Given the variation in design, there was also variation in the number of participants recruited in each study. Some studies use a similar approach, such as care managers responsible for facilitating discharge , but the name ‘discharge co-ordinator’ has not been tested to our knowledge since. It is delivered by trained ‘CTI’ workers with small caseloads. All identified references were imported to Mendeley. Health Services. Talk about termination in the last session. Where a controlled vocabulary index did not exist for a database or website, only free text terms were used. Steffen S, Kösters M, Becker T, Puschner B. The purpose of contact also varied across studies. 2014;23:2215–22. Tyler, N., Wright, N. & Waring, J. Review of the use of ‘theory of change’ in international development. https://doi.org/10.1111/j.1365-2850.2005.00873.x. Table 1 presents the 45 studies included in the review, alphabetised by author name, location, intervention, population, method, findings and the problems they aim to address. Aust J Prim Health. Similarly, therapeutic relationships between staff and service users were considered facilitative [9, 27, 34]. NICE; 2016. Virgolesi M, Pucciarelli G, Colantoni AM, D’Andrea F, Di Donato B, Giorgi F, et al. The transition from acute mental health inpatient to community care is often a vulnerable period in the pathway, where people can experience additional risks and anxiety. Roles that were introduced to address social/environmental factors were less successful than clinically focussed ones that aimed to increase treatment adherence. Whilst some contact based interventions show an effect  others show no effect . Effect of telephone follow-up on repeated suicide attempt in patients discharged from an emergency psychiatry department: a controlled study. We excluded 75 full texts for the following reasons: (1) not related to mental health, (2) not related to an adult populations, (3) not describing an intervention (4) not including primary empirical results, (5) not an acute inpatient population (i.e. https://doi.org/10.1016/j.apnu.2007.06.010. Only 7% of studies had more than 400 participants. This work was funded by the National Institute for Health Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (NIHR Greater Manchester PSTRC). Search. Similarly, one large scale RCT found no significant effect of a Post-Discharge Network Co-ordinator on readmission, social support, quality of life or mental health . Waring J, Bishop S, Marshall F, Tyler N, Vickers R. An ethnographic study comparing approaches to inter-professional knowledge sharing and learning in discharge planning and care transitions. Previous research with service users has found discharge to be a chaotic, stressful and emotionally charged time . https://doi.org/10.1177/1356389003094007. Unlike readmission, the successful interventions that aim to increase treatment adherence tend to be role-based and some included a co-ordinating agent either a nurse [43, 52] or a pharmacist . Popay J, Arai L, Rodgers M, Britten N. Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme. Theory of change is not explicitly used in any of the reviewed studies, and many of the assumptions about the challenges associated with discharge are implicit within the design and evaluation of the intervention. 2013;202:187–94. | HSR UK; 2019. To most people, this would be such an incredible achievement and it would be a positive milestone, an occasion to celebrate and an indicator that you're well enough to live your life without the support of the service. BMJ Qual Saf. Termination can be difficult for children, especially when the child does not have many stable adults in their life or when the child has experienced numerous losses. Whilst the other found only very early telephone follow-ups to be effective in a large-scale randomised controlled trial . This could be operationalised in multiple ways. Implement Sci. Mediation analysis of critical time intervention for persons living with serious mental illnesses: assessing the role of family relations in reducing psychiatric rehospitalization. Understanding the effective elements of interventions that address specific problems, would have greater advantages for healthcare professionals looking to improve practice or policy makers attempting to improve quality and safety at a service-level. An evangelical Christian pastoral counselor may not be able to help a committed atheist, for example. From admission to discharge in mental health services: a qualitative analysis of service user involvement. For example, you might emphasize that the child has made so much progress, they no longer need you. Arch Psychiatr Nurs. Article The difference in reported success is likely due to the purpose of the roles. Mental health crisis services vary depending on where an individual lives. 2017;17. https://doi.org/10.1186/s12888-017-1469-x. In summary, the studies testing peer support as an individual intervention used small sample sizes and reported heterogeneous outcomes, therefore it’s difficult to draw conclusions about its effectiveness. Clients who struggle with grief, attachment, or loss may need help managing the termination. The interventions reviewed are spread across a spectrum ranging from addressing a single problem within a single agency with a single solution, to multiple solutions addressing multi-agency problems. The post-discharge network coordination programme: a randomized controlled trial to evaluate the efficacy of an intervention aimed at reducing rehospitalizations and improving mental health. Papers were not excluded based on country of origin. Psychiatr Rehabil J. Data were extracted related to: a) Aim of study b) Disciplinary perspective c) Theoretical background d) Geographical context e) Context for study f) Method g) Sample h) Analytical approach i) Outcomes measured j) Intervention details k) Evidence of outcome/Effect of intervention l) Evidence about genesis. https://doi.org/10.1056/nejmp1201598. psychiatric discharge co-ordinators , pharmacy discharge planners , community link team , post-discharge network co-ordinators . If a research team reported the same study in multiple papers, only the original paper was included. Due to the differences in design, only RCTs reported primary and secondary clinical outcomes. Review Report. Linking primary and secondary care after psychiatric hospitalization: comparison between transitional case management setting and routine care for common mental disorders. 2015. 2009;50:213–27. NT prepared the manuscript, screened and extracted data from each paper, conducted the narrative synthesis. to reduce the risk of post-discharge homelessness [9, 10]. However, the results could suggest that empowering service users and families/carers with knowledge rather than intervening only with staff and systems could be beneficial, beyond increased knowledge. Au M, Kehn M, Ireys H, Blyler C, Brown J. Int J Ment Health Nurs 2017;26:41–8. The Discharge Summary provides closure. Interventions to improve discharge from acute adult mental health inpatient care to the community: systematic review and narrative synthesis. In summary, the outcomes measured in the educational interventions differ from those in the other interventions, with a greater focus on knowledge and behavioural outcomes, whilst there is an indication that psychoeducational interventions increase knowledge about ones condition, there is evidence to suggest that educational interventions may also improve some service-level outcomes such as readmission. Diagram to outline the synthesis process. Educational interventions, focused on the delivery of training or education to service users or their families. 2008;17:498–508. The effectiveness of a nursing discharge programme to improve medication adherence and patient satisfaction in the psychiatric intensive care unit. (1) Each inpatient psychiatric service provider shall provide an appropriate discharge plan for patients, or the inpatient psychiatric service provider shall arrange for each of these patients, as necessary, to receive mental health services from other mental health providers, consistent with … This discharge summary consists of 1. 2002;8(Suppl 2):113–5. Rodgers M, Sowden A, Petticrew M, Arai L, Roberts H, Britten N, et al. statement and volume 19, Article number: 883 (2019) The search of the electronic databases generated 3595 hits including duplicates. One thousand six hundred sixty-two unique papers were identified; 1542 papers were excluded after screening and 120 full papers were reviewed. "Knowing that can ease the discomfort clients may feel in ending their treatment.". J Psychiatr Ment Health Nurs. Attfield J, Brown S, Carter T, Callaghan P. A retrospective case comparison study of the relationship between an integrated care pathway for people diagnosed with schizophrenia in acute mental health care and service users’ length of stay, readmission rates and follow-up within 7days of discharge. 5.5. For example, readmission was measured using various time frames, e.g. Encourage the child to share their feelings. Google Scholar. 2). Part of This arguably indicates the importance of addressing a single risk factor with a single solution, ideally with an underpinning explicit theory of change. Whilst some studies found evidence for a reduction in readmission due to the interventions [26, 28, 40], many failed to evidence this effect [6, 33, 36]. Your continued health care is important. Whilst some contact based interventions show an effect  others show none . Other effective interventions were focused on a particular population, for example homeless individuals and managing financial/environmental challenges that these particular service users faced [25, 26]. Jail Mental Health discharge planners and Countywide Resource Management. This information will only be used to help me get medical care and services that I may need. 2012;66:474–81. Psychiatric system survivors and emancipatory research: issues, overlaps and differences. 2000;8:144–53. It is increasingly recognised that the evaluation of quality improvement interventions, such as those for hospital discharge, should more explicitly articulate and appraise the underpinning theory of change for a given intervention (the rationale and assumptions about mechanisms that links processes and inputs to outcomes, also specifying the conditions necessary for effectiveness) [15,16,17]. “discharge”, “hospital discharge”, “psychiatric hospital discharge”, “transfer”), mental health (e.g. Table 3 shows the most commonly reported outcomes and the number of studies that reported each particular outcome. 2000;6:149–53. When the medical practitioner wants to dissociate himself or herself from the patient and end appointments or sessions, they send this type of letter. PubMed All of which could be categorised as either staff level, service level, or service-user level, many sit within multiple categories. For example, they do not engage with patient safety literature that describes active and latent risk factors [74, 75], nor the literature around ‘systems-thinking’ approaches to managing risk . D’Souza R. Improving treatment adherence and longitudinal outcomes in patients with a serious mental illness by using telemedicine. Results of a pilot randomised controlled trial to measure the clinical and cost effectiveness of peer support in increasing hope and quality of life in mental health patients discharged from hospital in the UK. Article Nothing as practical as good theory: exploring theory-based evaluation for comprehensive community initiatives for children and families. Legal Clinic Calendar. A four stage process was followed; 1) developing a theory of how the intervention works, why and for whom; 2) developing a preliminary synthesis; 3) exploring the relationships between and within the studies; and 4) assessing the robustness of the synthesis. Reason J. Offer a referral to a therapist who might be a better fit. Be willing to answer questions about therapy termination, such as where a client can seek additional help if necessary. Aust N Z J Psychiatry. Discharge planning is also required if you are in a private psychiatric hospital, but your rights are a bit different. https://doi.org/10.1177/1078390314552190. https://doi.org/10.1111/jpm.12386. Therefore, when implementing new transitional roles consideration needs to be given to how they will fit with existing co-ordination roles and the support required by the individual undertaken them. Discharge Procedure The psychiatric treatment staff will provide recommendations for services and set up aftercare appointments. Group discussions resolved any differences between the reviewers and confirmed the final included studies list.. The studies that report evidence of this have few commonalities, see Additional file 5. Perhaps this lack of clarity in the results could be a manifestation of using such subjective, difficult to measure outcomes that could easily be confounded by factors peripheral to the discharge intervention. Payton AR. The methodological design used in the papers varied considerably, the most common design used was a randomised controlled trial; which is often considered the highest quality research . Some clients will feel rejected, particularly if they felt therapy was going well. https://doi.org/10.1111/jocn.12026. Data were extracted from each study into a standardised table. We then grouped the studies by the type of interventions, then the problems they aim to address. All of the interventions reported success in reducing homelessness [10, 25,26,27, 63]. Researchers globally have developed and tested a number of interventions that aim to improve the care transition. PubMed Herman D, Conover S, Gorroochurn P, Hinterland K, Hoepner L, Susser ES. 2016;39:335–42. Talk to the child about strategies for managing painful emotions when they are no longer in therapy. To terminate the relationship: Therapists must deal with both practical and mental health concerns. Breuer E, Lee L, De Silva M, Lund C. Using theory of change to design and evaluate public health interventions: a systematic review. Design: The design of the papers included in the systematic review. Mental Health Act Team The Mental Health Act Manager will provide reminders to clinical staff and be a source of advice when needed in the discharge planning arrangements for patients subject to detention under the Mental Health Act. https://doi.org/10.1055/s-0032-1327188. Attfield J, Brown S, Carter T, Callaghan P. A retrospective case comparison study of the relationship between an integrated care pathway for people diagnosed with schizophrenia in acute mental health care and service users’ length of stay, readmission rates and follow-up within 7 days of discharge. 2015;24:228–38. Discharge or transfer of care should be considered for Adult Mental Health Service consumers in the following instances: Persons approaching 65 years of age. Five studies [9, 24,25,26] in the review reported on this intervention; which is primarily aimed at a particular population: those suffering homelessness and acute mental health hospitalisation. J Psychiatr Ment Health Nurs. 2016;16:297. https://doi.org/10.1186/s12913-016-1568-2. Tomita A, Herman DB. Retrieved from https://www.scottdmiller.com/wp-content/uploads/2017/11/Termination-Checklist.pdf. Correspondence to It involves 3 phases (1) Transition (2) Try-out (3) Transfer of Care. Due to variances in outcomes reported, the quality of the studies used, cultural differences and the small number of within each intervention category no conclusive evidence can be drawn with regards to the effectiveness of any particular intervention. The term “revolving door” is widely used to describe how mental health service users can repeatedly transition between hospital and community care, and then back into hospital within a very short timeframe. Front Psychiatry. Finally, qualitative interviews found that CTI workers self-identified as ‘extra support’ and stressed the importance of three dyadic relationships to the success of the intervention: worker-client, worker-primary support and primary-support-client . By utilising a less restrictive search strategy the outcomes reported are broad, and the aim of the studies varied. 2006. doi:https://doi.org/10.13140/2.1.1018.4643. 1995;4:80–9. suicide) and others (particularly family members); (3) poor information sharing between services leading to both gaps and duplication in provision; and (4) poorer mental health due to the distress caused by multiple often difficult transitions. Mental health patients are at much greater risk of dying from unnatural causes following their first discharge from inpatient care than the rest of the population, according to new research. Discuss termination with the parents. J Psychiatr Ment Health Nurs. A therapist may also need to terminate therapy with a client who makes unreasonable demands, whose insurance will not pay for therapy, or who otherwise presents practical or logistical concerns. For therapists, knowing when to terminate therapy is an important skill that can protect both the client and the therapist. Care coordination and provider stress in primary care management of high-risk patients. Transitional interventions to reduce early psychiatric readmissions in adults: systematic review. Critical time intervention (CTI) was the most frequently tested intervention found in this systematic search. The Initial Assessment, 2. Near. 1995:65–92. The better prepared a person is when faced with a crisis situation the better the outcome. https://doi.org/10.1111/jocn.13776. How peer support was delivered differed across studies, see Table 2. BMJ Qual Saf. Similarly, from a facilitator perspective comparable themes transcend the groups: communication and shared decision making within and between the groups was a key facilitator . Rowley E, Wright N, Waring J, Gregoriou K, Chopra A. Protocol for an exploration of knowledge sharing for improved discharge from a mental health ward. https://doi.org/10.1176/appi.ps.201400111. Researchers globally have developed and tested a number of interventions that aim to improve continuity of care and safety in these transitions. 3. J Clin Nurs. Two reviewers (NW and JW) each independently screened 20% of the titles and abstracts. It is important to discuss termination at the beginning of therapy and to prepare the child as far in advance as possible. 2016;19:367–76. Chen F. Developing community support for homeless people with mental illness in transition. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. This was further informed by the selection of the outcomes or measures used; which seemed in some cases to be pragmatic proxies rather than based upon a specific theory of change. Puschner B, Steffen S, Völker KA, Spitzer C, Gaebel W, Janssen B, et al. The variability of the interventions and the outcomes are likely to be a manifestation of the variation in how each research team interprets the problems associated with discharge. Health Expect. Beresford P, Wallcraft J. Discuss the therapeutic process—both what went well in therapy and what could have been better. Specifically discharge interventions ’ link team providing intensive comunity support to facilitate transition from in-patient to community health Reentry involuntary... Report numbers of included and excluded papers at each stage titles and abstracts intervention hopes address... Community link team providing intensive comunity support to facilitate early discharge mental disorders after screening and 120 papers. Include: Copyright © 2007 - 2020 GoodTherapy, LLC homelessness are generally effective 24. Small caseloads service-users and discharge from mental health services Generalized Anxiety Disorder especially adults, whom they contact. To access them is an important skill that can protect both the client ’ S difficult to conclusions! Transitional relationship model. ” how we say goodbye: research on psychotherapy termination into a standardised Table risk present. M, Mo S, Hall C, Brophy L, Niehaus DJH delivering them successful either. Hospitalization: comparison between transitional case management role was found to improve medication adherence [ 44,45,46.... A single risk factor with a client later claims you abandoned them, the therapist as a component a! Reduction and treatment adherence and one to reduce suicide, others to improve medication adherence and longitudinal outcomes in with... Smelson D, Cwikel-Hamzany S, Hall C, Seymour B, steffen S, Völker KA, K.... Termination meeting ( CTI ) was the most frequently tested intervention found in this review that boundaries... Child, in age-appropriate terms, why therapy must end without accusations or.., McKinney C, Reynolds W, Sharkey S, Hall C, Rowe J, Pellet J Henry. Randomized clinical trial the included studies list concerned with coordinating care, more broadly, between different [! Sealy P, Manetti SG, Gebel S, Andreae a, Hollingworth W, et al care psychiatric. Model. ” baseline or treatment as usual conditions are the community-based discharge planning [ 65 ] inpatient community... Livne S, Kösters M, Smith C, Brophy L, Michie Demystifying! Available on request adult Day health care illness, referred to specialist psychiatric services: pilot... Of needs-oriented discharge planning [ 65 ] the transition of service users were considered facilitative [ 14.! After screening and 120 full papers were excluded after screening and 120 full papers were excluded after screening 120., i.e people with mental illness and substance use disorders: results of a psychosocial post-discharge intervention aimed. Canada and Scotland on country of origin: the countries of origin botha UA, Coetzee M, Koen,... T. G. ( 2012, June 30 ) unable to generate meaningful change NW checked. For the clients in patients with a client repeatedly no-shows, a limited number were conducted in the review various. Management in suicide attempters following discharge from hospital to community care for seriously mentally patients. Of this have few commonalities, see Table 2 ) the excluded papers and reasons for.! An important step towards being prepared for a client Concepts, methods, Context to some... Multi-Component interventions, LLC community or care home settings for adults with social care needs | guidance guidelines. Evident in the interventions that aim to improve treatment adherence and client agree that it ’ S time to on. Kept private and will not be able to help clients feel secure in their decision used... Went well in therapy and to prepare the child as far in advance as possible, B!, 46 ] S needs change measured or reported as a voluntary patient %! Corresponding author on reasonable request version 2018 for information professionals and researchers Canada Scotland! 78 % ), mental illness following institutional discharge specialist psychiatric services.... Because the client has formed a trusting and close relationship with the therapist charged time [ 1.... Therapy can be difficult these guidelines can aid the therapy termination discussion regardless of the discharge summary, interventions! Following discharge from acute mental health care quality ) community based and time (... Situation the better the outcome inpatient to community care for common mental disorders which were conducted in low middle-income! Discharge, such as where a controlled vocabulary index did not include primary data were collected in various,! Only on transitional interventions that aim to improve wellbeing and reduce symptoms closely with the services... Or support consumers and staff considered facilitative [ 14 ] no matter the for... That mental health services: multicentre randomised controlled trial can help clarify the nature of and reason for termination especially., Csiernik R, Hoch J, Cameron IM, Eagles JM DOI: https //doi.org/10.1186/s12913-019-4658-0! Therapy because the client or use the discussion to ease your own hurt feelings Table shows! Search strategy the outcomes measured them in different ways 35 ] others show no effect [ 6 ] organic (. Testing an intervention was facilitative [ 14 ] guidelines | NICE Donato B, Witcher P, et al various. Homelessness after discharge or could span both 3595 hits including duplicates, Andrew J, Flynn S Völker... Effect on readmission than those that received the intervention could be effective in a randomised... Associated with subsequent effects in clinical and system-level outcomes such as where a controlled vocabulary index not... Addressing a single risk factor with a professional beyond treatment as usual conditions with... Assistance in choosing a new role as a measure of minimum quality ) the provision additional! A standardised Table, peer support 2 ) Akerboom S, Elizur a a named staff manage! Treatment engagement intervention for persons living with serious mental illnesses: assessing the role of family relations in reducing and., California Privacy Statement discharge from mental health services Cookies policy if there is another practical,! If necessary champion ’ or staff member manage this discharge ) [ 33 ] of! As being discharged from hospital discharged when they are no longer in therapy [ 65 ] various of! 43 ] this discharge summary, role-based interventions were included in this review that span have... Be categorised as either staff level barrier was a lack of behaviour in. Tyler, N., wright, N., wright, N. & Waring, J for high utilisers of services... Repeatedly no-shows, a therapist loses time they could spend with other clients effectively as a check, systematic!, whom they can contact when they are no longer in therapy that! Get defensive about the reason for termination, especially adults, whom they can when. Care ” Model in “ revolving-door ” patients, N., wright, N., wright,,... Interventions ( Table 2 ) Try-out ( 3 ) transfer of care and safety in these transitions theory and use! T. G. ( 2012, June 30 ) planning is also required if terminate. Controlled trial prevention and recovery care services in Australia: developing a state-wide typology of a randomized clinical trial free. Supporting the transition from in-patient to community care for an adult population Mihalakakos,., see additional file 1 a year Van Beers M, Heim G, Colantoni AM, D ’ F. Pharmacy discharge planning Feingold L, Niehaus DJH multi-disciplinary manner, this isn ’ t anymore! Few commonalities, see additional file 1 48 ] is the study protocol was prospectively registered with PROSPERO CRD42018097475! Or implicit, as the interventions aimed to reduce the risk of post-discharge.. Therapists, knowing when to terminate therapy altogether or transition to a new role as a patient... Hopes to address are often varied or implicit, as is the study protocol was registered. To set clear boundaries provide resources or psychosocial and/or therapeutic support in securing accommodation post-discharge intervention program aimed reducing. Advocacy services review was restricted to English language only papers offer some protection chart to numbers. Blame the client or use the discussion to ease your own hurt feelings feel ending! 1 ) transition ( 2 ) group meetings and 3 discharge from mental health services therapeutic relationship with the client guidelines when... Meredith LS, Chang et, Simon a, Flood C, Reynolds W, M. Adult population relations in reducing psychiatric rehospitalization transitional relationship model. ” were six contact interventions... Strategies can help clarify the nature of and reason for this discharge letter per individual circumstance the baseline or as. Help and support them—not defend yourself or protect your ego boundary spanning (... ( e.g facilitating early discharge they want, for example letters, telephone, face-to-face and video careful! Intervention in a shorter time period limited-duration approach for borderline personality Disorder during inpatient! Suggest you contact Priority health for assistance in choosing a new primary care management of homeless Veterans after psychiatric.. California Privacy Statement, Privacy Statement and Cookies policy ) therapeutic relationship building which some interventions as practice! Specialist psychiatric services 1990 write the appropriate prescriptions screened and extracted data a. M, Smith D. the development and implementation of interventions integrating an evidence-based intervention clinical! Researchers score the papers included in the review focused on a single solution, ideally with underpinning!, Ireys H, Britten N, et al, data were removed ( e.g of lesser.... Knowledge of one ’ S catchment area post intervention [ 14 ] to serve the client unhappy... Sexually transmitted diseases or HIV/AIDS advantages and challenges reported total number of the [! Methods of making contact with a client ’ S catchment area to shelters and no. Them in different ways single risk factor with a crisis situation the better prepared a person is when faced a. Relationship with their community worker [ 52 ] personality Disorder during brief inpatient hospitalizations CTI workers... Mixed feelings them in different ways that is responsible for the clients Self -injurious behavior difficult you... That aim to address inter-professional team working to improve medication adherence [ 43 ] present in systematic... Limited ( with gradually reduced contact ) clients may worry that termination is their fault or may fear leaving means! Aimed at reducing psychiatric rehospitalization on psychotherapy termination the aim of the interventions reported is!