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TREATMENT MILLIEU IN FJORDHUS . Center for Cognitive Therapy St. Hans Hospital, Denmark February 2006. Background Research.
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TREATMENT MILLIEU IN FJORDHUS Center for Cognitive Therapy St. Hans Hospital, Denmark February 2006

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Background Research Dual conclusion is characterized as a co-happening psychiatric confusion and substance mishandle clutter. It has a tendency to be an incessant backsliding issue with persistance over numerous years (Drake et al 1996). Co-horribleness with emotional instability and medication manhandle is exceptionally regular: 25-35% of individuals with maladjustment show substance mishandle scatter inside the previous 6 months (Mueser et al 1995) People with double conclusion encounter higher rates of vagrancy, exploitation and HIV disease than individuals with psychiatric ailment alone (Alverson 2000)

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Background Research Integration of medicines for dysfunctional behavior and substance manhandle. Arrangement of close checking and bolster Recovery happens over months/years. Programs take a long haul viewpoint (connect inpatient - outpatient administrations) Motivation/responsibility to recuperation is variable: motivational procedures can have a critical part Treatment ought to suit for patients phase of recuperation and indication seriousness (Drake & Mueser 2000), (Bellack & DiClemente 1999)

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Treatment in Fjordhus Established in March 2003, comprising of 6 committed wards (90 patients) for treatment of double conclusion. Open wards with screen function* Treatment in view of intellectual behavioral model Multi-disciplinary group (specialists, analysts , medical attendants, OT\'s and socialworkers) Contact individual is in charge of the co-appointment of all parts of patient treatment

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Cognitive Milieu Therapy Integrated treatment of psychosis and medication abuse utilizing a mix of pharmacological and mental intercessions. ( Adapted shape Kognitiv Miljøterapi (2001)* Focus on inspiration and the improvement/usage of individual treatment programs inside a strong situation. Mental mediations with a down to earth introduction and specific accentuation on social working and indication administration Ward milieu empowering cooperation in gatherings with specific concentrate on self-adequacy and assuming liability

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Treatment ranges in CMT The subjective model : recognize tricky considerations (convictions) and conduct and grow new more versatile procedures and thought designs Pscho-instruction : data and exchange of pertinent points and issues (substance mishandle, wellbeing issues, schizophrenia, uneasiness) Social aptitudes : create social ability and set up and keep up significant connections Millieu: All patients are relied upon to be dynamic and particpate in like manner gatherings, obligations and exercises. Investment in various treatment gatherings is likewise energized

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Assessment (BPRS, SCQ BDI) Stabilize abuse and psychological wellness Extended leave – test methodologies, Re-build up coommunity joins Participate in psycho-instruction ADMISSION DISCHARGE Work on inspiration and treatment objectives Strategies for backslide Particpate in treatment millieu Introduction to subjective model Cognitive issue detailing Develop intellectual/conduct systems Participate in gatherings (substance manhandle, tension, self-regard) Treatment in Fjordhus

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Fjordhus Evaluation 1. General assessment : Evaluate the reaction of double conclusion inpatients to subjective milieu treatment, inspect affect on medication abuse, psychopathology, social working and long haul fulfillment 2. Singular assessment : Evaluate the effect of individual intercessions offered to chose inpatients (eg: bunches for uneasiness, low self-regard, social abilities & abuse) 3. Ward Atmosphere : Examine the treatment milieu as saw by patients and work force

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3. Ward Atmosphere Goal : measure the genuine and fancied treatment mileu as at present saw by inpatients and individual Participants: All inpatients willing to finish questionaire and all work force associated with ward (mulit-disciplinary)

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Assessment T1: with begin of Assessment T2: 12 mths after Assessment T3: 24 mths after All patients and personel finish : WAS (S): Ideal & Reall All patients and personel finish : WAS (S): Ideal & Reall All patients and personel finish : WAS (S): Ideal & Real Experimental plan: Ward climate 2004 2005 2006

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Ward Atmosphere Ward Atmosphere is worried with the social environment and characteristics of inpatient projects that add to the treatment milieu (Jansson & Eklund 2002) The connection between reasonable treatment millieu and constructive treatment results is entrenched (Eklund & Hannson 1997) Rudolf Moos (1996) has operationalized the estimation of ward air through the Ward Atmosphere Scale (WAS) (genuine and perfect adaptations)

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Ward Atmosphere The formation of a specific ward air in view of attributes on the patients sickness can enhance treatment results. Insane patients can enhance more in a millieu with low hostility, high request and association and high staff-tolerant contact (Friis 1986, Vaglum & Friis 1984) It has been proposed that other patient gatherings (non-crazy and double finding ) may likewise profit by various treatment milieus

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Ward Atmosphere Scale (WAS) (Moos 1996) Involvement Support Relationship Spontaneity Dimensions Autonomy Personal issues introduction Practical orientation Personal Growth Anger and Aggression Dimensions Order and association Program Clarity System Maintenance Staff Control Dimensions Involvement Support Relationship Spontaneity Dimensions

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Realtionship Dimension Involvement: how dynamic and lively patients are in the program Support: How much patients help and bolster each other. How steady staff are to patients Spontaneity: How much the program empowers the open articulation of sentiments by patients and staff

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Personal Growth Dimension Autonomy: how self sufficent and free patients are in settling on their own choices Practical introduction : the degree to which patients learn useful abilities and are set up for release Personal issue introduction : the degree to which patients look to comprehend their emotions about individual issues Anger and Aggression : how much patients contend with different patients and staff or show forceful conduct

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System Maintainance Dimension Order and association : how essential request and association are in the Program Clarity : the degree to which patients recognize what\'s in store in their everyday schedule Staff control : the degree to which staff utilize measures to hold persistent under pointless control

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Perception of current treatment millieu (genuine) Patients and work force to a great extent concur on current treatment millieu Patients see treatment as more strong and with less program clarity than faculty. Faculty see the outflow of outrage and hostility lower than patients PERSONNEL * PATIENTS *

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Treatment millieu made by CMT RELATIONSHIP DIMENSION: High in support, direct in inclusion, and suddenness PERSONAL GROWTH DIMENSION: Moderate concentrate on individual issues, independence and useful aptitudes and low in the statement of outrage and animosity SYSTEM MAINTAINENCE: High in program clarity, direct in program structure and low/direct in staff control How is this diverse to the your customers impression of treatment ?

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Perception of fancied treatment millieu (Ideal) PERSONNEL Patients and staff generally concur how the perfect treatment millieu ought to be. Patients need more concentrate on commonsense aptitudes, individual issues and articulation of outrage and animosity than work force. Both gatherings see a low/direct measure of staff control as proper * PATIENTS *

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Desired treatment millieu RELATIONSHIP DIMENSION * : High in association, support and suddenness PERSONAL GROWTH DIMENSION: Moderate concentrate on på self-rule, individual issue orientation* and commonsense skills*. Low in articulation of outrage and animosity SYSTEM MAINTAINENCE: Very high in program clarity*, direct/high in program structure* and low/direct in staff control What angles do group patients want from treatment ?

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(Eklund & Hansson 2001), (Shipley et al. 2000) Ward Patient Participation Treatment Outcomes Atmosphere Satisfaction or compliance (Psychopathology , (Aspects of (Long term) with treatment social working, program) tranquilize abuse). Nature of Care Conceptual model What do you think about this model? Are there any issues or impediments?

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Issues to consider Is it conceivable to acheive the perfect treatment millieu and what effect would it have on results? Is it something worth being thankful for that patients and individual hold similar recognitions about treatment millieu? Can one gauge treatment millieu with a cross sectional survey? What are some different choices? Is double finding, excessively wide a gathering, making it impossible to propose a solitary reasonable treatment millieu?

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Selected References Bellack, AS & DiClemente, CC (1999) Treating substance manhandle among patients with schizophrenia. Psychiatric Services 50: 75-80 Drake, RE & Mueser, KT (2000) Psychological ways to deal with double analysis Schizophrenia Bulletin Vol 26 No.1 105-118 Eklund, M & Hansson, L (2001) Perceptions of genuine and perfect ward air. European Psychiatry 16: 299-306 Friis, S (1986) Characteristics of good ward climate Acta Scandanavia 74: 469-73 Middelboe, T Schødt, T Brysting, K Gjerris, A (2001) Ward environment in intense psychiatric inpatient mind. Acta Psychiatrica Scandinavica 103: 212-219 Moos, R (1996) Ward Atmosphere Scale . Mind Garden California USA Vaglum, P & Friis, S (1985) Milieu treatment in long haul treatment of practical psychosis

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