Teaching Psychiatric Inpatients to Re-Enter the Community: A Brief Method of Improving the Continuity of Care

University of California, Los Angeles, Los Ángeles, California, United States
Psychiatric Services (Impact Factor: 2.41). 11/1998; 49(10):1313-6. DOI: 10.1176/ps.49.10.1313
Source: PubMed


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.

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    • "morning and afternoon) [27]. These 16 sessions (see table 1) were selected because they were described by the authors of the community re-entry program as particularly relevant for patients who are preparing for discharge from the hospital [26], and also because this program is formatted for continuous implementation, with participants " dropping in " as their schedules permit [11]. "
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    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.
    Full-text · Article · Jan 2015
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    • "The importance of targeted interventions focusing on community re-entry for individuals with serious mental illness moving from inpatient psychiatric care to the community has been documented (Kopelowicz, Wallace, & Zarate, 1998). In a study of 59 patients with schizophrenia or schizoaffective disorder randomly assigned to a community re-entry program or occupational therapy, those in the re-entry program increased their knowledge and skills on the material addressed in the program and were more likely to attend their first aftercare appointment post-discharge (Kopelowicz et al., 1998). "
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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.
    Full-text · Article · Mar 2014 · International Journal of Forensic Mental Health
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    • "Evidence of the effectiveness of highly structured, manual-driven treatment programs that combine social skills and daily living skills training is strong. Three Level I studies found skills training based on the Social and Independent Living Skills Program developed by the University of California, Los Angeles, to be effective in improving independent living skills (Anzai et al., 2002; Kopelowicz, Wallace, & Zarate, 1998; Liberman et al., 1998). Positive results were also noted in three Level I studies of Functional Adaptation Skills Training, a manualdriven cognitive–behavioral intervention for patients with schizophrenia or schizoaffective disorder. "
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    ABSTRACT: In this systematic review, we investigated research literature evaluating the effectiveness of occupational therapy interventions focusing on participation and performance in occupations related to paid and unpaid employment and education for people with serious mental illness. The review included occupation- and activity-based interventions and interventions addressing performance skills, aspects of the environment, activity demands, and client factors. The results indicate that strong evidence exists for the effectiveness of supported employment using individual placement and support to result in competitive employment. These outcomes are stronger when combined with cognitive or social skills training. Supported education programs emphasizing goal setting, skill development, and cognitive training result in increased participation in educational pursuits. The evidence for instrumental activities of daily living interventions that targeted specific homemaking occupations and supported parenting was limited but positive. Environmental cognitive supports, such as signs, and other compensatory strategies are useful in managing maladaptive behavior.
    Preview · Article · May 2011 · The American journal of occupational therapy.: official publication of the American Occupational Therapy Association
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