Factors related to hospital utilisation for people living with schizophrenia: Examining Allen's Cognitive Level Scores, recommended supports and routinely collected variables.

INTRODUCTION: Australian occupational therapists working on mental health inpatient wards are often requested to assess a person's function and, based on that assessment, recommend the best support environments for that person post-discharge. The Allen Cognitive Level Screen (ACLS) is a tool used by some therapists to screen cognitive functioning as a basis with which to make support recommendations. There is limited examination of the outcomes for people post-discharge if the ACLS score-based support recommendations are followed. METHOD: A retrospective cohort design involved quantitative analysis of archival data for 150 adult (18-65 years old) consumers with a primary diagnosis of schizophrenia and an ACLS completed pre-discharge. Data up to 12 months post-discharge from hospital were studied. Outcomes examined included re-presentations or readmission to hospital, length of time in community prior to re-presentation and length of stay in hospital if readmitted. RESULTS: Being younger, male, receiving formal supports, having a drug and alcohol disorder comorbidity, living in public housing and having a lower cognitive level as measured by the ACLS were significant univariate factors associated with higher hospital utilisation for one or more of the outcome variables. Multivariate analyses revealed fewer significant relationships, with being younger and receiving formal supports significantly associated with greater likelihood of return to hospital. CONCLUSION: This research contributes to evidence of the complexity of living with schizophrenia in the community and supporting people to stay out of hospital. More research regarding how the ACLS score-aligned support recommendations are carried out and the impact on hospital utilisation is needed in order to enhance occupational therapists confidence in their use and prescription.

The role of executive functions and psychiatric symptom severity in the Allen Cognitive Levels.

This study examined the relationship between Allen Cognitive Level (ACL) and psychiatric symptom severity, level of nursing support required to complete activities of daily living (ADLs), and post-hospitalization discharge disposition in a sample of 193 acute psychiatric inpatients. A subsample of 31 participants with acute psychotic disorders were administered three measures of executive functioning in order to examine the convergent validity between ACL and basic sequencing and shifting, phonemic fluency, and visuospatial construction. Findings indicated significant moderate positive correlations between ACL and motor processing speed, basic sequencing and shifting, and phonemic fluency, and a nonsignificant relationship with visuospatial construction. A subsample of 166 participants were administered the Brief Psychiatric Rating Scale-Expanded (BPRS-E) to assess psychiatric symptom severity. Results indicated a significant weak negative correlation between ACL and total psychiatric symptomatology, as well as significant weak negative correlations with specific symptoms. In contrast with prior research, there was no significant correlation between ACL and level of nursing assistance required to complete ADLs. A logistic regression did not identify ACL as a contributing factor to post-hospitalization discharge disposition. These findings call into question the clinical utility of the ACLS-5 as an assessment of functional cognition for those experiencing acute psychiatric illness.