Biomedical subjects

P N Goering

Publications and source records attributed to P N Goering.

7 recordsLinked to original sources

PubMed1995

The role of research in systems reform.

Knowledge concerning the care of people with severe and persistent mental illness has grown dramatically, but that knowledge is seldom translated into improvements in care. The authors describe their involvement in three service delivery projects in Ontario and discuss how, by assuming multiple roles, they were able to ensure that planning and policy development were informed by current knowledge. In addition to being an investigator, such roles may include being an administrator, planner, consultant and advocate. The redevelopment of Whitby Psychiatric Hospital resulted in an innovative plan for a comprehensive, integrated service delivery system based upon community support services research. Implementation of the Graham Report in Ontario provided an array of district mental health plans which incorporate current knowledge with regard to service delivery. Ontario's mental health reform strategy represents a close connection between public policy and scientific information. The authors recommend that researchers be prepared to assume multiple roles in the service delivery field so as to reduce the gap between science and practice.

Comprehensive Health Care↗

PubMed1994

Intensive studies of patients and the experiences of investigators and clinicians.

Mental processes, normal or abnormal, are complex and multifaceted, needing to be viewed from diverse perspectives. But our field has split increasingly into two discrete groups. One group includes those investigators and clinicians who are often seen as most scientific and have restricted themselves more and more exclusively to directly observable, generally superficial phenomena and patients as classified according to those phenomena. Such variables can be reliably rated, a crucial aspect of any scientific endeavor. But in this group there has been a tendency to be like the person who lost the keys in the middle of the block but looked for them at the corner because "the light is better here." Those of us in this group have tended to act as though, if we can't measure a phenomenon with relative ease, it doesn't exist--potentially the antithesis of an adequate science. Others, and they have become rarer, have focused on understanding the psychological processes of individuals with mental disorder in great depth, while paying less attention to questions of scientific approaches to proof.

Female↗

PubMed1993

The hostel outreach program: assertive case management for homeless mentally ill persons.

OBJECTIVE: This study measured the impact of an assertive case management program for psychiatrically disabled homeless persons in metropolitan Toronto. It was hypothesized that the program would improve residential stability, reduce psychiatric symptoms, improve social functioning, improve social networks, and increase use of appropriate services. METHOD: For 59 clients admitted to the program, assessments for the nine-month period before program entry were completed and were repeated nine months later. The Brief Psychiatric Rating Scale and a version of the Scale for Level of Functioning were the main measures of outcome. RESULTS: At follow-up significant improvements in residential stability and reductions in psychopathology were demonstrated. Improvements in social functioning and increases in social network size were significant. Although no baseline data about service use were collected, clients used basic support services during their first nine months in the program. CONCLUSIONS: The success of the program demonstrates that a difficult-to-treat patient population can be helped in a humane fashion if trained personnel are available.

Activities of Daily Living↗

PubMed1992

Marital support and recovery from depression.

A prospective study of 47 married women who met RDC for major depressive disorder investigated the relationship between the social support provided by the husbands and the post-hospital symptom course of the women. Separate taped semistructured interviews were held with the patient and husband at the time of admission. Six months later, symptom course was rated using the LIFE psychiatric status schedule. Only 51% of the sample recovered in the six months. Few demographic or clinical factors were related to symptom course. Recovery was predicted by the depressed woman's ratings of the current marital relationship and by the husband's rating of the pre-morbid relationship but not by the husband's level of expressed criticism or his ratings of the current relationship.

Adult↗

PubMed1989

Components of care for patients with schizophrenia.

To assist in the planning of mental health services for Metropolitan Toronto, the Mental Health Care Committee of the Metropolitan Toronto District Health Council convened a Task Force on Mental Health Epidemiology to help determine the need for services for patients suffering from schizophrenia. As part of its work, the Task Force described components of care which comprise a comprehensive treatment model. Underlying this approach was the recognition that many efficient, effective interventions for the treatment of schizophrenia have been developed and evaluated, but few attempts have been made to apply these various interventions in a systematic, comprehensive manner. This report presents an inventory of state-of-the-art approaches to dealing with schizophrenia which should be of interest both to practicing clinicians and health care planners.

Adult↗

PubMed1988

What difference does case management make?

The outcomes of 82 patients in a rehabilitation-oriented case management program six months and two years after they were discharged from an inpatient setting to join the program were compared with those of 82 matched control patients who had been discharged from the same inpatient settings before the case management program was established. At the two-year follow-up, the patients in the case management program were significantly more likely than the control patients to have better occupational functioning, to live in a residence requiring more independence than they did at the six-month follow-up, and to be less socially isolated; in contrast, at the six-month follow-up only their occupational functioning was better than the control group's. The two groups did not differ in number of hospitalizations at either follow-up. The authors believe the study supplies much-needed documentation of the effectiveness of rehabilitation-oriented case management.

Chronic Disease↗

PubMed1985

Impact of a case manager program on psychiatric aftercare.

Shifting the locus of aftercare planning from hospital to community can enhance continuity of care. The authors compared chronically mentally ill patients assessed and managed by community-based practitioners trained in psychiatric rehabilitation with patients whose discharge planning was arranged by inpatient staff members. They found significant differences between the two groups in aftercare needs identified, aftercare referrals made, and use of aftercare services. The authors conclude that this approach to psychiatric aftercare is superior to more traditional models if practitioners are carefully trained.

Adult↗