The Changes Group: A Follow-Up Report on a Group Intervention to Assist the Successful Discharge of Hospital Residents

Objective: This is a follow-up study of a pilot project first reported on in 2006. A group model was developed for a state psychiatric hospital setting to assist residents who had displayed characteristics of “institutionalism.” This includes an aversion or ambivalence to discharge efforts and an acceptance of prolonged life in the hospital. The pilot project, while small, was promising, with five of seven people entering the community successfully within a year and a half. Method: The current project expanded the scope to include three groups with a total of 25 participants. Additional refinement included a standardized group curriculum, expanding outcome measures to include participant attitudes toward change, a protocol to inform and meaningfully involve clinical treatment teams in the participants’ progress, and enhanced training for group facilitators. Results: Of the original participants, 32% achieved discharge in the first year of participation in the group. In addition, participants who were not discharged within the first year developed more positive attitudes toward making changes in their life. Discussion: The guiding principles of this model—including personal reflection, a team approach for sharing life experiences, and encouragement from participants and staff—seem conducive for supporting the attitudinal change and motivation necessary for successful discharge after prolonged hospital stays.