Systematic Review of Supported Housing Literature 1993 – 2008

Supported housing for individuals with severe mental illness strives to provide the services necessary to place and keep individuals in independent housing that is integrated into the community and in which the consumer has choice and control over his or her services and supports. Supported housing can be contrasted to an earlier model called the “linear residential approach” in which individuals are moved from the most restrictive settings (e.g., inpatient settings) through a series of more independent settings (e.g., group homes, supervised apartments) and then finally to independent housing. This approach has been criticized as punishing the client due to frequent moves, and as being less likely to result in independent housing. In the supported housing model (Anthony & Blanch, 1988) consumers have choice and control over their living environment, their treatment, and supports (e.g., case management, mental health and substance abuse services). Supports are flexible and faded in and out depending on needs. Results of this systematic review of supported housing suggest that there are several well-controlled studies of supported housing and several studies conducted with less rigorous designs. Overall, our synthesis suggests that supported housing can improve the living situation of individuals who are psychiatrically disabled, homeless and with substance abuse problems. Results show that supported housing can help people stay in apartments or homes up to about 80% of the time over an extended period. These results are contrary to concerns expressed by proponents of the linear residential model and housing models that espoused more restrictive environments. Results also show that housing subsidies or vouchers are helpful in getting and keeping individuals housed. Housing services appear to be cost effective and to reduce the costs of other social and clinical services. In order to be most effective, intensive case management services (rather than traditional case management) are needed and will generally lead to better housing outcomes. Having access to affordable housing and having a service system that is well-integrated is also important. Providing a person with supported housing reduces the likelihood that they will be re-hospitalized, although supported housing does not always lead to reduced psychiatric symptoms. Supported housing can improve clients’ quality of life and satisfaction with their living situation. Providing supported housing options that are of decent quality is important in order to keep people housed and satisfied with their housing. In addition, rapid entry into housing, with the provision of choices is critical. Program and clinical supports may be able to mitigate the social isolation that has sometimes been associated with supported housing.National Institute on Disability and Rehabilitation Research, Grant # (H133A050006

CARE TEAM EDUCATION ON THE USE OF SENSORY RESOURCES IN INPATIENT PSYCHIATRY

Sensory processing is the way the nervous system receives, organizes, and understands sensory information gained through our body’s senses and physical environment. The deprivation of sensory processing, or the inability of one’s nervous system to use meaningful sensations, can lead to negative outcomes such as anxiety, stress, depression, withdrawal and reduced motivation, or agitation and disturbed behavior. Dr. Ayres\u27 Sensory Integration Theory was used as the guiding framework for this project. Research literature indicates that sensory modulated approaches are an effective treatment approach for patients who are distressed, anxious, agitated, or potentially aggressive, and can be used as an alternative to more coercive actions such as seclusion and restraint. It has also demonstrated that sensory modulated approaches can be helpful for people with various psychiatric diagnoses such as anxiety, depression, mania, psychosis, and post-traumatic stress disorders. The aim of this project was to provide an educational in-service to psychiatric inpatient staff members about the use of sensory modulated approaches as an additional preventive tool for mental health patients. A post evaluation was provided to identify the effectiveness of the educational in-service. Participants of the in-service included sixteen (16) staff members and ten (10) undergraduate nursing students. All participants who completed the post evaluation reported the rating of helpfulness of sensory integration approaches to their current practice. All staff members reported it as very helpful, while eighty-six percent (86%) of students thought it was very helpful to their current practice. Sixty-nine percent (69%) of the staff reported the in-service as very helpful for increasing their knowledge of sensory resources, and eighty-six percent (86%) of the students reported it as very helpful. The favorable outcomes demonstrate success in providing staff education. Increased knowledge and understanding allow staff members to adopt the sensory modulated approach to further help reduce behavioral disturbances, empower staff and patients to build positive relationships, and provide alternative strategies to more coercive practices such as seclusion or restraints. Further research on the effect of this educational in-service on the actual implementation of sensory modulated approach is needed to support the true effectiveness of this project. Future implications for advanced nursing practice, education, research, and health policy are to promote and implement this alternative approach, provide evidence based data to improve the quality of clinical practice, and analyze the data collected to improve future practices and overall patient outcomes

Organisatie van geestelijke gezondheidszorg voor kinderen en jongeren : literatuurstudie en internationaal overzicht

INTRODUCTIE: In de laatste decennia van de vorige eeuw werden er in de Westerse landen belangrijke hervormingen ingezet in de sector van de geestelijke gezondheidszorg (GGZ). In de GGZ voor volwassenen kwam er geleidelijk een model van “balanced care” (“gebalanceerde zorg”) op de voorgrond: een diversiteit aan diensten biedt de zorg zo kort mogelijk bij de eigen leefwereld van de patiënt aan, en enkel indien nodig in een instelling. Tegelijkertijd moet men ook een vlotte en naadloze overgang van de ene dienst naar de andere garanderen. Geestelijke gezondheidsproblemen bij kinderen en jongeren zijn niet onfrequent. De WGO (Wereldgezondheidsorganisatie) schat de prevalentie in Westerse landen op ongeveer 20%. Ongeveer 5% zou een klinische tussenkomst nodig hebben. De sector van GGZ voor kinderen en jongeren is pas veel later ontstaan dan deze van de volwassenen, en kent een andere zorgstructuur. Toch dringen de hierboven geschetste hervormingsprincipes ook hier door. Bovendien dient zorg voor kinderen en jongeren vaak over de grenzen van de GGZ sector heen te gebeuren, bijvoorbeeld door de huisarts of kinderarts, en komen veel problemen bij kinderen en jongeren voor het eerst aan het licht buiten de zorgsector, zoals op school. GGZ voor kinderen en jongeren dient dan ook deze zogenaamde “belendende sectoren” mee te betrekken: welzijnswerk, justitie, gehandicaptenzorg, onderwijs. DOELSTELLING: De doelstelling van dit rapport is om kennis bijeen te brengen over organisatorische en financieringsaspecten van GGZ voor kinderen en jongeren, en dit in het licht van de hierboven geschetste context. De specifieke therapie-inhoud blijft buiten beschouwing. Het rapport bestaat uit twee delen: een overzicht van de literatuur en van de organisatie van GGZ voor kinderen en jongeren in België en drie andere landen. Dit rapport formuleert nog geen voorstellen voor de zorgorganisatie in België. Voor dit proces zullen Belgische stakeholders betrokken worden. Het resultaat hiervan zal beschreven worden in een afzonderlijk rapport. METHODE: Zowel voor het literatuuronderzoek als voor het internationale overzicht werd gezocht in databases met peer-reviewed publicaties en in de grijze literatuur. In het literatuuronderzoek werden naast vergelijkend onderzoek ook descriptieve studies en kwalitatief onderzoek geïncludeerd. Voor het internationaal overzicht werd de beschikbare literatuur aangevuld met gegevens van lokale informanten. MODELLEN VAN ZORGORGANISATIE: Dit rapport legt de focus op de meest geciteerde modellen, en die modellen waarvoor er vergelijkend onderzoek gebeurde. De twee meest geciteerde modellen in de literatuur zijn het WGO-model en het Systems of care model. Beide zijn vrij algemeen en vragen verdere uitwerking door het land of de regio die GGZ voor kinderen en jongeren wil implementeren. De meeste vergelijkende studies zijn wel gekenmerkt door talrijke methodologische beperkingen zoals onduidelijke inclusiecriteria, onduidelijke uitkomstmaten of kleine steekproeven. INTERNATIONAAL OVERZICHT: Om redenen van haalbaarheid werd gekozen om dit deel te beperken tot België, Nederland, Canada (British Columbia) en Engeland. De selectie vertrok van een long-list waarop vervolgens een aantal selectiecriteria werden toegepast. CONCLUSIE: Het belang van een nationaal/regionaal beleid voor kinder- en jeugd GGZ, geconcretiseerd in een duidelijk plan, is al langer bekend. Toch is de literatuur over organisatiemodellen binnen kinder- en jeugd GGZ weinig richtinggevend voor beleidsmakers. De twee belangrijkste modellen die in de literatuur aangetroffen werden geven enkel grote beleidslijnen van algemene aard aan. Bovendien zijn de wetenschappelijke studies in dit domein van beperkte kwaliteit en blijft een groot deel van de beleidsvraagstukken niet of onvoldoende onderzocht. Wel kan men uit het onderzoek ivm. het Systems of care besluiten dat de overheid niet enkel een betere zorgorganisatie en –coordinatie dient te stimuleren. Zij dient ook het ontwikkelen en verspreiden van doelmatige therapeutische concepten te bevorderen. Het onderzoek ivm. preventie en behandeling van angststoornissen via scholen toont aan dat men moet durven zoeken naar oplossingen in samenwerking met andere sectoren buiten de gezondheidszorg. In de bestudeerde landen gaan de hervormingen uit van theoretische denkkaders die gebaseerd zijn op belangrijke ethische principes en waarden; deze overlappen in belangrijke mate tussen de verschillende landen. Echter, bij het praktisch realiseren van dit denkkader ondervindt men talrijke moeilijkheden, en in een aantal gevallen mislukt men in de vooropgestelde doelstellingen. Over het daadwerkelijke resultaat van de gevoerde hervormingen zijn er meestal weinig harde gegevens. Wellicht kan men pas tot een positief resultaat komen als zowel klinische, organisatorische, als financiële aspecten alle tegelijk aangepakt worden; en als ook de eigenheid van elk van de betrokken sectoren daarbij niet uit het oog verloren wordt. In de volgende faze van deze studie zullen samen met de Belgische stakeholders voorstellen voor hervormingen geformuleerd worden. De resultaten hiervan worden afzonderlijk gepubliceerd

User-centered visual analysis using a hybrid reasoning architecture for intensive care units

One problem pertaining to Intensive Care Unit information systems is that, in some cases, a very dense display of data can result. To ensure the overview and readability of the increasing volumes of data, some special features are required (e.g., data prioritization, clustering, and selection mechanisms) with the application of analytical methods (e.g., temporal data abstraction, principal component analysis, and detection of events). This paper addresses the problem of improving the integration of the visual and analytical methods applied to medical monitoring systems. We present a knowledge- and machine learning-based approach to support the knowledge discovery process with appropriate analytical and visual methods. Its potential benefit to the development of user interfaces for intelligent monitors that can assist with the detection and explanation of new, potentially threatening medical events. The proposed hybrid reasoning architecture provides an interactive graphical user interface to adjust the parameters of the analytical methods based on the users' task at hand. The action sequences performed on the graphical user interface by the user are consolidated in a dynamic knowledge base with specific hybrid reasoning that integrates symbolic and connectionist approaches. These sequences of expert knowledge acquisition can be very efficient for making easier knowledge emergence during a similar experience and positively impact the monitoring of critical situations. The provided graphical user interface incorporating a user-centered visual analysis is exploited to facilitate the natural and effective representation of clinical information for patient care

Therapeutic Environment and Premature newborns Development

Introduction: Prematurity is the leading cause of neonatal mortality, however, the survival of preterm infants is guaranteed. Prolonged exposure to numerous sensory stimuli during early neonatal intensive care units contributes to the increased likelihood of organic and/or psychological sequelae. Objectives: Identify the best measures to minimize the impact that the sensorial environment of neonatal intensive care units has on the development of premature newborns. Methods: An integrative literature review was carried out in CINAHL, PubMed and MEDLINE databases, according to the PICOD methodology (participants, intervention, context, results and design). Results: The analysis of the 6 articles included in the study showed a set of environmental measures to be included in the care of premature newborns. The main recommendations mentioned were organized into categories, namely, physical environment, sensory environment, technology and parental training. Conclusion: From this review emerges the need to define consistent and consensual strategies for the optimization of the therapeutic environment in neonatal intensive care units

Integrating Research and Quality Improvement Using TeamSTEPPS: A Health Team Communication Project to Improve Hospital Discharge

Purpose/Objectives: The purpose of this article is to describe an innovative approach to the integration of quality improvement and research processes. A project with the objective of improving health team communication about hospital discharge provides an exemplar case. Description of the Project/Program: The TeamSTEPPS 10-step action planning guide provided the structure for planning, developing, and evaluating a redesign of interprofessional health team communication to improve hospital discharge led by 2 clinical nurse specialists. The redesign involved development of processes for team bedside rounding, registered nurse bedside shift reports, and briefing tools to support the rounding processes. Outcome: Using the TeamSTEPPS process, a 4-phase combined quality improvement and research project was designed and implemented. Implementation is ongoing, supported by process evaluation for continuing process improvement. Longitudinal analysis of research outcomes will follow in the future. Conclusions: Led by unit-based clinical nurse specialists, use of an integrated process of quality improvement and research creates evidence-based innovation to solve interprofessional practice problems. Incorporating research within the project design allows for data-based decisions to inform the clinical process improvement, as well as documentation of both the processes and outcomes of the local improvements that can inform replications in other sites

New ways of working in acute inpatient care: a case for change

This position paper focuses on the current tensions and challenges of aligning inpatient care with innovations in mental health services. It argues that a cultural shift is required within inpatient services. Obstacles to change including traditional perceptions of the role and responsibilities of the psychiatrist are discussed. The paper urges all staff working in acute care to reflect on the service that they provide, and to consider how the adoption of new ways of working might revolutionise the organisational culture. This cultural shift offers inpatient staff the opportunity to fully utilise their expertise. New ways of working may be perceived as a threat to existing roles and responsibilities or as an exciting opportunity for professional development with increased job satisfaction. Above all, the move to new ways of working, which is gathering pace throughout the UK, could offer service users1 a quality of care that meets their needs and expectations

NICU Infants & SNHL: Experience of a western Sicily tertiary care centre

Introduction: The variability of symptoms and signs caused by central nervous system (CNS) lesions make multiple sclerosis difficult to recognize,Introduction: This study adds the evaluation of the independent etiologic factors that may play a role in the development of SNHL in a NICU population. We compared neonatal intensive care unit NICU infants with sensorineural hearing loss SNHL to age and gender matched normal hearing NICU controls. Materials and methods: 284 consecutive NICU infants positive to the presence of risk indicators associated with permanent congenital, delayed-onset, or progressive hearing loss underwent to global audiological assessment. The following risk factors were researched, making a distinction between prenatal and perinatal risk factors: in the first group, family history of permanent childhood hearing impairment, consanguinity, pregnant maternal infection and drugs exposition during pregnancy; in the second group, premature birth, respiratory distress, hyperbilirubinemia requiring exchange tranfusion, very low birth weight, cranio-facial abnormality, perinatal infections, ototoxic drugs administration, acidosis, hyponatremia, head trauma. Results: The analysis of the auditory deficit for infants according to numbers of risk factors showed mean values of: 78 + 28.08 dB nHL for infants positive to two risk factors; 75.71 + 30.30 dB nHL in cases positive to three risk factors; 96.66 + 34.46 dB nHL for four risk factors and 85 + 35 dB nHL in case of >5 risk factors. Conclusion: NICU infants have greater chances of developing SNHL, because of the presence of multiple risk factors; in fact, as the number of coexisting risk factors increases, the prevalence rate of SNHL also increases (r=0.81)

Student Family Support Services Initiative: Final Evaluation Report

The Student Family Support Services Initiative (SFSI) provided intensive case management and housing assistance to families with children who were identified as residing in "doubled-up" living situations (e.g. living with relatives or friends because they had lost stable housing but were not yet in homeless shelters or cycled out of shelters) and considered at risk of becoming homeless by the Chicago Public Schools (CPS) in 2009 and 2010. The program offered case management, housing assistance, and a menu of services that families might need to stabilize in housing including therapeutic services, employment services, and asset building. The theory of change was that addressing a family's primary housing and employment needs would positively impact the educational stability and achievement of students, while at the same time benefiting the family overall. This report, prepared by the Social IMPACT Research Center, presents a final evaluation of the initiative