Opinion/Feedback Many mobile teams were created over the past decade in various medical specialties including physical medicine and rehabilitation (MPR). The Pôle Saint-Helier has created a mobile ...team of rehabilitation–reintegration (EM2R) in December 2012 with support from the Regional Health Agency of Brittany. It operates on the health territory No. 5 of Brittany near people experiencing neurological disability. Its main mission is to implement the necessary devices to facilitate the home return of people hospitalized after a neurological event or maintaining to home people with neurological disorders. The number of supported annual is about 200, either for 2015: 20 requests per month. People with brain lesions account for two third of the population, mean age 60 years, with a high degree of dependence. A minimum of two professionals involved by patient and a variable number and term of interventions depending on pathologies. Occupational therapy represents the majority of requests for intervention. We will discussed based of three years of functioning about: – the innovative nature of this activity: supported to people with brain tumor lesions that usually have little access to the MPR, collaborations with mobile teams of support and palliative care and hospital to home, formation and education of caregivers; – the increase of supported people with neurodegenerative illness such as ALS that needs an access to care fast; – the notion of alternative to the MPR care offer in link especially with the recommendations of SOFMER and HAS on the organization of care pathway of strokes 1,2.
Objective Access to a specialized rehabilitation is limited for most of post stroke patients who are often transferred in non-specialized rehabilitation hospitals. We have set up a multidisciplinary ...mobile team working in these hospitals. The aim of this pilot study was to describe the contribution of our mobile team specialized in post acute care of stroke. Materials/patients and methods We collected the changes in the management of rehabilitation for 31 patients hospitalized in non-specialized rehabilitation hospital referred to our mobile team. We assessed the training of healthcare workers that we provided and the impact on the care pathway. Results Our team permitted for almost all patients a specialized assessment (occupational therapy, referred for a psychological or neuropsychological assessment, a social evaluation, further evaluation, including specific neurovascular investigations). Therapeutic was changed, including learning self-rehabilitation methods, physiotherapy, and speech therapy. An adaptation of the care pathway has been done (neurovascular consultations, change of place of life project, accompanying a return home and reorientation in specialized rehabilitation unit). The team also permitted a training of the paramedical crew. All the doctors who requested the team declared this intervention as facilitator for admission of post-stroke patients in their hospital. Discussion/Conclusion These results show that our rehabilitation mobile team provides a large and diverse contribution to the non-specialized hospitals. This support covers all medical and social aspects. Beyond the individual impact, it helps, with training, to improve overall care and quality of care for non-specialized hospitals. Our results also suggest our mobile team is a facilitator for admission in post acute post-stroke unit.
World Health Organization recommends the implementation of alternatives to full-time hospitalizations. Psychiatric home-care has known a worldwide development in the last 20 years. The psychiatric ...mobile team for social and medico-social institutions in Saint-Etienne, France,
(Equipe mobile d’intervention en établissements Sociaux et Médico-sociaux
, ESMS) aims to support professionals from medico-social housing institutions (MSHI) in order to maintain people in housing. The objective of the study was to evaluate the efficiency of home-based interventions to reduce hospitalizations and improve collaboration between psychiatric hospital facilities and MSHI. We used a pre-post study design. A same cohort of patients living in a MSHI one year before intervention and one year after implementation of the ESMS was studied. Hospitalizations were compared between the two periods. A survey was conducted for qualitative evaluation among professionals in MHSI. Sixty-three patients were included. Most patients suffered from psychotic disorders (71%). We found a significant decrease in the mean number of admissions per year from 2,06 to 1,48 (Wilcoxon signed rank test; df64;
p
= 0,01). Mobile-team interventions included answering phone calls, home visits, coordination meetings, or clinical interviews with patients in inpatient and outpatient services, with an average of 9,3 interventions per patient (SD = 11,4). ESMS was evaluated as “essential” for 73% of 11 professionals from MSHI who answered the questionnaire in May 2017. Assertive Community Treatment and Crisis Resolution Teams are the most studied home-care models in psychiatry. Our results tend to show the efficiency of mobile-team interventions in MSHI, to enhance partnerships.
Based on a clinical situation of a patient infected with COVID-19, the caregivers of the Saint-Étienne mobile psychiatric team describe their anxieties. Are the procedures carried out appropriate? ...Did we respect the safety measures? Are we at risk of contracting the virus and contaminating other people? The scientific discourse of "experts", who used to guide our actions, has throughout this crisis been inadequate and people's beliefs have crumbled. This abandonment is a source of anxiety for everyone, an anxiety about death. However, this reflection should kindle hope, a precious emotion for those working with patients in psychiatry.
L’accident vasculaire cérébral (AVC) est un véritable problème de santé publique. La prévention joue un rôle important sur l’incidence de la maladie. La rapidité de l’intervention sanitaire réduit la ...mortalité, en contrepartie le nombre de personnes héritant d’un handicap augmente. Il n’est pas toujours visible et nécessite une prise en charge adaptée. L’objectif est une diminution de la durée d’hospitalisation et le maintien à domicile. Mais la sortie de l’hôpital est toujours un moment très délicat en raison des efforts d’adaptation et de réorganisation qui sont nécessaires dans la vie quotidienne des personnes concernées. La neuropsychologie y a toute sa place. La prise en charge à domicile permet au patient et à sa famille de mieux gérer le « vécu » du corps, mais aussi, en entrant dans l’intimité de son lieu de vie, de personnaliser la prise en charge. Les troubles cognitifs fréquents diminuent l’autonomie mais également les capacités d’introspection. Dans le Limousin une équipe mobile, HEMIPASS, a été créée en 2010 pour accompagner les patients et leurs aidants à domicile. Dans cet entretien, les psychologues Michèle Chazot-Balcon, Élise Henry et le neurologue Jean-Yves Salle, du Centre Hospitalier Universitaire de Limoges, évoquent l’AVC, les séquelles possibles liées à cette pathologie pour les personnes qui en sont victimes et leur prise en charge psychologique à domicile.
Stroke is a major public health issue with a high priority. Prevention plays an important role in reducing the impact of the disease. Although quick health intervention reduces death, it results in an increased number of disabled people. The handicap is not always visible, and requires appropriate strategies for the patient. Such approaches aim to allow patients to stay at home, reducing their time spent in the hospital. However, transitioning from the hospital is always a tricky time, as efforts are necessary to adapt and reorganize around the new everyday life of the affected people. In this context, neuropsychology offers interesting perspectives. In-home care not only allows the patient and their family to better deal with a new perception of the body, but also enables personalized support by bringing care within the intimate environment where they live. Post-stroke cognitive impairment decreases the autonomy and introspective capacities of patients. In Limousin, a trained team of itinerant healthcare professionals (HEMIPASS) was founded in 2010 to support patients and their relatives at home. Psychologists Michèle Chazot-Balcon, Elise Henry and the neurologist Jean-Yves Salle from the University Hospital in Limoges, discuss the semiology of stroke, its possible psychological effects, and how to deal with them from the patient's home.
Centers for Social Work, in accordance with Law on Protection from Domestic Violence have a coordinating role in the protection of victims of violence. Centers for Social Work are obliged to form an ...expert team consisting of representatives of the Center, bodies and departments of the local government, the police, non-governmental organizations and experts dealing with the issues of family and domestic violence in order to establish victim assistance plan, in accordance with their needs and choices. The activities on the treatment of victims of violence, as well as the prevention of violence against children, are carried out through Center for Social Work that provide multisectoral and interdisciplinary approach.Keeping in mind that violence is basically a relationship in which power relations are manifested, it isessential that the relevant institution, including the Center for Social Work are efficiently and successfully involved in early detection, monitoring, prevention and protection of children from violence. In accordance with the Family Law Center for Social Work is empowered to intervene measures of family and legal protection in situations of abuse of a child, its development and exercising their rights. For the purpose of early detection and emergency response in cases of acute violence Centre for Social Work formed Mobile teams to combat domestic violence, which are available 24 hours. Mobile team - a team for providing support and assistance for victims of violence, intervene on the police call, after domestic violence is reported. Members of team are going out on the field where they taking measures to protect victims of violence and provide adequate and the timely assistance. Based on the activities carried out by mobile teams in preventing acute phase of violence professionals at Center for Social Work develops a plan for the protection of victims of violence. Research and experience of mobile teams show growing in number of reported domestic violence and the growing need for engagement of mobile teams.This paper will present an analysis of data relating to the type of violence, activities and measures of protection and re-offending in the city of Banjaluka in the period from 2012 to 2016. Paper presents recommendations for improvement of activities of the Mobile Team that are based on the analysis of data.
En juin 2017, face aux difficultés du secteur de la ville de Saint-Étienne (Loire) à fournir une offre de soins adaptée aux caractéristiques de sa population, ce service s’est réorganisé. Ainsi, les ...moyens une unité d’hospitalisation complète ont été pratiquement entièrement redéployés pour la création d’une équipe mobile de soins au domicile. C’est donc autour d’une évolution de paradigme tendant vers les philosophies de rétablissement que s’est construit le projet. Les modèles choisis sont l’assertive community treatment (suivi intensif dans le milieu), le case management de transition et l’intervention de crise au domicile. Les premières observations mettent en exergue certaines difficultés en lien avec la fermeture du service d’hospitalisation. Mais cette réorganisation a permis de proposer, pour un accompagnement dans un projet de vie au domicile, une autre possibilité de prise en charge de la crise, ainsi qu’un soutien et une remobilisation de l’entourage. Les premiers retours sont positifs et prometteurs. Grâce aux échanges constants avec les associations de familles et d’usagers, les autres unités et structures du secteur et des équipes ayant connu des expériences similaires, l’équipe mobile de psychiatrie du secteur Saint-Étienne poursuit son évolution afin d’améliorer l’accompagnement des usagers et de leur famille.
In June 2017, the psychiatric catchment area (sector) of the city of Saint-Étienne (Loire, France) closed a full-time hospitalization unit to create a community treatment outreach team. This reorganization, which appeared necessary to both healthcare teams and direction teams of the hospital, was stirred by overwhelming presence of psychiatric users in the emergency department and difficulty in providing adequate care to the population of the catchment area. The complex situation of the city of Saint-Étienne thus proved to be an opportunity for change. The project was build according to concepts of recovery. The chosen models were assertive community treatment, intensive home monitoring, transitional case management (transition from hospital to home) and crisis intervention at home. The first observations highlighted some difficulties related to the hospitalization unit shutting, in particular because both health care providers’ staff and users relied on long-term hospitalization for rehabilitation. Many encouraging points were underlined, however. Indeed, this reorganization enabled new life project in the community for numerous patients, managing crisis without systematic requirement of hospitalization, as well as support and remobilization of the family. The first returns are both positive and promising. Thanks to a rich training program, constant exchanges with family and user associations, other unit in the sector and teams with similar experiences, the Saint-Étienne mobile psychiatry team is continuing to evolve and improve in supporting users and their families.
La famille est le lieu où s’exerce la grande majorité des violences envers les enfants. L’enfant peut être maltraité et il se retrouve alors victime d’une violence intentionnelle qui lui est ...destinée. L’enfant peut aussi être « exposé » indirectement à la violence intrafamiliale, violence dont il est témoin, comme c’est le cas des violences conjugales, mais qui le place dans une situation qu’il subit et dont les conséquences peuvent être pour lui délétères. L’exposition à la violence intrafamiliale peut en effet entraîner chez les enfants mineurs, ce d’autant que cette exposition est précoce et répétée, des difficultés psychiques s’exprimant par des symptômes internalisés ou émotionnels et/ou des symptômes externalisés, difficultés qui vont perturber leur développement psychoaffectif. Ces enfants/adolescents accèdent peu souvent au soin de façon directe à partir d’une demande de consultation faite par leur représentant légal. Les établissements scolaires et services sociaux peuvent repérer des enfants et adolescents en souffrance et les orienter, mais interviennent souvent tardivement quand les symptômes sont déjà installés, après plusieurs mois voire années d’exposition à la violence intrafamiliale. Les services de gendarmerie peuvent avoir alors un rôle de prévention lors de leurs interventions « sur le terrain » des violences intrafamiliales ou lors de rencontres avec le représentant légal violenté au moment d’un dépôt de plainte. C’est ainsi qu’un partenariat a été mis en place depuis 6ans entre la pédopsychiatrie et les services de gendarmerie donnant lieu à un dispositif innovant : l’équipe mobile de crise intrafamiliale (CrIFEM). Ce dispositif permet aux enfants/adolescents et aux familles de mobiliser le travail psychique de chacun, de désamorcer certains conflits impactant négativement la dynamique familiale et d’orienter, après évaluation, les enfants/adolescents qui nécessiteraient un suivi sur le plan psychologique.
The family is the place where children are most likely to be exposed to violence. The child may be abused and then becomes the victim of an intentional violence directed towards him/her. The child may also be “exposed” indirectly to domestic violence as a witness, but may suffer from this situation can lead to deleterious consequences for him/her. In under age children, exposure to domestic violence can indeed lead to psychological problems expressed through internalized or emotional symptoms and/or externalized symptoms. These problems may disrupt emotional and psychological development in children, especially when facing early and repeated exposure to domestic violence. These children/adolescents have most of the time little access to care directly from a request made by their legal representative. Primary and secondary schools, and social services can identify suffering children and adolescents and guide them, but they often intervene late when symptoms are already settled, following months or years of exposure to domestic violence. Then, Police/Gendarmerie services can have a preventive role when they intervene “on the ground” of domestic violence or meet the abused legal representative at the time of the complaint. Thus, a partnership was established 6 years ago between child psychiatry and the Police/Gendarmerie services leading to an innovative creation of a mobile team of domestic crisis (équipe mobile de crise intrafamiliale CrIFEM). This mobile team allows the children/youth and their families to psychically mobilize themselves, to defuse some conflicts negatively affecting the family dynamics and to guide, after evaluation, children/adolescents that would require psychological care.
PDF
