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Contents. Introduction Foster Families Patients Evolution Research (1993-2007) Residential Crisis Intervention The Future. OPZ Geel. FFC Geel is part of OPZ Geel OPZ Geel = Openbaar Psychiatrisch Zorgcentrum Geel = Public Centre for Psychiatric Care Geel. Organization structure.

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  1. 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  2. Contents Introduction Foster Families Patients Evolution Research (1993-2007) Residential Crisis Intervention The Future 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  3. OPZ Geel FFC Geel is part of OPZ Geel OPZ Geel = Openbaar Psychiatrisch Zorgcentrum Geel = Public Centre for Psychiatric Care Geel 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  4. Organization structure Board of Directors Staff Managing Director Director Nursing Director Therapy Medical Department. Admin. & Technical Services 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  5. Belgium 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  6. Flanders 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  7. Geel 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  8. Foster Family Care Geel • Geel: small town in Flanders (North of Belgium) • 35 500 inhabitants • East–West: 15 km • North-South: 20 km 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  9. Foster Family Care Geel • Program run by psychiatric hospital • Adults with severe psychiatric disabilities • Geel and surrounding towns (2001) • Origin: Legend of Saint- Dimpna • 13th/14th century 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  10. Foster Family Care Geel • Unique Combination of: • concentrated catchment area • high number of patients and families • history/tradition/legend 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  11. Foster Family Care Geel • FFC Geel: • international attention • controversy (+ and -: extremes!) 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  12. Foster Family Care Geel • Today • positive attitude (community care) • new initiatives in Europe • economic and humane approach WHO report (2002): “best practice” 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  13. FFC Geel: Organization • Hospital in centre of town: easy access to support team • Maximum distance between hospital and foster family: 25 km 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  14. FFC Geel: Organization • Residential unit (30 beds): • observation • crisis intervention • hotel (respite care) • very accessible! • no waiting list 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  15. FFC Geel: Organization • Districts (12): 23 <X< 40 patients 22 <X< 33 families • 3 decentralized interdisciplinaryteams: nurses, psychiatrist, GP, social worker, occupational therapist, psychologist 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  16. FFC Geel: Organization • 50% of clients Activities: in the families household, garden, shop,… • 50% of clients Activities: organized by the OPZ activity-centres, workshop, work in local businesses, club for the elderly,… 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  17. FFC Geel: Organization • OPZ offers: • Art House (Art en marge/Art Brut: exhibitions, work with professional artists,…) • Clubhouse • Leisure activities (parties, daytrips, holidays,…) 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  18. FFC Geel: Structure District teams (3) Division Adults Division Rehabilitation Patient Foster family Division Geriatrics Activities: Work Leisure 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  19. FFC Geel: 2008 2008 400 patients living in 300 families / 35 500 inhabitants In comparison 1939 +3700 patients / 15 000 inhabitants! 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  20. FFC Geel: Finances • Funded as a hospital : €40/day a) families: €17-21 /day • age of patient • accommodation • extra care b) staff, organization,… 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  21. FFC Geel: Foster Families • Conditions (1) • caring, stable home • stable income • enough space to lodge one or more guests • no criminal record 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  22. FFC Geel: Foster Families • Conditions (2) • willing to work with us and abide by the principles outlined in the contract • aware of the implications • no specific training required 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  23. FFC Geel: Foster Families Motives • financial incentive, helping hand, friendship, social status • > 95% knows the system, lives in Geel • 50% is motivated by family or befriended foster family 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  24. FFC Geel: Foster Families • 108 Foster Families (singles) • 188 Foster Families (couples) 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  25. FFC Geel: Foster Families • 207 Foster Families: 1 patient • 73 Foster Families: 2 patients • 16 Foster Families: 3 patients 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  26. FFC Geel: Foster Families • Every year approximately 10 new foster families • No adverts, word of mouth publicity • Foster families familiar with the system (experience from within) 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  27. FFC Geel: Patients Historic patient population • Large group of patients has been in foster care for decades • from childhood onwards • socially marginalized background • learning disabilities/psychiatric symptoms • psychotic disorder • average age: 59 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  28. FFC Geel: Patients (Age) 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  29. FFC Geel: Evolution Changes in referral patern • since 1958 only adults • changing patient population Changes in society • both partners have a job • changing life style (travelling,…) • industrialization • level of care foster families offer drops 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  30. Research 1993-2007 01/01/1993 to 31/12/2007 • span of 15 years • 240 patients involved in the study • 256 admissions: 165 men, 91 women • 13 readmissions:11X2, 1X3, 1x4 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  31. Research 1993-2007 Admissions per year • Average:17 • Minimum:10 • Maximum:28 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  32. Research 1993-2007 Referrals • Psychiatry (88%): • psychiatric hospitals in Flanders • OPZ Geel accounts for 40%! • Home/family situation (5%) • Other • Youth care • Institutions for people with learning disabilities • Crisis centres 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  33. Research 1993-2007 Reason of admission • (present) inability to live independently • diverse and complex problems 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  34. Research 1993-2007 Diverse patient population • Marital status: married (with or without children), single, divorced,… • Previous living conditions: hospital, sheltered accommodation, family, institution,… • Professional background • Level of intelligence 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  35. Research 1993-2007 Diagnosis (main problem) • conduct disorder: behavioral problems, sometimes in combination with learning disorder (38%) • psychotic disorder (33%) • personality disorder (14%) • mood disorder (9%) • cognitive disorder (e.g. ex-alcoholics, autistic behavior,… ) (6%) 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  36. Research 1993-2007 Age at time of admission • Youngest:17 • Oldest:79 • Averages • 50% between 35 and 54 • 25% older than 50 • 10% older than 60! • Minors: 4 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  37. Research 1993-2007 Situation per 15/03/2008 Total # of admissions: 256 (165M, 91F) Total # of people discharged: 134 (94M, 40F) Currently in foster care: 122 (71M,51F) 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  38. Research 1993-2007 Patients still living in foster care (122) First family: 72 Second family: 22 Third family: 16 Fourth family: 7 Fifth family: 1 Sixth family: 4 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  39. Research 1993-2007 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  40. Research 1993-2007 Patients in first or second family • Stabilized psychiatric problem • Behavioral problem under control due to structure offered by foster family • Used to living in a family-like situation (disrupted social network) 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  41. Research 1993-2007 # of foster families patients (134) lived with before leaving the program no family: 35 (13% of admitted patients!) 1 family: 58 2 families: 29 3 families: 9 4 families: 0 5 families: 1 6 families: 0 7 families: 1 8 families: 1 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  42. Research 1993-2007 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  43. Research 1993-2007 35 admissions ended before the patient entered a foster family Reasons are various: • agression • suicide-attempt • automutilation • psychiatric instability • …. 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  44. Research 1993-2007 Reasons for discharge once people have started living in a foster family: • behavioral problems too difficult to handle in a family situation • instability (rapidly changing moods, psychoses,…) • too much physical help needed • other options for the future (friend, family,…) • legal “freedom” at 18 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  45. Research 1993-2007 • step to independent living (sheltered accommodation,…) • foster family is destabilized (personality disorder) • patient died • patient doesn’t want to stay in foster care anymore 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  46. Crisis intervention 2006-2007 Residential crisis intervention (foster family OPZ):112 admissions 2006: 63 admissions (36M,27F) 2007: 49 admissions (30M,19F) It concerns 76 different persons, average 38 per year. This is ±10% of patient population 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  47. Crisis intervention 2006-2007 Circumstances of intervention • mostly planned, negotiated intervention • at night: 2 times • police intervention: 3 times 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  48. Crisis intervention 2006-2007 Reasons for intervention • Behavioral problems (60) • Mental problems (20) • Patient wants to leave the foster family(6) • Alcohol abuse (5) • Psychotic episode (5) 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  49. Crisis intervention2006-2007 Other reasons • relational conflict between partners of FF • physical problems • intoxication (medication) • admission to prevent crisis • complaint about foster family • observation (change in behavior) • conflict with other patient,… 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

  50. Crisis intervention 2006-2007 After the crisis and residential stay • Back to same foster family: 62 • To other foster family: 33 • Discharge: 11 • Still in hospital (april 2008): 6 24/25/26//09//2008 "Familie im Mittelpunkt" Tübingen

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