The overlooked part of flexible assertive community treatment:A retrospective study on factors related to discharge from FACT for clients with a psychotic disorder

Flexible assertive community treatment (FACT) is a recovery-based treatment and its manual describes discharge criteria for clients who are recovered. Yet research on discharge is lacking. In this retrospective and observational study, between 2009 and 2019, we explored how sociodemographic, clinical, and treatment factors are associated with planned discharge or no discharge. We included 1734 clients with a psychotic disorder of which 38.5% were discharged after a mutual decision that FACT was no longer necessary. Logistic regression analysis was used to create a discharge profile which was more favorable for discharged clients. They were older at the start of FACT, had lower HoNOS scores, were diagnosed with another psychotic disorder, and had fewer contacts with non-FACT members. Discharge is a part of FACT and is more common than anticipated. While this study provides preliminary answers, further research is necessary to better understand discharge and its associated factors

The association between executive functioning and personal recovery in people with psychotic disorders

Background Recovery in psychotic disorder patients is a multidimensional concept that can include personal, symptomatic, societal, and functional recovery. Little is known about the associations between personal recovery (PR) and functional recovery (FR). FR involves a person’s ability to recover or compensate for impaired cognition, such as executive functions, and the loss of skills. Method In this cross-sectional study (the UP’S study), we used measures of executive functioning and personal recovery to assess a cohort of people with a psychotic disorder. PR was measured using the Recovering Quality of Life (ReQOL) and Individual Recovery Outcomes (I.ROC). FR was assessed using two forms of assessment. The Behavioral Rating Inventory of Executive Functioning Adult version (BRIEF-A) was used for self-rated executive functioning, and the Tower of London (TOL) for performance-based executive functioning. Regression models were calculated between executive functioning (BRIEF-A and TOL) and PR (ReQOL and I.ROC). Model selection was based on the Wald test. Results The study included data on 260 participants. While total scores of BRIEF-A had a small negative association with those of the ReQOL (β = −0.28, P > .001) and the I.ROC (β = −0.41, P > .001), TOL scores were not significantly associated with the ReQOL scores (β = 0.03, P = .76) and the I.ROC scores (β = 0.17, P = 0.17). Conclusion Self-reported EF, which measures the accomplishment of goal pursuit in real life was associated with PR. However, processing efficiency and cognitive control as measured by performance-based EF were not

Symptomatic and Functional Recovery:Does symptom severity affect the recovery of executive functioning in people with psychotic disorders?

Background: Recovery in psychotic disorder patients is a multidimensional concept that can include personal, symptomatic, societal and functional recovery. Here we define Functional Recovery (FR) as recovery or compensation after the loss or impairment of skills in different cognitive functions. Some of the most impaired cognitive functions in psychosis are the executive functions, whose impairment in people with a psychotic disorder can produce problems that are difficult to overcome, partly because treatment often focuses only on Symptomatic Recovery (SR). Although symptom severity may be a risk factor for longstanding impairments of executive functioning, the association is not always found. To date, there has been little research on the association between the 2. MethodThis study is part of the UP’S study, a longitudinal cohort study of patients with a psychotic disorder. The Behaviour Rating Inventory of Executive Functioning Adult version (BRIEF-A) was used to measure FR at baseline and after 1 year. SR was measured using the Positive and Negative Symptom Scale-Remission (PANSS-R), also at baseline and 1 year? At both time points, correlations were computed as cross-sectional analyses. For the longitudinal analysis, the difference scores were used to calculate generalized linear models. Model selection was based on the Wald-Chi square test. Results323 people were included for the baseline assessment of the UP’S study, 163 of whom had completed the T1 follow-up measurement at the time of this study. We found a moderate association between PANSS-R baseline scores and BRIEF-A baseline scores (β=3.76). While there was also an association between the PANSS-R score at baseline and the BRIEF-A difference scores (β=1.67), we found no association between the PANSS-R difference scores and the BRIEF-A differences scores. ConclusionOur finding that less overall symptom severity was associated with 1 year improvement in executive functioning suggests that symptom severity could be a way of improving executive functioning over a year. However, as no link was found within the year between changes in symptoms and changes in executive functioning, it is possible that symptom severity does not have an immediate effect on executive functioning, but that its effect is delayed. This leaves scope for targeted interventions to improve executive functioning, and thus functional recovery

Dealing with care disruption in High and Intensive Care wards:From difficult patients to difficult situations

High and Intensive Care is a relatively new care model in Dutch mental health care for clinical admissions. One of the goals is to keep the admission short. For some patients, this goal is not realized, which results in a long-term admission. Often, this is experienced as a disruption. Disruptions in care processes are frequently defined in terms of patient characteristics. Yet, it may be that other factors play a role. The aim of this study is to gain better insight into the perceptions of care professionals of what is characteristic for disruptions at High and Intensive Care wards and how professionals can deal with these. Qualitative research was performed by means of semi-structured interviews and a focus group with professionals. Results show that a focus on patient characteristics is too narrow and that other factors also play an important role. These factors include challenges in the relation between professionals and the patient, a divided team, and a lack of collaboration with ambulatory care. In order to deal with these factors, professionals should invest in the relationship with the patient, identify destructive team processes early, and improve communication with ambulatory care. It is recommended to develop a monitoring tool that includes all these factors. Another recommendation is to organize structured reflection on dilemmas experienced in care. In conclusion, this study shows the importance of going beyond patient characteristics in order to better understand, identify, and deal with disruption at High and Intensive Care wards

The Active Recovery Triad (ART) model:A new approach in Dutch long-term mental health care

Unlike developments in short-term clinical and community care, the recovery movement has not yet gained foothold in long-term mental health services. In the Netherlands, approximately 21,000 people are dependent on long-term mental health care and support. To date, these people have benefited little from recovery-oriented care, rather traditional problem-oriented care has remained the dominant approach. Based on the view that recovery is within reach, also for people with complex needs, a new care model for long-term mental health care was developed, the active recovery triad (ART) model. In a period of 2.5 years, several meetings with a large group of stakeholders in the field of Dutch long-term mental health care took place in order to develop the ART model. Stakeholders involved in the development process were mental health workers, policy advisors, managers, directors, researchers, peer workers, and family representatives. The ART model combines an active role for professionals, service users, and significant others, with focus on recovery and cooperation between service users, family, and professionals in the triad. The principles of ART are translated into seven crucial steps in care and a model fidelity scale in order to provide practical guidelines for teams implementing the ART model in practice. The ART model provides guidance for tailored recovery-oriented care and support to this “low-volume high-need” group of service users in long-term mental health care, aiming to alter their perspective and take steps in the recovery process. Further research should investigate the effects of the ART model on quality of care, recovery, and autonomy of service users and cooperation in the triad

High and Intensive Care in Psychiatry: Validating the HIC Monitor as a Tool for Assessing the Quality of Psychiatric Intensive Care Units

This study aims to validate the HIC monitor as a model-fidelity scale to the High and Intensive Care (HIC) model, a recently developed model for acute psychiatric wards. To assess the psychometric properties of the HIC monitor, 37 audits were held on closed inpatient wards at 20 psychiatric hospitals in the Netherlands. Interrater reliability, construct validity and content validity were examined. Our results suggest that the HIC monitor has good psychometric properties. It can be used as a tool for assessing the implementation of the HIC model on acute psychiatric wards in the Netherlands, and for quality assessment and improvement