Assignment: Access to Shelter to Schizophrenic Patients

Access to shelter to schizophrenic patients
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Abstract
Schizophrenia is a very serious mental illness. The goal of the present project is to show that providing housing services helps in reducing re-hospitalization of patients suffering from schizophrenia. The project will address the following question: In schizophrenic patients, how does access to shelter compared to no access to shelter/homelessness help in decreasing re-hospitalization within a 3 month period? Evidence that lack of access to shelter is related to readmission is an indication that interventions for housing could in fact decrease the rates of relapse. Two clinical outcomes, one satisfaction outcome and one cost outcome are defined and measured. To translate the project into sustainable change in practice, Kotter’s change model would be utilized.
Table of Contents
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Abstract  PAGEREF _Toc459026853 \h
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Access to shelter to schizophrenic patients  PAGEREF _Toc459026854 \h
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1.0 Statement of the problem  PAGEREF _Toc459026855 \h
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2.0 Background and significance  PAGEREF _Toc459026856 \h
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3.0 Systems context  PAGEREF _Toc459026857 \h
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4.0 Definition of clinical, satisfaction, and cost outcomes  PAGEREF _Toc459026858 \h
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4.1 Clinical outcome  PAGEREF _Toc459026859 \h
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4.2 Satisfaction outcome  PAGEREF _Toc459026860 \h
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4.3 Cost outcome  PAGEREF _Toc459026861 \h
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5.0 Methods of measuring clinical, satisfaction and cost outcomes  PAGEREF _Toc459026862 \h
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5.1 Clinical outcome  PAGEREF _Toc459026863 \h
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5.2 Satisfaction outcome  PAGEREF _Toc459026864 \h
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5.3 Cost outcome  PAGEREF _Toc459026865 \h
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6.0 Implications of outcomes for quality management  PAGEREF _Toc459026866 \h
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6.1 Clinical outcomes and quality management  PAGEREF _Toc459026867 \h
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6.2 Satisfaction outcomes and quality management (QM)  PAGEREF _Toc459026868 \h
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6.3 Cost outcomes and quality management  PAGEREF _Toc459026869 \h
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7.0 Ethical balance  PAGEREF _Toc459026870 \h
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8.0 Sustainability plan for translating evidence into practice  PAGEREF _Toc459026871 \h
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9.0 References  PAGEREF _Toc459026872 \h
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Access to shelter to schizophrenic patients
1.0 Statement of the problem
Schizophrenia is understood as a brain illness and is currently among the most serious mental diseases in the United States. Common symptoms of this mental illness include bizarre behavior, delusions which are irrational or false beliefs, mixed-up thoughts, and hallucinations whereby the individual hears or sees non-existent things (Goldberg et al., 2013). The chronic course of schizophrenia is a contributing factor to the ongoing social problems in the country. Consequently, schizophrenic people are highly over-represented in homeless and prison populations. Homelessness and lack of access to shelter increases the mortality rate for schizophrenic individuals as it makes them more vulnerable to diseases and accidents (Folsom & Jeste, 2012). The key goal of this project is to demonstrate that access to shelter helps to decrease re-hospitalization of schizophrenic patients. The question which the project seeks to address is as follows: In schizophrenic patients, how does access to shelter compared to no access to shelter/homelessness help in decreasing re-hospitalization within a 3 month period?
Re-hospitalizations on a psychiatric unit, which mainly affects people with serious mental illness such as schizophrenia, are a significant problem. Tsai et al. (2011) reported that between 40%-50% of people who have a history of repeated psychiatric hospitalizations are re-hospitalized within 1 year. Reported re-admission rates for schizophrenia range from ten percent for a 30-day interval of observation following discharge from the hospital to as high as eighty-six percent in a 7-year period (Tsai et al., 2011). In addition, increased chances of re-hospitalization have been found to be linked to a number of factors such as lack of access to shelter, insufficient community support as well as inadequate ambulatory care visits (Timms, 2012).
Re-hospitalizations are expensive and disruptive to both families as well as individuals, and could cause patients and health care providers alike to have a sense of failure or feel demoralized (Leutwyler, Chafetz & Wallhagen, 2011). While they could reflect lack of adherence with outpatient care, ineffective inpatient care or the severity of psychiatric disease, re-hospitalizations in some instances might actually be more related to community resources like residential status or employment (Ogden, 2014). A reduction in the number of psychiatric admissions, which is often measured in 12 months, 3 months or 30 days interval, is a vital measure of successful outpatient mental health treatment (Bota, Munro & Sagduyu, 2011). The housing provided to schizophrenic patients should be of very high quality. There is a correlation between quality of housing options for schizophrenic patients and re-hospitalization rates. Leutwyler, Chafetz and Wallhagen (2011) noted that schizophrenic patients who are discharged to lower-quality housing situations generally have greater hospital re-admission rates. The lack of good housing options contributes to the revolving door phenomenon that a lot of people who have mental diseases experience (Ogden, 2014).
2.0 Background and significance
Patients who have psychiatric comorbidities such as schizophrenia in general have very complicated treatment needs. In addition, they are at a high risk for avoidable hospital admissions and re-hospitalizations, and contribute in a disproportionate manner to the overall costs of healthcare (Auquier et al., 2013). Mental illness comorbidity is linked to costs of healthcare which are 60 percent to 70 percent higher than healthcare costs for people who do not have any mental illness, and costs of healthcare are two to three times greater for persons who are both schizophrenic and homeless, owing to high rates of re-admissions and re-hospitalizations (Bota, Munro, & Sagduyu, 2011).
With the mounting pressure to decrease costs of healthcare, reducing the number of hospital bed days – psychiatric or otherwise – is by and large an important priority for not just insurers, but also healthcare providers. Supported housing has been found as being effective to people suffering from schizophrenia (Browne & Courtney, 2012). In addition to housing, supported housing programs provide diverse services for instance work and education opportunities, physical health care, mental health treatment, daily living and money management skills, as well as peer support. Each of these services is critical in improving the quality of life for schizophrenic individuals (Hill, Mayes & McConnell, 2012).
High rate of re-admission often indicates negative prognostic outcomes in schizophrenic inpatients. Moreover, a high rate of re-hospitalization could be an indication of many schizophrenic patients that cannot be accommodated adequately in communities and they could be utilized as an indicator of inappropriateness or inadequacy of community-based aftercare. Researchers have reported that homelessness is a major social factor which is associated with rates of re-admissions in adult patients who have schizophrenia (Bota, Munro, & Sagduyu, 2011). This implies that providing schizophrenic patients with access to shelter can actually help in lowering the risk of re-admission three months after discharge. As such, the current study is significant as it will demonstrate how providing proper and quality access to shelter and housing can decrease re-admission rates for schizophrenic patients and improve outcomes which would in turn help reduce costs of healthcare associated with treating people with this psychiatric disorder.
Evidence that lack of access to shelter is linked to readmission indicates that interventions for housing could actually decrease the rates of relapse. Generally, when patients with schizophrenia need both psychiatric care and access to housing, services for housing make the crucial difference for community tenure (Folsom & Jeste, 2012). In communities with high rates of homelessness and in those with low homelessness rates, it is important that housing services be provided to schizophrenic patients within these communities. Housing should be provided to them along with psychiatric care. It is of great importance that schizophrenic patients after hospital discharge be provided with high quality housing and residential services as this will increase the capacity of those patients to stay within the community and reduce their chances for readmission.
3.0 Systems context
The proposed project would be carried out in a behavioral mental health setting in San Bernardino, California. The name of this facility is withheld to ensure anonymity. It provides a wide range of services. The facility offers outpatient and inpatient behavioral health treatment for adults, teenagers and children in the San Bernardino, California area. This mental health setting is led by clinicians who are recognized across California and beyond for their expertise and skill in mental illness. Stakeholders for the project consist of the facility’s management, staff, patients with mental illness particularly schizophrenia, and community members who live close to the behavioral mental health facility.
It is essential to involve not just the support staff and frontline clinicians, but also other key stakeholders including the patients and other healthcare providers and providers of housing services/programmes. These stakeholders would be involved in the project by consulting with them, asking for their views and opinions and listening to them (Ogden, 2014). In addition, it would be important to put into practice their views when implementing the project rather than disregarding them. In essence, their opinions would be solicited and respected. To sustain stakeholder involvement and support, feedback would be gathered from these stakeholders including the clinicians and staffs. For instance, the researcher will compile a number of problems and questions from the support staff and clinicians which would be considered in the implementation of the project.
The feedback loop that would be used to sustain stakeholder involvement and support is as follows:


Feedback Loop
The feedback loop is made up of 5 steps. Engagement strategy: in this step, the vision and level of ambition of future engagement is set and previous actions are reviewed. Stakeholder Mapping: this step entails defining criteria that would be used to identify and prioritize stakeholders. An engagement mechanism is then selected. Preparation: this step entails focusing on long-term and short-term goals, determining the logistics for that engagement, and setting the rules. Engagement: here, the engagement itself is carried out. The researcher will ensure equitable stakeholder contribution and mitigate tension whilst at the same time remaining focused on the relevant issues. Action plan: this final step will entail identifying the opportunities from feedback and determining actions, revisiting goals, and planning subsequent follow-up as well as future engagement (Timms, 2012).
4.0 Definition of clinical, satisfaction, and cost outcomes
4.1 Clinical outcome
For clinical outcome, the two variables which would be measured are quality of life of the schizophrenic patient which is defined through the use of Quality of Life (QoL) scales, and symptoms of schizophrenia which is defined using the DSM-IV schizophrenia criteria. QoL basically refers to a person’s view of his/her position in life within the context of value systems and culture in which he/she lives, and relative to his/her concerns, standards, expectations as well as goals (Bobes & Garcia-Portilla, 2012). In relation to the symptoms, schizophrenia is typified by intense disruption in emotion and cognition, and affects the most basic human attributes such as affect, thought, self-image, and language. While the symptoms are extensive, they comprise psychotic manifestations for instance hearing internal voices or the individual experiences other sensations which are not associated with a clear source/hallucinat...