1. Mayview Discharge Study Progress Report December, 2009

2. Acknowledgments Collaborators are Katie Greeno and Sue Estroff Supported by AHCI and OMHSAS

3. Policy Goals Participatory, intensive discharge planning and re-settlement process Re-settlement of people to sake, comfortable, and therapeutic living situations Guarantee consistent access to necessary mental and physical health resources and services

4. Policy Goals Maintain and improve clinical status Maximize opportunities to engage in a recovery process, including social relationships, employment, education, and other pursuits contributing to quality of life

5. Research Questions How do participants view the discharge, departure, and re-settlement process? How do participants describe their current living situation? What mental and physical health services are the participants receiving?

6. Research Questions What is the clinical status of participants since leaving Mayview? How do participants describe their social networks and relationships with others? How do participants assess their current well being, recovery process, and overall quality of life?

7. Mayview discharge study “Eyes-on” procedures supplement administrative data Choose a small group of people to represent the larger group Visit participants every three months until two years after their discharge

8. Participants Random sample of 90 people involved in CSP process Recruited 66 (73%) Discharge dates from 8/07 – 12/08 Some people recruited in the hospital, some people recruited after discharge

9. Design Surveys at the first visit, then every six months (every other visit) Observations every visit, “check-ins” every other visit Interview when the participant prefers: For example, over one year: Surveys and observations Check-in and observations Surveys and observations Check-in and observations Interview Surveys and observations

10. Observations Field notes at every visit Open-ended “check in” form every other visit Includes information from provider, if permission is given Interview Open-ended interview regarding experiences with closure and re-location Conducted when the participant chooses Can extend over multiple visits

11. Surveys Brief Psychiatric Rating Scale WHO Quality of Life – Brief Form Recovery Assessment Scale Social Adjustment Scale – Social Relationships subscale Social Networks Structured Interview Perceptions of Care Drug Attitude Inventory

12. Progress We are about mid-way through the study Some contacts are missed, but only after we provide many opportunities for connection As of November 1, we have completed 268 of 458 total interviews in the protocol

13. How are people doing? What they tell us, and what we see People tell us they are really happy to have left Mayview We see people in settings that are comfortable and pleasant People were mostly satisfied with the discharge process People see providers often Some people are more active socially than others

14. “The freedom factor” Participants consistently express the view that discharge represented emancipation, not eviction Interviewer: Compare where you are now with being at Mayview. Participant: No comparison. It’s better…it’s the freedom factor. I don’t like Mayview. It is like a penitentiary almost. Interviewer: What are you looking forward to? Participant: I am looking forward to moving. I have been here at Mayview for 4 years and am ready to go. Interviewer: Have you been feeling nervous or anxious? P: I am feeling nervous about leaving Mayview. I think it will get better when I leave.

15. What’s missed from Mayview One participant expressed sadness over his lost contact, a Mayview staff member who took a job at Torrance. Interviewer: Do you miss anyone from Mayview? Participant: One of the other patients. I: Compare where you are now with living at Mayview. Is it better or worse? P: Better would be the shower. I get to decide when I take it. I do miss the dances at Mayview, though.

16. View of discharge process The CSP process, when it is remembered, is seen as generally positive, though people did not always feel deeply involved Did you get to pick this place or did someone pick it for you? Someone picked it for me. Did you have any say in whether you wanted to live here? No I didn’t. But I knew when I came here I was going to like it. I said “Hallelujah! I am getting the hell out of here”. Did you have CSP meetings? Yeah. I had 3 or 4 of them. Interviewer: How was that for you? It was alright. It was at my last CSP meeting that I was told I was coming here. Did you feel like you got to say what you wanted in those meetings? Yeah. Did you feel like they took account of what you said? Yes they did.

17. Contact with service providers Participants report regular and generally satisfactory contact with providers I just saw him [psychiatrist] recently and will see him again in another month. [I see my case manager] just about every day. I like seeing my case manager. Some days, they don’t come. The staff [at the PCH] says I get to see my case manager more in a week than some people do in a month. I have 24 hour access to my case manager. I can call her whenever I need help or need to talk.

18. Social Networks Some people report very active social lives. Others report that most social contact is with providers, but not everyone seems dissatisfied with this Who helps you the most/best? These people here [staff]. Do you have a peer mentor? Have you seen your peer mentor? Yes…I’ve seen her several times. She comes twice a week. Has anyone visited you? My mother was here once. It was all right. I would like to get visitors.

19. Surveys Preliminary survey results show a consistent pattern that symptoms (BPRS), quality of life (WHOQOL), and recovery (RAS) are maintained over time. Interpretation needs to be preliminary We have two or more time points for most people, but not always the same time points

20. BPRS

21. Quality of Life: Psychological

22. Quality of Life: Relationships

23. “Rate your quality of life”

24. Recovery Assessment: Hope

25. Summary Qualitative data show that people are doing at least as well, and in many cases, better than when they were in Mayview. Quantitative data suggest that symptom levels and quality of life are maintained over time

26. Final thoughts What have been your best and worst experiences? Best – living here. The people here treat me good. Worst – living in Mayview. Do you miss anyone from Mayview? That’s not even on my mind. I don’t even think of Mayview any more. … I’m cool, calm, and collected.

27. Extra slides The remaining slides provide additional detail about methods, and more findings, as time and interest permit

28. Recruitment timing Time post-dischargeNumber recruited In hospital19 < 6 months31 7-12 months11 13-18 months5 Total66

29. Qualitative analyses: methods We review all visits made every week Additionally, we randomly selected 17 participants, and reviewed all qualitative data (field notes, check ins, interviews) Organized in terms of themes that address the major questions of the study

30. BPRS: details Hosp3 months 6 months 12 months 18 months N1911393110 averag e 4035 3229

31. Quality of life: detailed NormHosp361218 N1713362810 Phys746673597265 Psych716057586342 Relns725475606158 Envrn756165596941

32. Items related to environment The six items in the WHOQol related to satisfaction with environment are tabulated separately. Ratings are highest for “safety” and “access to health services”, and lowest for “enough money”. Slides are ordered to reflect “best” to “worst” rating overall

33. Interpretation is preliminary, but the scale scores suggest: People are the happiest about safety, access to health services, opportunities to do things, and transportation. Although they are quite satisfied with “conditions of living place” they are less positive about “healthy living environment”. They are the least positive about having the information they need, and having enough money

34. “Are you satisfied with your access to health services”

35. “How safe do you feel in your daily life”

36. “Do you have opportunities to do things you like”

37. “Are you satisfied with your transport”

38. “Are you satisfied with the conditions of your living place”

39. “How healthy is your physical environment”

40. “Do you have the information that you need for your daily life?”

41. “Do you have enough money to meet your needs?”