Abstract
BackgroundClinically operated community-based residential rehabilitation units (Community Rehabilitation Units) are resource intensive services supporting a small proportion of the people with severe and persisting mental illness who experience difficulties living in the community. Most consumers who engage with these services will be diagnosed with schizophrenia or a related disorder. This review seeks to: generate a typology of service models, describe the characteristics of the consumers accessing these services, and synthesise available evidence about consumers’ service experiences and outcomes.MethodA systematic review was undertaken to identify studies describing Community Rehabilitation Units in Australia, consumer characteristics, and evidence about consumer experiences and outcomes. Search strings were applied to multiple databases; additional records were identified through snowballing. Records presenting unique empirical research were subject to quality appraisal.ResultsThe typology defined two service types, Community-Based Residential Care (C-BRC), which emerged in the context of de-institutionalisation, and the more recent Transitional Residential Rehabilitation (TRR) approach. Key differentiating features were the focus on transitional care and ‘recovery’ under TRR. Schizophrenia spectrum disorders were the most common primary diagnosis under both service types. TRR consumers were more likely to be male, referred from community settings, and less likely to be subject to involuntary treatment. Regarding outcomes, the limited quantitative evidence (4 records, 2 poor quality) indicated C-BRC was successful in supporting the majority of consumers transferred from long-term inpatient care to remain out of hospital. All qualitative research conducted in C-BRC settings was assessed to be of poor quality (3 records). No methodologically sound quantitative evidence on the outcomes of TRR was identified. Qualitative research undertaken in these settings was of mixed quality (9 records), and the four records exploring consumer perspectives identified them as valuing the service provided.ConclusionsWhile there is qualitative evidence to suggest consumers value the support provided by Community Rehabilitation Units, there is an absence of methodologically sound quantitative research about the consumer outcomes achieved by these services. Given the ongoing and increasing investment in these facilities within the Australian context, there is an urgent need for high-quality research examining their efficiency and effectiveness.Trial registrationPROSPERO (CRD42018097326).
Highlights
The provision of clinically-operated rehabilitation in a community residential setting (Community Rehabilitation Units) reflects one approach to supporting people with severe and persisting mental illness to manage in the community
The typology defined two service types, Community-Based Residential Care (C-BRC), which emerged in the context of de-institutionalisation, and the more recent Transitional Residential Rehabilitation (TRR) approach
Typology of Australian community rehabilitation units From the 24 records providing service descriptions, two types of Community Rehabilitation Units were identified– the original Community-Based Residential Care (C-BRC) type operating from the mid-1990s until the early 2000s, and the more recent Transitional Residential Rehabilitation (TRR) type
Summary
The provision of clinically-operated rehabilitation in a community residential setting (Community Rehabilitation Units) reflects one approach to supporting people with severe and persisting mental illness to manage in the community. Community Rehabilitation Units are typically transitional in focus, aiming to help consumers to reside in more independent living situations by the time of discharge Alternative approaches such as Housing First, which are focussed around the issue of homelessness rather than clinical rehabilitation, have been increasingly championed in North America. Advocates for Housing First style approaches criticise clinically operated residential services for their limited evidence base [6, 9, 10] and ethical issues associated with making the provision of accommodation conditional on engagement with treatment [6, 7, 11] Despite these criticisms, continued growth in the availability of different models of Community Rehabilitation Units such as Community Care Units and Community Rehabilitation Centres has occurred in Australia over the past two decades [1, 10, 12]. This review seeks to: generate a typology of service models, describe the characteristics of the consumers accessing these services, and synthesise available evidence about consumers’ service experiences and outcomes
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
