Health Rehabilitation Services Research Articles

Does Ageism Exist Among Multidisciplinary Rehabilitation Students? Predictors of Attitudes Toward Older Adults.

With the growing population of older adults, the demand for health rehabilitation services has rapidly increased. Like many countries around the world, the older population in Saudi Arabia is increasing. Tackling ageism has powerful provenance for uncovering and changing the dynamics of contemporary aging in Saudi Arabia. This study examined the attitudes toward older adults and the potential predictors influencing these attitudes among multidisciplinary health rehabilitation students. A total of 293 health rehabilitation students completed an online survey with a mean age of 21.1± 1.3 years. The survey included data about demographic and geriatric-related characteristics, attitudes toward older adults (UCLA-GA), knowledge of aging (FAQ) and aging anxiety (AAS). Most participants were female (70.3%), with 53% of the students specializing in physical therapy. The average score of attitudes toward older adults was 3.43 (0.40). The predictors of attitudes toward older adults were knowledge of aging (β = 0.34, p < 0.0001), living with older adults (β = 0.12, p = 0.02) and the importance of contact (very important, β = 0.31, p = 0.04). Theseresultsprovide furtherevidencetosupportthat ageist attitudes among students can be overcome by enhancing knowledge of aging and promoting positive contact with older adults. With the demographic shift in Saudi Arabia, we propose that there is a great need for establishing a competency-based geriatric education and strategies to enhance positive contact with older adults.

Contemporary Mental Health Rehabilitation

A major driver during the era of 'deinstitutionalisation' was the change in societal attitudes towards people with mental illness, away from exclusion and marginalisation towards inclusion and participation in society. More recent mental health policy has tended to focus on promotion, prevention and early intervention, with little mention of those with more complex problems. However, despite the significant investment in early intervention services, long term studies consistently show that around a quarter of people newly presenting with psychosis do not do well. Nevertheless, there is good evidence that with appropriate treatment and support from specialist mental health rehabilitation services, even people with the most severe problems can achieve, sustain and enjoy a rewarding life in the community, yet many 'deinstitutionalised' countries fail to provide rehabilitation services, placing this group at risk of neglect, exploitation and institutionalisation. Happily, this situation is beginning to change. The publication of the first National Institute of Health and Care Excellence (NICE) Clinical Guideline on Rehabilitation for People with Complex Psychosis (NICE; CG 181, 2020) represents a sea change in the recognition of the needs of those with the most severe mental health problems and provides evidence-based recommendations about the treatment and support that should be provided. Alongside this, policy makers in many countries are beginning to recognise the need to include rehabilitation services in their mental health plans. It has been a long time coming, but mental health rehabilitation services are finally being acknowledged as an essential component of the mental health system.

Urban-rural difference in the costs of disability and its effects on poverty among people with disabilities in China.

The urban-rural difference in poverty is an important issue in China, particularly for people with disabilities. The extra costs of disability render this population susceptible to falling into poverty, where this can exacerbate the inequality among people with disabilities between urban and rural areas of the country. Previous studies have provided empirical evidence for the extra costs of disabilities in certain countries, but little scholarly attention has been devoted to the urban-rural gap in the costs of disability, particularly in countries like China that have a dual urban-rural system. This study explores changes in the extra costs of disability in China between urban and rural households with disabled members from 2008 to 2018 by using the standard of living approach. We apply the Foster-Greer-Thorbecke Poverty Index to measure the rates of poverty in urban and rural households with disabilities after considering the costs of disability. The results reveal that the costs of disability were not always lower for rural households than for urban households. At the same time, many rural households with disabled people were found to suffer from severe poverty owing to the high costs of their disabilities. The difference in health insurance and rehabilitation services between urban and rural China have led to an urban-rural gap in the costs of disability. This suggests that supplying more goods and services for disabled people in rural areas, especially free services, and raising the reimbursement due to them from their health insurance can help improve their standard of living.

Staff Experiences of Integrating Peer Support Workers and Clinical Staff in Community-Based Residential Mental Health Rehabilitation: A Pragmatic Grounded Theory Analysis.

Mental health services are increasingly incorporating the views and expertise of people with a lived experience of mental illness in service delivery. A novel approach to this is the 'integrated staffing model' being trialled at two Australian public residential mental health rehabilitation services (Community Care Units, CCUs) where peer support workers (PSWs) occupy the majority of staff roles and work alongside clinicians. Semi-structured interviews were completed with fifteen staff 12-to-18-months after service commencement. Transcripts were analysed following principles of grounded theory analysis. Key emergent themes were: (1) recovery is a deeply personal and non-linear process; (2) The CCU as a transitional learning environment; (3) the integrated staffing model facilitates an effective rehabilitation team; and (4) coming together under the integrated staffing model required a steep learning curve. The findings suggest that the integrated staffing approach may provide a pathway to facilitate the meaningful inclusion of PSWs in rehabilitation settings.

Strengthening rural surgery in the Philippines: Essential in achieving universal health care.

The Lancet Commission on Global Surgery (LCoGS) launched Global Surgery 2030 to address the surgical services inequities with a bias toward low-income and middle-income countries like the Philippines. The same inequity is observed particularly when it comes to the urban-rural divide. With more than half of the population living in rural areas, access to surgery becomes a major challenge that further impedes the much-needed health of an economically productive workforce. The Universal Health Care [UHC] Act (RA 11332) of 2019 ensures that all Filipinos have access to quality, cost-effective, promotive, preventive, curative, rehabilitative, and palliative health services without causing a financial burden. Recognizing the provision of essential surgery, in the context of primary healthcare is important. It should be accessible, continuous, comprehensive, and coordinated at the time of need - parallel to the principle of primary health care. Driven by this concept and experiences, the authors conceptualized and presented the Philippine Rural Surgery model for future development and implementation. This is envisioned to provide essential surgery among local rural primary health care settings that is universal, accessible, cost-effective and safe. As this is still new in the Philippines, we proposed tenets and recommendations based on WHO Health System Strengthening building blocks to guide stakeholders in creating formal plans towards institutionalization under the principles of UHC. Such access to surgical service in the context of a unique socio-demography of the Philippines would be essential in attaining the parameters and provisions set by the UHC Act.

Direct, indirect, post-infection damages induced by coronavirus in the human body: an overview.

BackgroundSevere acute respiratory syndrome Coronavirus-2 invades the cells via ACE2 receptor and damages multiple organs of the human body. Understanding the pathological manifestation is mandatory to endure the rising post-infection sequel reported in patients with or without comorbidities.Materials and methodsOur descriptive review emphasises the direct, indirect and post-infection damages due to COVID-19. We have performed an electronic database search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with selective inclusion and exclusion criteria.ResultsThe included studies substantiated the extensive damages in the multiple organs due to direct and indirect consequences of COVID-19. After an apparent recovery, the prolonged presentation of the symptoms manifests as post-COVID that can be related with persisting viral antigens and dysregulated immune response.ConclusionA few of the symptoms of respiratory, cardiovascular, and neuropsychiatric systems that persist or reappear as post-COVID manifestations. Vaccination and preventive programs will effectively reduce the prevalence but, the post-COVID, a multisystem manifestation, will be a significant tribulation to the medical profession. However, the issue can be managed by implementing public health programs, rehabilitation services, and telemedicine virtual supports to raise awareness and reduce panic.

Evaluation of the Impact of the First Wave of COVID-19 and Associated Lockdown Restrictions on Persons with Disabilities in 14 States of India.

Background: There is a paucity of data to assess the impact of the COVID-19 pandemic on persons with disabilities (PwDs) in India. About 27.4 million cases were reported as of 27 May 2021. The continuing pandemic in the form of subsequent waves is expected to have negative repercussions for the disabled globally, particularly in India, where access to health, rehabilitation, and social care services is very limited. Therefore, this study aimed to assess the impact of the COVID-19 pandemic and lockdown restrictions on PwDs in India. Objective: To determine the level of disruption due to COVID-19 and the associated countrywide lockdown restrictions on PwD in India during the first wave. Methods: Using a cross-sectional, mixed-methods approach, data were collected from a representative sample of 403 persons with disabilities in 14 states in India during the COVID-19 first wave at two different points in time (Lockdown and post-lockdown phase). Factors associated with the negative impact were examined using the Chi-square test for associations. The paired comparisons between ‘lockdown’ with the ‘post-lockdown’ phase are presented using McNemar’s test and the marginal homogeneity test to compare the proportions. Additionally, a subsample of the participants in the survey was identified to participate in in-depth interviews and focus group discussions to gain in-depth insights on the study question and substantiate the quantitative findings. The framework approach was used to conduct a thematic analysis of the qualitative data. Results: About 60% of the PwDs found it difficult to access emergency medical services during the lockdown, and 4.6% post lockdown (p < 0.001). Likewise, 12% found it difficult to access rehabilitation services during the lockdown, and 5% post lockdown (p = 0.03). About 76% of respondents were apprehensive of the risk of infection during the lockdown, and this increased to 92% post lockdown (p < 0.001). Parents with children were significantly impacted due to lockdown in the areas of Medical (p = 0.007), Rehabilitation (p = 0.001), and Mental health services (p = 0.001). The results from the qualitative study supported these quantitative findings. PWDs felt that the lockdown restrictions had negatively impacted their productivity, social participation, and overall engagement in everyday activities. Access to medicines and rehabilitation services was felt to be extremely difficult and detrimental to the therapeutic benefits that were gained by them during the pre-pandemic time. None of the pandemic mitigation plans and services was specific or inclusive of PWDs. Conclusions: COVID-19 and the associated lockdown restrictions have negatively impacted persons with disabilities during the first wave in India. It is critical to mainstream disability within the agenda for health and development with pragmatic, context-specific strategies and programs in the country.

Community-based rehabilitation for adults with cognitive-communication disorders following traumatic brain injury: A mixed methods investigation

ABSTRACT Objective To investigate the experiences and perspectives of speech pathologists when delivering cognitive-communication therapy to adults following traumatic brain injury (TBI). Methods An explanatory sequential mixed methods design was used to explore the practices of speech pathologists working in community-based rehabilitation (CBR) settings. The first participant group completed an in-depth online survey, whilst the second group participated in an interview to discuss their processes and recommendations when managing adults following TBI. Results Participants highlighted the need for services to be client-centered and inclusive in their approaches to meet the rehabilitation needs of people following TBI in community-based settings. The key features identified to achieve this included utilizing a flexible service delivery approach, implementation of meaningful therapy, as well as inclusion of significant others. Conclusions These findings provide a snapshot of the current practices employed by a range of speech pathology services across Australia and New Zealand. Health professionals and rehabilitation service providers should consider the key factors highlighted by the participants when designing future CBR models of care for this client group.

More than just a health care assistant: peer support working within rehabilitation and recovery mental health services.

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Impact of the Early COVID-19 Pandemic on Burn Care: A Multi-National Study.

This qualitative study documents and analyzes COVID-19’s impacts on burn care in twelve nations. Burn care saw valuable improvements in surgical techniques, skin grafting, and other acute treatments during the decades before the COVID-19 pandemic which increased severely burned patients’ survival rates and quality of life. Detailed interviews, conducted in the 12 nations reveal that the COVID-19 pandemic greatly affected the delivery of acute and rehabilitation services for burn patients. Resources have been suctioned away from non-COVID healthcare and burn care has not been spared. Acute, post-acute rehabilitation, and mental health services have all suffered. Weak preparation has deeply burdened health care services in most nations, resulting in lower access to care. Access problems have accelerated innovations like telehealth in many nations. The spread of misinformation through social and traditional media has contributed to the varied responses to COVID-19. This compounded problems in health care delivery. Burn care providers delivered services for survivors during extremely difficult circumstances by continuing to furnish acute and long-term services for patients with complex disease. Emphasis on future pandemic preparedness will be vital because they undermine all aspects of burn care and patient outcomes. As the COVID-19 pandemic continues to unfold around the world, it will be important to continue to monitor and analyze the adaptability of nations, health care systems, and burn care providers.

Association of Anxiety with Oral Health-Related Quality of Life Among Kashmiri Residents

Introduction: Along with other healthcare indicators, psychological well-being of the population worldwide has been greatly affected after outbreak of covid-19. Almost all states in India including Jammu and Kashmir suffered during COVID-19. Thus this study was planned to determine the association of anxiety and its impact on oral health-related quality of life (14-item Oral Health Impact Profile [OHIP-14]) among residents of four districts of Jammu and Kashmir state during COVID-19. Materials and Methods: A self-administered questionnaire consisting of OHIP-14 along with a 7-item Generalized Anxiety Disorder Scale (GAD-7 Scale) was distributed among the residents of Kashmir via e-mails, WhatsApp groups, and Facebook using Google Forms. Results: Majority of the participants were males (53%) over 18 years of age. The most frequently experienced problems were discomfort during eating food (75%) and physical pain in the mouth such as aching in the mouth (60%). A highly statistically significant negative correlation was found between OHIP-14 and GAD among painful aching in the mouth (−0.044) (0.154**) **p&lt;0.001. Half (50%) of the participants reported minimal anxiety. Conclusion: There is an unmet and immediate need to escalate the mental health services in Jammu and Kashmir state of India, which consisted of community participation, awareness programs, and mental health rehabilitation services.

A Pilot Study Comparing Two Measures of Perceived Health Services Access Among Military Veterans With Musculoskeletal Injuries and Mental Health Conditions.

ABSTRACTIntroductionService members endure a number of musculoskeletal injuries (MSIs) during service (e.g., ankle sprains and chronic back pain). Musculoskeletal injuries can reduce engagement in physical activity after military service and contribute to a sedentary lifestyle that diminishes physical health and elevates the risk for psychological distress including suicide-related behaviors. Yet, little is known about barriers and facilitators to accessing care in veterans with co-occurring MSI and mental health conditions. The purpose of this study was to pilot two brief measures of barriers and facilitators to rehabilitation and mental health services in military veterans with musculoskeletal and mental health conditions. Self-report tools vary in their response formats in ways that can impact usability, data quality, and completeness. We examine two response styles (i.e., checklist vs. thermometer) for two health services (mental health and rehabilitation) to determine usability, patterns in item endorsement, and veteran preference.Materials and MethodsBarriers and facilitators informed by the Fortney Veterans Healthcare Access model were assessed by veterans (n = 31) on the newly developed 22-item, paper-and-pencil scale with separate ratings for mental health and rehabilitation services. All participants completed scales with both response styles and the order of administration was randomized (i.e., either the checklist first or the thermometer-style response first). Data also included self-reported demographics, musculoskeletal and mental health diagnoses, health-related quality of life, physical activity levels, mental health symptoms, suicide risk, and coronavirus disease of 2019 pandemic-related stress.ResultsVeterans reported no differences in ease of use across response formats; however, 83.9% (n = 26) preferred the checklist style, with only 3.22% (n = 1) preferring the thermometer format. Checklist items also resulted in less missing data (i.e., range 0.00%-6.45%) than the thermometer-style option (i.e., range 6.45%-61.30%). On the checklist, total number of perceived barriers was low for mental health and rehabilitation services (i.e., M = 1.58 and M = 1.61, respectively). Distance to care and problems related to symptoms were the most frequently identified barriers for both services. Facilitators outnumbered barriers for mental and rehabilitation services, and nearness of the clinic/hospital was the top-rated facilitator for both. On the thermometer, the perceived strength of each mental health (M = 39.37) and rehabilitation (M = 39.81) service barrier was moderate (0-100 scale), while the average perceived strength of each mental health (M = 61.66) and rehabilitation service (M = 61.84) facilitator was higher. Associations between barrier and facilitator scores with mental and physical health indicators were small with exceptions. For instance, suicide attempt likelihood was positively correlated with rehabilitation services barriers; mental health burden was positively associated with both barriers and facilitators.ConclusionsResults of this pilot comparing two measurement approaches identified actionable next steps. Brief barriers and facilitators checklists were viable for veteran ratings across type of health. The thermometer-based tool captured the perceived strength of barriers and facilitators but yielded problematic rates of missing data in its current form and was not preferred by veterans.

Effective long-term management of brachial plexus injury following surgery: What is needed from hand therapists’ perspectives

IntroductionTraumatic, brachial plexus injuries (BPI) result represent a significant cost to the individual and society. Recovery involves multiple surgeries, takes years, and often results in permanent physical dysfunction. While the last couple of decades have seen advancements in surgical management, the BPI rehabilitation literature has not kept pace with these developments. PurposeWe aim to explore the experience of public and privately employed hand therapists’ in delivering effective long-term rehabilitation services to inviduals with BPI in Australia. MethodsAn interpretative qualitative study. Two focus groups were conducted with Australian hand therapists’ (n = 10). Data were analyzed using an inductive thematic approach. ResultsThree key themes were generated from the data. The first theme ‘Falling through the gaps: overlooked components of therapy for BPI’ captures participants’ thoughts on postinjury health care and rehabilitation services. The second ‘Developing a therapeutic alliance: underpinned by time and trust’ relates to the relationship building challenges and opportunities following trauma that will withstand the long-term recovery of individuals following BPI. The last theme, ‘Factors required for professional development: knowledge and support,’ considers the variation seen with these clients in relation to therapy needs and outcomes. ConclusionsThe findings of this study highlight the need to better equip hand therapists’ skills and knowledge in responding to pain and psychological management post BPI. Our results reinforce the benefit of interdisciplinary models of care in the management of individuals with BPI.

The COVID-19 pandemic impacts all domains of quality of life in Egyptians with spinal cord injury: a retrospective longitudinal study.

Background and objectiveDuring the COVID-19 pandemic, several aspects of life have been affected. These aspects have been impacted especially in persons with spinal cord injury (SCI). The current study explored the overall effect of the COVID-19 pandemic on quality of life (QOL) domains in persons with SCI as well as evaluated their adherence to WHO-COVID 19-preventive measures.DesignA retrospective longitudinal study was conducted after asking participants to complete an online validated Arabic version of the WHOQOL-BREF questionnaires including their demographics. The WHOQOL-BREF questionnaires were completed targeting two separate occasions to represent their scores prior to and during the pandemic. Participants were asked to rate their adherence to WHO-COVID-19 preventive measures on a 10-point scale.Setting and participants115 participants with complete/ incomplete SCI were recruited via social media and contacted by phone to complete the questionnaires.ResultsPersons with SCI had lower QOL scores during the COVID-19 period compared to their QOL during the pre-COVID-19 period; all QOL domains (Physical Health, Psychological, Social Relationships, and Environment) showed a significant decrease (P < 0.001). Regarding COVID-19 preventative measures, participants were most likely to endorse self-isolation as well as staying home measures and least likely to adhere to hand washing and social distancing measures.ConclusionThe robustly reduced QOL reported by individuals with SCI during the COVID-19 pandemic highlights the need for rehabilitation and mental health services, particularly administered via telehealth, to buffer the effects of the pandemic. Additionally, psychoeducation and support regarding COVID-19 preventative behaviors in this region would be critical.

Health care and rehabilitation services utilization, benefits and satisfaction: a community survey of individuals with spinal cord injury in Thailand.

Cross-sectional study. This study aimed to explore and report on health care and rehabilitation service utilization, rehabilitation service benefits, and levels of satisfaction of individuals with spinal cord injury (SCI) living in communities in Thailand. Four rehabilitation facilities in Thailand, two university hospitals (Maharaj Nakorn Chiang Mai Hospitalin Chiang Mai Provinceand Siriraj Hospital in Bangkok), one large provincial hospital (Ratchaburi Hospital in Ratchaburi Province), and one national rehabilitation institute (Sirindhorn National Medical Rehabilitation Institute in Nonthaburi Province). This study was part of the International Spinal Cord Injury Community Survey (InSCI). Individuals with SCI completed a set of questionnaires, then data related to their health care and rehabilitation services were extracted and analyzed. Of the 320 participants, most were male (71%), and the majority were living with paraplegia (73%). In cases of mild illnesses where hospitalization was not required, 46% went to anearby health service hospital. In cases of serious illnesses where hospitalization was required, 39% went to a higher-level hospital. The majority (80%) were satisfied with their experience with health care services. The three top preferred products and services in descending order were wheelchairs and cushions, increased disability pension, medication and medical equipment including bladder relaxants, urinary catheters and urine bags. Individuals with SCI living in communities in Thailand preferred treatment at a nearby district hospital for mild illnesses with one-third transferring to a higher-level hospital for serious illnesses. The majority were satisfied with the health care services and rehabilitation services.

The Effect of Implementing Health Promotion Hospitals' Plan on the Awareness of Cardiac Patients Admitted to Selected Educational Hospitals in Yazd

Background: Health promotion includes the concepts of health education, disease prevention and rehabilitation services. Accordingly, the implementation of standards and indicators of health promotion in hospitals is necessary to ensure the quality of the services provided. Therefore, this study was conducted to investigate the effect of implementing a health promotion hospital plan on the awareness of hospitalized cardiac patients in selected educational hospitals in Yazd. Methods: This was an interventional study, which was performed on 62 cardiac patients referred to 2 selected educational hospitals of Yazd University of Medical Sciences. 31 patients from Afshar Hospital (the case group), and 31 patients from Shahid Sadoughi Hospital (the control group) were selected by purposive sampling method. In the case group, in addition to the routine trainings, the subjects received face to face and group educational interventions based on the Health Belief Model and the Guidelines to the American Cardiovascular and Pulmonary Rehabilitation Association for 3 months, and were finally given an educational package. The samples in the control group also underwent routine training. Data analysis was performed using a questionnaire based on Health Belief Model, before the educational intervention and 3 months after, using SPSS 23 software, Chi-square and independent t-tests. Results: Awareness scores in the case and control groups before the intervention were 7.90 ± 4.01 and 10.67 ± 5.31, and after the intervention were 21 ± 1.61 and 11.54 ± 5.31 respectively, and a significant difference was seen in the scores of the post-intervention group (p &lt; 0.001). Conclusion: The implementation of the health promotion hospital plan can be effective in increasing the awareness and improving the performance of cardiac patients. Therefore, it is recommended for hospitals to move towards health promotion.

Closing the rehabilitation utilization gap of New Zealand’s (Aotearoa) Māori people: Multiple case studies

AbstractWe aimed to explore personal factors in use of rehabilitation counseling and mental health services by Māori adults. Participants were three Māori adults (females = 2, residing in major urban settings, age range 45–50 years old; male = 1, residing in a rural setting, age range = 25–30 years old). Thematic analysis yielded the following findings: (a) a preference of Māori service providers who understand whānau culture, (b) an understanding of whakapapa or the family structure as an integral source of social support as counselors are planning for treatment, (c) establishing and maintaining trusting relationships within the Māori community by non-Māori counselors, (d) having financial difficulties when attempting to access rehabilitation resources, (e) limited access to health care facilities and services or lack of information about the services available, and (f) a general mistrust of government operated systems. Rehabilitation and mental health services with Māori should address personal cultural and systemic exclusion factors for better service engagement.

Demonstrating the processes and outcomes of a rural Community Mental Health Rehabilitation Service: A realist evaluation.

As part of significant mental health reform, the Community Mental Health Rehabilitation Service (CMHRS) was implemented in rural South Australia. The CMHRS is a 10-bed mental health residential program offering rehabilitative mental health support to rural residents. To analyse the CMHRS service delivery model and its impact on recovery outcomes for consumers. A mixed method, realist evaluation approach was utilised. A purposive sample of CMHRS staff (n = 6) and consumers (n = 8) were recruited. Consumer recovery was measured using the RAS-DS (on admission and discharge). Participants' perspectives of the service were gained via one staff focus group (n = 6) and individual semi-structured interviews (consumers n = 6; staff n = 2). Pre-post RAS-DS scores were analysed using paired t-tests/Wilcoxon paired-signed rank test, with qualitative data analysed thematically. Significant positive increases in RAS-DS total scores were observed at discharge, supported by the qualitative themes of (re)building relationships and social connections and recovering health and wellbeing. Contextual factors (e.g. staffing) and program mechanisms (e.g. scheduling) impacting on service implementation were identified. Maintaining a rehabilitation recovery-focused approach, balanced with an appropriately trained multi-disciplinary team, are vital for maximising positive consumer outcomes. This realist evaluation identifies critical factors impacting rural mental health rehabilitation service delivery.

Physical Rehabilitation and Mental Health Care After Burn Injury: A Multinational Study.

While remarkable improvements have been made to acute hospital burn care in recent decades, it is not matched by improvements in post-acute care, including physical rehabilitation and mental health. Progress in acute hospital treatment of burn survivors now highlights the next important step-addressing care once a patient leaves intensive treatment and is discharged to the community. Long-term physical rehabilitation and mental health services are vital to improving quality of life for burn survivors. Using qualitative methods, we apply an adapted Reeve framework to assess and compare post-acute physical rehabilitation and mental health care across 13 countries on 6 continents. Twenty semistructured interviews were conducted with burn surgeons and rehabilitation specialists. One major theme that emerged was the importance of training and resources to the quality of post-acute care. This exploratory study suggests the value of investing scarce resources in a range of low-cost interventions to improve follow-up burn care. One intervention identified here is short-term training in post-acute rehabilitation and mental health to upgrade and standardize best clinical practices to address as-yet unmet post-discharge needs of burn survivors.

Cross-Sectional Comparison of Treatment Provided Under the Clinical, Integrated, and Partnership Staffing Models for Community-Based Residential Mental Health Rehabilitation.

In Queensland (Australia), community-based residential mental health rehabilitation services have three distinct staffing profiles. The traditional 'clinical' staffing model has nursing staff occupying most staff roles. The 'partnership' approach involves collaboration between the health service and a Non-Government Organisation. Under the 'integrated' staffing approach, Peer Support Workers reflect the majority staffing component. This study compares the treatment received by consumers (N = 172) under these staffing models using cross-sectional administrative data. Staffing models were generally comparable on demographic, diagnostic, and symptomatic/impairment measures. However, statistically significant differences were present on a range of treatment variables. Differences mainly occurred between the clinical and integrated approaches, with the integrated staffing model having lower rates of involuntary treatment, antipsychotic polypharmacy, depot use, and chlorpromazine dose equivalence levels. These findings indicate the need to carefully examine the impact of staffing configuration on rehabilitation processes to understand whether differences in approaches are likely to impact rehabilitation outcomes.