Classic Care Research Articles

Effectiveness of the Therapeutic Community Model in Addiction Treatment: A Retrospective Pilot Study in French Prisons.

In France, addiction care in prison usually consists of nurses' interventions, medical care and socio-educational programs, but new alternatives have arisen, namely the therapeutic community (TC) model. This pilot study aims to evaluate the effectiveness of this prison-based TC in comparison with classic and socio-educational care offered in French prisons. To compare these three types of prison-based care, two detention centers' files were screened for use of multiple drugs, willingness to participate and absence of psychiatric comorbidities incompatible with group therapy. A custom questionnaire was built based on the fifth version of the Addiction Severity Index. It investigates medical status, employment and support, primary addiction status, legal status, social/familial status and psychiatric status through various items. Our sample only consisted of male repeat offenders with a mean age of 37.7 ± (9.1) years. Primary addiction status improvement was observed for all care studied but was more important in TC than in classic care. Self-esteem and social/familial status saw significant improvement throughout TC care. The TC model represents an alternative to classic and socio-educational care in French prisons. More studies are needed to assess the extent of the benefits provided on both the medical side and economic side.

Situations critiques : une approche clinique spécifique est nécessaire

In November 2013, French health ministry notified a device “critical situations” to compensate for the situations “with no solutions” of welcoming and caring for persons disabilities. The existing specialized already saturated devices (for rare diseases, rare handicaps, autism) not being able to assure them, existing institutions were endowed with additional ways to answer these emergencies. In Nîmes (France), a team of Medical Educational Institute (MEI) welcomed, from 2013 to 2015, 12 “Critical situations”. The families’ disturbances intensity imposed creation of a new device: the transitional unity. First, we describe all the peculiarities of social isolation impacts and the need of care for families and children: their confinements at home, the stopping of the educational project, the installation of negative parental representations on the child, couples who isolated themselves socially, and sibling great difficulties. For the disabled child, preexisting disabilities got more complicated or deteriorated. With family adaptation came along relational handicaps (tyrannical/powerful child, attachment disorders: insecure, avoiding or ambivalent). It is difficult to discriminate what returned to the appropriate child disorder, or to the lack of care, expressed with the effects of family adaptations. We explain then the necessity of developing a specific device to restore parents confidence in the system of care and accompany this confined child: 1 – not to neglect course of parents and child during all this period, to collect it, to understand and to recognize the efforts of parent's adaptation, to estimate their capacity to get loose from it; 2 – to individualize the child welcoming, to sequence his activities, resting on the experiment of the parents and on what he can bear of a new frame; 3 – to accompany the child home and modify interactions between him and his family. This device implies an individual frame for the child and a personalized support by the teams until he can benefit from the more classic care in the MEI group.

Roles of Pathway-Based Models and their Contribution to the Redesign of Health-Care Systems

Care pathways provide a practical analytical tool that encompasses both organizational efficiency and individual patients' care. In the UK, constructing the care pathway has been a recommended starting point for the redesign of health-care systems. This paper examines the redesign cycle for health-care systems and looks at the role of pathway-based models in the design and operation phases of the cycle. In addition, the models provide further benefits for communicating recommended practice and audit of care and outcomes. The models span the classic care pathway with extensions to simulation modelling. An example of the use of care pathways in the redesign of an emergency department is used for illustration. This study shows the role of pathway models as: a tool for redesign, a catalyst for enhancing communication and as a repository for audit information. The final role of a tool for modelling contingencies was not implemented. From the example it can be concluded that sophisticated models can be useful, in some applications; however, the simpler approaches may often be the best, offering rapid, transparent recommendations based on a multidisciplinary approach.