The International Journal of Psychosocial Rehabilitation

Participants’ Reported Experiences of an
Irish Psychiatric Residential Rehabilitation Programme



Barbara A. Price, B.A. Psy., M.A.
 (Cluain Mhuire Family Centre)
and
Barbara C. Western, B.A. Psy.
(Cluain Mhuire Family Centre)


  Citation:
Price B. & Western B. (2004). Participants’ Reported Experiences of anIrish Psychiatric Residential
 Rehabilitation Programme.
  International Journal of Psychosocial Rehabilitation. 9 (1), 121-134.


Correspondence to:                                
Barbara Western, 22 Woodstown Heath, Knocklyon D16, Dublin, Ireland
barbarawestern@eircom.net

Abstract
Individuals currently participating in the high, medium and low support components of the Cluain Mhuire Residential Rehabilitation Programme (RRP) in Dublin, Ireland were asked to give an account of their experiences of the programme and their evaluation. Participants completed two questionnaires containing qualitative and quantitative questions. Demographic information was sought on age, marital status and cultural identity as well as information on their current living and employment status. A qualitative section at the end of this questionnaire gave participants the opportunity to state their own understanding of the reasons for being in the programme and their expectations of the programme. Secondly, participants completed a standardised questionnaire called Measuring Psychosocial Rehabilitation Outcomes (MPRO) that provided them with the opportunity for self-evaluation. The MPRO assesses quality of life issues, beliefs around empowerment and the ability to influence and control one’s life using a rated scale that provides scores on four main outcomes: 1) Subjective Quality of Life (SQOL); 2) Mastery (M); 3) Empowerment (EMP); and 4) Programme Satisfaction (PROG). A qualitative section at the end of this questionnaire gave participants the opportunity to evaluate what are the most and/or least satisfactory aspects of their time within the RRP.

The data was statistically analysed to evaluate whether there are correlations between a participants’ living status and the four outcome measures on the MPRO – Subjective Quality of Life, Mastery, Empowerment, and Programme Satisfaction- and if there are any positive or negative correlations between these four outcome measures.

The results indicate that a participants’ level of residential support can be statistically significant in correlation to their self-evaluation, with those in high support scoring the lowest on PROG (p=0.01) and those in medium support scoring higher and more consistently. There were also significant correlations within the four outcome measures on the MPRO (p=0.01 to p=0.05).

Keywords:  psychosocial rehabilitation; evaluation; programme satisfaction

Introduction
“The main tasks of psychiatric rehabilitation are: (1) to assist in reintegrating psychiatrically disabled persons into the community and (2) to maintain their ability to function independently…in other words, psychiatric rehabilitation practitioners attempt either to reduce the patient’s dependence on the mental health system of people and facilities, or to reinforce whatever level of independence from the system the patient has been able to achieve.” (Anthony Cohen and Vitalo, 1978, p.365)

The term psychosocial rehabilitation is currently most often used to describe those programmes with a focus on providing the least restrictive setting, avoiding hospitalisation and providing skills training. Fields (1990) criticizes a lack of discernment and definition with regard to residential programmes, and claims the same term is often applied to very different programmes. He provides a definition: “the purpose of residential treatment programmes is twofold: (1) to provide treatment alternatives for those individuals who would otherwise be left in acute and longterm hospitals or other institutional settings, including jails, due to the severity and seriousness of their disabilities; (2) to utilize a range of residential settings to transition the mental health system from an institutional dependency to a community based services perspective”(p.107).

Fields (1990) explains that “on a programmatic level, residential treatment programmes are therapeutic communities designed to assist clients to stabilise from a crisis, to develop and implement a community support plan, and to interact with other people, staff members and clients, in order to strengthen interpersonal skills and identify individual goals….the programmes should be active in the life of their communities and not isolated facilities” (p.109).

Research studies into the measurement of rehabilitation outcomes have found that there is a need for baseline analysis in this area, as programme evaluation is contingent on continuous assessment of the delivery of rehabilitation programmes (Hawthorne et al., 1994, p. 152). Gathering this data will hopefully provide an opportunity for researchers in years to come to obtain information on the programmes offered within the Cluain Mhuire Residential Rehabilitation Programme (RRP) and to measure the improvements, or need for change, within the programme. Indeed there is much to be said for creating a culture of research and ongoing programme evaluation within the RRP, bearing in mind that “assessment of rehabilitation outcome must be more than a research activity. It should be an ongoing responsibility of each practitioner “(Anthony et al., 1978, p.379). Issues such as quality of care, the cost effectiveness of programmes and, most importantly, the benefit to the client can be dramatically and positively affected by this kind of research.

Such evaluations have been encouraged by researchers who posit that “the main tasks of rehabilitation are to assist clients in re-integrating into the community and to maintain their ability to function independently” (Anthony et al., 1978, p.365). A key to comprehensive evaluation must include the participants’ satisfaction of the services. An evaluation model that includes a self - evaluation component is preferable to an evaluation conducted by non - treatment personnel”. (Anthony et al., 1978, p. 379).

The Cluain Mhuire Residential Rehabilitation Programme
The Cluain Mhuire Residential Rehabilitation Programme (RRP) addresses differing levels of need and provides a transition from institutional dependency to a community- based services perspective such as that advocated by Fields (1990, p.107). However, there has not yet been an evaluation provided by residents nor a compilation of information gathered on their current circumstances. To date, there has been substantial movement through the programme, with an average of about seven people making a transition each year. Occasionally, those who have made such a transition to a lower level of support discover that they need to return to a higher level once again.

The RRP is a component of the Cluain Mhuire Mental Health Service and run under the auspices of the Hospitaller Order of St. John of God. The emphasis is on helping participants to move through the different phases of the programme with a focus on rehabilitative possibilities based on individualised assessment. The ultimate aim is for re-integration into the community where appropriate.

Previously named the Community Living Programme, the RRP was so named after a review in 2000, which recognised the increased need to focus on rehabilitation and the attainment of skills in helping people, re-integrate into the community. Largely, the programme encompasses many different elements, examples of which are: residential, educational, medical, the teaching of social and domestic living skills and recreation. All participants maintain outpatient contact with their psychiatrist. Participants are required to pay a weekly rent and are encouraged to maintain regular payment. Rent covers all domestic expenses and the programme funds group recreational activities.
 The three phases of the RRP are 1) High Support, 2) Medium Support and 3) Low Support.

Those individuals residing in Oropesa¹, the high support component of the RRP, are in most cases referred by their medical team from St John of God Hospital. Oropesa is a 20-bed hostel in the community and the level of support is designed for those individuals who have been identified and assessed as being most suitable to participate in the skills training offered within the Residential Rehabilitation Programme. Participants of the programme are usually expected to engage in outside activities that are either provided by the service  - for example, day centres or workshops - or other agencies accessed by participants themselves. Staff encourage maintenance of self-care. Meals are prepared by kitchen staff and participants are requested to help in maintaining cleanliness in the building. Medication is either supervised or unsupervised depending on the needs and capabilities of the individual participants. There are a minimum of two staff members on duty at all times (24 hrs).

The participant is assigned two keyworkers who will over a period of time, work with them in formulating and actualising personal goals, the achievement of which are necessary for transition through the programme. A link worker is on duty to facilitate keyworkers with such goals as improving self care, budgeting and initiating daily activity as well as management of anxiety/stress and support in coping with current life issues.

A medium support environment, Avila², is provided elsewhere in the community, and caters for fifteen people. There are alternately one or two staff members on duty on a twenty-four hour basis. Each participant at Avila is assigned a keyworker who will help to build upon the goals that have been met within the high support component and to continue programme plans adapted to a medium support environment.  This is usually based on the improvement/attainment of daily living skills such as cooking and shopping, budgeting and self care i.e. hygiene. There is also support in managing anxiety, stress, grief or any current issues in participants’ lives. Participants are expected to engage in the routine activities of the hostel and to maintain room hygiene.

The main theme is self-governance with participants’ meetings held weekly, where menus are planned and shopping duties allocated. Participants take turns to cook and to shop while observing budgetary limits. All necessities are met by the hostel budget including food and cleaning materials. Group recreational activities are funded by the hostel and participants are encouraged to access activities in the community that are conducive to their goals and may be funded where appropriate. Most participants take unsupervised medication where appropriate.

Those who have successfully completed the other modules move to one of the low support hostels³ with the eventual aim of moving to private or local authority housing. This comprises three houses on housing estates in the Stillorgan/Blackrock area. Each house contains four/five residents, each with their own room. Two staff members are available within flexible working hours. Rent relief can be claimed, unlike in the other hostels. Staff inspect the homes and ensure that they are kept to a good standard in terms of hygiene. Group activities are funded by the service and are facilitated by staff. Residents are expected to have a daily activity where possible. Since this research was initiated there has been an added component to low support in the provision of a unit specifically for those who will imminently make the transition from supported living to independence with an outreach service.

The aim of this study is to provide an overview of the current circumstances of those participating in the RRP, which we hope will help to identify and meet their needs to the maximum level, and will help in assessing outcomes. Overall we hope that information gleaned would provide valuable knowledge for future planning and an information base for future studies. We also hope to promote a greater awareness of the issues in psychosocial rehabilitation today.

This study will address the hypothesis that:

The Residential Rehabilitation Programme benefits the participant in terms of quality of care, employment, empowerment and independence. The benefits of the programme are related to progressive movement through the Residential Rehabilitation Programme.

1. Oropesa is the place name of an area in Spain where St John of God spent his childhood. He lived and worked here as a shepherd until adulthood, when he left to join the Spanish army.
2. Avila is a reference to Father John de Avila who was a minister living in Grenada whom John looked up to as a mentor. He became a very good friend of John’s and was instrumental in guiding John through his spiritual conversion.
3. Ardmeen, Allen Park and Leopardstown Avenue are the names of the three houses , or low support hostels, that are  nestled in the communites of Blackrock and Stillorgan.

Method
Demographic questionnaire:
An adapted questionnaire produced by the US based Human Services Research Institute (HSRI) was used to seek demographic information such as living status, age, marital status, income, employment status, time spent in the RRP and readmissions to hospital. Two qualitative questions at the end of the questionnaire asked for people’s expectations of the programme and their reasons for being part of the programme, in their opinion.
 
Measuring Psychosocial Rehabilitation Outcomes (MPRO)
The MPRO is a scale devised by the research committee of the International Association of Psychosocial Rehabilitation Services in cooperation with the Evaluation Center at the Human Services Research Institute (HSRI) in the US.  It is specifically designed to measure the perspective of programme users in a number of areas that are relevant to the goals of psychosocial rehabilitation programmes. The four areas focused on were:

1)    Subjective Quality of Life (SQOL) - assesses overall perception of well-being.
2)    Empowerment (EMP) - assesses the individual’s sense of his/her rights and opportunities to control his/her life and services received.
3)    Mastery (MAST) - assesses the individual’s beliefs around ability to control and influence his/her own life.
4)    Programme Satisfaction (PROG) - assesses satisfaction with the programme.

The questionnaire contains 20 questions, with five questions for each variable. Participants rated their answers on a scale, which measured the extent to which they agreed or disagreed with the statements made. Questions were scored and added with an average figure taken for each individual for all four variables and an average overall score for each variable.

Lower scores indicated less satisfaction with the programme, or a lower sense of well being, while higher scores indicated the opposite. At first glance the lowest overall average score was for Mastery, followed by Subjective Quality of Life, and then Empowerment and the highest score was Programme Satisfaction. The use of a computer statistical package (SPSS) helped to analyse the data for differences between the four variables and their relation to the three levels of support.

After securing the Hospitaller Order of St. John of God Ethics Committee approval, individual programme participants were posted a letter of information and a letter of consent along with a stamped addressed envelope and a return date prior to commencement of the project. Letters of consent were to be posted or dropped into sealed boxes in Avila and Oropesa. After the return date, the MPRO, demographic questionnaire and stamped addressed envelope were posted individually.  Again, participants were asked to either return the questionnaire by post or to leave them in sealed boxes located securely in the offices of Avila and Oropesa by a certain date. Other staff members were briefed on the ethical concerns. The researchers were contactable in the event of any queries. Estimated time to complete the questionnaires was approximately 20 minutes and participants were given four weeks to return the completed questionnaires. The study related to the RRP only and not to the service as a whole. All consultants’ permission was sought and any opinions/concerns regarding individual residents were invited. No funding was requested or obtained for the purpose of this project.

Subjects
Fifty participants of the Cluain Mhuire Residential Rehabilitation Programme were provided with the demographic questionnaire and the MPRO. Twenty-four RRP participants responded (48%). The age range of the 24 participants was 19 to 65 years old (mean = 42, median = 44). Sixteen were male and eight were female.

Results
Demographic questionnaire:
48% of RRP programme participants took part in the study. The average age was 42. Only two respondents had been married and one was divorced/separated. All other respondents were single (92%).

22 responded that they are Irish with two failing to answer that question.

7 (29.16%) of the study participants were residing in Low Support, 5 (20.8%) were in Avila, the medium support setting, and 12 (50%) were residing in Oropesa, the high support component of the RRP.

When asked about their current employment status, 8 (33.3%) cited that they were in a sheltered workshop. 4 (16%) said they were currently unemployed. 3 (12.5%) were on a training course such as Roslyn Park, a service provided by the Rehab group, and another 4 (16%) classified themselves as actively seeking employment. 3 (12.5%) said they were employed outside of St John of God services. One person said they were studying and another said they were starting their own business.

16(66%) had been previously employed, with occupations being or having been; library assistant, real estate apprentice, gardener, secretarial work, cashier, commis chef, maintenance technician/ production, advertising copywriter, babysitter, data input, accounts assistant

The hours of those currently engaged in outside activities ranged from 9 to 40 hours a week. Income ranged from €17 to €335.75 per week of those who were earning a salary. Of three people employed independently, two were permanent and one was temporary.

19 (79.16%) had some kind of educational qualification. 3(12.5%) were educated to degree level, 13 (54.16%) to cert level and 3(12.5%) to diploma level. 7 (29.16%) had attended third level institutions, a further 7 (29.16%) had attended technical/ vocational colleges and 3 (12.5%) had attended community courses.

14(58%) cited the disability allowance as their main source of income.

The average age at first hospitalisation was 23 yrs. The average time spent in the RRP was 6.5 yrs and the average number of self-reported readmissions to hospital since being admitted to the RRP was 2. The lowest rate of self reported readmission to hospital was in medium support with the rate of re-admission from medium support being one third that of high support and a quarter of that of low support.

Table 1. 

 

 

 

 

 

 

N

 

 

 

Mean

 

 

 

Std. Deviation

 

 

 

Std. Error

 

95% Confidence Interval for Mean

 

 

 

F ratio

 

 

 

P value

Lower Bound

Upper Bound

firsthosp     1.00

               2.00

               3.00

              Total

11

4

7

22

21.09

24.35

25.57

23.09

4.989

3.594

9.199

6.502

1.504

1.797

3.477

1.386

17.74

18.53

17.06

20.21

24.44

29.97

34.08

25.97

1.104

 

.352

timerrp      1.00

               2.00

               3.00

              Total

11

5

7

23

6.21

5.20

7.86

6.49

6.322

3.701

2.795

4.878

1.906

1.655

1.056

1.017

1.96

.60

5.27

4.38

10.46

9.80

10.44

8.60

.444

 

 

 

.648

readhosp     1.00

               2.00

               3.00

              Total

11

5

7

23

2.55

.60

1.86

1.91

3.205

.894

1.215

2.410

.966

.400

.459

.503

.39

-.51

.73

.87

4.70

1.71

2.98

2.96

1.136

 

 

 

.341

 

 

 

firsthosp = first hospitalization; timerrp = length of years in RRP; readhosp = number of readmissions to hospital while in the RRP 

Qualitative Questionnaire
Four qualitative questions were asked. The first question asked respondents what were the reasons for their referral to the RRP. Overall six out of twenty four people cited diagnostic criteria alone for their admission to the RRP such as anxiety/depression and schizophrenia. Two others used more general terms such as “I have an illness” or “mental health”. The majority of the above eight were in the High support component. Seven reported that they were in the RRP in order to live independently/learn new skills. All but one of these seven was in Med/Low support. Three cited accommodation needs as being their main reason for admittance to the RRP. Two of these respondents were in the high support component. Three others cited conflict with family or inability to function alone. Three did not answer.

 The second question asked what are your expectations of your time in the RRP?
In answering this question, the majority of respondents reported that they expected a supportive and stable environment from which they could gain the confidence to live independently. One respondent wrote; “to build up my self confidence as I learn to cope again in the ‘real’ world – every day you take a step forward and sometimes it can be two backwards. Taking responsibility for oneself and living with the consequences of your actions, something one has to learn again. Living in a group home, one has to learn to live and let live.” Another wrote, “my chief expectations are time and support. Time to readjust to life outside and the support to enable me do that.” Another
, “to be mentally strong enough to live independently and practically”.

The third question was: What are the most satisfactory aspects of your time in the RRP?
Again many focused on the learning of new skills and the availability of staff support, while some were very appreciative of the material comforts available such as regular meals, the provision of washing machines/dryers, and the economical advantages. The majority of those who cited practical/ material concerns were those in the high support component. One person in the low support component   wrote;

“being challenged to ‘go for it’ - feeling at home with my housemates – a sense of belonging which does not exist to the same extent in the high support hostels – a real sense of independence and being able to use my own initiative”.  Another from medium support wrote; “social rehabilitation, independence, budgetary management, access to training. Personal freedom, self reliance, tolerance, increasing maturity and assertiveness” another from medium support – “The RRP allows me to have time to think and this to me is very important. but I think there should be more intervention from the staff, attitude reconstruction, personal development” etc. Another from medium support wrote: “My experience of the service has in general been very positive. I have felt supported, well cared for, and have benefited from living with others in my position. The environment is one of healing.”

The fourth question was: What are the least satisfactory aspects of your time in the RRP?
This was the least answered question of the four qualitative questions, with seven people not answering. Five people cited problems in their relations with staff. Two referred to confrontations they had had with individual staff members and others gave more general comments such as “too strict – the staff are” and “sometimes I don’t think that staff understand how ill I feel”. Or “staff have too much control.” One person said: “Institutionalisation – even the medium support is so regimented, one loses the ability to make any decisions – totally reliant on the staff. Resentment that a well educated person can be treated in the same manner as others less intelligent, taking no account of the person’s age or life experience and a perceived level of patronisation.” Environmental concerns ranged from an uncomfortable bed to smoke and dirty surroundings to irritation with other clients. One person answered “medication”.

Measuring Psychosocial Rehabilitation Outcomes (MPRO)
The results showed that across the three levels of support, clients’ perception of subjective quality of life was similar when analysed using the Oneway Analysis of Variance (ANOVA). Those in medium support were more consistent with each other and scored higher than the other groups on this variable than those in high or low support, with those in low support being less sure of things.


Table 2.

 

 

 

 

 

 

N

 

 

 

Mean

 

 

 

Std. Deviation

 

 

 

Std. Error

 

95% Confidence Interval for Mean

 

 

 

F ratio

 

 

 

P Value

Lower Bound        

  Upper Bound

SQOL     1.00

               2.00

               3.00

              Total   

12

5

7

24

2.852

3.200

2.743

2.893

.5246

.3742

.8384

.6063

.1514

.1673

.3169

.1238

2.518

2.735

1.967

2.636

3.185

3.665

3.518

3.149

.874

.432

EMP       1.00

               2.00

               3.00

              Total

12

5

7

24

2.97

3.24

3.03

3.04

.584

.410

.390

.493

.168

.183

.148

.101

2.60

2.73

2.67

2.83

3.34

3.75

3.39

3.25

.523

.601

MAST     1.00

               2.00

               3.00

              Total

12

5

7

24

2.813

3.040

2.514

2.773

.6238

.5550

.6309

.6166

.1801

.2482

.2385

.1259

2.416

2.351

1.931

2.513

3.209

3.729

3.098

3.033

1.121

.345

PROG    1.00

               2.00

               3.00

              Total     

12

5

7

24

2.907

3.410

3.400

3.155

.4887

.3090

.4000

.4870

.1411

.1382

.1512

.0994

2.596

3.026

3.030

2.950

3.217

3.794

3.770

3.361

3.930

.036

Oneway ANOVA – Subjective Quality of Life (SQOL), Empowerment (EMP),  Mastery (MAST), Program (PROG)

Level of Support – 1.00 = High Support, 2.00 = Medium Support, 3.00 = Low Support



On empowerment, although not statistically significant, it is worth mentioning that those in medium support scored noticeably higher on this variable. It is also important to mention that there was a less than 50% response rate (33%) from those in medium support, which suggests a possible difference between those who responded and those who did not and may explain this increased level.

 

Scores on mastery, although again not statistically significant, were higher for those in medium support. The overall score for this variable was the lowest of the four variables.

 

When it came to programme satisfaction, there was a statistically significant lower evaluation from those in high support than from those in the other levels whose evaluations were the same. Those in medium and low support had similar levels of satisfaction with the programme.

 

There were positive correlations between subjective quality of life and empowerment, between empowerment and mastery, and between programme satisfaction and empowerment, which was the strongest correlation. All of the above were moderate to high positive correlations at p= 0.01 significance. There was a low positive correlation between programme satisfaction and subjective quality of life.


Table 3. 

 

SQOL

EMP

MAST

PROG

SQOL     Pearson Correlation

               Sig. (2 Tailed)

               N         

1

.               24

.668**

.000

24

.307

.145

24

.440*

.032

24

EMP       Pearson Correlation

               Sig. (2 Tailed)

               N         

.668**

.000

24    

1

.

24

.594**

.002

24

.681**

.000

24

MAST     Pearson Correlation

               Sig. (2 Tailed)

               N         

.307

.145

24

.594**

.002

24

1

.

24

.310

.141

24

PROG     Pearson Correlation

               Sig. (2 Tailed)

               N         

.440*

.032

24

.681**

.000

24

.310

.141

24

1

.

24

            **. Correlation is significant at the 0.01 level (2-tailed)
                  *. Correlation is significant at the 0.05 level (2-tailed)

Discussion
In general, it would appear that the RRP is achieving much of what it sets out to do, and that it is evaluated quite highly by those who have participated in this study.

Although the response rate of 48% was fairly typical of such studies, it leaves a large portion of those residing in the programme that did not respond. This may be due to the fact that many residents would simply find it difficult to concentrate on such a task as filling out a questionnaire. Many of those who did respond informally indicated to staff their satisfaction at the opportunity to express themselves, however one or two wanted to satisfy themselves as to the anonymity of the project before participating.

The majority (92%) of respondents are single. Many would have come straight to the Cluain Mhuire RRP from their family homes. As the average age of first hospitalisation fell between 20 to 25 for all respondents, it may be assumed that their illness has disrupted the formation of long term relationships for many.

 A large number of respondents (33%) are attending a sheltered workshop provided by the service of the with 12.5% employed outside of the St. John of God Services. This may indicate a reliance on the agency to provide long-term daily activities. This result may pose a question as to why such a number are not accessing jobs in the community? It may be that they are just not well enough or they are not accessing a job coach/placement supervisor. Perhaps we need to be accessing more employers who are capable of providing a supportive and independent work environment for programme participants. An approach such as this  - where there is an opportunity for people to try out work related skills in a safe and independent environment – would have greater overall economic and societal benefits. With 66% of participants having been previously employed it is obvious that their illnesses have been disruptive and seem to be the main reason for inability to re enter the work force. Is there anything more we as a service could be doing? It is of course an inappropriate and sometimes unrealistic goal for some to contemplate unsupported employment and economic independence. Of those who responded that they were employed outside of the St. John of God Services (12.5%), it is unclear if they accessed these jobs alone or with the help of the service.

 It would appear that the overall policy of the RRP, that of imparting independence skills to residents in order to achieve optimum self-reliance and appropriate movement through the programme, is effective. This is evident in the responses elicited from the first qualitative question: what are your reasons for referral to the RRP? Those in high support tended to be more concrete in their answers, such as citing their illnesses alone as the reason for their admittance. Generally, it appears that those in medium and low support were more likely to be future orientated and focussed on eventual independent living and to cite this as their reason for referral. The emphasis for these people was not their illness but their coping skills.

 The overall high scores related to programme satisfaction suggests that most respondents believe that their expectations of the programme are being met and are thus satisfied with the services they receive. However the significantly lower programme satisfaction from those in high support is interesting. This may be a reflection of what individuals expect of themselves when they are first admitted to the RRP, as high support would usually be their introduction to the programme. Individuals at Oropesa may have a notion of having skills deficits and their self-confidence and self-esteem may be negatively affected by this self-perception. As part of their individual programme plans they would be given goals and objectives. If they do not achieve these goals, this could reflect on their evaluation of the programme as a whole. Their responses overall were more concrete with regard to their reasons for being on the programme, and most viewed their satisfaction with the programme in terms of material and economic concerns. Those in medium and low support described their satisfaction and expectations of the programme in terms of their relations with, and support from, staff and the skills they are acquiring. Generally, there is an obvious trend of people gaining more of an understanding of the role of the RRP for them as they move through. This finding is consistent with our hypothesis that the Residential Rehabilitation Programme benefits the participant in terms of quality of care, employment, empowerment and independence. The benefits of the programme are related to progressive movement through the Residential Rehabilitation Programme.

 It is interesting to note that participants in Oropesa (high support) scored lowest on programme satisfaction, and on empowerment, yet rated much the same as residents of Avila (medium support) and the low support homes on subjective quality of life. So, being less satisfied with the programme and feeling less empowered than those in other components does not seem to have affected the evaluation of subjective quality of life for those in high support despite the overall positive correlations as outlined above. In addition to scoring lower on these variables, those in high support as already mentioned above, were more inclined to view their placement in concrete terms, seeing the programme as a place of refuge with material and economic benefits. However as people progress through the programme they are less likely to view their placement in those terms and evaluate the programme more highly in addition to feeling more empowered.

Overall, the lowest score for all respondents was for mastery - the individuals’ beliefs around ability to control and influence one’s own life. This implies that although people are satisfied with the programme and understand the objectives of the programme, they feel less confident about going out and interacting with the wider world. This would suggest that a focused approach on building confidence and self-esteem may be worthwhile. An increased focus on helping participants to acquire skills, other than domestic management skills, such as interview skills and knowledge of basic rights and resources in relation to statutory bodies may also have an important effect on scores of mastery.  Perhaps workshops on self esteem or anxiety management aimed specifically at users of this programme would be beneficial in helping those who make the transition through the programme to maintain their progress. This could ensure that there is an emphasis on the value of progress and psychological change, rather than solely on movement and the acquisition of skills. 

An overall trend that emerges is that there is a greater consistency and higher scores in medium support. Once again it is worth bearing in mind that the level of response (33%) from medium support could skew results. It may appear that there are two distinct levels of functioning in medium support, if level of functioning is a factor in the response rate. Perhaps this greater consistency and higher scores indicate a need for further investigation as to the reasons behind such a marked difference in scores across the groups. The higher scores within the medium support respondents would also be borne out by the significantly lower rate of readmission to hospital of this group – measuring at one third of the rate for low support and one quarter of the rate of high support (see Table 1).  

 

In comparison to the results here, a Canadian review of the MPRO using factor analysis suggested the two concepts of mastery and empowerment were less conceptually distinct than first thought, resulting in a questionnaire based on three factors: programme satisfaction, quality of life and mastery. In addition, empowerment seemed to be related to programme satisfaction. The Canadian study also said that some items developed to measure empowerment appeared to be measuring programme satisfaction. Programme satisfaction and empowerment were the most strongly correlated in our study. So it may be that feelings of empowerment are related to the programme and not necessarily to their lives in general, as supported by the low mastery scores.

In conclusion, the Cluain Mhuire Residential Rehabilitation Programme was rated highly by all participants with those in medium support scoring the highest and most consistently across the variables. Although the response rate was lower for this group, the scores suggest different levels of functioning in the medium support setting. The overall lower scores in mastery for all three levels of support may be a result of too much emphasis on movement rather than confidence building and psychological change. Further investigation may give a clearer picture of whether medium support differs in a significant way that could inevitably benefit those in high and low support. Suggestions for further areas of study include: a detailed initial assessment of self-esteem and anxiety levels for individuals being admitted to the Cluain Mhuire Residential Rehabilitation Programme and specifically designed workshops on self-esteem and coping with anxiety that are specially tailored for RRP participants. Many of the Cluain Mhuire Service Users who attend workshops such as the above are functioning at a higher level in terms of social skills, independence and self-esteem in comparison with the RRP participants. In addition, administering the MPRO at follow up intervals may yield interesting results when compared with programme change and enhancement.


 References


Anthony, W.A., Cohen, M.R. and Vitalo, R. (1978). The Measurement of Rehabilitation Outcome  Schizophrenia Bulletin, V.4, No. 3, pp. 365, pp379.


Fields, S (1990). The Relationship Between Residential Treatment and Supported Housing
in a Community System of Services. Psychosocial Rehabilitation Journal V. 13,  No.4 pp. 104 – 113.


Wherley, M. and Bisgaard, S. (1987). Beyond Model Programmes – Evaluation of a County Wide System of Residential Treatment Programmes Hospital and Community Psychiatry V. 38, No. 8, pp. 852 – 857.

Research Committee of the Internatioal Association of Psychosocial Rehabilitation services (IAPSRS) (1995). Toolkit for Measuring Psychosocial Rehabilitation Outcomes – PN4. Human Services Research Institute. Cambridge, MA.


Appendices

 Appendix 1

Questionnaire: (all information given is voluntary and will be treated with the utmost confidentiality)

 

Name:                                                              _________________________

 

Date of Birth                                                     __________________________

         

Gender                                                             __________________________

 

What is your Marital Status?                             ___________________________

 Ie single or married

 
Ethnic Background (optional )   (eg .White Irish, African- Irish, African, Asian –Irish, Other –please specify;

                                                                                                                                                                                       

What Age were you at your first psychiatric hospitalisation         ?                                                                                             


How many hospital readmissions have you had since first coming to residential services? (RRP)

                             


 

               Residential Status: (please tick)

 
High support                                                     _________

 
Medium support                                               _________

 
Low support                                                     _________

 
Citygate                                                            _________

 
 Independent of RRP in community                   _________

 

Employment status : (please tick)


Independent competitive employment    ___________

 
Job coach                                                         ___________

 
Agency paid transitional employment     ___________

 
CE scheme                                                       ___________

 
Fas                                                                   ___________

 
Sheltered workshop                                          ___________

 
Non-paid work experience                               ___________

 
 No employment                                               ___________

 
Other                                                               ___________

 
If working,

Hours   (part- time or full time)                 ___________                                                 

Salary                                                               ____________

 
Start date                                                         ____________

 
Benefits                                                            ____________

 
Job status ( eg. temporary or permanent)           ____________

Education:

Qualifications achieved                          _____________

 
Type of institution attended                               _____________

 
Length of time attended institution                      _____________

 
Apprenticeship—time served                            _____________

Financial details (please Tick)

 

Currently receiving;

 
Disability allowance                                                _____________

 
Disability Pension                                                    _____________

 
Unemployment benefit                                            _____________

 
Private Income                                                       _____________

 
Not disclosed                                                         _____________

 
Paid Salary                                                 _____________

 
Other                                                                     _____________

 

   

What were the reasons for your referral to the Residential Rehabilitation Programme?

 
What are your expectations of your time in the Residential Rehabilitation Programme?

 

Appendix 2

 Measuring Psychosocial Rehabilitation Outcomes

 In order to get information about how people are feeling in a variety of areas, we are asking that you complete the following survey. All information will remain confidential. If you need help reading the statements, please feel free to ask for help.

Each statement is followed by four options. Please circle/underline the response which most closely represents how you feel. Thank you for your time.
 

S1. If I were given the opportunity I am sure I could work.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S1. S2. Overall, I am satisfied with my life.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S3. Overall, I am satisfied with the program.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S4. I feel I have the right to approve all services I receive.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S5. The services offered at this program are relevant to my needs.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S6. Overall, I have a good relationship with members of my family.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S7. I know who to go to when I am not receiving good service.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S8. I can do just about anything I set my mind to.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



 

 

S9. I can change many of the important things in my life.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree

 

 





S10. The staff here are interested in my moving on to better things.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S11. I am happy with my current living situation.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S12. I have a lot of choice about how I spend my free time.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S13. I have an active social life.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S14. I would recommend this program to other people needing services.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S15. My opinions and ideas count in the development of my rehabilitation plan.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S16. What happens to me in the future mostly depends on me.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree



S17. I believe that together with others I can influence the mental health social service system.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree

 

 

 

S18. I am inclined to think I am a success.

1

Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree

 

 

S19. I am in good physical health.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree

 

 

S20. I want to remain in this program for the time being.

1
Strongly Disagree

2
Disagree

3
Agree

4
Strongly Agree

 

What are the most satisfactory aspects of your time in the Residential Rehabilitation Programme?
 
 
 
 What are the least satisfactory Aspects of your time in the Residential Rehabilitation Programme?

 
 
 


Copyright © 2004 Hampstead Psychological Associates, Ltd - A Subsidiary of Southern Development Group, SA.
All Rights Reserved.   A Private Non-Profit Agency for the good of all, published in the UK & Honduras