The concept—and reality—of continuity of care crosses disciplinary and organisational boundaries. The common definitions provided here should help healthcare providers evaluate continuity more rigorously and improve communication 

Patients are increasingly seen by an array of providers in a wide variety of organisations and places, raising concerns about fragmentation of care. Policy reports and charters worldwide urge a concerted effort to enhance continuity,1–3 but efforts to describe the problem or formulate solutions are complicated by the lack of consensus on the definition of continuity. To add to the confusion, other terms such as continuum of care, coordination of care, discharge planning, case management, integration of services, and seamless care are often used synonymously. This synthesis was commissioned by three Canadian health services policy and research bodies. The aim was to develop a common understanding of the concept of continuity as a basis for valid and reliable measurement of practice in different settings.

We searched academic and policy literature for documents in which the principal focus was continuity of patient care or continuity. We searched electronic databases (Medline, HealthSTAR, Embase, CINAHL, Current Contents, PsychINFO, AIDSLINE, CancerLit, Cochrane Library, Dissertation abstracts, Papers1st (conferences and paper abstracts), Web of Science, WorldCat) as well as web library catalogues, peer reviewed internet sites, internet search engines, and several in-house databases. The search included documents dated from 1966 to November 2001 written in English, French, or Spanish. The reviewers (RJR, JLH, RMcK) used a data abstraction form to summarise relevant documents from every health discipline, and all reviewers read key documents.

We presented the results of an initial review of 314 documents to participants of a workshop on continuity held in Vancouver in June 2001. We obtained structured feedback to a discussion paper, problem based scenarios, and expert presentations. Participants validated the common themes …

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Continuity of care: a multidisciplinary review

We test whether significant differences in mental illness exist in a matched sample of Mental illness and the criminal justice system. In T. L. Scheid T. N. Brown (Eds.), A handbook for the study of mental health: Social contexts, theories. Find 9780521567633 A Handbook for the Study of Mental Health : Social Contexts, Theories, and Systems by Horwitz et al at over 30 bookstores. Buy, rent. A review of mental health problems in fathers following the birth of a child. for the study of mental health:Social contexts, theories, and systems (2nd ed., pp.

A Handbook for the Study of Mental Health: Social Contexts, Theories, and Systems

We describe different models of community care for persons with severe mental illness and review the research literature on case management, including the results of 75 studies. Most research has been conducted on the assertive community treatment (ACT) or intensive case management (ICM) models. Controlled research on ACT and ICM indicates that these models reduce time in the hospital and improve housing stability, especially among patients who are high service users. ACT and ICM appear to have moderate effects on improving symptomatology and quality of life. Most studies suggest little effect of ACT and ICM on social functioning, arrests and time spent in jail, or vocational functioning. Studies on reducing or withdrawing ACT or ICM services suggest some deterioration in gains. Research on other models of community care is inconclusive. We discuss the implications of the findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse. We suggest directions for future research on models of community care, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.

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Models of community care for severe mental illness : A review of research on case management

Fidelity may be defined as the extent to which delivery of an intervention adheres to the protocol or program model originally developed. Fidelity measurement has increasing significance for evaluation, treatment effectiveness research, and service administration. Yet few published studies using fidelity criteria provide details on the construction of a valid fidelity index. The purpose of this review article is to outline steps in the development, measurement, and validation of fidelity criteria, providing examples from health and education literatures. We further identify important issues in conducting each step. Finally, we raise questions about the dynamic nature of fidelity criteria, appropriate validation and statistical analysis methods, the inclusion of structure and process criteria in fidelity assessment, and the role of program theory in deciding on the balance between adaptation versus exact replication of model programs. Further attention to the use and refinement of fidelity criteria is important to evaluation practice.

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Fidelity Criteria: Development, Measurement, and Validation.

Objective: A number of legal, social, and political factors over the past 40 years have led to the current epidemic of psychiatric disorders in the U.S. prison system. Although numerous investigations have reported substantially elevated rates of psychiatric disorders among prison inmates compared with the general population, it is unclear whether mental illness is a risk factor for multiple episodes of incarceration. The authors examined this association in a retrospective cohort study of the nation’s largest state prison system. Method: The study population included 79,211 inmates who began serving a sentence between September 1, 2006, and August 31, 2007. Data on psychiatric disorders, demographic characteristics, and history of incarceration for the preceding 6-year period were obtained from statewide medical information systems and analyzed. Results: Inmates with major psychiatric disorders (major depressive disorder, bipolar disorders, schizophrenia, and nonschizophrenic psychotic disorders) had sub...

https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2008.08030416

Psychiatric Disorders and Repeat Incarcerations: The Revolving Prison Door

The authors discuss what can be learned from our experience with deinstitutionalization. The deinstitutionalization of mentally ill persons has three components: the release of these individuals from hospitals into the community, their diversion from hospital admission, and the development of alternative community services. The greatest problems have been in creating adequate and accessible community resources. Where community services have been available and comprehensive, most persons with severe mental illness have significantly benefited. On the other hand, there have been unintended consequences of deinstitutionalization-a new generation of uninstitutionalized persons who have severe mental illness, who are homeless, or who have been criminalized and who present significant challenges to service systems. Among the lessons learned from deinstitutionalization are that successful deinstitutionalization involves more than simply changing the locus of care; that service planning must be tailored to the needs of each individual; that hospital care must be available for those who need it; that services must be culturally relevant; that severely mentally ill persons must be involved in their service planning; that service systems must not be restricted by preconceived ideology; and that continuity of care must be achieved.

http://www.antoniocasella.eu/archipsy/Lamb_Bachrach_2001.pdf

Some Perspectives on Deinstitutionalization

The author discusses seven dimensions of continuity of care, a basic concept in planning services for chronic mental patients. Continuity of care in psychiatry is distinguished from that in other medical specialties by the unique needs of chronic mental patients. Different approaches to continuity must be used for chronic mental patients with different institutional histories and specialized service needs.

Continuity of care for chronic mental patients: a conceptual analysis.

Model programs for chronic mental patients may be viewed from four perspectives: evaluation of individual programs, commonalities in successful programs, generalizability and reproducibility of specific programs, and relevance of model programs to problems of service delivery in mental health systems. Although successful model programs share certain common structural elements, such programs cannot be readily reproduced or generalized. Having limited value for the problems of service delivery in mental health systems, model programs are best seen as experimental efforts, not as solutions. Strategies for translating model-derived knowledge into systems-related action are needed.

Overview: model programs for chronic mental patients.

Many serious problems in deinstitutionalization result from conceptual oversights or confusion. Understanding deinstitutionalization as a process and a philosophy, as well as a fact, permits planning that will accommodate the variety of patient populations that are the products of the deinstitutionalization movement. The role and possible contributions of the state hospital in caring for chronic patients must be assessed objectively. Effective program planning for chronic patients during this period of deinstitutionalization depends on a careful and realistic definitiin of what individuals are to be treated in the community. Such planning must not only attempt to match patients and appropriate treatment settings but must aim at enhancing rehabilitation, where feasible, through a skills training approach.

A conceptual approach to deinstitutionalization.

Three criteria--diagnosis, duration, and disability--are gaining currency in efforts throughout the United States to define the concept of chronic mental illness in a precise manner. However, there is presently no consensus on the specific character or relative importance of these criteria. Nor is there consensus on the nature of the interrelationships among these elements. These conceptual concerns must be resolved if uniformity in service planning and research on the chronic mentally ill is to be achieved.

Leona L. Bachrach

Papers

Some Perspectives on Deinstitutionalization

Continuity of care for chronic mental patients: a conceptual analysis.

Overview: model programs for chronic mental patients.

A conceptual approach to deinstitutionalization.

Defining Chronic Mental Illness: A Concept Paper