Abstract
Aims: Community-based residential alternatives to hospitalization are an emerging service model. Evidence for their acceptability and effectiveness is promising but limited. Prevention and Recovery Care (PARC) services are one such residential model, offering short-term subacute treatment and care (usually between 7 and 28 days). PARC services in Victoria, Australia, are designed to support consumers with severe mental illness to either avoid a psychiatric hospital admission (step-up care) or transition from hospital back into the community (step-down care). As a precursor to a series of studies investigating the appropriateness, effectiveness and efficiency of PARC services, we aimed to investigate whether a typology of PARC services can be developed. Methods: A manager or other appropriately knowledgeable staff member from each of the 19 adult PARC services included in the study completed a tool based on PARC operational guidelines (the Victorian PARC service mapping questionnaire) and a validated instrument measuring the quality of care in residential mental health settings (the Quality Indicator for Rehabilitative Care, QuIRC). Thirty (of 42) stakeholders participated in a modified Delphi study to select 23 from the available 230 variables for entry into a hierarchical cluster analysis. Results: Cluster analysis produced three clusters of equal dissimilarity. At the 90% confidence level, there were four variables which were significantly different between clusters. These were the year the PARC was opened, the QuIRC Living Environment domain score, the proportion of all admissions that were a step-down admission from an inpatient unit, and how often families were invited to care meetings. Sensitivity analyses suggested the findings were robust to the method used to identify clusters. Conclusions: Although PARC services were broadly similar, their identified differences suggest there is variable model implementation across Victoria sufficient to generate a PARC service typology. This typology may prove important for interpreting differences in outcomes experienced by consumers and carers using PARC services, when applied in our analyses of service effectiveness. The value of conducting service mapping and typology studies is underscored. Further research to characterize subacute residential services, including recovery-promoting features of the built environment, is warranted.
Highlights
Community-based residential alternatives to hospitalization in psychiatric inpatient units are becoming increasingly available in health systems in many developed countries
The Prevention and Recovery Care (PARC) services were mostly in suburban locations within the state capital city: inner city [3], suburban [13], and regional [3]
Twelve clinical mental health services were involved in auspicing a PARC service, most only one
Summary
Community-based residential alternatives to hospitalization in psychiatric inpatient units are becoming increasingly available in health systems in many developed countries The rationales for their development are varied and include the following: providing a less restrictive and potentially more home-like alternative to acute wards, which is consistent with consumer preferences; a greater emphasis on providing recovery-oriented care; and an increased focus on reducing acute hospital admissions, especially in the context of the drive to reduce involuntary admissions and to reduce costs and pressure on inpatient beds [1,2,3]. Consumer satisfaction and cost effectiveness tended to favor community-based alternatives, and no clinical outcomes were identified that were worse than for acute admissions [4] These findings are echoed elsewhere [2, 5], but existing research is limited by factors such as the paucity of long-term follow-up studies and the diverse and poorly defined communitybased alternatives [e.g., Refs. That study classified community-based service types by services such as the following: clinical crisis houses; crisis team beds; nonclinical alternatives typically managed by the voluntary sector; and specialist crisis houses for specific groups, such as women
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