Motivational aftercare planning to better care: applying the principles of advanced directives and motivational interviewing to discharge planning for people with mental illness

Kisely, Steve, Wyder, Marianne, Dietrich, Josie, Robinson, Gail, Siskind, Dan and Crompton, David (2017) Motivational aftercare planning to better care: applying the principles of advanced directives and motivational interviewing to discharge planning for people with mental illness. International Journal of Mental Health Nursing, 26 1: 41-48. doi:10.1111/inm.12261


Author Kisely, Steve
Wyder, Marianne
Dietrich, Josie
Robinson, Gail
Siskind, Dan
Crompton, David
Title Motivational aftercare planning to better care: applying the principles of advanced directives and motivational interviewing to discharge planning for people with mental illness
Journal name International Journal of Mental Health Nursing   Check publisher's open access policy
ISSN 1447-0349
1445-8330
Publication date 2017-02-01
Year available 2017
Sub-type Article (original research)
DOI 10.1111/inm.12261
Open Access Status Not yet assessed
Volume 26
Issue 1
Start page 41
End page 48
Total pages 8
Place of publication Richmond, VIC, Australia
Publisher Blackwell Publishing
Language eng
Subject 2921 Phychiatric Mental Health
Abstract Improving the input of people with mental illness into their recovery plans can potentially lead to better outcomes. In the present study, we evaluated the introduction of motivational aftercare planning (MAP) into the discharge planning of psychiatric inpatients. MAP is a manualized intervention combining motivational interviewing with advance directives. We measured changes in the level of patient input into discharge planning following training staff in the use of MAP. This included the following: (i) documentation of early relapse signs along with successful past responses; (ii) evidence of aftercare planning; and (iii) the use of the patients' own words in the plan. We used a ward-level controlled before-and-after design comparing one intervention ward with two control wards. We used anonymized recovery plans, with a goal of 50 plans per ward before and after the intervention, to look for evidence of patient input into care planning with a standardized checklist. There were also qualitative interviews with individuals discharged from the unit. We reviewed 100 intervention ward plans and 197 control ones (total n = 297). There were no significant differences in recovery plans from intervention and control wards at baseline. Following MAP training, the intervention ward improved significantly (e.g. identification of triggers increased from 52 to 94%, χ = 23.3, d.f. =1, P < 0.001). This did not occur in the control wards. The qualitative data (n = 20 interviews) showed improvements in participants' experiences of discharge planning. MAP increased inpatient input into discharge planning and was valued by participants. The effect on subsequent health service use needs evaluation.
Formatted abstract
Improving the input of people with mental illness into their recovery plans can potentially lead to better outcomes. In the present study, we evaluated the introduction of motivational aftercare planning (MAP) into the discharge planning of psychiatric inpatients. MAP is a manualized intervention combining motivational interviewing with advance directives. We measured changes in the level of patient input into discharge planning following training staff in the use of MAP. This included the following: (i) documentation of early relapse signs along with successful past responses; (ii) evidence of aftercare planning; and (iii) the use of the patients' own words in the plan. We used a ward-level controlled before-and-after design comparing one intervention ward with two control wards. We used anonymized recovery plans, with a goal of 50 plans per ward before and after the intervention, to look for evidence of patient input into care planning with a standardized checklist. There were also qualitative interviews with individuals discharged from the unit. We reviewed 100 intervention ward plans and 197 control ones (total n = 297). There were no significant differences in recovery plans from intervention and control wards at baseline. Following MAP training, the intervention ward improved significantly (e.g. identification of triggers increased from 52 to 94%, χ2 = 23.3, d.f. =1, P < 0.001). This did not occur in the control wards. The qualitative data (n = 20 interviews) showed improvements in participants' experiences of discharge planning. MAP increased inpatient input into discharge planning and was valued by participants. The effect on subsequent health service use needs evaluation.
Keyword Advance directive
Joint crisis plan
Motivational interviewing
Recovery
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID SG0009-000412
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
Faculty of Medicine
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