Housing and Support Program (HASP): Final Evaluation Report

More documents

Recommendations

Info

56 Section 6 The ability of the program to maintain clinical functioning and provide an acceptable quality of life for those supported by the program This section of the report explores factors related to clinical functioning and how these are maintained under HASP. Factors such as changes in clinical functioning, medication use, physical health, client goals, participation in meaningful activities, employment, level of independence and the need for inpatient care are discussed. 6.1 Readmissions to acute inpatient care The need for readmission to acute care is one indicator of how well a program can maintain clinical functioning in individuals with high levels of disability. Of the 80 clients in our sample, admission data (number of admissions and length of stay) were available for 70 clients at 12 months prior to entering HASP and 12 months post-entry into HASP. While 61 of the 70 clients for which data were available (87.1%) required time in hospital in the 12 months prior to HASP, 41 of these clients spent the entire 12 months in hospital prior to entry into HASP. However, following entry into HASP, only 26 clients (37.1%) required time in hospital in the 12 months post-HASP. The average time in inpatient care for each individual in the 12 months prior to HASP decreased signifi cantly from an average of 227 days to an average of 18.9 days in the 12 months post-HASP. This reduction in inpatient bed days was statistically signifi cant (paired t = 10.44, p=0.001). Finally, the number of admissions also decreased signifi cantly from an average of 1.22 admissions in the 12 months prior to HASP, to an average of .66 admissions per individual in the 12 months post-HASP (paired t = 3.22, p=0.002). Final Evaluation Report 6.2 Changes in functioning As noted earlier, ‘outcomes’ data were obtained from the Queensland Health Information System ‘CIMHA’ for the 77 clients who provided written consent for their data to be used for the evaluation. (Three clients refused to provide consent for their outcomes data to be used in this way). Having identifi ed the date that each individual entered HASP, it was possible to obtain the outcomes data from CIMHA for clients at 12 months and three months prior to entering HASP and for three months and 12 months after entering HASP. The mean scores for the both the Life Skills Profi le (LSP) and the Health of the Nation Outcome Scales (HoNOS) are summarised in the graph below. The LSP provides a measure of general life skills functioning, while the HoNOS provides an assessment of disability and clinical functioning. There was a considerable amount of missing data for the 77 clients. HoNOS data were available for 33 of the 77 clients across all four time-points, while LSP data were available for 17 of the 77 clients across all four time-points. Fig. 6.1 Changes in functioning Score 20 15 10 5 0 Legend HoNOS (n=33) 12 months pre 3 months pre LSP (n=17) 3 months post 12 months post Overall, the clients, as a group, demonstrated improvement in functioning as indicated by the lower mean scores (lower scores on these scales indicate
etter functioning). However, while these changes/ improvements approached signifi cance, they were not statistically signifi cant. 6.3 Clients who improved, stayed the same, or deteriorated While some of the clients improved, others remained the same or deteriorated. Identifying the proportion of clients in each of these groups is a useful method of assessing outcomes. To identify those in the three categories (improved, remain the same, deteriorated) we added the two-scale scores pre-HASP (i.e. the score for HoNOS at 12 months pre and three months pre) and subtracted the combined score from the two measures post-HASP. This provided a range of ‘change’ scores. We then calculated the standard deviation for the change scores. One standard deviation around the mean was used to differentiate between clients in each of the groups. Thus, clients with a total scale score greater than .5 of a standard deviation above the mean were classifi ed as having highly deteriorated (since a higher score represented more severe problems). Those with scores less than .5 of a standard deviation below the mean were classifi ed as having improved, while those with scores ± .5 of a standard deviation around the mean were classifi ed as having remained the same. The data for each category is summarised in the Table below. Table 6.1 Proportion of clients who improved, stayed the same, or deteriorated Group Proportion of clients who improved, stayed the same or deteriorated Life Skills Profile (LSP Data) Proportion of clients who improved, stayed the same or deteriorated Health of the Nation Outcomes (HoNOS Data) Improved 51.0% 42.9% Stable 19.6% 33.3% Deteriorated 29.4% 23.8% It is clear from the data that just over half of the clients in the study group improved on measures of their life skills performance, while 43% showed improvement on clinical functioning. 6.4 Perceptions of change in client functioning — Case Managers versus support workers Case Managers (n=40) and support workers (n=58) were asked to indicate their level of agreement with the statement ‘the functioning of HASP clients has improved in the past six months’. The responses for both groups are compared in the graph below. Fig. 6.2 Change in client functioning — past six months versus next six months Percent 100 80 60 40 20 0 Legend Strongly agree Agree Case Managers Neither Support workers Disagree Strongly disagree Sixty-two percent (62%) of Case Managers agreed that the functioning of HASP clients had improved over the past six months. This is compared with 69% of support workers who believed that the functioning of HASP clients had improved over the past six months. Housing and Support Program (HASP) 57
Page 1 and 2:
Department of Psychiatry (UQ) and S
Page 3 and 4:
Final Evaluation Report of the Quee
Page 5 and 6:
• Community integration While eig
Page 7 and 8:
List of contents Executive summary
Page 9 and 10:
Section 1 Introduction Since the 19
Page 11 and 12:
1.1.1 HASP — Management Structure
Page 13 and 14: 1.2 Housing and supports - previous
Page 15 and 16: Table 1.2.2 Outcomes for clients mo
Page 17 and 18: activities, while others tried to c
Page 19 and 20: 1.2.6 Section summary It is clear f
Page 21 and 22: Section 2 Method 2.1 Design The stu
Page 23 and 24: 2.2.1.2 Clients unavailable to part
Page 25 and 26: 2.2.1.5 Clinical staff — sample F
Page 27 and 28: 4) Data collected from mental healt
Page 29 and 30: 2.4 Procedure 2.4.1 Clients - proce
Page 31 and 32: All focus group discussions and ind
Page 33 and 34: However, it was clear that the deve
Page 35 and 36: Importance of the Supports Facilita
Page 37 and 38: Accountability There was a percepti
Page 39 and 40: Support workers highlighted issues
Page 41 and 42: 4.1.2 Client perceptions of support
Page 43 and 44: In general, Case Managers expressed
Page 45 and 46: 4.2.2 Client perceptions of the amo
Page 47 and 48: Support workers felt, as a result o
Page 49 and 50: 4.2.8 Amount of support required in
Page 51 and 52: 4.3.2 Living arrangements The major
Page 53 and 54: 4.3.7 Housing in HASP — compariso
Page 55 and 56: The majority of HASP clients (76%)
Page 57 and 58: 5.2 Satisfaction with key life doma
Page 59 and 60: 5.7 Depth of friendships We explore
Page 61 and 62: 5.11 Community involvement Clients
Page 63: 5.13 Section summary During our int
Page 67 and 68: 6.7 Physical and mental health Link
Page 69 and 70: 6.10 Section summary The average ti
Page 71 and 72: 7.2 Comparing HASP with inpatient/r
Page 73 and 74: of applications, increase Case Mana
Page 75 and 76: available when and where needed by
Page 77 and 78: 8.4 The ability of the program to m
Page 79 and 80: Section 9 Recommendations 1. More i
Page 81 and 82: Section 10 Reference list Anthony,
Page 83 and 84: Shepherd, G., Murray, A. & Muijen,
Page 85 and 86: Housing and Support Program (HASP)
show all

Housing and Support Program (HASP): Final Evaluation Report

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?