Effectiveness of the Comprehensive Approach to Rehabilitation (CARe) methodology: design of a cluster randomized controlled trial

BMC Psychiatry

Jaap van Weeghel³  Chijs van Nieuwenhuizen²  Diana P. K. Roeg²  Neis A. Bitter¹ 

[1] Tilburg University, Department of Social and Behavioural Sciences, Tranzo Scientific Centre for Care and Welfare, Tilburg, 5000 LE, The Netherlands;GGzE Centre for Mental Health Care, PO BOX 909, Eindhoven, 5600 AX, The Netherlands;Parnassia Group, Dijk en Duin Mental Health Centre, Castricum, 1900 AH, The Netherlands

关键词: CARe methodology;    Strengths;    Rehabilitation;    Recovery-oriented care;    Recovery;    Severe mental illness;   

Others  :  1221350
DOI  :  10.1186/s12888-015-0564-0

 received in 2014-07-28, accepted in 2015-07-14,  发布年份 2015

【 摘 要 】

Background

There is an increasing amount of evidence for the effectiveness of rehabilitation interventions for people with severe mental illness (SMI). In the Netherlands, a rehabilitation methodology that is well known and often applied is the Comprehensive Approach to Rehabilitation (CARe) methodology. The overall goal of the CARe methodology is to improve the client’s quality of life by supporting the client in realizing his/her goals and wishes, handling his/her vulnerability and improving the quality of his/her social environment. The methodology is strongly influenced by the concept of ‘personal recovery’ and the ‘strengths case management model’. No controlled effect studies have been conducted hitherto regarding the CARe methodology.

Methods/design

This study is a two-armed cluster randomized controlled trial (RCT) that will be executed in teams from three organizations for sheltered and supported housing, which provide services to people with long-term severe mental illness. Teams in the intervention group will receive the multiple-day CARe methodology training from a specialized institute and start working according the CARe Methodology guideline. Teams in the control group will continue working in their usual way. Standardized questionnaires will be completed at baseline (T0), and 10 (T1) and 20 months (T2) post baseline. Primary outcomes are recovery, social functioning and quality of life. The model fidelity of the CARe methodology will be assessed at T1 and T2.

Discussion

This study is the first controlled effect study on the CARe methodology and one of the few RCTs on a broad rehabilitation method or strength-based approach. This study is relevant because mental health care organizations have become increasingly interested in recovery and rehabilitation-oriented care.

Trial registration

The trial registration number is ISRCTN77355880.

【 授权许可】

   
2015 Bitter et al.

【 图 表 】

Fig. 1.

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【 参考文献 】

• [1]De Heer-Wunderink C, Visser E, Sytema S, Wiersma D: Social inclusion of people with severe mental illness living in community housing programs. Psychiatr Serv 2012, 63:1102-7.
• [2]Marwaha S, Johnson S: Schizophrenia and employment. Soc Psych Psych Epid 2004, 39:337-49.
• [3]Borge L, Martinsen EW, Ruud T, Watne Ø, Friis S: Quality of life, loneliness, and social contact among long-term psychiatric patients. Psychiatr Serv 1999, 50:81-4.
• [4]Weiner A, Roe D, Mashiach-Eizenberg M, Baloush-Kleinman V, Maoz H, Yanos PT: Housing model for persons with serious mental illness moderates the relation between loneliness and quality of life. Community Ment Hlt J 2010, 46:389-97.
• [5]Perese EF, Wolf M: Combating loneliness among persons with severe mental illness: social network interventions’characteristics, effectiveness, and applicability. Issues in Mental Health Nursing 2005, 26:591-609.
• [6]Slade M, Leese M, Cahill S, Thornicroft G, Kuipers E: Patient-rated mental health needs and quality of life improvement. Brit J Psychiat 2005, 187:256-61.
• [7]Hansson L: Determinants of quality of life in people with severe mental illness. Acta Psychiat Scand 2006, 113:46-50.
• [8]Sibitz I, Amering M, Unger A, Seyringer M, Bachmann A, Schrank B, Benesch T, Schulze B, Woppmann A: The impact of the social network, stigma and empowerment on the quality of life in patients with schizophrenia. Eur Psychiat 2011, 26:28-33.
• [9]Van Weeghel J, Van Audenhove C, Colucci M, Garanis-Papadatos T, Liégeois A, McCulloch A, Muijen M, Norcio B, Ploumbidis D, Bauduin D: The components of good community care for people with severe mental illnesses: views of stakeholders in five European countries. Psychiatr Rehabil J 2005, 28:274-81.
• [10]Le Boutillier C, Leamy M, Bird VJ, Davidson L, Williams J, Slade M: What does recovery mean in practice? A qualitative analysis of international recovery-oriented practice guidance. Psychiatr Serv 2011, 62:1470-6.
• [11]Pratt CW, Gill KJ, Barrett NM, Roberts MM: Psychiatric rehabilitation. Academic, San Diego; 2013.
• [12]Anthony WA, Cohen MR, Farkas MD, Gagne C: Psychiatric rehabilitation: center for psychiatric rehabilitation, sargent college of health and rehabilitation sciences. University Boston, MA, Boston; 2002.
• [13]Drake RE, Bond GR, Essock SM: Implementing evidence-based practices for people with schizophrenia. Schizophrenia Bull 2009, 35:704-13.
• [14]Leamy M, Bird V, Le Boutillier C, Williams J, Slade M: Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. Brit J Psychiat 2011, 199:445-52.
• [15]van Gestel-Timmermans J, Brouwers E, Bongers I, van Assen M, van Nieuwenhuizen C: Profiles of individually defined recovery of people with major psychiatric problems. Int J Soc Psychiatr 2012, 58:521-31.
• [16]Kelly M, Gamble C: Exploring the concept of recovery in schizophrenia. J Psychiatr Ment Health Nurs 2005, 12:245-51.
• [17]Anthony WA: Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Pscychosoc Rehabil J 1993, 16:11.
• [18]Silverstein SM, Bellack AS: A scientific agenda for the concept of recovery as it applies to schizophrenia. Clin Psychol Rev 2008, 28:1108-24.
• [19]van Nieuwenhuizen, Ch., Wilrycx G, Moradi M, Brouwers E: Psychometric evaluation of the Dutch version of the Mental Health Recovery Measure (MHRM). Int J Soc Psychiatr. 2013,0020764012472302.
• [20]Farkas M, Gagne C, Anthony W, Chamberlin J: Implementing recovery oriented evidence based programs: Identifying the critical dimensions. Community Ment Hlt J 2005, 41:141-58.
• [21]Lloyd C, Waghorn G, Williams PL: Conceptualising recovery in mental health rehabilitation. Brit J Occup Ther 2008, 71:321-8.
• [22]Wilrycx G, Croon M, van den Broek A, van Nieuwenhuizen C: Mental health recovery: evaluation of a recovery-oriented training program. Scientific world J 2012, 2012:820846.
• [23]Moran GS: Walking on the sunny side: What positive psychology can contribute to psychiatric rehabilitation concepts and practice. Psychiatr Rehabil J 2013, 36:202-8.
• [24]Drake RE, Green AI, Mueser KT, Goldman HH: The history of community mental health treatment and rehabilitation for persons with severe mental illness. Community Ment Hlt J 2003, 39:427-40.
• [25]Farkas M, Anthony WA: Psychiatric rehabilitation interventions: a review. Int Rev Psychiatr 2010, 22:114-29.
• [26]Rössler W: Psychiatric rehabilitation today: an overview. World Psychiatry 2006, 5:151.
• [27]Slade M, Amering M, Farkas M, Hamilton B, O’Hagan M, Panther G, Perkins R, Shepherd G, Tse S, Whitley R: Uses and abuses of recovery: implementing recovery‐oriented practices in mental health systems. World Psychiatry 2014, 13:12-20.
• [28]Rapp CA, Goscha RJ: The strengths model: a recovery-oriented approach to mental health services. Oxford University Press, Oxford; 2011.
• [29]Burns T, Catty J, Becker T, Drake RE, Fioritti A, Knapp M, Lauber C, Rössler W, Tomov T, Van Busschbach J: The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet 2007, 370:1146-52.
• [30]Bowie CR, McGurk SR, Mausbach B, Patterson TL, Harvey PD: Combined cognitive remediation and functional skills training for schizophrenia: effects on cognition, functional competence, and real-world behavior. Am J Psychiat 2012, 169:710-8.
• [31]Medalia A, Choi J: Cognitive remediation in schizophrenia. Neuropsychol Rev 2009, 19:353-64.
• [32]Hansen JP, Østergaard B, Nordentoft M, Hounsgaard L: Cognitive adaptation training combined with assertive community treatment: A randomised longitudinal trial. Schizophr Res 2012, 135:105-11.
• [33]Velligan DI, Diamond PM, Maples NJ, Mintz J, Li X, Glahn DC, Miller AL: Comparing the efficacy of interventions that use environmental supports to improve outcomes in patients with schizophrenia. Schizophr Res 2008, 102:312-9.
• [34]Bond GR, Salyers MP, Rollins AL, Rapp CA, Zipple AM: How evidence-based practices contribute to community integration. Community Ment Hlt J 2004, 40:569-88.
• [35]Swildens W, van Busschbach JT, Michon H, Kroon H, Koeter M, Wiersma D, van Os J: Effectively working on rehabilitation goals: 24-month outcome of a randomized controlled trial of the Boston psychiatric rehabilitation approach. Can J Psychiat 2011, 56:751-60.
• [36]Michon H, van Busschbach J, van Vugt M, Stant A, Kroon H, Wiersma D, van Weeghel J: Effectiveness of the Individual Placement and Support (IPS) model of vocational rehabilitation for people with severe mental illnesses in the Netherlands. Psychiat Prax 2011, 38:OP26_EC.
• [37]Crowther R, Marshall M, Bond G, Huxley P: Vocational rehabilitation for people with severe mental illness. Cochrane Database Syst Rev 2001, 2:CD003080.
• [38]Bird VJ, Le Boutillier C, Leamy M, Larsen J, Oades L, Williams J, Slade M: Assessing the strengths of mental health consumers: A systematic review. Psychol Assessment 2012, 24:1024.
• [39]Björkman T, Hansson L: What do case managers do? An investigation of case manager interventions and their relationship to client outcome. Soc Psych Psych Epid 2000, 35:43-50.
• [40]Fukui S, Goscha R, Rapp CA, Mabry A, Liddy P, Marty D: Strengths model case management fidelity scores and client outcomes. Psychiatr Serv 2012, 63:708-10.
• [41]Powell Stanard R: The effect of training in a strengths model of case management on client outcomes in a community mental health center. Community Ment Hlt J 1999, 35:169-79.
• [42]Björkman T, Hansson L, Sandlund M: Outcome of case management based on the strengths model compared to standard care. A randomised controlled trial. Soc Psych Psych Epid 2002, 37:147-52.
• [43]Heer-Wunderink C: Successful community living: A’Utopia’?: a survey of people with severe mental illness in Dutch regional institutes for residential care. University Library Groningen, Groningen; 2012.
• [44]Wilken JPL, den Hollander D: Rehabilitation and recovery: a comprehensive approach. Uitgeverij SWP, Amsterdam; 2005.
• [45]Wilken JP, Den Hollander D: Handboek integrale rehabilitatie benadering. Uitgeverij SWP, Amsterdam; 2012.
• [46]Merks A, Gillissen R: Rehabilitatie in complexe zorgsituaties. Goes, Emergis; 2005.
• [47]Wilken JP, Duurkoop P: Een weg naar wens; resultaten van het onderzoek. Zwolle, Zwolse Poort; 2002.
• [48]Campbell MK, Piaggio G, Elbourne DR, Altman DG: Consort 2010 statement: extension to cluster randomised trials. BMJ 2012, 345:e5661.
• [49]Baart A: Theorie van de presentie. Lemma, Utrecht; 2001.
• [50]Den Hollander D, Wilken JP: Zo worden clienten burgers. Praktijkboek systematisch rehabilitatiegericht handelen. Uitgeverij SWP, Amsterdam; 2011.
• [51]Birchwood M, Smith J, Cochrane R, Wetton S, Copestake S: The Social Functioning Scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. Brit J Psychiat 1990, 157:853-9.
• [52]Priebe S, Huxley P, Knight S, Evans S: Application and results of the Manchester Short Assessment of Quality of Life (MANSA). Int J Soc Psychiatr 1999, 45:7-12.
• [53]van Nieuwenhuizen C, Schene A, Koeter M: The Manchester-short assessment of quality of life. Institute of Mental Health Care Eindhoven, Eindhoven; 2000.
• [54]Boevink W, Kroon H, Giesen F: Empowerment–Constructie en validatie van een vragenlijst. Trimbos Instituut, Utrecht; 2010.
• [55]van Gestel-Timmermans H, Brouwers EP, van Assen MA, van Nieuwenhuizen C: Effects of a peer-run course on recovery from serious mental illness: a randomized controlled trial. Psychiatr Serv 2012, 63:54-60.
• [56]Gestel‐Timmermans V, Van Den Bogaard J, Brouwers E, Herth K, Van Nieuwenhuizen C: Hope as a determinant of mental health recovery: a psychometric evaluation of the Herth Hope Index‐Dutch version. Scand J Caring Sci 2010, 24:67-74.
• [57]Herth K: Abbreviated instrument to measure hope: development and psychometric evaluation. J Adv Nurs 1992, 17:1251-9.
• [58]Castelein S, van der Gaag M, Bruggeman R, van Busschbach J, Wiersma D: Measuring empowerment among people with psychotic disorders: a comparison of three instruments. Psychiatr Serv 2008, 59:1338-42.
• [59]Carpenillo SE, Knight EL, Markowitz FE: The development of the mental health confidence scale: a measure of self-efficacy in individuals diagnosed with mental disorders. Psychiatr Rehabil J 2000, 3:236-43.
• [60]Phelan M, Slade M, Thornicroft G, Dunn G, Holloway F, Wykes T, Strathdee G, Loftus L, McCrone P, Hayward P: The camberwell assessment of need: the validity and reliability of an instrument to assess the needs of people with severe mental illness. Brit J Psychiat 1995, 167:589-95.
• [61]De Beurs E, Zitman F: The Brief Symptom Inventory (BSI): reliability and validity of a practical alternative to SCL-90. MGV 2006, 61:120-41.
• [62]Wilrycx G, Croon MA, van den Broek A, van Nieuwenhuizen C: Psychometric properties of three instruments to measure recovery. Scand J Caring Sci 2012, 26(3):607-14.
• [63]Bedregal LE, O’Connell M, Davidson L: The recovery knowledge inventory: assessment of mental health staff knowledge and attitudes about recovery. Psychiatric Rehabil J 2006, 30:96-103.
• [64]Killaspy H, White S, Wright C, Taylor TL, Turton P, Schützwohl M, Schuster M, Cervilla JA, Brangier P, Raboch J: The development of the Quality Indicator for Rehabilitative Care (QuIRC): a measure of best practice for facilities for people with longer term mental health problems. BMC Psychiatry 2011, 11:35. BioMed Central Full Text
• [65]Montori VM, Guyatt GH: Intention-to-treat principle. Can Med Assoc J 2001, 165:1339-41.
• [66]Hewitt CE, Torgerson DJ, Miles JNV: Is there another way to take account of noncompliance in randomized controlled trials? Can Med Assoc J 2006, 175:347.
• [67]Gill KJ, Barrett NM: Psychiatric rehabilitation: an emerging academic discipline. Israel J Psychiat 2008, 46:94-102.
• [68]Wolff N: Using randomized controlled trials to evaluate socially complex services: problems, challenges and recommendations. J Ment Health Poliy Econ 2000, 3:97-109.