Treatment In Residential Care Research Articles

The Renfrew Unified Treatment for Eating Disorders and Comorbidity: Long-Term Effects of an Evidence-Based Practice Implementation in Residential Treatment.

Background: The Renfrew Unified Treatment for Eating Disorders and Comorbidity (UT) is a transdiagnostic, emotion-focused treatment adapted for use in residential group treatment. This study examined the effect of UT implementation across five years of treatment delivery.Methods: Data were collected by questionnaire at admission, discharge (DC), and 6-month follow-up (6MFU). Patient outcomes were measured by the Eating Disorder Examination-Questionnaire, Center for Epidemiologic Studies-Depression Scale, Brief Experiential Avoidance Questionnaire (BEAQ), Anxiety Sensitivity Index, and Southampton Mindfulness Scale. Data were analyzed for N = 345 patients treated with treatment-as-usual (TAU), and N = 2,763 treated with the UT in subsequent years.Results: Results from multilevel models demonstrated a significant interaction between implementation status (TAU vs. UT) and time, both linear and quadratic, for the depression, experiential avoidance, anxiety sensitivity, and mindfulness variables. Patients treated with the UT showed more improvement in these variables on average, as well as more rebound between DC and 6MFU. Results from multilevel models examining eating disorder outcome showed no significant difference between the TAU and UT for the full sample, but a significant three-way interaction indicated that the UT produced more improvement in the EDE-Q relative to the TAU particularly for patients who entered treatment with high levels of experiential avoidance (BEAQ score).Conclusion: This long-term study of a transdiagnostic, evidence-based treatment in residential care for eating disorders and comorbidity suggests implementation was associated with beneficial effects on depression and emotion function outcomes, as well as eating disorder severity for patients with high levels of baseline emotion regulation problems. These effects did not appear to diminish in the 5 years following initial implementation.

Developing an Australian health and aged care research agenda: a systematic review of evidence at the subacute interface.

Objective The aim of the present study was to systematically review articles describing recent interventions that aimed to improve access and outcomes for older people at the interface between health and aged care, with a focus on subacute care programs of palliative care, rehabilitation, geriatric evaluation and management (GEM) and psychogeriatrics. Methods Australian studies published between 2008 and 2013were evaluated using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and National Health and Medical Research Council of Australia (NHMRC) guidelines. Included studies were summarised according to focus areas and results discussed in the current Australian subacute health care context. Results Eleven Australian research articles were identified. Three did not achieve any NHMRC rating level because of methodological approach. Focus areas included: discharge planning; information management or communication; rehabilitation; hospital treatment in residential care; screening and intervention; and Telehealth. Interventions were primarily system centred; only three studies featured patient-level outcome measures. Conclusions There is limited high-quality research investigating the effectiveness of interventions at the health and aged care interface of subacute care. Further research is needed. What is known about the topic? Subacute care offers important healthcare programs for older people, operating at the interface between health and aged care. However, for the most part this has not been subject to research scrutiny. What does this paper add? Identified studies were predominantly hospital oriented and designed to avoid hospital admission and associated costs. Locally integrated, collaborative and multidiscipline based interventions improve system-level outcomes. Alternative and individualised models of care, particularly when provided in their home setting, yields positive outcomes for older people. What are the implications for practitioners? Health and aged care reforms and related research agenda must include the perspectives and experiences of patients and/or carers accessing subacute care programs, yet these are under-reported. The present review highlights opportunities to improve the quality of existing evidence and create a research agenda for the future.

Hospital treatment in residential care facilities is a viable alternative to hospital admission for selected patients

To determine if hospital treatment in residential care facilities, led by a geriatric team, might be a viable alternative to inpatient admission for selected patients. Case series with a new intervention were compared with historical controls receiving the conventional treatment. Treatment in residential care facilities (TRC) by the Residential Care Intervention Program in The Elderly (RECIPE) service was compared against the conventional treatment group, aged care unit (ACU) inpatients. A total of 95 patients in TRC and 167 patients in ACU were included. The mean Charlson Comorbidity Index score was 7 in both groups and demographics were similar, except more patients in the TRC group had dementia. Palliative care support was provided to 35.8% in the TRC group, compared with 7.8% in ACU, P < 0.001. Six-month mortality rates were similar at 30% for both groups. Rehospitalization rates at 6 months were similar at 41% for both groups. Length of care was significantly shorter for TRC (mean 2 days) compared with ACU (mean 11 days), P < 0.001. Hospital treatment in residential care is viable for most patients, including those with dementia and those who need palliative care support. This model of care offers a valuable geriatric service to residents who would prefer to avoid hospital transfers, with no difference in mortality or rehospitalization rates for those treated in residential care, but a significant reduction in length of care.

Aspetti relazionali ed organizzativi delle comunità terapeutiche per adolescenti quali fattori di trattamento: validazione di uno strumento

The aim of this work is to propose a new instrument to investigate organizational characteristics in Therapeutic Communities for adolescents. Organizational Climate is considered as a specific therapeutic factor in a residential care treatment where the quality of the environment and the emotional atmosphere become essential aspects of communitarian work. In such a context, the working team is the main instrument of the treatment (educational and therapeutic). The questionnaire has been administered to 173 subjects, working in therapeutic communities for adolescents, searched in the whole of the Italian territory. The last version of the statistic, that has been carried out, enhanced 119 items.

P03-17 - Nursing demands of patients with schizophrenia with long term maintenance treatment at home

In the last seven years there has been an increase in the number of schizophrenia disease in Lithuania (in 2002-2369,5; in 2008-2795,65 to 100.000 residents). The length of treatment in residential care is getting shorter because of changing regulations.ObjectiveThe goal of the study to explore nursing demands in patients with schizophrenia disorders with long term maintenance treatment at home.MethodsResearch was carried out in four Kaunas primary mental health centers. We used standardized International Mental Health Quality Of Life Scale (QOL-36) questionnaire implemented by Phillip W. Long (2003). Our group was randomly selected and consisted of 123 patients with schizophrenia aging from 18 to 65 years.ResultsSeveral main problems were disclosed: 46% reduced everyday home activities, 68 % mentioned physical fatigue, apathy- 60%, sleep disorders- 81%, memory and attention disorders- 64%, communication problems- 76%. 25% of respondents had suicidal attempt. There were more suicidal attempts in younger patients than others (p &lt; 0,05). We disclosed statistically confident correlation between disease duration and suicidal attempts (p &lt; 0,05). For the senior patients the most often were communication problems (50%), sleep disorders (55%), memory and attention disorders (53%).ConclusionsThe most frequent nursing demands mentioned by patients are caused by memory and attention disorders, as well as sleep disorders. Those problems most frequently occur among older respondents.

P03-146 Evaluation of 2 years’ residential care treatment for adolescents and young adults with schizophrenia

Aims:In 2002 the Professor Eggers Foundation started a 2-year-programme for patients suffering from early-onset schizophrenia (EOS) following discharge from a clinic (outpatient care). the aim is with intense residential care and treatment to support recovery and independence. Interactive and psychoeducational family care, coping with persistent symptoms, development of social and emotional competence, independent house keeping, and support of school and vocational training are the main features.Methods:Psychopathology, social and neuropsychological function were assessed with a set of questionnaires and tests at the start, after 1 year and after 2 years on completion of the programme for 12 participants. Living and working situation were monitored. the results were compared with the progress of 12 EOS patients treated as usual (comparison group).Results:Positive and negative symptoms showed a significantly greater decrease with respect to the comparison group. Social function improved considerably stronger in the participants. Working memory, attention and some executive functions also improved in the participants, while there was a deterioration of speed and selective attention (trend) in the comparison group. Neither group showed changes in measures of intelligence or the subjective quality of life with the exception of increased contentedness with family relations in the participants.Conclusions:We show the benefits of an early intensive residential training programme for EOS patients. Further research may be able to show if these improvements can be maintained and whether the costs of the programme are economical avoiding continued residential care.

PW02-01 Evaluation of 2 years’ residential care treatment for adolescents and young adults with schizophrenia

Aims:In 2002 the Professor Eggers Foundation started a 2-year-programme for patients suffering from early-onset schizophrenia (EOS) following discharge from a clinic (outpatient care). The aim is with intense residential care and treatment to support recovery and independence. Interactive and psychoeducational family care, coping with persistent symptoms, development of social and emotional competence, independent house keeping, and support of school and vocational training are the main features.Methods:Psychopathology, social and neuropsychological function were assessed with a set of questionnaires and tests at the start, after 1 year and after 2 years on completion of the programme for 12 participants. Living and working situation were monitored. The results were compared with the progress of 12 EOS patients treated as usual (comparison group).Results:Positive and negative symptoms showed a significantly greater decrease with respect to the comparison group. Social function improved considerably stronger in the participants. Working memory, attention and some executive functions also improved in the participants, while there was a deterioration of speed and selective attention (trend) in the comparison group. Neither group showed changes in measures of intelligence or the subjective quality of life with the exception of increased contentedness with family relations in the participants.Conclusions:We show the benefits of an early intensive residential training programme for EOS patients. Further research may be able to show if these improvements can be maintained and whether the costs of the programme are economical avoiding continued residential care.

Time to change – an exploratory study of motivation among untreated and treated substance abusers

This exploratory study examines whether the attitudes towards change and treatment of untreated non-abstinent substance abusers differ from those of patients undergoing treatment in residential care. The sample (n = 97) consists of untreated, voluntarily and compulsorily treated substance abusers who completed a questionnaire in 2003. Attitudes were measured with scales on e.g. problem recognition, desire for help, treatment readiness and aspects of time perspectives, e.g. past, present and future orientation. The attitudes of the three groups – untreated, voluntarily and compulsorily treated subjects – differed with respect to lifestyle change. Factor analysis of the measures revealed one component of primary interest, general willingness to change. Results show that willingness to change was correlated with other attitudinal characteristics in the three groups. The stability of substance abusers’ motivation is discussed with the focus on different social contexts’ influence on change-compliant attitudes and behaviour.

Factors associated with antidepressant treatment in residential care: changes between 1990 and 1997

Depression is common among older people living in residential and nursing homes. Detection and treatment of late life depression may be sub-optimal in these settings. To report the changes in, and factors associated with, antidepressant use among residents in care homes in 1990 and 1997. Censuses of those aged 65 years and over in any type of residential care in the county of Leicestershire, UK, on 27 November 1990 and 30 November 1997. Care staff were asked to complete an assessment form for each resident which included a rating of depression and use of antidepressants. The use of antidepressants increased from 11% (484/4415) in 1990 to 18.9% (777/4111) in 1997. Severity of depression as assessed by care staff, gender, younger age, better cognitive functioning, and use of other medications were consistently associated with antidepressant treatment. Antidepressant use was associated with better physical functioning (p = 0.001) in 1990 and frequency of falls in 1997 (p = 0.044). Increased use of antidepressants appears to be due to the wider range of antidepressant drugs available since 1990. However there is a need for better methods for care staff to detect depression in residents, and for appropriate action to be taken by those responsible for their medical management.

Availability to peer group treatment in residential care as a function of relational ethics

Forty-five adolescent boys from abusive and depriving homes were not doing well in positive peer culture residential care. Despite their backgrounds, given a modified form of the Relational Ethics Scale, they indicated that their relational life with their families of origin was trustworthy, fair, and worthy of continued devotion. In contrast, on the Firo-B these same boys demonstrated distrust of others outside of their families and an unwillingness to get involved. These results support the inference from contextual family theory that peer group interventions cannot bypass identification and resolution of the injustices that took place in the family of origin.

Toward the Nonpathological Assessment of Behavioral and Conduct Disordered Adolescents

The purpose of this study was to investigate the behavioral problems of 113 adjudicated male juvenile offenders from the normalized, circumplex personality assessment perspective used in the Personal Styles Inventory. The results of the investigation suggest that this assessment model provides correctional practitioners a valid assessment, which is easily understood, sensitive to the needs of both the youth and their families, and useful in developing the goals required of student individual service plans. The findings are discussed in relation to other classification models, as well as their implications for public and residential care treatment programs.

Treatment in Residential Care: A Case Study

Treatment in Residential Care: A Case Study