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Report on
Occupational Therapy Program
For
Adult Psychiatric Out-Patient
(April 2001/March 03)
Prepared by the Working Group on OT Program for Adult Psychiatric Out-
patient, OTCOC/HA(December 2003)
Members:Mr. Ip Yee-chiu, DM(OT)/KCH
Mr. Frederick Au, DM(OT)/PWH
Mr. Leung Kwok-fai, DM(OT)/QEH
Mr. Candy Lee, SOT/CPH
Ms. Lily Lo, OTI/EKPCMs. Sharifa Yam, OTI/SKCPC
Ms. Daphne Hung, OTI/YMTPC
Mr. Raymond Au, OTI/SH
Ms. Vicky Chang, OTI/SH
Ms. Eyan Tsao, OTI/PWH
Mr. Davis Lak, OTI/KH
Ms. YoYo Yiu, SOT/KH
Mr. Sunny Cheung, OTI/CPH
Ms. Codi Wong, RA/QEH
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I. Background
The aim of psychiatric service is to enable patients to return to the community as soon as possible after
treatment and rehabilitation to avoid institutionalization (MSDC P81, 1999). Therefore, a range of
ambulatory and community psychiatric rehabilitation services is essential to reduce prolonged
hospitalization or to minimize the need for hospitalization as which could lead to institutionalization andreducing discharge potential.
Three and a half OTIIs from the HAHO are allocated to pilot the Out-patient OT Service in Psychiatry (1
OTII each to NTN(CPH /NDH), NTE(PWH/SH), NTS( KCH and cluster clinics) and 0.5 OTII to KH).
Hopefully the OT Program for Adult Psychiatric Out-Patient could help the psychiatric out-patients
adjust to a structured and purposeful life routine in the community and reduce re-admission.
II. Literature Review
E. Susser et al 1997 concluded that strategies of interventions for individuals with mental illness should
be focused on a critical time of transition from shelter institution to the community placement.1 Also, theyproposed that the first months of community care living are crucial for adjustment.
2Generally during
these first months, relationships are exquisitely fragile and mutual obligations are being negotiated
between the de-institutionalized individual and those who may offer formal or informal support in
community living. Hence, OT interventions for these out-patients after their discharge from the Hospital
will be very crucial.
III. Objectives:
To enhance psychiatric out-patients coping skills such as stress management and problem-solving on the
problems they encountered in daily life after discharge, and to promote their work adjustment, retention,
and employment opportunity through vocational assessment, counselling and guidance as there is a
significant relationship between outpatient defaulters and unemployment ( Pang et al, 1995)
The study is to measure the outcomes of the OT program for adult psychiatric patients in the area of
occupational & functional performances, work status, living status, health status, happiness and their
QOL.
IV. Service ModeThe OT Program for Adult Psychiatric Out-Patient is a short-term sessional-based ambulatory care
service provided by occupational therapist in the Department settings or in the community settings as well as theclients home environment with definite rehabilitation goals.
V. Referral Criteria:Adult psychiatric patients range from 18-60 years of age from psychiatric SOPD. Clients with adjustment
problems in work, community living or at home should be referred with the appended Referral Form.
(Appendix I)
1 Susser E, et al. Preventing Recurrent Homelessness among Mental Ill Men: A Critical Time Intervention after Discharge
from a Shelter. American Journal of Public Health. Feb.,1997, Vol.87,No.2:256-262.2 Valencia E, et al. Critical Time Points in the critical care of homelessness mentally ill individuals. In: Vaccaro JV, Clarke GH
Jr, eds. Practicing Psychiatry in the Community: A Manual. Washington, DC: American Psychiatric Press; 1996:259-276.
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VI. OT Intervention Programs:
VI. 1) Work Adjustment Program for Adult Psychiatric Out-patient (Appendix II)
On receiving a referral for work adjustment program, therapist will conduct a screening assessment
through interviewing clients and/or their informants, as well as collecting data from case notes. The
screening assessment helps to determine if the client can benefit from our service.
If an indication for service is rendered, detailed functional assessment will be conducted, which will
include work capacity evaluation through standardized assessment tools, work samples or workshop
observation. The functional assessment provides therapist and client a complete picture of critical skills
required for achieving the treatment goal.
A treatment plan will then be formulated together with the client. Necessary services will be provided
accordingly, which will mainly include vocational counselling, job planning and preparation, job
matching, job hunting, as well as job follow-up.
Continuous evaluation of clients performance will be conducted, through the use of various measurementtools including Work Personality Profile, Workshop Behaviour Checklist, Social & Occupational
Functioning Assessment Scale etc. During the treatment implementation period, adjustment of the
treatment plan will be made as indicated.
On achievement of treatment goal, client will be discharged from the program and secure a job in the
community independently.
VI. 2) Home Adjustment Program for Adult Psychiatric Out-patient (Appendix III)
When a referral for home adjustment program is received, client will be contacted to attend an initialinterview. The interview allows therapist to screen for needs, clarify referral aims, determine suitability of
client for O.T. services, make referral to other services, and acquire relevant data from client and/or carer
who accompanies client to the interview.
Assessment will be conducted to assess client's ability in household management, stress and leisure
management, life-style management, relationship building as well as relatives' need of carer support
program. Depending on the referred aims and needs of client and their relatives, a variety of assessment
tools will be selected for the Home Adjustment program. The St. Louis Inventory Community Living
Skills Chinese version (SLICLS-C) is for household management. The Relative Stress Scale (RSS) is
for career support and relationship building. The Social Problem Solving Inventory and other coping style
questionnaire are for stress management. The Interest Checklist is for leisure management and the TimeChart for Occupational Life-style Re-design.
A treatment plan will be formulated with the client to empower the client to take a more active role in
rehabilitation. Treatment programs include training of household management skills, basic relationship
building skills, problem solving skills and life-style redesign to achieve a more balanced and healthy
living, and to improve their quality of life, as well as making referrals to appropriate services, etc.
Treatment will be monitored and modified according to client's progress, and therapist will discuss with
client about his or her progress and review their needs. Progress report will be sent to the referred medical
officer.
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Client will be discharged from the services when the referred aims are achieved, or a client is found no
longer suitable for the OT Program, or self-withdrawal from the Program. The referring medical officer
would be contacted, and a case summary would be submitted on completion of the program or
termination of services. Therapist will discuss with the client and relevant parties about the need of
referrals to other services and further actions on termination of services.
VI. 3) Community Adjustment Program for Adult Psychiatric Out-patient (Appendix IV)
When a referral for community adjustment program is received, an information collection and screening
process will be done for client. An initial interview will be conducted with client and/or their informants.
This process helps us to clarify the referral aim and together, to determine whether this client shall benefit
from OT Service.
A standard assessment on community adjustment skill St. Louis Inventory of Community Living
Skills will be conducted as an outcome indicator for this Adult Out-patient project. Whereas detail
functional assessment on areas like community living skill, community resources usage and social /
coping skill will be conducted subject to the needs of the client. These assessments provide objective
measure for therapists and client on treatment program planning.
A treatment plan will then be formulated with the client based on his/her needs and problems encountered.
Treatment programs will include community living skill teaching and practice, resources orientation,
establishment of social support network etc..
Treatment program will be closely monitored and adjusted according to clients progress. On-going
evaluation report and progress report will be provided.
Client will be discharged from the program on achievement of treatment goal. For those clients who show
little progress or fail to meet the goal, therapist will review the treatment program and discuss with
relevant parties for alternative arrangements
VII. Outcome Measurement Tools.
The clinical outcome measurements are specified with regard to the protocol of the out-patients services,
namely Work Adjustment, Home Adjustment and Community Adjustment. One instrument is chosen for
each specific area of treatment.
VII. 1) The Chinese version Work Personality Profile (CWPP)
The Chinese version Work Personality Profile (CWPP) is selected as a measure of outcome of the Work
Adjustment program.
It is an observational work behavioral rating instrument developed by Bolton and Roessler (1986) and
was further validated and revised by Mr Chan Siu-ching et al in 2002. It is supposed to measure work
attributes essential to maintain employment. It employs a 4-point scale for rating 58 behavioral items
subsumed in 11 rational scales.
The authors have reported internal consistency of the 11 work performance scales ranging from .71 to .92.
Its inter-rater reliability is .80. It is highly correlated (.78) to the General Aptitude Test Battery
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demonstrating good concurrent validity. Its predictive validity is also eminent with p
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VII. 4) The Relatives Stress Scale (RSS)
The Relatives Stress Scale (RSS) is selected as a measure of carers subjective feelings towards
burden in looking after patients3.
Items of the scale are selected through literature review and judgment of the authors. Its wordingshave been tuned for use with non-professional persons. For each item, a five-point scale (from 0 through
4) is used to indicate either never, rarely, sometimes, frequently, always or not at all, a little,
moderately, quite a lot, considerably.
The instrument has been field-tested on 38 relatives of senile dementia patients who are assessed by
research psychologists. Data are then analyzed through factor analysis condensing into 15 items
subsumed under three subscales and there is sub-total for each subscale.
(i) personal distress experienced by the relatives in relation to the patient
(ii) degree of life upset produced by having to care for the patients
(iii) negative feelings towards patients
Test-retest reliability has been studied with psychologists reassessment of the relatives after lapse
of three weeks. The reliability coefficients for each subscale were reported ranging from .72 to .88.
The authors have also studied the tools construct validity. The scale was discriminated with three
constructs namely relatives perception on patients cognitive level, behavioural disturbance and self-care
abilities, which were measured by the Clifton Assessment Schedule (CAS), and the physical self
maintenance (PSM) and activities of daily living (ADL) scales of Lawton and Brody respectively. The
RSS has low correlation with cognition (r=.06), self-care (r=.09) and behavioural disturbance (r=.08).
3 There is currently no specific measure on stress of careers of adult psychiatric patients. The RSS is originally developed for
relatives of dementia patients with construct closely related to our interest and is thus adopted for use.
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VIII. Results:VIII. 1) Cases Recruitment:
The Out-patients were recruited from the following centers: EKDH, KCH, KH, NDH, PWH, SH, TMMH,
YMTPC, SKCPC.
Total out-patients treated by the centers from April 01 to March 03 from EIS = 1204
Total cases recruited to the Program = 431 (36% of total out-patients are suitable for the Program, the
others may not suitable due to non-compliance to the program, short episodes of care, e.g. vocational
counseling service, or vocational assessment or independent living skills assessment, or household
assessments)
Total cases discharged from the Program as at 31/3/2003 = 164 (38% cases were discharged from the
Program in 2 years time and the detail analysis of the outcomes of them are listed below.)
Total Number of cases completed Interview at 3 months follow-up = 67 (40.8%)
VIII. 2) Drop-outs
Cases Loss to follow up at Discharge =12. (2.8%)
Re-admission to Hospital before Discharge= 25 (5.8%)
Re-admission to Hospital after Discharge = 2 (1.2%)
VIII. 3) Demographic Variables
Sex: Male 77
Female 87
Age: Mean 35 (Mini.18 & Maxi. 60)
Education:
Frequency Percent Valid Percent Cumulative Percentno formal edu 2 1.2 1.2 1.2
P1-6 33 20.1 20.1 21.3
F1-5 100 61.0 61.0 82.3above F5 29 17.7 17.7 100.0
Total 164 100.0 100.0
Diagnosis:
Frequency Percent Valid Percent Cumulative Percent
schizophrenia 83 50.6 50.6 50.6schizoaffective
disorder3 1.8 1.8 52.4
bipolar affectivedisorder
7 4.3 4.3 56.7
depressive episode 36 22.0 22.0 78.7other anxiety
disorder9 5.5 5.5 84.1
obsessive-compulsive disorder
2 1.2 1.2 85.4
others 17 10.4 10.4 95.7
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personality disorder 1 .6 .6 96.3early psychosis 6 3.7 3.7 100.0
Total 164 100.0 100.0
Duration of Illness: Mean 8.3 years (Mini. 0 year & Maxi. 48)
No. of Previous Admissions: Mean 1.77 (Mini. 0 & Maxi. 14)
Living Status (Pre & Post Comparison):
living status (pre) * living status (dc) Crosstabulation
Count
114 4 1 6 1 126
7 5 1 13
1 1
5 1 12 18
1 1
127 10 1 19 2 159
livingstatus(pre)
Total
living status (dc)
Total
The living status of the out-patients remained almost the same after the program. They are well
maintained in the living environment 3 months after discharge.
VIII. 4) Outcome Assessments:
For the Social & Occupational Functioning Assessment Scale (SOFAS), there is significant improvement
in discharge.
N Minimum Maximum Mean Std.Deviation
SOFAS_A 148 35.00 90.00 65.9392 9.8404SOFAS_D 147 40.00 95.00 74.1973 10.3723
Valid N (listwise) 147
Paired Samples Correlations
147 .760 .000SOFAS_A &SOFAS_D
Pair1
N Correlation Sig.
Paired Samples Test
-8.2177 7.0327 .5800 -9.3641 -7.0713 -14.167 146 .000SOFAS_A -SOFAS_D
Pair1
MeanStd.
DeviationStd. Error
Mean Lower Upper
95% ConfidenceInterval of the
Difference
Paired Differences
t dfSig.
(2-tailed)
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For the Chinese version Work Personality Profile (CWPP), there are 61 cases (37%) being rated by this
scale and also significant improvements in all the 5 domains in discharge.
Paired Samples Statistics
64.5902 61 13.2179 1.6924
67.8033 61 14.1124 1.8069
63.3333 60 13.7984 1.7814
66.2778 60 15.1557 1.9566
66.4286 60 12.4797 1.6111
71.1310 60 11.3567 1.4661
66.8944 61 13.1693 1.6862
69.9454 61 13.7260 1.7574
72.1311 61 18.0268 2.3081
76.8443 61 15.9485 2.0420
cwpp_s1 (adm)cwpp_s1 (dc)
Pair1
cwpp_s2 (adm)
cwpp_s2 (dc)
Pair2
cwpp_s3 (adm)
cwpp_s3 (dc)
Pair3
cwpp_s4 (adm)
cwpp_s4 (dc)
Pair4
cwpp_s5 (adm)
cwpp_s5 (dc)
Pair5
Mean NStd.
DeviationStd. Error
Mean
Paired Samples Correlations
61 .792 .000
60 .728 .000
60 .715 .000
61 .704 .000
61 .644 .000
cwpp_s1 (adm)& cwpp_s1 (dc)
Pair1
cwpp_s2 (adm)& cwpp_s2 (dc)
Pair2
cwpp_s3 (adm)& cwpp_s3 (dc)
Pair3
cwpp_s4 (adm)& cwpp_s4 (dc)
Pair4
cwpp_s5 (adm)& cwpp_s5 (dc)
Pair5
N Correlation Sig.
Paired Samples Test
-3.2131 8.8640 1.1349 -5.4833 -.9429 -2.831 60 .006
-2.9444 10.7548 1.3884 -5.7227 -.1662 -2.121 59 .038
-4.7024 9.0516 1.1686 -7.0407 -2.3641 -4.024 59 .000
-3.0510 10.3651 1.3271 -5.7056 -.3964 -2.299 60 .025
-4.7131 14.4633 1.8518 -8.4173 -1.0089 -2.545 60 .014
cwpp_s1 (adm)- cwpp_s1 (dc)
Pair1
cwpp_s2 (adm)- cwpp_s2 (dc)
Pair2
cwpp_s3 (adm)- cwpp_s3 (dc)
Pair3
cwpp_s4 (adm)- cwpp_s4 (dc)
Pair4
cwpp_s5 (adm)- cwpp_s5 (dc)
Pair5
MeanStd.
DeviationStd. Error
Mean Lower Upper
95% ConfidenceInterval of the
Difference
Paired Differences
t dfSig.
(2-tailed)
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For the St. Louis Inventory of Community Living Skills (SLICLS), 66 cases (40%) are being rated and
there are significant improvements in discharge.
Paired Samples Statistics
76.5488 66 14.7857 1.8200
83.6532 66 12.9866 1.5985
SLICLS-C(adm,0-100 scale)
SLICLS-C(dc,0-100 scale)
Pair1
Mean NStd.
DeviationStd. Error
Mean
Paired Samples Correlations
66 .800 .000
SLICLS-C(adm, 0-100scale) & SLICLS-C(dc,
0-100 scale)
Pair1
N Correlation Sig.
Paired Samples Test
-7.1044 8.9525 1.1020 -9.3052 -4.9036 -6.447 65 .000
SLICLS-C(adm,0-100 scale) -SLICLS-C(dc, 0-100
scale)
Pair1
MeanStd.
DeviationStd. Error
Mean Lower Upper
95% ConfidenceInterval of the
Difference
Paired Differences
t dfSig.
(2-tailed)
For the Relatives Stress Scale (RSS), only 17 cases (10%) are being rated though the changes in the 4
sub-scales are significant.
Paired Samples Statistics
22.3039 17 21.9958 5.3348
18.3824 17 22.6815 5.5011
23.8235 17 22.0461 5.3470
21.4706 17 22.8968 5.5533
25.0000 17 20.4920 4.9700
18.7500 17 20.1314 4.8826
20.5882 17 22.7756 5.5239
17.4510 17 22.6853 5.5020
RSS-personal distress(adm, 0-100 scale)
RSS-personal distress(dc, 0-100 scale)
Pair1
RSS-life upset (adm,
0-100 scale)RSS-life upset (dc,0-100 scale)
Pair
2
RSS-negative feelings(adm, 0-100 scale)
RSS-negative feelings(dc, 0-100 scale)
Pair3
RSS-total score (adm,0-100 scale)
RSS-total score (dc,0-100 scale)
Pair4
Mean NStd.
DeviationStd. Error
Mean
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Paired Samples Correlations
17 .982 .000
17 .991 .000
17 .905 .000
17 .980 .000
RSS-personal distress(adm, 0-100 scale) &
RSS-personal distress(dc, 0-100 scale)
Pair1
RSS-life upset (adm,0-100 scale) & RSS-lifeupset (dc, 0-100 scale)
Pair2
RSS-negative feelings(adm, 0-100 scale) &RSS-negative feelings(dc, 0-100 scale)
Pair3
RSS-total score (adm,0-100 scale) &RSS-total score (dc,0-100 scale)
Pair4
N Correlation Sig.
Paired Samples Test
3.9216 4.2875 1.0399 1.7172 6.1260 3.771 16 .002
2.3529 3.1213 .7570 .7481 3.9578 3.108 16 .007
6.2500 8.8388 2.1437 1.7055 10.7945 2.915 16 .010
3.1373 4.5599 1.1059 .7928 5.4817 2.837 16 .012
RSS-personal distress(adm, 0-100 scale) -
RSS-personal distress(dc, 0-100 scale)
Pair1
RSS-life upset (adm,0-100 scale) - RSS-lifeupset (dc, 0-100 scale)
Pair2
RSS-negative feelings(adm, 0-100 scale) -RSS-negative feelings(dc, 0-100 scale)
Pair3
RSS-total score (adm,0-100 scale) -RSS-total score (dc,0-100 scale)
Pair4
MeanStd.
DeviationStd. Error
Mean Lower Upper
95% ConfidenceInterval of the
Difference
Paired Differences
t dfSig.
(2-tailed)
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For the working status of the cases pre- & post-discharge, the number of cases being employed increased from 22 to 47 at discharge, the numberof cases unemployed from 89 drops to 45.
working status (pre) * working status (dc) Crosstabulation
Count
4 1 1 2 3 1 1 1 1 15
1 1 2
1 1
1 1 21 1 2
3 2 1 1 7
1 2 11 1 1 1 1 18
1 1 2
1 1
2 2
1 1 1 3
6 8 1 3 1 1 1 1 10 5 1 1 39
3 6 1 1 4 1 1 2 15 8 1 6 2 51
1 1 2
1 2 1 4
2 1 1 2 6
1 1
1 1
20 18 3 6 8 20 3 1 3 3 4 31 15 5 13 4 2 159
-
-
workinstatus(pre)
Total
-
-
working status (dc)
Total
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N um ber of unem ploym ent m onths before joining the Program : M ean 14 (M ini.1 & M axi. 48)
Their m ain financial source before the program com paring to discharge is quite the sam e, the num ber of self
earning increases from 35 to 42.
main financial source(pre) * main financial source(dc) Crosstabulation
Count
43 8 20 71
15 28 7 50
12 8 15 35
70 44 42 156
/
/
mainfinancialsource(pre)
Total
/
/
main financial source(dc)
Total
For the O ccupational Perform ance A ssessm ent Q uestionnaire, the m ean rating score is 3.2 during adm ission &3.6 during discharge show ing significant im provem ent subjectively.
Occupational Performance Assessment Questionnaire Rating
163 1.00 4.43 3.2051 .5994
162 2.00 4.57 3.6085 .4958
161
opaq (adm)
opaq (d/c)
Valid N (listwise)
N Minimum Maximum MeanStd.
Deviation
Paired Samples Correlations
161 .392 .000opaq (adm) & opaq(d/c)
Pair1
N Correlation Sig.
Paired Samples Test
-.4082 .6113 4.82E-02 -.5033 -.3130 -8.472 160 .000opaq (adm) - opaq(d/c)
Pair1
MeanStd.
DeviationStd. Error
Mean Lower Upper
95% ConfidenceInterval of the
Difference
Paired Differences
t dfSig.
(2-tailed)
For the Subjective rating on their Life satisfaction, the m ean score is 3 during adm ission & 3.45 during
discharge show ing significant im provem ent.
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Life Satisfaction Questionnaire
163 1.25 4.75 3.0153 .6308
162 1.00 4.50 3.4537 .6125
161
life satisfaction (adm)
life satisfaction (d/c)
Valid N (listwise)
N Minimum Maximum MeanStd.
Deviation
Paired Samples Correlations
161 .238 .002life satisfaction (adm)& life satisfaction (d/c)
Pair1
N Correlation Sig.
Paired Samples Test
-.4363 .7697 6.07E-02 -.5561 -.3165 -7.193 160 .000life satisfaction (adm)- life satisfaction (d/c)
Pair1
MeanStd.
DeviationStd. Error
Mean Lower Upper
95% Confidence
Interval of theDifference
Paired Differences
t dfSig.
(2-tailed)
For the perceived H ealth status & Q O L, there are m ore satisfied on discharge.
health status(pre) * health status(dc) Crosstabulation
Count
2 1 2 5 10
2 22 15 28 1 68
1 2 8 11 22
1 8 4 42 1 56
1 2 2 5
6 34 29 88 4 161
extremely dissatisfied
dissatisfied
neither satisfied nordissatisfied
satisfied
extremely satisfied
healthstatus(pre)
Total
extremelydissatisfied
dissatisfied
neithersatisfied
nordissatisfi
ed satisfiedextremelysatisfied
health status(dc)
Total
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QOL(pre) * QOL(dc) Crosstabulation
Count
2 1 1 4 8
1 9 19 23 1 53
3 23 19 1 46
1 2 5 42 1 51
3 3
4 15 48 91 3 161
extremely dissatisfied
dissatisfied
neither satisfied nordissatisfied
satisfied
extremely satisfied
QOL(pre)
Total
extremelydissatisfie
ddissatisfi
ed
neithersatisfied
nordissatisfi
ed satisfiedextremelysatisfied
QOL(dc)
Total
For the overall happiness of the discharged cases, there is a significant shift to the happy side.
happiness(pre) * happiness(dc) Crosstabulation
Count
3 11 12 9 35
1 15 29 4 49
4 48 12 1 65
2 7 1 102 2
4 30 91 32 4 161
unhappy
slightly happy
happy to a certainextent
very happyextremely happy
happiness(pre)
Total
unhappySlightlyhappy
happy toa certainextent
veryhappy
extremelyhappy
happiness(dc)
Total
For the satisfaction tow ards O T service at discharge, the m ean rating is 3.9 w hich is satisfactory.
Satisfaction towards OT Service at Discharge
161 2.00 5.00 3.9074 .4448
161
OT serv satisfaction(d/c)
Valid N (listwise)
N Minimum Maximum MeanStd.
Deviation
A t 3 m onths Follow -up, there is no change for their perceived health status, Q O L score & perceived happinessw hich m eans that they are w ell m aintained w ith no deterioration.
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health status(dc) * health status(3m) Crosstabulation
Count
2 2
6 5 2 13
3 9 2 14
2 2 33 2 39
1 1
13 16 37 3 69
extremely dissatisfied
dissatisfied
neither satisfied nordissatisfied
satisfied
extremely satisfied
healthstatus(dc)
Total
dissatisfied
neithersatisfied
nordissatisfi
ed satisfiedextremelysatisfied
health status(3m)
Total
QOL(dc) * QOL(3m) Crosstabulation
Count
2 2
4 2 6
4 10 5 19
2 3 35 401 1 2
12 13 43 1 69
extremely dissatisfied
dissatisfied
neither satisfied nordissatisfied
satisfiedextremely satisfied
QOL(dc)
Total
dissatisfied
neithersatisfied
nordissatisfi
ed satisfiedextremelysatisfied
QOL(3m)
Total
happiness(dc) * happiness(3m) Crosstabulation
Count
1 1 1 3
1 7 3 11
2 3 27 6 38
1 1 13 15
1 1 2
4 12 32 20 1 69
unhappy
slightly happy
happy to a certainextent
very happy
extremely happy
happiness(dc)
Total
unhappyslightlyhappy
happy toa certainextent
veryhappy
extremelyhappy
happiness(3m)
Total
For the perceived change of Q O L at discharge. 86% of cases expressed im provem ent.
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Change of QOL at Discharge
7 4.3 4.4 4.4
49 29.9 30.6 35.082 50.0 51.3 86.3
21 12.8 13.1 99.4
1 .6 .6 100.0
160 97.6 100.0
4 2.4
164 100.0
extremelyimproved
much improveda little bit improved
unchanged
extremely worse
Total
Valid
SystemMissing
Total
Frequency PercentValid
PercentCumulative
Percent
For the perceived change of Q O L at 3-m onths Follow -up, 65% cases show ed im provem ent & 32% cases
expressed no change w hich m eans that they are w ell m aintained again.
Change of QOL at 3-months Follow-up
2 1.2 2.9 2.9
12 7.3 17.4 20.3
31 18.9 44.9 65.2
22 13.4 31.9 97.1
1 .6 1.4 98.6
1 .6 1.4 100.0
69 42.1 100.0
95 57.9
164 100.0
extremelyimproved
much improved
a little bit improved
unchanged
a little bit worse
much worse
Total
Valid
SystemMissing
Total
Frequency PercentValid
PercentCumulative
Percent
W hen com paring their satisfaction tow ards their living status & w orking status before adm ission to discharge,
it show s significant changes in their satisfaction.
Comparision of Satisfaction to Living Status & Working Status before
Admission & at Discharge
3.4088 159 .9086 7.21E-02
3.6604 159 .8331 6.61E-02
2.6899 158 .9300 7.40E-02
3.1709 158 .8309 6.61E-02
satisfy with livingstatus (pre)
satisfy with livingstatus (dc)
Pair1
satisfy with working
status (pre)
satisfy with workingstatus (dc)
Pair
2
Mean NStd.
DeviationStd. Error
Mean
A lso, w hen com paring betw een discharge & 3-m onths follow -up, it show s significant changes in their
satisfaction.
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18
Comparision of Satisfaction to Living Status & Working Status at
Discharge & 3-months Follow-up
3.7101 69 .8243 9.92E-02
3.83 69 .73 8.75E-02
3.2319 69 .7886 9.49E-02
3.45 69 .80 9.58E-02
satisfy with living
status (dc)satisfy with livingstatus (3m)
Pair
1
satisfy with workingstatus (dc)
satisfy with workingstatus (3m)
Pair2
Mean NStd.
DeviationStd. Error
Mean
The Service Statistics:
Length of Stay in Psy. Out-patient OT Service
160 3.00 514.00 145.5938 108.3635
160
date of complete OT - date ofcommence OT(x21-x05), days
Valid N (listwise)
N Minimum Maximum MeanStd.
Deviation
Psy. Out-patient OT Attendances
155 1.00 202.00 20.8774 27.4818
155
No. of out-pt attn
Valid N (listwise)
N Minimum Maximum MeanStd.
Deviation
Number of COT Visits & Telephone Contacts
132 0 10 .47 1.41
135 0 30 2.24 4.02
131
no. of COT visit
no. of tel consultation
Valid N (listwise)
N Minimum Maximum MeanStd.
Deviation
IX. Conclusions:With the existing service delivery mode in HA Psychiatric OT Departments, about 36% (431) of the total
psychiatric Out-patient referrals (1204) will receive intensive OT rehabilitation services.
Among them, 164 are discharged within 2 years. Their mean length of stay in Psy out-patient OT
program is about 5 months.
Their mean age is 35 years old with the average duration of illness is 8.3 years. Half of them are suffering
from Schizophrenia, 22% are suffering from Depressive Episodes.
25 cases were re-admitted to the Hospital during this 2 years period (5.8%). Their mean period in
receiving the OT services is 85.5 days (min 9 days, max 214days, 16 cases with unknown length of
period). Comparing to KCH statistics, the total re-admissions in 2003 was 2444 , with 26000 active cases
followed-up under the KCH cluster Psy Out-patient Units, the re-admission rate is about 9.4%.
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19
This can be the baseline for our future benchmarking purpose.
Functionally, they all showed significant improvements. For work aspect, in the domains of Social,
adaptability, Self control, personal presentation, attitudes under supervision, the improvement is
significant. (N=60, p
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20
Everson, R.C., & Boyd, M.A. (1993). The St. Louis inventory of community living skills. Psychosocial
Rehabilitation Journal, 17(2): 93-99.
Fitz, D., & Evenson, R.C. (1995). A validity study of the St. Louis inventory of community living skills.
Community Mental Health Journal, 31(4): 369-377.
Fitz, D. (1999). Recommending client residence: a comparison of the St. Louis inventory of community
living skills and global assessment. Psychiatric Rehabilitation Journal, 23(2): 107-113.
Hilsenroth, M.J., et al. (2000). Reliability and validity of DSM-IV axis V. American Journal of Psychiatry.
157(11): 1858-1863.
Lysaker, P., & Bell, M., (1995). Work performance over time for people with Schizophrenia.
Psychosocial Rehabilitation Journal, 18(3): 141-146.
Williams,R. (1997). Work personality profile: validation within the supported employment environment.
Journal of Rehabilitation, 63(2): 26-31.
Greene J.G., et al (1982). Measuring behavioral disturbance of elderly demented patients in the
community and its effects on relatives: a factor analytic study. Age and Ageing. 11: 121-126.
XII. Appendices:
Appendix I : Psychiatric Out-patient Referral Form
Appendix II : Work Adjustment Program
Appendix III : Home Adjustment Program
Appendix IV : Community Adjustment Program
Appendix V : Relative Stress Scale
Appendix VI : St. Louis Inventory of Community Living Skills Chinese Version
Appendix VII : Social and Occupational Functioning Assessment Scale
Appendix VIII : Chinese Work Personality Profile
Appendix IX : Occupational Therapy Generic Outcome Questionnaire, Hospital Authority
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Appendix I: Referral Form on OT Program for Psychiatric Out-patient
KWAI CHUNG HOSPITAL
OCCUPATIONAL THERAPY
PSYCHIATRIC OUT-PATIENT SERVICES
REFERRAL FORM
(Please affix label)
Hospital / OPD No:
Name:
ID No: Sex: Age:
Team:
Diagnosis:
Presenting Problem:
Status: ? Ordinary ? PFU Target ? PFU Subtarget
Precautions (Psychiatric): ? Suicidal ? Aggressive ? Others:
Precautions (Medical): ? Epilepsy ? Diabetes Mellitus ? Hypertension
? Chronic Obstructive Pulmonary Disease ? Others:
Referral Aims:
? Work Adjustment Program
e.g. work capacity evaluation; work related social skills training; job planning & preparation; job placement; supported
employment; vocational counseling; on site job visit, etc.
(please specify, if necessary)
? Home Adjustment Programe.g. household management; career support & relationship building; stress & leisure management; etc.
(please specify, if necessary)
? Community Adjustment Program
e.g. community living skills; use of community resources; social & coping skills enhancement, etc.
(please specify, if necessary)
? Occupational Life-Style Re-design
e.g. structured use of daily routines, etc.
(please specify, if necessary)
? Others
(please specify, if necessary)
Date of Referral: Referring Medical Officer
(Signature)
(Name in block letter)
(Tel. No)
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Appendix II: Work Adjustment Program for Adult Psychiatric Out-patients
Yes
Yes
No
NoRecommend or Refer to other services
Termination of Occupational Therapy service
Data base collection
Screening Assessment
Occupational Therapy referral for
WORK ADJUSTMENT PROGRAM
Problem Identification
Continue Occupational
Therapy service?
Outcome Measurement: Admission
Functional assessment
Treatment Plan formulation
Treatment Implementation
Treatment Goal meet?
Outcome Measurement: Discharge
Outcome Measurement: Follow Up
Termination of Occupational
Therapy service
Work Capacity Evaluation, WPP, WBC, Relative Stress Scale,
Social & Occupational Functioning Assessment Scale
Vocational Counselling, Job Planning & Preparation,
Work-related Social Skill, Job Placement, Job Follow-up
Work Adjustment Program for Adult Psychiatric Out-patients
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1
Appendix III: Home Adjustment Program for Adult Psychiatric Out-patient
Referrals from Case Medical Officer (C.M.O.)
(case summary attached)
OPD Occupational Therapist to
contact client to clarify referred aims and O.T. services
If not suitable Initial Interview If refusal of
for O.T. services (with client and /or carer) O.T. services
Inform C.M.O. Assessment Inform C.M.O.
and /or recommend and /or recommend
other services Formulate Treatment Plan other services
with client
Client is discharged Client is discharged
from O.T.services OT intervention from O.T. services
Review
of Progress and Treatment Plan with ClientDocument Progress Report
and further treatment if required
Little Progress or Achieve Treatment Goal
refusal of treatment
Terminate O.T. services,
Terminate O.T. services,
and send Discharge summary inform CMO and
send Discharge Summary
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Appendix IV: Community Adjustment Program for Adult Psychiatric Out-patient
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RELATIVES STRESS SCALE (RSS)
Score
1. Do you ever feel you can no longer cope with the situation?
0 1 2 3 4
2. D you ever feel that you need a break?
0 1 2 3 4
3. Do you ever get depressed by the situation?
0 1 2 3 4
4. Has your own health suffered at all?
0 1 2 3 4
5. Do you worry about accidents happening to ?
0 1 2 3 4
6. Do you ever feel that there will be no end to this problem?
0 1 2 3 4
7. Do you find it difficult to get away on holiday?
0 1 2 3 4
8. How much has your social life been affected?
0 1 2 3 4
9. How much has the household routine been upset?
0 1 2 3 4
10. Is your sleep interrupted by ?
0 1 2 3 4
11. Has your standard of living been reduced?
0 1 2 3 4
12. Do you ever feel embarrassed by ?
0 1 2 3 4
13. Are you at all prevented from having visitors?
0 1 2 3 4
14. Do you ever get cross and angry with ?
0 1 2 3 4
15. Do you ever feel frustrated at times with ?
0 1 2 3 4
Subscales:
Q. 1-6 / 24(Personal distress)
Q. 7-11 / 20(Life upset)
Q. 12-15 / 16(Negative feelings)
Total score: / 60
Code: never / not at all / Score 0rarely / a little / 1sometimes / moderately / 2
frequently / quite a lot / 3always / considerable / 4
01/2/RSS
Appendix V
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St. Louis Inventory of Community Living Skill s Chinese Version
(SLICLS-C)
__________________ _____________________ __________________ _____________________
_________________
():
1.
2.
3.
4.
5.
6.
7.
"4"
1. ,
1 2 3 4 5 6 7
2. , ,
1 2 3 4 5 6 7
3.
1 2 3 4 5 6 7
4.
1 2 3 4 5 6 7
5.
1 2 3 4 5 6 7
6.
1 2 3 4 5 6 7
7.
1 2 3 4 5 6 7
Appendix VI
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8.
,
1 2 3 4 5 6 7
9.
1 2 3 4 5 6 7
10. ,
1 2 3 4 5 6 7
11. ,
1 2 3 4 5 6 7
12. 1 2 3 4 5 6 7
13. /
1 2 3 4 5 6 7
14.
1 2 3 4 5 6 7
15.
1 2 3 4 5 6 7
16. :
__________
:
1 15 :
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Psy/Out/1/12/2001
Occupational Therapy Department KCH
Social and Occupational Functioning Assessment Scale (SOFAS)
Hospital ___________________ ID No: ____________________
Patient Name _______________ Date of Assessment __________
DOA ______ Age ___ Sex ___ Diagnosis: _________________
SOFAS Score _______________ Rater __________________
Consider social and occupational functioning on a continuum from excellent functioning to
grossly impaired functioning. Include impairments in functioning due to physical limitations, as well as
those due to mental impairments. To be counted, impairment must be a direct consequence of mental
and physical health problems; the effects of lack of opportunity and other environmental limitations are
not to be considered.
Code (Note: Use intermediate codes when appropriate, e.g. 45, 68, 72)
100
|
91
Superior functioning in a wide range of activities.
90
|
81
Good Functioning in all areas, occupationally and socially effective.
80
|
71
No more than a slight impairment in social (e.g., infrequent interpersonal conflict),
occupational (e.g., missing a few deadlines or appointment), or school functioning (e.g.,
temporarily falling behind in schoolwork).
70
|
61
Some difficulty in social, occupational (e.g., frequent work absences, work occasionally
incomplete or judged not up to standards) or school functioning (e.g., occasional truancy, or
theft within the household), but generally functioning pretty well, has some meaningful
interpersonal relationships.
60|
51
Moderate difficulty in social (e.g., few friends, conflicts with peers or co-workers),occupational, or school functioning, (e.g., unable to complete work assignments,
unsatisfactory work performance).
50
|
41
Serious impairment in social, occupational, or school functioning (e.g., no friends, unable to
keep a job at expected or prior level of performance).
40
|
31
Major impairment in several areas, such as work or school, family relations (e.g., depressed
person avoids friends, neglects family, and is unable to work; child frequently beats up
younger children, is defiant at home, and is failing at school).
30
|21
Inability to function in almost all areas (e.g., stays in bed all day; no job, home, or friends).
20
|
11
Occasionally fails to maintain minimal personal hygiene (e.g., smear feces), unable to
function independently.
10
|
1
Persistent inability to maintain minimal personal hygiene. Unable to function without harming
self or others or without considerable external support (e.g. nursing care and supervision).
0 Inadequate information
Appendix VII
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KWAI CHUNG HOSPITAL
OCCUPATIONAL THERAPY DEPARTMENT
The Chinese Work Personality Profile
Please Use Block Letter or Affix Label
Medical Record No.:
Name :
I.D. No.: Sex : Age :
Dept. : Ward / Bed No.:
Date : Case OT :
? ? ?
(4) ?
(3) ?
(2) ?
(1) ?
(X)
1)
2)
3)
4)
5) 6)
7)
8)
9)
10)
11)
12)
13)
14)
15)
Appendix VIII
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16)
17)
18)
19)
20)
21)
22)
23)
24)
25)
26)
27)
28)
29)
30)
31)
32)
33)
34)
35)
36)
37)
38)
39)
40)
41)
42)
43)
44) ?
45)
46)
47)
48)
49)
50)
51)
52) ? ? ?
53)
54)
55)
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56)
57) ? ? ? ?
58)
?
/100 /60 /28 /36 /8
? ? ?
(4) ?
(3) ?
(2) ?
(1) ?
(X)
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PSY-D/O-AD
1 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
()
To be administered by case therapist or interviewer around the time of starting of the Day- / Out-patient
OT service. (All scores should be entered into the subject corresponding answer book.)
[Interviewer should read the followings to the subject]
[Read the followings to the subject for practice.]
,
,
()
o1 o2 o3 o4 o5
()
o1 o2 o3 o4 o5
Appendix IX
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PSY-D/O-AD
2 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
()
[If interviewer feel that the subject understand well what he/she is requested in
answering the question, the next example can be skipped]
o1 o2 o3 o4 o5
[/]
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PSY-D/O-AD
3 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
:[/]
1. o01 o04 o07 o10
o02 o05 o08 o12()
o03 o06 o09 o13()
o11 _____________
2. o1 o2 o3 o4 o5
3. ()()
o01 o06 o11 o16
o02 o07 o12 o17
o03 o08 o13 o18
o04 o09 o14 o19
o05 o10 o15 _____________
3a. [/], :? (999 =)
3b. [/], :
? (999 =)
4.
o1 o2 o3 o4 o5
5. ()o1 o2 o3 o4 o5 o9
===========================================================================
5a. :o1 /o3 /o4
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PSY-D/O-AD
4 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
: [/]
[/]
14. o1 o2 o3 o4 o5
15. o o o o o
16.
(
)
o o o o o
17.
o o o o o
18.
o o o o o
19.
(? )
o o o o o
20.
(
)
o o o o o
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PSY-D/O-AD
5 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
: [/]
[/]
21. o1 o2 o3 o4 o5
22. o o o o o
23.
()o o o o o
24.
()o o o o o
25. o o o o o
26.
o o o o o
27. o1 o2 o3 o4 o5
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PSY-D/O-DC
6 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
()
To be administered by case therapist or interviewer around the time of Discharge
(All scores should be entered into the subjects corresponding answer book.)
[Interviewer should read the followings to the subject]
[Read the followings to the subject for practice.]
,
,
()
o1 o2 o3 o4 o5
()
o1 o2 o3 o4 o5
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PSY-D/O-DC
7 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
()
[If interviewer feel that the subject understand well what he/she is requested
in answering the question, the next example can be skipped]
o1 o2 o3 o4 o5
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PSY-D/O-DC
8 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
:
6.
o9 o1 o2 o3 o4 o5
7.
(
)
o o o o o o
8.
o o o o o o
9.
(
)
o o o o o o
10.
o o o o o o
11.
o o o o o o
12.
o o o o o o
13.
(
)
o o o o o o
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PSY-D/O-DC
9 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
:
14. o1 o2 o3 o4 o5
15. o o o o o
16.
(
)
o o o o o
17.
o o o o o
18.
o o o o o
19.
(? )
o o o o o
20.
(
)
o o o o o
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PSY-D/O-DC
10 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
:
21. o1 o2 o3 o4 o5
22. o o o o o
23.
()o o o o o
24.
()o o o o o
25. o o o o o
26.
o o o o o
27. o1 o2 o3 o4 o5
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PSY-D/O-DC
11 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
: [Out-patient Only]
()
28.o01 o04 o07 o10
o02 o05 o08 o12()o03 o06 o09 o13()
o11 _____________
29.
o1 o2 o3 o4 o5
30.
()
o01 o06 o11 o16o02 o07 o12 o17
o03 o08 o13 o18
o04 o09 o14 o19
o05 o10 o15 _____________
30a., :? (999 =)
30b., : ? (999 =)
31.
o1 o2 o3 o4 o5
32. ()
o1 o4 o7
o2 o5 o8
o9
33.()
o1 o2
o3 o9
34.()o1 o2 o3 o4 o5 o9
========================================================
34a. :o1 /o3 /o4
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PSY-D/O-DC
12 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
: ()
35.
o1
o2
o3
o4
o5
o6
o7 /
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PSY-D/O-DC
13 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
()()
36.
o1
o2
o3
o4
o5
o6
o7 /
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PSY-D/O-FU
14 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
()
To be administered by case therapist or interviewer around the period of [no. of months]-month
follow-up. (All scores should be entered into the subjects corresponding answer book)
[Interviewer should read the followings to the subject]
[Read the followings to the subject for practice.]
,
,
()
o1 o2 o3 o4 o55
()
o1 o2 o3 o4 o5
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PSY-D/O-FU
15 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
()
[If interviewer feel that the subject understand well what he/she is requested in
answering the question, the next example can be skipped]
o1 o2 o3 o4 o5
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PSY-D/O-FU
16 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
:
14. o1 o2 o3 o4 o5
15. o o o o o
16.
(
)
o o o o o
17.
o o o o o
18.
o o o o o
19.
(? )
o o o o o
20.
(
)
o o o o o
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PSY-D/O-FU
17 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
:
21. o1 o2 o3 o4 o5
22. o o o o o
23.
()o o o o o
24.
()o o o o o
25. o o o o o
26.
o o o o o
27. o1 o2 o3 o4 o5
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PSY-D/O-FU
18 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
: ()
28.o01 o04 o07 o10
o02 o05 o08 o12()
o03 o06 o09 o13()
o11 _____________
29.
o1 o2 o3 o4 o5
30.
()
o01 o06 o11 o16
o02 o07 o12 o17o03 o08 o13 o18
o04 o09 o14 o19
o05 o10 o15 _____________
30a., :? (999 =)
30b., : ? (999 =)
31.
o1 o2 o3 o4 o5
32. ()
o1 o4 o7
o2 o5 o8
o9
33.()
o1 o2
o3 o9
34.()
o1 o2 o3 o4 o5 o9
===========================================================================
34a. :
o1 /o3 /o4
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PSY-D/O-FU
19 Occupational Therapy Generic Outcome Study Psychiatry Day / Out-Patient (25 Apr 02)
: ()
35. 3
o1
o2
o3
o4
o5
o6
o7 /
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PSY-D/O-FU()()
36. 3
o1
o2
o3
o4
o5
o6
o7 /