Saturday, 15 January 2005 - 12:00 PM

This presentation is part of: Poster Session II

Individual Change in Psychosocial Functioning in Community-Based Rehabilitation Programs for Individuals with Schizophrenia

Purpose

Community-based treatment programs for individuals with schizophrenia have not consistently demonstrated improvements in client's functioning. There are wide individual variations in responsiveness to the interventions; therefore, it is important to understand the individual predictors of rehabilitative change over time. Hospitalization is typically seen as a negative outcome for individuals in community-based treatment.

The purpose of this study was to investigate the relationship between the number of hospital days in the six months prior to admission to a community-based psychosocial rehabilitation program and the rate of clients' psychosocial functioning during community treatment. There were three hypotheses: 1) the aggregate trajectory of individual change in global psychosocial functioning will be linear and positive; 2) more hospital days in the six months prior to admission to community treatment will be related to lower global psychosocial functioning at admission (baseline); and 3) more hospital days in the six months prior to admission to community treatment will decrease the rate of rehabilitative improvement during 12 months of community-based treatment.

Method

The sample consisted of 166 individuals diagnosed with schizophrenia who were recruited upon admission to three similar community-based psychosocial rehabilitation interventions. The sample was followed prospectively for 12 months, with psychosocial observations made at baseline and every six months. The psychosocial outcome measure was the Role Functioning Scale. Latent growth curve modeling was used. A linear curve model was tested for the first hypothesis. A covariate (days of hospitalization) was introduced into the linear model, and a path coefficient between the latent intercept and the covariate was tested for the second hypothesis. Last, a path coefficient between the latent slope and the covariate was tested for the third hypothesis.

Results

The hypothesized linear curve model fit the data very well (¥ö2 (1) = .042, P = .837; ¥ö2/df (1) = .042; RMSEA = .000). The linear change model with the covariate (days of hospitalization) fit the data as well (¥ö2 (2) = .528, P = .768; ¥ö2/df (2) = .264; RMSEA = .000). The path between the latent intercept and the covariate was significant (b = -.010, CR = -1.856, P < .05). However, the second path between the latent slopes and the covariate was not significant (b = .001, CR = .953, P = .167).

The conclusions are: 1) global psychosocial functioning in this sample showed significant linear improvement over 12 months; 2) that more hospital days in the six months prior to admission to community treatment decreased initial scores in psychosocial functioning; 3) that days in the hospital did not affect the rate of improvement in psychosocial functioning during community treatment.

Implication for practice

Hospitalization is typically seen as a negative outcome for individuals in community-based treatment services, and higher hospitalization rates have been seen as a negative prognostic indicator for responsiveness to treatment. The findings of this study suggest that hospitalization rates will deflate initial psychosocial functioning levels, but that they do not appear to impede progress while participating in community-based psychosocial rehabilitation. Therefore, clinicians should not use hospitalization rates as a negative prognostic indicator for treatment change potential, although they will impact initial functioning status.

See more of Poster Session II
See more of Oral and Poster

See more of Celebrating a Decade of SSWR (January 13 - 16, 2005)