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Tolonen J, Jääskeläinen E, Kiviniemi L, Majuri T, Haapea M, Miettunen J, Moilanen K. Functioning, psychiatric symptoms and quality of life of individuals with severe mental disorders after psychiatric rehabilitation. Nord J Psychiatry 2024; 78:54-63. [PMID: 37815430 DOI: 10.1080/08039488.2023.2262448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE Psychiatric disorders may have a negative effect on individuals' living, forming intimate relationships, education, and employment. The aim of psychiatric rehabilitation is to promote recovery - finding ways to cope with mental disorders despite debilitating symptoms. This study aimed to explore the outcomes of accommodation, social inclusion, psychiatric symptoms, substance and service use, quality of life and subjective recovery of young adults with severe mental illness after psychiatric rehabilitation. MATERIALS AND METHODS The study population consisted of individuals who had been in residential psychiatric rehabilitation between the ages of 18-29 years. Data on outcomes were collected using a questionnaire after a flexible follow-up period (mean 29 months). The questionnaire was answered by 32 eligible persons. We analysed multiple outcomes and compared the proportion of persons living independently at the start, after psychiatric rehabilitation, and at the follow-up point. RESULTS At the start of the rehabilitation, 33%, at the end, 69%, and at follow-up, 78% lived independently. However, most had not reached competitive employment nor were studying. Cognitive symptoms were the most common psychiatric symptoms, followed by depressive symptoms. More than 80% of the sample felt that they had partly recovered from their severe mental illness. CONCLUSION According to the results of this study residential psychiatric rehabilitation may have positive effects on functioning and independent living at follow-up. Reaching competitive employment is difficult for persons with severe mental disorders and effective rehabilitation interventions need to be implemented. However, this study had limitations, and these results should be considered preliminary.
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Affiliation(s)
- Jonna Tolonen
- Humana Sähäkkä Ltd., Ylivieska, Finland
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Erika Jääskeläinen
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | | | - Tuomas Majuri
- Research Unit of Population Health, University of Oulu, Oulu, Finland
| | - Marianne Haapea
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Jouko Miettunen
- Research Unit of Population Health, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kristiina Moilanen
- Humana Sähäkkä Ltd., Ylivieska, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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Sammells E, Logan A, Sheppard L. Participant Outcomes and Facilitator Experiences Following a Community Living Skills Program for Adult Mental Health Consumers. Community Ment Health J 2023; 59:428-438. [PMID: 36074286 PMCID: PMC9981707 DOI: 10.1007/s10597-022-01020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022]
Abstract
Outcomes from participating in a six-week small-group living skills program, periodically implemented over two years with twelve adult mental health consumers, are reported as a case study. Occupational therapy and recovery-oriented approaches underpinned the development and implementation of the program thus it was important that outcome measures aligned with these perspectives. Data were gathered pre and post program using the Canadian Occupational Performance Measure (COPM) and the Life Skills Profile-16 (LSP-16) in each iteration of the program. Two occupational therapy program facilitators were interviewed about their experience of running the program and using these measurement tools. COPM occupational performance (p = 0.001) and COPM satisfaction (p = 0.004) scores indicated significant change at post-program whereas the LSP-16 total and subscale scores did not (p = 0.132 for total scores). Facilitator insights into the experience of implementing the living skills program and the perceived alignment of the COPM and LSP-16 with recovery-oriented practice are reported.
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Affiliation(s)
- Eliza Sammells
- Occupational Therapist, BOccThy (HONS), Australian Catholic University, Melbourne, Australia
| | - Alexandra Logan
- Occupational Therapy Senior Lecturer, School of Allied Health, Faculty of Health Science, Australian Catholic University, Melbourne, Australia
| | - Loretta Sheppard
- Occupational Therapy, Deputy Head, School of Allied Health, Australian Catholic University, Melbourne, Australia.
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3
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L’empowerment des usagers en santé mentale. Satisfaction du club thérapeutique : quel lien avec la qualité de vie et le soutien social perçus ? ANNALES MÉDICO-PSYCHOLOGIQUES, REVUE PSYCHIATRIQUE 2022. [DOI: 10.1016/j.amp.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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4
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Sanches SA, Feenstra TL, Swildens WE, van Busschbach JT, van Weeghel J, van Asselt TDI. Cost Effectiveness and Budget Impact of the Boston University Approach to Psychiatric Rehabilitation for Increasing the Social Participation of Individuals With Severe Mental Illnesses. Front Psychiatry 2022; 13:880482. [PMID: 35722578 PMCID: PMC9199888 DOI: 10.3389/fpsyt.2022.880482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation. METHOD In a randomized clinical trial with 188 individuals with SMIs, BPR (n = 98) was compared to ACC (n = 90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants. RESULTS Total costs per participant at 12-month follow-up were € 12,886 in BPR and € 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to €190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions. CONCLUSIONS This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole.
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Affiliation(s)
- Sarita A Sanches
- Altrecht Institute for Mental Health Care, Utrecht, Netherlands.,Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands.,Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg, Netherlands
| | - Talitha L Feenstra
- University of Groningen, University Medical Center, Department of Epidemiology, Groningen, Netherlands.,University of Groningen, Groningen Research Institute of Pharmacy, Groningen, Netherlands.,Center for Nutrition, Prevention, and Health Services Research, Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Wilma E Swildens
- Altrecht Institute for Mental Health Care, Utrecht, Netherlands.,Inholland University of Applied Sciences, Amsterdam, Netherlands
| | - Jooske T van Busschbach
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Rob Giel Research Center, Groningen, Netherlands.,Windesheim University of Applied Sciences, School of Human Movement and Education, Zwolle, Netherlands
| | - Jaap van Weeghel
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands.,Tilburg University, Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg, Netherlands.,Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Thea D I van Asselt
- University of Groningen, Groningen Research Institute of Pharmacy, Groningen, Netherlands.,University of Groningen, University Medical Center, Department of Health Sciences, Groningen, Netherlands
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Lu W, Oursler J, Herrick S, Beninato J, Gao N, Brown L, Durante A. Work-Related Interview Skills Training for Persons with Substance Use Disorders. JOURNAL FOR SPECIALISTS IN GROUP WORK 2021. [DOI: 10.1080/01933922.2021.1900959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Weili Lu
- The State University of New Jersey
| | | | | | | | - Ni Gao
- The State University of New Jersey
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6
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Sanches SA, Swildens WE, Schaefer B, Moerbeek M, Feenstra TL, van Asselt ADI, Danner UN, van Weeghel J, van Busschbach JT. Effectiveness of the Boston University Approach to Psychiatric Rehabilitation in Improving Social Participation in People With Severe Mental Illnesses: A Randomized Controlled Trial. Front Psychiatry 2020; 11:571640. [PMID: 33173519 PMCID: PMC7538503 DOI: 10.3389/fpsyt.2020.571640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND People with severe mental illnesses (SMIs) have difficulty participating in society through work or other daily activities. AIMS To establish the effectiveness with which the Boston University Approach to Psychiatric Rehabilitation (BPR) improves the level of social participation in people with SMIs, in the Netherlands. METHOD In a randomized controlled trial involving 188 people with SMIs, we compared BPR (n = 98) with an Active Control Condition (ACC, n = 90) (Trial registration ISRCTN88987322). Multilevel modeling was used to study intervention effects over two six-month periods. The primary outcome measure was level of social participation, expressed as having participated in paid or unpaid employment over the past six months, as the total hours spent in paid or unpaid employment, and as the current level of social participation. Secondary outcome measures were clients' views on rehabilitation goal attainment, Quality of Life (QOL), personal recovery, self-efficacy, and psychosocial functioning. RESULTS During the study, social participation, QOL, and psychosocial functioning improved in patients in both groups. However, BPR was not more effective than ACC on any of the outcomes. Better social participation was predicted by previous work experience and a lower intensity of psychiatric symptoms. CONCLUSIONS While ACC was as effective as BPR in improving the social participation of individuals with SMIs, much higher percentages of participants in our sample found (paid) work or other meaningful activities than in observational studies without specific support for social participation. This suggests that focused rehabilitation efforts are beneficial, irrespective of the specific methodology used.
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Affiliation(s)
- Sarita A Sanches
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands.,Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands.,Altrecht Institute for Mental Health Care, Department Research and Monitoring, Utrecht, Netherlands
| | - Wilma E Swildens
- Altrecht Institute for Mental Health Care, Department Research and Monitoring, Utrecht, Netherlands.,Inholland University of Applied Sciences, Interprofessional Mental Health Care, Department of Nursing, Amsterdam, Netherlands
| | | | - Mirjam Moerbeek
- Department of Methodology and Statistics, Utrecht University, Utrecht, Netherlands
| | - Talitha L Feenstra
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, Netherlands.,University of Groningen, Groningen Research Institute of Pharmacy, Groningen, Netherlands.,Centre for Nutrition, Prevention, and Health Services Research, Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Antoinette D I van Asselt
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, Netherlands.,University of Groningen, University Medical Center Groningen, Department of Health Sciences, Groningen, Netherlands
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, Netherlands
| | - Jaap van Weeghel
- Phrenos Center of Expertise for Severe Mental Illness, Utrecht, Netherlands.,Tilburg School of Social and Behavioral Sciences, Tranzo Scientific Center for Care and Welfare, Tilburg University, Tilburg, Netherlands.,Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Jooske T van Busschbach
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Rob Giel Onderzoekcentrum, Groningen, Netherlands.,School of Human Movement and Education, Windesheim University of Applied Sciences, Zwolle, Netherlands
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Roos E, Bjerkeset O, Svavarsdóttir MH, Steinsbekk A. Like a hotel, but boring: users' experience with short-time community-based residential aftercare. BMC Health Serv Res 2017; 17:832. [PMID: 29246222 PMCID: PMC5732432 DOI: 10.1186/s12913-017-2777-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 12/05/2017] [Indexed: 11/26/2022] Open
Abstract
Background The discharge process from hospital to home for patients with severe mental illness (SMI) is often complex, and most are in need of tailored and coordinated community services at home. One solution is to discharge patients to inpatient short-stay community residential aftercare (CRA). The aim of this study was to explore how patients with SMI experience a stay in CRA established in a City in Central Norway. Methods A descriptive qualitative study with individual interviews and a group interview with 13 persons. The CRA aims to improve the discharge process from hospital to independent supported living by facilitating the establishment of health and social services and preparing the patients. The philosophy is to help patients use community resources by e.g. not offering any organized in-house activities. The main question in the interviews was “How have you experienced the stay at the CRA?” The interviews were analyzed with a thematic approach using systematic text condensation. Results The participants experienced the stay at the CRA “Like a hotel” but also boring, due to the lack of organized in-house activities. The patients generally said they were not informed about the philosophy of the CRA before the stay. The participants had to come up with activities outside the CRA and said they got active help from the staff to do so; some experienced this as positive, whereas others wanted more organized in-house activities like they were used to from mental health hospital stays. Participants described the staff in the CRA to be helpful and forthcoming, but they did not notice the staff being active in organizing the aftercare. Conclusions The stay at the CRA was experienced as different from other services, with more freedom and focus on self-care, and lack of in-house activities. This led to increased self-activity among the patients, but some wanted more in-house activities. To prepare the patients better for the stay at the CRA, more information about the philosophy is needed in the pre-admission process. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2777-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eirik Roos
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, 7491, Trondheim, Norway. .,, Municipality of Trondheim, Norway.
| | - Ottar Bjerkeset
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Margrét Hrönn Svavarsdóttir
- Department of Health Sciences, Norwegian University of Sciences and Technology, Gjøvik, Norway.,School of Health Sciences, University of Akureyri, Akureyri, Iceland
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, NTNU, 7491, Trondheim, Norway
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Moran GS, Westman K, Weissberg E, Melamed S. Perceived assistance in pursuing personal goals and personal recovery among mental health consumers across housing services. Psychiatry Res 2017; 249:94-101. [PMID: 28088068 DOI: 10.1016/j.psychres.2017.01.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 10/30/2016] [Accepted: 01/03/2017] [Indexed: 11/30/2022]
Abstract
Personal goals/plans play a central role in personal recovery and psychiatric rehabilitation of persons with mental illnesses. Yet, few studies have explored whether perceiving practitioners' assistance towards the pursuit of goals are associated with personal recovery and other favorable rehabilitation outcomes. A total of 2121 mental health consumers, of which 1222 use supported-housing services and 899 use group-home services, completed self-report questionnaires as part of a larger quality-assurance study conducted during the years 2013-2014. Eighty percent of participants living in supported-housing and 72% living in group-homes reported having personal goals/plans for the forthcoming year. Furthermore, their type of goals was different. Irrespective of the type of goal or housing service, participants who reported having goals/plans (compared with those who did not) showed higher levels of personal recovery and more favorable psychosocial outcomes. Regression analyses showed that perceiving professional staff members (but not para-professionals) as assisting in pursuing goals/plans was positively associated with personal recovery. This study empirically validates the value of having personal goals and professionals' assistance in pursuing goals/plans in regards to personal recovery. We propose that recovery-oriented services should seek to enhance goal setting and goal-pursuit, and to train practitioners in these areas.
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Affiliation(s)
- Galia S Moran
- The Spitzer Department of Social Work Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Kinneret Westman
- The Quality Assurance Project, Yozma - Derech Halev Organization, Kfar Saba, Israel
| | - Esther Weissberg
- The Quality Assurance Project, Yozma - Derech Halev Organization, Kfar Saba, Israel
| | - Samuel Melamed
- Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Jormfeldt H, Svensson B, Hansson L, Svedberg P. Relatives' experiences of the Boston Psychiatric Rehabilitation approach: a qualitative study. Int J Qual Stud Health Well-being 2014; 9:22918. [PMID: 24717266 PMCID: PMC3982116 DOI: 10.3402/qhw.v9.22918] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2013] [Indexed: 11/28/2022] Open
Abstract
The Boston Psychiatric Rehabilitation (BPR) approach is individualized and characterized by being based entirely on the individual's unique needs and preferences in the areas of working, learning, social contacts, and living environment. Relatives of clients in mental health services influence the client's possibilities for recovery by their everyday relationship. Relatives have, however, traditionally had a subordinated role in the care of their mentally ill family member. The perspective of relatives is an important aspect in the development of new approaches to psychiatric rehabilitation. The purpose of this study was thus to describe and explore relatives’ experiences of the BPR approach. Ten relatives of clients in mental health services taking part in the BPR were interviewed. The interviews were transcribed and analyzed with a qualitative content analysis method to explore relatives’ experiences of the BPR intervention in a county in Sweden. The findings from the interviews could be summarized in the theme “To meet the clients’ needs” consisting of three categories: “Dependence on staffs’ competence,” “Responsibility for user involvement,” and “The necessity for coordination between authorities and caregivers.” The findings suggest that relatives may contribute with important information about clients’ needs related to outcome of care. Relatives’ perspectives may be of importance in future development of BPR. Further research about the relatives’ role in psychiatric rehabilitation is needed as well as studies that compare different kinds of psychiatric rehabilitation from the perspective of relatives.
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Affiliation(s)
- Henrika Jormfeldt
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden;
| | - Bengt Svensson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Lars Hansson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Petra Svedberg
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden
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Jormfeldt H, Svensson B, Hansson L, Svedberg P. Clients' experiences of the Boston Psychiatric Rehabilitation Approach: a qualitative study. Int J Qual Stud Health Well-being 2014; 9:22916. [PMID: 24717265 PMCID: PMC3982115 DOI: 10.3402/qhw.v9.22916] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2013] [Indexed: 11/14/2022] Open
Abstract
The Boston Psychiatric Rehabilitation Approach (BPR) is person-centered and characterized by being based entirely on the individual's unique needs and preferences in the areas of working, learning, social contacts, and living environment. Nevertheless, the person-centered approach is lacking firm evidence regarding outcomes, and empirical studies regarding clients' experiences of this particular model are needed. A qualitative content analysis of 10 transcribed semistructured individual interviews was used to describe and explore clients' experiences of the BPR during an implementation project in Sweden. The findings from the interviews could be summarized in "A sense of being in communion with self and others" theme, consisting of three categories: increased self-understanding, getting new perspectives, and being in a trusting relationship. The results showed that clients do not always recognize nor are able to verbalize their goals before they have been given the possibility to reflect their thoughts in collaboration with a trusted person. The guidelines of the approach are intended to support the clients' ability to participate in decision making regarding their own care. More research about efficacy of different rehabilitation approaches and exploration of fidelity to guidelines of rehabilitation programs are required.
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Affiliation(s)
- Henrika Jormfeldt
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden;
| | - Bengt Svensson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Lars Hansson
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Petra Svedberg
- School of Social and Health Sciences, Halmstad University, Halmstad, Sweden
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