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The Day Center EPAPSY

The Day Center EPAPSY. Dr. Konstantinos Papakonstantinou, Psychiatrist, psychoanalyst Scientific manager of Day Center. Day Center. Founded in 2004 5 th Psychiatric Sector ( 2 0 0 .000 population approx.) Offers complete psychosocial interventions for psychotic patients

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The Day Center EPAPSY

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  1. The Day CenterEPAPSY Dr. Konstantinos Papakonstantinou, Psychiatrist, psychoanalyst Scientific manager of Day Center

  2. Day Center • Founded in 2004 • 5th Psychiatric Sector (200.000 population approx.) • Offers complete psychosocial interventions for psychotic patients • The main focus is to prevent them from relapsing, help reduce hospitalisation and also working towards recovery and reintegration • The aim is to facilitate the recovery process and improve users’ quality of life • 35 users have attended the program

  3. Multi-disciplinary team • Psychiatrist / Scientific manager of the D.C • Psychologists • Social worker • Occupational therapist • Psychiatric nurse • Administrator • Assistant/cook • Participation of university students and junior professionals offering volunteer work

  4. Users’ Entry Criteria • a/. Psychopathology (psychotic disorders) • b/. Age (18-45yrs.), • c/.Users should be followed by an external collaborating Psychiatrist who will be overseeing their treatment and medication plan • d/. User’s relation with their family (which takes part in the whole process of the user’s rehabilitation) • e/. Users’ strong motivation to attend the program • f/. Users with dual diagnosis are excluded

  5. Levels of intervention A/. Individual level Therapeutic interventions • Individual and group activities (Psychotherapeutic, educational, entertaining) inside and outside the D.C) • individualized case management • Active participation of the users (PercorsidiCuraCondivisi, Co-ordination of group activities) B/. Social level Family interventions • Families : individual and group support (narrow target group) • SOFPSY: psycho-education and support (broader community) C/ .Community level • Creation of a community-based support network • Social club • Creation of KoiSPE (Social Cooperative) • Creation of SOFPSY (Users’ family & friends association) • Anti-stigma interventions in the community

  6. Assessment • Users’ assessment is carried out in two levels • Quantitative (scales) • Qualitative (group activities, clinical meetings) • Staff assessment • Staff development and assessment program currently running • Internal and External Clinical supervision • Regular team meetings

  7. Qualitative outcomesPsychodynamic approach • Psychodynamic understanding of the patient, family and dynamics. • It is also used in the professionals’ education program • External psychodynamic supervision • PSCYCHOANALYTIC TEQUNIQES ARE NOT BEEN USED FOR INDIVIDUAL OR GROUP PSYCHOTHERAPY OFFERED IN THE D.C

  8. Qualitative outcomesImportant aspects of group activities • The material is been recorded and evaluated as a groupand also individually over an extended period of time. Changes in users are evaluated in clinical meetings and are used to inform and adjust the individual care plan (ICP). Consideration to use material as raw data for conducting qualitative research. • These activities offer users alternative pathways of expressing or narrating their story and are been worked through. More subtle changes of users can be assessed. • Furthermore, they facilitate and reflect users’ inclinations and talents, which contributes in the users’ self integration and improves users’ thought process.

  9. The example of Painting groups • A volunteer professional of Fine Arts, after offering a basic training on drawing and colors’ usage, s/he collaborates with the users and they all conclude on what is important and valuable to be further used in certain circumstances. • The evolution of users’ techniques is particularly interesting . However, the most significant aspect is the evolution of the users’ expressiveness and the ability to express emotions over time. • The users, though initially reluctant about the whole process, as a consequence of the group’s framing, they come to embrace being exposed and exhibiting their work. Pictures exhibited in the Conference: Psychiatry and Art, May 2010, Chania-Crete

  10. Painting 1

  11. Painting 2

  12. Qualitative OutcomesVocational Rehabilitation-KoiSPE (Social Cooperative) “Iliotropio” • Part of the Social Economy and Solidarity movement in Europe • Covers the 5th Psychiatric sector (partial absence of mental health services/units in this sector) • Management of KoiSPE from Day Center staff • Present activities 1/. Cleaning Services: Co-operation with School Committees 9 users have worked in the project, (October 2010) 2/. Cleaning services: Collaboration with the Ministry of Labour and Social Security (6 users), March 2011 • Future activities • Plan of establishing a new business (coffee shop) Important note: Users’ training, preparation and support for the job tasks

  13. PercorsidiCuraCondivisi • Programs’ experts: -Barbara D’Avanzo (Institution Mario Negri, Milan, Program supervisor) -Renzo De Stefani (Responsible of Mental Health Service, Trento) -PierluigiMorosini (Research Director of InsitutoSuperiorediSanita, Rome) • Training in vivo, (Trento) • Training of Greek professionals (psychiatrists, mental health professionals, families, volunteers) • 8 Day Center users have already joined the program and have completed the 1st verification. 7 more have also been recently introduced. • Program Outline: The user, a family member, the key-person, the psychiatrist and a guarantor have regular joint meetings every 6 months, and assess as a group the user’s progress in the following areas: a)Psychopathology, b)Functioning, c) Social skills And set goals to be met until the next verification meeting as a part of their follow up) Users: -active participation in the therapeutic process (empowerment) -Acknowledgement for their need for help, -More effective management of symptoms during relapse ( realization of the psychotic dimension of their omnipotence during a psychotic relapse -Reality testing & healthy aspect of self vs. Psychotic omnipotence

  14. Quantitative AssessmentAssessment tools • Tests are administered to users a month after signing in the therapeutic program • PANSS (1/year psychiatrist) • COTE (1/6months, Occupational Therapist) • WHO-QuoL(1/year, self-administered) • Family practices (1/year, facilitator&user) • Family burden (1/year, administered to the family)

  15. Results-PANSS • Year 1: 22 Valid (Mean 94,18) • Year 2: 14 Valid (Mean 87,64) • Year 3: 10 Valid (Mean 85,30) • Year 4 : 7 Valid (Mean 74,86), Table1.Mean PANSS score per year

  16. PANSS- Results Table 2. PANSS Mean scores in 3 sub-scales& total score

  17. Results- COTE 0= no difficulty, 1= little difficulty, 2= some difficulty, 3= serious difficulty, 4= very serious difficulty 1st semesterΝ=15 2ndsemesterΝ=15 3rd semesterΝ=15 4th semesterΝ=11 5th semesterΝ=9 6th semesterΝ=5 7th semesterΝ=4 8th semesterΝ=3 9th semesterΝ=1 Table 3. COTE Means of Interpersonal Relationships and total score

  18. Results-Family Burden Scale Year 1&2 N=17, Year 3 N=13, Year 4 N= 6 , Year 5 N=3 Table 4. Family Burden Scale Means of total FB score and Means of aggressive behaviour

  19. Results- Family Practices Scale Year 1 N=20, Year 2 N=18, Year 3 N=11, Year 4 N=8, Year 5 N=4, Year 6 N=4 Table 6. Mean Scores of Family Practices Scale

  20. Implications…concerning the users Because of the fragmented continuity of care, users typically stay longer in the Day Center. Although this extended stay causes difficulties, such as institutionalisation phenomena and prolonging new user intake, there is evidence (both qualitative and quantitative) that the existing users continue to benefit from the program for more than the average 2-3 years. Efforts are made to assure extended care pathways, by developing a post- Day Center program and the Social Co-operative. Discussion Is it good practice to extend the therapeutic contract with the DC(?) and extend the users’ dependence on services(?) narrowing their autonomy (?)

  21. Implications… concerning the staff The Day Center staffoperate in many levels (different roles, goals). This happens due to the lack of established care pathways. However, there needs to be an effort to concentrate on more specific and strategic priorities in the near future. Subject for discussion Is this enriching the Day Center’s services or distract the staff from their role (?) and cause confusion and burn out (?) Which priorities(?)

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