The role of psychosocial rehabilitation interventions in everyday users of their clinical and prevention of hospitalizations. Villa
SR Agnew - CD UOSM Cava - Vietri
Co - managing the social cooperative "La Fenice"
SR Agnew - CD UOSM Cava - Vietri
Co - managing the social cooperative "La Fenice"
Poster Epidemiological
The meeting place winner national SIEP ( Italian Society of Psychiatric Epidemiology)
The meeting place winner national SIEP ( Italian Society of Psychiatric Epidemiology)
Nocera Inferiore 2005
Introduzione
Le strutture residenziali inaugurate a seguito della chiusura degli OO.PP. cominciano a non essere più “abitate” da pazienti ex OP, bensì da utenti provenienti dal territorio, come nella fattispecie di “Villa Agnetti”. Il problema attuale è che in esse non sempre muta il modus operandi con il pericolo di ri-proporre, in scala ridotta, quegli atteggiamenti di custodia ed asilari che caratterizzavano la vita all’interno dei manicomi, generando così nuove forme di istituzionalizzazione.
Il progetto iniziato nell’ottobre 2002, presso la UOSM Cava-Vietri, prevedeva invece il “mutamento” come elemento chiave dell’intervento. Si è cercato di change the work focusing on the quality, type and training of operators, with the aim not handouts, but the realization of individual and group projects, aimed at improving the autonomy and the prevention of hospital admissions, both public and private.
Methods
users - were taken into account over 18 months 13 people, 8 of which are guests of the SR "Villa Agnew and 5 members of the CD UOSM Cava - Vietri. Nine people are male and four female. The median age was 35 years (min. 20, max 44). All suffer from a chronic course of psychotic illness (With the prevailing diagnosis of schizophrenia).
mode of action - The work was mainly done in small groups of 3-6 participants and involved the state and self-expression, the King - social integration and testing work. The first line of intervention was conducted by a social worker for the group (tec. rehabilitation and / or op.'s Community). The second and third axis were followed by the operator as well as social well from the masters of art in the various activities provided by the cooperative. The groups are provided with stable structure, with internal rules, heterocentric and ready to express the history and experience collective in a flexible manner. There are two crucial elements within the group: the family atmosphere and the group dimension. The first promotes a sense of belonging, the need to take responsibility (depending on individual resources) and the birth of a journey, and the second facilitates the recovery of the relational skills based on tolerance and sharing time and space. Subjects covered
and methods employed in the social rehabilitation interventions.
State and self-expression - Understanding the capabilities of taking care of themselves and express these skills outside. The goal is to go beyond just "body", to understand the gratification resulting focusing also on the family sphere, and relational capital (carried food, cleanliness, space of life, satisfaction with their image, etc...) Re
- social integration - Promotion of skills and social skills not trying to separate the achievements in the real world experiences or frustrations that people can live (management tools social relations with the individual, relationship with the group, social interests, satisfactions in contacts with others, etc...) Experimental work
- Promoting rehabilitation of laboratories as tools in order to produce reports, test skills, to assess stress levels and personal rhythms and ability to cooperate. Further processing of such laboratories in professional activities placed in circuit protected and not working (quantity and quality of time spent on work, with colleagues and stakeholders, autonomy and initiative, etc.).. Tools used
- In this study we have taken into account two parameters: GFR (Global Assessment Functioning) and the number and severity of exacerbations. Le strutture residenziali inaugurate a seguito della chiusura degli OO.PP. cominciano a non essere più “abitate” da pazienti ex OP, bensì da utenti provenienti dal territorio, come nella fattispecie di “Villa Agnetti”. Il problema attuale è che in esse non sempre muta il modus operandi con il pericolo di ri-proporre, in scala ridotta, quegli atteggiamenti di custodia ed asilari che caratterizzavano la vita all’interno dei manicomi, generando così nuove forme di istituzionalizzazione.
Il progetto iniziato nell’ottobre 2002, presso la UOSM Cava-Vietri, prevedeva invece il “mutamento” come elemento chiave dell’intervento. Si è cercato di change the work focusing on the quality, type and training of operators, with the aim not handouts, but the realization of individual and group projects, aimed at improving the autonomy and the prevention of hospital admissions, both public and private.
Methods
users - were taken into account over 18 months 13 people, 8 of which are guests of the SR "Villa Agnew and 5 members of the CD UOSM Cava - Vietri. Nine people are male and four female. The median age was 35 years (min. 20, max 44). All suffer from a chronic course of psychotic illness (With the prevailing diagnosis of schizophrenia).
mode of action - The work was mainly done in small groups of 3-6 participants and involved the state and self-expression, the King - social integration and testing work. The first line of intervention was conducted by a social worker for the group (tec. rehabilitation and / or op.'s Community). The second and third axis were followed by the operator as well as social well from the masters of art in the various activities provided by the cooperative. The groups are provided with stable structure, with internal rules, heterocentric and ready to express the history and experience collective in a flexible manner. There are two crucial elements within the group: the family atmosphere and the group dimension. The first promotes a sense of belonging, the need to take responsibility (depending on individual resources) and the birth of a journey, and the second facilitates the recovery of the relational skills based on tolerance and sharing time and space. Subjects covered
and methods employed in the social rehabilitation interventions.
State and self-expression - Understanding the capabilities of taking care of themselves and express these skills outside. The goal is to go beyond just "body", to understand the gratification resulting focusing also on the family sphere, and relational capital (carried food, cleanliness, space of life, satisfaction with their image, etc...) Re
- social integration - Promotion of skills and social skills not trying to separate the achievements in the real world experiences or frustrations that people can live (management tools social relations with the individual, relationship with the group, social interests, satisfactions in contacts with others, etc...) Experimental work
- Promoting rehabilitation of laboratories as tools in order to produce reports, test skills, to assess stress levels and personal rhythms and ability to cooperate. Further processing of such laboratories in professional activities placed in circuit protected and not working (quantity and quality of time spent on work, with colleagues and stakeholders, autonomy and initiative, etc.).. Tools used
The overall performance of each subject was assessed longitudinally in a GFR default times with the manual GO. The number and severity of exacerbations were observed by counting of hospital admissions and hospital days during the 18 months and compared with those occurring in the two previous years.
Results
global operation - the beginning of the path are those at time zero (T0) to an average global GFR lower than the expiry of 18 months.
With the implementation of psychosocial rehabilitation project, has been an increase not only on the average overall performance, but also on the "extreme" figures of the first and second assessments. So if in October 2002, the minimum and maximum values \u200b\u200bwere 11 and 50, in April 2004, the values \u200b\u200brose to 18 and 65 (Table 2).
Table 2 - Ratings VFG per soggetti.
Soggetti VFG Ott-02 VFG Apr-04
G. P. 11 18
M.D.G. 30 51
A.P. 25 35
G.B. 25 35
A.A. 31 55
A.M. 20 49
P.G. 35 50
R.M.M. 30 45
C.S. 19 35
LR 21 30
S.S. 35 49
M.P. 50 55
V.M. 40 65
Exacerbations - The effects of the period October '02 - April '04 were significantly lower than the frequency with which they occur in history personnel of the subjects considered. The survey carried out by consulting the data archive of the information system of the DSM Psynfo ASL SA1, it appears that the number of admissions made during the period under consideration, is significantly lower than the previous two years the implementation of the rehabilitation project. In the first six months, the total admissions in three SPDC, while in the next twelve months of the eighteen considered, not whether it occurred at all.
the thirteen members present in the facility for various reasons (8 and SR 5 CD), the number of admissions for the period September '01 - September '02 was equal to 22. Over time in October '02 - April '04, the number of hospitalizations was reduced to three. As these data concerning days in hospital show that we have moved from a maximum of 254 days, pre - implementation of the rehabilitation project, for a minimum of 37.
Conclusions Compared to the parameters evaluated in this study shows that the subjects considered to have benefited from the practices put into rehabilitation. You may notice improvements in both the values \u200b\u200bof global function in the drastic reduction in the use of the practice of hospital stay.
We believe that this type of intervention appears effective even in everyday, in fact, issues such as state expression of self, the social, interpersonal relations and work activities are indicative of a much more "extended" the concept of rehabilitation in particular, to encourage the development of life in a qualitative sense.
The data collected in this work are to be considered preliminary given the small number of subjects observed. However it seems that the criteria of efficiency and effectiveness to which these data refer are in line with the same objective contained in the Draft Mental Health Protection 2002 - 2004 the Campania Region.
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