A Proof of Concept Trial of an Online Psychoeducational Program for Relatives of Both Veterans and Civilians Living with Schizophrenia
VA Greater Los Angeles Healthcare System at West Los Angeles, CA 90073, USA. Psychiatric Rehabilitation Journal
(Impact Factor: 1.16).
03/2010; 33(4):278-87. DOI: 10.2975/33.4.2010.278.287
Family psychoeducation has been found to reduce relapse in schizophrenia but penetration rates are low. In this study, we evaluate the feasibility of an online multifamily group program for relatives of persons with schizophrenia that can be accessed from participants' homes.
We explored participation rates and evaluations of a 12-month multimodal website intervention. Using a quasi-experimental design, we compared illness outcomes (factors on the Brief Psychiatric Rating Scale, hospitalizations) of persons with diagnosed schizophrenia, and relative distress outcomes (somatic concerns and anxiety/depression subscales on the Brief Symptom Inventory) from relatives participating in the intervention (n = 26) to archival data we had from comparable dyads who received customary care (n = 16).
The majority of participants in the program attended more than half the core online support sessions, expressed high levels of satisfaction, and found the technology easy to access. There appeared to be little impact of online participation on clinical status of persons with schizophrenia or relatives' distress, although there was a trend for fewer hospitalizations in the online group. Small sample size is a factor in interpreting results.
Online interventions for relatives of persons with schizophrenia, while feasible, present unique challenges. These include 1) assuring access to the intervention in populations who do not own a computer; 2) addressing privacy concerns; 3) overcoming the special challenges of conducting groups in real time; 4) managing emergent situations adequately; and 5) questions about efficacy.
Available from: Jacqueline Sin
- "Multi-component interventions for these conditions commonly include: information sharing, networked peer support, electronic resources and facilitated discussion forums ; but much less work has been done in the field of severe mental illness [19,20]. To date, there are only three known exploratory controlled trials evaluating online psychoeducational interventions with service users with psychosis and their family carers in the U.S.A. [19,21,22] and with service users with bipolar disorder in Australia . In the UK, a few online blogs and information-giving websites have been established by leading charities over the last few years (for example: http://www.sibs.org.uk and http://www.rethink.org/siblings). "
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ABSTRACT: BackgroundSiblings of individuals with first episode psychosis are natural partners to promote service users’ recovery and are themselves vulnerable to mental ill health due to the negative impact of psychosis within the family. This study aims to develop and undertake a preliminary evaluation of the efficacy of an online multi-component psychoeducational intervention for siblings of individuals with first episode psychosis. The impetus for the intervention arose from siblings' expressed needs for peer support and information on psychosis, coping and management strategies for common symptoms and ways to promote recovery.Methods/DesignThe project design draws on the Medical Research Council framework for the design and evaluation of complex interventions. Mixed methods comprising collection of qualitative focus group data, systematic review and expert advisory group consultation are used to develop the theoretical basis for and design of the intervention. This protocol focuses on the modelling and piloting phase which uses a randomised controlled trial with factorial design to test the efficacy of the intervention. Outcome data on participants’ mental wellbeing, knowledge, perceived self-efficacy and experiences of caregiving will be assessed at baseline, at end of the intervention (10 weeks later) and at 10 week follow-up. In addition, a post-intervention semi-structured interview with 20% of the participants will explore their experiences and acceptability of the intervention.DiscussionThis multi-component online psychoeducational intervention aims to enhance siblings' knowledge about psychosis and their coping capacity, thus potentially improving their own mental wellbeing and promoting their contribution to service users’ recovery. The factorial design randomised controlled trial with a supplementary process evaluation using semi-structured interviews and usage-monitoring will collect preliminary evidence of efficacy, feasibility and acceptability, as well as feedback about the barriers and strategies to using such an innovative resource. The RCT will provide data for estimating the likely effect size of the intervention on outcomes for siblings and inform the development of a definitive future trial.Trial registrationTrial registration:
BMC Psychiatry 04/2013; 13(1):123. DOI:10.1186/1471-244X-13-123 · 2.21 Impact Factor
Available from: Adam Darkins
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ABSTRACT: Between July 2003 and December 2007, the Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Demographic changes in the veteran population necessitate VHA increase its noninstitutional care (NIC) services 100% above its 2007 level to provide care for 110,000 NIC patients by 2011. By 2011, CCHT will meet 50% of VHA's anticipated NIC provision. CCHT involves the systematic implementation of health informatics, home telehealth, and disease management technologies. It helps patients live independently at home. Between 2003 and 2007, the census figure (point prevalence) for VHA CCHT patients increased from 2,000 to 31,570 (1,500% growth). CCHT is now a routine NIC service provided by VHA to support veteran patients with chronic conditions as they age. CCHT patients are predominantly male (95%) and aged 65 years or older. Strict criteria determine patient eligibility for enrollment into the program and VHA internally assesses how well its CCHT programs meet standardized clinical, technology, and managerial requirements. VHA has trained 5,000 staff to provide CCHT. Routine analysis of data obtained for quality and performance purposes from a cohort of 17,025 CCHT patients shows the benefits of a 25% reduction in numbers of bed days of care, 19% reduction in numbers of hospital admissions, and mean satisfaction score rating of 86% after enrolment into the program. The cost of CCHT is $1,600 per patient per annum, substantially less than other NIC programs and nursing home care. VHA's experience is that an enterprise-wide home telehealth implementation is an appropriate and cost-effective way of managing chronic care patients in both urban and rural settings.
Telemedicine and e-Health 01/2009; 14(10):1118-26. DOI:10.1089/tmj.2008.0021 · 1.67 Impact Factor
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ABSTRACT: The US Department of Veterans Affairs (VA) is quickly becoming a leader in psychosocial rehabilitation and in implementing evidence–based practices for people with severe mental illnesses. Transformation efforts within the VA system also emphasize that veterans with mental illnesses are to be respected as persons and not defined by their illness; they have the right to direct their own treatment and are encouraged to develop a recovery oriented action plan for themselves. Peer Support Services are provided by trained individuals who themselves are in recovery from a mental illness and who serve as clinically supervised members of the mental health care team. Partnering with families, with the veteran's consent, is an essential component of recovery-oriented services. A range of vocational experiences and employment are offered to help veterans achieve their goals and enhance their quality of life. We hope that the work included in this Special Issue of the Psychiatric Rehabilitation journal inspires others to contribute to the advancement of recovery–oriented services and supports for veterans and other adults living with serious mental illnesses. (PsycINFO Database Record (c) 2013 APA, all rights reserved)
Psychiatric Rehabilitation Journal 03/2010; 33(4):255-8. DOI:10.2975/33.4.2010.255.258 · 1.16 Impact Factor
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