Functional Outcome Measures of Severe Mental Disorders in Homes for Special Care Felicia Iftene, Dianne Groll Department of Psychiatry, Queen's University, Kingston, Ontario, Canada

Background  Our ongoing study involves clients with severe mental disorders who are living in Homes for Special Care (HSC).  It is a peer support recovery-oriented model for clients and their caregivers.

Objectives  to improve the general functioning of the clients living in group homes;  to increase the quality of life of the home operators and their helpers.

Methods - Subjects  Clients followed by Community Treatment Teams (n=30), living in HSC;  Caregivers (n=15);  Control group: 10 clients living in the Community.

Methods - Instruments  Socio Demographic information;  Brief Psychiatric Rating Scale;  Quality of Life Enjoyment and Satisfaction Questionnaire;  The materials from the program “Your Recovery Journey” initiated last year by Schizophrenia Society of Canada:  guide for facilitators,  participant workbook,  power-point and video presentations.

Methods - Procedure  10 educational sessions, two hours each, once per week (recovery, quality of life, self-management, medication and personal action planning)  3 working groups  Each group includes 8-12 clients and 4-6 caregivers

Data Collected  Demographic information  Clients  Brief Psychiatric Rating Scale; Quality of Life Enjoyment and Satisfaction Questionnaire administered five times (baseline, end of the program, monthly next 3 months)  Caregivers  Quality of Life Enjoyment and Satisfaction Questionnaire administered 5 times Due to the relatively small sample size, groups were compared using the Mann-Whitney U test. Demographic data were analysed using means, frequencies, and counts.

Results  12 clients finished the program, 7 discontinued their participation and 11 are still following it  5 caregivers have finished the program so far

Results: Demographic data for the in-home clients included in this program Number of hospitalizations12.8 (7.1) Age of onset20.1 (3.4) Years of Schooling8.8 (1.5) Years living in a home for special care10.4 (7.2) Number of homes for special care1.9 (1.2) Ever been married? Yes33% Do you have Children? Yes17% Are you currently Employed? Yes0% Current Neuroleptic Treatment (oral)66% VariableMean (SD) or %

Results: Demographic data for the control group Number of hospitalizations2.7 (1.1) Age of onset25.6 (3.2) Years of Schooling14.0 (2.5) Years living in a home for special care0 Number of homes for special care0 Ever been married? Yes43% Do you have Children? Yes0% Are you currently Employed? Yes43% Current Neuroleptic Treatment (oral)71% VariableMean (SD) or %

Results: Variable (mean SD) In-home clients Clients living in community p-value Age59.3 (8.3)48 (7.5)0.017 Number of hospitalizations12.8 (7.1)2.7 (1.1)<0.001 Age of onset20.1 (3.4)25.6 (3.2)0.004 Years of Schooling8.8 (1.5)14.0 (2.4)<0.001 Years living in a home for special care10.4 (7.2)0 (0)<0.001 Number of homes for special care1.9 (1.2)0 (0)<0.001

Results: Differences between baseline symptoms on the BPRS between Clients in HSC and control group:

Results: Significant differences baseline symptoms in BPRS Variable (mean SD) In-home clients Community clients p-value Somatic Concern3.5 (1.7)1.1 (0.4)0.010 Anxiety 4.8 (8.3)3.7 (1.0)0.022 Conceptual disorganization 4.4 (6.7)3.6 (0.5)0.028 Blunted affect 5.7 (0.5)4.6 (1.0 )0.017 Mannerisms and posturing 4.0 (0.6)3.0 (0.6)0.007

The Brief Psychiatric Rating Scale: Average pre-treatment and 3-months post treatment scores for in-home clients 1Somatic Concerns10Disorientation 2Anxiety11Conceptual Disorganization 3Depression12Excitement 4Guilt13Motor Retardation 5Hostility14Blunted affect 6Suspiciousness15Tension 7Unusual Thought Content16Mannerisms and posturing 8Grandiosity17Uncooperativeness 9Hallucinations18Emotional Withdrawal

Results: Significant differences in BPRS: in-home clients Variablebaseline3-months postp-value Somatic Concern3.5 (1.7)2.7 (1.2)0.047 Anxiety 4.8 (8.3)3.5 (1.0)0.011 Blunted affect 5.7 (0.5)4.7 (0.5 )0.004 Tension 5.7 (0.5)3.8 (0.9 )0.023

The Brief Psychiatric Rating Scale: Average pre-treatment and 3-months post treatment scores for community clients 1Somatic Concerns10Disorientation 2Anxiety11Conceptual Disorganization 3Depression12Excitement 4Guilt13Motor Retardation 5Hostility14Blunted affect 6Suspiciousness15Tension 7Unusual Thought Content16Mannerisms and posturing 8Grandiosity17Uncooperativeness 9Hallucinations18Emotional Withdrawal

Results: Significant differences in BPRS: community clients VariableBaseline 3-months post p-value Anxiety 3.7 (1.0)2.1 (0.7)0.015 Tension 3.7 (1.0)2.9 (0.4)0.034

Results: Differences between 3-month symptoms on the BPRS between Community living clients and Clients in HSC:

Results: Significant differences in 3- month symptoms in BPRS Variable In-home clients Community clients p-value Somatic Concern2.7 (1.2)1.6 (0.5)0.035 Anxiety 3.6 (1.0)2.1 (0.7)0.008 Tension 3.8 (0.9)2.9 (0.4)0.015

Results: Mean Quality of Life and Enjoyment scores – in-home clients. Out of 100

Individual Quality of Life items: Average pre-treatment and 3-months post treatment scores for in-home clients 1 Physical Health 8Ability to function in daily life 2Mood9Sexual drive/interest, and/or performance 3Work10Economic Status 4Household Activities11Living/housing situation 5Social Relationships12Ability to get around physically 6Family Relationships13Vision 7Leisure Time Activities14Overall sense of wellbeing

Results: Significant differences in individual QOL items: in-home clients Variablebaseline3-months postp-value Physical health 2.3 (0.9)4.3 (0.5)0.023 Household activities 1.5 (0.5)4.3 (0.5)0.006 Social relationships 1.8 (0.6)4.0 (0.0 )0.006 Leisure time activities 1.8 (0.6)4.1 (0.4 )0.002 Ability to function in daily life2.2 (0.6)4.0 (0.0)0.010 Vision2.3 (0.8)4.0 (0.0)0.008 Overall wellbeing2.2 (0.7)4.0 (0.0)0.006

Results: Mean Quality of Life and Enjoyment scores - Community clients. Out of 100

Individual Quality of Life items: Average pre-treatment and 3-months post treatment scores for community clients 1 Physical Health 8Ability to function in daily life 2Mood9Sexual drive/interest, and/or performance 3Work10Economic Status 4Household Activities11Living/housing situation 5Social Relationships12Ability to get around physically 6Family Relationships13Vision 7Leisure Time Activities14Overall sense of wellbeing

Results: Significant differences in individual QOL items: community clients Variablebaseline3-months postp-value Physical Health3.6 (0.5)4.3 (0.5)0.025 Work 2.3 (0.8)3.4 (1.3)0.034 Household Activities 2.9 (0.7)4.3 (0.5 )0.015 Social Relationships 2.4 (0.5)4.0 (0.0 )0.015 Family Relationships3.2 (1.0)4.3 (0.5)0.038 Leisure time activities2.4 (0.5)4.1 (0.4)0.016 Ability to function in daily life3.1 (0.4)4.0 (0.0)0.014 Vision3.1 (0.4)4.0 (0.0)0.014 Overall wellbeing3.3 (0.5)4.0 (0.0)0.025

Results: Differences between individual baseline QOL items between Community living clients and Clients in HSC:

Results: Significant differences baseline QOL items Variable In-home clients Community clients p-value 1. Physical health2.3 (0.9)3.6 (0.5) Mood 2.4 (0.8)3.4 (0.5) Work 1.3 (0.5)2.6 (0.8) Household activities 1.5 (0.5)2.9 (0.7 ) Family relationships 1.5 (0.5)3.2 (1.0) Ability to function in daily life2.2 (0.6)3.1 (0.4) Sexual drive/interest1.5 (0.5)2.3 (0.5) Economic status2.2 (0.6)3.4 (0.5) Living/ household situation3.0 (0.6)3.9 (0.4) Ability to get around physically2.6 (0.7)3.6 (0.5) Vision2.3 (0.8)3.1 (0.4) Overall wellbeing2.2 (0.7)3.3 (0.5)0.005

Results: Differences between individual 3-month QOL items between Community living clients and Clients in HSC:

Results: Significant differences in 3-month QOL items Variable (mean SD) In-home clients Community clients p-value 1. Physical health3.0 (0.9)4.3 (0.5) Mood3.2 (0.8)4.3 (0.5) Household activities2.7 (1.0)4.3 (0.5) Social relationships2.8 (0.7)4.0 (0.0 )< Family relationships1.9 (0.9)4.3 (0.5)< Leisure time activities2.9 (0.7)4.1 (0.4) Ability to function in daily life3.2 (0.8)4.0 (0.0) Sexual drive/interest1.7 (0.5)3.0 (1.2) Economic status2.3 (0.9)4.1 (0.4) Ability to get around physically3.0 (0.6)4.0 (0.0) Vision2.8 (0.6)4.0 (0.0)< Overall wellbeing3.3 (0.8)4.0 (0.0)0.036

Results: In-home clientsCommunity Clientsp-value QOL baseline25.9 (10.9)51.3 (6.3)<0.001 QOL post intervention35.0 (14.0)72.2 (6.0)<0.001 QOL 3 months post43.0 (13.4)75.0 (5.8)<0.001

Results: Mean Quality of Life and Enjoyment scores – caregivers (out of a possible 100)

Individual Quality of Life items: Average pre-treatment and 3-months post treatment scores for caregivers 1 Physical Health 8Ability to function in daily life 2Mood9Sexual drive/interest, and/or performance 3Work10Economic Status 4Household Activities11Living/housing situation 5Social Relationships12Ability to get around physically 6Family Relationships13Vision 7Leisure Time Activities14Overall sense of wellbeing

Results: Significant differences in individual QOL items: caregivers  No items changed significantly, however the following items were close to significant:  Leisure time activities p =  Sexual drive/interest p =  Overall sense of wellbeing p = 0.083

Limitations  Small number of subjects; ongoing study; no final results  Program conceived for higher functioning clients; we adjusted and reorganized the sessions  We did not take into account the stress level of the home operators

Summary  So far, our study shows a better symptom amelioration on BPRS, post intervention, for the clients living in HSC. For the QOL the improvement was more important for the clients living on their own in the community.  The impairment of social functioning is impressive when the clients have a semi institutionalized life, early onset of mental disorder, long term hospitalisations, lack of family support  We need to develop flexible programs, delivered at an earlier stage of illness, adjustable to clients’ specific needs, in a well-constructed comprehensive plan, including both pharmacological and psychosocial interventions.

Thank you