Quality of the residential environment in board-and-care homes for mentally and developmentally disabled persons

Data from a multistate survey of board-and-care homes were used to compare the quality of the residential environment in homes for mentally disabled and developmentally disabled persons. Staffing levels, services, quality of the physical structure, rapport between residents and staff, number of residents, staff training, and fire and safety precautions were analyzed. The global quality of the residential environment was found to be appreciably better in homes serving the developmentally disabled. Implications of the findings for public policy are discussed, with specific reference to advocacy strategies used in behalf of developmentally and mentally disabled persons.     

Crimes against discharged mental patients in board-and-care homes

A survey of 278 persons discharged from mental hospitals who were living in board-and-care homes showed that one-third of them had been victims of crime during the preceding year. In a comparison of nonvictims, victims of theft, and victims of violence, it was found that victims of violence were younger, were more active socially, reported more psychopathology and less satisfaction with their lives, and engaged in more criminal behaviors themselves than the other groups. Both victim groups used emergency mental health services more than nonvictims did during the preceding year. Strategies for future research and interventions are discussed.     

Reducing psychiatric hospitalization among mentally ill veterans living in board-and-care homes

OBJECTIVE: The effectiveness of a community-based case management program at the Veterans Affairs West Los Angeles Healthcare Center in reducing hospital readmission of mentally ill veterans living in privately operated board-and-care homes was evaluated. METHODS: A retrospective cohort design was used. The sample consisted of 321 patients identified by hospital records as living in one of 24 board-and-care homes in the Los Angeles area that were approved by the community residential care program. A total of 214 subjects who received monthly home visits from case managers (program group) were compared with 107 subjects who did not receive monthly home visits (comparison group). The median number of psychiatric bed-days used was calculated for the two years before and after follow-up. The number of days from the start of follow-up to the first psychiatric hospitalization was also calculated. RESULTS: Among subjects in the program group, the median number of psychiatric bed-days used decreased significantly, from 59 days to 50 days. No significant change in the median number was observed for comparison subjects. Comparison subjects were rehospitalized 1.7 times more often than program subjects. Overall, program subjects under age 62 (younger subjects) were rehospitalized 2.5 times more often than older subjects. In the program group, those who had received home visits for more than two years were hospitalized three times more often than those who had received visits for less than two years, and younger subjects were rehospitalized 1.8 times more often than older subjects. CONCLUSIONS: The findings suggest that home visits conducted by case managers in a community residential care program helped reduce psychiatric hospitalization among veteran patients living in privately operated board-and-care homes.     

Negative emotion as predictor of relapse in persons with schizophrenia living in board and care homes

Negative emotion exhibited by the board and care providers toward residents, resident behavior, medication dosage, medication noncompl ance, and gender were used to predict resident relapse over a 6-month period. Relapse was defined as movement to a higher, more intensive level of care. Eighty-four residents with a diagnosis of chronic schizophrenia disorder, living in board and care homes in the Fresno, California, area participated in the study. Board and care providers were interviewed using Kreisman's Patient Rejection Scale and Gurel's Behavior Rating Scale. Neither patient rejection nor resident behavior was predictive of relapse; however, medication noncompliance did predict relapse with the male residents and lower medication dose predicted relapse with the female residents. Rejection of the patient by the board and care operator was found to correlate .73 and .64 with negative behavior of the male and female residents respectively. Implications of these results for expressed emotion research were discussed.Reprint requests should be directed to Robert J. Calsyn, California School of Professional Psychology, 1350 N St., Fresno, CA 93721.     

Critical incident stress management for persons residing in institutions

Critical Incident Stress Management (CISM) approaches have proven themselves to be effective in mitigating the stress and anxiety that are often found in at-risk populations in the aftermath of traumatic incidents. A frequently overlooked group of persons at risk are those individuals who reside in a variety of institutions. Extensive research spanning a half century has shown these individuals to have heightened sensitivity to anxiety in general and traumatic events in particular. CISM approaches would appear to hold promise in assisting with these residents' needs. This paper outlines a basic CISM approach that could be adopted and adapted by a variety of institutional settings for the special needs of their residents. Preincident, acute care, and postincident response initiatives are presented, and the implications for such program development are discussed.     

Wandering behavior in veterans with psychiatric diagnoses residing in nursing homes

OBJECTIVE: To investigate nursing home residents with psychiatric diagnoses who wander and who are not diagnosed with dementia. METHOD: A national cross-sectional study was conducted in a male Veterans Administration Nursing Home Care Unit population using a retrospective review of the MDS. RESULTS: Eleven thousand six hundred and nineteen residents were identified as having a psychiatric diagnosis without significant cognitive impairment; just under 1% (n = 113) wandered. Using rare events logit regression, we determined that a diagnosis of schizophrenia/bipolar disorder or comorbid psychiatric conditions were associated with increased risk of wandering compared to residents diagnosed with anxiety/depression. Psychiatric wanderers were also more likely to, have symptoms of delirium, exhibit socially inappropriate behavior, manifest problems in decision-making, take anti-psychotic medications, and to be more independent in locomotion. CONCLUSIONS: Psychiatric wanderers may be conceptualized better as exhibiting ambulatory concomitants of unremitted neurological/psychiatric symptoms or medication side effects of their treatment. Findings have implications for addressing treatable causes of wandering.     

Correlates of vocational recovery for persons with schizophrenia

The correlates of vocational recovery and vocational success among persons with schizophrenia were examined to identify prospective attributes that might be malleable and accessible to intervention. A national, non-representative sample of 109 individuals with a selfreported diagnosis of a schizophrenia spectrum disorder that met criteria for vocational recovery completed a survey on sustained employment of people with serious mental illness. Eighty-two participants (75%) had uninterrupted employment during the two years prior to entering the study while the rest sustained employment for at least 12 months during the same period of time. Respondents worked from 10 to 64 hours per week in jobs ranging from unskilled to professional and managerial positions. In multivariate analyses, previous work history and current receipt of Supplemental Security Income (SSI)/Social Security Disability Income (SSDI) were correlated with current work hours per week; educational level and employment in consumer self-help/advocacy settings were associated with occupational status; and current receipt of SSI/SSDI was correlated with current salary per hour.This study provides evidence that some individuals with a schizophrenia spectrum disorder have the capacity to achieve and maintain successful employment despite the challenges presented by this serious mental illness.     

Cognitive profiles in persons with chronic schizophrenia

Cognitive heterogeneity has been a key barrier to clarifying the neuropathologic underpinnings of schizophrenia. We used an idiographic method for cluster analysis of neuropsychological data from 144 middle-aged and older people with schizophrenia to characterize and group the patterns of relative (within-person) profiles of cognitive strength and weakness. Results indicated a 5-cluster solution as most appropriate, with relatively even distribution across the 5 clusters in terms of the proportion of patients in each cluster. Cognitive subtyping may be useful in imaging and genetic research on schizophrenia, as well as having practical utility in treatment planning and cognitive rehabilitation.     

A hybrid supported employment program for persons with schizophrenia in Japan

INTRODUCTION BY THE COLUMN EDITORS: Because the mental health system in Japan has emphasized hospital-based treatment (1), patients with schizophrenia often remain institutionalized for long periods, even after their symptoms have stabilized. In addition, the introduction of modern community-based methods of treatment and rehabilitation was delayed by an antipsychiatry movement in the 1970s and the ascendance of a reductionistic biological approach to services (2). Lack of adequate outpatient services and community residential care in Japan has been a serious obstacle to destigmatization of mental disorders and has contributed to the heavy burden and stress experienced by families of mentally ill persons (3). More than 80 percent of patients discharged from mental hospitals return to live with their families, who are ill prepared to provide the supportive services required for community tenure.Involvement in work activities can facilitate community reentry for people with serious and persistent mental illness because employment displaces symptoms, provides structure and meaning in daily life, offers socialization with peers, and permits workers to earn income for shelter and food. In this issue's Rehab Rounds column, the authors describe an innovative vocational rehabilitation program for patients with schizophrenia that was designed to overcome obstacles to discharge and community adjustment. The program at Yabuki Prefecture Psychiatric Hospital, in the northern prefecture of Fukushima, Japan, has been successful in training patients for competitive work while capitalizing on the importance of work in Japanese culture and its traditionally supportive employer-employee relationships. The program is termed "hybrid" because it combines elements of transitional employment with supported employment (4).     

Body mass index in persons with schizophrenia.

BACKGROUND: Schizophrenia has been associated with several health concerns and risks. Overall mortality among persons with schizophrenia has been shown to be about twice that of the general population. There is growing concern that persons with schizophrenia may also be at risk for being overweight or obese, compared with the general population. To examine this possibility, the author compared the distribution of body mass index values (BMI = kg/m2) in people with schizophrenia with that of the Canadian population as a whole. METHOD: Weights and heights were obtained for 183 patients receiving treatment in a hospital-based program for persons with schizophrenia. These BMI values were compared with the results of Statistics Canada's 1996-1997 National Population Health Survey (NPHS), which provided average BMI values for the general population. RESULTS: The average BMI in the study sample was 29.02, with the average for men being 28.49 (range 15.55 to 49.22, SD 6.25) and the average for women, 30.02 (range 19.30 to 45.71, SD 6.45). This is compared with the NPHS average BMI of 26.3 for men and 24.3 for women. The prevalence of obesity (BMI > 30) in the sample was 42.08%, 3.5 times that of the Canadian average of 12% and 2.8 times that of the 15% prevalence in Manitoba. In this sample, 26.78% had a BMI in the acceptable range, in contrast to the 48% of those in the NPHS who had a weight appropriate to their height. CONCLUSIONS: This analysis provides evidence that the BMI distribution of the sample population is different from that of the national population as represented in the NPHS data. The data indicate that patients with schizophrenia are significantly heavier than the general population.     

Structure of needs among persons with schizophrenia

Abstract Background The importance of needs assessment for service development has been widely recognised. Several studies have focused on the associations between ratings of needs by patients and staff and have found clear differences, especially concerning the unmet needs. Methods The present study is part of a Nordic Multicentre study that investigates the life and care of outpatients with a schizophrenia group illness in all the Nordic countries. The aim of this paper is to study the patterns of needs as identified by patients and staff according to the Camberwell Assessment of Needs (CAN). Quality of life, level of functioning, and psychiatric symptoms were assessed. Results The sample includes 300 patients, 194 (65%) men and 106 (35%) women. The factor analysis identified five factors for patients and four factors for staff in the questionnaire on ratings of needs. In four of the five patient-related factors a meaningful interpretation was possible, and the factors were named skills, illness, coping, and substance abuse. The staff-related factors were named skills, impairment, symptom, and substance abuse. There were significant associations between the sum scores constructed from the factors and measures of functioning level and symptoms. Conclusions It seems that the sum factor reflecting secondary needs was the most important of the identified factors among both patient and staff ratings. The item-by-item comparisons in previous studies have emphasised differences between patient and staff ratings, but our analysis of the structure of needs also found similarities in the structures and in the associations between the identified sum scores and measures of symptoms, functioning level, and quality of life.     

Using communication plans to facilitate interactions with communication-impaired persons residing in long-term care institutions

Background: A large proportion of residents in long-term care institutions present severe and chronic communication disorders that may not respond well to therapy focused on improving language and speech. Moreover, given the ecological relevance of considering communication in situations of interaction, speech-language intervention could aim at facilitating interactions with those residents by informing caregivers about the residents' specific characteristics and communication disorders. Aims: The aims of the present research were (1) to elaborate a Communication Plan that contained information about a resident's specific characteristics and communication disorder, and (2) to evaluate the effects of Communication Plans by considering the point of view of the resident's caregivers. Methods & Procedures: In three long-term care institutions, 10 residents (between the ages of 63 and 95 years) who had severe aphasia or communication impairment, and 39 professional and non-professional caregivers attending to these residents, were recruited. An individual Communication Plan for each resident was constructed employing the results of speech-language and communication evaluations. Before and after these Communication Plans were used, participant caregivers completed a questionnaire designed to measure communication and interactions with residents. Outcomes & Results: A qualitative and quantitative analysis of the results indicated that after using Communication Plans, professional and non-professional caregivers felt more comfortable in communicating with residents, were more knowledgeable about communication characteristics of a given resident, and employed more facilitating strategies in communicating with residents. They perceived Communication Plans as being clear, complete, easy to use, and adapted to their needs with communication-impaired residents. Conclusions: The use of Communication Plans is an appropriate speech-language pathology tool, which may enable caregivers to adjust their manner of communicating to the specific needs of a given person residing in a long-term care unit. It is possible that Communication Plans helped caregivers become more skilled communicators with communication-impaired persons.