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Results for “Deinstitutionalization”

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PubMed1992

An evaluation of hospital-based specialized staffed housing for people with seriously challenging behaviours.

Resident and staff activity was observed in two hospital-based staffed houses for adults with severe or profound mental handicap, and seriously challenging behaviours. The results indicated that: (1) staffing resources were inefficiently deployed, leading to low levels of support being provided to service users; (2) staff attention was inequitably distributed across users, individuals showing the highest levels of seriously challenging behaviours received disproportionately more staff attention; (3) users spent little of the time they were observed engaged in constructive activities. Comparisons with data collected previously on four of the users in institutional settings indicated that: (4) no overall changes occurred in either user participation in constructive activities or (5) duration of challenging behaviours; and (6) overall, more staff contact was provided in the specialized housing projects compared to previous institutional settings. The results are discussed in terms of the determinants of quality in residential provision for people with seriously challenging behaviour.

Activities of Daily Living↗
PubMed1993

Effects of a community-based service on adaptive and maladaptive behaviours: a longitudinal study.

Changes in skill acquisition and problem behaviour, contingent upon the introduction of a new community-based service, were compared for subjects in three different residential settings: supported accommodation; hospital; and private family homes. Results over a 5-year period indicate links between service contact and increases in skill level, together with an increase in problem behaviour for subjects who moved from hospital to supported accommodation. The interpretation of client income in the context of service process is discussed.

Adult↗
PubMed1993

Mental health services for people with mental retardation: a framework for the future.

The mental health needs of mentally retarded people cannot be met satisfactorily with generic mental health services. Specialized services are required. A number of different service models have evolved which require evaluation. They include subregional units, community-based services with a small admission facility, integrated services and specialist teams. Staff working in specialist mental health services must be appropriately trained.

Combined Modality Therapy↗
PubMed1994

A move from hospital to community-based homes for people with learning disabilities: activities outside the home.

Eighteen people with learning disabilities who moved from hospital to community-based homes were compared with a matched group of 18 who did not. A week-long time budget diary was used to record each occasion that the person left their home, the people accompanying them on each trip, their mode of transport and their destination. The diary was completed before they left the hospital and was repeated at least 1 year later. There was a strong correlation between the number of trips made from hospital wards at baseline and the number made at follow-up in both groups. Moving from the hospital had no significant effect on the number of trips made, but it did change their nature. Movers made more trips to unsegregated facilities; they made fewer trips alone and more in groups which included both staff and residents.

Activities of Daily Living↗
PubMed1995

Community adjustment of mobile people with learning difficulties after total hospital closure: a preliminary report.

A study is described in which 50 residents of a hospital for people with learning difficulties were assessed immediately before and 1 year after moving into two types of community provision; purpose-built campuses or small homes in residential streets. Measures were taken of residents' adaptive and unwanted behaviours and of aspects of their lifestyles. The results report the changes in these measures that were found for both campus and small home residents.

Adaptation, Psychological↗
PubMed2004

Coping with social stigma: people with intellectual disabilities moving from institutions and family home.

BACKGROUND: Social stigma and its impact on the life opportunities and emotional well-being of people with intellectual disabilities (IDs) are a subject of both practical and theoretical importance. The disability movement and evolving theories of self, now point to individuals' ability to develop positive identities and to challenge stigmatizing views and social norms. METHOD: This paper presents findings from a phenomenological study of 10 individuals making the transition from their family home to live more independently and 18 individuals moving from a long-stay hospital to live in community housing. It builds on an earlier data set obtained from people living at home with their families and examines: (1) people's awareness of stigma, and (2) their modes of adaptation to stigma. RESULTS: The participants all believed that they faced stigmatized treatment and were aware of the stigma associated with ID. They presented a range of views about self in relation to disability and stigma. These views included regarding themselves as part of a minority group who reject prejudice, and attempts to distance themselves from stigmatizing services and from other individuals with IDs. CONCLUSIONS: The findings are discussed in relation to theories of self and the importance of considering psychosocial factors is stressed in clinical work with people who have IDs.

Activities of Daily Living↗
PubMed2006

Community and cluster centre residential services for adults with intellectual disability: long-term results from an Australian-matched sample.

BACKGROUND: Changes in residential accommodation models for adults with intellectual disability (ID) over the last 20 years in Australia, the United Kingdom and the United States have involved relocation from institutions primarily into dispersed homes in the community. But an evolving alternative service style is the cluster centre. METHODS: This paper reports on the relocation of a matched group of 30 pairs of adults with moderate and severe IDs and challenging behaviour who were relocated from an institution into either dispersed housing in the community or cluster centres but under the same residential service philosophy. Adaptive and maladaptive behaviour, choice-making and objective life quality were assessed prior to leaving the institution and then after 12 and 24 months of living in the new residential model. RESULTS: Adaptive behaviour, choice-making and life quality increased for both groups and there was no change in level of maladaptive behaviour compared with levels exhibited in the institution. However, there were some significant differences between the community and cluster centre group as the community group increased some adaptive skills, choice-making and objective life quality to a greater extent than the cluster centre group. CONCLUSIONS: Both cluster centre and dispersed community living offer lifestyle and skill development advantages compared with opportunities available in large residential institutions. Dispersed community houses, however, offer increased opportunities for choice-making, acquisition of adaptive behaviours and improved life quality for long-term institutionalized adults with IDs.

Activities of Daily Living↗
PubMed2006

Comprehensive health assessments during de-institutionalization: an observational study.

BACKGROUND: People with intellectual disability (ID) leaving institutions pass through a transition stage that makes them vulnerable to inadequate health care. They enter into community care under general practitioners (GPs) who are often untrained and inexperienced in their needs. Specifically designed health reviews may be of assistance to both them and their new GPs as they go through that phase. METHODS: This research aimed to investigate the effectiveness of a specially designed health review, the comprehensive health assessment program (CHAP) health review, in a group of adults as they transitioned out of the care of the last institution for people with ID in Tasmania. There were 25 residents reviewed by their GPs. RESULTS: The CHAP reviews picked up a number of health conditions and stimulated health promotion activities. Some of the findings were: a high number of abnormal Body Mass Indexes (19/23), immunizations given (13/23), vision impairment reported (2/23), mental health issues recorded (4/23) and skin abnormalities described (17/23). There were 22 referrals made to other health professionals (Australian Hearing Service 4, dentists 3, optometrists 3, psychiatrists 2, neurologists 2, ophthalmologist 1, urologist 1, ultrasound 1, mammogram 1, family planning 1, physiotherapist 1, continence nurse 1 and respiratory physician 1). These were in addition to various requests for pathology. CONCLUSIONS: The CHAP health review was effective in identifying a number of health issues in the population of people with ID as they transitioned out of institutional care into the general community.

Adult↗
PubMed1995

Staff perception of their roles during the transition of psychiatric care into the community.

The objective of this study was to investigate the staff's experiences involved in the processes of the transition of 20 non-demented long-stay psychiatric patients. Staff members expressed satisfaction from working outside the hospital. They believed that the patients' condition and their quality of life had improved and that they were likely to achieve successful resettlement after a lengthy process of rehabilitation. However, staff members considered that their roles were demanding and involved a lot of domestic activities. They recommended gradual and slow preparation for the patients, and an educational programme for the public as well as appropriate preparation and continuing professional support for staff.

Adult↗
PubMed2006

Greek psychiatric care reform: new perspectives and challenges for community mental health nursing.

The purpose of this article is twofold: (1) to explore the main issues of psychiatric care reform in Greece and outline the operating way of the new residential structures of psychiatric care and rehabilitation; and (2) to focus on the implementation of mental health nursing roles in the primary care services such as supervisor-therapist, liaison, coordinator-crisis interventionist and counsellor-trainer within the context of a multidisciplinary therapeutic team. Given that multiple professionals are involved in mental health care in primary care, issues of role are likely to be crucial to the effective implementation of new workers. Moreover, there is existing evidence of ambiguity in the roles of different mental health professionals in primary care, relating to the problems they manage and the treatments they provide. The authors believe that more emphasis needs to be given to the mental health nursing specialty in Greece, because the large majority of patients requiring mental health care should have the possibility of taking better quality of care as the psychiatric structures at community are continuously developing.

Community Health Nursing↗
PubMed2006

Conceptions of patients and personnel concerning the substance of post-ward outpatient visits in psychiatric care.

In post-ward outpatient services patients discharged from hospital are provided further care by the same ward personnel. The aim of this study was to describe and analyse the conceptions concerning the substance of post-ward outpatient visits (PWOV). A phenomenographic approach was used. The data were gathered by interviewing post-ward outpatients, personnel at psychiatric wards and in outpatient care and administrative personnel in psychiatric units. Seven main categories of describing the PWOV were formed: natural interaction, continuous assessment, follow-up of the implementation of pharmacotherapy, relapse prevention, search for coping methods, establishing motivation for treatment and family members' participation in care. The patient's health, life situation and coping in everyday life were constantly evaluated and followed up in diverse ways during the PWOV. To make PWOV successful, treatment should be planned individually based on the patient's needs, and the patient should have a close and functional cooperative relationship with the nurse.

Activities of Daily Living↗
PubMed2006

Parents' experiences of collaboration with community healthcare professionals.

Over the last decades there has been a reduction in the number of institutional beds in psychiatric care in Norway. This has led to more psychiatric patients being dependent on community care and consequently an increased need for collaboration with the parents of these patients. In most cases parents are an important source of support in helping patients manage their everyday life. The aim of this study was to explore how parents of adult psychiatric patients experience collaboration with health professionals in the community healthcare services. The data collection in this study is based on 12 interviews with six parents, and a qualitative analysis method was employed. Four themes emerged: (1) communication and relationship between parents and health professionals; (2) lack of information; (3) parents' participation in the treatment of their son or daughter; and (4) the need for guidance and support. It was reported that health professionals are suspicious of parental involvement and often refuse to allow them to participate in the care. Further research on parents' experiences of collaboration is necessary. The value of parents as an important source of support can be enhanced by means of increased collaboration.

Adult↗