Transition from an adolescent to an adult eating disorder treatment centre: A qualitative investigation of the experience of inpatients with anorexia nervosa and their carers using interpretative phenomenological analysis.

AIMS: To capture the subjective experience of eating disorder patients and their immediate family members in the transition between adolescent and adult treatment services and to explore how both groups make sense of this specific experience. DESIGN: Qualitative study in the form of in-depth interviews using interpretative phenomenological analysis. SETTINGS: Participants were recruited from a university department of a large psychiatric hospital specialising in eating disorders between July 2021 and September 2022. PARTICIPANTS: A convenience sample of 18 participants was recruited, including 12 patients aged 19-30 years (m = 22.5, SD = 3.8) and six of their respective caregivers. RESULTS: Four main themes were identified in relation to the participants' experience of transition to adult care: (1) the detailed description of the transition process, (2) the emotions associated with this experience, (3) the challenges encountered and (4) recommendations for improving the process. Two fundamental meaning-making processes emerged: the feeling of being "lost in transition" and the opportunity to "become an adult". The results highlighted the factors that characterise this experience for patients and their families, and the need for practical and psychological support during the transition process. CONCLUSIONS: This study provides a unique insight into the experience of patients and their immediate family members regarding the transition from adolescent to adult care. It reveals the multidimensional impact of the transition experience and highlights the need for increased support for family members. These findings may provide new insights into interventions that promote successful transition and encourage rethinking the organisation of this crucial stage of the care pathway.

How subjective well-being, patient-reported clinical improvement (PROMs) and experience of care (PREMs) relate in an acute psychiatric care setting?

BACKGROUND: Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are increasingly acknowledged as critical tools for enhancing patient-centred, value-based care. However, research is lacking on the impact of using standardized patient-reported indicators in acute psychiatric care. The aim of this study was to explore whether subjective well-being indicators (generic PROMs) are relevant for evaluating the quality of hospital care, distinct from measures of symptom improvement (disease-specific PROMs) and from PREMs. METHODS: Two hundred and forty-eight inpatients admitted to a psychiatric university hospital were included in the study between January and June 2021. Subjective well-being was assessed using standardized generic PROMs on well-being, symptom improvement was assessed using standardized disease-specific PROMs, and experience of care using PREMs. PROMs were completed at admission and discharge, PREMs were completed at discharge. Clinicians rated their experience of providing treatment using adapted PREMs items. RESULTS: Change in subjective well-being (PROMs) at discharge was significantly (p < 0.001), but moderately (r2 = 28.5%), correlated to improvement in symptom outcomes, and weakly correlated to experience of care (PREMs) (r2 = 11.0%), the latter being weakly explained by symptom changes (r2 = 6.9%). Patients and clinicians assessed the experience of care differently. CONCLUSIONS: This study supports the case for routinely measuring patients' subjective well-being to better capture the unmet needs of patients undergoing psychiatric hospital treatment, and the use of standardized patient-reported measures as key indicators of high quality of care across mental health services.

Experiencing eight psychotherapy approaches devoted to eating disorders in a single-day workshop increases insight and motivation to engage in care: a pilot study.

PURPOSE: For patients with eating disorders (EDs), early engagement in care is usually considered a positive prognostic factor. The aim of the study was to investigate how a single-day intervention devoted to early, brief, experiential exposure to a variety of psychotherapy approaches might support commitment to change and the decision to engage in care in patients with EDs. METHODS: One hundred and sixty-nine adult outpatients newly diagnosed with an ED took part in a single-day workshop for groups of up to ten patients, where they experienced eight psychotherapeutic approaches. Motivation to change care and level of insight were assessed at baseline and 10 days after the intervention. RESULTS: Motivation and commitment to take active steps toward change (expressed by the "Committed Action" composite score) significantly improved after the intervention (p < 0.001), and a significant number of patients specifically moved from "contemplation" to "action" stage (p < 0.001). The improvement of motivation to change was significantly associated with an increase in insight capacity (p < 0.001), and this increase was observed for almost all related dimensions such as recognition of illness or awareness of need for psychological treatment. CONCLUSION: A single-day session devoted to experiencing a range of group psychotherapies increased patients' insight and motivation to actively engage in care. To confirm potential longer-term benefits of this intervention, further studies are needed to explore the contribution of each approach and process specifically involved in patients' increased motivation for care, as well as the clinical characteristics of patients associated with better outcomes. LEVEL OF EVIDENCE: V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

[Employment and Recovery Process]. / Activité professionnelle et processus de rétablissement.

Objectives It is widely acknowledged and confirmed by research that there is a close relationship between work and recovery from a mental illness. The aim of this article is to discuss different aspects of the relationship between these two concepts.Methods The discussion is based on a synthesis of the relevant literature in two domains: the benefits of employment for people living with a mental illness and their contributions to the recovery process, and the specification of the recovery paradigm and of the recovery-oriented practices.Results The recovery paradigm may be characterized by some main shifts in the vision of people living with a mental illness and of their future, with consequences on how to support these people, and in particular how to conceive their vocational rehabilitation. One of the first shifts is that it is possible for a large majority of these people to recover, to return to active and social life, to consider a favourable future. This possibility, which gives rise to hope and a high expectation, should now be the priority objective of supporting practices, which implies a renewal of these practices. A second shift is that this possibility of recovery does not necessarily require a complete and prior reduction of the mental disorders. The recovery approach, by giving priority to commitment to an active and social life, supports vocational reintegration as a priority. This new approach to practices and services should be considered at two levels: in the design and organization of services, which must be redefined according to the primary objectives and the values of recovery, but also at the individual level, in the accompanying posture, which should be based on the values of recovery. In vocational rehabilitation, Individual Placement and Support (IPS) is recognized as an evidence-based practice and its principles are well defined. There is a striking convergence between the underlying principles of IPS programs and the principles of the recovery-oriented practices, but the shift in the accompanying individual posture is better specified by the recovery-oriented practice literature.A number of research focuses on the different ways by which employment contribute to the recovery process. We rely on existing qualitative meta-synthesis of these studies, to present the factors contributing to the recovery process according to the relevant main dimensions.Conclusion In the current French context of development of effective professional integration practices, based on the Place and train model, it is important to stress that these practices must be also recovery-oriented, which implies not only a new design of vocational services but also to adopt a new attitude for supporting people in the process of work integration.

[Supervisors and Employment Counselors in Messidor Transitional Social Firms Supporting People with Psychiatric Disability to Gain Competitive Employment]. / Les accompagnants à l'insertion professionnelle en milieu ordinaire pour les personnes en situation de handicap psychique au sein des ESAT de transition Messidor.

Objectives Some programs have been developed in France for helping people with a psychiatric disability to get competitive employment, especially prevocational programs such as transitional social firms. However, these programs have not been studied until now. Studies on supported employment programs (evidence-based practices) conducted in other countries demonstrated that variation of work outcomes is due, among other factors, to employment specialists' competencies. These results highlight the need for describing more specifically the work of the two professionals, employment counselors and supervisors, working in transitional social firms in order to better understand their role, tasks and competencies. Therefore, the objective of this study aims at describing the roles, tasks and competencies of these two professionals working in transitional social firms, to better understand how they support people with psychiatric disability for eventually obtaining competitive employment.Methods A qualitative method was used to describe roles, tasks and competencies of employment counselors and supervisors working in the transitional social firms of the Messidor's association (7 regions). In sum, 24 individual interviews with employment counselors and supervisors of these social firms as well as 7 focus groups with the two types of professionals, were conducted.Results This study allowed to define the work of the two professionals (role and tasks) and a list of 110 competencies for employment counselors as well as 155 competencies for supervisors working in these transitional social firms, emerged from qualitative analyses. This "double support" has been defined as a complementary approach helping workers to change their own perceptions, becoming more confident in their work abilities, and thus helping them to gain competitive employment. On the one hand, the employment counselor supports each worker in developing strategies and actions to reach competitive employment, and put in place "job development skills" to coordinate his role with key stakeholders (e.g. psychiatrist, employers) involved in the work integration of people with severe mental disorders. On the other hand, the supervisor is following each worker all day long, training and helping them to overcome potential difficulties regarding the work to do, and building confidence and self-esteem in the workers under their supervision, which are all key elements to gain competitive employment.Conclusion Clinical implications are suggested regarding the recruitment of professionals working in transitional social firms, and thus improving work outcomes for people with a severe mental illness.

Vocational Counselors in France: Comparison to Competencies of Employment Specialists Working in Canadian IPS Programs.

Supported employment programs are evidence-based practices to help people with severe mental illness to obtain competitive employment. The competencies of employment specialists working in these programs are key elements related to work integration. In France, the Messidor Association, a prevocational organisation, has developed a practice with similarities to supported employment and is beginning to develop supported employment programs in their context. The objective of this quantitative study was to evaluate the Messidor vocational counselors' competencies using the Behaviors, Attitudes and Knowledge in Employment Specialists' scale by comparing their results to those of employment specialists working in IPS programs in Canada. Descriptive analyses and a MANOVA highlighted similarities between French and Canadian counselors such as the same importance given to the working alliance with clients and the development of relationships with different stakeholders (e.g., employers). Skills that should be developed in vocational counselors in France include those related to rapid job search and dealing with stigma. In addition, clinical implications are suggested to ensure the development of vocational counselors' competencies in France.

Outcome, recovery and return to work in severe mental illnesses.

The assessment of outcomes of severe mental illnesses has become recently an important line of research in psychiatry, leading to distinguish different levels of outcomes and a diversity of underlying factors. The focus has shifted from a traditional medical notion of 'disease outcome' to a wider notion of 'functional outcome', and even to an inquiry about the fate of the person and its determinants. Recovery, rather than cure or remission, is regarded as the good outcome, with its own underlying factors. Return to work, as a vocational outcome, represents in research one of the good functional outcomes. It is generally understood as a sign of social recovery. But may work be regarded as a good outcome in its broader sense, i.e. as a means of full recovery? Several theoretical and empirical arguments are in favor of considering work as a privileged way toward recovery, but this does not mean it is the only way.

Person-centredness: conceptual and historical perspectives.

PURPOSE: The definition and aims of rehabilitation are both topics of frequent debate. Recently several authors have suggested defining rehabilitation and its goals in terms of 'person-centredness'. However such attempts to define rehabilitation in this way have not occurred without running into their own difficulties and criticisms. Consequently, one may question whether person-centredness is a good candidate to characterize and define rehabilitation. The purpose of this article is to reflect upon the historical background and conceptual underpinnings of this term and their relevance for understanding contemporary person-centred rehabilitation. METHOD: We conducted a conceptual and historical analysis of the notion of person-centredness in relation to rehabilitation. We ask first whether person-centredness has a consistent and fixed definition and meaning? Secondly, where does person-centredness come from, what is its conceptual history and does an historical approach enable us to identify a unique source for person-centredness? RESULTS: In the context of rehabilitation, we have identified four main understandings or interpretations of the term person-centredness, each of which denotes several ideas that can be, in turn, interpreted in quite different ways. Thus the concept of person-centredness in rehabilitation has multiple meanings. The conceptual history indicates that person-centredness has diverse meanings and that it has been used in a variety of contexts somewhat unrelated to disability and rehabilitation. Moreover, there does not seem to be any strict relationship between person-centredness as it is used in the context of rehabilitation and these prior uses and meanings. CONCLUSION: Person-centredness has an ancient pedigree, but its application in the field of rehabilitation raises both practical and theoretical difficulties. It may be that rehabilitation might get a better sense of what it should be and should do by focusing less on the rhetoric of person-centredness and by putting more emphasis on the investigation and operationalization of its key conceptual components.

Why is rehabilitation not yet fully person-centred and should it be more person-centred?

AIMS: It is a generally shared opinion that rehabilitation is not (yet) 'fully person-centred' and that it should be more. For a certain number of authors, this deficit in person-centredness has originated from the important weight of a 'medical framework' within rehabilitation. In this paper, we will discuss this criticism and its corollary: the idea that rehabilitation is bound to choose between a non-medical and a medical paradigm, since there is a fundamental contradiction between medicine and person-centredness. In the first section of the paper, we will examine the conceptual history of rehabilitation and question whether this history can really be summarized as a 'shift from a medical approach to a person-centred approach'. In the second section, we will question assumptions and suggestions that have been made to develop person-centredness in rehabilitation. In the third section, we will discuss what might be gained but also what might be lost by reinforcing person-centredness in rehabilitation. KEY FINDINGS AND IMPLICATIONS: (i) The history of rehabilitation is complex with several stages and paradigm shifts. Furthermore, these paradigms do not succeed one another but overlap. It would therefore be erroneous to reduce the history of rehabilitation to merely a shift 'from a medical approach to a person-centred approach'. (ii) Several proposals of how to make rehabilitation more person-centred are found within the literature. However, none of these appears satisfactory with each leading to theoretical and practical difficulties. (iii) Although person-centredness has unquestionably contributed to the overall progress of rehabilitation, it is not certain that more person-centredness is the solution to current challenges to rehabilitation. CONCLUSION AND RECOMMENDATIONS: In some ways, the challenge rehabilitation faces is the need to transpose and adapt a notion (person-centredness) that has emerged from fields that are in fact unrelated to disability such as, for example, clinical psychology. The difficulties encountered are therefore not so much related to the particular dominance of a 'medical model' in rehabilitation than they are to the complexities of the concept of disability. We argue that one way forward might be to clarify further the respective role of the medical and non-medical aspects of rehabilitation in ways that go beyond what has been already achieved in either the ICIDH or ICF but which is still unsatisfactory or incomplete in many respects.