psy outpatient

8/14/2019 Psy Outpatient

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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


61 .792 .000

60 .728 .000

60 .715 .000

61 .704 .000

61 .644 .000

cwpp_s1 (adm)& cwpp_s1 (dc)

Pair1


Pair2


Pair3


Pair4


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


Pair2


Pair3


Pair4


Pair5

MeanStd.

DeviationStd. Error

Mean Lower Upper


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.


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


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


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.


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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17 .982 .000

17 .991 .000

17 .905 .000

17 .980 .000

RSS-personal distress(adm, 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) -


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


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


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


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)


Deviation


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


dissatisfied


satisfied

extremely satisfied

QOL(pre)

Total

extremelydissatisfie

ddissatisfi

ed

neithersatisfied

nordissatisfi


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)


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


dissatisfied


satisfied

extremely satisfied

healthstatus(dc)

Total

dissatisfied

neithersatisfied

nordissatisfi


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


dissatisfied


satisfiedextremely satisfied

QOL(dc)

Total

dissatisfied

neithersatisfied

nordissatisfi


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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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)


Deviation

Psy. Out-patient OT Attendances

155 1.00 202.00 20.8774 27.4818

155

No. of out-pt attn

Valid N (listwise)


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)


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


20/51

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


21/51

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.


? Community Adjustment Program

e.g. community living skills; use of community resources; social & coping skills enhancement, etc.


? Occupational Life-Style Re-design

e.g. structured use of daily routines, etc.


? Others


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


23/51

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


25/51

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


26/51

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


27/51

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 :


28/51

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


29/51

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


30/51

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)


31/51

56)

57) ? ? ? ?

58)

?

/100 /60 /28 /36 /8

? ? ?

(4) ?

(3) ?

(2) ?

(1) ?

(X)


32/51

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


33/51

PSY-D/O-AD


()

[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

[/]


34/51

PSY-D/O-AD


:[/]

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


35/51

PSY-D/O-AD


: [/]

[/]

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


36/51

PSY-D/O-AD


: [/]

[/]

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


37/51

PSY-D/O-DC


()

To be administered by case therapist or interviewer around the time of Discharge

(All scores should be entered into the subjects corresponding answer book.)



,

,

()

o1 o2 o3 o4 o5

()

o1 o2 o3 o4 o5


38/51

PSY-D/O-DC


()

[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


39/51

PSY-D/O-DC


:

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


40/51

PSY-D/O-DC


:

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


41/51

PSY-D/O-DC


:

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


42/51

PSY-D/O-DC


: [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


43/51

PSY-D/O-DC


: ()

35.

o1

o2

o3

o4

o5

o6

o7 /


44/51

PSY-D/O-DC


()()

36.

o1

o2

o3

o4

o5

o6

o7 /


45/51

PSY-D/O-FU


()

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)



,

,

()

o1 o2 o3 o4 o55

()

o1 o2 o3 o4 o5


46/51

PSY-D/O-FU


()

[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


47/51

PSY-D/O-FU


:

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


48/51

PSY-D/O-FU


:

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


49/51

PSY-D/O-FU


: ()

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


50/51

PSY-D/O-FU


: ()

35. 3

o1

o2

o3

o4

o5

o6

o7 /


51/51

PSY-D/O-FU()()

36. 3

o1

o2

o3

o4

o5

o6

o7 /

psy outpatient

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