A Randomized Study Comparing the Treatment Environment in Alternative and Hospital-Based Acute Psychiatric Care

Hawthorne, William; Green, Elizabeth E.; Folsom, M.P.H. David P.; Lohr, James B.

doi:10.1176/ps.2009.60.9.1239

Cited by 12 publications

(21 citation statements)

References 19 publications

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“…It may also be that more recently established PARC services are seen to offer a tested and valued alternative to an inpatient admission prompting higher referrals from community services. Consistent with this, community alternatives to admission were rated as providing more involvement and support by residents and staff (42, 43) and seen as more collaborative and informal by stakeholders from other parts of the service (43, 44). However, as data were gathered for this study at a single time point, it is impossible to determine how proportions of step-up or step-down admissions have varied over time for any of the PARC services or clusters.…”

Section: Discussionmentioning

confidence: 70%

Prevention and Recovery Care Services in Australia: Developing a State-Wide Typology of a Subacute Residential Mental Health Service Model

et al. 2019

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Aims: Community-based residential alternatives to hospitalization are an emerging service model. Evidence for their acceptability and effectiveness is promising but limited. Prevention and Recovery Care (PARC) services are one such residential model, offering short-term subacute treatment and care (usually between 7 and 28 days). PARC services in Victoria, Australia, are designed to support consumers with severe mental illness to either avoid a psychiatric hospital admission (step-up care) or transition from hospital back into the community (step-down care). As a precursor to a series of studies investigating the appropriateness, effectiveness and efficiency of PARC services, we aimed to investigate whether a typology of PARC services can be developed. Methods: A manager or other appropriately knowledgeable staff member from each of the 19 adult PARC services included in the study completed a tool based on PARC operational guidelines (the Victorian PARC service mapping questionnaire) and a validated instrument measuring the quality of care in residential mental health settings (the Quality Indicator for Rehabilitative Care, QuIRC). Thirty (of 42) stakeholders participated in a modified Delphi study to select 23 from the available 230 variables for entry into a hierarchical cluster analysis. Results: Cluster analysis produced three clusters of equal dissimilarity. At the 90% confidence level, there were four variables which were significantly different between clusters. These were the year the PARC was opened, the QuIRC Living Environment domain score, the proportion of all admissions that were a step-down admission from an inpatient unit, and how often families were invited to care meetings. Sensitivity analyses suggested the findings were robust to the method used to identify clusters. Conclusions: Although PARC services were broadly similar, their identified differences suggest there is variable model implementation across Victoria sufficient to generate a PARC service typology. This typology may prove important for interpreting differences in outcomes experienced by consumers and carers using PARC services, when applied in our analyses of service effectiveness. The value of conducting service mapping and typology studies is underscored. Further research to characterize subacute residential services, including recovery-promoting features of the built environment, is warranted.

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Section: Discussionmentioning

confidence: 70%

Prevention and Recovery Care Services in Australia: Developing a State-Wide Typology of a Subacute Residential Mental Health Service Model

et al. 2019

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“…Availability and awareness of alternative resources for patients with acute psychiatric needs would also allow for the identification of patients potentially suitable for these resources. Previous research has shown that alternative resources could be beneficial for patients who require hospital level acute psychiatric care, [39][40][41] without medical care. 42 For example, in our study, 24% of patients were unable to take their medication independently and 5% were unable to carry out basic activities of daily living.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

et al. 2015

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Objective: To describe the characteristics and needs prior to, on admission, during the first month in hospital, at the thirtieth day of hospitalization and posthospital discharge of psychiatric patients occupying acute beds.Methods: This prospective observational study was conducted in 2 tertiary care hospitals. Adult patients hospitalized on a psychiatric unit for 30 days were identified. Data was collected from their medical charts and interviews with their health care team. The categorization of acute and nonacute status at day 30 was based on the health care professional's evaluation. Descriptive and univariate analyses were performed.Results: A total of 262 patients were identified (mean age 45 years), 66% lived at home and 11% were homeless. More than one-half were cognitively impaired and a few had special medical needs. Ninety-seven per cent had been admitted from the emergency department. At day 30, 81% of patients required acute care, while 19% (95% CI 15% to 24%) occupied an acute care bed, despite the resolution of their acute condition. The main reason preventing discharge of nonacute patients was the difficulty or inability to find appropriate resources that met patients' needs. As for patients who required acute care, the most common psychiatric issues were delusions or hallucinations (34%), inability to take medications independently (23.6%), and inadequate control of aggression or impulsivity (16.5%). Conclusions:Prevention of the discharge of nonacute patients is largely due to the difficulty in finding appropriate resources that meet patients' needs. Improved access to community and subacute care resources could potentially facilitate the hospital discharge of psychiatric nonacute patients. W W W Caractéristiques et besoins des patients psychiatriques dont le séjour à l'hôpital est prolongéObjectif : Décrire les caractéristiques et les besoins, avant l'hospitalisation, au moment de l'admission, durant le premier mois, au 30 e jour d'hospitalisation et après le congé de l'hôpital de patients psychiatriques occupant des lits de soins actifs.Méthode : Cette étude d'observation prospective a été menée dans 2 hôpitaux de soins tertiaires. Les patients adultes hospitalisés dans une unité psychiatrique pendant 30 jours ont été identifiés. Les données ont été recueillies dans leurs dossiers médicaux et par des entrevues avec leur équipe de soins de santé. La catégorisation du statut aigu et non aigu au 30 e jour se fondait sur l'évaluation des professionnels de la santé. Des analyses descriptives et univariées ont été exécutées.Résultats : Un total de 262 patients ont été identifiés (âge moyen 45 ans), dont 66 % vivaient à la maison et 11 % étaient sans abri. Plus de la moitié étaient cognitivement déficients et quelques-uns avaient des besoins médicaux spéciaux. Quatre-vingt

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“…Of the fifteen research studies, six used a quantitative approach, six used a qualitative approach and three used a mixed methods approach. In ten of the studies, scale-type questionnaires and surveys were used to collect data (Bettman & Tucker, 2011;Blay et al, 2008;Corring et al, 2013;Duvall & Kaplan, 2014;Harper et al, 2007;Hawthorne et al, 2009;Lariviere et al, 2012;Mills et al, 2015;Tucker et al, 2012;Unterrainer & Lewis, 2013). In one study, three questionnaires were used in a mixed method analysis of adolescents' perceptions of their attachment relationships (Bettman & Tucker, 2011).…”

Section: Chapter 4 Methodologymentioning

confidence: 99%

“…Since nature-based therapies are still quite new in Western social work, there exists a majority of positivist and biomedically-driven research in this field (Barton, Griffin, & Pretty, 2012;Bettman & Tucker, 2011;Blay, Batista, Andreoli, & Gastal, 2008;Corring et al, 2013;Duvall & Kaplan, 2014;Hawthorne, Green, Folsom, & Lohr, 2009;Lariviere, Couture, Ritchie, Cote, Oddson, & Wright, 2012;Mills, Wilson, Iqbal, Alvarez, Pung, Wachmann, Rutledge, Maglione, Zisook, Dimsdale, Lunde, Greenberg, Maisel, Raisinghani, Natarajan, Jain, Hufford, & Redwine, 2015;Norton, 2010;Tucker et al, 2012;Unterrainer & Lewis, 2013). As a result, the voices of interpretive and critical researchers, as well as any "alternative" "mental health" practitioners, are limited.…”

Section: Chapter 3 Literature Reviewmentioning

confidence: 99%

“…Only four of the fifteen studies included more female-identified participants than males (Gray, 2007;Munoz et al, 2008;Norton, 2010;Unterrainer & Lewis, 2013), and only one of the fifteen studies specifically included the voices of trans-identified and genderqueer people (Munoz et al, 2008). Across the fifteen research studies, seven identified using majority White samples (Bettman & Tucker, 2011;Blay et al, 2008;Harper et al, 2007;Hawthorne et al, 2009;Mills et al, 2015;Norton, 2010;Tucker et al, 2012) while the remaining did not specify racial identities at all (Barton et al, 2012;Corring et al, 2013;Duvall & Kaplan, 2014;Gray, 2007;Lariviere et al, 2012;Munoz et al, 2008;Teghtsoonian, 2009;Unterrainer & Lewis, 2013). Additionally, in five studies, the researchers overtly acknowledged the exclusion of specific groups including people living in long-term care homes, people weighing more than 170 lbs, people living with comorbid medical conditions, and students who reported histories of psychiatric diagnoses or treatment (Blay et al, 2008;Corring et al, 2013;Hawthorne et al, 2009;Munoz et al, 2008;Unterrainer, 2013), in order to control their outcomes.…”

Section: Gaps In Literaturementioning

confidence: 99%

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The Roots Of Practice: An Anti-Colonial Critical Discourse Analysis Of Western Nature-Based Mental Health Therapies

Chui¹

2021

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<div>This study seeks to explore how nature-based therapies are understood in Western “mental health” practices. Specifically, horticultural and equine-assisted therapeutic models are examined for discursive themes tied to mind-body connections, attachment and healing. Additionally, texts used to teach specific therapeutic modalities are examined to further explore common concepts such as mindfulness and coping. In conducting a review of relevant literature, similar themes were revealed which contributed to a base knowledge for understanding the discourse around nature-based therapies. Engaging in an anti-colonial theoretical framework and a modified critical discourse analysis methodology, this qualitative study explores the research question: “What are the discourses which inform Western nature-based therapies?” Ultimately, this study aims to develop a more thorough understanding of how these therapies are linked to Indigenous approaches, how practices may be appropriated and used by Western practitioners, and the shift in social work towards more wholistic therapeutic practices. </div>

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A Randomized Study Comparing the Treatment Environment in Alternative and Hospital-Based Acute Psychiatric Care

Abstract: The more favorable ratings of the treatment environment at START in this study are consistent with previously published findings demonstrating the viability of the START model as an alternative to hospital-based acute psychiatric care.

Cited by 12 publications

References 19 publications

Prevention and Recovery Care Services in Australia: Developing a State-Wide Typology of a Subacute Residential Mental Health Service Model

Prevention and Recovery Care Services in Australia: Developing a State-Wide Typology of a Subacute Residential Mental Health Service Model

Characteristics and Needs of Psychiatric Patients with Prolonged Hospital Stay

The Roots Of Practice: An Anti-Colonial Critical Discourse Analysis Of Western Nature-Based Mental Health Therapies

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