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Research in psychiatric rehabilitation: A review of experimental and quasi-experimental studies
Abstract
Reviews the literature on the outcome of psychiatric rehabilitation. The material reviewed reflects the mission, client demographics, types of interventions, and outcomes that characterize the field of psychiatric rehabilitation. All studies were analyzed with respect to certain key dimensions (source, setting, focus, outcome type, intervention, research design, and findings). Studies were categorized as to the predominant environment on which the intervention is focused (i.e., the client functioning in living, learning, or working environments). Indications of prevailing philosophies within psychiatric rehabilitation are provided. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... As many researchers and evaluators have noted, the psychiatrically disabled are ancng the most difficult clients to rehabilitate (Anthony & Blanch, 1987;Dion & Anthony, 1987;Rubin & Roessler, 1978). Among the Psychiatrically disabled Population, those persons with the most severe diagnoses and inçaizments (e.g., schizophrenics) obtain the lowest success rates no matter how such rates are defined (Anthony & Blanch, 1987;Dion & Anthony, 1987). ...
... As many researchers and evaluators have noted, the psychiatrically disabled are ancng the most difficult clients to rehabilitate (Anthony & Blanch, 1987;Dion & Anthony, 1987;Rubin & Roessler, 1978). Among the Psychiatrically disabled Population, those persons with the most severe diagnoses and inçaizments (e.g., schizophrenics) obtain the lowest success rates no matter how such rates are defined (Anthony & Blanch, 1987;Dion & Anthony, 1987). It has been estimated that the oczretitive employment rate of psychiatrically disabled persons is 20% to 25% and the rate for the severely psychiatrically disabled is 15% or less (Dion & Anthony, 1987;Anthony & Blanch, 1987). ...
... Among the Psychiatrically disabled Population, those persons with the most severe diagnoses and inçaizments (e.g., schizophrenics) obtain the lowest success rates no matter how such rates are defined (Anthony & Blanch, 1987;Dion & Anthony, 1987). It has been estimated that the oczretitive employment rate of psychiatrically disabled persons is 20% to 25% and the rate for the severely psychiatrically disabled is 15% or less (Dion & Anthony, 1987;Anthony & Blanch, 1987). Though job success rates have been found to be low among the severely psychiatrically disabled, successful adaptation to work does appear to facilitate ongoing recovery (Rubin & Roessler, 1978). ...
Executive Summary
In response to AB 2541 and Governor Deukmejian's initiative to provide
coordinated services for the mentally ill, the Department of Rehabilitation
(1) set aside $2.5 million in FY 1986-1987 for the Mental Health Initiative,
a program to develop county vocational rehabilitation services for
the severely mentally disabled. Fourteen projects (MHI projects) were
funded through a process in which county departments of mental health (MH)
and DR District administrators jointly submitted proposals. Another five
projects (MOU projects) were provided case service funds following the
development of memoranda of understanding between county MH Directors and
DR District Administrators. This report is an evaluation of the iiiplementation
phase of the Initiative, from October 1986 through August 1987
• Fourteen MHI and 4 MOU projects provided vocational services for the
severely mentally disabled during the first 11 months of the Initiative.
• In all, 18.5 FTE counselors and supporting staff were funded (13.5 MHI
and 5.0 MOU). This represents 88% of the funds allocated for staff
positions in FY 1986-1987.
• A total of 585 clients became ER Applicants through August 1987 (522 MHI
clients and 63 MOU clients).
• Projects started slowly and most caseloads are not yet full: More than
70% of the Initiative clients became DR Applicants after February 1987; 84%
were still involved in the rehabilitation process in August (440 MHI and 51
MOU clients); and more than 50% of these remained in Applicant status
awaiting the development of an individualized Rehabilitation Plan.
• The project caseloads include a large proportion of the severely mentally
disabled. About 50% are psychotic, 70% are severely disabled, 40% are on
551, and 65% are on sate form of public assistance.
• Most (60%) clients received some purchased case services.
• Through August 1987, a canbined total of $68,515 was expended on case
services by the MHI and MOU projects ($63,262 in the MHI projects and
$5,253 in MOU projects).
• A small proportion of case service funds were expended because most
clients are not yet at the stage of the rehabilitation process at which
costly services are purchased and because counselors were purchasing low
cost services for those in the process of being rehabilitated.
• In FY 1986-1987, approximately 11% of the allocated case service funds
were expended or cannitted to clients (encumbered).
• Counselor morale remained high despite concern about the small number of
Rehabilitation Plans and Successful Rehabilitations in the Initiative as
compared with customary DR standards.
• The DR and county departments of mental health are developing comfortable
working relationships in most projects.
In MHI projects, 26 individuals were successfully rehabilitated, but they
were not representative of most Initiative clients. They were generally
functioning at a relatively high level at referral: less likely to be
Psychotic, severely disabled, on SSI, and on public assistance. From
referral to closure, they took an average of only 8 months to be
rehabilitated.
• During the implementation period of the Initiative, it is premature to
evaluate the success of providing vocational rehabilitation to the severely
mentally disabled, or to assess cost-effectiveness.
There were 8 recommendations to the State of California.
... Habilitation-rehabilitation , as we use the term here, is a philosophical approach to mental health service delivery that can be incorporated into case management programs. The focus of rehabilitation-based services is on individuals in their environments with interventions broadly classified into two types: those aimed at helping clients develop the skills they need to function in their particular community environment and those aimed at modi-fying the environment (e.g., helping clients acquire supportive community resources to compensate for skill deficits; Anthony & Nemec, 1984; Dion & Anthony, 1987; Modrcin, Rapp, & Chamberlain, 1985; ). These approaches are quite different from traditional mental health interventions , which have tended to rely on reducing and controlling symptoms and promoting therapeutic insight into psychodynamic phenomena as the primary means for achieving successful adaptation to community living. ...
... These approaches are quite different from traditional mental health interventions , which have tended to rely on reducing and controlling symptoms and promoting therapeutic insight into psychodynamic phenomena as the primary means for achieving successful adaptation to community living. Studies concerning psychiatric rehabilitation generally indicate that such approaches can be effective in promoting community adjustment for many people afflicted with serious and persistent mental illness (Bond, Dincin, Setze, & Witheridge, 1984; Dion & Anthony, 1987; Rosenfield, 1992; Stein & Test, 1980). However, although an important conceptual distinction has been made between community support and habilitationrehabilitation services, differences in the effectiveness of these services have not been examined (Dion & Anthony, 1987 ). ...
... Studies concerning psychiatric rehabilitation generally indicate that such approaches can be effective in promoting community adjustment for many people afflicted with serious and persistent mental illness (Bond, Dincin, Setze, & Witheridge, 1984; Dion & Anthony, 1987; Rosenfield, 1992; Stein & Test, 1980). However, although an important conceptual distinction has been made between community support and habilitationrehabilitation services, differences in the effectiveness of these services have not been examined (Dion & Anthony, 1987 ). Furthermore , it is not clear whether rehabilitation-based approaches make a significant contribution to improving community functioning beyond traditional psychiatric treatments that focus on medication and reducing mental pathology. ...
Three methods of accounting for case manager effects in tests of the efficacy of mental health services are explored. These methods include (1) treating the case manager as a fixed factor, (2) treating the case manager as a random factor, and (3) examining service effects within the case manager. They are demonstrated with data from a nationally known case management program serving individuals with serious and persistent mental illness. Specifically, 3 conceptually distinct types of services provided or brokered by case managers are identified: habilitation-rehabilitation, community support, and traditional psychiatric services. The effectiveness of each in improving clients' adjustment is then examined with multiple regression adjustment strategies and each of the 3 methods to account for case manager effects. The results provide strong support for effects attributable to case managers and some support for the efficacy of habilitation-rehabilitation and community support services beyond the effects of traditional psychiatric services. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Over the next five years, much work was done in an attempt to improve the service and outpatient community-based treatment jettisoned in prevalence. In 1986, mental health services focusing on the chronically mentally ill within the community was recognized as experiencing the greatest growth relative to other services (Dion & Anthony, 1987). With this evolution came new programs, models, and research. ...
... With this evolution came new programs, models, and research. Dion and Anthony (1987) reviewed over 30 experimental and quasi-experimental studies examining the outcomes of psychiatric rehabilitation. ...
Psychiatric rehabilitation is a service designed to improve functioning that is impaired by the symptoms of severe mental illness. A review of the literature identified several functional domains impaired by mental illness and established the need and effectiveness of the service. Adult Rehabilitative Mental Health Services (ARMHS) is a psychiatric rehabilitation model that seeks to improve functioning in each impaired domain. ARMHS requires a complex array of documentation to demonstrate the existence of such impairments, the need for the service, and progress made toward improving functioning. The complexities of this documentation dissuade recipient and practitioner satisfaction, initial expeditious provision of services, compliance with state regulations, and fluid programmatic functioning. A training manual demarcating and edifying all components of required ARMHS documents was developed to assuage such dissuasions.
... This technology has been demonstrated as effective in numerous experimental and quasi-experimental studies. 16 Choices had the following 4 major features: ...
... Random assignment procedures resulted in 91 individuals'being assigned to the Choices experimental program and 77 to the standard treatment control condition (χ 2 =1. 16; not significant). Individuals in the control group were provided information by the research interviewers about local homelessness service programs. ...
This study tested a psychiatric rehabilitation approach for organizing and delivering services to street-dwelling persons with severe mental illness.
Street-dwelling persons with severe mental illness were randomly assigned to the experimental program (called Choices) or to standard treatment in New York City. We assessed study participants at baseline and at 6-month intervals over 24 months, using measures of service use, quality of life, health, mental health, and social psychological status. The average deviation from baseline summary statistic was employed to assess change.
Compared with persons in standard treatment (n = 77), members of the experimental group (n = 91) were more likely to attend a day program (53% vs 27%), had less difficulty in meeting their basic needs, spent less time on the streets (55% vs 28% reduction), and spent more time in community housing (21% vs 9% increase). They showed greater improvement in life satisfaction and experienced a greater reduction in psychiatric symptoms.
With an appropriate service model, it is possible to engage disaffiliated populations, expand their use of human services, and improve their housing conditions, quality of life, and mental health status.
... In various studies social skills training has found moderately to strongly effective on increasing skills acquisition and reducing psychiatric symptoms (Dilk, and Bond, 1996). Skills training are effective for virtually every area of role functioning for person with severe psychiatric disabilities (Dion, and Anthony, 1987). However, there is scarcity of research that validates the efficacy of social skills tainting to maintain personal, social and occupational life of persons with schizophrenia. ...
Social skill training is a collection of behavioral techniques that helps a person to restart her/his life in her/his community. Schizophrenia is a psychotic disorder with almost life long course causing a suffer withdrawal from his community and social life. The study aimed at assessing socio-occupational functioning of persons with chronic schizophrenia and assessing efficacy of social skills training module on socio-occupational functioning. Findings of the study shows significant improvement in self-care, communication and instrumental skills. Individuals improved coping and communication skills, evaluated anomalous experiences more objectively and improved socio-occupational functioning.
... The third group of factors considers the social environment. In their analysis of 35 studies, Dion and Anthony (1987) found that psychiatric rehabilitation reduces re-hospitalizations, positively affect employment, skills development, customer satisfaction and the amount of time spent in the community. Reducing the use of hospital treatment after the inclusion of the subject in psychiatric rehabilitation programs and / or case management is well documented and is a sustainable finding in many studies (Dincin & Witheridge, 1982). ...
At the current level of development in psychiatry, in the conditions of deinstitutionalization of mental health services and increased opportunities for control of the symptoms of mental disorders, the problem related to the socialization of patients is becoming more and more relevant. More than 50% of patients with schizophrenia are in a socially active age, which gives rise to the social significance of their rehabilitation. International practice shows that all specialists dealing with the rehabilitation of patients with mental disorders need to undergo training, which includes the adoption of special methods and techniques. Their work is complex, long and creative. In Bulgaria there are many national strategies that present different programs for long-term care or only analyze the current situation and care needs. There is no clear vision of how exactly in the future and with what means and specialists this process will take place. The development of psychiatric care lags far behind the needs of the population. There is a serious risk that the lack of trained specialists can ruin the good intentions for deinstitutionalization. The goal of the present study is to examine the readiness of specialists working in specialized medical institutions and social services to work with patients and users suffering from mental illness. A survey method was used among specialists from medical institutions and social services for patients with mental and behavioral disorders. Most of the specialists in psychiatric hospitals in Bulgaria feel prepared to work with the mentally ill - 88.9%; Almost everyone believes that they need additional training.
... Initially the idea of establishing the employment status of mental health consumers serviced by the team was promoted in the weekly multi-disciplinary team meetings. Consistent with the methodology adopted in similar studies (e.g., Crowther & Marshall, 2001;Anthony, Cohen, & Vitals 1978;Anthony & Dion, 1984) all clinicians in the HUH team were asked to complete a questionnaire designed by the author, to record the numbers of clients who were employed for more than 20 hours per week, employed part-time for less than 20 hours per week, doing a course or undergoing some training, not attending a course and not employed and number of clients on the invalids benefit. Clinicians would only fill in for clients for whom they were the key worker. ...
For adults using mental health services it is envisaged that the single largest outcome would be employment status. This paper describes a pilot survey on the employment status of mental health consumers serviced by the Hamilton-Huntly team in the Waikato region of New Zealand and suggests a way forward. The author concludes by recommending that adult mental health service providers should employ occupational therapists as employment specialists within multi-disciplinary treatment teams to achieve better employment outcomes.
... In the initial review of this body of research, Anthony and Margules (1974) concluded that persons with long-term psychiatric disabilities can learn a variety of skills regardless of their symptoms and that these skills, when properly integrated into a comprehensive rehabilitation program that provides support for the use of these skills in the community, can have a significant impact on client rehabilitation outcome. Since that 1974 literature review, several other reviews and studies have also concluded that rehabilitation outcome is a function of clients' skills and the supportive resources in their communities (Anthony, 1979b;Anthony, 1994;Anthony, Cohen, & Vitalo, 1978;Anthony & Jansen, 1984;Anthony & Liberman, 1986;Arns & Linney, 1995;Dion & Anthony, 1987). ...
Psychiatric rehabilitation assessment is the first phase of the psychiatric rehabilitation process. The psychiatric rehabilitation process itself varies greatly in terms of its formality, specificity, and documentation. At its most generic level, the practice of psychiatric rehabilitation involves consumers figuring out the residential, vocational, educational, and/or social goals they want to achieve and developing the skills and supports they need to reach their goals. In some psychiatric rehabilitation programs, this process is helped to unfold in an indirect, less formal, and less documented manner (for example, clubhouses). In other psychiatric rehabilitation programs, this process is directly facilitated and documented by a practitioner (for example, programs using the psychiatric rehabilitation approach developed at Boston University). Even with differences in how the entire psychiatric rehabilitation process is structured in various rehabilitation settings, the psychiatric rehabilitation assessment process at a minimum should include information on consumers' goals and the skills and supports needed to reach those goals. Psychiatric rehabilitation assessment is not to be confused with traditional psychiatric diagnosis. A rehabilitation assessment and a traditional psychiatric diagnosis are very different. The goal is different; the process is different; the tools are different. Yet, each provides useful and meaningful information, each requires training to implement, and each has a role in a comprehensive treatment and rehabilitation intervention. The focus of this chapter is on psychiatric rehabilitation assessment. A psychiatric rehabilitation assessment and a psychiatric diagnosis focus on completely different aspects of the person. In contrast to the traditional diagnostic focus on pathological conditions and symptom development over time, the rehabilitation assessment focuses on the skills and the resources the person needs to achieve an overall rehabilitation goal.
... These data provide significant empirical support for the following seven points. 15 (1) People with long-term mental illness can be maintained in the community with minimal use of inpatient services. (2) People with long-term mental illness can be helped to function more successfully in the commu-nity with interventions to enhance skills and supports. ...
... It became clear that some mechanism was needed to help people negotiate complex, fragmented, and sometimes inaccessible community-based services. It also became clear that many people needed help learning or re-learning a variety of daily living skills (Dion & Anthony, 1987), and that such skills were best taught in consumers' natural environments (Stein & Test, 1980). Intensive case management was hailed as a mechanism that could fulfill these needs. ...
Recent work suggests that some people who have severe and persistent mental illnesses can be transferred to less intensive services without suffering ill effects. However, the factors that affect the success of such transitions remain unknown. This longitudinal study examines consumer characteristics and types of intensive case management services that predict decompensation. We examined the trajectories of 86 individuals in an intensive case management program after they attained the highest level of functioning, identifying three patterns: stability, immediate decline followed by improvement, and gradual decline. Number of hospitalizations prior to program entry, being judged suicidal at program entry, and greater use of psychiatric services during program participation consistently predicted decompensation. Substance abuse and psychiatric symptomatology at program entry also predicted decompensation, but did so less consistently. Predictors of differences in specific patterns of decompensation are explored.
... People with severe mental illness (SMI) are significantly underrepresented in the American workforce. Early reviews of the rehabilitation literature consistently reported a competitive employment rate of 15% or lower for this population [2,3,14]. More recently, studies of supported employment have suggested that * Address for correspondence: Michael McQuilken, Director of the Office of Consumer and Family Affairs, Mental Health Corporation of Denver, 4141 E. Dickenson Place, Denver, CO 80222, USA. ...
Objective: Mental health consumers at an urban mental health center were surveyed about their motivations for working and perceived barriers to employment. Design: A survey was developed and administered by a consumer-led research team to 389 persons receiving case management and outpatient services. Results: Most consumers were either working (16%; n = 59) or reported a desire to work (46%; n = 170). The latter group constituted 55% of the 310 respondents who were not working at the time of the study. The most common perceived barrier was the fear of losing Social Security benefits. Consumers also reported concerns about receiving low pay and being ashamed of their job histories. Among the 38% of the total sample who expressed a reluctance or unwillingness to work, two-thirds (n = 58) indicated that, if they did not have to worry about losing their Social Security benefits while working, they would try to obtain employment. A total of 179 (49%) respondents expressed a preference for receiving vocational services at their clinical sites, versus at a clubhouse location. Conclusions: Most consumers in this study were working or wanted to work. Consumers' motivations for work can be increased, especially if key barriers to work are described as removable. Preferences for types and locations of vocational services need to be considered in planning services.
... While outcome research in psychosocial rehabilitation is a relatively new initiative in mental health research, there is growing evidence that it has a positive impact on the lives of people with serious and persistent mental illness. After reviewing 35 studies Dion and Anthony[1] reported that psychosocial rehabilitation interventions have a positive impact on skill development, employment, and the amount of time spent in the community. Participation in psychosocial rehabilitation has been found to increase the level of independent living.[2] ...
People with severe and persistent mental illness need help in most aspects of their lives, as the disability associated with these diseases can be debilitating. Psychosocial rehabilitation interventions aim to help them relearn skills that would reduce disabilities so that they can be reintegrated into society.
To study the efficacy of the rehabilitation program at the Richmond Fellowship Society (RFS) 'ASHA' half-way home.
Fifty-four clients diagnosed with either schizophrenia or affective disorder who stayed at the half-way home for more than 6 months.
A retrospective evaluative approach was followed. An evaluation checklist was developed for the purpose and this was used to assess the level of functioning of the clients. A paired sample t-test was used to score changes in client progress between admission and discharge.
Significant improvement ( P≤.05 level) was noticed on all the parameters from baseline to discharge. CONCLUSSION: The psychosocial rehabilitation program at the RFS half-way home has a beneficial effect.
... The 2-year follow-up study by 10hnstone and colleagues (1990) showed that poorer vocational outcomes were associated with poorer social skills in a sample of people with SMI. Literature indicated that 75% to 90% of adults with SMI are unemployed (Bond, Becker, Drake et aI., 2001; Dion & Anthony, 1987; Mueser, Saylers & Mueser, 2001; Trupin, Sebesta, Yelin et aI., 1997; Unger & Anthony, 1984). In Hong Kong, available statistics showed that the competitive employment rate was around 30% in a sample of 325 people with psychiatric disabilities (Equal Opportunities Commission, 1997) .. Another problem revealed by literature was that people with SMI had interpersonal difficulty in their workplace that might have led to their pre-maturejob termination (Becker, Drake, Bond et aI., 1998; Cook & Razzano, 2000; Tsang, Lam, Ng & Leung, 2000). ...
165, [299] leaves : ill. ; 30 cm. PolyU Library Call No.: [THS] LG51 .H577M RS 2005 Cheung Background: Literature has shown that people with severe mental illness (SMI) experience deficits in social skills and social competencies which affect their performance in getting and keeping a job. However, there was a scarcity of studies on social skill needed in the workplace. This study aimed at developing a Job-specific Social Skills Training (JSST) based on the conceptual framework of Work-related Social Skills and Work-related Social Skills Training (WSST) programme in psychiatric rehabilitation (Tsang, 2001b; Tsang & Pearson, 1996) in order to further improve employment outcomes of individuals with SMI in Hong Kong. A control study was carried out to assess its efficacy. Method: In Phase One of the study, factor structure of relevant Job-specific SoCial Skills Components (JSSC) required by salespersons which may contribute to successful employment of consumers was identified by exploratory factor analysis of results of a questionnaire survey. The respondents consisted of 106 salespersons from the retail market. In Phase Two. the JSST module for consumers who have a vocational goal working as salespersons was developed. The content of the module follows the factor structure results in Phase One. Five skill areas are covered in the module. In Phase Three, a control study was conducted to test the efficacy of the module. An Integrated Social Skills Training group (WSST with JSST) (n=37) was compared with two historical comparison groups conducted by Tsang and Pearson (2001), a training group with WSST only (n=30), and a control group (n=41). Results: Comparisons of the pre-treatment and post-treatment assessment results among the three groups, using a series of work-related social skills assessments and vocational follow-up questionnaire, showed that the Integrated Social Skills Training group (WSST with JSST) was effective in improving work-related social skills of participants in a larger progress. Vocational follow-up assessment after three-month completion of the training showed that the integrated training group had the most participants (70.3%) who were employed when compared with the previous results (WSST group = 46.7%; control group = 2.4%) done by Tsang and Pearson (2001). Conclusion: This study substantiated that the training module of JSST used as an Integrated Social Skills Training with WSST is efficacious in improving the work-related social skills and the chance of open employment of people with SMI in Hong Kong. M.Phil., Dept. of Rehabilitation Sciences, The Hong Kong Polytechnic University, 2005
... De acuerdo a varios reportes de estudios llevados a cabo en países desarrollados, apenas 20 a 30% de los pacientes con trastornos psiquiátricos tiene un empleo competitivo de tiempo completo (3, 12, 17, 33 ), y sólo 15% de aquellos con esquizofrenia (7). Este porcentaje puede ser aún más bajo en países en vías de desarrollo , pues las dificultades de los pacientes para encontrar trabajo no se deben sólo a la falta de tratamiento y/o entrenamiento, o a barreras culturales como el estigma (32), sino a los problemas socioeconómicos de una nación en particular. ...
... De acuerdo a varios reportes de estudios llevados a cabo en países desarrollados, apenas 20 a 30% de los pacientes con trastornos psiquiátricos tiene un empleo competitivo de tiempo completo (3, 12, 17, 33 ), y sólo 15% de aquellos con esquizofrenia (7). Este porcentaje puede ser aún más bajo en países en vías de desarrollo , pues las dificultades de los pacientes para encontrar trabajo no se deben sólo a la falta de tratamiento y/o entrenamiento, o a barreras culturales como el estigma (32), sino a los problemas socioeconómicos de una nación en particular. ...
Introducción.
La evaluación de habilidades sociales para el trabajo en esquizofrenia de Tsang y Pearson (EHSTE) resulta un método especialmente valioso en virtud de que, a diferencia de la mayoría de medidas generales de habilidades sociales disponibles a la fecha, ésta se dirige a evaluar específicamente los problemas y necesidades de las personas con esquizofrenia para conseguir y mantener un trabajo; y porque las otras herramientas de evaluación del constructo especialmente diseñadas para esta población son más bien listas de chequeo. La EHSTE consta de dos partes: 1) Una escala de auto administración (AA) que evalúa la percepción subjetiva de los pacientes acerca de su competencia en habilidades sociales relacionadas con la obtención y el mantenimiento de un trabajo; y 2) Un ejercicio simple de juego de roles para evaluación por expertos (EE), en donde se observa la ejecución social de los pacientes en la simulación de dos situaciones laborales: solicitar trabajo en una entrevista y pedir autorización a un supervisor para ausentarse en un día cotidiano de trabajo. El objetivo del presente estudio fue traducir al español y evaluar la confiabilidad y validez de las formas de AA y EE que integran la EHSTE, en pacientes mexicanos con esquizofrenia.
Método.
Con base en un muestreo no intencional de pacientes atendidos en los servicios de consulta externa y hospitalización del Centro de Atención Integral en Salud Mental del Instituto Jalisciense de Salud Mental, se conformó una muestra de adultos de ambos sexos con diagnóstico de esquizofrenia en cualquiera de sus tipos. El diagnóstico fue confirmado mediante la entrevista estructurada SCAN y se completó la AA y EE en el total de la muestra. Adicionalmente, un psiquiatra registró su funcionamiento global mediante la escala propuesta por la Asociación Psiquiátrica Norteamericana (EEAG) así como otras variables sociodemográficas y clínicas relevantes para el estudio. A los quince días, un sub grupo participó en una segunda aplicación de ambas formas de evaluación de la EHSTE.
Resultados.
Participó un total de 54 pacientes con esquizofrenia. Los coeficientes Alpha de Cronbach fueron, para la AA=0.69 y para la EE=0.85. Un total de 36 pacientes completaron las evaluaciones inicial y a 15 días, y las correlaciones entre ellas fueron: para AA=0.66, y para EE=0.73, p≤.01. En el total de la muestra, las puntuaciones en la EEAG y EE se correlacionaron alta, positiva y significativamente (r = 0.71, p ≤.01). Empero, la relación entre EEAG y AA no fue estadísticamente significativa. Asimismo, la puntuación EE, y no la de AA, fue clínica y estadísticamente superior en los pacientes atendidos en consulta externa vs. hospitalización (12.9 ± 2.5 vs. 10.72 ± 3.4; t=-2.77, gl = 52, p = .008); con mejor funcionamiento psicosocial (59.79 ± 8.5 vs. 52.12 ± 8.5; t = 2.97, gl = 52, p = .004), y entre aquellos que tenían experiencia laboral (12.76 ± 2.55 vs. 8.91 ± 3.53; t = 4.11, gl = 51, p≤.0001). No se registraron diferencias por género.
Conclusiones.
Se aporta evidencia de consistencia interna, estabilidad temporal y validez de constructo de la evaluación de habilidades sociales para el trabajo por expertos y mediante la técnica de juego de roles, en pacientes mexicanos con esquizofrenia. Se recomienda que la evaluación de este constructo en pacientes de habla hispana y con baja escolaridad se haga con base en este método, pues los formatos de auto aplicación pueden ser una herramienta de cuestionable validez y confiabilidad en esta población. Sin embargo, serán necesarios futuros estudios que permitan la generalización de los resultados en el entendido de que existen diferencias culturales importantes en ésta como en muchas otras variables de funcionamiento humano.
... Because work serves an important function in a person's life, impairments in vocational ability (which includes choosing, getting, and keeping a job in the community ) are considered to be a central feature of mental disorders (Massel et al. 1990). Results of surveys on employment rates of persons discharged from psychiatric hospitals show that the figures for full-time competitive employment range from 20 percent to 30 percent (Goldstrom and Manderscheid 1982; Anthony and Jansen 1984; Wayslenki et al. 1985; Dion and Anthony 1987). For those who are more chronically ill, the figure drops to about 15 percent (Unger and Anthony 1984). ...
This article describes a prospective blinded outcome study of a vocational social skills training program developed in Hong Kong for people affected by chronic schizophrenia. The aim was to improve their ability to find and keep a job. Participants were randomly assigned to three groups: a social skills training group with followup support, a social skills training group without followup support, and a comparison group who received standard after-care treatment. Participants who had participated in either of the training groups statistically outperformed those in the comparison group. Those receiving the training plus followup were statistically much more successful at finding and keeping a job than participants in either of the other two groups. A comparatively small amount of followup contact (a monthly group meeting or phone call) for 3 months after the training finished had a very significant effect on participants' success rate.
La rehabilitación de base comunitaria en salud mental ha hecho la diferencia en la vida de muchas personas y promete seguir aportando al mejoramiento de la salud y la calidad de vida de quienes padecen trastornos mentales. No obstante, este tipo de intervenciones aún requiere fortalecer sus instrumentos y escalas de medición, en especial, aquellos asociados a la funcionalidad mental de las personas en proceso de rehabilitación. En un esfuerzo mancomunado, la organización Asociación Coometas Campesinas y Saludarte, después de diez años continuos de trabajo en esta área, y la Fundación Universitaria Juan N. Corpas desarrollaron una investigación para atender esta necesidad, en el periodo de 2015 a 2020. La investigación produjo como resultado la Batería de Estimulación y Valoración de la Funcionalidad Mental, y también permitió identificar puntos críticos que es necesario discutir en relación con la principal clasificación de la funcionalidad y la discapacidad: la Clasificación Internacional de Funcionalidad de la Organización Mundial de la Salud. Este artículo presenta algunas de las críticas y reflexiones que surgieron durante la investigación. Se espera que estas permitan abrir un camino de exploración para construir la comprensión de la funcionalidad mental que integre efectivamente la perspectiva desde los cuidados de la enfermería.
An Opportunity to Develop a Full Partnership Among Nurses, Consumers, and Families
This study evaluated whether a direct skills training (DST) approach for persons with disabilities can better prepare participants for job interviews. Twenty graduate students in a master's program in rehabilitation counseling at various agency internship sites were trained in a 4‐session Presenting Qualifications curriculum based on DST administered to 126 participants in 20 group settings. Participants reported greater confidence and preparedness in the interview process, in answering difficult questions, and in highlighting past accomplishments after the group. Results support the feasibility of training entry‐level rehabilitation counselors in the DST approach to teach job interview skills to individuals with disabilities.
Achondroplasia is inherited in an autosomal dominant manner. This disorder is caused by mutation in FGFR3 gene (Fibroblast Growth Factor Receptor 3). Over 80% of individuals with achondroplasia have parents with normal stature and have achondroplasia as the result of a de novo gene mutation. Such parents have a low risk of having another child with achondroplasia. Achondroplasia is characterized by abnormal bone growth that results in short stature with disproportionately short arms and legs, a large head, and characteristic facial features. Intelligence and life span are usually normal. The aim of this study is a case report of pregnant woman with a fetus suffering from achondroplasia.
Introduction. People with mental disorders sometimes experience that they are perceived as abnormal or different.
Aim. The study aimed at investigating the experiences of otherness among students diagnosed with depression and/or anxiety disorder who participated in a psychosocial rehabilitation program.
Method. The data were gathered with focus groups by interviewing eight groups of students (n=47) aged 16−25 years diagnosed with depression and/or anxiety disorder who participated in a rehabilitation program during 2011−2013.
Results. Seven themes were discovered related to the sense of otherness: 1) Carnival of depression, 2) Stereotypes, 3) Shame, 4) Ethos of self management, 5) Overabundance of help, 6) Minimisation and lack of understanding, and 7) Power of peer support.
Conclusion. Sense of otherness is related to stigma experiences which may carry both negative and positive meanings. Health care professionals should be aware of the power of peer support and humour among young adults with mental disorders.
An on-line job information system facilitating the vocational rehabilitation process for use by rehabilitation professionals, people with psychiatric disabilities, and their relatives are to be developed in Hong Kong. The preferred functions and features of the system were collected by a questionnaire survey among 90 occupational therapists, social workers, and nurses as the potential end users. The preferred functions included job matching, providing information on job vacancies relevant to people with psychiatric disabilities, and making suggestions on areas of improvement on clients' abilities.
Ten individuals with mental retardation and psychiatric disorders who failed in their community placements due to aggression, property destruction, and suicidal ideation were provided an environment emphasizing a network of mental health and developmental disabilities services. The focus of programing was the application of psychiatric rehabilitation principles and environmental behavior support strategies. Components of the treatment model included goal-setting, comprehensive case management, social skills training, positive reinforcement, crisis intervention, competency-based skills teaching, medication monitoring, data-based outcome measurement, and community-living arrangements. Results indicated that in contrast to their preintervention status, all individuals demonstrated significant reductions in targeted behaviors, maintained extended placement within the community without emergency hospitalizations, developed effective and adaptive social skills, secured job placement, and reported satisfaction with their quality of life.
Objective: To study use and awareness of the Social Security Work Incentives (SSWIs) and to obtain empirical data on barriers to returning to work.
Study Design: Using parallel surveys and multiple sampling and recruitment strategies, the authors administered a brief survey about the SSWIs.
Participants: Persons with a psychiatric disability (n=539), service providers (n=120), and family members (n=174). Results: All groups registered the greatest concern about the loss of health insurance; this and other concerns were perceived as serious barriers to returning to work. There were differences in the perceptions of the 3 groups about the importance of disincentives to work and differences among consumers by demographic characteristics.
Conclusions: Consumers, family members, and providers of services need more information about the work incentives, particularly if the goals of the new Ticket to Work legislation are to be realized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Rehabilitation evaluation is an important part of the rehabilitation process of those disabled for work. Its aim is to assess a client's working capacity and/or his/her potential to benefit from rehabilitation. At the Rehabilitation Foundation in Helsinki, Finland, more than 800 rehabilitation evaluation clients are examined yearly. In a third of them mental problems are associated with the disability. The Foundation has started a follow-up study for the purpose of evaluating the rehabilitation process of clients with mental problems. A questionnaire with 49 questions was mailed to 779 clients with mental disability examined in 1981–83. The follow-up period lasted approximately 2 years. A total of 78% of former clients responded. The evaluations resulted in recommendations for “direct employment”, “vocational rehabilitation”, or “pension”. Altogether 44% of the group recommended for direct employment were employed at the time of the follow-up. There were no differences in employment between different groups of mental disorders (psychotics, those with personality disorders, neurotics).
This paper introduces the concept of total quality management (TQM) to top managers of mental health systems. While TQM is
a philosophy of management at the cutting edge of U.S. business, it has only recently entered the vocabulary of health care
managers. To our knowledge, TQM has yet to be systematically applied to the state mental health service delivery system. After
introducing some key concepts and techniques, we develop two extensive examples of how TQM can be integrated into the already
existing management structure of the psychiatric hospital.
Within the framework of a study on vocational rehabilitation of the mentally ill, we examined 83 schizophrenic outpatients enrolled in a work therapy program. The course of illness and rehabilitation was documented over a 3-year period by means of annual follow-up examinations. The sample comprised 44 men and 39 women with an average age of 35 years (SD±8,5). The majority were chronically ill patients with a history of frequent and long psychiatric hospitalization. After 3 years, 22% of the patients were integrated into the general labor market, 26% had sheltered employment, 23% were still in work therapy, and 29% were unemployed. Besides the patients’ subjective expectations, early introduction of rehabilitative measures and a favourable course of illness were found to be predictors of a successful rehabilitation leading to vocational integration. Outpatient work therapy is a contemporary, effective organizational form of sociotherapy. It may contribute to improved vocational competence and integration, reduced psychiatric hospitalization and stabilized psychopathology.
Assessing the fidelity with which program models are transferred from program designers to program staff is essential for testing and disseminating program theory. Technologies for assessing fidelity are not well developed. Concept mapping techniques may be used to identify the key conceptual domains that define a program and the structural relationships among these domains. In this paper, concept mapping is used to assess the fidelity of an experimental program model for persons who are street dwelling and psychiatrically disabled. The program was developed from a well understood psychiatric rehabilitation model designed at Boston University (BU). Data from program and BU staff were used to construct concept maps that portrayed the program as conceptualized by BU and by program staff. Quantitative and descriptive analyses of the maps indicated good fidelity of model transfer but also highlighted important local adaptations of the program.
Knowledge concerning the care of persons with severe mental illness is seldom translated into improvements in service delivery. Recent developments in the research utilization field suggest that the manipulation of contextual and bureaucratic variables may be the key to enhancing the use of relevant outcome data. The assumption of multiple roles by the researcher as a strategy to influence decisions and produce change is described. Common issues and problems associated with the researcher acting as administrator, planner or consultant are explored.
Major changes have occurred in mental health services in the last 20 years, but restructuring is still taking place. In order for evaluation to play a significant part in the future, its role in the past should be analyzed. A review of the literature describes evaluation activities in three major change areas: financial, programmatic/clinical, and new constituencies. Three areas of major evaluation activity but lesser importance to the public mental health system are also analyzed: prevention, needs assessment, and program performance measurement. From this review, suggestions are made to enhance future contributions. While increased support for evaluation and mandated evaluation involvement in major program/system change efforts would undoubtedly help, lessons from the past show us that such changes, alone, may have little impact. In addition, administrators' knowledge of research and evaluation and motivation to utilize findings must be increased. Suggestions are presented for a structured process of replication and reimbursement of nontraditional services, building in evaluation considerations. Besides the funding investment and clearer specification of program objectives that these suggestions will require, changes will also be necessary in developing alternative methodologies and instrumentation to improve consumer input.
This paper is a critical review of four major rehabilitation programs: assertive community treatment, case management, vocational rehabilitation, and educational rehabilitation. Reported outcomes are reviewed in the context of study design, service characteristics, client characteristics, and operationalization of outcomes. Findings from the four programs are compared with one another. The authors concluded that clients are able to learn most of the skills taught, independently of the rehabilitation model. Furthermore, skills learned in one life domain generalized to a moderate extent to other areas. The four rehabilitation programs had varied effects on the outcome variables, and part of the variability in the findings appears to be related to client characteristics. Limitations of the studies reviewed are identified and a set of recommendations was suggested for the future practice of research into psychiatric rehabilitation.
Psychosocial rehabilitation refers to a treatment philosophy incorporating vocational, residential, and social programming in the community. Psychosocial rehabilitation is widely acknowledged as a major element in the treatment of schizophrenia and allied disorders. With an increased focus on community treatment, the Clubhouse (or Fountain House) Model has become increasingly prominent as an effective and cost-efficient mode of psychosocial rehabilitation.
Abstract: The purpose of this study was to evaluate the types of vocational rehabilitation services provided to individuals with psychiatric disabilities through the federal-state vocational rehabilitation program and the relationship of these services to employment outcome. With the cooperation and support of the Rehabilitation Services Administration (RSA), the data for this study consisted of consumers with psychiatric disabilities who received services during federal fiscal year 2002 (n = 79,967). In addition, this study evaluated and described the demographic variables that were involved in successful employment outcome such as gender, race/ethnicity, age, diagnosis, significant disability, years of education, and disability benefits. To ensure that the regression model had both generalizability and transferability to the population and situations for which it was intended, model validation was accomplished by splitting the sample approximately in half, resulting in a top (n = 40,000) and bottom sample (n = 39,967). Correlational analyses and chi-square analyses were used to assess the bivariate relationship between the dependent variables (program closure status) and each of the predictor variables to identify high intercorrelations and assist in determining which variables were entered into the logistic regression model. The best fit model was identified and interpreted based on the top and bottom halves of data. Neither race/ethnicity nor gender were predictors of employment outcome and after being force entered into the initial logistic regression model, race/ethnicity was dropped in the final model. However, job placement services, on-the-job services, job search assistance and other support services were somewhat predictive of a positive employment outcome for individuals with psychiatric disabilities. This may be due in part to the use of these services as a conduit toward achieving competitive employment, thus consumers receiving such services would be closer to achieving employment. In contrast, recipients of disability benefits, most especially individuals receiving SSI and SSDI, were the least likely to have an employment outcome after receiving services. Likewise, significant disability was also associated with fewer closures with employment outcomes. Many of the results of this study mirrored the existing literature on individuals with psychiatric disabilities, suggesting that additional research is needed to clarify the conflicting results of many studies. Model limitations and recommendations for further research are suggested. Title from first page of PDF file. Document formatted into pages; contains xv, 171 p.; also includes graphics Thesis (Ph. D.)--Ohio State University, 2005. Includes bibliographical references (p. 155-171). System requirements: World Wide Web browser and PDF viewer.
Increasing numbers of people with psychiatric disabilities are residing in communities rather than in inpatient settings. They are also becoming more aware of the benefits of working and of their legal right to employment with accommodations. Traditional work preparation programs have failed to result in employment for many people with psychiatric disabilities. However, supported employment, when modified to reflect the basic principles and practices of effective psychiatric rehabilitation, has been shown to result in employment benefits for participants at a reasonable cost to providers. With supported employment methodologies such as the choose-get-keep approach, providers can do much to help people with psychiatric disabilities reap the many social and financial benefits of employment and achieve their community living goals.
The last decade has witnessed a burgeoning interest in case management services to people with severe mental illness. While the literature on case management is proliferating, there remains a paucity of rigorously designed outcome research. This paper provides a methodological review of that outcome research on case management, which found that the term case management is used to describe a diverse array of interventions that yield differing client outcomes. Suggestions for the direction of future inquiry are described.
The authors discuss the benefits of including a research component in psychosocial programming and strategies for evaluating the outcomes and implementation of a rehabilitation program.
Research concerning the care and treatment of people with severe mental illness has not been consonant with the well-established emphasis on consumer empowerment in social work and the psychiatric rehabilitation field. This article provides a set of research strategies that would help bridge the gap. We argue that research should amplify "the voice of the consumer" by attending to the context of research, the vantage point, the process of formulating research questions, the selection of interventions to be tested, the selection of outcomes and measures, and the dissemination of research results.
This study examined the efficacy of task analysis training for case managers helping seriously mentally ill patients find roommates and housing. Behavioral objectives and task analysis were used to develop the task-oriented behavioral training program. Case managers were trained to use a checklist for every session with patients, which included the goal of the session, tasks required to accomplish that goal and lists of all the sub-tasks. The results of this study suggest that this methodology: (1) reduced the time required for patients to find roommates and housing; (2) increased the percentage of patients finding housing; and (3) decreased hospitalization rates occurring during the process of looking for roommates and housing.
This chapter summarizes consumer outcomes following receipt of psychiatric rehabilitation services and reviews prior research studies in order to generate suggestions for improving the quality and consumer sensitivity of future outcomes research.
This paper presents a discussion of the historical development of deinstitutionalization in the United States, including the political, ideological, and social origins of that policy. The outcomes of deinstitutionalization are considered, including the impact of the policy on the quality of life of people with severe mental disorders. The authors also provide a brief review of the literature on the efficacy and cost-effectiveness of hospitalization versus outpatient (community) care. Recent developments in the use of involuntary hospitalization are discussed, along with a number of important trends in the delivery and financing of services for persons with severe mental disorders.
Over the past decade substantial advances have been made in the psychiatric rehabilitation of persons with severe mental illnesses such as schizophrenia and bipolar disorder. In this review we highlight progress in several areas that have been the focus of extensive research, including case management, social skills training, supported employment, family intervention, and integrated treatment for comorbid substance use disorders. We also identify characteristics of successful psychiatric rehabilitation programs: (1) effective interventions tend to be direct and behavioral; (2) rehabilitation programs have specific effects on related outcomes, with limited generalization to other domains; (3) short-term interventions are less effective than long-term ones; (4) interventions need to be delivered close to patients' natural environments; and (5) effective programs often combine skills training and environmental support.
Work therapy is a widespread form of sociotherapy. In contrast to pharmacological and somatic forms of treatment, proof of efficacy is difficult to produce in multimodal therapy of schizophrenic patients on account of the many methodological problems involved. Within the framework of an extensive study on the vocational rehabilitation of mentally ill patients, we carried out a naturalistic follow-up study of 83 schizophrenic patients attending outpatient work therapy. The sample, which comprised 44 men and 38 women with a mean age of 35 years (+/- 8.5 years), can be seen as regionally representative. The courses of illness and rehabilitation were documented prospectively at annual follow-ups over a 3-year period. Most of the probands were chronically mentally ill patients with a history of frequent and long-term hospitalisation. At the end of the 3-year period, 22% of the patients were integrated into the open labour market, 26% were working in sheltered employment, 23% were still in work therapy, and 29% were unemployed. Two-thirds had achieved their stated rehabilitation objectives. The 3-year rehabilitation outcome was strongly dependent on the patients' subjective expectations. Other factors proving to be predictors of successful rehabilitation were less pronounced psychopathological symptoms (ADMP), better social functioning (GAS), a higher level of education and an early introduction to work therapy. Work therapy appears to have a favourable impact on hospitalisation rates.
Government-run sheltered workshops in the Netherlands are not as easily accessible to people with psychiatric histories as they are to other groups, such as those with physical and intellectual disabilities. This was found in a large-scale nationwide study in 21 such workshops, commissioned by the Dutch Ministry of Social Affairs and Employment. The workshops varied in their degree of accessibility. The more accessible ones placed stronger emphasis on social objectives and had shorter waiting periods and more lenient admission policies.
This paper aims at assessing the vocational integration attained after a 3-year period by psychiatric patients who participated in different vocational rehabilitation programmes.
In the north-western German region of Westphalia-Lippe a naturalistic follow-up study was carried out on 471 patients from three different types of vocational rehabilitation programmes. The sample comprised chronically ill patients with a history of repeated and long-term hospitalization.
After 3 years 11% of the patients were in competitive employment, 67% (still) in sheltered employment, 7% in out-patient work therapy programmes and 15% were unemployed. It is important to notice that 74% achieved their subjective rehabilitation goals expressed at baseline.
Vocational rehabilitation programmes are an essential part in the treatment of people with chronic mental illness. Integration into work varies markedly while patients' satisfaction is comparably good. Competitive employment represents a realistic objective only for patients with high motivation and favourable preconditions.
Fifty participants with mental illness and a concrete discharge plan were selected from two mental hospitals in Hong Kong and assessed on their Psychosocial support by the Chinese Version of the Significant Others Scale, social vocational competence using the Workshop Behavior Checklist and the Vocational Social Skills Scale, medical history, work history, and demographic variables. At three months after discharge, the employed participants (n = 12) were shown to have better psychosocial support and social vocational competence than the unemployed participants (n = 24) by univariate comparison. The employed and unemployed participants did not differ in their medical and work history, and demographic variables. Implications of the results for rehabilitation programming are discussed.
With the admission of people who experience psychiatric disabilities in the state-federal vocational rehabilitation system and the Social Security disability rolls in the 1960s, assessment of their capacity to work has been a major concern. Given the rising rates of claims for psychiatric disability in both the public and the private sectors, and the disappointing employment outcomes of people with psychiatric disabilities compared to those with other disabilities, there have been numerous initiatives to accurately assess their employment potential. Historically, such assessment within the Social Security Administration has relied upon evaluation of a person's medical impairment, but numerous studies suggest a weak relationship between measures of psychiatric diagnosis or symptoms and work outcome. Efforts have been undertaken to identify valid and reliable methods of assessing the ability of people with psychiatric disabilities to work. The authors review (a) methods of assessing work function for this population, and (b) the literature on predictors of work functioning and the nature of psychiatric disability, and suggest implications for disability determination policies and for future research.
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