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Journal ArticleDOI

A 2-year follow-up study of people with severe mental illness involved in psychosocial rehabilitation

15 Jul 2014-Nordic Journal of Psychiatry (Informa Healthcare)-Vol. 68, Iss: 6, pp 401-408

TL;DR: The results indicate that the BPR approach has impact on clients’ health, empowerment, quality of life and in particular concerning psychosocial functioning.

AbstractBackgrounds. A focus on psychiatric rehabilitation in order to support recovery among persons with severe mental illness (SMI) has been given great attention in research and mental health policy, b ...

Topics: Psychiatric rehabilitation (71%), Mental health (61%), Mental illness (59%), Psychosocial (58%), Rehabilitation (54%)

Summary (3 min read)

A two-year follow-up study of people with severe mental illness involved in psychosocial rehabilitation

  • Svedberg, Petra, Associate professor 1., Svensson, Bengt, Associate professor 2., Hansson, Lars, Professor 2., Jormfeldt, Henrika, Associate professor 1.
  • School of Social and Health Sciences, Halmstad University, Sweden 2. Department of Health Sciences, Lund University, Sweden Corresponding author: Petra Svedberg School of Social and Health Sciences Halmstad University SE - 301 18 Halmstad Sweden Phone: +46-35167786 Fax: +46-35167264 Email: petra.svedberg@hh.se 2.

Backgrounds

  • A focus on psychiatric rehabilitation in order to support recovery among persons with severe mental illness (SMI) has been given great attention in research and mental health policy, but less impact on clinical practice.
  • There is a lack of research regarding the model called “Psychiatric Rehabilitation Approach from Boston University (BPR)”.
  • The aim was to investigate the outcome of the BPR intervention regarding changes in life situation, use of health care services, quality of life, health, psychosocial functioning and empowerment.
  • In total 71 clients completed the assessment at baseline and of these 49 completed the 2-year follow-up assessments.
  • Furthermore, 65% of the clients reported that they had mainly or almost completely achieved their self-formulated rehabilitation goals at the 2-year follow-up.

Background

  • A focus on psychiatric rehabilitation in order to support recovery among persons with severe mental illness (SMI) has been given great attention in research and mental health policy, but still lacks implementation in clinical practice in a broader perspective [1] [2].
  • Common elements of these programs are that they offer extensive and person-centred support aimed at strengthening the person’s ability to take responsibility for their lives and thereby improve their quality of life [6].
  • The BPR model has been investigated in some empirical studies from United States [18] [19] and in a few studies from European countries [20-23].
  • Swildens et al [22] showed that the BPR was effective in supporting persons with SMI in societal participation and to achieve self-formulated goals, but no effects were found regarding social functioning, needs for care, and quality of life.
  • This study was conducted as a part of an implementation project in the county of Halland that aimed to develop mental health rehabilitation services and to initiate a recovery-oriented approach for persons with severe mental illness.

Aims

  • The aims of the present study were to investigate outcome of the intervention in terms of changes in life situation, use of health care services, quality of life, health, psychosocial functioning and empowerment.
  • A further aim was to investigate to what extent the clients’ self-formulated rehabilitation goals were attained.

Design

  • The study has a prospective longitudinal design and the data collection at baseline started in August 2007 and a 2-year follow-up data collection ended in December 2010.
  • At both baseline and follow-up all clients were interviewed by either of two of the authors (PS or HJ).
  • The interviewers had no involvement in the clients’ care or rehabilitation.

Settings and participants

  • The setting was seven mental health services who implemented the BPR approach in the county of Halland in Sweden.
  • Six of these were municipal services for persons with mental illness and one was an outpatient specialist psychiatric service.
  • Two of the six municipal services only provided vocational rehabilitation.
  • A total of 71 clients consented to participate and completed the assessment at baseline, and of these 49 completed the 2-year follow-up data collection.

Intervention

  • The BPR approach is based on the principles and practices of psychiatric rehabilitation developed by Anthony, Cohen and Farkas [24] at Boston University.
  • The model was first applied in vocational rehabilitation, and then extended to educational and housing situations [17].
  • The model is highly individualized and is based entirely on the individual’s unique needs and preferences.
  • The purpose of the BPR intervention in Halland was to support and guide the client to formulate and achieve his/her own goals for various life areas such as work/occupation, 7     housing, education and leisure time.
  • A program fidelity evaluation was carried out using a new instrument developed by the research group inspired by a Dutch questionnaire [25].

Outcome measures

  • Subjective quality of life was assessed by the Manchester Short Assessment of Quality of Life scale.
  • The instrument contains 16 items including satisfaction with work, finances, social relations, leisure, living situation, safety, family relations, sexual relations, and health using a 7-point scale ranging from could not be worse to could not be better.
  • Needs of care were measured using the Camberwell Assessment of Needs Short Appraisal Schedule, [29].
  • This is a 22-item self-report questionnaire with three subscales: autonomy, social involvement and comprehensibility.
  • The instrument has showed good reliability and validity in a Swedish context [33- 35].

Ethics

  • The study was approved by the Regional Ethical Review Board for southern Sweden, Dnr 316/2007.
  • All participants were informed both orally and in writing about the purpose and the structure of the study before they gave their informed consent.
  • Participation was voluntary, and the participants were informed about the ethical considerations of confidentiality and that they could withdraw from the study at any time.

Statistical analysis

  • Differences between baseline and 2-year follow-up were analyzed with Student’s t-test.
  • Analyses of differences between subcategories of clients were made using the χ2 test.
  • The statistical software used was SPSS version 15.

Socio-demographic characteristics

  • The mean years since first admission were 8 years (range 0-24).
  • A majority (57 %) of the participants were single, 30.6 % were married or co-habiting and 98% had an independent living.
  • The patients who did not participate in the follow-up were not different in any of the sociodemographic variables measured at baseline compared with the patients who completed the study (See table 1).

External life situation

  • The clients’ external life situation in terms of housing, education and leisure activities showed no significant differences between baseline and the two-year follow-up.
  • Quality of life, health, empowerment and psychosocial functioning Quality of life, health, empowerment as well as psychosocial functioning were significantly improved between baseline and the two year follow up (table 2).
  • Effect sizes for all these domains were generally small, with the exception of psychosocial functioning where the effect size was large.
  • Thirty-two of the clients (65%) considered that they mainly or almost completely had achieved their goals.

Discussion

  • The most significant finding of the present study was an improved psychosocial functioning (large effect size) at the two-year follow-up.
  • Health, empowerment, quality of life and psychosocial functioning improved over time, with large significant differences between clients who mainly/completely achieved their self-formulated rehabilitation goals and the clients who only to a small extent or not at all achieved their goals.
  • In the study by Rogers, Anthony and Farkas [17] there were no significant differences between the intervention group and the control group regarding work situation at a two-year follow up.
  • There is a risk regarding self-reported data that the client under-estimate their symptoms and dysfunction as well as diagnosis.
  • In spite of these limitations the authors still suggest that the BPR approach can be an important factor in improving clients’ clinical and social situation.

Conclusion

  • In conclusion this study provides support for that BPR contribute to an improved life situation in terms of employment and sheltered employment/job training, and a decrease in number of people with disability pension, while no changes were shown concerning housing situation, education and leisure time.
  • This study also provides support for that BPR contribute to an increased quality of life, health, empowerment and psychosocial functioning as well as to a reduced utilization of psychiatric services.

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LUND UNIVERSITY
PO Box 117
221 00 Lund
+46 46-222 00 00
A 2-year follow-up study of people with severe mental illness involved in psychosocial
rehabilitation
Svedberg, Petra; Svensson, Bengt; Hansson, Lars; Jormfeldt, Henrika
Published in:
Nordic Journal of Psychiatry
DOI:
10.3109/08039488.2013.851737
2014
Link to publication
Citation for published version (APA):
Svedberg, P., Svensson, B., Hansson, L., & Jormfeldt, H. (2014). A 2-year follow-up study of people with severe
mental illness involved in psychosocial rehabilitation.
Nordic Journal of Psychiatry
,
68
(6), 401-408.
https://doi.org/10.3109/08039488.2013.851737
Total number of authors:
4
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A two-year follow-up study of people with severe mental illness involved in psychosocial
rehabilitation
Svedberg, Petra, Associate professor
1
., Svensson, Bengt, Associate professor
2
., Hansson,
Lars, Professor
2
., Jormfeldt, Henrika, Associate professor
1
.
1. School of Social and Health Sciences, Halmstad University, Sweden
2. Department of Health Sciences, Lund University, Sweden
Corresponding author:
Petra Svedberg
School of Social and Health Sciences
Halmstad University
SE - 301 18 Halmstad
Sweden
Phone: +46-35167786
Fax: +46-35167264
Email: petra.svedberg@hh.se

2"
"
Abstract
Backgrounds
A focus on psychiatric rehabilitation in order to support recovery among persons with severe
mental illness (SMI) has been given great attention in research and mental health policy, but
less impact on clinical practice. Despite the potential impact of psychiatric rehabilitation on
health and wellbeing, there is a lack of research regarding the model called “Psychiatric
Rehabilitation Approach from Boston University (BPR)”.
Aim: The aim was to investigate the outcome of the BPR intervention regarding changes in
life situation, use of health care services, quality of life, health, psychosocial functioning and
empowerment.
Methods: The study has a prospective longitudinal design and the setting was seven mental
health services who worked with the BPR in the county of Halland in Sweden. In total 71
clients completed the assessment at baseline and of these 49 completed the 2-year follow-up
assessments.
Results: The most significant finding was an improved psychosocial functioning at the
follow-up assessment. Furthermore, 65% of the clients reported that they had mainly or
almost completely achieved their self-formulated rehabilitation goals at the 2-year follow-up.
There were significant differences with regard to health, empowerment, quality of life and
psychosocial functioning for those who reported that they had mainly/completely had
achieved their self-formulated rehabilitation goals compared to those who reported that they
only had to a small extent or not at all reached their goals.

3"
"
Conclusions: Our results indicate that the BPR approach has impact on clients’ health,
empowerment, quality of life and in particular concerning psychosocial functioning.
Key words: psychiatric rehabilitation, psychosocial rehabilitation, severe mental illness,
Choose–Get–Keep Model, Boston psychiatric rehabilitation approach

4"
"
Background
A focus on psychiatric rehabilitation in order to support recovery among persons with severe
mental illness (SMI) has been given great attention in research and mental health policy, but
still lacks implementation in clinical practice in a broader perspective [1] [2]. The
development of mental health systems in Sweden have in recent decades been characterized
by a shift from traditionally hospital-based care to community-based care [3]. However,
moving toward a recovery-oriented approach takes time and presents several challenges for
mental health services [4]. With the increasing emphasis on an evidence-based practice and
research findings which confirm that people with SMI can recover from their illness [5] there
is a promising future for a further focus on recovery-oriented mental health care services [2].
!
The development of new models for psychiatric rehabilitation have resulted in a number of
intervention programs designed to improve health, social functioning and the quality of life of
persons with SMI. Common elements of these programs are that they offer extensive and
person-centred support aimed at strengthening the person’s ability to take responsibility for
their lives and thereby improve their quality of life [6]. Most programs include interventions
aimed to improve social skills, to create opportunities for independent living, to get persons
into work and actions to achieve a meaningful leisure time. The most common rehabilitation
oriented models are the Fountain House model of psychiatric rehabilitation [7], case-
management [8] [9], assertive community treatment (ACT) [10] [11] [2] and supported
employment (SE) [12]. Both ACT [13] [14] and supported employment according to the IPS
model [12] [15] have been identified as evidence-based practices that support people with
severe mental illness. Despite the potential impact of psychiatric rehabilitation on wellbeing
and health, there is a lack of research regarding the model called Psychiatric Rehabilitation
Approach from Boston University (BPR)
1
[16] [17] although it is established in clinical
practice in a number of countries. The BPR model has been investigated in some empirical
studies from United States [18] [19] and in a few studies from European countries [20-23].
Four of these studies used a randomized controlled design [18] [19] [22] [23]. Swildens et al
[22] showed that the BPR was effective in supporting persons with SMI in societal
participation and to achieve self-formulated goals, but no effects were found regarding social
functioning, needs for care, and quality of life. Rogers, Anthony, Lyss and Penk [18] found no
significant differences between the intervention group and a control group regarding
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
1
"Sometimes "called"ChooseGetKeep Model (CGK)"

Citations
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BookDOI
01 Jan 2016
TL;DR: This chapter discusses the person as center of health, the experience of and values in health, and the interdisciplinary team approach for clinical care.
Abstract: Introduction -- The person as center of health -- Person-centered patient perspectives -- Person-centered family perspectives -- Health status from illness to wellbeing -- Contributory factors to health and illness -- The experience of and values in health -- Joint diagnostic understanding: Interviewing and assessment -- Shared decision-making between clinicians, patients and families -- Interdisciplinary team approach for clinical care -- Person-centered prevention -- Person-centered rehabilitation -- Person-centered health promotion -- Person-centered care for major mental disorders -- Person-centered care for psychiatric and general medical comorbidity -- Person-centered forensic psychiatry -- People-centered organization of psychiatric services -- Person-centered public mental health -- Person-centered psychiatric education -- Person-centered psychiatric and mental health research -- Epilogue.

20 citations


Cites background from "A 2-year follow-up study of people ..."

  • ...However, as a clinical discipline, psychiatry must integrate phenomenological aspects of experience with naturalistic explanations of mental mechanisms [60, 63, 72]....

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  • ...Ornish has found in longitudinal studies that they lead to improved well-being, including longer telomeres (a predictor of longevity) compared to others who do not change their lifestyle [53, 54, 60]....

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  • ...Concern about the risk of appropriating the other’s cultural knowledge, and reducing culture to a set of impersonal “factors” led medical educators to the construct of cultural humility as corrective stance [60]....

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  • ...Their points of convergence encompass a holistic theoretical perspective, an emphasis on contextualization and establishing a common ground for understanding and action, development of person-centered procedures for clinical care and health promotion, and, last but not least, an ethical commitment [60]....

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  • ...However, these factors interact between themselves and many are mediators for the development of health problems as is the case with certain biological factors [60], like the genetic stock of the individual (through epigenetics)....

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TL;DR: Whether mental well-being has prognostic significance or other utility in this context is discussed, as well as how to measure it.
Abstract: Mental well-being is being used as an outcome measure in mental health services The recent Chief Medical Officer's (CMO's) report raised questions about mental well-being in people with mental illness, including how to measure it We discuss whether mental well-being has prognostic significance or other utility in this context

17 citations


Journal ArticleDOI
TL;DR: It is proposed that recovery-oriented services should seek to enhance goal setting and goal-pursuit, and to train practitioners in these areas, to support personal recovery and other favorable rehabilitation outcomes.
Abstract: Personal goals/plans play a central role in personal recovery and psychiatric rehabilitation of persons with mental illnesses. Yet, few studies have explored whether perceiving practitioners' assistance towards the pursuit of goals are associated with personal recovery and other favorable rehabilitation outcomes. A total of 2121 mental health consumers, of which 1222 use supported-housing services and 899 use group-home services, completed self-report questionnaires as part of a larger quality-assurance study conducted during the years 2013–2014. Eighty percent of participants living in supported-housing and 72% living in group-homes reported having personal goals/plans for the forthcoming year. Furthermore, their type of goals was different. Irrespective of the type of goal or housing service, participants who reported having goals/plans (compared with those who did not) showed higher levels of personal recovery and more favorable psychosocial outcomes. Regression analyses showed that perceiving professional staff members (but not para-professionals) as assisting in pursuing goals/plans was positively associated with personal recovery. This study empirically validates the value of having personal goals and professionals' assistance in pursuing goals/plans in regards to personal recovery. We propose that recovery-oriented services should seek to enhance goal setting and goal-pursuit, and to train practitioners in these areas.

12 citations


Journal ArticleDOI
TL;DR: A qualitative content analysis of 10 transcribed semistructured individual interviews was used to describe and explore clients’ experiences of the BPR during an implementation project in Sweden, showing that clients do not always recognize nor are able to verbalize their goals before they have been given the possibility to reflect their thoughts in collaboration with a trusted person.
Abstract: The Boston Psychiatric Rehabilitation Approach (BPR) is person-centered and characterized by being based entirely on the individual's unique needs and preferences in the areas of working, learning, social contacts, and living environment. Nevertheless, the person-centered approach is lacking firm evidence regarding outcomes, and empirical studies regarding clients' experiences of this particular model are needed. A qualitative content analysis of 10 transcribed semistructured individual interviews was used to describe and explore clients' experiences of the BPR during an implementation project in Sweden. The findings from the interviews could be summarized in "A sense of being in communion with self and others" theme, consisting of three categories: increased self-understanding, getting new perspectives, and being in a trusting relationship. The results showed that clients do not always recognize nor are able to verbalize their goals before they have been given the possibility to reflect their thoughts in collaboration with a trusted person. The guidelines of the approach are intended to support the clients' ability to participate in decision making regarding their own care. More research about efficacy of different rehabilitation approaches and exploration of fidelity to guidelines of rehabilitation programs are required.

9 citations


Cites background from "A 2-year follow-up study of people ..."

  • ...Ten participants were purposefully selected from the group of 49 clients who had completed the 2-year follow-up evaluation project (Svedberg et al., 2013) to attain variation in terms of sex, age, and experiences regarding duration of illness and previous contacts with mental health services....

    [...]


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TL;DR: The challenge of integrating core concepts of health into mental health nursing praxis, the experiences in psychiatric rehabilitation from the perspective of both patients and their relatives, and the nurses’ experiences of giving support to patients during the transition to hospitalbound hemodialysis are presented.
Abstract: As a Guest Editor of the International Journal of Qualitative Studies on Health and Well-being’s special edition on perspectives on health and well-being in nursing, it is my wish to present four original articles embracing some essential core aspects of nursing science irrespective of their specialization. They represent different aspects of qualitative research that focus on; the challenge of integrating core concepts of health into mental health nursing praxis, the experiences in psychiatric rehabilitation from the perspective of both patients and their relatives, and the nurses’ experiences of giving support to patients during the transition to hospitalbound hemodialysis. The common basis for the articles is the authors’ ambition in their work of generating nursing knowledge in terms of core elements for the provision of health and well-being among individuals with a need for nursing care. (Published: 8 April 2014) Citation: Int J Qualitative Stud Health Well-being 2014, 9 : 23026 - http://dx.doi.org/10.3402/qhw.v9.23026

7 citations


Cites background from "A 2-year follow-up study of people ..."

  • ...Ten participants were purposefully selected from the group of 49 clients who had completed the 2-year follow-up evaluation project (Svedberg et al., 2013) to attain variation in terms of sex, age, and experiences regarding duration of illness and previous contacts with mental health services....

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References
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Reference EntryDOI
11 Jun 2013

113,026 citations


Book
01 Jan 1987
Abstract: Unit I: Introduction to Nursing Research. Discovery of the World of Nursing Research. The Evolution of Research in Nursing. Introduction to Quantitative Research. Introduction to Qualitative Research. Unit II: The Research Process. Research Problem and Purpose. Review of Relevant Literature. Frameworks. Objectives, Questions and Hypotheses. Ethics in Research. Understanding Research Design. Selecting a Research Design. Sampling. The Concepts of Measurement. Measurement Strategies in Nursing. Data Collection and Management. Concepts of Statistical Theory. Descriptive and Exploratory Analyses. Bivariate Inferential Data Analyses. Advanced Statistical Analyses. Qualitative Research Methodology. Outcomes Research. Interpreting Research Outcomes. Communicating Research Findings. Unit III: Strategies for Using Research in Practice. Critical Analysis of Nursing Studies. Utilization of Research in Nursing Practice. Unit IV: Seeking Support for Research Activities. Proposal Writing for Research Approval. Seeking Funding for Research.

3,913 citations


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TL;DR: Use of the community program for 14 months greatly reduced the need to hospitalize patients and enhanced the community tenure and adjustment of the experimental patients, and the results suggest that community programming should be comprehensive and ongoing.
Abstract: • A conceptual model for the development of communitybased treatment programs for the chronically disabled psychiatric patient was developed, and the results of a controlled study and follow-up are reported A community-treatment program that was based on the conceptual model was compared with conventional treatment (ie, progressive short-term hospitalization plus aftercare) The results have shown that use of the community program for 14 months greatly reduced the need to hospitalize patients and enhanced the community tenure and adjustment of the experimental patients When the special programming was discontinued, many of the gains that were attained deteriorated, and use of the hospital rose sharply The results suggest that community programming should be comprehensive and ongoing

1,601 citations


Journal ArticleDOI
TL;DR: The Manchester Short Assessment of Quality of Life (MANSA) is a brief instrument for assessing quality of life focusing on satisfaction with life as a whole and with life domains and its psychometric properties appear satisfactory.
Abstract: Background Based on experiences and empirical evidence gained in studies using the Lancashire Quality of Life Profile (LQLP), the Manchester Short Assessment of Quality of Life (MANSA) has been developed as a condensed and slightly modified instrument for assessing quality of life. Its properties have been tested in a sample of community care patients.Method Fifty-five randomly selected patients on the Care Programme Approach were interviewed using the LQLP, the MANSA and the Brief Psychiatric Rating Scale.Results Correlations between subjective quality of life scores on MANSA and LQLP were all 0.83 or higher (0.94 for the satisfaction mean score). Cronbach's alpha for satisfaction ratings was 0.74, and association with psychopathology was in line with results for LQLP as reported in the literature.Conclusions The MANSA is a brief instrument for assessing quality of life focusing on satisfaction with life as a whole and with life domains. Its psychometric properties appear satisfactory.

796 citations


Journal ArticleDOI
TL;DR: The findings in terms of the need for specialization of ACT or ICM teams to address social and vocational functioning and substance abuse are discussed, including evaluating implementation fidelity, exploring patient predictors of improvement, and evaluating the role of the helping alliance in mediating outcome.
Abstract: 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.

792 citations


Frequently Asked Questions (2)
Q1. What are the future works in this paper?

A possible conclusion is that an intervention such as BPR that focuses on the relationship between a 12 person ’ s self-formulated goals and their values for the future promotes health related issues and facilitates recovery. A further argument was that there is a rather widespread implementation of the BPR approach but a lack of clinical studies focusing the evidence of the approach. A further issue of concern is whether the population in the actual community setting is a representative group of clients with SMI. In spite of these limitations the authors still suggest that the BPR approach can be an important factor in improving clients ’ clinical and social situation. 

Unless other specific re-use rights are stated the following general rights apply: Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. You may not further distribute the material or use it for any profit-making activity or commercial gain •