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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Psychiatry | doi: 10.3389/fpsyt.2019.00798

A comprehensive cohort description and statistical grouping of community-based residential rehabilitation service users in Australia

 Stephen Parker1, 2*,  Dan Siskind1, 2,  Daniel F. Hermens3,  Frances L. Dark1, 2, Gemma McKeon2, Nicole Korman2, Urska Arnautovska4, Meredith Harris1 and Harvey Whiteford1
  • 1School of Public Health, University of Queensland, Australia
  • 2Metro South Addiction and Mental Health Services, Australia
  • 3Sunshine Coast Mind and Neuroscience Thompson Institute, University of the Sunshine Coast, Australia
  • 4Other, Australia

Background

Community Care Units (CCUs) are a model of community-based residential rehabilitation support available in Australia that assists people affected by severe and persistent mental illness to enhance their independent living skills and community involvement. These services have been subject to limited evaluation, and available descriptions of consumer cohorts lack relevance to the understanding of their rehabilitation needs.

Method

An assessment battery covering a broad range of relevant domains was completed with all consumers commencing at three CCUs in Queensland, Australia, between December 2014 and December 2017 (N=145). The cohort was described based on demographic, diagnostic, treatment-related variables, and the assessment battery. The comparability of included sites was assessed. This contemporary cohort was also compared to the pooled cohort of Australian community-based residential rehabilitation services emerging from a previous systematic review. Additionally, cluster analysis (CA) was completed in two stages based on the clinician-rated assessments: hierarchical CA (Wards method) to identify the optimal number of clusters, followed by K-means clustering.

Results

Dominant features of the cohort were male sex and a primary diagnosis of a schizophrenia spectrum disorder. The average consumer age was 31.4 years. Most consumers were referred from the community, had been living with family, and were not subject to involuntary treatment orders. No site-based differences emerged on demographic, diagnostic and treatment-related variables. However, some site-based variation in levels of symptoms and functional impairment emerged. Overall, the cohort was comparable with the Transitional Residential Rehabilitation (TRR) cohort defined in a previous systematic review. Through CA, a three-cluster solution emerged: Cluster 1 (15%) was characterised by higher levels of substance use comorbidity; Cluster 2 (39%) was characterised by higher levels of disability and symptoms; and Cluster 3 (46%) was distinguished by lower levels of general psychiatric symptoms.

Conclusions

The cohort was generally comparable to the TRR cohort. Site-based variability in the characteristics of admitted consumers was minimal. The CA solution suggested that three different sub-groups of consumers are admitted to CCUs, which have implications for adapting the approach to rehabilitation. Recommendations include ensuring early availability of interventions to address co-morbidities and pacing rehabilitation expectations to consumers stage of recovery.

Keywords: Community care unit, Rehabilitation, Residential care adults, Schizophrenia, Severe and persistent mental illness

Received: 12 Jul 2019; Accepted: 07 Oct 2019.

Copyright: © 2019 Parker, Siskind, Hermens, Dark, McKeon, Korman, Arnautovska, Harris and Whiteford. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Mx. Stephen Parker, School of Public Health, University of Queensland, Herston, Queensland, Australia, stephen.parker@health.qld.gov.au