Objetivo: Este trabalho tem os seguintes objetivos: (a) analisar a mudança do atendimento nos Centros de Atenção Psicossocial (CAPS) entre 2004 a 2009 em Porto Alegre, Rio Grande do Sul, (b) descrever o perfil dos pacientes atendidos nos CAPS do Rio Grande do Sul no mesmo período e (c) descrever, com base populacional, o alcance dos CAPS. Método: Foi realizado um estudo transversal com base em dados públicos do Sistema de Informações Ambulatoriais (SIA-SUS) e Cadastro Nacional de Estabelecimentos de Saúde (CNES), disponíveis no site do Departamento de Informática do SUS (Sistema Único de Saúde)- DATASUS–, www.datasus.gov.br, no período de 2004 a 2009. Foram analisadas as frequências da produção ambulatorial dos serviços CAPS, em Porto Alegre e no Rio Grande do Sul, no período de 2004 a 2009, e calculado o Índice de Cobertura – IC de CAPS / 100.000 habitantes. Resultados: O estudo evidenciou que de 2004 a 2009 houve: (a) expansão em 142,5% dos CAPS no Brasil (de 605 para 1.467 unidades), 100% no Rio Grande do Sul (de 70 para 144 CAPS); (b) evolução oposta da produção ambulatorial entre o estado do Rio Grande do Sul e a capital do estado, com duplicação de procedimentos de cuidado intensivo no Estado (de 209.923 para 424.500), e redução de quase 50% dos mesmos na Capital (de 10.487 para 5.577); (c) aumento de 76% na cobertura do CAPS medida através do Índice de Cobertura no Estado (de 0,52 para 0,91), (d) redução de desigualdades regionais (em 2009, 37% das 19 regiões apresentavam Índice de Cobertura abaixo de 0,90, enquanto em 2010 passou para 10%) e (e) persistência do déficit global (49,04% da população do estado ainda residindo em municípios com cobertura Insuficiente, ou seja com IC abaixo de 0,90). Conclusão: Constatou-se a persistência de cobertura Insuficiente de CAPS para 49,04% da população do estado (IC abaixo de 0,9). Dez anos depois da implementação da Portaria nº 336/2002, que definiu os 3 modelos de serviços dos CAPS (I, II, III) e a sua finalidade (atendimento de transtornos mentais graves e persistentes), ainda encontramos no estado regiões de saúde com Índice de Cobertura Insuficiente, e principalmente, quase a metade da população vivendo em municípios com cobertura Insuficiente. Adicionalmente, em Porto Alegre, constatou-se uma redução no atendimento de pacientes nos centros de atenção psicossocial, o que mostra que a população-alvo dos CAPS está utilizando outros serviços que não o CAPS, ou não está utilizando os serviços montados para ela, por diferentes motivos (filtros, barreiras de acesso, opção por outros tipos de pagamento ou convênios). O estudo mostra necessidade de investigações adicionais para responder as questões levantadas, sobre o caminho que os pacientes tomaram, se estão em tratamento em outros locais não diretamente financiados por SUS (convênios, planos de saúde, sociedades beneficentes) ou se estão ficando fora dos serviços de saúde, confinados à cuidado na família e comunidade, somente utilizando o SUS na reativação da doença, emergências ou serviços gerais de saúde. / Objective: This paper aims: (a) to analyze the change in service at Psychosocial Care Centers (CAPS) in Porto Alegre, Rio Grande do Sul, from 2004 to 2009; (b) to describe the profile of patients at the CAPS in Rio Grande do Sul in the same period; and (c) to describe the scope of the CAPS on a population basis. Methods: We conducted a cross-sectional study based on public data from the Outpatient Information System (SIA-SUS) and the National Register of Health Establishments (CNES), available at the Department of the SUS (Unified Health System) - DATASUS-, www.datasus.gov.br from 2004 to 2009. We analyzed the frequencies of production generated from CAPS services by SIA in Porto Alegre and in Rio Grande do Sul from 2004 to 2009, and calculated the Coverage Ratio - CI CAPS / 100,000 inhabitants. Results: it was observed that from 2004 to 2009: (A) there was an increase of 142,5% in the number of CAPS in Brazil (from 605 to 1,467) and in Rio Grande do Sul they also increased from 70 to 144 (more than 100%); (B) there was a reduction of outpatient intensive care services in the capital city, Porto Alegre, in the period (from 10,487 to 5,577) while in the state of Rio Grande do Sul such services doubled (from 209,923 to 424,500) in the same period; C) there was an increase of 76% (0.52 to 0.91 CAPS/100.000 inhabitants) in the Coverage Ratio of Rio Grande do Sul, (d) there was an inequality reduction in health regions in 2009 (37% CI of 19 regions with below 0.90 in 2009 to 10% in 2010). (e) there was a persistent overall deficit (49,04% of the state population still lived in cities with inadequate coverage, with CI below 0.90 CAPS/100.000 inhabitants). Conclusion: Persistent Insufficient coverage (CI below 0,9) was found in 49.04% of the state population in 2009. Ten years after the implementation of Ordinance No. 336/2002, which defined the three service models of CAPS (I, II, III) and their purpose to care for severe mental disorders, we still find health regions with Low Index Coverage in the state and almost half the population living in cities with Insufficient Coverage. Furthermore, we also observed that there was a reduction in service in CAPS in Porto Alegre, showing that the target population is either resorting to other services rather than CAPS or not enjoying the benefits of available services for various reasons. This study shows the need of further investigation to answer some remaining questions about what directions patients have taken, if they are being treated somewhere else in private hospitals or by private medical plans, not funded by the SUS, if they are not being treated at all, or perhaps if they are being cared by their families or communities and only use health services provided by the SUS when the disease strikes back or in health emergencies.

Objetivo: Este trabalho tem os seguintes objetivos: (a) analisar a mudança do atendimento nos Centros de Atenção Psicossocial (CAPS) entre 2004 a 2009 em Porto Alegre, Rio Grande do Sul, (b) descrever o perfil dos pacientes atendidos nos CAPS do Rio Grande do Sul no mesmo período e (c) descrever, com base populacional, o alcance dos CAPS. Método: Foi realizado um estudo transversal com base em dados públicos do Sistema de Informações Ambulatoriais (SIA-SUS) e Cadastro Nacional de Estabelecimentos de Saúde (CNES), disponíveis no site do Departamento de Informática do SUS (Sistema Único de Saúde)- DATASUS–, www.datasus.gov.br, no período de 2004 a 2009. Foram analisadas as frequências da produção ambulatorial dos serviços CAPS, em Porto Alegre e no Rio Grande do Sul, no período de 2004 a 2009, e calculado o Índice de Cobertura – IC de CAPS / 100.000 habitantes. Resultados: O estudo evidenciou que de 2004 a 2009 houve: (a) expansão em 142,5% dos CAPS no Brasil (de 605 para 1.467 unidades), 100% no Rio Grande do Sul (de 70 para 144 CAPS); (b) evolução oposta da produção ambulatorial entre o estado do Rio Grande do Sul e a capital do estado, com duplicação de procedimentos de cuidado intensivo no Estado (de 209.923 para 424.500), e redução de quase 50% dos mesmos na Capital (de 10.487 para 5.577); (c) aumento de 76% na cobertura do CAPS medida através do Índice de Cobertura no Estado (de 0,52 para 0,91), (d) redução de desigualdades regionais (em 2009, 37% das 19 regiões apresentavam Índice de Cobertura abaixo de 0,90, enquanto em 2010 passou para 10%) e (e) persistência do déficit global (49,04% da população do estado ainda residindo em municípios com cobertura Insuficiente, ou seja com IC abaixo de 0,90). Conclusão: Constatou-se a persistência de cobertura Insuficiente de CAPS para 49,04% da população do estado (IC abaixo de 0,9). Dez anos depois da implementação da Portaria nº 336/2002, que definiu os 3 modelos de serviços dos CAPS (I, II, III) e a sua finalidade (atendimento de transtornos mentais graves e persistentes), ainda encontramos no estado regiões de saúde com Índice de Cobertura Insuficiente, e principalmente, quase a metade da população vivendo em municípios com cobertura Insuficiente. Adicionalmente, em Porto Alegre, constatou-se uma redução no atendimento de pacientes nos centros de atenção psicossocial, o que mostra que a população-alvo dos CAPS está utilizando outros serviços que não o CAPS, ou não está utilizando os serviços montados para ela, por diferentes motivos (filtros, barreiras de acesso, opção por outros tipos de pagamento ou convênios). O estudo mostra necessidade de investigações adicionais para responder as questões levantadas, sobre o caminho que os pacientes tomaram, se estão em tratamento em outros locais não diretamente financiados por SUS (convênios, planos de saúde, sociedades beneficentes) ou se estão ficando fora dos serviços de saúde, confinados à cuidado na família e comunidade, somente utilizando o SUS na reativação da doença, emergências ou serviços gerais de saúde. / Objective: This paper aims: (a) to analyze the change in service at Psychosocial Care Centers (CAPS) in Porto Alegre, Rio Grande do Sul, from 2004 to 2009; (b) to describe the profile of patients at the CAPS in Rio Grande do Sul in the same period; and (c) to describe the scope of the CAPS on a population basis. Methods: We conducted a cross-sectional study based on public data from the Outpatient Information System (SIA-SUS) and the National Register of Health Establishments (CNES), available at the Department of the SUS (Unified Health System) - DATASUS-, www.datasus.gov.br from 2004 to 2009. We analyzed the frequencies of production generated from CAPS services by SIA in Porto Alegre and in Rio Grande do Sul from 2004 to 2009, and calculated the Coverage Ratio - CI CAPS / 100,000 inhabitants. Results: it was observed that from 2004 to 2009: (A) there was an increase of 142,5% in the number of CAPS in Brazil (from 605 to 1,467) and in Rio Grande do Sul they also increased from 70 to 144 (more than 100%); (B) there was a reduction of outpatient intensive care services in the capital city, Porto Alegre, in the period (from 10,487 to 5,577) while in the state of Rio Grande do Sul such services doubled (from 209,923 to 424,500) in the same period; C) there was an increase of 76% (0.52 to 0.91 CAPS/100.000 inhabitants) in the Coverage Ratio of Rio Grande do Sul, (d) there was an inequality reduction in health regions in 2009 (37% CI of 19 regions with below 0.90 in 2009 to 10% in 2010). (e) there was a persistent overall deficit (49,04% of the state population still lived in cities with inadequate coverage, with CI below 0.90 CAPS/100.000 inhabitants). Conclusion: Persistent Insufficient coverage (CI below 0,9) was found in 49.04% of the state population in 2009. Ten years after the implementation of Ordinance No. 336/2002, which defined the three service models of CAPS (I, II, III) and their purpose to care for severe mental disorders, we still find health regions with Low Index Coverage in the state and almost half the population living in cities with Insufficient Coverage. Furthermore, we also observed that there was a reduction in service in CAPS in Porto Alegre, showing that the target population is either resorting to other services rather than CAPS or not enjoying the benefits of available services for various reasons. This study shows the need of further investigation to answer some remaining questions about what directions patients have taken, if they are being treated somewhere else in private hospitals or by private medical plans, not funded by the SUS, if they are not being treated at all, or perhaps if they are being cared by their families or communities and only use health services provided by the SUS when the disease strikes back or in health emergencies.

Nineteenth-century state mental hospitals across New England and the United States are linked today with images of confinement, forced treatment, torture, abandonment, and family separation. This project does not directly challenge those associations. An ethnographic study in medical anthropology, this study is based on three years of fieldwork observations and qualitative interviews with neighbors, townspeople, former employees, and visitors to the open campus of a decommissioned state mental hospital in Massachusetts. Excavated from that hospital’s annual reports dating back to 1896 and gathered from local memories and storytelling, this projects considers the central place that work once held in the lives of psychiatric patients at Medfield State Hospital and the place that idleness holds for patients living within today’s institution of community care. Participants’ memories track the shifting perceptions and meanings of mental illness that resulted once “industrial therapy” programs were ended in state mental hospitals. This inquiry describes the ways that the loss of work changed psychiatric patients’ experiences of suffering, promoting the use of new chemical treatments, accelerating deinstitutionalization, and catalyzing new patterns nationally of service utilization and psychiatric disability. From participants’ memories and the author’s reflections on clinical practice as an independently licensed social worker (LICSW) in Massachusetts, this analysis uncovers the social functions of staying sick within contexts of unequal opportunity and joblessness. This study reveals the complicated and punishing work of surviving and helping people survive across de-industrialized landscapes as mental health practitioners assist the disenfranchised by recasting social suffering into psychiatric illness with treatment-induced embodiments that simultaneously help to manage poverty and perpetuate risk within disabilized citizens.

Background: the aims of this study were to assess the outpatients needs among 155 patients at Al-Amal Complex for Mental Health in Riyadh, Saudi Arabia, and identifying the demographic variables that are associated with these needs. Method: the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) was used to assess the needs and the demographic questionnaire was used to identify the patient’s demographic variables includes gender, age, income and level of education. Results: patient who meets any one of these criteria; being elderly, poor, and the uneducated are more likely to have higher total number of needs. Men and women are more likely to report similar met needs, but women are more likely expressed more unmet needs.

A saúde é o resultado do gerenciamento adequado das áreas físicas, emocionais, sociais, profissionais, intelectuais e espirituais, e a qualidade de vida do trabalhador está relacionada a manter-se em equilíbrio, diante das situações do dia a dia. O ambiente hospitalar agrega aspectos muito específicos de carga de trabalho, contato direto com situações limite, elevado nível de tensão e altos riscos para si e para os outros. Este estudo teve por objetivo identificar a satisfação e o impacto do trabalho entre profissionais da equipe multiprofissional de um Hospital Psiquiátrico. Estudo exploratório descritivo, de abordagem quantitativa, do tipo transversal, realizado numa cidade do interior de São Paulo, junto a equipe multiprofissional de um Hospital Psiquiátrico. A população deste estudo foi constituída pelos 136 membros da equipe multiprofissional de um Hospital Psiquiátrico, totalizando 116 participantes. Foram utilizados três instrumentos para a coleta dos dados: Roteiro para entrevista com os sujeitos (REPSM), Escala de Avaliação da Satisfação da Equipe em Serviços de Saúde Mental (SATIS-BR abreviada) e Escala de Avaliação do Impacto do Trabalho em Serviços de Saúde Mental (IMPACTO-BR). Respeitaram-se os preceitos éticos. Realizou-se análise descritiva com base na análise estatística inferencial. Os resultados mostram que dos 116 participantes do estudo, 63,8% são do sexo feminino, com média etária de 37,5 anos, 54% são solteiras, 41,9% vivem com companheiro e 51,7% não tem filhos. Na faixa entre 1 e 5, o escore médio de satisfação foi 3,4 tendo ocorrido maior satisfação no fator \"Relacionamentos\" e menor no fator \"Participação no serviço\". O escore médio de sobrecarga foi 1,9 tendo maior impacto no fator \"Efeitos do trabalho no relacionamento da equipe\" e menor nos \"Efeitos sobre a saúde física e mental\". Observou-se correlação negativa entre resultados da satisfação e sobrecarga com destaque para o número de funcionários, a necessidade de capacitação específica da equipe e possibilidade de maior participação nas decisões no serviço. Conclusão: baixos níveis de sobrecarga e de satisfação mostram a necessidade de revisão dos projetos institucionais para melhorar a qualidade de vida do trabalhador e da assistência prestada / Health is the result of proper management concerning physical, emotional , social, professional, intellectual and spiritual areas of ones life, and the quality of life of the working man or woman is relates to maintaining in equilibrium, given the situations of everyday life . The hospital adds to the employers working environment very specific aspects of workload, direct contact with extreme situations, and high level of tension and high risks for themselves and others. This study aimed to identify job satisfaction and the job\'s impact on professional workers from a multidisciplinary team in a Psychiatric Hospital. An exploratory, descriptive study, with a quantitative cross-sectional approach was conducted in the city of São Paulo with the multidisciplinary team of a Psychiatric Hospital. The study population was composed of 136 members of the multidisciplinary team of the Psychiatric Hospital, totaling 116 participants. Three instruments were used for data collection: Roadmap for interview subjects (REPSM), Scale for Assessment of Satisfaction on he for Mental Health Services Team (SATIS - BR abbreviated) Rating Scale of Labor Impact inside Mental Health Services (IMPACT - BR). Ethical approaches were respected. We conducted a descriptive analysis based on inferential statistical analysis. The results show that of the 116 study participants, 63.8 % were female, with an average age of 37.5 years, 54 % were single, 41.9 % lived with a partner and 51.7 % did not have children. In the range between 1 and 5, the average satisfaction score was 3.4, in which satisfaction concerning \"Relationship\" occurred in greater number, and in lower number concerning the factor: \"Participation in the service\". The average score concerning overload was 1.9, in respect to \"Effects of the job upon the relationship inside the team\" and lesser on \"Effects on physical and mental health\". We observed a negative correlation between satisfaction and overload, highlighting as such the number of employees, the necessity for specific training of staff and the possibility of greater participation in decisions during service. Conclusion: Low levels of overload and satisfaction show the need for revision of institutional projects to improve the quality of life of workers and assistants

A saúde é o resultado do gerenciamento adequado das áreas físicas, emocionais, sociais, profissionais, intelectuais e espirituais, e a qualidade de vida do trabalhador está relacionada a manter-se em equilíbrio, diante das situações do dia a dia. O ambiente hospitalar agrega aspectos muito específicos de carga de trabalho, contato direto com situações limite, elevado nível de tensão e altos riscos para si e para os outros. Este estudo teve por objetivo identificar a satisfação e o impacto do trabalho entre profissionais da equipe multiprofissional de um Hospital Psiquiátrico. Estudo exploratório descritivo, de abordagem quantitativa, do tipo transversal, realizado numa cidade do interior de São Paulo, junto a equipe multiprofissional de um Hospital Psiquiátrico. A população deste estudo foi constituída pelos 136 membros da equipe multiprofissional de um Hospital Psiquiátrico, totalizando 116 participantes. Foram utilizados três instrumentos para a coleta dos dados: Roteiro para entrevista com os sujeitos (REPSM), Escala de Avaliação da Satisfação da Equipe em Serviços de Saúde Mental (SATIS-BR abreviada) e Escala de Avaliação do Impacto do Trabalho em Serviços de Saúde Mental (IMPACTO-BR). Respeitaram-se os preceitos éticos. Realizou-se análise descritiva com base na análise estatística inferencial. Os resultados mostram que dos 116 participantes do estudo, 63,8% são do sexo feminino, com média etária de 37,5 anos, 54% são solteiras, 41,9% vivem com companheiro e 51,7% não tem filhos. Na faixa entre 1 e 5, o escore médio de satisfação foi 3,4 tendo ocorrido maior satisfação no fator \"Relacionamentos\" e menor no fator \"Participação no serviço\". O escore médio de sobrecarga foi 1,9 tendo maior impacto no fator \"Efeitos do trabalho no relacionamento da equipe\" e menor nos \"Efeitos sobre a saúde física e mental\". Observou-se correlação negativa entre resultados da satisfação e sobrecarga com destaque para o número de funcionários, a necessidade de capacitação específica da equipe e possibilidade de maior participação nas decisões no serviço. Conclusão: baixos níveis de sobrecarga e de satisfação mostram a necessidade de revisão dos projetos institucionais para melhorar a qualidade de vida do trabalhador e da assistência prestada / Health is the result of proper management concerning physical, emotional , social, professional, intellectual and spiritual areas of ones life, and the quality of life of the working man or woman is relates to maintaining in equilibrium, given the situations of everyday life . The hospital adds to the employers working environment very specific aspects of workload, direct contact with extreme situations, and high level of tension and high risks for themselves and others. This study aimed to identify job satisfaction and the job\'s impact on professional workers from a multidisciplinary team in a Psychiatric Hospital. An exploratory, descriptive study, with a quantitative cross-sectional approach was conducted in the city of São Paulo with the multidisciplinary team of a Psychiatric Hospital. The study population was composed of 136 members of the multidisciplinary team of the Psychiatric Hospital, totaling 116 participants. Three instruments were used for data collection: Roadmap for interview subjects (REPSM), Scale for Assessment of Satisfaction on he for Mental Health Services Team (SATIS - BR abbreviated) Rating Scale of Labor Impact inside Mental Health Services (IMPACT - BR). Ethical approaches were respected. We conducted a descriptive analysis based on inferential statistical analysis. The results show that of the 116 study participants, 63.8 % were female, with an average age of 37.5 years, 54 % were single, 41.9 % lived with a partner and 51.7 % did not have children. In the range between 1 and 5, the average satisfaction score was 3.4, in which satisfaction concerning \"Relationship\" occurred in greater number, and in lower number concerning the factor: \"Participation in the service\". The average score concerning overload was 1.9, in respect to \"Effects of the job upon the relationship inside the team\" and lesser on \"Effects on physical and mental health\". We observed a negative correlation between satisfaction and overload, highlighting as such the number of employees, the necessity for specific training of staff and the possibility of greater participation in decisions during service. Conclusion: Low levels of overload and satisfaction show the need for revision of institutional projects to improve the quality of life of workers and assistants

The purpose of this study was to develop an understanding of how social secretaries in childwelfare service (CWS, in swedish BoF) work with children with symptoms ofneurodevelopmental disorder (NDD, in swedish NPF) and how they experience that the longcare queues at Child and Adolescent Psychiatric Services (CAP, in swedish BUP) affect theirwork. The empirics were collected through six semi-structured interviews with socialsecretaries from CWS in six different municipalities in a county in Sweden. The empirics wereanalyzed through a qualitative content analysis, and the professional logic has been used as atheoretical framework in the analysis of the results. In summary, the study showed that thesocial secretaries felt that they often came into contact with children with NDD problems. It isfurther explained that, based on their area of responsibility, they handled different problems inthe child's social situation. The results also showed that social secretaries experienced that theyhad many different opportunities to handle these children's social situation. However, the socialsecretaries wanted more alternatives of interventions directly to the child and that they couldwork more preventively and less in an emergency situation. The social secretaries' workclimate, workload and cooperation between the two organizations are some examples of areasthat the results showed were negatively affected by the care queues for CAP. One conclusionwas that social workers did not experience working differently with children with suspected ordiagnosed NPF, in comparison with other children. Their work was instead guided by the child'sneeds. Another conclusion is that the social secretaries had different experiences about how thecare queues affected their work. The results of the study provided valuable experiences fromthe social secretary and invited further studies of the staff on CAP's experiences, in order tothen solve the problem areas that are also highlighted in the study. / Syftet med denna studie var att utveckla förståelsen för hur socialsekreterare på Barn-ochfamiljeenheten (BoF) arbetar med barn med misstänkt eller diagnostiserad neuropsykiatriskfunktionsnedsättning (NPF) samt hur de upplever att de långa vårdköerna till Barn- ochungdomspsykiatrin (BUP) påverkar deras arbete. Empirin insamlades genom sexsemistrukturerade intervjuer med socialsekreterare på BoF i sex olika kommuner i ett län iSverige. Empirin analyserades genom en kvalitativ innehållsanalys, och den professionellalogiken användes som teoretisk utgångspunkt vid analys av resultatet. Sammanfattningsvisvisade studiens resultat att socialsekreterarna upplevde att de ofta kom i kontakt med barn medNPF-problematik. Vidare förklarades att de utifrån sitt ansvarsområde hanterade olika problemi barnets sociala situation. Resultatet visade även att socialsekreterare upplevde sig ha mångaolika möjligheter att hantera dessa barns sociala situation. Socialsekreterarna önskade dock fleralternativ av insatser direkt till barnet och att de kunde arbeta mer förebyggande och mindre iett akut läge. Socialsekreterarnas arbetsklimat, arbetsbelastning och samarbetet mellan de tvåorganisationerna var några exempel på områden som resultatet visade påverkas negativt avvårdköerna till BUP. En slutsats var att socialsekreterare inte upplevde sig arbeta annorlundamed barn med misstänkt eller diagnostiserad NPF, i jämförelse med andra barn. Deras arbetestyrdes istället utifrån barnets behov. Ytterligare en slutsats är att socialsekreterarna hade olikaupplevelser om hur vårdköerna påverkade deras arbete. Studiens resultat gav värdefullaupplevelser från socialsekreterare och inviterade till vidare studier av personalen på BUP:supplevelser, för att sedan lösa de problemområden som också har lyfts i studien

No description available.

A descriptive survey to identify factors influencing relapse of psychiatric outpatients in the rural communities of the Eastern Cape was undertaken. A questionnaire was used to collect data from family caregivers who were relatives of psychiatric patients receiving their monthly medications from two rural clinics. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 17. A total number of 92 family caregivers participated. Respondents reported side effects of psychotropic drugs, poor family role, poor referral system, lack of home visits, non-compliance and stigmatization as major factors contributing to relapse of psychiatric outpatients. Active involvement of caregivers in follow up care of their relatives is effective in fostering collaboration between the psychiatric hospitals and patients with the common goal of relapse avoidance. It is recommended that adequate provision of resources in conjunction with health education is effective in enhancing collaboration towards prevention of relapse in psychiatric patients. This would promote team work among patients, caregivers and health care providers. / Public Health / M.A. (Public Health)

Considerable attention has focussed on identifying individual factors associated with, or predictive of, sexual offending (e.g., Efta-Breitbach & Freeman, 2004). In light of these individual factors, clinicians and researchers have developed standardized instruments for assessing the risk posed by sexually offending youth. Two such instruments are the Juvenile Sex Offender Assessment Protocol-II (J-SOAP-II; Prentky & Righthand, 2003) and the Estimate of Risk of Adolescent Sexual Offence Recidivism Version 2.0 (ERASOR-II; Worling & Curwen, 2001). In addition to individual factors, research on crime has demonstrated that structural factors within the community may be important determinants of sexual and non-sexual offending (e.g., McCarthy, 1991; Ouimet, 1999; Shaw & McKay, 1942; Wirth, 1938). Therefore, the purpose of this study was twofold: (a) to compare the psychometric properties of two newly developed risk assessment instruments (i.e., J-SOAP-II and ERASOR-II) and (b) to use the better instrument to compare the levels of risk posed by sexually offending youth in 3 neighbouring, but diverse communities. Using file information, the J-SOAP-II and ERASOR-II were scored on 84 adolescent males between the ages of 11 and 20 years who had committed a sexual offence and received treatment at Youth Forensic Psychiatric Services (YFPS) in the Greater Vancouver Area (GVA; n = 30), Central Okanagan (CO; n = 26), and Thompson Nicola region (TN; n = 28). Calculations of interrater reliability and item-total correlations indicated that the J-SOAP-II was a better assessment instrument for this sample of offenders. Consequently, further regional analysis of risk was conducted using the J-SOAP-II data. Results indicated that although there were no regional differences among the severity and history of sexual offending, TN youth generally had a greater number of risk factors than did youth in CO and GVA. Specifically, youth in TN were found to be higher risk in the areas of intervention, general problem behaviour, iii and family/environment dynamics. These results suggest that to better understand youth who commit sexual offences and to provide appropriate prevention and intervention strategies for individual offenders and their communities, youth should not be evaluated in isolation from their social and community context. Recommendations for practice are discussed.