Soutien d’intensité variable (SIV) et rétablissement : que nous apprennent les études expérimentales et quasi expérimentales ?

Comment structurer le soutien d’intensité variable (SIV) pour les personnes qui ont des troubles mentaux graves, mais qui ne requièrent pas de suivi intensif ? Pour répondre à cette question, les auteurs ont effectué une recension des études de langue anglaise publiées entre 1980 et 2010. Ils ont identifié cinq modèles principaux : le modèle de courtage, la gestion de cas clinique, le modèle de réadaptation, le modèle des forces, et la gestion de cas intensive. En tout, 11 études expérimentales et 13 quasi expérimentales pertinentes ont été répertoriées. Selon ces études, le modèle des forces, considéré comme une façon de structurer le soutien d’intensité variable, est le mieux fondé sur des données probantes, non seulement en termes de réduction du nombre d’hospitalisations, mais aussi au niveau des dimensions telles que les symptômes, la qualité de vie et le fonctionnement social. Ce modèle est aussi compatible avec le concept du rétablissement, bien que les preuves demeurent restreintes.How should case management be organized for people who have severe mental illness, but do not need Assertive Community Treatment or similar high-intensity programs? To address this question, the authors conducted a systematic review of studies published in English between 1980 and 2010. Five main case management models were identified: broker, clinical case management, rehabilitation, strengths and intensive case management. In all, 11 experimental and 13 quasi-experimental studies evaluating case management programs not targeted at a typical ACT clientele were identified. These studies suggest that the strengths model, which can be viewed as a way of structuring intensive case management for a moderate-need population, is the best supported by evidence if one desires to see effects not only on hospital days, but also on other domains such as symptoms, quality of life and social functioning. It is also compatible with a recovery orientation. The evidence in its favor, however, remains modest.¿Cómo estructurar el apoyo de intensidad variable (AIV) para las personas que sufren de trastornos mentales graves pero que no requieren de un seguimiento intensivo? Para responder a esta pregunta, los autores efectuaron una recensión de estudios de lengua inglesa publicados entre 1980 y 2010. Identificaron cinco modelos principales: el modelo de corretaje, la gestión de casos clínicos, el modelo de readaptación, el modelo de fuerzas y la gestión de casos intensivos. Catalogaron un total de 11 estudios experimentales y 13 cuasi experimentales pertinentes. Según estos estudios, el modelo de fuerzas, considerado como una forma de estructurar el apoyo de intensidad variable, es el mejor fundado en datos probantes, no sólo en términos de reducción del número de hospitalizaciones sino también a nivel de dimensiones tales como los síntomas, la calidad de vida y el funcionamiento social. Este modelo también es compatible con el concepto de restablecimiento aunque las pruebas son todavía limitadas.Como estruturar o acompanhamento de intensidade variável (AIV) a pessoas que sofrem de transtornos mentais graves, mas que não necessitam de um acompanhamento intensivo? Para responder a esta pergunta, os autores realizaram uma recensão da literatura em língua inglesa publicada entre 1980 e 2011. Eles identificaram cinco modelos principais: o modelo de corretagem, a gestão de caso clínico, o modelo de readaptação, o modelo das forças e a gestão de caso intensivo. Ao todo, foram repertoriados 11 estudos experimentais e 13 quase-experimentais pertinentes. Segundo estes estudos, o modelo das forças, considerado como uma maneira de estruturar o acompanhamento de intensidade variável, é o mais fundamentado sobre os dados probatórios, não apenas em termos de redução do número de hospitalização, mas também ao nível das dimensões tais como os sintomas, a qualidade de vida e o funcionamento social. Este modelo é também compatível com o conceito do restabelecimento, apesar das provas serem restritas

Relationship between perceived improvement and treatment satisfaction among clients of a methadone maintenance program

Purpose The objective of this study was to evaluate the relationship between perceived improvement and client satisfaction in a methadone maintenance treatment population. A secondary objective was to evaluate the psychometric properties of the Perceived Improvement Questionnaire (PIQ).Data sources/study setting Two hundred and thirty-two clients of a methadone maintenance treatment program filled out self-reported questionnaires and two open-ended questions measuring their perceived improvement and their level of satisfaction with the services received.Principal findings Correlation analyses revealed a significant relationship between participants' perceived improvement and their level of satisfaction with services received throughout their treatment. A factor analysis identified 3 sub-scales of the PIQ: emotional health, social relations and physical health. The PIQ's internal consistency and construct validity supported the adequacy of the metric properties of the questionnaire.Conclusion Further research is needed to investigate the link between clients' input and treatment satisfaction in different substance abuse populations. The scale's potential to provide valuable information such as clinical assessment and program evaluation should be explored.Client satisfaction Perceived improvement Treatment outcome Methadone treatment