An evaluation of a
psychosocial intervention
group for older people with a
diagnosis of schizophrenia
Katherine Berry
University of Manchester
Acknowledgements

Service users who participated and their care
co-ordinators
 Tony Ellis, Michelle O’Donal, Ellie Brew and
Katherine McIvor
 Christine Barrowclough, Nitin Purandare,
Richard Drake, Richard Emsley, Lisa Jones
and Katherine O’Neill
 Beryl Clarke, Catherine Cross and Julie
Colville and Janet Costello
 The BUPA Foundation
Outline

Background and aims
 Methods
 Intervention
 Key findings
 Discussion and further work
Background

Good evidence for psychological interventions in
psychosis (e.g. Wykes et al., 2008), but large trials
often exclude older people.
 Older adults may have different needs e.g. may
need adaptations to format and different focus
(Berry & Barrowclough, 2009).
 Group-based psychosocial interventions for older
adults with schizophrenia in US (Granholm et al.,
2005; Patterson et al., 2006; Mueser et al., 2010).
Background

Large trials of these interventions show positive
effects on social and/or independent living skills
(Granholm et al., 2005; Patterson et al., 2006;
Mueser et al., 2010).
 But interventions focused on didactic teaching of
skills, whereas psychological treatments in the UK
are collaborative and value service user expertise
(e.g. Barrowclough et al., 2006).
Aims
 Using UK and US expertise develop an intervention
tailored to the needs of older adults with
schizophrenia in NHS settings.
 Assess the feasibility and acceptability of
intervention by running one group in North
Manchester.
 Develop an intervention and research protocol for a
larger evaluation of the intervention.
Method
 Amended US manuals through consultation with
working groups of UK researchers, clinicians and
service users.
 Selected US modules that were most relevant to
older people’s needs in UK, included modules on
self-esteem and goals for the future and
emphasised service user expertise in their
experiences.
 Indentified three facilitators from the local Trust
to co-run the groups.
Method
 Participants recruited from old age and adult
psychiatry services.
 Inclusion criteria:
- Diagnosis of schizophrenia
- 55 years or older
- Informed consent
- English speaking
- Able to complete study questionnaires and
interviews
Method
 Participants and their care co-ordinators
completed questionnaires and interviews with
research assistants before and after the group
- Self-esteem
- Hopelessness
- Symptoms
- Behavioural problems
- Daily living skills
 Participants and facilitators also participated in
feedback interviews
Intervention

16 weekly sessions of 2-hours duration,
facilitated by 2-5 professionals.
 Key topics
- Identifying strengths
- Making decisions and solving problems
- Managing symptoms and stress
- Social skills and increasing social contacts
- Daily living skills and self-care
- Planning for the future
Intervention

-
-
Each meeting followed same format
Review of previous week
Recap of previous session
Review of between-session tasks
Brief presentation of week’s topic
BREAK
Small group work
Set between-session task
Summary and feedback
Intervention

All meetings held in same room
 Refreshments and taxis provided
 Facilitators met at the end of each meeting
to review group and plan next session
 Feedback to care co-ordinators mid- and
post-intervention
Key findings

69% of people referred to the group agreed
to participate, but poor rate of referrals.
 Completed baseline assessments with 11
participants and 7 of these attended more
than half of the meetings.
 Mean number of sessions attended = 12.86
(range 9-16).
Key findings

-
Group characteristics
5 males and 2 females
Mean age = 63.43 years
5 White British, 1 Asian and 1 AfroCaribbean participant
All participants living independently
Mean age of first contact with services =
30.57 years
Median number of hospital admissions = 2
Key findings

Interview and questionnaire measures
Baseline
Median
Self-esteem
20
Posttreatment
Median
25
P value
Hopelessness
5
3
.115
Positive
symptoms
14
12
.527
.017
Key findings

Interview and questionnaire measures
Baseline
Median
Negative
symptoms
Behavioural
problems
Daily living
skills
P value
13
Posttreatment
Median
9
40
40
.150
2.97
3.29
.128
.045
Key findings

Key themes from feedback interviews
- Social contact. All of the participants and
facilitators commented on the benefits of
the group in terms of social contact.
‘Just by going I think it helped. I mean that
was positive if nothing else. You know that’s
one step in the right direction, rather than
just stopping here you know, not seeing
anybody.’ (Participant 7)
Key findings
- Skills learnt. Several participants
commented on new activities or changes
that they had tried as a result of attending
the group.
‘ And, I never noticed the signs before, but
being at the group and hearing other people
give out their signs for possible illness made
me think about what were my signs’
(Participant 9).
Key findings
- Group dynamics. Several participants
commented on how well the group worked
together. But participants who were regular
attenders also expressed anger about people
not attending regularly, leaving sessions
early and not contributing as much as
themselves.
Key findings
‘People got on well together. There was no “I’m
better then you” attitude in the group at all, it
was all people got on well together, there was
a great cohesiveness in the group’
(Participant 1)
‘Well, there was some people –perhaps this is
not my business to say this, but some people
came for only one or two sessions at the
beginning and then gave up altogether.’
(Participant 7)
Discussion

Small uncontrolled study so difficult to
interpret findings.
 But good uptake, positive direction of
findings and qualitative feedback support
the need for further work.
 Participants had higher independent living
skills and less social behavioural problems
than US samples.
 Benefits for self-esteem and negative
symptoms particularly encouraging.
Further work

Adapt intervention on basis of feedback e.g.
reduce focus on independent living and
increase focus on coping with symptoms.
 Further work to identify and overcome
barriers to recruitment.
 Application for funding to expand the study
across different Trusts.