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• W104063923 abstract "Background: A significant component of psychiatric hospital reform in Queensland (Australia) involved the resettlement of people with long-term mental illness that resided in the three psychiatric hospitals in that State. A number of strategies were initiated to promote the resettlement of these individuals. One of these became known as ‘Project 300’ and was established in 1995 with the aim of relocating 300 long-stay clients back to their community of origin or choice. Each individual returning to the community received a package of care consisting of case management services, housing and disability/lifestyle support services in keeping with their needs. Many of the individuals involved in Project 300 had tried unsuccessfully to re-enter the community on previous hospital downsizing schemes. An important addition in the Project 300 initiative was the use of non-government organisations to provide disability support services to those individuals returning to the community. While the philosophy underpinning the provision of disability support to people with psychiatric disability seems plausible and appropriate, there has been little investigation of the services provided by the disability sector in Australia or overseas. As a result, it remains unclear how the provision of support services impacts on the clinical and disability outcomes for people with psychiatric disability living in the community. Aims: This study examined the relationship between the interventions provided by disability services and outcomes for a cohort of long-stay clients returning to the community under a resettlement program called ‘Project 300’. The following were hypotheses were proposed: . • Service provision under the Project 300 program will lead to significant improvement in general and vocational functioning but not in symptoms. . • The intensity of support provided (ie weekly support hours) will decrease over the study period. . • Deficits in general functioning rather than clinical functioning will predict support intensity (ie. support hours allocated). . • The focus of interventions provided by support workers will change as clients adapted to community living. An increase in the level of support worker assistance with community integration is predicted. . • The level of support worker assistance (with ADLs, community integration, and supervision) and the intensity of assistance (hours of support) will be related to client disability. . • Changes in client functioning between assessments will be related to the level of support worker assistance and the number of support hours provided. . • Support agency expertise in the provision of support services will be associated with better client outcomes. Methods: The study employed a multi-site, repeated measures, longitudinal design. Clinical, occupational and general functioning data were collected prospectively from the same clients (n=181) at 6 weeks prior to discharge from institutional care and again at 6, 18, and 36 months post-discharge. Support worker interventions were evaluated in three broad areas: assistance with activities of daily living, community integration and supervision of client troublesome behaviours. Data were analysed using repeated measures analysis of variance and multiple regression analysis. Results: General functioning remained stable while symptoms and clinical functioning improved significantly over the study period. When the scores for all three measures of disability (LSP, HoNOS, and BPRS) were combined to provide a single ‘composite’ score of disability, there was no significant change in the level of disability in the client group over the study period. While there was a significant decrease in the intensity of support (ie. support hours) over the study period, clients with higher levels of disability received significantly more support hours (than those with lower levels of disability). Moreover, clients who received higher levels of support produced greater improvement in functioning. It was predicted that the level of support worker assistance provided would be related to changes in client disability and this was partially supported. The level of support worker assistance at 6 months was not related to changes in client disability in the period between 6 months and 18 months. However, the level of support at 18 months was related to changes client disability in the period between 18 months and 36 months post-discharge. Finally, support agency expertise did have an impact on the outcomes for clients. A support agency that had expertise in the provision of support to people with psychiatric disability demonstrated significantly better clinical and general functioning outcomes and better vocational outcomes for clients over the study period. This agency achieved superior outcomes despite using significantly less hours of support at 6 and 18 months post-discharge. It is possible that the better outcomes achieved by this agency are related to the type of support provided in that significantly more support worker activity was devoted to community integration rather than assistance with ADLs and client supervision. Conclusions: After 3 years of community living, the majority of people in the study remained unemployed and about half reported having no structured activity. Contrary to findings from previous studies, general functioning remained stable while symptoms improved significantly following resettlement. The evidence of successful community tenure, notwithstanding in many cases, a history of unsuccessful discharge prior to the introduction of Project 300, suggests that the support worker role actively contributed to successful community tenure. However, neither the support worker contribution, nor living in the community, resulted in reduced disability for the clients as a group (while some clients did improve, others deteriorated). The reasons for the low level of functional gain among the group remains a matter for speculation but may result from inadequate focus on rehabilitation on the part of both clinical staff and support workers or may reflect illness factors or some combination of the two." @default.
• W104063923 created "2016-06-24" @default.
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• W104063923 date "2008-02-01" @default.
• W104063923 modified "2023-09-27" @default.
• W104063923 title "Disability support services for people with psychiatric disability: Outcomes at 3 years post-discharge from long-term care" @default.
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