Performance and effectiveness of step progressive care pathways within mental health supported accommodation services in Italy

Martinelli, Alessandra Rezende; Iozzino, Laura; Pozzan, Tecla; Cristofalo, Doriana; Bonetto, Chiara; Ruggeri, Mirella

doi:10.1007/s00127-021-02128-3

Cited by 10 publications

(19 citation statements)

References 44 publications

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“…RFs in Italy admit patients with SSD who have increased needs for care, severe psychopathology and low functioning (de Girolamo et al ., 2002 ; Ministero Italiano della Salute, 2013 ; Martinelli et al ., 2022 a , 2022 b ), and who would have been hospitalised for a long time in a psychiatric hospital before de-institutionalisation (de Girolamo et al ., 2002 ; Thornicroft and Tansella, 2004 ; McPhearson et al ., 2018 ). RFs represent a fundamental component of long-term care and aim to support users in learning or relearning daily living skills and gaining confidence to achieve social inclusion, independent living and personal recovery (UN General Assembly, 2006 ; Priebe et al ., 2009 ; Martinelli and Ruggeri, 2020 a ; Raugh et al ., 2021 ), and to cover all adult roles (Ruggeri et al ., 2004 ; Kimhy et al ., 2014 ; McPhearson et al ., 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Needs for care of residents with schizophrenia spectrum disorders and association with daily activities and mood monitored with experience sampling method: the DIAPASON study

Martinelli

D'Addazio²,

Zamparini³

et al. 2023

Epidemiol Psychiatr Sci

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Aims Care needs represent an essential paradigm in planning residential facility (RF) interventions. However, possible disagreements between users and staff are critical issues in service delivery. The Experience Sampling Method (ESM) tracks experiences in the real world and real time. This study aimed to evaluate the care needs of patients with schizophrenia spectrum disorder (SSD) in RFs and its association with daily activities and mood monitored using the ESM. Methods As part of the DIAPASON project, 313 residents with SSD were recruited from 99 Italian RFs. Sociodemographic and clinical characteristics were recorded. Care needs, the severity of symptomatology and negative symptoms were assessed. Fifty-six residents were also assessed for 7 consecutive days using the mobile ESM. Descriptive, agreement, predictor and moderator analyses were conducted. Results The staff rated a higher number of total and met needs than service users (p < 0.001). Only a slight agreement between users and staff on unmet needs was found in self-care (k = 0.106) and information (k = 0.100) needs, while a moderate agreement was found in accommodation (k = 0.484), food (k = 0.406), childcare (k = 0.530), physical health (k = 0.470), telephone (k = 0.458) and transport (k = 0.425) needs. Older age (−0.15; p < 0.01), longer SSD diagnosis (−0.16; p < 0.01), higher collaboration (−0.16; p < 0.01) and lower symptomatology (−0.16; p < 0.01) decreased the number of unmet needs, while being a female (0.27; p < 0.05) and a shorter length of stay in an RF (0.54; p < 0.001) increased the number of unmet needs. A higher number of unmet needs was associated with a lower amount of time spent in leisure activities or reporting a positive mood: on the contrary, more unmet needs were associated with a greater amount of time spent in religious or non-productive activities. The associations between unmet needs rated by staff and users and momentary mood as assessed using the ESM were not moderated by the severity of symptomatology. Conclusions Although care needs are fundamental in planning residential activities aimed at recovery-oriented rehabilitation, RF interventions did not fully meet users' needs, and some disagreements on unmet needs between users and staff were reported. Further efforts are necessary to overcome Italian RF limits in delivering rehabilitative interventions defined by real users' needs to facilitate users' productivity and progress towards personal recovery.

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Section: Introductionmentioning

confidence: 99%

Needs for care of residents with schizophrenia spectrum disorders and association with daily activities and mood monitored with experience sampling method: the DIAPASON study

Martinelli

D'Addazio²,

Zamparini³

et al. 2023

Epidemiol Psychiatr Sci

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“…The matched comparison group was drawn from the participants of the VALERE-REC Study (eVALuation of outcomE in Residential—use of clinical data with REsearch objeCtives) [ 33 , 40 ]. It was a survey that, developed from 2014 to 2015, involved 167 patients from 25 out of the 30 mental health supported accommodations in Verona, and aimed to evaluate clinical, social, and rehabilitative outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…It is both a Type A and Type B cooperative. Its Type A component involves the provision of supported accommodation for people with mental problems, while its Type B function comprises personalized job placements for people with mental disorders, which aim to facilitate social inclusion within a strong recovery orientated ethos [ 33 ].…”

Section: Introductionmentioning

confidence: 99%

Supported employment for people with severe mental illness: a pilot study of an Italian social enterprise with a special ingredient

et al. 2022

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Background People with mental disorders are far more likely to be unemployed than the general population. Two internationally recognized, evidence-based models of interventions for employment for people with severe mental health problems are Individual Placement Support and the Clubhouse. In Italy, a common model is the ‘social enterprise’ (SE), which is a programme run by non-profit organisations that help individuals with disabilities to be employed. Despite SEs spread and relevance in Italy, there are no studies about Italian samples. This paper reports on a pilot evaluation of psychosocial and work outcomes of a SE based in Verona, Italy. The study aims to investigate if people with SMI involved in SE job placements may achieve personal recovery and better outcomes over time, and in comparison with a comparable group of users. Methods This is a pilot descriptive study with three components. A longitudinal design that comprised a functioning description of 33 SE members with a psychiatric disability in two time-points (when they joined the SE—on average 5 years before the study recruitment, and at the study recruitment—year 2018); and a repeated collection of job details of the 33 members in three time points: 2 years before the recruitment,—year 2016; 1 year before the recruitment – year 2017; and at the recruitment—year 2018. An assessment at the recruitment time—year 2018, of SE users’ satisfaction with the job placement, symptoms, functioning, and quality of life (QoL). A cross-sectional study that compared the 33 SE members at the recruitment time—year 2018, with a matched group of people with the following criteria: living in local supported accommodations, being unemployed and not SE members. The two groups were compared on ratings of psychopathology, functioning, and QoL. Descriptive analyses were done. Results At the recruitment time – year 2018, all SE participants showed a significant better functioning (p < 0.001) than when they joined the SE—when they had been employed for an average of 5 years. In comparison to the matched group, SE members had significantly better functioning (p = 0.001), psychopathology (p = 0.007), and QoL (p = 0.034). According to their SE membership status, participants comprised trainees (21.2%) and employee members (78.8%). Trainees compared to employees had lower autonomies, functioning, QoL and more severe psychopathology. Over the two years prior to study recruitment, trainees showed stable poor autonomies, while employee members showed a variation from average autonomies in the 2 years before the recruitment time – year 2016, to good ones at the recruitment time – year 2018. Over the two years, all SE members set increasing numbers of objectives in all three domains. All SE participants reported high levels of satisfaction with all aspects of the job placement. Conclusions SE that provides tailored support to assist people to gain employment skills may be an effective component in helping recovery from SMI.

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“…It is possible that the difference in prescribing patterns observed in our study between residential patients and outpatients is due, at least in part, to residential patients showing greater clinical severity than outpatients, echoing much of the differences between patients on APP and APM described above. Indeed, similarly to patients on APP, residential patients also showed higher psychopathological severity and worse psychosocial functioning, as well as longer hospitalizations ( Martinelli et al , 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Patterns of antipsychotic prescription and accelerometer-based physical activity levels in people with schizophrenia spectrum disorders: a multicenter, prospective study

Oliva¹,

Fanelli²,

Zamparini³

et al. 2022

International Clinical Psychopharmacology

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Antipsychotic polypharmacy (APP) in patients with schizophrenia spectrum disorders (SSDs) is usually not recommended, though it is very common in clinical practice. Both APP and SSDs have been linked to worse health outcomes and decreased levels of physical activity, which in turn is an important risk factor for cardiovascular diseases and premature mortality. This real-world, observational study aimed to investigate antipsychotic prescribing patterns and physical activity in residential patients and outpatients with SSDs. A total of 620 patients and 114 healthy controls were recruited in 37 centers across Italy. Each participant underwent a comprehensive sociodemographic and clinical evaluation. Physical activity was monitored for seven consecutive days through accelerometer-based biosensors. High rates of APP were found in all patients, with residential patients receiving more APP than outpatients, probably because of greater psychopathological severity. Physical activity was lower in patients compared to controls. However, patients on APP showed trends of reduced sedentariness and higher levels of light physical activity than those in monopharmacy. Rehabilitation efforts in psychiatric residential treatment facilities were likely to result in improved physical activity performances in residential patients. Our findings may have important public health implications, as they indicate the importance of reducing APP and encouraging physical activity. Int

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Performance and effectiveness of step progressive care pathways within mental health supported accommodation services in Italy

Cited by 10 publications

References 44 publications

Needs for care of residents with schizophrenia spectrum disorders and association with daily activities and mood monitored with experience sampling method: the DIAPASON study

Needs for care of residents with schizophrenia spectrum disorders and association with daily activities and mood monitored with experience sampling method: the DIAPASON study

Supported employment for people with severe mental illness: a pilot study of an Italian social enterprise with a special ingredient

Patterns of antipsychotic prescription and accelerometer-based physical activity levels in people with schizophrenia spectrum disorders: a multicenter, prospective study

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