PSYCHIATRIC REHABILITATION: EFFICACY OF FOUR MODELS
Section snippets
FOCUS OF THE PRESENT REVIEW
Since Dion and Anthony's (1987) review, several rehabilitation programs, designed following specific models, were implemented in psychiatric outpatient settings. The purpose of the present review, covering the post-1987 literature, is to update Dion and Anthony's work by evaluating the efficacy of psychiatric rehabilitation models most frequently implemented.
TYPE OF PSYCHIATRIC MODELS REVIEWED
An extensive review of the studies meeting the criteria for psychiatric rehabilitation interventions, target population and experimental design was undertaken. PSYCHLIT and MEDLINE systems were used to identify relevant studies published from 1987 to 1996, inclusively. These were grouped according to one model of psychiatric rehabilitation. Models of rehabilitation that were implemented and documented a minimum of three times are included in this review. They are: Assertive Community Treatment,
CASE MANAGEMENT MODEL
When the process of deinstitutionalization started, people with a psychiatric disability who were discharged from institutions faced a fragmented and uncoordinated mental health system. The development and implementation of case management (CM) came as a response to this dysfunctional system. CM is defined as a process by which clients are supported in negotiating for the different services they want and need (Anthony et al., 1988). While such programs as ACT and Social Skills Training (SST)
VOCATIONAL REHABILITATION MODEL
The majority of vocational rehabilitation programs for people with psychiatric disabilities emerged after the 1986 Rehabilitation Act Amendments. These amendments intended to improve competitive employment opportunities for those individuals for whom past employment had been intermittent as a result of severe disability. The philosophy underlying this approach acknowledges that individuals, regardless of the extent of their disabilities, can do meaningful work in an integrated setting if they
EDUCATIONAL REHABILITATION MODEL
In 1984, the Center for Psychiatric Rehabilitation at Boston University established the Continuing Education Program. Its purpose was to develop and evaluate a university-based program for young adults with psychiatric disabilities (Unger et al. 1991). Integrating people in higher learning institutions was a logical step following their integration into the workforce through vocational rehabilitation programs. A university or higher learning center facilitates community integration by providing
OVERALL IMPACT OF REHABILITATION PROGRAMS
A summary of the impact of the four rehabilitation models is found in Table 6. The four models reviewed had a positive impact on individuals with severe psychiatric disorders. Findings showed that clients have the ability to learn the skills they are taught. However, the effect size of skills teaching is generally larger when the skills taught and the skills evaluated are highly similar. This suggests that learned material does not automatically generalize to other situations or other areas of
LIMITS OF THE PSYCHIATRIC REHABILITATION REVIEW
Study findings were analyzed without commenting on their limitations. With the exception of one or two studies, outcome evaluations were performed on programs that had been in operation for only a few months. These programs were subject to the usual instability characteristic of newly implemented programs. With the exception of Bigelow and Young (1991), the programs had not been the object of a process implementation prior to the present evaluation. So not only were the researchers evaluating a
IMPLICATIONS FOR FURTHER RESEARCH IN PSYCHIATRIC REHABILITATION
In order to reduce the limitations of the reviewed studies, researchers should conduct process evaluations first, and should ensure that outcome studies are performed on programs that have been in operation for a minimum of 5 years (Posavac and Carey, 1992). Researchers should also favor true-experimental designs, and take into account the strength of the designs when comparing findings. A complete description of client characteristics and the nature, frequency, and intensity of all services
Acknowledgements
The authors thank Dr. Robert Flynn and Dr. Tim Aubry, School of Psychology, University of Ottawa, for their support and helpful suggestions, and Pamela Prince for editorial assistance.
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