Milieu Outcome Focused Literature Review

Abstract

The systematic review focused on aggregated quantitative outcome evidence for milieu interventions. Outcomes considered significant were offending and symptom reduction. Where milieu evidence of positive outcomes was forthcoming we searched for further aggregated evidence to discover if their component parts when applied independently also had a positive effect on outcomes e.g. just a community meeting. Strength of outcome evidence for various milieu and individual interventions (in descending order) :
Milieu interventions democratic model therapeutic communities 8 RCT’s.
Core elements: daily community meeting, democracy or patient participation in decision-making and running the therapeutic community, and a predominance of group activities, reality confrontation, permissiveness
Milieu interventions Concept model Therapeutic communities3 RCT’s
Core elements: daily community meeting, psycho educational classes, dual recovery groups, self help, reality confrontation, hierarchy
Milieu interventions Milieu therapy 1 RCT
Individual interventions Psycho education : good evidence
Individual interventions Patient participation/democratisation: good evidence
Individual interventions Group activities: good evidence
Individual interventions Social learning: some evidence
Individual interventions Health Care environment: mixed evidence
Individual interventions Community meeting: limited evidence
Individual interventions Interactional characteristics of ward staff: limited evidence
Milieu interventions Changing Ward atmosphere mixed evidence
Milieu interventions Recovery models – no outcome evidence
Milieu interventions Star wards – no outcome evidence

Note:

Funding Information: I was employed by The state hospital NHS trust when doing part of this work.

Conflict of Interests: I have no competing interests in completing this work.

Keywords: milieu, outcome, systematic review