CPG for Psychosocial Interventions in Severe Mental ... - GuÃaSalud

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Summary of evidence 1- 1- 1- 1- The evidence is insufficient to determine if pre-vocational training confers an additional benefit to the labour expectations of people with SMI when we compare it with standard treatment, with respect to maintenance of competitive employment 168,170,171,173,174 . PVT favours obtaining some type of employment when compared with standard hospital treatment 168 . There are no differences with respect to hours worked per month between PVT and hospital ST, for people with SMI 171 . The incorporation of payment into PVT produces a limited but significant improvement of the results 172 . The incorporation of payment into PVT produces a limited but significant improvement of the results 172 . 1+ There is no difference with respect to participation level of users in programmes when PVT programmes are compared with standard hospital treatment 165 . 1+ Neither PVT nor community ST improve the programme finalisation rates 165 . 1+ PVT does not improve the hospital readmission ratios 165 . 1- 1- 1+ 1+ 1+ 1+ 1+ 1+ 1+ 3 There are no differences between PVT (clubhouse model) vs. ST in relation to achieving competitive employment 170 . There are less hospital readmissions in the group that participated in PVT-clubhouse than in the group that received standard treatment 170 . The participants in the paid sheltered work group presented greater permanence, lower number of hospital readmissions and lower scores in symptoms than those who only received PVT 176 . Those who received PVT + additional psychological intervention presented differences in favour of obtaining “some form of employment” and “some form of employment or education at the end of the study” 178 . There are no differences between PVT + psychological techniques vs. control group with respect to clinical improvement 178 . Patients with prior labour failure integrated in the sheltered employment programme with cognitive training presented greater probability of having worked, having maintained more jobs, worked more weeks, more hours and higher salaries than patients who were only offered sheltered employment 188 . Users with transitional employment and accelerated entry did not achieve better employment data than users with transitional employment and gradual entry, but they did earn more money 179 . The sheltered employment group showed a significantly larger number of people in competitive employment after 24 and 36 months, as well as greater probability than the ST group of being in some type of employment and of earning more money 180 . Sheltered employment did not show significant differences with respect to the control group in participation ratios or in number of readmissions 180 . The greater access and participation in labour rehabilitation services was associated with a greater probability of achieving competitive employment, and to a greater extent, noncompetitive employment 189 . 88 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
1+ 1+ 1++ 1+ 1+ 1+ 1+ The people included in the individual placement and support programme (IPS) obtained greater probability of competitive employment, some type of paid work, higher levels of satisfaction, longer duration of the employment than those people where the job did not coincide with their preferences 187 . There is strong evidence that SE (including SE-IPS) is superior to PVT in Improving the expectations of competitive employment and hours worked per week 165 . The SE-IPS models speed up the possibility of obtaining a first job and double the time worked per year, maintaining the competitive work for longer 186 . People in sheltered employment worked more hours in competitive work than those who receive PVT 183 . People in sheltered employment earn more money that those in pre-vocational training 181,182,184,185 . There are no differences between SE (including SE-IPS ) . vs. . PVT in global functioning 181 . People included in sheltered employment programmes and pre-vocational training present greater probability of having worked, having lower abandonment and readmission figures. The local employment rates also affect the efficacy of the sheltered employment programmes 164 . Recommendations A C D B B Sheltered employment programmes are necessary for people with SMI who express their desire to return to work or get a first job. Programmes based on placement models are recommended, with a short preliminary training period, immediate placement, and with frequent individual support. Sheltered employment programmes aimed at searching for normalised employment must not be the only programmes related to labour activity that are offered to people with SMI. It would be recommendable for the psychosocial rehabilitation centres that look after people with SMI and diagnosis of schizophrenia and related disorders, to include employment integration programmes. When employment insertion programmes are offered to people with SMI, the preferences on the type of job to be carried out must be assessed and taken into account. For people with SMI and diagnosis of schizophrenia and related disorders, who has a history of previous job failure, it would be advisable to incorporate cognitive rehabilitation as a part of the employment programmes they are going to participate in. The mental health teams, in coordination with the institutions and other social agents involved, must advise about all types of employment resources, aimed at gainful occupation and production, and adapted to the local employment opportunities. Likewise, they must be orientated towards interventions that put into motion different devices adapted to the needs and to the ability level of people with SMI, to increase stable and productive occupation expectations. CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 89
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Clinical Practice Guidelines for Ps
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This CPG is an aid for decision mak
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Table of Contents Presentation 7 Au
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Presentation Healthcare practice is
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Authorship and collaborators CPG de
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José Manuel Lalana Cuenca. Special
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c) SERVICE LEVEL INTERVENTIONS •
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A B A A B B B C Psychosocial inter
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B B B C A C C 5.3. SERVICE LEV
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20 CLINICAL PRACTICE GUIDELINES IN
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independence, quality of life, pers
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This guideline is aimed at mental h
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Figure 1. Search Strategy Search fo
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The highest evidence level found wa
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4. Characteristics of the CPG 4.1.
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The main focus of rehabilitation is
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5. Psychosocial type rehabilitation
Page 39 and 40: From another point of view, social
Page 41 and 42: defined as “standard care” or
Page 43 and 44: General global state In the short r
Page 45 and 46: Specific symptoms: when CBT was com
Page 47 and 48: In the systematic review by Kurtz a
Page 49 and 50: Summary of evidence 1- 1- 1- 1- 1-
Page 51 and 52: People with SMI and a diagnosis of
Page 53 and 54: 5.1.3. Interpersonal therapy The li
Page 55 and 56: weekly or fortnightly sessions. The
Page 57 and 58: 5.1.5. Family interventions There a
Page 59 and 60: In the RCT carried out by Hogarty e
Page 61 and 62: A family intervention of more than
Page 63 and 64: After two years’ treatment, and b
Page 65 and 66: Family intervention vs. other psych
Page 67 and 68: 1- 1- 1- 1- 1- 1- 1- 1- 1+ No diffe
Page 69 and 70: Question to be answered • Are pys
Page 71 and 72: Summary of evidence Pyschoeducation
Page 73 and 74: with schizophrenia and that the tre
Page 75 and 76: With reference to the type of train
Page 77 and 78: would normally receive and which in
Page 79 and 80: Hypnosis vs. relaxation No improvem
Page 81 and 82: Supervised fl ats are a community h
Page 83 and 84: 3 Programmes directed to leisure an
Page 85 and 86: SMI (schizophrenia, affective schiz
Page 87 and 88: When PVT is compared with standard
Page 89: Patients included in the individual
Page 93 and 94: Music therapy Music therapy + stand
Page 95 and 96: A series of Case Management systems
Page 97 and 98: • The satisfaction data originati
Page 99 and 100: Loss of contact With respect to the
Page 101 and 102: There is not sufficient evidence, e
Page 103 and 104: 1+ 1+ 1+ 1+ Respect to ICM teams or
Page 105 and 106: Finally, in the RCT by Cheng et al
Page 107 and 108: 5.4.2. “Homeless” with SMI The
Page 109 and 110: Patients who access housing with no
Page 111: ceptive disorders. This series of c
Page 115 and 116: 7. Recommendations for Future Resea
Page 117: Appendices
Page 120 and 121: Appendix 2. Information obtained fr
Page 122 and 123: Appendix 4. Information for people
Page 124 and 125: 4. Regulatory and legal framework 1
Page 126 and 127: Several protocols have been publish
Page 128 and 129: The coordination of these resources
Page 130 and 131: Social protection systems Pursuant
Page 132 and 133: Specifi c regulation • (SPANISH)
Page 134 and 135: Service Management: The first anti-
Page 136 and 137: on Mental Health and the future Eur
Page 138 and 139: Spanish Society of Legal Psychiatry
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Appendix 5. Abbreviations ACT Asser
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Appendix 6. Glossary Therapy adhere
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Appendix 7. Declaration of interest
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15 Rossler W. Psychiatric rehabilit
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53 Graeber DA, Moyers TB, Griffi th
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86 Schooler NR, Keith SJ, Severe JB
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117 Sohlberg MM, Mateer CA. Effecti
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154 López M, García-Cubillana P,
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190 Bond GR, Drake RE. Predictors o
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225 Hurley AD. Individual psychothe
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