student profile: Ms Kylie Stewart


Thesis work

Thesis title: Successful community living for people with schizophrenia: the role cognition and formal and informal support

Supervisors: Roger STANCLIFFE , Nicola HANCOCK

Thesis abstract:

Occupational Therapists working in mental health services are frequently asked to predict how people diagnosed with a mental illness will perform in the community and to recommend suitable accommodation options. To date there has been limited research examining whether accommodation-related recommendations made by an occupational therapist at discharge are followed and whether this leads to enhanced outcomes for people living with schizophrenia. Cognitive deficits associated with schizophrenia are unarguable (Green, 1996, Green et al., 2004; Green et al., 2000; Su et al., 2011; Velligan et al., 2000). People with schizophrenia have been found to have deficits with information processing speed, verbal and visual memory, attention and motor processing speed (Green et al., 2000). Cognitive deficits associated with schizophrenia are strongly associated with functional disabilities and burden of disease (Rajji et al., 2014). Occupational therapists in mental health are routinely asked to assess a consumer’s functional capacity (Brown, 2009). The results from this assessment are used to make recommendations on supports and discharge destinations. The Allen Cognitive Level test (ACL) (Allen et al., 2007), is a commonly administered assessment of cognition used by mental health occupational therapists (Scanlan et al., 2013). Performance on the test is evaluated against standardised scoring criteria resulting in an ACL score. Each ACL score has a corresponding descriptor of the level of cognitive assistance and support required. Research has found that the ACL score is associated with predicting social and occupational function, level of productive activity and social effectiveness in the community (Velligan et al., 1998); level of independence at discharge (Velligan et al., 1998); and life skills (Keller & Hayes, 1998). However, there has been no research to investigate if the support and housing recommendations offered by the ACL score lead to better outcomes for people with schizophrenia.Within the limited research examining the ability to predict community functioning post discharge from hospital for people with schizophrenia, the Allen Cognitive Level test(ACL)( Allen et al., 2007) score has shown a positive relationship with community functioning (Velligan, 1998). For each ACL score a recommendation on the supports required for successful living is given. For example, for people scored at certain levels 24-hour supervision is recommended, while those scored at another level may require drop-in support once a week. Thus far there has been no research examining whether a fit between a person’s ACL score and their actual accommodation placement results in better outcomes for consumers.New South Wales Health mandates that standardised outcome measures, the Mental Health Outcome and Assessment Tools (MH-OAT), are completed for every consumer of public mental health services. These measures include the Life Skill Profile (LSP) (Parker et al., 1991), and the Health of a Nation Outcome Scale (HoNOS) (Wing et al., 1998). The LSP-16 is a clinician completed, 16-item rating scale developed to assess consumer’s life skills over the preceding 3 months. The LSP emphasises the consumers “life skills” rather than “lack of skill”, measuring four subscales of self-care, anti-social behaviour, withdrawal and compliance (NSW Health, 2011). The HoNOS is a 12-item clinician rated measure to assess the severity of mental disorders experienced by consumers. It has four subscales of behavioural problems, impairment, symptomatic problems and social problems (NSW Health, 2011). The combination of the LSP and HoNOS provide a multidimensional representation of outcomes for consumers.The overarching research question is can the ACL score and corresponding descriptors of support required be used to provide suitable accommodation recommendations for people with schizophrenia? Three specific null hypotheses will be investigated: Life Skill Profile (LSP), Kessler 10 (K10) and Health of the Nation Outcome Scale (HoNOS) scores will not differ significantly between people with schizophrenia who are placed in recommended supports based on their Allen Cognitive Level (ACL) score from consumers placed in non-recommended supports.Number of readmissions to hospital 1 years post discharge will not be significantly different between people with schizophrenia who are placed in recommended accommodation with recommended supports based on their ACL score and those placed in non-recommended supports. Length of stay for hospital readmissions will not be significantly different between people with schizophrenia who are placed in recommended accommodation with recommended supports based on their ACL score and those placed in non-recommended supports.

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