Community Care For People Research Articles

The uniquely relational role of nurses during the closure of large residential institutions for people with intellectual disability in Australia: A qualitative study

ABSTRACT Background After decades of planning, nurses played a pivotal role in achieving the closure of large residential institutions for people with intellectual disability by 2018. This paper describes the experiences of nurses facilitating the closure of these institutions in New South Wales and Victoria, Australia. Method An interview-based, qualitative study was conducted with twenty-four registered nurses from Australia who had more than twelve months’ experience of caring for people with intellectual disability any time between 1960 and 2016. Results Nurses facilitated transition for residents and their families during devolution. However, nurses’ personal experiences of transition to work in community settings was complicated by inconsistent preparation, uncertainty of employment, and changes in professional status. Conclusions Extensive experience and detailed knowledge of their clients enabled nurses to maximise opportunities for smooth transition out of institutions into community care for people with intellectual disability. Devolution was personally and professionally costly for some nurses.

Community care for people with mental illness: challenges emerging in the 2020s and consequent recommendations.

Community care for people with mental illness: challenges emerging in the 2020s and consequent recommendations.

정신장애인 대상 지역사회통합돌봄의 실행 및 성과에 대한 실무자의 인식 연구

Through focus group interviews, this study explores perceptions of practitioners participating in the community care for people with mental illnesses and analyzes the operation process and performance of the community care. The main contents are ① evaluation of the overall circumstances that have changed while promoting the community care project, ② public participation and its role in the service delivery process, ③ collaboration with various service delivery entities, ④ expansion of regional social network for providing multi-field services, and ⑤ changes in awareness of people with mental disabilities and mental health through the community care. In terms of changes in users, the major keywords include expansion of community services and user-centered service provision method. In regards to changes in the service delivery system, the major keywords are ① securing access to regional services, ② changes in service provision methods based on linkage and cooperation, and ③ general changes in community service provision and community perceptions of care. The results of the analysis serve as evidence in evaluating the changes in the service users and the service delivery system, and identifying the performance and limitations of the community care project for people with mental illnesses. This study provides basic knowledge necessary to develop a community-centered mental health service system and service delivery method in the future. This study will contribute to the establishment and expansion of a community-centered mental health service model that supports the mentally disabled to return to the community and normalized life.

Clinician views on best practice community care for people with complex emotional needs and how it can be achieved: a qualitative study

BackgroundIndividuals with Complex Emotional Needs (CEN) services, a working description to refer to the needs experienced by people who may have been diagnosed with a “personality disorder”, face premature mortality, high rates of co-morbidity, service user and treatment costs. Service provision for this population is recurrently identified as needing to be transformed: there are serious concerns about quality, accessibility, fragmentation of the service system and the stigma and therapeutic pessimism service users encounter. Understanding clinician perspectives is vital for service transformation, as their views and experiences shed light on potential barriers to achieving good care, and how these might be overcome. In this study, we aimed to explore these views.MethodsWe used a qualitative interview design. A total of fifty participants from a range of professions across specialist and generic community mental health services across England who provide care to people with CEN took part in six focus groups and sixteen one-to-one interviews. We analysed the data using a thematic approach.FindingsMain themes were: 1) Acknowledging the heterogeneity of needs: the need for a person-centred care approach and flexibility when working with CEN, 2) ‘Still a diagnosis of exclusion’: Exploring the healthcare provider-level barriers to providing care, and 3) Understanding the exclusionary culture: exploring the system-based barriers to providing care for CEN. Across these themes, staff highlighted in particular the need for care that was person-centred, relational, empathic, and trauma informed. Major barriers to achieving this are stigmatising attitudes and behaviour towards people with CEN, especially in generic mental health services, lack of development of coherent service systems offering clear long-term pathways and ready access to high quality treatment, and lack of well-developed structures for staff training and support.DiscussionOverall, the findings point towards clinician views as generally congruent with those of service users, reinforcing the need for priorities towards systemwide change to ensure that best practice care is provided for people with CEN. Particularly prominent is the need to put in place systemwide training and support for clinicians working with CEN, encompassing generic and specialist services, and to challenge the stigma still experienced throughout the system.ConclusionsStaff working with this service user group report that delivering best practice care requires services to be flexible, integrated, and sustainably funded, and for staff to be supported through ongoing training and supervision.

Service user perspectives of community mental health services for people with complex emotional needs: a co-produced qualitative interview study

BackgroundThere is consensus that services supporting people with complex emotional needs are part of a mental health care system in which change is needed. To date, service users’ views and co-production initiatives have had little impact on the development of interventions and care. This needs to change, and our paper evidences the experiences and perspectives of a diverse range of people on how community services can best address the needs of people with complex emotional needs.MethodsA co-produced qualitative research study. Lived experience researchers led data collection and analysis. Individual interviews were conducted with 30 people across England who had a diverse range of experiences and perspectives of using community services for complex emotional needs. Participants were asked about their experiences of using community services for their mental health, and views on how community services can best address their needs. Thematic analysis was used to analyse the data.ResultsParticipants reported some experiences of good practice but also of experiences of severely stigmatising interventions, a lack of effective support and service fragmentation. Relational Practice was identified as the central overarching theme and describes how community services can best support people with complex emotional needs. This approach involves care delivered in a non-stigmatising, individualised and compassionate way and care that is trauma-informed. It involves care that is planned collaboratively with service users to ensure their multiple needs are addressed in a flexible, holistic and consistent way which accounts for the long-term and fluctuating nature of their needs.ConclusionsRelational practice approaches have potential to facilitate better community care for people with complex emotional needs. Research and service development are needed to examine how best to implement such approaches across the mental health service system. This work must be co-produced with people with relevant lived experience, their carers and the professionals who support them.

The impact of integrated care in community-based substance use treatment in Brazil: A longitudinal study.

Integrated care (outpatient-inpatient) plays a vital function in community care for people with drug use problems. Its recent and innovative treatment model is representing a challenge for the deinstitutionalisation process. The purpose of this study was to assess the impact of integrated care using biopsychosocial indicators. We conducted a prospective longitudinal study with 122 clients from the baseline undergoing integrated care of two Psychosocial Care Centers for Alcohol and Other Drugs in São Paulo, Brazil, with three months follow-up (February 2019-January 2020). To assess the biopsychosocial indicators of the impact, we used the Substance Addiction Consequences (SAC), WHOQOL-BREF quality of life scales and the psychosocial rehabilitation axes (housing, work/income, and support network). We conducted a longitudinal analysis with linear mixed-effects models. The integrated care impacted the reduction in the days of substance use and increase of abstinence with a significant difference for cannabis (p<0.001) and crack (p=0.021). It reduced the substance use harms in all SAC scale dimensions (p<0.001). Quality of life increased and remained mainly associated with the psychological size (p<0.001). All psychosocial rehabilitation axes improved with a difference for income (p=0.025). The increase in people's participation in treatment was relevant. The integrated care of Brazilian services has a positive impact on reducing substance use days and harms associated, improves the quality of life and contributes to the psychosocial rehabilitation of clients. Should be taken efforts to maintain long-term results.

Improving access to community care for people with intellectual disability is needed to avert unnecessary hospitalisations

Improving access to community care for people with intellectual disability is needed to avert unnecessary hospitalisations

Development and feasibility testing of a person‐centered cognitive service manual to enhance community care for people with dementia in Korea

AbstractBackgroundIn order to improve the quality of life for persons with dementia and their families and to ensure the efficiency of national cost for managing dementia, there is a need to support them in their communities as long as possible. Therefore, person‐centered cognitive interventions for early detecting of dementia and delaying its progression in the community is an urgent priority at the international level. This study aimed to develop a person‐centered cognitive service manual for early dementia to use for national long‐term care agencies and test its feasibility.MethodsThis study was conducted from February to July, 2019. The theoretical rationale for the manual was developed through systematic review of previous guidelines and studies. The focus group interviews identified the needs and preferences of stakeholders. The manual consisted of assessment, intervention, and outcome based on six domains. Six domains were individuality, independence, psychological health, physical health, safety, and social support. The manual provides comprehensive needs assessment tools and algorithms to plan and provide individualized service plan. The feasibility study was conducted at 47 senior welfare centers in Korea.ResultsThis study found that the manual was effective for initial consultation (63.0%), comprehensive evaluation (50.0%), service planning (72.7%), service provision (78.3%), goal achievement evaluation (50.0%), and service termination (100.0%). However, service provider’s increased workloads and the time for completing the needs assessment were identified as barriers to apply the manual. In addition, service providers experienced lack of knowledge and skills in comprehensive evaluation (55.9%) and service planning (29.4%). The continuous educational support for manual application was suggested.ConclusionThe national manual of person‐centered cognitive service can be useful to provide the best community services to improve the quality dementia community care. Development and dissemination of ICT based care pathways into the long‐term care service system to support best practices through the manual can be suggested.

Responsive community care for people with dementia &amp; their families: Evaluating a person centred and integrated care model

Introduction : In 2013, Genio, a non-governmental agency, provided innovative two year funding to develop individualised supports for people with dementia (PwD) and their informal carers in the community. This paper aims to report on the evaluation of an integrated care model in two community settings in Ireland, with a focus on the innovative supports provided. Methods : Data were collected pre- and post-implementation of individual supports. A mixed methods approach was employed and included the following: service providers’ awareness and knowledge of dementia; survey and interviews with PwD and informal carers about their experiences of community dementia care, interviews with service providers about their experience of community dementia care, and an economic analysis. Ethical approval was secured from the Faculty of Health Sciences Research Ethics Committees in Trinity College Dublin and relevant Ethics Committees in the services. Results : Results are based on data collected at two time points from service providers and PwD and informal carers. Service providers demonstrated reasonably high levels of dementia awareness and knowledge. For PwD and informal carers, the most valuable source of support was the provision of flexible, individualised home support hours. These benefits outweighed the provision of assistive technology and carer respite (weekend away for the informal carer). There was a range of positive outcomes reported by/on behalf of PwD and informal carers e.g. provision of additional home support hours when ‘mainstream’ supports were unavailable (overnight, at weekends etc), relief of carer burden, and satisfaction with facilitation of input into the selection of hours. Discussion : Tensions arose in the mainstreaming of additional hours provided by the project due to budgetary constraints within the health service and the limitations of existing community care services. The sustainability of project gains must be considered in the context of broader national developments. Conclusions (comprising key findings): Responsive care is best provided within a person-centred, relational care approach in order to acknowledge and respond to the needs of the PwD and informal carer dyad in the provision of dementia care services. Provision of additional, flexible home support hours was of the greatest benefit to informal carers in terms of support, and relief of carer burden. A re-conceptualisation of the provision of community care services would be required in order for project outcomes to be maintained and for the project ethos to continue. Suggestions for future research : This research focused on those with advanced dementia. It would be valuable in future research to further explore the implementation of responsive care for PwD and their informal carers in the community across all stages of the dementia journey. It would also be useful to examine how assistive technology might better support PwD and their informal carers in advanced dementia.

Augmenting mHealth with human support: Notes from community care of people with serious mental illnesses.

This article describes the activities of 2 mHealth specialists who supported the deployment of FOCUS-a smartphone self-management application for individuals with serious mental illnesses. Several support activities have been identified as potentially advantageous for individuals using mHealth interventions: facilitation of user engagement, data utilization to enhance care, and promotion of meaningful use. We present 3 examples to demonstrate the implementation of these activities during a 12-week smartphone intervention. The personal experiences of 2 mHealth specialists are shared within the context of 3 examples of individuals who participated in the smartphone intervention. The application of these support activities highlights the future opportunities that mHealth interventions could offer to individuals with serious mental illnesses and their providers. Additionally, these examples call for conversation about technology support roles and where they belong in the context of community-based care. (PsycINFO Database Record

Community Care for People with Complex Care Needs: Bridging the Gap between Health and Social Care.

Introduction:A growing number of people are living with complex care needs characterized by multimorbidity, mental health challenges and social deprivation. Required is the integration of health and social care, beyond traditional health care services to address social determinants. This study investigates key care components to support complex patients and their families in the community.Methods:Expert panel focus groups with 24 care providers, working in health and social care sectors across Toronto, Ontario, Canada were conducted. Patient vignettes illustrating significant health and social care needs were presented to participants. The vignettes prompted discussions on i) how best to meet complex care needs in the community and ii) the barriers to delivering care to this population.Results:Categories to support care needs of complex patients and their families included i) relationships as the foundation for care, ii) desired processes and structures of care, and iii) barriers and workarounds for desired care.Discussion and Conclusions:Meeting the needs of the population who require health and social care requires time to develop authentic relationships, broadening the membership of the care team, communicating across sectors, co-locating health and social care, and addressing the barriers that prevent providers from engaging in these required practices.

Towards a community mental health care for people with schizophrenia in Colombia.

Mental health care based on the community has shown to be effective and successful for the health care service to people with severe mental disorders such as schizophrenia, evidence that is less clear in the health care system in Colombia, where weaknesses are present, both for prevention and rehabilitation, although national guidelines give importance to the social context in relation to the disease. As a contribution to the discussion on providing care for people living with schizophrenia, a topic review was conducted with the aim of identifying experiences in community mental health care services, in relation to their relevance to these people at the national level. Articles were searched on Scientific Electronic Library Online (SciELO) Medline with Full text, Science Direct and documents of the World Health Organization, Pan American Health Organization and the Colombian Ministry of Health and Social Protection. Few experiences in community care for people with schizophrenia in Colombia were found and given its importance to public health worldwide, a call for attention is made towards the construction and implementation of these models in the Colombian context.

Inter-professional perspectives of dementia services and care in England: Outcomes of a focus group study.

Many people living with dementia are supported at home using a variety of health and social care services. This paper reports the findings from a focus group study undertaken with staff in community mental health teams to explore areas for improvement in relation to national policies and recommendations for dementia care. Two focus groups were held with staff (n = 23) in 2011 to discuss topics including service delivery, information and communication, and provision of health and community care for people with dementia. Respondents identified problems with information sharing and incompatible electronic systems; inflexibility in home care services; and poor recognition of dementia in hospital settings. General practitioners had developed a greater awareness of the disease and some community services worked well. They felt that budgetary constraints and a focus on quality indicators impeded good dementia care. Key areas suggested by staff for improvements in dementia care included the implementation of more flexible services, dementia training for health and social care staff, and better quality care in acute hospital settings.

精神障害者の地域ケアにおける通過型グループホームの役割―「ケア空間」の形成に注目して―

精神障害者の地域ケアにおける通過型グループホームの役割―「ケア空間」の形成に注目して―

“Why can’t they be in the community?” A policy and practice analysis of transforming care for offenders with intellectual disability

Purpose – The purpose of this paper is to describe key policy and practice issues regarding a significant subgroup of people with intellectual disability – those with offending behaviour being treated in forensic hospitals. Design/methodology/approach – The reasons why psychiatrists continue to be involved in the treatment of people with intellectual disability and mental health or behavioural problems and the factors that may lead to patients needing hospital admission are examined. Using two illustrative examples, three key questions – containment vs treatment, hospital care vs conditional discharge and hospital treatment vs using deprivation of liberty safeguards usage in the community are explored. Findings – Patients with intellectual disability, mental health problems and offending behaviours who are treated within forensic inpatient units tend to have long lengths of stay. The key variable that mediates this length of stay is the risk that they pose to themselves or others. Clinicians work within the framework of mental health law and have to be mindful that pragmatic solutions to hasten discharge into the community may not fall within the law. Originality/value – This paper makes practical suggestions for the future on how to best integrate hospital and community care for people with intellectual disability, mental health and offending behaviours.

Skrb za osebe z depresijo v Sloveniji: pregled literature

Uvod: Članek predstavlja rezultate raziskave o obsegu in vrsti objavljenega znanstvenega in strokovnega znanja o skrbi za osebe z depresijo v Sloveniji. Temeljni namen je bil na podlagi pregleda, analize ter sinteze znanstvenih in strokovnih informacij ugotoviti, ali to znanje omogoča razvoj celostne, integrirane skupnostne skrbi za osebe z depresijo v Sloveniji. &#x0D; &#x0D; Metode: Uporabljen je bil pregled literature. Zbiranje znanstvene in strokovne literature je potekalo po vzajemni bibliografsko-kataložni bazi podatkov (COBIB.SI) v obdobju od januarja do julija 2013. Za analizo je bilo uporabljeno spletno orodje EndNoteWeb. Rezultati pregleda vključujejo število najdenih enot po ključnih besedah ločeno glede na časovno obdobje izida, ocena kakovosti temelji na analizi vključenih znanstvenih raziskav.&#x0D; &#x0D; Rezultati: Rezultati obsegajo bazo literature znanstvenoraziskovalnega in strokovnega publiciranja v Sloveniji od leta 2000 do 2013 (435 enot) in iz nje izhajajoč zemljevid kategorij pojmovanja skupnostne skrbi za osebe z depresijo. Narejena je bila analiza kakovosti vključenih raziskav z vidika uporabljenih raziskovalnih metod. Pri kvalitativni sintezi so bile uporabljene kode (31) in kategorije (4) kot rezultat pregleda kvalitativne sinteze.&#x0D; &#x0D; Diskusija in zaključek: Za razvoj skupnostne skrbi za osebe z depresijo je v Sloveniji premalo empiričnih dokazov. Primanjkuje tudi orodij za merjenje in primerjavo stopnje integracije ter celovitosti integriranih storitev skupnostne skrbi na ravni lokalnih skupnosti.

Effectiveness of a community-based intervention for people with schizophrenia and their caregivers in India (COPSI): a randomised controlled trial

SummaryBackgroundObservational evidence suggests that community-based services for people with schizophrenia can be successfully provided by community health workers, when supervised by specialists, in low-income and middle-income countries. We did the COmmunity care for People with Schizophrenia in India (COPSI) trial to compare the effectiveness of a collaborative community-based care intervention with standard facility-based care.MethodsWe did a multicentre, parallel-group, randomised controlled trial at three sites in India between Jan 1, 2009 and Dec 31, 2010. Patients aged 16–60 years with a primary diagnosis of schizophrenia according to the tenth edition of the International Classification of Diseases, Diagnostic Criteria for Research (ICD-10-DCR) were randomly assigned (2:1), via a computer-generated randomisation list with block sizes of three, six, or nine, to receive either collaborative community-based care plus facility-based care or facility-based care alone. Randomisation was stratified by study site. Outcome assessors were masked to group allocation. The primary outcome was a change in symptoms and disabilities over 12 months, as measured by the positive and negative syndrome scale (PANSS) and the Indian disability evaluation and assessment scale (IDEAS). Analysis was by modified intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN 56877013.Findings187 participants were randomised to the collaborative community-based care plus facility-based care group and 95 were randomised to the facility-based care alone group; 253 (90%) participants completed follow-up to month 12. At 12 months, total PANSS and IDEAS scores were lower in patients in the intervention group than in those in the control group (PANSS adjusted mean difference −3·75, 95% CI −7·92 to 0·42; p=0·08; IDEAS −0·95, −1·68 to −0·23; p=0·01). However, no difference was shown in the proportion of participants who had a reduction of more than 20% in overall symptoms (PANSS 85 [51%] in the intervention group vs 44 [51%] in the control group; p=0·89; IDEAS 75 [48%] vs 28 [35%]). We noted a significant reduction in symptom and disability outcomes at the rural Tamil Nadu site (−9·29, −15·41 to −3·17; p=0·003). Two patients (one in each group) died by suicide during the study, and two patients died because of complications of a road traffic accident and pre-existing cardiac disease. 18 (73%) patients (17 in the intervention group) were admitted to hospital during the course of the trial, of whom seven were admitted because of physical health problems, such as acute gastritis and vomiting, road accident, high fever, or cardiovascular disease.InterpretationThe collaborative community-based care plus facility-based care intervention is modestly more effective than facility-based care, especially for reducing disability and symptoms of psychosis. Our results show that the study intervention is best implemented as an initial service in settings where services are scarce, for example in rural areas.FundingWellcome Trust.

Development of a sustainable community mental health program in a remote region: the Austral Institute for Mental Health

This paper described a community-based rehabilitation program in a remote region of Argentina. The program is located in Neuquén Province, in the Patagonia region. At the time it was initiated, about 20 years ago, the province had an excellent system of primary care, but one in which mental disorders were neglected. There were only a few psychiatrists in the province, and none involved in community care of people with severe mental disorders. Starting from this point, the "Austral" program was developed by making use of the local resources (such as primary care doctors) that were available, and it later earned a reputation as a model program.In 2012, Neuquén became a site of the RedeAmericas, a National Institute of Mental Health funded regional mental health network in Latin America.

Outcome data for the remote patient monitoring over three years of over 1000 patients in Northern Ireland with a long-term chronic illness

Over a period of four years Alere Connected Health’s (ACH) management and specialist telehealth nurses have designed, implemented and delivered a completely new and re-engineered model of community care for people with long-term conditions (LTC) that has resulted in the delivery of a full ‘end to end’ clinical telehealth managed service monitoring over the period for over 1000 patients from two NHS Trusts in Northern Ireland. ACH were commissioned to develop programmes to deliver chronic disease monitoring and from the outset it was clear that the Department of Health was looking for a ‘service delivery’ partner rather than a ‘kit provider’. This regional telehealth programme in partnership with Belfast Health and Social Care Trust and South Eastern Health and Social Care Trust managed patients with one or more long-term conditions, their main chronic conditions being COPD, CHF and Diabetes. This new model of care has now been commissioned by the NHS in Northern Ireland as a National telehealth monitoring service awarding a 6-year contract for the monitoring of several thousand people with a LTC. The ACH telehealth service is ‘technology agnostic’ and can be used with point of care devices from any manufacturer, making it easier for commissioners and users that are already familiar with a particular telehealth product or manufacturer. During the four-year programme the ACH team developed an innovative web based activity database and telehealth management system software (TMS) in order to gather additional data from and about the patients care in order to determine more accurate programme evaluation data. The data gathered involved clinical, technical and statistical information in order to determine patient utilisation, return on investment (ROI) information and programme outcomes not usually derived from most commercial telehealth ‘back-end’ web server solutions. (In the process the ACH nursing team won two National Awards for ‘Innovation and Partnering’ with the NHS.) A number of significant outcomes and goals have been achieved during the past four years about service delivery and clear evidence suggests that tele health home patient monitoring can be used as a method of reducing hospital admissions, it appears to promote patients to become better self managers of their long term condition and ultimately enjoy a better quality of life, whilst delivering cost efficiencies to the health care provider. This resulted in fewer unnecessary appointments with their GP.

Influence of location on a good death

With the recent emphasis of the Department of Health on reducing unnecessary hospitalisation at the end of life and improving community care for people dying at home, it could be assumed that dying at home is the gold standard. However, healthcare professionals should be able to give a patient choice over where they die, whether that is at home, in hospital or in a hospice. This article asks the reader to consider whether location of death has an influence on the quality of death.