Psychiatric Rehabilitation Settings Research Articles

Unidimensional versus multidimensional: A bifactor factor structure of the Self-Stigma Scale-Short (SSS-S) among U.S. adults with psychiatric disabilities.

This study aimed to examine the psychometric properties of the English version of the Self-Stigma Scale-Short (SSS-S), a nine-item self-report self-stigma measurement, among U.S. adults with psychiatric disabilities. We obtained reliability and validity evidence from a sample of 275 adults with psychiatric disabilities. Exploratory factor analysis (EFA; n = 139) yielded a two-factor solution that accounts for 64.97% of the variance. Confirmatory factor analysis (CFA; n = 136) was conducted to compare alternative solutions, including a single-factor model, a two-correlated-factor model, a three-correlated-factor model, and a bifactorial model. The CFA results supported the bifactor S·I - 1 model as a superior latent factor structure for the SSS-S. The coefficient ω of the SSS-S was .94, indicating excellent internal reliability. Concurrent validity of the SSS-S was supported by significant positive correlations with societal stigma and psychiatric symptom severity, and negative correlations with psychiatric disability acceptance, general self-efficacy, and hope. The overall findings concluded that the English version of the SSS-S demonstrated reliable and valid scores and a primarily unidimensional structure of self-stigma among U.S. adults with psychiatric disabilities. Given the adverse impact of self-stigma and its relationships with recovery-related constructs shown in this study, the routine use of the SSS-S is recommended in psychiatric rehabilitation settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Bridging the humanities and health care with theatre: Theory and outcomes of a theatre-based model for enhancing psychiatric care via stigma reduction.

This article describes the rational, methods, implementation, and effectiveness of Identity Development Evolution and Sharing (IDEAS), an evidence-supported, narrative theater-based training that reduces stigma among health care providers to increase health care equity in psychiatric rehabilitation. The IDEAS model has been used to reduce provider bias toward patients. From May 2017 to January 2020, we interviewed people from three patient groups who have been harmed by stigma, including Black women, transgender, and gender-diverse people, and people with substance use disorders. These interviews informed the creation of three theatrical scripts that were performed by professional actors for audiences of health care providers from January 2020 to May 2022. The performances aimed to raise conscious awareness of implicit provider biases and to provide a reflective opportunity to ameliorate these biases. The purpose of IDEAS is to improve experiences in health care settings such as psychiatric rehabilitation of patients from groups who have been harmed by stigma. We used paired-samples t tests to compare pre/postprovider stigma, measured via the Acceptance and Action Questionnaire-Stigma (AAQ-S). Sociodemographic factors for providers who viewed IDEAS were similar across all three performances. IDEAS significantly decreased AAQ-S scores (t = 11.32, df = 50, M = 13.65, 95% confidence limit: [11.32, 15.97], p < .0001). IDEAS reduces provider stigma to support positive clinical encounters with diverse patient populations. These findings are relevant for psychiatric rehabilitation settings, which seek to establish positive rapport between providers and patients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Experiences of the Occupational Therapists During the COVID-19 Pandemic: A Scoping Review.

Occupational therapy has been impacted by the worldwide COVID-19 pandemic and has transitioned from a traditional face-to-face therapy method to an online one. In the wake of the pandemic, occupational therapist faced the challenge of providing online services to people with disabilities. The review aimed to identify and synthesize the best available evidence on the experience of occupational therapists in psychiatric rehabilitation settings during the COVID-19 pandemic. Additionally, the challenges posed by changes in the mode of training were examined. Electronic database search included PubMed, PsycINFO, PsycNET, Cochrane Library, Ovid, MEDLINE, CINAHL, SAGE Journals, Elsevier Science Direct, Springer, Wiley Online Library, JAMA Psychiatry, and Society E-Journals. Inclusion criteria were studies describing the experience of the occupational therapists during the COVID-19 pandemic in psychiatric rehabilitation settings. A systematic search identified 8 studies included quantitative, qualitative and mixed methodology conducted between 2020 and 2022. The findings from the reviewed articles revealed that the complexities and challenges faced by occupational therapists during the COVID-19 pandemic were professional, personal, and organizational; innovative practices were implemented in the psychiatric settings. The review findings expressed both positive (accepting a new mode of training, time saving) and negative experiences (problems with interaction & internet) perceived by the rehabilitation professionals. Enhancing the training of occupational therapists will help in easing the access and know-how of using telerehabilitation services for patients and coping with COVID-19-like situations in the future.

Evaluation of physical health in an in-patient psychiatric rehabilitation setting

BackgroundThe mortality gap between patients with and without serious mental illness (SMI) is around 15–20 years. Here, we aim to identify some of the factors contributing to that gap via poor physical health and sub-optimal medical management. MethodsWe report the results of a detailed cross-sectional study of physical health parameters in an in-patient rehabilitation population in Scotland, including a consideration of concordance with guidelines and comparisons to healthy populations. ResultsData was collected from 57 of all 62 in-patients. 42% were obese (compared to 28% of the population), 84% were smokers (vs 16%), 16% were hypertensive, 22% had raised HbA1c, 50% had raised cholesterol, 47% had QRISK >10%. 68% agreed to a full physical health review, 65% agreed to flu vaccination. Completed screening uptake compared to the Scottish population was low: Cervical (30% vs 69%), Bowel (8% vs 64%), Breast (23% vs 72%), Abdominal Aortic Aneurysm (0% vs 78%). Patients generally had up to date recorded weight (100%), blood pressure (98.2%), heart rate (98.2%) and lipids (89.4%), but not ECG's (61.4%) or Diabetes screening (59.6%). Following review, 17 referrals were made to medics/surgeons, 29 to broader specialties, 24 medications were started, 9 stopped and 27 changed: most commonly statins (12 patients), vitamin D (8 patients) and hypoglycemics (5 patients). ConclusionsThe findings highlight cardiovascular risk factors and cancer screening as specific areas to target for improving poor physical health in populations with SMI. Patients are often willing to engage but specific ways to lower the barriers to screening and treatment are required.

Patient outcomes in an Australian low secure forensic psychiatric rehabilitation inpatient unit: a 10-year retrospective study

The aim of this study is to investigate the background and discharge outcomes of the forensic patient population rehabilitated through a low secure forensic psychiatric rehabilitation inpatient unit. Currently within Australia and internationally there is a scarcity of research completed within this setting. A quantitative methodology was selected coupled with descriptive statistics to investigate a total of 23 patients and analyse their demographics, historical information, length of stay and post-discharge outcomes including readmission and breach of forensic orders. This study provides insights into this unique patient group and further clarifies their psychiatric treatment and biopsychosocial needs. A significant variance was found within patient length of stay throughout each stage of the forensic system. Low rates of readmissions and breaches of forensic orders were found. Additional research is needed in this low secure psychiatric rehabilitation setting to clarify the forensic pathways of care and needs amongst this cohort.

Evaluation of Physical Health in an In-Patient Psychiatric Rehabilitation Setting

AimsThe mortality gap between patients with serious mental illness (SMI) and without is around 15–20 years. This has multiple contributing factors including poor physical health, side effects of antipsychotic medications and sub-optimal medical management. Presented here is a detailed cross-sectional study of physical health measures in an in-patient rehabilitation population in Scotland. Results are compared to national averages and clinical guidelines with the aims to a) benchmark physical health in this population and b) where possible improve physical health.MethodsPhysical health data including observations, blood tests, and investigations was collected ahead of detailed structured interviews and physical exams performed by a post-foundation doctor. These results were compared to recommendations for physical health monitoring from numerous national and government guidelines (SIGN, NICE, Scottish Government, Maudsley). Data were collected in 4 domains, 1) Indicators of physical health, 2) Engagement with physical health, 3) Concordance with guidelines and 4) Outcomes of reviews.ResultsData were collected from 57 of all 62 in-patients. 34 reported being generally happy with their health vs 15 unhappy. 42% were obese (compared to 28% of the general population), 84% were smokers (vs 16% in the local population) 16% were hypertensive, 22% had raised HbA1c, 50% had raised cholesterol, 47% had QRISK &gt;10%. 68% agreed to a full physical health review, 65% agreed to flu vaccination. Completed cancer screening uptake compared to the Scottish population was low; Cervical (30% vs 71%), Bowel (8% vs 59%), Breast (23% vs 72%), AAA (0% vs 84%). Patients were generally up to date in terms of recorded weight (100%), BP (98.2%), HR (98.2%) and lipids (89.4%), but not ECG's (61.4%) and Diabetes screening (59.6%). 17 referrals were made to medics/surgeons, 29 to MDT's, 24 medications started, 9 stopped and 27 changed, most commonly statins (12 patients), vitamin D (8 patients) and hypoglycemics (5 patients).ConclusionCardiovascular disease indicators were notably raised, uptake of screening was very poor and there were areas where the service didn't meet national guidelines. The number of referrals and medication changes suggest an unmet need within such services. The findings, if generalisable across similar populations, suggest that more can be done to address ongoing poor physical health in populations with SMI and indeed patient readiness to comply with physical health screening. Screening for key physical health parameters needs to be augmented by working to engage patients and following up with management plans for abnormalities found.

Self-reported pain, somatization and depression in psychiatric rehabilitation setting

Self-reported pain, somatization and depression in psychiatric rehabilitation setting

A realist evaluation of weighted modalities as an alternative to pro re nata medication for mental health inpatients.

Implementing psychosocial approaches into mental health inpatient settings continues to be challenging. This is despite mental health policies prioritizing trauma-informed and recovery-orientated care approaches. This study reports on an interdisciplinary project that implemented and examined the uptake of weighted modalities in a psychiatric inpatient rehabilitation setting. While over-reliance on pro re nata (PRN) medication in these settings has been reported, weighted modalities are a sensory approach that can be self-initiated by consumers as an alternative to use of PRN to manage distress and agitation. A mixed-methods realist approach was used to determine what works, for whom, and in what circumstances weighted modalities were offered by clinicians and used by consumers. Additionally, we were interested in determining whether there was an associated change in PRN use during the trial. Data included in-depth interviews with consumers (n = 12) and clinicians (n = 11), and extraction of PRN medication use preceding, throughout, and following implementation. Statistical analysis revealed a significant increase in PRN rates in the first 3 months of implementation (mean difference from baseline = 29.5, P = 0.047) but a significant decrease in the second three-month period following implementation (mean difference from baseline = -30.7, P = 0.036). Qualitative findings highlighted the key components of successful implementation as being environmental restructuring (availability/accessibility and visibility of weighted modalities) and social influences. Strategies to enhance these components are discussed.

Patient &amp; staff perceptions of animal-assisted therapy in psychiatric rehabilitation

AimsTo study patients' subjective experiences of having access to a therapy dog and to assess the staff perception of the impact of pet therapy. Hypothesis: pet therapy services are acceptable for rehabilitation patients.BackgroundAnimal-assisted therapy (AAT) is the supervised use of an animal in a therapeutic setting to help in the treatment of physical or psychological disorders in humans. The use of dogs in the context of AAT - ‘dog therapy’ (DT) - has been piloted in the context of stroke rehabilitation; schizophrenia in elderly patients; depression, loneliness and anxiety in elderly patients; Alzheimer's disease; symptom reduction in PTSD; cognitive impairment; and dementia. The impact of pet therapy in long term psychosis care has not been adequately assessed.MethodThis feasibility pilot study used questionnaires to assess patient (n = 12) and staff (n = 10) perceptions of dog therapy in an in-patient psychiatric rehabilitation setting. 24 patients on a rehabilitation ward with complex psychosis were offered the opportunity to interact with ‘Nugget,’ a corgi trained in the United States as a ‘therapy dog.’ A ‘patient questionnaire’ (PQ) and a ‘staff questionnaire’ (SQ) assessed the acceptability and self-rated benefits of the intervention.ResultAll patients (100%) rated highly on the enjoyment, anxiety, calmness, and comfort domains during the dog therapy, and expressed willingness to receive further sessions in the future. The SQ measured staff perceptions of patients’ engagement, enjoyment, comfort and emotional response to the therapy. 100% of staff rated highly on all questions and thought the interventions had recovery value. Engagement was one key factor noted in the feedback. There were no reported adverse reactions to the intervention.ConclusionOur preliminary results showed high acceptability and perceived value for Animal assisted therapy in a psychiatric rehabilitation setting. Given the impact of social isolation and need for connectedness, we recommend access to pet therapy where possible to be integrated into individual recovery programmes.

Psychometric validation of the Job Satisfaction of Persons with Disabilities Scale in a sample of peer support specialists.

The primary purpose of the study was to evaluate the psychometric properties of the Job Satisfaction of Persons with Disabilities Scale in a sample of peer support specialists. A total of 121 employed peer support specialists with lived experience of a serious mental health condition were recruited for this study from statewide peer certification training programs and the International Association of Peer Supporters. Respondents completed an online survey on job satisfaction and related constructs. A principal components analysis was used to explore and identify the instrument subscales. The findings identified 2 factors: (a) the 9-item job satisfaction with intangible benefits factor and (b) the 5-item job satisfaction with tangible benefits factor. The Job Satisfaction of Persons with Disabilities Scale demonstrates good-to-excellent psychometrics. The use of this scale among peer support specialists within training and supervision practices in psychiatric rehabilitation settings is warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Sportliche Aktivität und psychische Erkrankungen

Current meta-analyses demonstrate convincing evidence regarding the efficacy of exercise on depression, insomnia, anxiety disorders, schizophrenia and ADHD. However, exercise and sports therapy approaches for patients with psychological disorders are mostly integrated in psychiatric inpatient or rehabilitation settings, but not applied in the outpatient sector. Thus, the German Health sector does not take the advantage of the compelling therapeutic effects of exercise. This review covers the theoretical and empirical fundamentals of the effects of exercise and illustrates practical implications by means of the presentation of the group-therapeutic exercise program ImPuls, that was specifically designed for patients with psychological disorders in outpatient settings. ImPuls integrates current evidence of the effects of exercise (type of sport, duration, frequency, intensity) and the facilitation of motivational and volitional strategies to support patients to integrate exercise in their daily life routines.

Sportliche Aktivität und psychische Erkrankungen

Current meta-analyses demonstrate convincing evidence regarding the efficacy of exercise on depression, insomnia, anxiety disorders, schizophrenia and ADHD. However, exercise and sports therapy approaches for patients with psychological disorders are mostly integrated in psychiatric inpatient or rehabilitation settings, but not applied in the outpatient sector. Thus, the German Health sector does not take the advantage of the compelling therapeutic effects of exercise. This review covers the theoretical and empirical fundamentals of the effects of exercise and illustrates practical implications by means of the presentation of the group-therapeutic exercise program ImPuls, that was specifically designed for patients with psychological disorders in outpatient settings. ImPuls integrates current evidence of the effects of exercise (type of sport, duration, frequency, intensity) and the facilitation of motivational and volitional strategies to support patients to integrate exercise in their daily life routines.

Consumer factors predicting level of treatment response to illness management and recovery.

This study aims to identify consumer-level predictors of level of treatment response to illness management and recovery (IMR) to target the appropriate consumers and aid psychiatric rehabilitation settings in developing intervention adaptations. Secondary analyses from a multisite study of IMR were conducted. Self-report data from consumer participants of the parent study (n = 236) were analyzed for the current study. Consumers completed prepost surveys assessing illness management, coping, goal-related hope, social support, medication adherence, and working alliance. Correlations and multiple regression analyses were run to identify self-report variables that predicted level of treatment response to IMR. Analyses revealed that goal-related hope significantly predicted level of improved illness self-management, F(1, 164) = 10.93, p < .001, R2 = .248, R2 change = .05. Additionally, we found that higher levels of maladaptive coping at baseline were predictive of higher levels of adaptive coping at follow-up, F(2, 180) = 5.29, p < .02, R2 = .38, R2 change = .02. Evidence did not support additional predictors. Previously, consumer-level predictors of level of treatment response have not been explored for IMR. Although 2 significant predictors were identified, study findings suggest more work is needed. Future research is needed to identify additional consumer-level factors predictive of IMR treatment response in order to identify who would benefit most from this treatment program. (PsycINFO Database Record

Clinician Perspectives of Inpatient Forensic Psychiatric Rehabilitation in a Low Secure Setting: A Qualitative Study

There is a dearth of research into what low secure forensic psychiatric rehabilitation means in Australia and internationally. The aim of this study was to understand clinician perspectives of forensic psychiatric rehabilitation in a low secure setting in Australia and offer insight into a model of care. A qualitative methodology was chosen with separate semi-structured interviews being conducted with staff members involved in decision-making for forensic psychiatric patients in a rehabilitation unit. Analysis of the interviews identified three domains that the questions related to: ‘defining and describing security’, ‘defining and describing low secure forensic psychiatric rehabilitation’ and ‘describing the role of staff and services in a low secure forensic psychiatric rehabilitation setting’. Where relevant, themes were abstracted from the questions that related to these domains. This study revealed that clinicians had a varied understanding of definitions for security but a similar understanding of what low secure forensic psychiatric rehabilitation means, what patients are suitable and the general goals of rehabilitation in this setting. Further research is needed on low secure rehabilitation and specific models of care. There is also a need to develop clear definitions for both security and rehabilitation in low secure forensic psychiatric settings.

Assessing Community Functioning and Independent Living Skills of Individuals with Severe Mental Illness

Background: Community integration and participation are important predictors of successful rehabilitation and recovery in individuals with severe mental illness (SMI). However, individuals with SMI still experience considerable psychosocial barriers to meaningful participation in social, community, civic, and daily living activities. Aims: The purpose of this study was to evaluate and validate a revised version of the Independent Living Skills Survey-Self-Report (ILSS-SR), the R-ILSS-SR, for use by rehabilitation researchers and practitioners in psychiatric rehabilitation settings. Method: One hundred ninety-four individuals with SMI were recruited from four mental health agencies in two states in the Midwestern and Southern United States. Factorial validity of the R-ILSS-SR was evaluated using exploratory factor analysis (EFA). Findings: Principal components analysis of the R-ILSS-SR yielded a four-factor measurement structure (self-care, home maintenance, and health maintenance; meaningful activity/work; transportation; and job maintenance). R-ILSS-SR subscales also correlated with known predictors of community participation in the expected directions. Conclusions: This study validated the R-ILSS-SR as a measure of community participation in a sample of adults with SMI. The ILSS-SR is the only measure of community participation specifically developed and validated for adults with SMI. Given that community participation is an integral aspect of recovery for adults with SMI, the R-ILSS-SR can be used to assess participation in psychiatric rehabilitation research and practice.

Development of a Social Skills Assessment Screening Scale for Psychiatric Rehabilitation Settings: A Pilot Study.

Context:Deficits in social skills may present in a range of psychiatric disorders, particularly in the more serious and persistent conditions, and have an influence on functioning across various domains.Aims:This pilot study aimed at developing a brief measure, for structured evaluation and screening for social skills deficits, which can be easily integrated into routine clinical practice.Settings and Design:The sample consisted of 380 inpatients and their accompanying caregivers, referred to Psychiatric Rehabilitation Services at a tertiary care government psychiatric hospital.Materials and Methods:The evaluation included an Inpatient intake Proforma and the 20-item Social Skills Assessment Screening Scale (SSASS). Disability was assessed using the Indian Disability Evaluation and Assessment Scale (IDEAS) for a subset of 94 inpatients.Statistical Analysis Used:The analysis included means and standard deviations, frequency and percentages, Cronbach's alpha to assess internal consistency, t-tests to assess differences in social skills deficits between select subgroups, and correlation between SSASS and IDEAS scores.Results:The results indicated the profile of social skills deficits assessed among the inpatients with varied psychiatric diagnoses. The “psychosis” group exhibited significantly higher deficits than the “mood disorder” group. Results indicated high internal consistency of the SSASS and adequate criterion validity demonstrated by correlations with select IDEAS domains. Modifications were made to the SSASS following the pilot study.Conclusions:The SSASS has potential value as a measure for screening and individualised intervention plans for social skills training in mental health and rehabilitation settings. The implications for future work on the psychometric properties and clinical applications are discussed.

Successful evaluation of cognitive function and the nature of cognitive deficits among people with schizophrenia in clinical rehabilitation settings.

Despite possessing considerable relevance for planning and delivery of effective rehabilitation interventions, systematic evaluation of cognitive function is often ignored in clinical practice. This paper describes a successful method for measuring cognitive function and the nature of cognitive deficits (CD) in people with schizophrenia admitted to psychiatric rehabilitation services. Data on the cognitive functioning of consecutive patients with schizophrenia / schizoaffective disorder admitted during a 5-year period to a public in-patient rehabilitation facility was collated retrospectively and analysed. The Brief Assessment of Cognition in Schizophrenia (BACS) was used to evaluate cognitive function. It was possible to administer the BACS to 122 of 135 consecutive admissions. The mean composite score on the BACS was 1.8 standard deviations below the norm, and 43% had moderate or severe CD. The BACS sub-tests of list learning and symbol coding revealed more severe deficits. The study indicates that evaluation of cognitive function using brief instruments is feasible in psychiatric rehabilitation settings. Global and domain-specific CD were prevalent among people with schizophrenia. In view of the strong association of cognitive functioning with community functioning and rehabilitation outcomes, further studies exploring the feasibility and utility of routinely evaluating cognitive function are warranted.

PM444. Effectiveness of Integrating Cognitive Remediation Program into Everyday Clinical Practice of Schizophrenia at Psychiatric Rehabilitation Settings

PM444. Effectiveness of Integrating Cognitive Remediation Program into Everyday Clinical Practice of Schizophrenia at Psychiatric Rehabilitation Settings

Clinical dashboards and their use in an adult mental health inpatient setting, a pilot study

Purpose – The purpose of this paper is to explore the experiences and opinions of mental health professionals working in two rehabilitation wards to a clinical dashboard system. Design/methodology/approach – Following the creation of the clinical dashboards, a questionnaire was developed and sent to staff and patients across two clinical wards involved in the clinical dashboard mental health pilot. Findings – The clinical dashboards were viewed as being useful tools for clinicians, supporting engagement. They can offer rapid access to large volumes of clinically useful information, in a palatable format. The pilot suggested that they could be presented in different ways to make them easier to engage with however they could also result in more paperwork for clinicians. Research limitations/implications – The main limitations included the sample size, responder bias and the limited sampling period. It would have been helpful to have obtained further responses to understand why individuals came to their conclusions. Practical implications – The development and use of clinical dashboards in a psychiatric rehabilitation setting offered the opportunity to improve quality, collect and respond to relevant clinical data trends: which is regarded positively by staff and patients. Originality/value – This study represents the first study to examine the use of clinical dashboards within a UK long stay adult mental health ward setting. The results suggest a positive response from both staff and patients and illustrates the potential benefits relating to clinical quality.

Recovery narrative photovoice: Feasibility of a writing and photography intervention for serious mental illnesses.

The primary purpose of this article is to describe the development and feasibility of the Recovery Narrative Photovoice intervention. The nature of this intervention will be discussed, including facilitating empowerment and a positive sense of identity among people with serious mental illnesses. We will also describe the integration of Photovoice methodology with psychoeducational components, informed by principles of the recovery movement and narrative therapy. Sixteen participants with serious mental illnesses from a psychosocial rehabilitation and education center in the Northeast participated in a pilot study evaluating this new 10-week intervention with a pre-post test design. To assess feasibility, descriptive statistical analyses were conducted of attendance data and number of works produced. The pilot study was implemented in 2 consecutive waves with 8 participants each. High rates of attendance (69%) and production of photovoice works (82%) were demonstrated over the course of the 2 waves of the pilot. Findings support the feasibility and acceptability of the Recovery Narrative Photovoice for individuals with serious mental illnesses. These results reflect the potential for using this intervention in psychiatric rehabilitation settings to facilitate recovery-related outcomes, including empowerment, positive identity, and community integration. Future research will require a replication of pre-post assessment of this intervention to further establish the efficacy of this program.