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Kelly, Glenn, and Dianne Winkler. "Long-Term Accommodation and Support for People With Higher Levels of Challenging Behaviour." Brain Impairment 8, no. 3 (December 1, 2007): 262–75. http://dx.doi.org/10.1375/brim.8.3.262.
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AbstractThe purpose of the present article is to describe the issues associated with providing lifelong accommodation and support to people with severe brain injury, neurobehavioural disability, and overt challenging behaviours. In particular, the article focuses on two groups of people within an Australian context: (a) those who live in community settings but whose behaviour is not adequately managed even by specialist outreach behaviour management services, and (b) those who are confined to aged care residential facilities and who show challenging behaviour. These groups bring to the fore different lifelong behaviour management issues. At present, if community-based clients seriously offend or have an adequate psychiatric diagnosis, they may be placed in heavily secured psychiatric units or prison. Otherwise, by default, they will reside in less restrictive options such as family homes and shared supported accommodation. We will argue that the current service system lacks the ability to apply appropriate structure and control to many clients with serious challenging behaviours, and propose that specialised facilities would make an important addition to the service system. Conversely, young clients confined to residential aged care facilities live in impoverished environments that often contribute to challenging behaviour that can be enormously disruptive, distressing, and unsafe. We will review the recent Australian State and Federal Government initiative aimed at transitioning some young people out of nursing homes, and we raise considerations for future service development. There are many individuals with the potential to make significant gains in a tightly structured setting before returning to the community, while others will manage well with long-term placement in a setting designed for residents with neurobehavioural disability. Case studies and service data are used to support these arguments, and key elements of accommodation and rehabilitation models for those in need of long-term neurobehavioural support are described.
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Isaacs, Anton N., Kim Dalziel, Keith Sutton, and Darryl Maybery. "Referral patterns and implementation costs of the Partners in Recovery initiative in Gippsland: learnings for the National Disability Insurance Scheme." Australasian Psychiatry 26, no. 6 (February 19, 2018): 586–89. http://dx.doi.org/10.1177/1039856218759408.
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Objective: The purpose of this paper is to provide some learnings for the NDIS from the referral pattern and cost of implementing the Partners in Recovery initiative of Gippsland. Method: Information on referral areas made for each consumer was collated from support facilitators. Cost estimates were determined using budget estimates, administrative costs and a literature review and are reported from a government perspective. Results: Sixty-three per cent of all referrals were made to organisations that provided multiple types of services. Thirty-one per cent were to Mental Health Community Support Services. Eighteen per cent of referrals were made to clinical mental health services. The total cost of providing the service for a consumer per year (set-up and ongoing) was estimated to be AUD$15,755 and the ongoing cost per year was estimated to be AUD$13,434. The cost of doing nothing is likely to cost more in the longer term, with poor mental health outcomes such as hospital admission, unemployment benefits, prison, homelessness and psychiatric residential care. Conclusions: Supporting recovery in persons with Severe and Persistent Mental Illness is likely to be economically more beneficial than not doing so. Recovery can be better supported when frequently utilised services are co-located. These might be some learnings for the NDIS.
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Crotty, G., O. Doody, and R. Lyons. "Identifying the prevalence of aggressive behaviour reported by Registered Intellectual Disability Nurses in residential intellectual disability services: an Irish perspective." Advances in Mental Health and Intellectual Disabilities 8, no. 3 (April 29, 2014): 174–87. http://dx.doi.org/10.1108/amhid-03-2013-0016.
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Purpose – Despite the high incidence of aggressive behaviours among some individuals with intellectual disability, Ireland has paid little attention to the prevalence of aggressive behaviours experienced by Registered Intellectual Disability Nurses (RNID). Within services the focus is mainly on intervention and management of such behaviours. Therefore a disparity occurs in that these interventions and management strategies have become the exclusive concern. Resulting in aggressive behaviour being seen as a sole entity, where similar interventions and management strategies are used for ambiguously contrasting aggressive behaviours. Consequently the ability to document and assess-specific behaviour typologies and their prevalence is fundamental not only to understand these behaviour types but also to orient and educate RNIDs in specific behaviour programme development. The paper aims to discuss these issues. Design/methodology/approach – This study reports on a survey of the prevalence of verbal aggression, aggression against property and aggression against others experienced by RNIDs’ within four residential settings across two health service executive regions in Ireland. A purposeful non-random convenience sampling method was employed. Totally, 119 RNIDs responded to the survey which was an adaptation of Crocker et al. (2006) survey instrument Modified Overt Aggression Scale. Findings – The findings of this study showed the experienced prevalence rate of verbal aggression, aggression against property and aggression against others were 64, 48.9 and 50.7 per cent, respectively. Cross-tabulation of specific correlates identifies those with a mild and intellectual disability as displaying a greater prevalence of verbal aggression and aggression against property. While those with a moderate intellectual disability displayed a higher prevalence of aggression against others. Males were reported as more aggressive across all three typologies studied and those aged between 20 and 39 recorded the highest prevalence of aggression across all three typologies. The practice classification areas of challenging behaviour and low support reported the highest prevalence of aggression within all typologies. Originality/value – The health care of the person with intellectual disability and aggressive behaviour presents an enormous challenge for services. In-order to improve considerably the quality of life for clients, services need to take a careful considered pragmatic view of the issues for the person with intellectual disability and aggressive behaviour and develop realistic, proactive and responsive strategies. To do this, precise knowledge of the prevalence of aggressive behaviours needs to be obtained. This study is the first of its kind in the Republic of Ireland.
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Worthington, Rachel, Chris Patterson, and Neel Halder. "Working with intellectually disabled autistic individuals – a qualitative study using repertory grids." Journal of Intellectual Disabilities and Offending Behaviour 9, no. 1 (March 12, 2018): 22–31. http://dx.doi.org/10.1108/jidob-08-2017-0017.
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Purpose The purpose of this paper is to elucidate how care professionals/providers construe, understand and make sense of the characteristics that are important when providing care to adults with intellectual disability and autism spectrum disorder, based on their experiences of working within their roles within a residential care setting. Design/methodology/approach Care professionals and providers working at a community autism and intellectual disability service were interviewed to ascertain their experiences of working with this client group. The research design adopted a qualitative methodology using repertory grids. Findings Ten members of staff who agreed to participate formed the study’s sample. This consisted of team leaders, support workers, one member of the executive management team and one clinical member of staff. Ten themes were identified for working effectively with people with autism and intellectual disabilities. These were: making autism-specific adaptations, approachable, reflective/self-aware, strong understanding of their residents/empathetic, benevolent, empowering, follows plans consistently, confident in ability to support residents with autism, resilient, respectful. Practical implications The paper discusses each of these ten themes above and how employers can aid in selecting individuals who may be more suited to working with this patient group. Originality/value A literature search demonstrated a lack of empirical research, especially qualitative research, on this topic.
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Joy, Read, Cable Sarah, Löfqvist Charlotte, Iwarsson Susanne, Bartl Gergely, and Schrag Anette. "WED 128 Care and unmet needs in late-stage parkinsonism: a qualitative study." Journal of Neurology, Neurosurgery & Psychiatry 89, no. 10 (September 13, 2018): A14.2—A14. http://dx.doi.org/10.1136/jnnp-2018-abn.51.
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AimTo explore experiences and views about care needs and service use by people with late-stage Parkinsonism.MethodTen participants at Hoehn and Yahr stage 4 or 5 were interviewed using semi-structured open ended questions and qualitative content analysis.FindingsDespite severe disability, participants expressed their desire to maintain normality of activities and interests in their lives. Many perceived that even though health care was provided by professionals they could do nothing more for them. Participants experienced having to ‘fit-in’ to service structures that did not always accommodate their complex needs. The quality of relationships with health care professionals and formal carers shaped perception of service provision and mediated adaptation. Informal support and knowledge on disease management were key factors in their perceived ability to remain in control and to enable normal functioning. There was common reluctance to discuss, and uncertainty about, future plans. For example, moving to a residential nursing home was perceived an undesirable but potentially necessary only option for future care.ConclusionAddressing these findings including greater flexibility of healthcare structures and better future planning could increase ability of patients with late-stage parkinsonism to remain at home and improve quality of life of patients in this late disease stage.
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Santambrogio, Jacopo, Michela Russo, Sergio Terrevazzi, Gianluca Peschi, Massimo Clerici, and Marco O. Bertelli. "Mitigating the impact of SARS-CoV-2 on residential facilities for persons with intellectual disability and/or autism spectrum disorder: two experiences from the Italian red zone." Advances in Mental Health and Intellectual Disabilities 15, no. 4 (August 27, 2021): 132–40. http://dx.doi.org/10.1108/amhid-02-2021-0006.
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Purpose Persons with intellectual disability and/or low-functioning autism spectrum didorder are with high support need (ID/ASD-HSN) are among the people who are most vulnerable to the COVID-19 pandemic. The specific vulnerability and the protective factors for persons with ID/LF-ASD attending residential and rehabilitative facilities have however received little attention. This paper aims to describe how two facilities located in the Italian COVID-19 red zone faced the risks associated with the spread of the pandemic and the results they have achieved so far. Design/methodology/approach Interventions to contrast the spread of the pandemic and preserve clients’ health conditions have been systematically monitored and recorded since the very beginning of the pandemic. Findings 26/138 clients had to undergo clinical screening and laboratory tests for COVID-like symptomatology, but only one resulted affected by COVID-19 and survived. Considering that Lombardy had 89,595 cases and 16,262 deaths (January–May 2020), one COVID-19 case/138 clients is a good result. Temporarily limiting physical contacts with friends/family in favor of reducing the burden of risk and adopting a system of prevention/safety strategies directed for persons with ID/LF-ASD attending and their caregivers have been useful measures. Research limitations/implications Structured or semi-structured interviews (using professional caregivers as informant) to confirm behavioral and emotional changes in the clients could not be carried out because of lack of time and resources (which were captured by the management of the pandemic) and could be the next goal for our residential facilities to implement the management of epidemic acute phases in a research-oriented view. Originality/value This study is a service evaluation report about facing COVID-19 pandemic. Only few such studies are present in medical literature about ID/ASD.
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Nguyen, Jean-Louis. "Dung Hop: Psychiatric Disability Rehabilitation Support Service for the Vietnamese Community." Australian Journal of Primary Health 12, no. 2 (2006): 11. http://dx.doi.org/10.1071/py06017a.
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The Western Region Outreach Service (WROS), a service of the Western Region Health Centre (WRHC), has developed an innovative program and model for service delivery for Vietnamese people with a mental illness, their carers and family members. This model is known as Dung Hop, a family- and community-based model that reflects Vietnamese values and culture. Dung Hop is an eclectic merging of the Psychiatric Disability and Rehabilitation Support Service (PDRSS) principles and the Vietnamese Collectivist Philosophical principles, suggesting a harmonious and balanced way to provide support for clients and their support systems. The written text of this model and some of its applications to the success of the Vietnamese Program can be found at www.wrhc.com.au
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Udovenko, Iuliia, Tetiana Melnychuk, and Julia Gorbaniuk. "Mentoring as an individual form of preparing orphans for independent living in Ukraine." Current Problems of Psychiatry 21, no. 3 (September 1, 2020): 167–73. http://dx.doi.org/10.2478/cpp-2020-0016.
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Abstract Objective: The purpose of the study is to analyze and define the content, specifics, and procedures of social and psychological work with citizens who have expressed a desire to become mentors for orphans. Introduction: In Ukraine, there are more than 750 foundations of institutional care and upbringing of children, in which approximately 106,000 children live. Only 8% among them have the status of orphans and children deprived of parental care; the other 92% have parents, but due to some difficult life circumstances of parents or presence of special needs or disability in children, they cannot live or be brought up in the family. It means that 92% of children without the status of orphans or children deprived of parental care cannot be adopted or placed for living and upbringing to other forms of family placement (guardianship/care, foster family, family-type orphanage). Along with this, out of 8% of orphan children and children deprived of parental care, there are no opportunities to be accommodated in any family forms of upbringing the following children: teenagers and youngsters, brothers and sisters from families with many children, and children with disabilities. In such children, close emotional relationships with meaningful, constant adults, which is a vital necessity for their psycho-emotional development and well-being, have been lost or were not formed at all. Accordingly, the introduction of mentoring for orphans and children deprived of parental care who live in relevant institutions is motivated by the necessity to satisfy the need of every child in emotional support, assistance and protection by a significant, authoritative person, and friend. Methods: The study uses an experience which was gained during the realization of the project as the author-developer of the methodology of socio-psychological work with citizens and children concerning preparations for mentoring and training for both coordinators and mentors of the Mentoring Program in cooperation with specialists of the “One Hope” non-governmental organization; in the role of educator for the preparation of coordinators for the Mentoring Program implementation, as well as in the role of expert during the implementation of Mentoring Program by the community organization “One Hope” during the 2009-2016 period [1]. Also, authors participated in developing of the mentors preparing program over orphans and children deprived of parental care in order to receive approval at the state level. Results: Mentoring for orphans and children deprived of parental care residing in institutions has been implemented in Ukraine since 2009 by the “One Hope” (“Odna Nadia”) public organization in cooperation with the Kyiv City Children’s Service and the Kyiv City Center of Social Services for Families, Children and Young People. The project “One Hope” was launched in the city of Kyiv and the Kyiv region during 2009-2016. Since 2016, mentoring as an individual form of support and assistance for a child living in a residential institution has been introduced in Ukraine at the state level. Conclusions: If an orphan child or a child deprived of parental care is unable to live and being brought up in a family, then the mentor’s role in the life of this child is of paramount importance. This is due to the fact that such a form of individual support through mentoring will facilitate the preparation of every orphan child for independent living in the future.
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Rothwell, N., A. A. McKechnie, and D. Lorimer. "Multi-centred day units in a psychiatric rehabilitation service." Psychiatric Bulletin 14, no. 8 (August 1990): 454–56. http://dx.doi.org/10.1192/pb.14.8.454.
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Psychiatric day care has expanded considerably over the past 20 years. Day hospitals may serve as alternatives to short-stay in-patient units or speed discharge from them. Day services are also necessary to ensure appropriate support for patients with chronic disability, especially chronic functional psychosis, if they are to remain in a community setting (these are often called day hospitals to ensure NHS support). The present paper focuses on this latter group and describes the characteristics of day attenders in a service that has developed a multi-facility approach to community support.
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Clarke, Ciaran S., and Brian Houlihan. "Learning disability among referrals to a community child psychiatric service." Irish Journal of Psychological Medicine 22, no. 1 (March 2005): 19–21. http://dx.doi.org/10.1017/s0790966700008740.
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AbstractObjectives:We sought to determine the frequency of learning disability (IQ > 70) among referrals over a period of six years to a community child psychiatric service in a socially disadvantaged area of Dublin.Methods:We investigated the gender and age characteristics, as well as the frequency of speech and language, emotional, and behavioural problems in this group. We tried to determine what educational help each child was receiving at the time of referral.Results:Sixty-five of 942 patients referred to the clinic had a mild (60) or moderate (five) learning disability. Forty-eight patients were male and 17 were female. The mean age at referral was 10.5 years, and there was no gender difference. All were referred because of educational problems. Behavioural disorders were present in 31, emotional disorders in 13 and speech and language disorders in 37. Six had suffered some form of abuse, mostly emotional. Five had problems with concentration or markedly impulsive behaviour. At the time of referral, 10 were in special schools, seven were in special classes in normal schools, and nine had a special resource teacher. Adequate educational support was not being adequately provided for 33 at the time of psychiatric referral.Conclusions:Learning disability occurs in 7% of children referred to the child psychiatry clinic of a disadvantaged urban community and, while this may reflect the late onset of psycho-social and educational problems in such children, these findings give cause for concern that delayed referral may exacerbate their and their families' problems. The educational needs of most of the children were not being addressed. Reasons for these findings are discussed.
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O'Sullivan, Deirdre. "The Working Alliance Efficacy Among Rehabilitation Service Providers by Education, Experience, and Disability Category." Rehabilitation Research, Policy, and Education 26, no. 2 (April 1, 2012): 217–28. http://dx.doi.org/10.1891/2168-6653.26.2.217.
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The Working Alliance, consisting of building bonds, establishing goals, and developing tasks, has been deemed the cornerstone of helping professions, and has been found to significantly and reliably predict client outcomes. The importance of client characteristics and perceptions of working alliance has been established in the literature. Less is known about service provider qualities that impact the working alliance. This study utilized 104 rehabilitation service providers to assess the impact of education, work experience, and disability category on working alliance efficacy. Results indicate that rehabilitation service providers with more education had significantly higher working alliance efficacy pertaining to clients with physical disability. This suggests that master level rehabilitation service providers have greater confidence to build bonds, identify goals, and structure tasks when working with clients with physical disabilities. No differences were found between education groups on working alliance efficacy for psychiatric disability. Work experience was found to relate to working alliance efficacy for physical disability, not psychiatric disability. The results of this study provide initial support for the notion that rehabilitation service providers with more education and more work experience demonstrate a more effective working alliance in their efforts with clients who have physical disabilities. The non significant differences in psychiatric disability working alliance scores among service providers with varying education levels and work experience may be indicative of provider stigma or burnout when working with this population.
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Jansson, Lennart, Karin Sonnander, and Frits-Axel Wiesel. "Clients with long-term mental disabilities in a Swedish county—conditions of life, needs of support and unmet needs of service provided by the public health and social service sectors." European Psychiatry 18, no. 6 (October 2003): 296–305. http://dx.doi.org/10.1016/j.eurpsy.2003.07.003.
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AbstractObjectiveThe purpose of the study was to identify and describe conditions of life and needs of support and public service for clients with a mental disability in a Swedish county population.MethodsPublic health care and social service providers identified clients and completed a questionnaire concerning the clients’ conditions of life and their special needs. A consecutively recruited sample of clients completed a similar questionnaire.ResultsTotally, 1261 clients were identified. The prevalence of clients with mental disabilities was in the urban and rural areas, 6.4/1000 inhabitants and 4.5/1000 inhabitants, respectively. The most prevalent unmet need (42.9%) was to participate in social and scheduled activities. Almost half of the group was reported to need support in activities of daily living. Clients living in urban settings more often needed support with activities of daily living (P < 0.001), whereas clients living in rural settings more often needed support with job training (P < 0.001) or finding work (P < 0.01). Clients and psychiatric care providers reported the needs of the clients in the same areas; however, clients reported a fewer number of needs than did the care providers.ConclusionsBy using both psychiatric care and social service providers, effective case findings of clients with a mental disability were possible to achieve. In general, there was high agreement between psychiatric care providers and clients regarding the clients’ number of needs of support and their unmet needs of service. However, at the individual level, the agreement between client and psychiatric care providers was lower.
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Beck, A., T. J. Croudace, S. Singh, and G. Harrison. "The Nottingham Acute Bed Study: Alternatives to acute psychiatric care." British Journal of Psychiatry 170, no. 3 (March 1997): 247–52. http://dx.doi.org/10.1192/bjp.170.3.247.
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BackgroundAlthough modern psychiatric services seek alternatives to hospitalisation wherever appropriate, the national trend toward higher bed occupancies on acute psychiatric wards has refocused attention on community-based alternatives and methods of assessing reed for acute care.MethodWe surveyed key decision makers in a community-oriented district service with a low acute psychiatric bed to population ratio, in order to examine alternatives to hospitalisation in a cohort of consecutive admissions over a six-month period.ResultsAlternatives to acute ward hospitalisation were identified for 29% of admissions, and for 42% of those with an admission duration of more than 60 days. Residential options were chosen more often than intensive community support. Simulated bed day savings were considerable.ConclusionsIn a community-oriented service, key decision-makers could identify further alternatives to acute ward hospitalisation, although relatively few non-residential, community support options were chosen. Although this methodology has limitations, data based upon keyworker judgements probably have greater local ‘ownership’, and the option appraisal process itself may challenge stereotyped patterns of resource use.
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Kandel, Isack, Mohammed Morad, Gideon Vardi, Joseph Press, and Joav Merrick. "The Arab Community in Israel Coping with Intellectual and Developmental Disability." Scientific World JOURNAL 4 (2004): 324–32. http://dx.doi.org/10.1100/tsw.2004.31.
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The Arab family in Israel is still embedded in the traditional society with extended family support systems, but we see a population in transition influenced by the surrounding society. This paper looks at the different religious attitudes toward the exceptional people in our society (i.e., the family reaction to a child born with intellectual or developmental disability), reviews recent studies on the Arab and Bedouin families in Israel, and presents data on the Arab population in residential care centers.Today, out of 57 residential care centers in Israel for persons with intellectual disability, 13 (22.8%) are providing service to the non-Jewish population. The Arab population constitutes 12–13% of the total residential care population, lower than the 19–20% in the total population. In residential care, the Arab population is characterized by younger children with severe and profound intellectual disability. The informal family support system is still a very important factor in the Arab family in Israel, a fact that we believe should be strengthened by implementing the British and Danish model of nurse home visitation.
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Cirillo, Irene, Pierluigi Politi, Elisa Rampi, Jenny Secker, Franca Brasia, and Anna Severino. "Employment status, aspirations and perceptions of support amongst psychiatric service users in Pavia, Italy." Epidemiologia e Psichiatria Sociale 18, no. 1 (March 2009): 40–47. http://dx.doi.org/10.1017/s1121189x00001445.
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SummaryAims – To describe the employment status of people using mental health service in Pavia, Italy; to explore their employment aspirations and perceptions of support to achieve these; and to test the feasibility of working with service users as researchers. Method – Face to face interviews carried out by two service user researchers with a consecutive sample of 200 service users attending the local psychiatric outpatient department using a translated version of a questionnaire developed for previous UK surveys. Results – A higher proportion of survey participants (42.5%) were in paid work compared to the UK, but 62.4% of those in work were dissatisfied with their employment. Amongst unemployed participants, 65.2% were interested in gaining employment but only 29.3% were receiving support to do so. Support was mainly limited to referral on to a generic disability organisation. The service user researchers carried out the survey to a high standard and reported benefits from undertaking the work. Conclusions – The results indicate a need in Pavia for specialist employment support using the Individual Placement and Support approach. Further development of service user involvement in research is indicated.
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Zimmermann, Adam, Dan I. Lubman, and Merrilee Cox. "Tobacco, Caffeine, Alcohol and Illicit Substance Use Among Consumers of a National Psychiatric Disability Support Service." International Journal of Mental Health and Addiction 10, no. 5 (January 7, 2012): 722–36. http://dx.doi.org/10.1007/s11469-011-9373-y.
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Clarkson, Rachael, Glynis H. Murphy, Jon B. Coldwell, and David L. Dawson. "What characteristics do service users with intellectual disability value in direct support staff within residential forensic services?" Journal of Intellectual & Developmental Disability 34, no. 4 (October 28, 2009): 283–89. http://dx.doi.org/10.3109/13668250903285630.
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Timmons, Suzanne, Anna de Siún, Emer Begley, and Mary Manning. "184 A National Survey of Clinicians who Assess People with Suspected Dementia: Service Characteristics and Practice." Age and Ageing 48, Supplement_3 (September 2019): iii1—iii16. http://dx.doi.org/10.1093/ageing/afz102.42.
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Abstract Background The Irish National Dementia Strategy (2014) identified timely diagnosis and intervention as a priority area. The National Dementia Office established a Dementia Diagnostic Project to develop a framework for diagnostic services nationally. As part of preparatory work, a national survey explored baseline peri-diagnostic practice in geriatric medicine, neurology and psychiatry of old age services. Methods A survey was developed by the project steering group, piloted, and then distributed to all 86 Geriatricians, 39 Neurologists, and 34 Psychiatrists of Old Age Psychiatrists in Ireland. Two reminder e-mails were sent. Results In total, 56 clinicians responded (response rate 35%). The majority (74%) saw 1-20 people with suspected dementia (PwSD) per month. Most referrals came from General Practitioners or other physicians; but rarely from Health and Social Care Professionals. Most people were referred specifically for their memory complaint, rather than a co-morbidity. Waiting times for urgent review varied between 24 hours and 4 years; neurology services had the longest waiting times. Only 30% saw PwSD in a dedicated clinic; about the same proportion saw PwSD in their own home; or in residential care settings. About half reported assessing people with intellectual disability and suspected dementia, mainly the neurologists. The Montreal Cognitive Assessment was the most commonly used cognitive tool (89%), followed by the Addenbrook’s Cognitive Examination (56%). Only 17% commonly used functional brain imaging in diagnosis, mainly neurologists; half of respondents ‘never’ or ‘rarely’ used cerebrospinal fluid analysis. Multidisciplinary input was mainly from Occupational Therapists (61%), Psychology/Neuropsychology (52%), and Nursing disciplines (33%). When asked which discipline would most benefit their diagnostic service, neurologists all chose psychology input; geriatricians selected a range of disciplines. Conclusion The significant variability within current services who see PwSD, in terms of multidisciplinary involvement, waiting times, setting, and supporting investigations, supports the need for a national diagnostic framework.
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Wyngaerden, François, Marie Tempels, Jean-Louis Feys, Vincent Dubois, and Vincent Lorant. "The personal social network of psychiatric service users." International Journal of Social Psychiatry 66, no. 7 (June 5, 2020): 682–92. http://dx.doi.org/10.1177/0020764020927447.
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Background: For psychiatric service users, the personal social network offers resources such as behavioural guidance, social support, and coherence of care delivery. So far, most research on the subject has assessed the availability of these resources using size and composition measures. However, the availability of network resources also depends on the cohesion of the relationships between network members, a topic that is rarely addressed in the literature. Aims: In this article, we aim to describe the cohesion of psychiatric service users’ networks. Method: We carried out a personal network survey and collected data on the social networks of 380 service users recruited in outpatient and inpatient services in Belgium. We used an ego-network mapping technique. The data were analysed using several structural metrics describing size, composition, and cohesion. We carried out analysis of variance (ANOVA) in relation to residential status, level of education, psychiatric history, and psychosocial functioning and analysed three cohesion indicators (density, fragmentation, and centralisation) with regression analyses. Results: Personal social networks were small and not very cohesive. Most were composed of a dense subgroup as well as several isolated network members. The analyses revealed that highly educated psychiatric service users had more fragmented networks, while users living in independent accommodation had less dense networks. Density and fragmentation were not associated with the severity of psychosocial functioning, whereas centralisation was. Conclusions: The low level of cohesion may indicate that service users aim to access multiple and diverse social resources and that better-off service users are more successful at doing so. On the whole, however, these personal social networks were fragile, because they contained a high number of isolated network members. Finally, it could be beneficial for professionals to pay special attention to the central persons within the networks of psychiatric service users.
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Wilson, Nathan J., Vivienne C. Riches, Tanya Riches, Seeta Durvasula, Renell Rodrigues, and Sonali Pinto. "Complex support needs profile of an adult cohort with intellectual disability transitioning from state-based service provision to NDIS-funded residential support." Journal of Intellectual & Developmental Disability 45, no. 4 (March 5, 2020): 355–64. http://dx.doi.org/10.3109/13668250.2020.1717069.
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Allen, C. I., C. R. Gillespie, and J. N. Hall. "A comparison of practices, attitudes and interactions in two established units for people with a psychiatric disability." Psychological Medicine 19, no. 2 (May 1989): 459–67. http://dx.doi.org/10.1017/s0033291700012496.
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SynopsisThis study evaluates and compares aspects of residential care in a community hostel setting and a hospital setting for people with a psychiatric disability. The clients were assessed to establish their level of general functioning, the comparison indicating there was no significant difference between the two groups on the measure used. A previously published protocol was used as a method of comparing the units. The findings indicated that the hospital unit was more individually orientated both in practices and staff attitudes, and had staff who were more optimistic about clients' potential accomplishments. No differences were found between perceived involvement of staff in decision making, or staff–resident interactions.These findings have implications for the ‘Care in the Community’ movement, as they indicate that the nature of a service is as important as its location. They suggest that the relocation of services to the community in itself will not automatically overcome some of the difficulties associated with institutional care.
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Moeller-Saxone, Kristen. "Cigarette smoking and interest in quitting among consumers at a Psychiatric Disability Rehabilitation and Support Service in Victoria." Australian and New Zealand Journal of Public Health 32, no. 5 (October 2008): 479–81. http://dx.doi.org/10.1111/j.1753-6405.2008.00283.x.
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Shepherd, Nicole, Tom Meehan, and Seiji Humphries. "Supporting recovery: challenges for in-home psychiatric support workers." Mental Health Review Journal 19, no. 2 (June 3, 2014): 73–83. http://dx.doi.org/10.1108/mhrj-07-2013-0027.
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Purpose – The concept of recovery is well accepted internationally as a guiding vision for mental health services. The purpose of this paper is to highlight the challenges faced by in-home psychiatric support workers in implementing this vision in their work with clients with severe psychiatric disability. Design/methodology/approach – The findings reported here are based on interviews with 27 support workers and ten managers of organisations providing support services. These were collected as part of evaluations of two supported housing programmes carried out between 2010 and 2011. Findings – Challenges faced by support workers coalesced around two areas: first, balancing the need to provide care with the need to promote autonomy and second, developing an effective working relationship while working mainly within a clients’ home. Practical implications – These challenges for support workers highlight tensions within the recovery vision that are not easily resolved. To ensure high quality, recovery-oriented care services are provided, support workers need access to training courses that focus on challenging areas of this work and should be provided with regular professional supervision. Originality/value – Existing literature on support workers has generally focused on the nature of the role and support worker interactions with other health workers. In this paper, the authors highlight difficulties faced by support workers in implementing the vision of recovery in their work. The paper provides important information for policy makers and managers who are designing service delivery systems that aim to promote recovery.
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Grey, Ian, Maryann Mesbur, Helena Lydon, Olive Healy, and Justin Thomas. "An evaluation of positive behavioural support for children with challenging behaviour in community settings." Journal of Intellectual Disabilities 22, no. 4 (July 3, 2017): 394–411. http://dx.doi.org/10.1177/1744629517716545.
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This study employs a multiple baseline across individual design to describe the implementation of positive behavioural supports for seven children and adolescents in residential community settings over a period of 24 months. These individuals with intellectual disability are residing in one county with long-standing challenging behaviour resulting in home breakdown and serious physical injury. Four types of outcome are presented: rates of behaviour, rates of medication, psychiatric symptomatology and quality of life (QoL). Behaviours reduced to lower levels for the majority of participants following the implementation of positive behavioural supports, and improvements were largely sustained. The use of psychotropic medications reduced or stabilized for the majority of individuals over the same period. QoL Questionnaire scores improved substantially for four participants. The results are discussed in the context of a framework for supporting children with severe challenging behaviours in the community.
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Lambri, Maria, Apu Chakraborty, Gerard Leavey, and Michael King. "Quality of Life and Unmet Need in People with Psychosis in the London Borough of Haringey, UK." Scientific World Journal 2012 (2012): 1–10. http://dx.doi.org/10.1100/2012/836067.
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Objectives. Deinstitutionalization of long-term psychiatric patients produced various community-based residential care facilities. However, inner-city areas have many patients with severe mental illness (SMI) as well as deprivation, unemployment, and crime. This makes meeting their community needs complex. We undertook a needs assessment of service provision and consonance between service users’ evaluation of need and by care workers.Design. Cross-sectional study with random sample of SMI service users in four housing settings: rehabilitation units; high-supported; medium-supported; low-supported housing.Setting. London Borough of Haringey.Outcome Measures. 110 SMI service users and 110 keyworkers were interviewed, using Camberwell Assessment of Need; SF-36; Lancashire Quality-of-Life profile; demographic and clinical information.Results. People in “low-support” and “high-support” housing had similar symptom scores, though low support had significantly lower quality of life. Quality of life was positively predicted by self-reported mental-health score and negatively predicted by unmet-need score in whole sample and in medium-support residents. Residents’ and care-workers’ assessments of need differed considerably.Conclusions. Although patients’ housing needs were broadly met, those in low-supported housing fared least well. Attendance to self-reported mental health and unmet social needs to quality of life underpins planning of residential services for those with SMI. Social and personal needs of people in supported housing may be underestimated and overlooked; service providers need to prioritise these if concept of “recovery” is to advance.
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Ronnau, Peggy, Arthur Papakotsias, and Glen Tobias. ""Not for" sector in community mental health care defines itself and strives for quality." Australian Journal of Primary Health 14, no. 2 (2008): 68. http://dx.doi.org/10.1071/py08025.
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This paper briefly describes the history and service context of the Psychiatric Disability Rehabilitation and Support sector (PDRSS) in Victoria, and, to a lesser extent, in New South Wales, South Australia and Western Australia. In describing the sector we will call upon the experience of a particular PDRSS - Neami - in operating and developing services, and the challenges it faced in establishing a culture of quality that directly improves consumer outcomes. Elements of this experience may serve as a guide in the development of mental health service policy at state and federal level.
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Koch, Lynn C., Ketevan Mamiseishvili, and Melissa J. Wilkins. "Postsecondary Integration and Persistence: A Comparison of Students With Psychiatric Disabilities to Students With Learning Disabilities/Attention Deficit Disorders." Rehabilitation Research, Policy, and Education 30, no. 3 (2016): 259–75. http://dx.doi.org/10.1891/2168-6653.30.3.259.
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Purpose:The enrollment of students with psychiatric disabilities in U.S. postsecondary institutions is on the rise. However, research is lacking in terms of how these students fare in comparison to other students with hidden disabilities (e.g., learning disabilities [LDs], attention deficit disorders [ADDs]) whose enrollment in postsecondary institutions is also on the rise. The objective of this study is to compare demographic characteristics, academic and social integration, and persistence of these two groups.Method:Using the Beginning Postsecondary Longitudinal Study (BPS:04/09) data set, we develop and compare persistence profiles of students with psychiatric disabilities to those of students with LD/ADD. This comparison enabled us to identify characteristics and postsecondary support needs that are shared by both groups as well as those that are unique to students with psychiatric disabilities.Results:Although the demographic characteristics, academic and social integration, and persistence of both groups reveal similar patterns, chi-square analyses reveal that students with psychiatric disabilities are significantly more likely to be male and significantly less likely to use disability-related services.Conclusions:The implications of these findings for vocational rehabilitation counselors, transition service specialists, accommodation service specialists in offices of students with disabilities, and campus mental health service providers are discussed, and future research directions for supporting students with psychiatric disabilities to persist in postsecondary settings are recommended.
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McDonald, Lynn, Dorothy Badry, and Christine Mueller. "The Elderly Physically and Developmentally Handicapped: An Analysis of Service Delivery." Canadian Journal on Aging / La Revue canadienne du vieillissement 7, no. 2 (1988): 134–47. http://dx.doi.org/10.1017/s0714980800007376.
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ABSTRACTIn view of the growing numbers of physically and developmentally handicapped older persons in Canada, this study attempts to determine the effects of basic client characteristics on the delivery of services to these groups. Using data from the 1984 Disability Information System of Calgary, a series of models are estimated which focus on the characteristics of age, gender, geographical location, and level of physical and cognitive functioning as determinants of the receipt or non-receipt of residential, professional, support and day program services. The results indicate that there is a weak relationship between age, gender and level of cognitive functioning and the overall receipt of services. However, when each service is analyzed separately, only day programs are adequately explained. As was anticipated, it appears the needs of the elderly handicapped are not being met within the rehabilitation service system.
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Reppermund, Simone, Theresa Heintze, Preeyaporn Srasuebkul, Rebecca Reeve, Kimberlie Dean, Melinda Smith, Eric Emerson, et al. "Health and wellbeing of people with intellectual disability in New South Wales, Australia: a data linkage cohort." BMJ Open 9, no. 9 (September 2019): e031624. http://dx.doi.org/10.1136/bmjopen-2019-031624.
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PurposePeople with intellectual disability (ID) experience high rates of physical and mental health problems, while access to appropriate healthcare is often poor. This cohort was established to develop an epidemiological profile related to the health, health service use, disability services, mortality and corrective services records of people with ID.ParticipantsThe cohort contains 92 542 people with ID (40% females) with a median age of 23 years (IQR: 12–43 years) and 2 004 475 people with a neuropsychiatric or developmental disorder diagnosis (50% females) with a median age of 51 years (IQR: 29–73 years) from New South Wales, Australia. The whole sample contains records for 2 097 017 individuals with most data sets spanning financial years 1 July 2001 to 30 June 2016. A wide range of data from linked population data sets are included in the areas of disability, health, corrective services and targeted specialist support services in public schools, Public Guardian and Ombudsman services.Findings to dateThis study includes one of the largest cohorts of people with ID internationally. Our data have shown that the presence of ID is significantly associated with emergency department presentations and psychiatric readmissions after the first psychiatric admission based on a subcohort of people with a psychiatric admission. Adults with ID experience premature mortality and over-representation of potentially avoidable deaths compared with the general population.Future plansWithin the health service system, we will examine different components, that is, inpatient, emergency adult services, children and younger people services and costs associated with healthcare as well as mortality, cause and predictors of death. The neuropsychiatric and developmental disorders comparison cohort allows comparisons of the physical health, mental health and service use profiles of people with ID and those with other neuropsychiatric disorders.
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Collins, Kimberly D. "Coordination of Rehabilitation Services in Higher Education for Students with Psychiatric Disabilities." Journal of Applied Rehabilitation Counseling 31, no. 4 (December 1, 2000): 36–39. http://dx.doi.org/10.1891/0047-2220.31.4.36.
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In today’s technologically advanced society, post-secondary education is a necessity to obtain stable positions with competitive salaries and adequate benefits. Many young adults with psychiatric disabilities have the cognitive abilities and academic skills to attend and complete college; however, they face significant barriers in achieving these goals. This article describes the barriers experienced by young adults with psychiatric disabilities attempting post-secondary education and the navigation of these barriers. The role of the disability services office in the provision of academic accommodations, service coordination with other on-campus and off-campus agencies, promotion of self-advocacy skills, psychological support, and one-to-one coaching to facilitate completion of a degree program is also discussed.
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Dowson, J. H., J. Butler, and O. Williams. "Management of psychiatric in-patient violence in the Anglia region." Psychiatric Bulletin 23, no. 8 (August 1999): 486–89. http://dx.doi.org/10.1192/pb.23.8.486.
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Aims and methodA total of 384 incidents of violence against the person (six ‘serious' and 378 ‘mild’), by adult in-patients in general psychiatric units (GPUs) and learning disability units (LDUs) in 10 National Health Service trusts in the Anglia region, were evaluated by Interviews with staff and examination of records.ResultsThe findings, when compared with standards derived from previous recommendations, showed deficiencies in the documentation of incidents (there was no satisfactory written record of physical restraint for 97% of incidents in GPUs and 86% in LDUs), in the training of staff in ‘control and restraint’ procedures (If two or more staff were involved In physical restraint, for 3% of incidents in GPUs and 100% in LDUs, the staff had received no training within the previous 12 months) and in policies for victim support (there was no written policy that included procedures for victim support in relation to 84% of incidents in GPUs and 44% in LDUs).Clinical implicationsTrusts should consider reviewing their policies on the prevention and management of violence, particularly in relation to staff training.
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Roy, Ashok, and Stuart Cumella. "Developing local services for people with a learning disability and a psychiatric disorder." Psychiatric Bulletin 17, no. 4 (April 1993): 215–17. http://dx.doi.org/10.1192/pb.17.4.215.
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Recent ministerial statements and health circulars have identified a key role for the NHS in providing services for people with a learning disability who have a mental illness or a severe behaviour disorder (NHS Management Executive, 1992). This is not an insignificant task, given that psychiatric disorders (including both mental illness and/or severe behaviour disorders) occur among approximately 30% of people with a moderate or severe learning disability (Corbett, 1979; Lund, 1985). Patients with psychiatric disorders have proved particularly difficult to resettle from mental handicap hospitals, and form a substantial proportion of the patients who become long-stay residents of mental handicap hospitals despite the development of community-based services. It is therefore essential that each district health authority defines the most appropriate pattern of services for this group of patients, as part of their purchasing strategy for mental health. The type of service required was discussed by the department of Health report Needs and Responses: Services for Adults with Mental Handicap who are Mentally Ill, who have Behaviour Problems, or who Offend. This noted that no consistent pattern of services has yet emerged, and that suitable alternatives included admission to a specialised mental illness unit in a mental handicap hospital, admission to a general psychiatric ward, admission to a small staffed house, or treatment by a community support team.
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Murray, G. C., K. McKenzie, G. R. Kidd, and A. Quigley. "Knowledge of the Features and Needs of People with Autism: A Comparison of Health and Social Care Staff." Journal of Learning Disabilities for Nursing, Health, and Social Care 3, no. 2 (June 1999): 74–79. http://dx.doi.org/10.1177/174462959900300204.
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This study aims to investigate the level of knowledge of the accepted criteria for autistic disorder, using Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 1994) criteria and the awareness of the needs of individuals with autism within three groups: health care workers, residential staff and day care staff. All participants were employed in providing a service to individuals with a learning disability, although experience of working with individuals with autism was not a prerequisite. The results were examined in relation to employment group and experience of working with individuals with autism. The health group demonstrated a significantly higher knowledge of the main defining features of autism and the needs of this population, compared to the other groups. A significant relationship between experience of autism and awareness of the features and needs was found.
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Rooks, Ronica. "Gentrification and Chronic Conditions in Older Adults: Service Providers’ Perspectives." Innovation in Aging 4, Supplement_1 (December 1, 2020): 341. http://dx.doi.org/10.1093/geroni/igaa057.1095.
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Abstract Where we live impacts our health, but this is more apt for older adults (aged 55+) aging-in-place in their neighborhoods. Gentrification, i.e. the transformation of neighborhoods from low to high value, can put community-dwelling older adults at risk for residential displacement with limited retirement incomes and financial stressors like increased housing costs and property taxes, residential turnover and changing access to resources. As a place-based stressor, gentrification may exacerbate social vulnerabilities (e.g., lower socioeconomic status and racial/ethnic minority status) related to chronic condition (CC) disparities. But, little gentrification research focuses on these issues. This research examines associations between gentrification and older adults’ CC management related to broader social determinants in Hamilton, Ontario, Canada from health and social service providers’ perspectives. Hamilton, a recovering steel industry city with in-migration from Toronto, is experiencing higher costs of living, income inequality and tension with recent gentrifiers. I conducted key informant interviews with service providers in city government and community-based organizations using thematic analysis. Across providers, food insecurity, social isolation and displacement were the biggest issues associated with gentrification and CC, particularly for older adults with lower incomes and government disability support. Results thus far reveal Hamilton has numerous older adult-focused providers, but older adults often have difficulties accessing services due to a lack of knowledge, not always asking or realizing when they need help and coordinated referral difficulties across providers. To address these challenges, providers consider environmental scans, mapping resources and advertisement in an online community information database from the city’s public library.
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Matkovic, Gordana. "Daycare as an entitlement and as a service in the social welfare system." Stanovnistvo 47, no. 1 (2009): 69–88. http://dx.doi.org/10.2298/stnv0901069m.
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The social welfare reform recognizes the further development and expansion of daycare center services as an important precondition for deinstitutionalization as one of the key objectives of the reform. Decreasing the number of children and adults in residential institutions, their return to their natural families and preventing institutionalization depend primarily on the support provided at local level to the family for taking care of their family members. Today in Serbia there are 49 daycare centers with 1400 children and persons with disability as beneficiaries. Between 2000 and 2007, thirty seven new daycare centers were established, the total number of beneficiaries more than tripled and the NGO sector became equal with the government sector in service provision. Yet, daycare center services are still not sufficiently developed. In 123 municipalities there are no daycare center services at all and overall these services are significantly less accessible than residential services. Daycare center services consist of both well established and sustainable daycare with significant capacity and also of small, project-based daycare centers that provide services for a few hours and have an uncertain future. The second group consists mostly of daycare centers organized by the NGO sector. The monthly costs of daycare center services per beneficiary in 2007 amounted to 13.750 diners on average. According to the survey findings, for example, the annual costs for running a daycare center service for 20 beneficiaries are between 2 and 6 million dinars depending on the complexity of the provided services and programs. The costs of residential placement are on average higher than the costs in daycare centers. Further development of daycare center services in Serbia requires additional and focused efforts at central level in terms of formulating special financial incentives for underdeveloped municipalities, developing professional capacity at local level, educating local governments, conceptualizing and establishing regulatory mechanisms, exchanging good practice examples, etc. Still, placing non-residential services at the heart of the social welfare system can be expected only after undertaking more profound legislative changes. .
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Burchell, Anna, Sabin Fernbacher, Robert Lewis, and Andrew Neil. ""Dental as Anything" Inner South Community Health Service Dental Outreach to People with a Mental Illness." Australian Journal of Primary Health 12, no. 2 (2006): 75. http://dx.doi.org/10.1071/py06025.
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This article provides an overview of a unique way to respond to the complex oral health needs of people with a mental illness. People with a psychiatric disability, especially those of low income and insecure housing, are at high risk of developing oral disease, due to issues associated with mental illness, poverty and the side-effects of psychotropic medication. The 'Dental as Anything' program is a collaborative partnership between the mental health, dental and administration teams of the Inner South Community Health Service (ISCHS) in Melbourne. It provides a flexible program incorporating engagement, clinical care, education and support in response to client needs. Utilising a health promotion framework and an assertive outreach model, it accesses people who traditionally do not approach mainstream services. The program manages to "reach the unreachable".
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Callaly, Tom, and Anna Fletcher. "Providing Integrated Mental Health Services: A Policy and Management Perspective." Australasian Psychiatry 13, no. 4 (December 2005): 351–56. http://dx.doi.org/10.1080/j.1440-1665.2005.02213.x.
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Objective: To review the challenge of providing integrated mental health services from a policy and health management perspective. Conclusions: The provision of integrated mental health services involving specialist mental health services, general practitioners, psychiatric disability and rehabilitation services and public community health services is a major challenge in the Australian health care context and is increasingly an expectation of the community. Government, Divisions of General Practice and public community health policy and many Government, State and local initiatives have attempted to address this challenge. However, much remains to be done, including culture change within services and professions and the development of technology to support integrated service provision.
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Wales, Lorna, Carolyn Dunford, and Kathy Davis. "Following severe childhood stroke, specialised residential rehabilitation improves self-care independence but there are ongoing needs at discharge." British Journal of Occupational Therapy 83, no. 8 (January 27, 2020): 530–37. http://dx.doi.org/10.1177/0308022619894870.
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Introduction Stroke is a major cause of mortality and disability in childhood. There is a false belief that children will recover better than adults and recent research confirms that younger age at injury can have a negative impact on rehabilitation outcomes, resulting in lifelong disability. Self-care is a key rehabilitation outcome for children and young people. Methods This service evaluation reviews routinely collected clinical self-care data from one specialised residential rehabilitation centre in the United Kingdom. Admission and discharge scores from the United Kingdom Functional Independence Measure +Functional Assessment Measure, Rehabilitation Complexity Scale – E and Northwick Park Nursing Dependency Scale were analysed. Results Twenty-six children and young people age 8 years and over with severe stroke were included. Mean scores of independence increased and mean scores of complexity and dependency decreased. A proportion of the sample had ongoing self-care needs in relation to support needed in washing, dressing and bathing. A small number remained highly dependent, requiring assistance from two carers. Conclusion Children and young people make significant gains in self-care independence during specialised rehabilitation. However, a proportion return to the community with high self-care needs. Occupational therapists and the wider care team should address ongoing self-care needs in this population.
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Trauer, Tom, and Glen Tobias. "The Camberwell Assessment of Need and Behaviour and Symptom Identification Scale as Routine Outcome Measures in a Psychiatric Disability Rehabilitation and Support Service." Community Mental Health Journal 40, no. 3 (June 2004): 211–21. http://dx.doi.org/10.1023/b:comh.0000026995.17908.06.
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Corcoran, Eleanor, Alice Guerandel, and Margo Wrigley. "The day hospital in psychiatry of old age – what difference does it make?" Irish Journal of Psychological Medicine 11, no. 3 (September 1994): 110–15. http://dx.doi.org/10.1017/s0790966700014762.
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AbstractObjective: Two day hospitals were established in North Dublin in 1989 to play a key role in the first old age psychiatry service in the Republic of Ireland. The purpose of this study was to identify the characteristics and needs of day hospital attenders, to carry out a preliminary evaluation of the role of the day hospitals in meeting these needs, and make recommendations for future developments. Method: All 237 regular attenders between March 1989 and 1992 were included. Demographic, social, medical and psychiatric data including CAGE questionnaire, Folstein mini-mental state, and Clifton Assessment Procedures for the Elderly survey version, were recorded at initial assessment. Data on duration and outcome of attendance, use of inpatient, general hospital and community care services were collected from a retrospective study of records and subjected to statistical analysis. Results: The average age was 78 years (SD 6yrs); 139 (59%) patients had organic and 98 (41%) had functional psychiatric disorders; 198 (84%) patients had a medical problem. In the functional group, 24 (25%) required acute admission; 70 (71%) patients were managed in the community. Twenty eight (29%) patients required residential care or had died on average 8 months after initial contact. In the group with dementia 104 (75%) had CAPE scores C/D/E at initial assessment, indicating high dependency. Eighty eight (63%) patients were in residential care or dead on average 8 months later. Conclusions: Day hospital treatment enabled elderly patients with functional psychiatric illness to be treated in the community with low usage of beds. It provided only short/medium term care for patients with dementia, who had little support from statutory services. A comprehensive network of services is necessary to support highly dependent patients in the community.
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Wellburn, Shaun, Cormac G. Ryan, Andrew Coxon, Alastair J. Dickson, D. John Dickson, Francis Fatoye, Diarmaid Ferguson, et al. "Long-term improvements following a residential combined physical and psychological programme for chronic low back pain." BMJ Open Quality 10, no. 2 (May 2021): e001068. http://dx.doi.org/10.1136/bmjoq-2020-001068.
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ObjectivesEvaluate the outcomes and explore experiences of patients undergoing a residential combined physical and psychological programme (CPPP) for chronic low back pain.DesignA longitudinal observational cohort design, with a parallel qualitative design using semistructured interviews.SettingResidential, multimodal rehabilitation.Participants136 adults (62 male/74 female) referred to the CPPP, 100 (44 male/56 female) of whom completed the programme, during the term of the study. Ten (2 male/8 female) participated in the qualitative evaluation.InterventionA 3-week residential CPPP.Outcome measuresPrimary outcome measures were the STarT Back screening tool score; pain intensity—11-point Numerical Rating Scale; function—Oswestry Disability Index (ODI); health status/quality of life—EQ-5D-5L EuroQol five-Dimension-five level; anxiety—Generalised Anxiety Disorder-7; depression—Patient Health Questionnaire-9. Secondary outcome measures were the Global Subjective Outcome Scale; National Health Service Friends and Family Test;.ResultsAt discharge, 6 and 12 months follow ups, there were improvements from baseline that were greater than minimum clinically important differences in each of the outcomes (with the sole exception of ODI at discharge). At 12 months, the majority of people considered themselves a lot better (57%) and were extremely likely (86%) to recommend the programme to a friend. The qualitative data showed praise for the residential nature of the intervention and the opportunities for interaction with peers and peer support. There were testimonies of improvements in understanding of pain and how to manage it better. Some participants said they had reduced, or stopped, medication they had been taking to manage their pain.ConclusionsParticipants improved, and maintained long term, beyond minimum clinically important differences on a wide range of outcomes. Participants reported an enhanced ability to self-manage their back pain and support for the residential setting.
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Boydell, Katherine M., and Barbara Everett. "What Makes a House a Home? An Evaluation of a Supported Housing Project for Individuals with Long-Term Psychiatric Backgrounds." Canadian Journal of Community Mental Health 11, no. 1 (April 1, 1992): 109–23. http://dx.doi.org/10.7870/cjcmh-1992-0008.
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Supported housing (as distinct from supportive housing) emphasizes the values of consumer choice; independence; participation; permanence; normalcy; and flexible, ongoing supports. As a model, it has only recently become popular in the literature and therefore little is known of its effectiveness in serving people with long-term psychiatric backgrounds. In 1989, Homeward Projects, a community mental health agency located in Metropolitan Toronto, established a supported housing project. Homeward included an evaluative component in its program from the outset. In order to give equal weight to the tenants' opinions, both quantitative and qualitative methodologies were employed. In the quantitative component, residential milieu, social support, and service delivery were examined. The qualitative component involved an ethnographic study which allowed the tenants to voice their experiences of living in such a setting. Results provided a rich understanding of the model. Overall, the tenants eventually came to describe their house as a home.
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Winkler, Dianne, Louise Farnworth, Sue Sloan, Ted Brown, and Libby Callaway. "Comparison of People With ABI Living in Two Accommodation Settings: Shared Supported Accommodation and Residential Aged Care." Brain Impairment 11, no. 3 (December 1, 2010): 313–25. http://dx.doi.org/10.1375/brim.11.3.313.
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AbstractBackground:People with severe acquired brain injury (ABI) often require high and ongoing levels of paid support, which is sometimes provided within a shared supported accommodation service (SSA). In Victoria there are more than 140 people with severe ABI living in shared supported accommodation services who have a similar level of disability as young people with ABI in residential aged care (RAC).Objectives:The aims of this article are twofold: (1) to describe the characteristics, support needs and level of community inclusion of people with an ABI living in shared SSA in Victoria and (2) to compare the characteristics, support needs, social contact, community integration and leisure participation of this group with a group of people with ABI under 50 years old living in RAC reported in a previous study.Participants:Information was obtained from SSA managers on 128 residents with an ABI, aged under 60 years, who were living in shared supported accommodation.Measures:Questionnaires were used to obtain information about the characteristics, support needs and occupational participation of participants. Support needs were measured utilising the Care and Needs Scale (CANS).Method:Questionnaires were sent to and completed by SSA managers.Results:Of the 39 SSA managers contacted, 32 provided information about the characteristics of 128 residents with ABI living in their facilities. While 72% of SSA residents accessed the community almost everyday or more often, 40% of this sample received a visit from a friend less often than once per year. Results of the CANS indicated that the SSA group required a similar level of support to the comparison group of people with ABI living in RAC, but went outside, participated in community based leisure activities, and visited friends significantly more often. There was no significant difference between the two groups in the frequency of visits to the facility from relatives or friends.Conclusion:Although the relationship between client outcomes and accommodation is a complex one, this study suggests that the type of accommodation and support has a significant impact on the frequency of community participation experienced people with ABI and high care needs.
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Callaly, Thomas, Mary Hyland, Tom Trauer, Seetal Dodd, and Michael Berk. "Readmission to an acute psychiatric unit within 28 days of discharge: identifying those at risk." Australian Health Review 34, no. 3 (2010): 282. http://dx.doi.org/10.1071/ah08721.
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Objective.To examine factors that could help identify those most at risk of readmission to an acute psychiatric in-patient unit within 28 days of a discharge. Method.A detailed file audit was conducted comparing 54 consecutive patients who had been readmitted within 28 days of discharge with 61 patients, chosen at random, who had not been readmitted during the same period. Results.Readmission within 28-days of discharge was associated with having been admitted in the previous year (P = 0.004), receiving the Disability Support Pension (P = 0.015), not having a discharge plan sent to the patient’s GP on discharge from the index admission (P = 0.05), receiving follow-up by the mental health team within 7 days of discharge (P = 0.007) and being unemployed (P = 0.015). Conclusions.Targeting those with previous admissions for focussed discharge planning may help organisations reduce the numbers of unnecessary early readmissions. What is known about the topic?Readmission within 28-days of discharge is being increasingly used by service funders and organisations as an indicator of the effectiveness of community care and of the organisation’s ability to provide continuous care across programs. Previous studies, mainly conducted in the US in the mid-90s, often reach contradictory conclusions and their relevance to the Australian setting is limited. What does this paper add?This paper uses data from an Australia mental health service. It identifies patient and service characteristics associated with rapid re-admission and provides a baseline to evaluate strategies to reduce the readmission rate. What are the implications for practitioners?This paper highlights the importance of careful discharge planning and communication with general practitioners particularly in relation to patients who have had previous admissions.
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Lanzara, Dino, Ugo Cosentino, Anna Maria Lo Maglio, Antonio Lora, Anna Nicolo, and Maria Stella Rossini. "Problems of patients with schizophrenic disorders and of their families." Epidemiologia e Psichiatria Sociale 8, no. 2 (June 1999): 117–30. http://dx.doi.org/10.1017/s1121189x00007624.
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SummaryObjective — To evaluate psychopathological symptoms, disabilities and family burden in schizophrenic patients and to analyse predictors of family burden and relatives' satisfaction. Design — Descriptive study of 203 patients with an ICD 10 — F2 diagnosis (schizophrenia and related disorders) in contact with the Desio Department of Mental Health on 31st December 1994. Setting — The Desio Department of Mental Health. Main outcome measures — The patients have been evaluated in three areas: disability (by ADC-DAS), psychiatric symptoms (by 24 items BPRS) and family burden (by Family Problems questionnaire). The outpatient, hospital and residential care contacts of the patients have been collected for six months by our service information system. For each area (DAS, BPRS and FP) a principal component analysis and a rotation of the significant components have been performed. Eleven factors, derived from three scales, have been retained as explanatory variables. Finally, a multiple regression analysis has been performed to assess the influence of explanatory variables on the set of response variables regarding family burden and relatives' satisfaction. Results — One third of patients suffer of moderate-severe positive symptoms, while negative symptoms are less frequent.
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Kavanagh, Annette, and Ena Lavelle. "The impact of a rehabilitation and recovery service on patient groups residing in high support community residences." Irish Journal of Psychological Medicine 25, no. 1 (March 2008): 5–10. http://dx.doi.org/10.1017/s0790966700010764.
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AbstractObjectives: To describe the characteristics of the patient groups with severe and enduring mental illness residing in high support community residences in Dublin North East Mental Health Service and the impact of a rehabilitation and recovery service on their outcomes since the instigation of that service.Method: Data was collected retrospectively on current and past residents from case notes and staff interviews. Data included demographics, psychiatric history and results of rehabilitation interventions. The results were compiled and analysed using descriptive statistics.Results: Fifty patients were identified. The majority were male (62%) with a diagnosis of paranoid schizophrenia (66%).The levels of co-morbid alcohol and drug misuse were 48% and 36% respectively. Histories of verbal/physical aggression were found in 70% and noncompliance in 60%. Two thirds of patients had a past history of being detained under the Mental Treatment Act (1945). Ninety-four per cent were unemployed at admission to the residence and following rehabilitation intervention 60% were linked with vocational training programmes and 10% with community employment schemes. ‘New long-stay’ and ‘old long-stay’ patients showed a trend towards poorer outcomes, whereas patients who had previously lived in the community showed a trend towards progressing to lower levels of support.Conclusions: Positive outcomes were achieved following active rehabilitation interventions, but there remained a cohort of patients whose needs could not be met in a supported community rehabilitation residential programme. This highlights the need to ensure that a range of rehabilitation services from inpatient to supported community placement are provided to meet the needs of patients with severe and enduring mental illness with complex needs.
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Bland, Roger C. "Psychiatry and the Burden of Mental Illness." Canadian Journal of Psychiatry 43, no. 8 (October 1998): 801–10. http://dx.doi.org/10.1177/070674379804300804.
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Objective: To examine the morbidity produced by mental disorders, to project changes in morbidity likely to be produced by demographic and economic change, and to review the possible role of psychiatry in the health care system. Methods: Using prevalence data for psychiatric disorders and population projections, this paper presents the likely changes in morbidity over the next 20 years. A review of social and economic information indicates changes in social attitudes and their effects on mental health. This paper examines the determinants of health and how they are likely to change and explores some possible directions for changes in health care delivery. Results: Psychiatric disorders have been greatly underestimated as a cause of disability but account for 5 of the 10 leading causes of disability and 47.2% of all years lived with a disability (YLD) in developed countries. By 2016, there will be significant changes in the distribution and type of psychiatric disorders seen in the population, with cases of dementia almost doubling. Most of the population growth will be in the older age-groups, who will be well informed and will demand high standards of service. The gap between rich and poor will increase, and the results of childhood poverty and abuse will become more apparent. The disadvantaged, including many mentally ill, will suffer deprivation as disability payments decline, but youth unemployment will improve, possibly reducing crime rates. Forced early retirements will decline. Alternative medicine will make inroads into health care. A crisis in subsidized accommodation for the elderly can be anticipated, which perhaps will lead to reopening institutions that are currently being closed or to developing new forms of care. As the baby boomers pass 50 years of age and begin consuming health care services, governments will revise plans and eligibility for services; users will pay for services more directly. Conclusions: Psychiatry is very vulnerable to minor changes in health care schemes and will increasingly be called on to show economic arguments to justify its services. Pressure to support a primary care model by changing practice styles, developing new skills, and training practitioners will probably occur. The major growth area likely will be geriatric psychiatry.
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Forsyth, Monica Ginn. "Psychogeriatric Care in a Forensic Setting." Journal of Mental Health and Addiction Nursing 1, no. 2 (October 18, 2017): e1-e5. http://dx.doi.org/10.22374/jmhan.v1i2.23.
Full textAbstract:
Background and Objective: With an aging population, it has become increasingly important that nurses are equipped to provide appropriate psychogeriatric care. Patients with dementia are more likely of committing legal violations related to their behavioural and psychosocial symptoms. Thus, it is imperative that we explore how nursing staff can effectively manage psychogeriatric care in a forensic setting, in order to minimize stress and burnout of staff.
Material and Methods: Three populations were explored with the context of dementia and the justice system: patients with dementia who enter the forensic system, aging inmates in corrections, and criminal offenders in long-term residential care. The literature suggests that there is a dilemma as to where this population is best managed as there are no appropriate designated psychiatric facilities for the elderly offenders. Four options for geriatric service enhancement will be explored: Provide Gentle Persuasive Approach (GPA) training to forensic staff; modification of existing policies and procedures to support appropriate geriatric care; implement the use of Psychiatric Care Aides in skill mix; and create a secure forensic unit for geriatric populations.
Results: The recommendation for action is to implement education specific to psychogeriatric care, while also adjusting policies and procedures for a forensic centre to support therapeutic care.
Conclusions: The author argues that further research is needed that will determine the design of a new Psychogeriatric Forensic Centre.
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Narendorf, Sarah Carter, J. Curtis McMillen, and Karen Matta Oshima. "Affect Dysregulation in Older Foster Youth." Journal of Emotional and Behavioral Disorders 24, no. 4 (July 24, 2016): 211–22. http://dx.doi.org/10.1177/1063426615591791.
Full textAbstract:
Affect dysregulation (AD) is characterized by heightened reactivity to strong emotions, difficulty calming down when upset, and mood instability. This phenomenon has not been widely examined in older foster youth, yet it may be an avenue to improve behavior and functioning in young adulthood. This study examines two dimensions of AD—affect skills deficits and affect instability—in a sample of 17-year-old foster youth, assessing the relationship of each dimension to risk factors and behavioral health service use at age 17, and as predictors of functional outcomes at age 19. We found that the level of AD among older foster youth was similar to a clinical sample and was associated with a history of physical abuse, depression, attention deficit hyperactivity disorder, and disruptive behavioral disorders. Higher levels of affect skills deficits were associated with use of intensive types of services such as psychiatric hospitalization, residential treatment, and psychiatric medications but affect instability was not. Higher levels of affect skills deficits were negatively related to graduating from high school and positively related to being arrested. AD, especially affect skills deficits, are a promising target for inclusion in interventions to support older foster youth with mental health problems.
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Struthers, P. "Equity and the distribution of rehabilitation personnel in one health district in the Western Cape." South African Journal of Physiotherapy 57, no. 4 (November 30, 2001): 4–8. http://dx.doi.org/10.4102/sajp.v57i4.513.
Full textAbstract:
This paper describes a situation analysis of the rehabilitation personnel, employed by the state and non-governmental organisations, and the services available for people with disabilities in one health district in Cape Town. The recurrent cost of employing the rehabilitation personnel is analysed to determine how funding is allocated within the district. The results indicate that most expenditure on personnel is at two state institutions in the district, with 76% of the expenditure at the regional psychiatric hospital and its residential facility for people with a profound intellectual disability. The balance - 24% of expenditure - is the cost of employing rehabilitation personnel who provide a district level service. Seventy percent of this district level expenditure is at one special school that accepts 6% of children with disabilities in the district. A high percentage of intellectually disabled children and adults, with or without physical disabilities, do not have access to rehabilitation. There is minimal expenditure on employing rehabilitation personnel at the community heath centre. The only expenditure on community based rehabilitation is provided by the non-governmental organisation. The study demonstrates the inequitable distribution of funding for rehabilitation services within one relatively well-resourced health district and makes recommendations to facilitate change.