Article

Effectively working on rehabilitation goals: 24-month outcome of a randomized controlled trial of the Boston psychiatric rehabilitation approach.

Senior Researcher, Altrecht Mental Health Care, Utrecht, the Netherlands.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.41). 12/2011; 56(12):751-60.
Source: PubMed

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.

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    • "The strength of the PARSS intervention is that it explicitly focuses on supporting parenting, which is often a neglected domain in mental health services. Another strength is that the PARSS approach is built on the evidence-based practice of psychiatric rehabilitation (Swildens et al., 2011), and informed by theory and practice supported in the literature. PARSS provides clear goals and a structure for working together with parents. "
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    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).
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    • "entirely on the individual's unique needs and preferences (Rogers et al., 2006) in the areas of working , learning, social contacts, and accommodation (Anthony, 1992). The BPR has been studied in a few empirical studies from the United States (Rogers, Anthony, Lyass, & Penk, 2006; Shern et al., 2000) and in a few studies from European countries (Gigantesco et al., 2006; Swildens et al., 2011; Van Busschbach & Wiersma, 2002) with varying outcomes (Michon & Van Weeghel, 2010; Rogers et al., 2006). However studies exploring clients' experiences of this approach are rare. "
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    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
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    • "The strength of the PARSS intervention is that it explicitly focuses on supporting parenting, which is often a neglected domain in mental health services. Another strength is that the PARSS approach is built on the evidence-based practice of psychiatric rehabilitation (Swildens et al., 2011), and informed by theory and practice supported in the literature. PARSS provides clear goals and a structure for working together with parents. "
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