Aftercare Services Research Articles

Evaluating the past to improve the future – A qualitative study of ICU patients’ experiences

BackgroundThe recovery period for patients who have been in an intensive care unitis often prolonged and suboptimal. Anxiety, depression and post-traumatic stress disorder are common psychological problems. Intensive care staff offer various types of intensive aftercare. Intensive care follow-up aftercare services are not standard clinical practice in Norway. ObjectiveThe overall aim of this study is to investigate how adult patients experience theirintensive care stay their recovery period, and the usefulness of an information pamphlet. MethodA qualitative, exploratory research with semi-structured interviews of 29 survivors after discharge from intensive care and three months after discharge from the hospital. ResultsTwo main themes emerged: “Being on an unreal, strange journey” and “Balancing between who I was and who I am” Patients’ recollection of their intensive care stay differed greatly. Continuity of care and the nurse’s ability to see and value individual differences was highlighted. The information pamphlet helped intensive care survivors understand that what they went through was normal. ConclusionsContinuity of care and an individual approach is crucial to meet patients’ uniqueness and different coping mechanisms. Intensive care survivors and their families must be included when information material and rehabilitation programs are designed and evaluated.

Self-harm hospitalised morbidity and mortality risk using a matched population-based cohort design.

Prior and repeated self-harm hospitalisations are common risk factors for suicide. However, few studies have accounted for pre-existing comorbidities and prior hospital use when quantifying the burden of self-harm. The aim is to quantify hospitalisation in the 12 months preceding and re-hospitalisation and mortality risk in the 12 months post a self-harm hospitalisation. A population-based matched cohort using linked hospital and mortality data for individuals ⩾18 years from four Australian jurisdictions. A non-injured comparison cohort was matched on age, gender and residential postcode. Twelve-month pre- and post-index self-harm hospitalisations and mortality were examined. The 11,597 individuals who were hospitalised following self-harm in 2009 experienced 21% higher health service use in the 12 months pre and post the index admission and a higher mortality rate (2.9% vs 0.3%) than their matched counterparts. There were 133 (39.0%) deaths within 2 weeks of hospital discharge and 342 deaths within 12 months of the index hospitalisation in the self-harm cohort. Adjusted rate ratios for hospital readmission were highest for females (2.86; 95% confidence interval: [2.33, 2.52]) and individuals aged 55-64 years (3.96; 95% confidence interval: [2.79, 5.64]). Improved quantification of the burden of self-harm-related hospital use can inform resource allocation for intervention and after-care services for individuals at risk of repeated self-harm. Better assessment of at-risk self-harm behaviour, appropriate referrals and improved post-discharge care, focusing on care continuity, are needed.

CHALLENGES FACING EX-OFFENDERS WHEN REINTEGRATING INTO MAINSTREAM SOCIETY IN GAUTENG, SOUTH AFRICA

Offender rehabilitation and reintegration have come to be embraced as a vital component of a comprehensive and holistic crime-fighting strategy. Despite this, research shows that upon release from prison, ex-offenders are faced with a myriad of challenges that weaken the possibility of reform and predispose ex-offenders to recidivism. Using primary data from a qualitative study, this paper discusses the challenges faced by ex-offenders when reintegrating into mainstream society in Gauteng, South Africa. The findings show that ex-offenders struggle to adjust because of broken family and community relationships, unemployment and lack of after-care services, among others factors.

Survived so what? Identifying priorities for research with children and families post-paediatric intensive care unit.

The involvement of patients and the public in the development, implementation and evaluation of health care services and research is recognized to have tangible benefits in relation to effectiveness and credibility. However, despite >96% of children and young people surviving critical illness or injury, there is a paucity of published reports demonstrating their contribution to informing the priorities for aftercare services and outcomes research. We aimed to identify the service and research priorities for Paediatric Intensive Care Unit survivors with children and young people, their families and other stakeholders. We conducted a face-to-face, multiple-stakeholder consultation event, held in the Midlands (UK), to provide opportunities for experiences, views and priorities to be elicited. Data were gathered using write/draw and tell and focus group approaches. An inductive content analytical approach was used to categorize and conceptualize feedback. A total of 26 individuals attended the consultation exercise, including children and young people who were critical care survivors; their siblings; parents and carers; health professionals; academics; commissioners; and service managers. Consultation findings indicated that future services, interventions and research must be holistic and family-centred. Children and young people advisors reported priorities that focused on longer-term outcomes, whereas adult advisors identified priorities that mapped against the pathways of care. Specific priorities included developing and testing interventions that address unmet communication and information needs. Furthermore, initiatives to optimize the lives and longer-term functional and psycho-social outcomes of Paediatric Intensive Care Unit survivors were identified. This consultation exercise provides further evidence of the value of meaningful patient and public involvement in identifying the priorities for research and services for Paediatric Intensive Care Unit survivors and illuminates differences in proposed priorities between children, young people and adult advisors.

Reducing readmission rates in inpatient settings

ABSTRACTThe provision of good quality and cost effective mental healthcare remains a significant public health issue. The objective of this study was to improve the transition from inpatient to outpatient aftercare services, thereby reducing readmission rates. A total of 1,707 patients in acute inpatient psychiatry units participated in the intervention program over a period of 12 months. The readmission was reduced by 27 percent (9.54% to 6.95%, p = 0.004). The data suggest that these modalities significantly lower readmission rates and therefore improve the cost effectiveness and quality of mental health care.

Mixed-Gender Shelter-Based Service for Child Survivors of Commercial Sexual Exploitation (CSEC) in Italy: A Case Study

ABSTRACTUsing a single case study, the article presents an innovative model of aftercare service for commercially sexually exploited children (CSEC), child abuse victims, and court-involved youth based in the Veneto region of Italy. Data included: (a) two interviews of the Executive Director of the shelter; (b) one first-hand observation of the shelter; and (c) input from program volunteers and staff who reviewed an early draft of the manuscript. This important public health problem is defined using this case study to describe the rationale for using an innovative mixed-gender, mixed-caseload rehabilitation model. The research questions of interest were: (a) What is the mixed-gender, mixed-caseload model of shelter-based service provision to CSEC and other youth in need of rehabilitative programming?; (b) What was the rationale for using this approach?; and (c) What have been the successes and challenges of changing to a mixed-gender, mixed-caseload shelter model? This study is exploratory and the actual model has not yet been evaluated, so it would be premature to suggest that there are clear clinical implications from this case study. For future researchers, aspects of the service provision model may be of clinical interest to other European providers and providers in other nations. Mixed-gender shelter models for youth in need of services may be worth considering, trying, and evaluating.

Effects of Outpatient Aftercare on Psychiatric Rehospitalization Among Children and Emerging Adults in Alberta, Canada.

The one-year readmission rates for children and youths hospitalized for a psychiatric condition is estimated at 38%. Studies suggest that these high readmission rates result from a lack of aftercare, but evidence is mixed. This study further explored the relationship between aftercare and readmission among children and youths ages five to 24 in Alberta, Canada, by using the same study sample to identify predictors of both outcomes. A retrospective analysis using linked administrative data was performed. Records of the index inpatient stay and any subsequent readmissions for a mental health reason between July 1, 2007, and December 31, 2012, were obtained from the Discharge Abstract Database. Data on outpatient aftercare for this sample were obtained from ambulatory care records and a patient-level physician billing database. Rates of aftercare and readmission were calculated. A Cox proportional hazards regression model was used to identify predictors of both outcomes. Overall, 15,628 hospitalizations were identified for 12,728 unique individuals. For these hospitalizations, aftercare services were recorded for 29.4% within one week of discharge and for 54.5% within 30 days. Fourteen percent of hospitalizations resulted in readmission within 90 days. Aftercare was associated with a 32% reduction in readmission. Prior service use, longer hospital stays, higher income, specific diagnoses, female sex, and comorbid mental health conditions were associated with a greater likelihood of aftercare receipt. Access to community mental health services for children and youths remains a priority. The significant role of aftercare in reducing readmission risk demonstrates the need to improve these services.

Contributing factors to relapse of drug addiction among clients attending rehabilitation centres of Dharan, Nepal

Relapse is the resumption of substance after a period of abstinence. It is frustrating but frequent part of recovery process. Several substance including opiates, cocaine and alcohol have particularly has high relapse rate with majority of client re­lapsing within 1 year following treatment. The first 90 days after treatment are very vulnerable time. Hence, the objective of the study is to assess the contributing factors to relapse of drug addiction since the aftercare services, the psycho-social aspect of the treatment has been ignored and high relapse is prevalent among the treated clients. A descriptive cross-sec­tional study was carried out among clients attending three rehabilitation centres of Dharan using lottery method of simple random sampling among 72 respondents using structured questionnaires from 20th September to 4th October, 2015. Findings of the study showed that majority (63.9%) of the respondents had started taking drugs again due to lack of self confidence. In addition to this another contributing factor to relapse was peer pressure (50%) followed by inability to give old habits (44.4%), easy accessibility of drugs (30.6%). The finding also indicated that there was significant relationship (p value = 0.054) between peer pressure and employment status. Lack of self-confidence, peer pressure, easy accessibility of drugs, lack of acceptance in society and family, adjustment problems had increased the chance of relapse after treatment. So, the treatment centres of Dharan should develop program that incorporate the overall development and treatment of client to prevent from relapse of drug addiction.

Important Elements of Aftercare Services for Youth Departing Group Homes

Aftercare services have been suggested to improve the outcomes of youth who depart group homes. The purpose of this study was to collect views from social service agency leaders about the aftercare supports they believed were most important for youth departing group homes. This project used a survey method and gathered views from 38 agency leaders who were 28–66 years of age, with an average of 21 years of experience working with residential care programs in 23 states across the United States. Participants ranked seven support domains (i.e., family, education, mental health, relationships, physical health, safety, and independent living) and rated 56 specific aftercare supports based on importance for youth who were departing group homes and returning to their homes/schools prior to high school graduation. Results suggested family, safety, and mental health supports were the most important domains of support for aftercare. Specific aftercare items that were rated critically important included support for self-harm/suicidal thoughts, accessing mental health services, coping with trauma, and managing medication for behavior/mental health. Tables are provided for the complete list of 56 specific support ratings. The findings are summarized and limitations are discussed. Also included are the implications the findings could have regarding future research on the design of aftercare services.

Comprehensive Care Model for Sex Trafficking Survivors.

The purpose of this study was to identify aftercare services for domestic minor of sex trafficking (DMST) survivors provided by U.S. residential treatment centers. A qualitative research study was conducted with aftercare program personnel from five U.S. residential treatment centers for DMST survivors. Interviews were conducted with staff from five different residential treatment centers providing services exclusively to domestic minor sex trafficking survivors. Participants described the range of services offered to address survivors' posttrafficking needs. Participants' responses assisted in expanding an existing care model to include education re-entry, family reunification, family reconciliation, and emergency substance use services. This study led to the refinement of an aftercare service delivery model and laid the foundation to develop best practice guidelines for providing aftercare services to DMST survivors. Sex trafficking is a global health problem affecting our youth today. Nurses have a vital role in combatting sex trafficking by raising awareness about the problem and restoring the lives of sex trafficking victims by implementing innovative care programs.

Cost-effectiveness of aftercare services for people with severe mental disorders: an analysis parallel to a randomised controlled clinical trial in Iran.

Aftercare services are not part of the usual care for people with severe mental disorders in Iran. This study was performed to assess the cost-effectiveness of aftercare services, including telephone follow-up or home visit, in addition to caregivers' education and training of social skills, for all subjects during the 20months after hospital discharge. An economic evaluation was performed along with a registered randomised controlled trial (IRCT201009052557N2) on two groups of 60 persons recruited between 2010 and 2012. Intervention's effectiveness was measured by psychopathology and quality of life indicators. Cost-effectiveness and cost-utility were analysed from the societal and Ministry of Health (MoH) perspectives. All indicators of psychopathology, quality of life and satisfaction with services in the intervention group were significantly different from the control group. Mean intervention costs was US$674 (95% confidence interval [CI]: 572-776) per subject in the intervention group. Average total direct costs were US$1445 (95% CI: 1086-1804) and US$1640 (95% CI: 1087-2093) per subject in the intervention and control groups respectively. From the societal perspective, intervention had more effects with lower costs. The ratios for incremental cost-effectiveness was US$8399.1 (95% CI: 8178.2-8620.0) per quality-adjusted life year (QALY) gained from the MoH perspective for 20months of follow-up. This study showed that aftercare services can create opportunities to use hospital beds more efficiently for unmet needs of people with psychiatric disorders. Indirect and intangible costs were not considered in this study, if taken into account, they are likely to further increase the efficiency of intervention.

Awareness of Sexual Violence Services Among LGBQ-Identified College Students

ABSTRACTThe sexual victimization of sexual minorities enrolled in college is not a topic that has been well researched. The present study examines the awareness that college minority students have of services they can access in the event they experience sexual violence. The results indicate that many students are unaware of specific services that they can access if they are sexually victimized. Disclosing an incident of sexual violence, or being the recipient of a disclosure of sexual violence, is related to knowledge of aftercare services. Non-White students demonstrate less awareness of services than White students, indicating that these students may not receive aftercare in the event of sexual victimization because they do not have the knowledge of which services are available. Several policy recommendations and directions for future research stem from these findings.

Living with Vulnerability and Resiliency: the Psychological Experience of Collective Trauma

Large-scale disasters often induce a chain of psychological phenomena that have direct impact on a person’s physiological condition, psychological state, functional capacity, interpersonal relationships, communal involvement and spiritual beliefs. Psychological knowledge about the emotional experience, process and impact of responding to a national-scale traumatic event such as the devastated earthquakes, floods, fires, viral outbreaks and terrorist attacks over the globe is often confusing if not overwhelming. Applying over two decades of clinical experience in working closely with the psychologically wounded, the author hereby seeks to deconstruct and introduce a practical model of the Psychological Process of Collective Trauma, accompanied by a novel model of the Resiliency Process of Collective Trauma. To put these two models that essentially illustrate ones’ internal state of vulnerability and resiliency, a general understanding of the long-term effects of primary trauma, secondary trauma, retraumatization and multitude grieving is crucial. This report aims to present a simply and clear framework of psychological recovery that can be applied across disciplines in the case of disaster work and the aftercare mental health services. Above all, the learned lesson that the author is humbly sharing is: Being weak is strong, being strong is weak, and being both is needed.

Rate and Predictors of 1-year Readmission in Tertiary Psychiatric Hospitals.

Objective:To obtain the rate of 1-year readmission among psychiatric patients in tertiary centers in Oman and to study the association between readmission and sociodemographic and clinical factors.Methods:This is a retrospective study using data from patients' medical records. All patients aged ≥18 years who were admitted to Al Masarra Hospital and the psychiatric ward at Sultan Qaboos University Hospital over a 6-month period were included in the study. Each patient was followed up for 1 year after discharge to determine whether they had been readmitted during that period. The analysis was conducted as a comparative study between patients with early readmission and those who had not been readmitted during the 1-year period. Fifteen factors were examined for association with readmission within the 1-year period.Results:A total of 466 patients were admitted to the two hospitals during the study period, with 39% of these patients readmitted within 1 year. The univariate analysis revealed that 11 factors were significantly associated with 1-year readmission (P < 0.05). The multivariate logistic regression analysis identified four factors as independent significant predictors for 1-year rehospitalization: male gender, unemployment, nonadherence to medications and a history of previous hospitalization.Conclusion:The rate of 1-year readmission was found to be high, in line with the findings of other studies. Specific sociodemographic factors and clinical factors were strongly associated with early readmission in psychiatric hospitals in Oman. Strategies for aftercare and community psychiatric services need to be implemented.

Barriers and facilitators to successful transition from long-term residential substance abuse treatment

Although residential substance abuse treatment has been shown to improve substance use and other outcomes, relapse is common. This qualitative study explores factors that hinder and help individuals during the transition from long-term residential substance abuse treatment to the community. Semi-structured interviews were conducted with 32 individuals from residential substance abuse treatment. Based on the socio-ecological model, barriers and facilitators to transition were identified across five levels: individual, interpersonal, organizational, community, and policy. The major results indicate that primary areas of intervention needed to improve outcomes for these high-risk individuals include access to stable housing and employment, aftercare services and positive support networks; expanded discharge planning services and transitional assistance; and funding to address gaps in service delivery and to meet individuals' basic needs. This study contributes to the literature by identifying transition barriers and facilitators from the perspectives of individuals in residential treatment, and by using the socio-ecological model to understand the complexity of this transition at multiple levels. Findings identify potential targets for enhanced support post-discharge from residential treatment.

Prediction of Relapse After Cognitive-Behavioral Treatment of Gambling Disorder in Individuals With Chronic Schizophrenia: A Survival Analysis

Gambling disorder (GD) in individuals with chronic schizophrenia is relevant because there are higher rates of GD in schizophrenic populations (10%) than in the nonschizophrenic population (1%–5%). In addition, these patients have more severe alcohol use disorder (i.e., meeting at least 6 of the DSM-5 11 criteria for diagnosis of this disorder), higher depression scores, a poor adherence to treatment, and more frequent use of outpatient mental health care. One of the main problems in GD is therapeutic failure (defined as three or more lapse episodes during treatment) or relapse (three or more lapse episodes in the follow-up period). Predicting a relapse of GD in individuals with chronic schizophrenia can be useful in targeting the patients for aftercare services. The main aim of this study was to estimate the time to a GD relapse (survival rate) and to evaluate some of the qualitative and quantitative variables related to a GD relapse by a survival analysis. The sample consisted of 35 patients with chronic schizophrenia and GD who were treated with pharmacological and cognitive-behavioral therapy. The therapeutic failure rate in the treatment period was 43%, and it was associated with the number of episodes of schizophrenia, the age of gambling onset, and the age of the patients. The relapse rate in the follow-up period was 32%, and it was associated with the patients’ age, educational level, and weekly allowance. The implications of this study for future research are discussed.

Availability of Aftercare for Youth Departing Group Homes

ABSTRACTAftercare has been suggested to improve the outcomes of youth who depart group homes. This project used a survey method to collect data from 38 agency leaders from across the United States on the aftercare supports they believed were available for youth departing group homes and returning to their homes/schools prior to high school graduation. The results revealed that 34% of agencies provided an aftercare service with a model, and 29% of agencies received external funding for aftercare. The findings are summarized and limitations and implications for future research are discussed.

Botulinum toxin prescription in the treatment of spasticity in the neurological rehabilitation service: 2012 to 2015 assessment

Botulinum toxins are often prescribed in aftercare and neurological rehabilitation services. In our hospital, they are exponentially used in the treatment of spasticity. The objective of this study is to make an assessment of their use over the period 2012–2015. All the botulinum toxin prescriptions are followed by the chemists. A traceability form allows to collect information about the patient, the prescriber, the medicine and its dose, the cost, and the indication. All these data are saved in an Excel file. The data from 2012 to 215 concerning the spasticity have been extracted and analysed. Speaking about figures, botulinum toxins represented an amount of €118,020 excluding tax in 2012 to €224,239 in 2015. The number of toxin injection sessions went from 435 (1.61 sessions per patient per year) to 643 (1.86 sessions per patient per year). The average dose in international unit (IU) for the treatment of the upper and/or upper limb spasticity increased during this period, going from 164 to 214 IU for Botox and from 595 to 793 IU for Dysport. In 2015, the treatment costs are quite similar for both molecules, with an average injection session cost of €300. The number of patients for whom the cost exceeds the amount supported by the hospital doubled over 3 years (from 20 to 42%), in relation to the increase either of the doses injected per muscle or of the number of treated muscles. This follow-up shows the complexity of the financial support of spasticity, and also of the economic and clinical monitoring of botulinum toxin administration. This must be carried on and refined, especially concerning the indication follow- up in association with the doctors (muscles treated per session, regulation compliance, treatment average costs)

Impact of energetic resonance by cutaneous stimulation sessions on the patient medicinal care: A pilot study in an aftercare and rehabilitation service

The patients in the neurological rehabilitation service are often in pain and anxious. To take care of them, some alternatives to medicine are being tested, especially to limit their side effects. A project of an energetic resonance by cutaneous stimulation service development, based on Chinese medicine, was started in 2013. It is about getting the feedback of the first patients taken care of. Energetic resonance by cutaneous stimulation is a multiprofessional project, associating doctors, chemists, health executives, and nursing staff. Four sessions are planned by the procedure. Pain is quantified thanks to the Visual Analog Scale (VAS); as for anxiety, it is quantified thanks to the Covi anxiety scale. During each session, data are saved on an Excel file like the session date and length, anxiety before and after, pain before and after, feeling of the patient. The chemist service follows constantly the painkiller, tranquilliser and antiemetic consumption, and this from a month before the first session to a month following the last one, thanks to the administrations indicated on Cristalnet software. Three nurses were trained in the service. Eight patients benefited from this program: 5 for pain, 1 for anxiety, 1 for insomnia and 1 for nauseas and vomitings. On average, each patient benefited from 3.9 sessions of about 33 minutes (± 7 minutes). When the patient is in pain, the average VAS reduction is of about −2.9 ± 2.2. When the patient is anxious at the beginning of the session, the average reduction of anxiety (on the covi scale) is about −2.9 ± 2.3. The patients’ feedback is positive and the reduction of medicinal treatment is noticeable. For example, paracetamol use decreases by 1000 mg ± 500. Despite the limits of the study (observation study without any control group), these results are encouraging. Energetic resonance by cutaneous stimulation seems to be beneficial for the patient even if it is difficult to assess objectively what is linked to the technique itself, to touch, to the care and support given to the patient and/or to the spontaneous evolution of the patient's state of health.

Social Inequality in Utilization of Aftercare Services Among Breast and Prostate Cancer Patients

This study examines social inequalities in the utilization of medical rehabilitation, complementary and alternative medicine (CAM) and psychosocial support programs among patients with prostate and breast cancer after surgery. A prospective, multicenter observational study was conducted. Subjects were 483 patients after primary manifestation of prostate and breast cancer (UICC-Stadium 0-IV) aged between 18 and 65 years. Patients were asked to fill out a questionnaire after surgery and 6 months later. Social inequality was measured by education, income and occupational status. In addition, the insurance status (private vs. statutory) was taken into account. Logistic regression models were used separately for each cancer site. The analyses were controlled for age, tumor stage and mental comorbidity. The associations between social inequality and the utilization of aftercare services vary by inequality indicator and the different health care services. Inequalities in utilization of CAM are most pronounced and consistent. Differences between status groups are small in utilization of rehabilitation. Among breast cancer patients, inequalities are more pronounced than among prostate cancer patients. Social inequalities in utilization of aftercare services among breast and prostate cancer patients are inconsistent. Future investigations should clarify to what extent such inequalities are due to access barriers or due to differences in health literacy or preferences.