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Seishin Igaku Volume 59, Issue 11 （November 2017）

精神医学 59巻11号（2017年11月発行）

Japanese English

研究と報告

精神科デイケアにおけるアウトリーチ支援が地域移行に与える効果—予備的検討 A Preliminary Study for Effects of Outreach Services Offered by a Psychiatric Day-care Center on the Transition from a Hospital to Community 佐藤さやか ¹ , 伊藤孝子 ² , 吉田統子 ² , 細谷章子 ¹ , 松長麻美 ¹ , 山口創生 ¹ , 武田裕美 ² , 大島真弓 ² , 坂田増弘 ² , 藤井千代 ¹ , 伊藤順一郎 ^1,3 Sayaka SATO ¹ , Takako ITO ² , Motoko YOSHIDA ² , Akiko HOSOYA ¹ , Asami MATSUNAGA ¹ , Sosei YAMAGUCHI ¹ , Hiromi TAKEDA ² , Mayumi OSHIMA ² , Masuhiro SAKATA ² , Chiyo FUJII ¹ , Junichiro ITO ^1,3 ¹国立精神・神経医療研究センター精神保健研究所社会復帰研究部 ²国立精神・神経医療研究センター病院 ³メンタルヘルス診療所しっぽふぁーれ ¹Department of Psychiatric Rehabilitation, National Institute of Mental Health, NCNP, Tokyo, Japan ²National Center Hospital, NCNP ³Mental Health Clinic “Si può fare” キーワード： Psychiatric day-care center , Outreach , Transition from a hospital to community Keyword: Psychiatric day-care center , Outreach , Transition from a hospital to community pp.1055-1065

発行日 2017年11月15日 Published Date 2017/11/15

DOI https://doi.org/10.11477/mf.1405205489

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抄録

　本研究の目的はデイケアにおけるアウトリーチ支援などの効果について予備的検討を行うことであった。導入基準を満たすデイケア利用者15名をリクルートし，通常の支援に加えケアマネジメントとこれに基づくアウトリーチ支援を1年間実施した。支援前後の変化を検討した結果，QOLと心理的Well-beingの下位領域に有意もしくは有意傾向の改善がみられた。また社会的機能の下位領域の一部も改善しており有意傾向であった。利用者ニーズと1年後の転帰では就職希望だった7名のうち3名が就労するなどデイケアから地域への移行が促進された。以上の結果と事例報告からアウトリーチ支援は従来デイケアで難渋していたケースを展開させる糸口になることが示唆された。

　This study is the preliminary research about out-reach services offered by day-care center staffs aimed at the transition from hospital to community for mental disabilities. We recruited 15 users of the day care center who met inclusion criteria following 1)were aged 20 or over, 2)were more than one year they had registered and have attended more than one per week over the last three months, 3)gave written consent to the research team, and 4)have following needs：a)instability derive from exacerbation of symptom or lack of motivation to visit to day-care center, b)having trouble getting in touch with family, c)non-responder to supports for return to community, d)(regardless of the severity of symptoms or level of function)hoping to get a job. We have offered subjects intensive case-management plus out-reach services for a year in addition to treatment as usual in day-care center and conducted pre-post analyses. As a result, we found the significant differences in “physical area in QOL” as a subscale of WHO-QOL, “self-acceptance” “personality growth” and “a forward-looking relationship with others” as a subscale of subjective well-being scale(SWS)besides total score of it(physical area in QOL：p＝.012；self-acceptance：p＝.028；personality growth：p＝.017；a forward-looking relationship with others：p＝.003；total score of SWS：p＝.011). Also 4 out of 7 who have wanted a job could be employed besides 4 out of 5 who have needs the transition from day-care center in the hospital to support agencies for the community life could find new place in the community that encouraged their recovery. Results of this study suggested that intensive case-management and out-reach services by day-care center staffs were very useful for supporting consumers to transfer to the community but not going smoothly in Japan.