Principles and Practice of Psychosocial Rehabilitation - Essay Example

Principles and Practice of Psychosocial Rehabilitation Executive summary. 2- Introduction. 3- Brief Overview of the Topic 4- Brief of Client and Context. 5- Assessment of motivation. 6- Assessment of Cognition. 7- Assessment of Need. 8- Negotiation of Goals. 9- Care Plan. 10- Monitoring Progress Towards Goals. 11- Modification of Goals. 12- Discussion of Overall Outcomes of Process 13- Findings and Recommendations 14- Conclusion Executive Summary: Paranoid Schizophrenia is very common and this paper presents a report of Brayne who is inflicted with Paranoid Schizophrenia. He is referred to Shellharbour Hospital Rehabilitation Unit. There is a multi disciplinary team consisting psychiatrists, psychologists, social workers, nurses and consumer advocates. This paper presents brief description of the client, need assessment of the patient, negotiation of goals, monitoring progress towards goals, modification of goals, and discussion of overall outcome of the process and the findings and recommendations. It is reported that the rehabilitation unit helped Mr. Brayan to develop living skills such as cognition, using laundry, cooking food etc. Introduction: Psychosocial Rehabilitation is the process in which the psychiatric patients are trained systematically to bring back them to the active participation in the society. “Psychiatric rehabilitation aims to improve the functioning and quality of life of individuals with psychiatricdisabilities due to serious mental illnesses”. (Rudnick 2003, p.1). “The strategies adopted for the management of schizophrenia may differ from one country to other country and may influence motivational readiness for change. For this purpose, rehabilitation approaches like vocational training, employment guidance, cognitive behavioural therapy, and psychosocial methods were included. In addition, issues surrounding gender differences, scarcity of resources, conventional medicine, and importance on family role were also need to be considered for the rehabilitation of patients.” (Review of Literature, p. 2.). The recovery is the objective of the psychosocial rehabilitation. In this case study the Psychosocial Rehabilitation of a patient suffering from Schizophrenia in Shellharbour Hospital Mental Health Rehabilitation Unit is done. The aim of the rehabilitation is to enhance the quality of life of the patient named Brayne, who is a 45 years old male with chronic Paranoid Schizophrenia. Brayne lives alone. His functioning at home was very poor. He was not able to manage his finance and his condition make him vulnerable to the extend of exploitation by other. These conditions often leave him without sufficient money towards the end of each fortnight for basic necessities such as food and transport. He came to rehabilitation in need of help in Shellharbour Hospital to learn many skills like how to use kitchen for cooking, how to use the laundry etc. The case study further explains about the rehabilitation program that is carried out in the Mental Health Rehabilitation Unit. Psychosocial Rehabilitation is the most successful intervention in dealing with the psychiatric patients. Individualization without predetermined time limit is more successful than preset time limit programs. “Pre-set, time-limited programs were easy to administer but have shown poor results due to their inability to truly address individual needs” (Assertive community treatment, 2009).  A Brief Description of Client and Context: Name of the client: Brayne Age: 45 Mental disorder: Chronic Paranoid Schizophrenia Hospital: Shellharbour Hospital Required skills: Using kitchen for cooking, using the laundry etc. Mr Brayne, 45 years old male with Chronic Paranoid Schizophrenia is currently living alone. He has been hospitalized since 6-10-2009. He is on Clozapine. It is felt that, Brayne will require a period of rehabilitation to give him the necessary skills for reintegration of society at discharge. His previous functioning at home was very poor. Mr Brayne has difficulties in managing his finance. His condition makes him vulnerable to exploitation by others and he has reported giving his money away to his girlfriend. In response to his symptoms, he also spends excessively on items such as locks for his unit due to fears that people are trying to break into his place. This type of behaviour often leaves him without sufficient money towards the end of each fortnight for basic necessities such as food and transport. Mr. Brayne needs to develop living skills like using kitchen for cooking and using laundry. In order to develop these living skills, Mr. Brayne was referred to the Shellharbour Hospital Mental Health Rehabilitation Unit. The patients who are referred to this hospital would stay there three to six months. Shellharbour Mental Health Rehabilitation Unit provides contemporary nursing and medical care, focusing on the holistic assessment taking into account the needs of the consumer experiencing a severe mental illness. In this hospital, the care to the consumer is provided by various activities such as promotion of illness education, illness maintenance and symptoms management, medication management, living skills and social integration. The care givers in this rehabilitation unit are psychiatrist, clinical psychologists, consumer advocate, nurses, head and security assistant, occupational therapist and social workers. Care plan in the rehabilitation centre “stuart & Sundeen (1995) state that a major goal of rehabilitation is to assist the person to develop independent living skills. Initially, an assessment must be made to determine what new skills are needed, and then from there a program could be developed and individualized for that client.” (Schizophrenia rehabilation, 2008). The various activities which are given more importance in the rehabilitation centre are given below. Hygiene: schizophrenic patients are not hygiene and they are not aware of that. They will be taught about keeping bed neatly, dressing, washing, using toilets, brushing etc. Shopping: Mr. Brayane is taken sometimes for shopping in view of development of cognition. Because whenever he goes for shopping he get opportunity for selecting something he wants such as soap, comp, paste, dress etc. Cooking: Mr: Brayane is asked to come to the Kitchen and assist the cook there. He will be given opportunities such as cutting vegetables, washing plates and it will be evaluated whether he does it properly or not. Cleaning: Mr. Brayane will be requested to clean kitchen, bedroom, toilets etc. to develop his living skills. Whenever he goes for shopping he gets opportunity for transportation and conversation with other people. Finance management: It is a required living skill for Brayane. Therefore the activities like going to the church, community centres and library, park are very important for him and these needs are fulfilled by the professionals in the rehabilitation unit. Socialisation: socialisation is very important for schizophrenic patients because their self esteem is damaged due to the disorder. Mr. Brayane is taken for various programmes in view of socialisation. “Schizophrenics can be referred to specialized community based programs such as social-recreational day programs with a focus on group interaction and activity. For example, some groups may use art or music to stimulate clients to interact and encourage socialization.” (Schizophrenia rehabilation, 2008). Physical health of Brayane: The care givers give special concern for Mr. Brayane’s physical health providing nutritious food and exercise. "Physical health and mental health are linked". (Schizophrenia rehabilation, 2008). Since there is a link between the mental and physical health, he must be given opportunities for maintaining his physical health. At the same time they must be encouraged to fulfil their spiritual and cultural needs. Mr. Brayane is taken to the church and other cultural programs. Vocational rehabilitation: In most of the rehabilitation centres it is found that the patients are engaged in different jobs. “Stuart & Sundeen (1995) state that aside from the development of work skills, the goal of these programs is to promote good work habits.” (Schizophrenia rehabilation, 2008). Education: The most vulnerability of the schizophrenic patient is the difficulty in cognitive processing. This is why schizophrenic patient is not able to learn new skills. “Cognitive processing difficulties are believed to restrict the schizophrenia patients ability to learn new skills, to perform them reliably over time, and to generalize them to new settings” (Heinssen, Liberman & Kopelowicz 2010, p.14). In the case of Mr. Brayne, he has to develop his living skills because he has no skills in using kitchen for cooking, use of laundry and managing money. The first program in the hospital is to promote the illness education. Brayne, his family and care giver also participated in the session of illness education. This helped him to give up the current stress and other problems. Psycho education helps to have “a focus on current stresses and problems and the elaboration of copying strategies” (Stein & Wilkinson 2007, 308). “Unfocused anxiety, tendency to argue and anger” (Springhouse 2003, p.164) are some of the symptoms of Paranoid Schizophrenia. When he feels that he is going to be affected, medicine must be taken and he was taught about the symptoms of the Schizophrenia. Since he is learnt, he can understand the symptoms of the disorder and the intense state of disease. When it becomes intense, he can take medicine or he can approach the professionals. He was asked to leave out stresses and tensions in the life. His family also was asked not to give any stress to the patient. One day he participated in various activities; but he became over stimulated. Hard work also will increase the risk of the disorder. This is what happened in the case of Brayne that day. “Over stimulation produced by intrusive attempts to reactivate patients through vocational rehabilitation or social re-motivation led to unfavorable outcomes for chronic schizophrenic patients” (Walsh, Craik & Price 2000, p.170). In the current scenario, he has seizure and it is reported that it is because of Clozapine. “Clozapine causes seizers in 3.5% of patients” (Taylor 2003, p.315). He was helped to go to kitchen and to cook the food. He did not know how to cook food. The nurses and social workers took him to the kitchen and taught how to prepare food and how to keep various things in the kitchen. Then the next living skill which is required to him is the use of laundry. He is taken to the laundry and the social worker will explain and help him to do the things according to the instruction. Many activities are performed to improve social integration of the patients. Mr. Brayne engages in speaking with others, watching television together and participating in various activities in the rehabilitation unit. Social integration activities and techniques are very important as far as it is concerned for a schizophrenic patient. Because “the paranoid patient is not sufficiently in tune with his-fellow men” (Searles 1986, p.469). Client’s Motivational Readiness for Change: “some studies have shown that the patients participation in psychosocial rehabilitative activities or community based aftercare programmes, have a positive effect on their family environment, due to the patients clinical stability and improvement of functioning, fewer investigators have explored this relationship within the framework of an experimental design” (Koukia & Madianos 2005). Develop hope, confidence and motivation to cooperate with the rehabilitation process. This is the primary step in the motivation development process. The secure 20-bed in-patient unit will focus on rehabilitation and recovery of those patients is able to move out of the acute ward. The Multi disciplinary team focuses on social inclusions in order to improve life skills. The motivational development is done through the enhancement of a consumers self sufficiency and autonomy. The infrastructure facility and the resources for mental health rehabilitation are sufficient here. On admission, clients are allocated a primary and secondary care coordinator to assist them to achieve maximum outcomes within the scope of their ability. The rehabilitation program allows 6 month stay in the centre creating a real life situation where the patient’s motivational readiness can be addresses successfully. The long stay and the sufficient infrastructure help the patient to sustain the motivational readiness. Assessment of Motivation: In this session the motivation of Mr. Brayne is discussed .Mr.Bryne spent money excessively. He always is exploited by others. He also use excessive amount of money in order to put lock due to unwanted fear. Sometime this type of behaviour leaves him without sufficient money towards the end of each fortnight for basic necessities such as food and transport. Brayne is allocated a primary and secondary care coordinator to assist during the time of admission. The primary and secondary coordinator assists Mr. Brayne in order to achieve maximum outcomes within the scope of his ability. In this motivation assessment, Mr. Brayne’s willingness to change the maladaptive behaviour such as unwanted spending of money and exploitation from others are assessed. “Importance concerns the desire or will to change. This can be regarded as the degree of discrepancy between the value of the current status and that of a future goal.” (Barkhof et al 2006, p.207). Mr. Brayne need help in learning skill like cooking, Laundry, etc., and he also need changes in the, maladaptive behaviour like spending excessive money for unwanted things and financial exploitation.. The motivational interviewing is done with Mr. Brayne to change his unwanted behaviour. Lack of motivation is one of the major problems faced in the rehabilitation process. “Contributing to the hopless attitude towards Schizoprenia the apparent lack of motivation is also the risk factor in rehabilitation” (Andresen et al n.d.). These case of behaviour need Motivational interviewing “Motivational interviewing (MI) is and intervention developed by Miller and Rollnick to assist people in recognizing problems, help them to build and maintain commitment to change certain behaviour and to actually carry out.” (Barkhof et al 2006, p.207). “Motivational interviews could serve as initial strategies to be implemented in the management of schizophrenia” (Corrigan et al. 2004). (Review of Literature, p.1). Assessment of Cognition: “The term Neurocognitive is derived from neurocognition would refer to ones ability to learn, understand, and become aware of the surrounding world with the input of mental abilities like memory perception, attention visuospatial ability and societal interactions (Brekke, Hoe & Green 2009).” (Review of Literature, p.1). Mr. Brayne thinks that the lock that is being used by him is not safe. There for he spends excessively on items such as locks for his unit, due to fears that people are trying to break into his place. This is a specific psychotic symptom related with the cognition named as delusion. This case needs Cognitive Behavioural therapy for the behavioural modification. “According to the Twamley et al. (2003), the assisted strategies for the management of schizophrenia include psychotherapy, vocational rehabilitation, social skills training, and psychosocial interventions. These approaches serve as promising candidates for enhancing cognitive functions, symptoms, and daily tasks (Twamley et al. 2003).” (Review of Literature, p.2). Cognition therapy is also required Mr. Brayne to come out with a better output. “This was revealed when a study compared the affects of this approach in patients and controls. The tool employed was script test measures of social cognition to determine the outcomes. The findings revealed that cognitive rehabilitation could develop social cognitive skills in schizophrenic patients.” (Matsui et al. 2009). Assessment of Needs: In the need assessment process all the needs as the met and the unmet need of Mr. Brayne are listed using the tool CANSAS. “The Camber well Assessment of Need(CAN) and it short version the caberwell Assessment of Beed Short Appraisal Schedule ( CANSAS) are 22 item structured interview schedules designed to identify the needs of consumers diagnosed with a severe enduring mental illness.” (Camberwell Assessment of need 1, p.2.). The Need assessment is done by both the client and the rehabilitation worker Mr. Brayne’s previous functioning at home was very poor. Mr. Brayne has difficulties in managing his finance, not able to perform the day today activities such as laundry and cooking. He is unable to prepare meals and has meals provided. He is unable to look after home and has regular domestic help. With the help of CANSAS the real needs of Mr. Brayne is not identified by him. The Out of the total 22needs Mr. Brayne has totally 9 met needs and one unmet need .based on the clinicians view. And Mr. Brayne feels that he has only one met need and has ‘0’ unmet needs. Totally only one need is there for him. The need required for Mr. Brayne is to perform day time activities. Mr. Brayne is suffering from Paranoid Schizophrenia. Hence the need assessment done by him is not sufficient for the better output. It is because the client may not feel the importance of behavioural modification. And it will be d d- difficult for anybody to motivate him. Discuss the extent to which clients are encouraged to set their own goals, develop the specific tasks needed to achieve their goals, and how this process is monitored. Monitoring of Goal Setting: The goal setting is the vital part in the rehabilitation process. It supports Mr. Brayne to recover as soon as possible. Based on the needs find out by the clients the goals for intervention is to be set. Here the extent to which Mr. Brayne is encouraged to set his goals is discussed. Mr. Brayne has to get help in learning day today activities such as cooking and laundry keeping. The clients cannot allow Mr. Brayne to set his own goals it is because the important need needed him to learn is not known to him by alone and he is not I a position to understand his problem. The first step in the Goal setting process is done on the basis of provided self awareness about his condition and the problem faced by him. The trained rehabilitation worker effectively encourages Mr. Brayne to set his own goals. The Shellharbour Mental Health Rehabilitation centre provides primary and secondary care co-coordinator. He assists Mr. Brayne to gain maximum output from the rehabilitation care within the scope of their ability. The specific tasks needed to achieve the goals of the consumers is done by providing the consumer with activities and skills that promote illness education, illness maintenance and symptoms management, medication management , living skills and social integration. This process is monitored through the case reviews. The case reviews are conducted regularly with input from the coordination of multi disciplinary team. “Goal setting ad review allows patients’ progress to be monitored and provided information to patients and families and gave feed back to refers and funders.” (Young, Manmathan & Ward 2008, p.1). Care coordinators are provided to assist the consumers to achieve maximum outcomes within the scope of their ability. Case reviews are conducted regularly with input from the multidisciplinary team to maintain a focused care plan in alignment with the goals of consumer. Once the consumer goals are identified; the care is coordinated with focus being placed on consumer participation. This is achieved by providing the consumer with activities and skills that promote illness education, illness maintenance and symptoms management, medication management, living skills and social integration. Modification of Goals: In the rehabilitation program the modification of goals process is done to think about the future based in the context of the needs of the client. It is to motivate the client to make the needs a reality as an outcome of the process. In the case of Mr. Brayne, he does not feels that the goal setting should be done based on his poor living condition at the house. In this case the goal modification is done with the cooperative work of the client and the clinicians. This will help Mr. Brayne to motivate his goal setting “Admittedly, individuals with serious mental Illnesses may sometimes have special difficulties engaging in critical dialogue due to delusional beliefs or cognitive impairments, so that special ways of accomplishing this may have to be explored.” (Rudnick 2003, p.3). In an atmosphere in which each participant feels wanted by the program the modification of the goals become easy. “Treatment goals were compliance with medications, reduction of hospital admissions, and adjustment to a chronic illness (Marder, 2005).” (Perese & Wu Bill Wu 2010, pp.43-56). In the goal setting process Mr. Brayne a set a goal in order to perform day today office work which is considered as the important need to meet is not the primary one to perform. Here the Goal must be set to tackle the problem of excess money spending and the exploitation by other. Another important area that the goal must be set is the skill learned for day today activities. Negotiation of Goals: Mr. Brayne needs help in some day today activities. Therefore the negotiation of goals must be set on the base of the real needs of the client. The main area under which the goals are to be set 1. Learn to use kitchen for cooking, 2. Learn to use laundry 3. Learn to manage his finance effectively. For example on the second week of the rehabilitation process Mr. Brayne is given a task of preparing tea from the kitchen. Monitoring Process: On admission consumers are allocated a primary and secondary care coordinator to assist the consumers to achieve maximum outcomes within the scope of their ability. Case reviews are conducted regularly with input from the multidisciplinary team to maintain a focused care plan in alignment with the goals of consumer. Once the consumer goals are identified care is coordinated with focus being placed on consumer participation. This is achieved by providing the consumer with activities and skills that promote illness education , illness maintenance and symptoms management, medication management, living skills and social integration. The team members are: staff specialis psychiatrist, register psychiatrist, clinical psychologist, consumer advocate, nurse unit manager, registered nurse, enrolled nurse, head and security assistant, occupational therapist, social worker. Care Plan: “Paranoid Schizophrenia is the most common schizophrenic disorder.” (Coon 2005, p.510). The Shellharbour Mental Health Rehabilitation Unit provides nursing and medical care to the patients who suffer from severe mental illness. The institution focuses on voluntary and involuntary patients. This hospital gives preference to the patients who shows treatment resistance with severe functional impairments and patients who are afflicted with intensively psychosis are their main focus. These patients would be suffering from functional impairments. Nursing and medical care given by this rehabilitation unit makes them be productive in life. This promotes social inclusion through improvement in life skills by enhancing the independence and autonomy of the patient. This in turn will provide the patient with hope for the future leading to successful community living with appropriate support. The patients are fully engaged with various activities and skills that promote illness education, illness maintenance, symptoms management, medication management, living skills and social integration. There is a multi disciplinary team to provide care and they are psychiatrist, clinical psychologist, consumer advocate, nursing unit manager, registered nurse, enrolled nurse, head and security assistant, occupational therapist and social workers. A care plan is written for the case of Brayane and it is given in the following table. Patient : Brayane Ward : Shellharbour Hospital Care Plan Written By : Date : 20-05-10 Need: Brayane wants to be active since his functioning at home is very poor. Mr Brayne wants to develop the skill of management since has difficulties in managing his finance. He has to be free from exploitation since he is subjected to exploitation by others and girl friend. He wants to avoid unnecessary fear like fear that people are trying to break into his place. He wants to develop the skill to manage his money since he does not have money at the end of the day. Expected Outcome / Aims : The expected outcome from the rehabilitation care are: developing living skills like management of money, dynamism in the activity, free from the exploitation and unnecessary fear, use of laundry and use of kitchen for cooking food etc. Intervention : 1. Providing a supportive environment to Brayane to develop life skills and to the cognitive refreshments. 2. The nurses and social workers develop a rapport among them, to make Brayane free from other stresses. 3. The psychiatrist and psychologist visits Brayan daily to assess improvement in him. 4. Cognitive behavioural therapy is practiced with Brayan to develop the cognitive skills. 5. The social workers assess the case of Brayan whenever he is in the kitchen and do other personal work to know whether he is improved or not. 6. For sessions are given for Brayane in order for the promotion of illness education, illness maintenance, symptom management and social integration. LOW Level Stress – MODERATE level stress – HIGH level stress – Care Discussion The social worker discussed with Brayane about the entire intervention program. Brayan is ready to be stay in the rehabilitation centre for the treatment. He is admitted in the rehabilitation unit to regain his living skills such as management of finance, use of laundry, use of kitchen for preparing food and be free from the exploitation form his girl friend and others. Patients Signature : Case Worker Signature : (Mercy care, n.d.). Discussion of the Overall Outcome of the program: In the case of a schizophrenia patient “psychiatric symptoms may persist despite treatment.” (Pratt, Gill & Barrett 2007). Therefore, rehabilitation for schizophrenic patient is very important to manage the disorder. “Paranoid Schizophrenia seems to be the commonest type diagnosed today.” (Turner 2003, p.15). There are multi disciplinary team in the rehabilitation centre consisting of psychiatrists, psychologists, nurses, social workers and consumer advocates. They are ready to give any help to the patient at any time. The rehabilitation program is efficient in its richness of resources and infrastructure where Brayne is given treatment. The programs are designed in a way that the motivational activities are carried out successfully. Multidisciplinary team gives illness education, activities for social integration, symptom management, activities to develop living skills and maintenance of illness. It is reported that there is a gradual improvement in the case of Brayne. The main focus was to develop the skills in using kitchen and laundry. After the treatment, there was a tremendous change in developing these skills. More over he started to speak very sensibly. He became able to tell the news what he heard in the television. It is because of the cognitive training given from the rehabilitation centre. There was a special focus on the development of cognition of Brayan. As he is doing business, it is very necessary to manage the money he collects. Therefore, I can say that the treatment in the rehabilitation unit is very effecting in developing living skills of the patient. Summary of Findings: The program deals the rehabilitation process with a multidianmentional approach using the coordination of the multidisciplinary team. It further addresses the needs of consumer in a systematic way. The case reviews help the professional to work in a systematic way where the meeting of the consumer needs and the motivation change can be evaluated. Consumer’s participation in the rehabilitation process is given primary concern. Recommendations: The program does not have an occupational therapist. A specialized occupational therapist can help consumers to learn many skills like how to use kitchen for cooking, use the laundry etc. Conclusion: “The clinical characteristics and service needs of persons with serious and persistent mental illness vary significantly throughout the life cycle and course of the illness” (Barton 1999). The Report mainly focusing on demonstrating the multidisciplinary practices involved in the development and implementations of collaborative approach to psycho social rehabilitation in the Shellharbour Hospital Mental Health Rehab Unit. The report is a case study of a patient who is suffering from Paranoid schizophrenia. The case study deals with the issue of maladaptive behaviour of the client. The brief description f the client and the program is discussed in the first part of the case study. The case study further deals with the involvement of the client in their individual psychosocial rehabilitation setting. The motivation of the client is to be measured in a systematic way using the standard techniques so that the outcome of the rehabilitation process can be improved. The Assessment of cognition is necessary because the client have problem with cognition. The Client is not in a position to deal with goal setting. The rehabilitation worker helps the client to modify his goal. “The assessment of needs has been put forthas an important dimension in both the planning, development and evaluation of psychiatric services” (Hansson, Bjorkman & Svensson 2007). The goals are set to fulfill the needswhich are considered as the most important for intervention. Finally the case study suggests some recommendations and brings out some findings. The care plan is helpful to understand the program and its effectiveness. Rehabilitation means a “sequence of services designed to restore optimum physical, psychological, social, and vocational levels of function” (Definitions of rehabilitation on the web, n.d). Reference List Andresen, R. et al., n.d. The Experience of Recovery from Schizophrenia: Towards an Empirically-Validated Stage Model. [Online] A stage modal of Recovery. Available at: http://www.uow.edu.au/content/groups/public/@web/@health/documents/doc/uow042403.pdf [Accessed 19 May 2010]. Anthony, W A., 1993. Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. [Online] Changing Towards the Future. Available at: http://www.bcss.dhh.louisiana.gov/offices/publications/pubs-305/anthony1993c.pdf [Accessed 17 May 2010]. Assertive community treatment, 2009. [Online] Psychosocial Rehabilitation. Available at: http://www.psychosocial.com/descript.html [Accessed 17 May 2010]. Barkhof, E. et al., 2006. Motivational interviewing in psychotic disorders. Current Psychiatry Reviews. (2.2). p.207. [Provide by customer]. Barton, R., 1999. Psychosocial rehabilitation services in community support system: A review of outcomes and policy recommendations. [Online] Psychiatric Services. Available at: http://www.psychservices.psychiatryonline.org/cgi/content/abstract/50/4/525 [Accessed 17 May 2010]. Camberwell Assessment of need 1, p.2. [Provide by customer]. Coon, D., 2005. Psychology: A modular approach to mind and behaviour. [Online] Cengage Learning, p.510. Available at: http://books.google.co.in/books?id=evrfDR09mDsC&pg=PA510&dq=paranoid+schizophrenia+awareness+program&hl=en&ei=Ru_vS9i8MYu4rAeaz7WTBw&sa=X&oi=book_result&ct=result&resnum=1&ved=0CC4Q6AEwAA# [Accessed 17 May 2010]. Core principle of psychosocial rehabilitation, n.d. [Online] Ontario Federation of Community Mental Health and Addiction Programs. Available at: http://www.psr.ofcmhap.on.ca/node/36 [Accessed 17 May 2010]. Definitions of rehabilitation on the web, n.d. [Online] Define: Rehabilitation. Available at: http://www.google.co.in/search?hl=en&defl=en&q=define:rehabilitation&ei=rcPvS4_UCIm3rAe3wuCTBw&sa=X&oi=glossary_definition&ct=title&ved=0CAoQkAE [Accessed 17 May 2010]. Hansson, L., Bjorkman, T & Svensson, B., 2007. The assessment of needs in psychiatric patients: Interrater reliability of the Swedish version of the Camberwell assessment of needs instrument and results from a cross-sectional study. [Online] Acta Psychiatrica Scandinavica. Available at: http://www3.interscience.wiley.com/journal/119231125/abstract?CRETRY=1&SRETRY=0 [Accessed 17 May 2010]. Harvey, P D., et al., 1998. Symptoms cognitive functioning and adaptive skills in geriatric patients with life long schizophrenia: a comparison across treatment sites. [Online] American Psychiatric Association. Available at: http://ajp.psychiatryonline.org/cgi/content/abstract/155/8/1080 [Accessed 17 May 2010]. Heinssen, R K., Liberman, R P & Kopelowicz, A., 2010. Psychosocial skills training for schizophrenia: Lesson from the laboratory. [Online] Schizophrenia Bulletin, (26.1), p.14. Available at: http://schizophreniabulletin.oxfordjournals.org/cgi/reprint/26/1/21.pdf [Accessed 17 May 2010]. Koukia, E & Madianos, M G., 2005. The effect of rehabilitation of schizophrenic on their family atmosphere and the emotional well-being of caregivers. [Online] Scielo: The European journal of psychiatry. Available at: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0213-61632005000100005 [Accessed 17 May 2010]. Mercy care, n.d. [Online] NHS. Available at: http://www.merseycare.nhs.uk/Library/Learning_Zone/Learning_Development/Practice_Development/Care_Plan_Resources/Example%20of%20Care%20Plan%20for%20Paranoid%20Schizophrenia.doc [Accessed 19 May 2010].Perese, E F., 2010.Short falls of treatment for patients with schizophrenia: Unmet needs, obstacles to recovery. [Online] Psychosocial Rehabilitation. Available at: http://www.psychosocial.com/IJPR_14/Shortfall_in_Treatment_Perrese.html [Accessed 17 May 2010]. Pratt, C W., Gill, K J & Barrett, N M., 2007. Psychiatric rehabilitation. [Online] Academic Press, p.33. Available at: http://books.google.co.in/books?id=ZYUAPfUWGwkC&pg=PA33&dq=rehabilitation+of+schizophrenia&hl=en&ei=H-PvS4D4Nsu8rAeq1umTBw&sa=X&oi=book_result&ct=result&resnum=10&ved=0CFcQ6AEwCQ#v=onepage&q=rehabilitation%20of%20schizophrenia&f=false [Accessed 17 May 2010]. Perese, E. & Wu Bill Wu, Y., 2010. Shortfalls of treatment for patients with Schizophrenia: unmet needs, obstacles to recovery [Online] The International Journal of psycho Social Rehabilitation, (14.2). pp. 43-56. Available at: http://www.psychosocial.com/IJPR_14/Shortfall_in_Treatment_Perrese.html [Accessed 19 May 2010]. Rudnick, A., 2003. Psychiatric rehabilitation: The challenges of goal setting. [Online] The Open Mind, p.1. Available at: http://www.stacommunications.com/journals/cme/2005/May/PDF/080.pdf [Accessed 17 May 2010]. Review of Literature, p. 2. [Provide by customer]. Schizophrenia rehabilation, 2008. [Online] Registered Psychiatric Nurses Association of Saskatchewan. Available at: http://www.rpnas.com/public/jsp/content/publications/papers/schizophrenia04.jsp [Accessed 17 May 2010]. Searles, H F., 1986. Collected papers on schizophrenia and related subject. [Online] Karnac Books, p.469. Available at: http://books.google.co.in/books?id=8tyOyxRLzPwC&pg=PA465&dq=paranoid+schizophrenia+awareness+program&hl=en&ei=Ru_vS9i8MYu4rAeaz7WTBw&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDMQ6AEwAQ#v=onepage&q&f=false [Accessed 17 May 2010]. Springhouse., 2003. Psychiatric nursing made incredibly easy. [Online] Lippincott Williams & Wilkins, p.164. Available at: http://books.google.co.in/books?id=H_NUCoZIHRUC&pg=PT179&dq=paranoid+schizophrenia+treatment&hl=en&ei=4e3vS4bcAoi0rAea1_iTBw&sa=X&oi=book_result&ct=result&resnum=1&ved=0CDAQ6AEwAA#v=onepage&q=paranoid%20schizophrenia%20treatment&f=false [Accessed 17 May 2010]. Stein, G & Wilkinson, G., 2007. Seminars in General Adult Psychiatry. [Online] RCP sych Publications, 308. Available at: http://books.google.co.in/books?id=6PGzHFuS1xkC&pg=PA308&dq=psychosocial+skills+development+for+schizophrenic+patients&hl=en&ei=NMnvS6ysGI7HrAfI0ryUBw&sa=X&oi=book_result&ct=result&resnum=7&ved=0CEsQ6AEwBg#v=onepage&q=psychosocial%20skills%20development%20for%20schizophrenic%20patients&f=false [Accessed 17 May 2010]. Taylor, R B., 2003. Family medicine: Principles and practice. [Online] Springer, p.315. Available at: http://books.google.co.in/books?id=HdxmrHrsKIUC&pg=PA315&lpg=PA315&dq=Clozapine+causes+seizures+in+3.5%25+of+patients&source=bl&ots=Y_L6hzR2JV&sig=nAUM_sRayR1c3qyuIevxNaTDXQY&hl=en&ei=Yc_wS_7rJpC5rAftptiTBw&sa=X&oi=book_result&ct=result&resnum=3&ved=0CBYQ6AEwAg#v=onepage&q=Clozapine%20causes%20seizures%20in%203.5%25%20of%20patients&f=false [Accessed 17 May 2010]. Turner, T H., 2003. Schizophrenia: your questions answered. [Online] Elsevier Health Sciences, p.15. Available at: http://books.google.co.in/books?id=LR9kNe_086MC&pg=PT26&dq=what+is+paranoid+schizophrenia&hl=en&ei=QejvS4WRDdLCrAeLk9CUBw&sa=X&oi=book_result&ct=result&resnum=5&ved=0CD4Q6AEwBDgo#v=onepage&q=what%20is%20paranoid%20schizophrenia&f=false [Accessed 17 May 2010]. Walsh, B., Craik, K H & Price, R H., 2000. Person-environment psychology: New directions and perspectives. [Online] Routledge, p.170. Available at: http://books.google.co.in/books?id=Lz-aLpLEZ-oC&pg=PA170&dq=psychosocial+skills+development+for+schizophrenic+patients&hl=en&ei=NMnvS6ysGI7HrAfI0ryUBw&sa=X&oi=book_result&ct=result&resnum=8&ved=0CFAQ6AEwBw#v=onepage&q=psychosocial%20skills%20development%20for%20schizophrenic%20patients&f=false[Accessed 17 May 2010]. Young, C A., Manmathan, G P & Ward, J C., 2008. Perception of goal setting in a neurological rehabilitation unit: A qualitative study of patients, carers and staff. [Online] Foundation of Rehabilitation Information, p.1. Available at: http://jrm.medicaljournals.se/files/pdf/40/3/902.pdf [Accessed 17 May 2010]. Read More