Recovery housing: assessing the evidence.

OBJECTIVE: Recovery housing is a direct service with multiple components that provides supervised, short-term housing to individuals with substance use disorders or co-occurring mental and substance use disorders. It commonly is used after inpatient or residential treatment. This article describes recovery housing and assesses the evidence base for the service. METHODS: Authors searched PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, and Social Services Abstracts. They identified six individual articles from 1995 through 2012 that reported on randomized controlled trials or quasi-experimental studies; no reviews or meta-analyses were found. They chose from three levels of evidence (high, moderate, or low) based on benchmarks for the number of studies and quality of their methodology. They also described the evidence of service effectiveness. RESULTS: The level of evidence for recovery housing was moderate. Studies consistently showed positive outcomes, but the results were tempered by research design limitations, such as lack of consistency in defining the program elements and outcome measures, small samples, and single-site evaluations, and by the limited number of studies. Results on the effectiveness of recovery housing suggested positive substance use outcomes and improvements in functioning, including employment and criminal activity. CONCLUSIONS: Recovery housing appears to be an important component in the continuum of care for some individuals. However, replication of study findings with greater specificity and in more settings is needed.

La atención de la fractura de fémur en las unidades de convalecencia / No disponible

El desarrollo de las Unidades de Media Estancia (UME) o Convalecencia (UC), según las diferentes acepciones, ha permitido proseguir el proceso rehabilitador en los pacientes ancianos afectos de fractura del tercio proximal de fémur. Este hecho, contribuye a una reducción de la mortalidad innata del proceso, un mejor resultado de recuperación funcional así cómo a una disminución de las complicaciones propias, que un evento como la fractura de fémur, dada su magnitud, ocasiona al paciente anciano. Otro aspecto fundamental es el de la utilización de los recursos sociales y sanitarios, que se ven favorecidos y optimizados en su gestión gracias a la existencia de dichas unidades. La reducción de la estancia media en los hospitales de agudos y una menor tasa de institucionalización al final del alta médica, son claros ejemplos de la efectividad y la eficiencia de las unidades de convalecencia(AU)

The development of Geriatric Assesment Units or Geriatric Rehabilitation Units, according to different meanings, has allowed the rehabilitation process to be carried on in old patients affected in hip fracture. This fact, leads to a reduction of the death of the process, a better functional recuperation, and at the same time, decreasing of the common complications, which uses to affect the old patient, due to its magnitude. Another fundamental aspect is the use of sanitary and social sources, which are being optimized in their management due to the existence of some sectors. The reduction of average in hospitals and a lower tax in institutionalization at the end of medical discharge, are clear examples of the effectiveness and efficiency of the convalescence sectors(AU)

["Responsiveness" in psychiatric outpatient care and in hostel management]. / "Responsiveness" in der psychiatrischen ambulanten Versorgung und in der Heimversorgung.

OBJECTIVE: Responsiveness is a concept developed by the World Health Organisation (WHO) to evaluate health system performance. It measures how well a health system meets its users' legitimate expectations in non-medical related service aspects. Responsiveness consists of the categories "patient orientation" and "respect for persons". It is operationalised by nine (8+1) domains. This project aims to explore the responsiveness concept as a possibility to evaluate the performance of mental health care. METHOD: Face to face interviews with users of outpatient and hostel mental health services by means of a standardised instrument, developed by WHO were carried out. RESULTS: Overall responsiveness in outpatient care was rated by a lower proportion of users negative than responsiveness in hostel care (15 vs. 20%). Socio-demographic characteristics were related only to responsiveness ratings in hostel care when legal guardianship was considered. Domains indicated as most important (attention, participation) in out-patient care did not perform well there. In hostel care the domains attention and respect were rated as most important. These domains performed well. DISCUSSION AND CONCLUSIONS: The results are in line with the literature and adequately reflect the realities in mental health care. The responsiveness concept offers a systematic approach for considering the categories "patient orientation" and "respect for persons" as quality criteria in mental health care. Evaluating mental health service provision using the concept of responsiveness, indicates where to launch reforms in health care.

Facility charter and quality of care for board and care residents.

In this investigation structure, process, and outcome measures of quality in for-profit and not-for-profit board and care homes are compared. We find one structural measure (providing nursing care), three process measures (food quality, staff treat residents with respect, and staff verbally abuse residents), and two outcomes measures (cleanliness of the facility and complaints to Ombudsman) to be significant. Moreover, the directions of these effects are all consistent, with for-profit facilities rated more poorly that not-for-profit facilities. These results are discussed emphasizing their implications for efficient and effective resident care.

Comparison of user assessed needs for care between psychiatric inpatients and supported community residents.

The aim of the present study was to compare user assessed needs for care for psychiatric patients in inpatient settings with that of residents in supported community residences. The Camberwell Assessment of Need was administered to 75 patients and residents in different housing settings. Residents in supported community settings had more needs for care (8.1), than patients in inpatient settings (5.8), partly because of differences in duration of illness. A greater proportion of those living in supported community residences reported needs in the areas of psychotic symptoms, accommodation, food, daytime activities, sexual expression and looking after the home. There were no differences in numbers of unmet needs. Relatives and friends provided emotional and social support predominantly in the areas of company and psychological distress. In conclusion, living in supported community residences does not imply more unmet needs, or less adequate response to needs from services, despite a greater number of needs being reported. In some areas of need, relatives and friends play an important role in the provision of support.

Quality of life in boarding houses and hostels: a residents' perspective.

In the last forty years deinstitutionalization has transferred the care of people with a serious mental illness from the psychiatric hospitals to community based facilities. More recently it has been questioned whether these new facilities offer the anticipated benefits of quality of life. This study examines the Quality of Life (QOL) of people diagnosed with schizophrenia living in two different accommodation facilities, hostels and boarding houses. QOL is examined from the resident's perspective. Lehman's (1988b) QOL Interview was used to measure objective, subjective, and global QOL of 60 participants in three hostels and two boarding house clusters. Hostel and boarding house data were compared and results showed that residents preferred boarding house accommodation. Overall, residents of both accommodation facilities reported satisfaction with QOL, and indicated that they regard them as asylum or sanctuary from the outside world.

Transitional housing for veterans with a psychiatric diagnosis.

1. Veterans with a psychiatric diagnosis needed affordable housing and emotional support to successfully reintegrate into the community. 2. A supervising nurse established a structured, transitional housing program with a housing manager and mandatory weekly meetings. 3. The focus of the house program was centered on resident independence and responsibility. 4. The housing program is cost effective and has shown a 79% success rate in assisting clients to become productive members of the community.

States' strategies for promoting supported housing for persons with psychiatric disabilities.

Survey data were used to analyze state government efforts to promote supported housing for persons with psychiatric disabilities in five states--Ohio, Oregon, Rhode Island, Washington, and Wisconsin. States worked to increase mental health service consumers' access to affordable housing by increasing the number of state staff who address housing issues, by developing housing units, and by increasing consumers' income. Legislative mandates and financial incentives were used to encourage service providers to offer more flexible support services. States promoted consumers' involvement in the mental health system by encouraging their participation in state-level decision making and by providing financial support to consumer organizations.

Effects of sheltered care environments and resident characteristics on the development of social networks.

Two hundred and thirty-four members of a 1973 sample of sheltered care residents, three-fourths of whom had schizophrenic disorders, were followed up between 1983 and 1985 to examine the role of supportive and of transitional, high-expectation sheltered care environments in the development of residents' social networks. The influences of revolving-door treatment experiences, psychopathology, and institutionalization were taken into account. The results showed that supportive rather than transitional, high-expectation environments contributed to the development of emotionally and instrumentally supportive social networks. Higher levels of psychopathology and a history of institutionalization resulted in the absence of certain support relationships. Surprisingly, revolving-door treatment experiences were related to positive support and social network outcomes.

Short-term group interventions for mentally ill young adults living in a community residence and their families.

Data from 12 families of chronic mentally ill young adults who were living in a supportive residential facility were used to compare the effects on family functioning of a multiple-family psychoeducational group and a multiple-family support group. The psychoeducational group provided information about mental illness and family dynamics and taught effective communication and conflict management skills. The support group consisted of unstructured discussions about topics raised by the families. Both groups met once a week for five weeks and included both parents and their mentally ill adult children. The emotional climate, level of organization, and other aspects of the family environment were assessed before and after treatment and at three-month follow-up. Both groups helped families to become more cohesive, to manage conflict more effectively, and to obtain a greater internal locus of control.

Creating a supportive environment using staff psychoeducation in a supervised residence.

The prevailing approach to rehabilitation in residential care emphasizes goal attainment. This approach often produces considerable stress for residents, most of whom have schizophrenia. Based on the view that low-demand environments, incorporating graduated expectations, may be more appropriate for this patient population, a three-component model for creating and maintaining a calm, supportive environment in a supervised residence was developed. The model utilizes staff psychoeducation, which is based on the principles of family psychoeducation, a highly effective intervention for patients with schizophrenia. The three components of the model are training in supportive interaction, a medication-monitoring program, and a behavioral approach to problem solving. Resident groups promote each of these components. The groups' goals are encouragement of positive, low-key interactions, compliance with medications, and slow, steady rehabilitation.

Quality of care for youths in group homes.

This paper analyzes findings pertaining to quality of care issues concerning group home care for adolescents in the greater Los Angeles County area during 1978-1979. The issues include normalization, institutionalization, treatment goals, continuity of care, and qualifications of child welfare staff, particularly child care workers. Recommendations for improvement are offered.

Evaluating community care for the mentally handicapped adult: a comparison of hostel, home and hospital care.

While community care for mentally handicapped adults has been received enthusiastically, there have been few attempts to evaluate this form of care. This paper reports a study of two hostels for mentally handicapped adults. By employing an experimental research design, it aimed to test the hypothesis that small, community based residences provide an environment in which individuals can acquire the skills necessary for independent living. Using Gunzberg's Progress Assessment Charts as an indicator, the residents of one hostel achieved significant improvements in the areas of self-help, communication, socialization and occupation over the year following admission. A group of matched controls living at home showed no such improvements, and a group of matched controls living in hospital showed a less certain and less dramatic improvement. A small group of people living in a second hostel also showed significant gains in social competence. The paper also discusses problems in the design and implementation of experimental studies in this field.

Self-preservation ability and residential fire emergencies.

Perske's concept of risk from the perspective of fire safety was examined for approximately 46,000 developmentally disabled persons. The National Bureau of Standards measurement of self-preservation ability was used to define individual risk, resulting in the Evacuation Assistance Score. Environmental risk was measured by grouping residences according to fire safety standards described in the National Fire Protection Association's Life Safety Code. Results indicated that: (a) the Evacuation Assistance Score is best thought of as a single variable that measures any risk that might impede a resident's safe evacuation in a fire emergency, (b) the majority of the developmentally disabled individuals receiving services in New York were totally capable of self-preservation, (c) resident demographic characteristics were not strong predictors of Evacuation Assistance Scores, and (d) the match between individual and physical environment risk vulnerability was not strong.