Models Of Psychiatric Rehabilitation Research Articles

Psychiatric Rehabilitation in the GDR against the Background of Soviet Influences

The study describes developments and local models of psychiatric rehabilitation in the GDR and the USSR. After the Second World War patient care was focused on hospitals. The Rodewisch Theses and the Brandenburg Theses as well as the "Conception to improve the patient care for mentally ill people after 1980" were important suggestions. The GDR primary literature review shows that soviet concepts were often received. The principles of stages, continuity and sectorization set the stage for success here and there. Transition units such as psychoneurological dispensaries, the occupational/protected workshops and assisted residences, therapeutic clubs, day and night hospitals were created. The occupational therapy was intended to facilitate the transition into the normal working. As a consequence, during the 1970s and 1980s in the GDR a high level of employment of mentally ill people in the economy could be achieved.

Personalisation and choice in psychiatric spaces Nachricht eingeben

Abstract In Europe psychiatric wards tend to be highly institutionalised settings, often lacking essential psychosocially-supportive elements which promote health, wellbeing and social interaction of patients and staff. This happens in the name of increased safety and anti-ligature standards or as a result of neglect and stigma often resulting from reduced opportunities of patients to actively participate in the decision making of their lives, the conditions of hospitalisation and the quality of their environments. Research on healthcare environments shows a profound impact of the built environment on therapeutic outcomes. While many recommendations derived from these studies, such as views to nature or single bedrooms, are difficult to implement in existing facilities, everyday objects potentially pose a powerful yet easily implementable resource for increasing therapeutic effects of the built environment. In this presentation we are going to briefly describe the hierarchies of psychiatric care affordances, as they derive from the SCP model –S stands for Safety and security, C for competence and P for personalisation and choice– that is a model especially developed for interpreting and evaluating psychiatric environments in relation to these principles. Then we are going to explore further the idea of personalisation and choice, its relationship with the psychosocial model of psychiatric rehabilitation and bring some implemented, practical examples of how this has been implemented in psychiatric settings across Europe and beyond. The aspects of co-design will be highlighted, as a key element of achieving personalisation and valorisation. This will help the audience come, who can be either from healthcare, policy or management backgrounds on the same page with members of the audience who come from a built environment background with concepts of institutionalisation vs ecopsychosocial concepts in relation to the built environment of the psychiatric wards.

Challenges of implementing psychiatric rehabilitation services: a low- and middle-income country case example.

This article aims to explore the barriers and challenges of implementing psychiatric rehabilitation services at a psychiatric hospital in Iran. We performed an internal mixed-methods evaluation by adopting a multi-method approach. The data were organised, analysed and interpreted by the evaluation team. A low participation rate, administrative issues, low fidelity to protocols and incomplete documentation were the main findings. Implementing and maintaining rehabilitation services in low- and middle-income country settings requires more than a mere transfer of models of psychiatric rehabilitation; it needs adaptation to the local context as well as continuous evaluation and quality improvement in an iterative fashion, given the rapidly changing contexts with scarce resources.

Psychiatric rehabilitation in indian general hospital psychiatry unit settings

In India, General Hospital Psychiatry Units (GHPUs) are the backbone for mental health care. GHPUs have less stigma, facilitate inter-specialty collaboration, and provide integrated mental and physical healthcare. GHPUs offer a predominantly medical model of care and face multiple challenges in offering psychiatric rehabilitation, including a severe crunch of human resources. This article summarizes the basic concepts of psychiatric rehabilitation, possible rehabilitation interventions in resource-constrained settings, and interventions that can be delivered with the help of caregivers and frontline mental health workers. The article concludes with some of the pragmatic indigenous models of psychiatric rehabilitation at GHPUs.

An Original Working Model of Psychiatric Rehabilitation

The aim of psychiatric rehabilitation is to achieve the maximum degree of freedom, autonomy and independence of the psychotic patients. We use an original program of rehabilitation born in the north of the Italy written in the book: ‘Freedom, Autonomy and Independence”, Milan 2011. The program is based above all on Neuro-Cognitive Trainings (NCT), and especially Social Skills Training (SST). We consider this interventions the most effective designed to improve social competence and other cognitive abilities of patients with schizophrenia. Methodology is largely oriented on cognitive behavior theory, but we developed an original program calibrated on the needs of our population of patients. Patients with schizophrenia can clearly improve their social competence with NCT and SST to different degrees. We show even a higher level of generalization and persistence of improvements. The most satisfying results are concerning cognitive functions, social and relational competences. Cognitive deficits, social and relational competences can clearly benefit from a structured program based on cognitive remediation and social skills training.

Clubhouse model of psychiatric rehabilitation: How is recovery reflected in documentation?

Recovery-oriented models of psychiatric rehabilitation, such as the Clubhouse model, are an important addendum to the clinical treatment modalities that assist people with chronic and severe mental illness. Several studies have described the subjective experiences of personal recovery of individuals in the clubhouse context, but limited research has been undertaken on how clubhouses have operationalized recovery in practice. The research question addressed in this paper is: How are recovery-oriented practices reflected in the documentation of a clubhouse? The documents examined included representative samples of key documents produced or utilized by a clubhouse, including public health-promotion materials and policy and membership documents. Data were subjected to content analysis, supported by the Recovery Promotion Fidelity Scale. The recovery categories identified in the documents included collaboration (27.7%), acceptance and participation (25.3%), quality improvement (18.0%), consumer and staff development (14.5%), and self-determination (14.5%). These categories show how the clubhouse constructs and represents personal recovery through its documentation. The findings are important in light of the role that documentation can play in influencing communication, relationships, and behaviour within organizations. The findings can also be used to inform future research related to recovery-oriented practices in clubhouse settings.

An overview of the clubhouse model of psychiatric rehabilitation

The aim of this article is to provide an overview of the clubhouse model and its capacity to assist people with severe mental illness. The paper uses a sample vignette (with all identifying information removed) and survey of literature describing clubhouses over the last 15 years. Strengths of the clubhouse model include its ability to provide a safe environment, supportive relationships and supported employment activities. Criticisms include its failure to provide onsite psychiatry clinics and a risk of promoting service dependence. Modern clubhouses continue to provide useful models of psychiatric rehabilitation which are popular worldwide. Studying and describing the model is challenging due to its complexity. Mixed methodological approaches and recovery-orientated measurement tools may assist future research and development.

Cognitive Remediation for Psychotic and Affective Disorders

Cognitive impairment has long been recognized as a symptom of schizophrenia, affective, and psychotic disorders. Until relatively recently, most research has focused on the severity, type, and course of impairment. As is reviewed in this series by Dr Alice M Saperstein and Dr Matthew M Kurtz,1 we have learned that cognitive deficits are evident in most people with schizophrenia and schizoaffective disorders, evident even in the prodromal phase but seem to worsen around the time of first episode, and stable for many years, even as positive symptoms, such as hallucinations and delusions, wax and wane. Dr Christopher R Bowie, Ms Maya Gupta, and Ms Katherine Holshausen2 report in this series that cognitive symptoms in the affective disorders appear to be more state related, though more than 60% of people with bipolar disorder (BD) continue to manifest cognitive dysfunction, even when clinically stable. Most studies comparing people with schizophrenia to nonpsychiatric samples find that cognitive test scores are on average 1.3 to 2.0 standard deviations below the mean, which means that 91% to 98% of the general population score higher. These deficits put patients at a considerable disadvantage when seeking employment and more generally facing the challenges of independent, productive living. Repeatedly, the research indicates that cognitive deficits are associated with functional outcome. It is for this reason that there is tremendous interest in finding ways to treat cognitive dysfunction.In this In Review are 2 papers that provide an overview of the behavioural approaches that have been developed to address cognitive dysfunction in the psychotic and affective disorders. Dr Saperstein and Dr Kurtz1 focus on cognitive remediation (CR) for schizophrenia, while Dr Bowie and colleagues2 address how CR is being used to treat people with psychotic and nonpsychotic affective disorders. We learn from these 2 papers that the field of psychology is at a crossroads. No longer is there debate about whether people with schizophrenia can learn, or if cognitive skills are malleable. The research overwhelmingly supports the efficacy of CR for schizophrenia and schizoaffective disorder-when it is done in the context of a psychiatric rehabilitation model. The evidence base for using CR for people with nonpsychotic affective disorders is relatively smaller; nevertheless, CR for mood disorders is emerging as an effective nonpharmacological treatment option for improving cognitive performance in people with major depressive disorder and BD. Further, CR impacts not only cognition but also, as intended, it helps to improve psychosocial functioning and reduce disability.Having established that cognitive deficits do respond to behavioural interventions, researchers are now tackling how to enhance the ability of CR to improve cognition, how to promote the transfer of cognitive gains to real-world functioning, and develop personalized treatments that are easily disseminated with fidelity. A tension has emerged as these issues are addressed. While there is tremendous enthusiasm for harnessing emerging knowledge about neuroplasticity to engineer more effective and efficient computer-based treatments, there is, simultaneously, a groundswell of support for integrating humanistic psychiatric rehabilitation principles into CR approaches to enhance functional outcomes. At their most extreme, these tensions emerge as camps.1 One side, fuelled by the technology industry, advocates a medical model approach that uses US Food and Drug Administration-approved computer devices that dose cognitive exercises like medications. The other side, fuelled by person-centred advocacy, emphasizes psychotherapeutic approaches to address the many factors (for example, beliefs, motivation, and emotions) that promote transfer of learning to real-world behaviours.The first large multisite study of CR in schizophrenia4 chose the model of dosed, device-based computer exercises to test the effectiveness of CR, and the results failed to replicate the promising findings from a single-site trial of device-based CR. …

Treatment plans in psychiatric community housing programs: Do they reflect rehabilitation principles?

This study examined the extent to which treatment plans of service users of community housing programs measure up to rehabilitation principles according to the Choose-Get-Keep model of psychiatric rehabilitation. The study evaluates whether these plans correspond with service-user and key-worker perspectives on unmet needs for care. A representative sample of key workers and service users of 16 Dutch Regional Institutes for Residential Care (RIRCs) participated in a cross-sectional survey. Sociodemographic and clinical data and an assessment of needs for care of 240 service users were collected. In addition, we received an anonymous copy of each participant's most recent written treatment plan. First, we developed a method to measure adherence to rehabilitation principles of written treatment plans, based on the Choose-Get-Keep model of psychiatric rehabilitation. Next, treatment plans were screened on the degree of adherence, expressed in a score from 0 to 10 for overall quality, and correlated with needs for care. RIRCs mostly seem to succeed in sufficiently integrating rehabilitation principles in their treatment plans. Adherence to rehabilitation principles was neither associated with the service-user perspective nor with the key worker perspective on needs for care. Rehabilitation principles are rather well documented in the majority of written treatment plans, although apparently without substantial consequences for needs for care among the service users. Further research is needed to validate our method and to investigate not only the adherence to rehabilitation principles in written treatment plans, but also in the actual care provision itself.

Parenting With Success and Satisfaction Among Parents With Severe Mental Illness

Parenting With Success and Satisfaction Among Parents With Severe Mental Illness

Comparing working role values of employed and unemployed Clubhouse members

Examine the impact of the Clubhouse Model of Vocational Rehabilitation by comparing the roles values of employed and unemployed members. It is a model of psychiatric rehabilitation and community support, which emphasizes the importance of work as a major re-integrative force for Clubhouse members. Sixty Clubhouse members consisting of 31 employed members and 29 non-employed members. A convenience sample of sixty participants completed the Role Checklist (Revised) (Oakley, Kielhofner, Barris, and Klinger-Reichler, 1988), the Maryland Addiction Questionnaire Short-Form (O'Donnell, 1997), and the Historical Background Survey (Gregitis, 2003). The study was completed at an ICCD certified Clubhouse in the United States. Results showed that there was no significant difference in the working role values of employed and unemployed participants. However, there was a significant difference in resistance to treatment of substance use by employed and unemployed participants. Volition and motivation of the employed Clubhouse members was higher when seeking work and pursuing life roles outside the Clubhouse environment. Unemployed Clubhouse members derived personal satisfaction and volition in the work-ordered day within the clubhouse setting. Further research should include verification, with a larger sample, of the importance of the working role in relation to mental health.

Asian models of excellence in psychiatric care and rehabilitation

In Asia, like other regions, the circumstances for psychiatric care and rehabilitation impose various limitations on us. However, committed professionals have been creating innovative models of excellence, which are culturally appropriate and clinically effective. In this paper, seven innovative models of psychiatric care and rehabilitation are presented.The Nitte project in India provides a comprehensive free rural psychiatric service, while transforming the ‘brain drain’ problem to ‘brain circulation’ cooperation. Through Social Enterprises in Hong Kong recovered clients are trained and employed. Senior Peer Counselling in Singapore emphasizes the relief of emotional distress by psychological methods and the primacy of communication in the healing or therapeutic relationship. Seoul Mental Health 2020, an epoch-making project in Korea, has increased the coverage rate of community mental health centres remarkably. Yuli Psychiatric Rehabilitation Model in Taiwan helps long-term inpatients to get reintegrated into the community. In Japan, models of excellence for community-based psychiatry have been developed at local government, hospital and community/NGO levels. Chinese Psychiatry Online, an excellent website, provides public education, resource searching, self-testing and consultation services for the public along with various contents for professionals.We must disseminate information about models of excellence which provide great benefit to the people who suffer from psychiatric illness without high expenses.

A Comparison of Competitive Employment Outcomes for the Clubhouse and PACT Models

A Comparison of Competitive Employment Outcomes for the Clubhouse and PACT Models

The choose-get-keep model of psychiatric rehabilitation: A synopsis of recent studies.

Objective: Comprehensive review of studies using the choose– get– keep (CGK) process model of psychiatric rehabilitation. Also, other studies are identified that have demonstrated methodologies useful in future research on the CGK model. Intervention Model: The CGK process is conceptualized as the phases through which people with psychiatric disabilities proceed as they engage in psychiatric rehabilitation. Conclusion: The CGK model is a potentially useful psychiatric rehabilitation intervention that can be implemented in a variety of service settings and that focuses on the activities of the practitioner and the service recipient. The CGK model warrants further empirical study to examine its effectiveness.

Place First, Then Train: An Alternative to the Medical Model of Psychiatric Rehabilitation

The medical model has promoted a train-place model for psychiatric rehabilitation. This model carefully trains people with psychiatric disabilities on a range of skills so they can handle real-world demands before placing them in work and independent living situations. More consistent with a social work perspective are place-train programs, which rapidly place people with psychiatric disorders in real-world settings so they can experience the benefits, as well as the challenges of these situations, and then provide the necessary training and support to successfully maintain these placements. This article compares the two models and shows that place-train approaches can help people with serious mental illness attain many of their work and housing goals without increasing the frequency of relapse.

Two Models of Psychiatric Rehabilitation: A Need for Clarity and Integration

Two distinct models are identifiable in the processes of psychiatric rehabilitation: treatment and training. The treatment model, which also can be presented as the "medical model," approaches the issues on the basis of defect which needs to be diagnosed and rectified. On the other hand, the training model, which can also be referred to as the "educational model," approaches the situation from the perspective of recognizing what strengths or abilities the individual may have which can be brought to bear constructively, and how to orchestrate that process. These two models involve different perspectives and different processes, and the model which is chosen affects the relationship of the clinician to the consumer. In the practical clinical situation, a thoughtful amalgam of these two orientations is called for in order best to serve the recipient. But clinicians nevertheless benefit from remaining aware of the two models involved and their attendant assumptions and modes of action, so that inconsistencies are minimized while the most effective and integrated services are provided. Administrators, payers, and researchers will similarly benefit from an understanding of the potential benefits of each of these two approaches to intervention.

Towards an integrated, structural model of psychiatric rehabilitation.

In the past two decades, the number of principles and approaches that have been touted as psychiatric rehabilitation have overwhelmed the service provider. As a result, the field seems to be bombarded by contradictory ideas. In this paper, I seek to resolve this problem by providing an overview of psychiatric rehabilitation in terms of four key structures: goals (the reasons why people with psychiatric disabilities seek rehabilitation), strategies (the tools which service providers might use to help consumers reach their goals), settings (the places in which providers and consumers use these tools), and roles (the variety of professional and personal backgrounds which influence providers in carrying out their duties). In this paper, I review the research literature that has identified relevant examples of each of these structural dimensions. This description of psychiatric rehabilitation is based on a two-factor model of the life challenges that arise from mental illness: the disabilities produced by the disease and the loss of opportunity that result from stigma and discrimination. The paper also includes a brief discussion of the two-factor model.

Implementation of a cognitive rehabilitation program in an iprt setting

Abstract Skills training is a hallmark of the psychiatric rehabilitation model. However, many people with psychiatric illness cannot take advantage of learning opportunities in rehabilitation treatment settings because they have pervasive cognitive deficits in attention, memory and problem solving processes. These cognitive deficits must be addressed if learning is to be facilitated and clients are to achieve their stated goals. This paper describes a cognitive rehabilitation program that was implemented within an intensive psychiatric rehabilitation program. The reasons for choosing this particular model of cognitive remediation, the mechanisms of implementation, response of users and recipients, and reasons for continued use in other settings are described. Results of program evaluation monitoring surveys related to program utilization, psychosocial outcome and skill enhancement are presented.

A century and a half of psychiatric rehabilitation in the United States.

After a brief history, this chapter describes important modalities and models of psychiatric rehabilitation.

Career development theory as a framework for assessment and planning in clubhouse-based transitional employment programs for people with psychiatric disabilities

This article describes assessment and career planning in programs using the clubhouse model of psychiatric rehabilitation and relates clubhouse practice to career development theory. Career development theory provides a useful framework to explain clubhouse assessment methodologies and the role of transitional employment in rehabilitation practice. This article also suggests practice improvements and areas for further research.