symptoms as well as improving their ability to make and keep appointments. Further studies should address the dissemination of the CREP in European countries, including a Portuguese Nursing version, as a way to increase the likelihood that the individual will be successful with skills training within the treatment and care areas of psychiatric and mental health nurses.
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ABSTRACT: Objective: Most research on the Illness Management and Recovery (IMR) program for people with severe mental illnesses has focused on individuals with stable symptoms living in the community, with less attention to persons being treated in an inpatient setting. We evaluated the feasibility and effects of an IMR program adapted for individuals with schizophrenia who were awaiting discharge into the community. Method: A randomized controlled trial was conducted at 2 hospitals in Taiwan to compare the adapted IMR program with treatment as usual (TAU). Ninety-seven individuals with schizophrenia were randomized to the adapted IMR program or TAU. Four outcome indicators including illness-management knowledge, attitudes toward medication, insight, and symptoms were assessed at baseline, posttreatment, and at a 1-month follow-up following discharge from the hospital. Results: Participants in the adapted IMR group showed significantly greater improvements at posttreatment and 1-month follow-up in illness-management knowledge, attitudes toward medication, insight, and negative symptoms on the Brief Psychiatric Rating Scale (BPRS) than individuals in the TAU group. There were no significant differences between the 2 groups on other subscales of the BPRS. Conclusions and Implications for Practice: This is the first controlled evaluation of a version of the IMR program in an East Asian culture, and the first to evaluate it in an acute care inpatient setting. Our findings support the feasibility and potential benefits of implementing an adapted IMR program, focused on the prevention of relapses and rehospitalizations, during the discharge period of an inpatient treatment stay to prepare individuals to reenter the community. (PsycINFO Database Record (c) 2013 APA, all rights reserved).Psychiatric Rehabilitation Journal 12/2013; 36(4):243-9. DOI:10.1037/prj0000013 · 0.75 Impact Factor
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ABSTRACT: The Transitional Rehabilitation Housing Pilot (TRHP) was designed to transition hospitalized forensic patients to the community. Twenty clients and their clinicians in two Ontario cities completed measures on functioning, substance use, recovery, social support, and quality of life at admission to the program and then every 6 months until 18 months post-admission. Clients also responded to open-ended questions on the impact of the program and living in the community on their recovery. Three (15%) clients re-offended. Eleven clients (55%) experienced rehospitalization; however, brief rehospitalization was seen as part of the recovery process. Level of community functioning was stable across time and 35% of clients had a decrease in the restrictiveness of their disposition order. Clients described numerous characteristics of community living that contributed to improvements in functioning, such as integration into the community, social contact, and newfound independence. Some aspects of TRHP that encouraged recovery included developing new skills and knowledge, staff support, and the programming that engaged clients in treatment and recovery-oriented activities. Findings suggest that forensic patients can transition successfully into the community with appropriate support and housing.03/2014; 13(1):62-74. DOI:10.1080/14999013.2014.885472