Psychological Reports, 1977,41, 1339-1342. @ Psychological Reports 1977
COMMLTNITY TENURE A N D AN ASSESSMENT OF READINESS FOR DISCHARGE A N D COMMLTNITY LIVING GLENN A. GROWE, DAVID B. KLASS, DAVID RUDOLF, A N D MICHAEL STRIZICH Manteno Mental Health Center Summnry.-The prediction of community tenure after discharge of a group of state hospital patients was examined using a recently developed rating scale designed to assess patients' readiness for discharge and community living. Length of community stay was negatively correlated with a predischarge rating of belligerent behavior. Ratings of other dimensions of behavior often believed to be of considerable clinical importance did not relate to community tenure. The findings suggest that social facrors are important in the readmission process.
The length of a psychiatric patient's stay out of the hospital after discharge has long been a major criterion of outcome in the psychoses. Besides its significance as an indicator of relapse, community tenure is an outcome measure of great administrative importance because of the costs involved in hospitalization. Previous research has investigated the relationship of a multitude of variables to length of stay out of the hospital and rehospitalization. For comprehensive reviews of this literature the reader is referred to the recent papers of Buell and Anthony (1975), Clum ( 1975), and Rosenblatt and Mayer (1974). Previous findings suggest that few of the many variables studied, except number of previous admissions, are reliably related to rehospitalization. It has proven difficult to relate measures of patient's behavior in the hospital to posthospital functioning (Ellsworth, Foster, Childers, Arthur, & Kroeker, 1968; Marks, Stauffacher, & Lyle, 1963; Williams & Walker, 1961). However, such studies have rated only patients' symptoms or aspects of their adjustment to the hospital environment. None attempted ro assess behaviors believed to be specifically relevant to successful functioning in the community. Hogarty and Ulrich (1971, 1972) developed the Discharge Readiness Inventory to yield information on the psychiatric inpatient's readiness for discharge and potential for successful community adjustment. The inventory yields four factors which are assumed to represent the components of discharge readiness: community adjustment potential, psychosocial adequacy, belligerence, and manifest psychopathology. The present study explored the relationship between patients' predischarge scores and their subsequent community tenure. This seemed to be a promising approach to the prediction of community tenure because the inventory was explicitly comprised of items intended to measure the potential of schizophrenic inpatients to adjust to community living. METHOD All patients discharged from an administrative section of Manteno Mental Health
1340
G. A. GROWE, ET AL.
Center (N = 212) during a 55-wk. period beginning in April, 1973 and ending in May, 1974 served as subjects. These patients were berween 1 9 and 75 yr. old (mean current age = 4 1 ) . Of the patients in the sample, 103 were male, 107 were female while 85 were white and 127 were black. One-hundred eighty-nine were diagnosed as psychotic, 18 as neurotic or character disordered and 5 as having affective disorders. Duration of non-hospitalization after discharge in weeks was obtained in February, 1975 through the State of Illinois computer system which records admissions and discharges to all mental institutions in Illinojs. Time out of the hospital was computed from the discharge date to the readmission date. Those patients who were discharged and did not return were assigned the time out between when they left and the computer run in February, 1975. If a patient had multiple admissions and discharges during the study period only the first readmission was considered. The mean length of follow u p was 7 3 wk. after discharge. Eighty-seven ( 4 2 % ) returned to a hospital in Illinois by February, 1975 and 125 ( 5 8 % ) did not. The patients were rated on the inventory at discharge by a trained professional with 5 yr. hospital experience. Ratings were based upon 30-min. structured interviews with the patient and discussions with a ward staff member who was very familiar with him. Brief descriptions of the four subscales are quoted from Hogarty and Ulrich (1772) in Table 1. Scores on the inventory did not influence the decision to release a patient.
TABLE 1
DISCHARGE READINESSINVENTORY DESCRIPTION OF SUBSCALES* Community &astmsnt potentid: Utilizes specific aspects of ward behavior to assess a patient's potential for posthospital adjustment in a number of important areas of social behavior and adjustment. psycho roc^ rrdequacy: Directly measures the actual performance of appropriate activities such as self-care, personal hygiene, instrumental role performance, and the ability to approximate standards of required social amenities. Belligerence: Assesses elements of hostile and obstreperous behavior. Manifest psychopathology: Assesses not only the presence of hallucinations or delusions, but that the patient's behavior is adversely affected and disrupted by their presence. *Quoted from Hogarty and Ulrich (1972).
RESULTS The partial correlations of the scales with community tenure are presented in Table 2. The week of the study during which the patient's discharge occurred was used as a control variable (covariate) to adjust for the effects of earlier vs later discharge during the study period. This approach rather than simple correlation was used because patients discharged earlier during the study TABLE 2
PARTIALC0RRELATlONS BETWEENSCALES AND COMMUNINTENURE Scale Community Adjustment Potential Psychosocial Adequacy * p .O1 with 209 df.
COMMLTNITY TENURE A N D AN ASSESSMENT OF READINESS FOR DISCHARGE A N D COMMLTNITY LIVING GLENN A. GROWE, DAVID B. KLASS, DAVID RUDOLF, A N D MICHAEL STRIZICH Manteno Mental Health Center Summnry.-The prediction of community tenure after discharge of a group of state hospital patients was examined using a recently developed rating scale designed to assess patients' readiness for discharge and community living. Length of community stay was negatively correlated with a predischarge rating of belligerent behavior. Ratings of other dimensions of behavior often believed to be of considerable clinical importance did not relate to community tenure. The findings suggest that social facrors are important in the readmission process.
The length of a psychiatric patient's stay out of the hospital after discharge has long been a major criterion of outcome in the psychoses. Besides its significance as an indicator of relapse, community tenure is an outcome measure of great administrative importance because of the costs involved in hospitalization. Previous research has investigated the relationship of a multitude of variables to length of stay out of the hospital and rehospitalization. For comprehensive reviews of this literature the reader is referred to the recent papers of Buell and Anthony (1975), Clum ( 1975), and Rosenblatt and Mayer (1974). Previous findings suggest that few of the many variables studied, except number of previous admissions, are reliably related to rehospitalization. It has proven difficult to relate measures of patient's behavior in the hospital to posthospital functioning (Ellsworth, Foster, Childers, Arthur, & Kroeker, 1968; Marks, Stauffacher, & Lyle, 1963; Williams & Walker, 1961). However, such studies have rated only patients' symptoms or aspects of their adjustment to the hospital environment. None attempted ro assess behaviors believed to be specifically relevant to successful functioning in the community. Hogarty and Ulrich (1971, 1972) developed the Discharge Readiness Inventory to yield information on the psychiatric inpatient's readiness for discharge and potential for successful community adjustment. The inventory yields four factors which are assumed to represent the components of discharge readiness: community adjustment potential, psychosocial adequacy, belligerence, and manifest psychopathology. The present study explored the relationship between patients' predischarge scores and their subsequent community tenure. This seemed to be a promising approach to the prediction of community tenure because the inventory was explicitly comprised of items intended to measure the potential of schizophrenic inpatients to adjust to community living. METHOD All patients discharged from an administrative section of Manteno Mental Health
1340
G. A. GROWE, ET AL.
Center (N = 212) during a 55-wk. period beginning in April, 1973 and ending in May, 1974 served as subjects. These patients were berween 1 9 and 75 yr. old (mean current age = 4 1 ) . Of the patients in the sample, 103 were male, 107 were female while 85 were white and 127 were black. One-hundred eighty-nine were diagnosed as psychotic, 18 as neurotic or character disordered and 5 as having affective disorders. Duration of non-hospitalization after discharge in weeks was obtained in February, 1975 through the State of Illinois computer system which records admissions and discharges to all mental institutions in Illinojs. Time out of the hospital was computed from the discharge date to the readmission date. Those patients who were discharged and did not return were assigned the time out between when they left and the computer run in February, 1975. If a patient had multiple admissions and discharges during the study period only the first readmission was considered. The mean length of follow u p was 7 3 wk. after discharge. Eighty-seven ( 4 2 % ) returned to a hospital in Illinois by February, 1975 and 125 ( 5 8 % ) did not. The patients were rated on the inventory at discharge by a trained professional with 5 yr. hospital experience. Ratings were based upon 30-min. structured interviews with the patient and discussions with a ward staff member who was very familiar with him. Brief descriptions of the four subscales are quoted from Hogarty and Ulrich (1772) in Table 1. Scores on the inventory did not influence the decision to release a patient.
TABLE 1
DISCHARGE READINESSINVENTORY DESCRIPTION OF SUBSCALES* Community &astmsnt potentid: Utilizes specific aspects of ward behavior to assess a patient's potential for posthospital adjustment in a number of important areas of social behavior and adjustment. psycho roc^ rrdequacy: Directly measures the actual performance of appropriate activities such as self-care, personal hygiene, instrumental role performance, and the ability to approximate standards of required social amenities. Belligerence: Assesses elements of hostile and obstreperous behavior. Manifest psychopathology: Assesses not only the presence of hallucinations or delusions, but that the patient's behavior is adversely affected and disrupted by their presence. *Quoted from Hogarty and Ulrich (1972).
RESULTS The partial correlations of the scales with community tenure are presented in Table 2. The week of the study during which the patient's discharge occurred was used as a control variable (covariate) to adjust for the effects of earlier vs later discharge during the study period. This approach rather than simple correlation was used because patients discharged earlier during the study TABLE 2
PARTIALC0RRELATlONS BETWEENSCALES AND COMMUNINTENURE Scale Community Adjustment Potential Psychosocial Adequacy * p .O1 with 209 df.
