A study to evaluate psychiatric rehabilitation services at the occupational therapy department of Butabika Hospital.
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INTRODUCTION The field of psychiatric rehabilitation has developed with the recognition that most psychiatric disorders are associated with persistent disability that become chronic and impair functional capacities. Psychiatric rehabilitation programs are developed by means of two phased (formative and summative) evaluation approaches which involves the use of scientific data to plan, implement, monitor and evaluate how effectively new programs or clinical practices achieved their goals. OBJECTIVE: The main objective of this study was to conduct a formative and summative evaluation of the Butabika Hospital based psychiatric rehabilitation modalities with the view of determining the effectiveness of the program’s components in meeting the stated treatment and outcome goals of the program. METHOD: This was a descriptive clinical audit combined with a single-subject design evaluation study for both qualitative and quantitative analytical components Purposive sampling method was used for data collection. Using observational methodologies for assessment of program modalities, delivery processes, program components (description) documentation, rehabilitation assessment tools and delivery instruments and facilities. A standardized review of participant’s hospital records, socio-demographics, diagnosis and rehabilitation progress notes were done. Quantitative data on percentile of improvements of patients based on changes in frequency of the designated problem behaviours from baseline at entry into the program to end-line at discharge was analyzed using EPI-INFO version 6.0 and the SPSS version 10.0 statistical programs. RESULTS: A total of 320 patients were studied, they constituted 5 diagnostic groups, 120 manic depressive disorder, 20 alcohol abuse disorder, 60 major depression disorder, 105 schizophrenia and 15 epilepsy. Formative evaluation data showed that the butabika OTD offer 7 western style psychiatric rehabilitation modalities namely and these are, self care, psycho education, activities of daily living skills(ADL), Social skills, leisure skills, vocational skills and community rehabilitation programs. Summative evaluation data showed the OTD’s overall program effectively delivered improvements to patients from baseline measure in the 20th percentile through to the 50th percentile (standard efficacy threshold) and upwards to the 82th percentile. The program’s efficacy rate was highest amongst patients with the diagnosis of manic-depressive disorder across all the six modalities, followed by the group with alcohol abuse disorder, then major depressive disorder, schizophrenia, and lastly, the group with epilepsy. CONCLUSION: This study established that the western style OTD’s psychiatric rehabilitation program modalities were effective in accomplishing improvement in the rehabilitees as designed to achieve despite inadequate staffing and facilities resources. RECOMMENDATIONS: There is s need for future wider studies to include the evaluation of the OTD’s community rehabilitation programs as well as cost effectiveness and efficiency of the OTD program as delivered at Butabika hospital.