Effectively working on rehabilitation goals: 24-month outcome of a randomized controlled trial of the Boston psychiatric rehabilitation approach.
ABSTRACT To investigate the effect of the Boston Psychiatric Rehabilitation (PR) Approach on attainment of personal rehabilitation goals, social functioning, empowerment, needs for care, and quality of life in people with severe mental illness (SMI) in the Netherlands.
A 24-month, multicentre, randomized controlled trial was used to compare the results of PR to care as usual (CAU). Patients with SMI were randomly assigned by a central randomization centre to PR (n = 80) or CAU (n = 76). The primary outcome of goal attainment was assessed by independent raters blind to treatment allocation. Measures for secondary outcomes were change in work situation and independent living, the Personal Empowerment Scale, the Camberwell Assessment of Needs, and the World Health Organization Quality of Life assessment. Effects were tested at 12 and 24 months. Data were analyzed according to intention to treat. Covariates were psychiatric centre, psychopathology, number of care contacts, and educational level of the professionals involved.
The rate of goal attainment was substantially higher in PR at 24 months (adjusted risk difference: 21%, 95% CI 4% to 38%; number needed to treat [NNT] = 5). The approach was also more effective in the area of societal participation (PR: 21% adjusted increase, CAU: 0% adjusted increase; NNT = 5) but not in the other secondary outcome measures.
The results suggest that PR is effective in supporting patients with SMI to reach self-formulated rehabilitation goals and in enhancing societal participation, although no effects were found on the measures of functioning, need for care, and quality of life.
- SourceAvailable from: Jaap van Weeghel[Show abstract] [Hide abstract]
ABSTRACT: Objective: The aim of this pilot implementation study was to explore the initial experiences with and impact of Parenting with Success and Satisfaction (PARSS), a psychiatric rehabilitation and recovery-based, guided self-help intervention, for parents with severe mental illnesses. Methods: Changes in the PARSS intervention group were compared with changes in a control group in a nonequivalent control group design. Outcome measures included: parenting satisfaction reported by parents; parenting success reported by mental health practitioners and family members; empowerment as reported by parents, practitioners and family members; and parents' reported quality of life. Additional process data were obtained on relationship with practitioner, quality of contact, satisfaction with the intervention and fidelity. Results: Parenting satisfaction increased after 1 year for the PARSS group, but not for the control group. Parents' reports of empowerment did not change for either group. The scores of parents' empowerment reported by practitioners and family members increased in the control group, with no such change in the PARSS group. Quality of life improved significantly for the intervention group. Process measures showed that, although PARSS was not always implemented as intended, both parents and practitioners expressed satisfaction with the intervention. Conclusions and Implications for Practice: The first experiences with PARSS were mixed. This intervention, implemented by mental health practitioners, has the potential to function as a useful tool for supporting parents. Attention must be paid to enhancing intervention implementation and fidelity. (PsycINFO Database Record (c) 2014 APA, all rights reserved).Psychiatric Rehabilitation Journal 05/2014; 37(3). DOI:10.1037/prj0000067 · 1.16 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The Boston Psychiatric Rehabilitation Approach (BPR) is person-centered and characterized by being based entirely on the individual's unique needs and preferences in the areas of working, learning, social contacts, and living environment. Nevertheless, the person-centered approach is lacking firm evidence regarding outcomes, and empirical studies regarding clients' experiences of this particular model are needed. A qualitative content analysis of 10 transcribed semistructured individual interviews was used to describe and explore clients' experiences of the BPR during an implementation project in Sweden. The findings from the interviews could be summarized in "A sense of being in communion with self and others" theme, consisting of three categories: increased self-understanding, getting new perspectives, and being in a trusting relationship. The results showed that clients do not always recognize nor are able to verbalize their goals before they have been given the possibility to reflect their thoughts in collaboration with a trusted person. The guidelines of the approach are intended to support the clients' ability to participate in decision making regarding their own care. More research about efficacy of different rehabilitation approaches and exploration of fidelity to guidelines of rehabilitation programs are required.International Journal of Qualitative Studies on Health and Well-Being 04/2014; 9:22916. DOI:10.3402/qhw.v9.22916 · 0.93 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: It is becoming increasingly clear that people with severe mental illness (SMI) are in need of support with parenting. So far, however, little is known about how many persons fall into this category. To estimate how many SMI patients aged 18 to 65 are parents with children and how many need help with parenting. We based our estimate on epidemiological studies and on official records and data relating to SMI patients for the year 2009. We estimated that 48% of patients with smi had children. The total number of such patients for the year 2009 was 68,000; this figure represents 0.9% of the Dutch population in the 18-64 age-group. Health professionals and carers need to be alerted to the fact that almost 50%of the patients with SMI require possibly help in fulfilling their parental role. Potential problems in the parent-child relationship need to be registered in greater details so that more adequate care can be provided both at individual level and national level.Tijdschrift voor psychiatrie 01/2011; 53(11):851-6.