evaluation of services

1. Research Article Open Access
Thabet, Clin Exp Psychol 2018, 4:1
DOI: 10.4172/2471-2701.1000182
Research Article Open Access
Clinical and Experimental
Psychology
Clinicaland
Experimental
Psychology
ISSN: 2471-2701
Clin Exp Psychol, an open access journal
ISSN: 2471-2701 Volume 4 • Issue 1 • 1000182
The Impact of Therapeutic Intervention on Increasing Capabilities and
Efficiency of Patients Referred to Gaza Community Mental Health Center
Abdelaziz M Thabet*
School of Public- Consultant Psychiatrist at Child and Family Training and Counseling Center, Al-Quds University, Gaza, Palestine
Abstract
Aim: The aim of the study was to the therapeutic and Guidance procedures using in increasing the individuals’
capabilities and efficiency who received service at the three Gaza Community Mental Health Program centers using
International Classification of Function (ICF).
Methodology: The sample included all new adult patients aged 16 and above years referred for the first time to
the three community mental health centers (GCMHP) with total number of 170 new cases had completed the three
phases of evaluation scale (ICF). Their age range between (18 to 67) years with age average 31.3 years, (SD= 11.6).
Instrument: The patients were assessed by self-report. The scale consisted of eight items of the ICF, which was
applied in the first interview three months later and after six months.
Results: To determine the extent of therapeutic process and its impact on increasing the capacity of individuals
attending the clinics after the first visit and the second visit, “T” independent test was conducted. The result of the
test between the first and second visit showed (P-value<0.001), and this showed that the individuals’ personal and
daily capacity and efficiency were increased after the second visit, as the difference mean reached 0.38. Since the
scale consisted of eight items, it was noted that the “T” independent test value for all scale’s items has statistically
significant between the first and third visit (P-value<0.01), and this gives an indication that the therapeutic and
guidance process had an active role in increasing clients’ capabilities and efficiency after the third visit.
Implications: From the above mentioned results, it’s important to increase the number of the therapeutic and
guidance meetings since it have an active impact in increasing the efficiency and capacity of clients to continue their
daily life normally in compared with others and to increase the number of clients ‘ visits to GCMHP clinics to receive
more guidance to help them to increase their abilities to the best.
*Corresponding author: Abdelaziz M Thabet, Emeritus Professor of Psychiatry,
School of Public- Consultant Psychiatrist at Child and Family Training and
Counseling Center, Al-Quds University, Gaza, Palestine, Tel: + 00970599604400;
E-mail: abdelazizt@hotmail.com
Received: January 03, 2018; Accepted: January 15, 2018; Published: January
22, 2018
Citation: Thabet AM (2018) The Impact of Therapeutic Intervention on Increasing
Capabilities and Efficiency of Patients Referred to Gaza Community Mental Health
Center. Clin Exp Psychol 4: 182. doi: 10.4172/2471-2701.1000182
Copyright: © 2018 Thabet AM. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and
source are credited.
Keywords: Disability; Disease; Health
Introduction
The international classification of impairments, disabilities
and handicaps
A short overview of the international classification of impairments,
disabilities and handicaps (ICIDH) is useful in order to understand
the more recent international classification of functioning, disability
and health (ICF), which was drafted as a revision of the older one. The
manual of the new classification refers to the ICIDH and explains why
major changes were decided. When the ICIDH was adopted, it was
the first time that an international institution provided a definition of
disablement and a classification founded on this definition. They were
in use for approximately 20 years (1980–2001). The ICIDH stated that
disablement was a compound of different notions separate but related
to each other. Several other definitions of disablement were published
in the literature during that period of time, yet ICIDH was one among
very few that were used to build a classification. The General Assembly
of the World Health Organization (1980) (WHO) [1] adopted the
ICIDH in 1976. It was published in 1980 ‘for trial purposes’. The subtitle,
as printed on the cover of the manual is: ‘a manual of classification
relating to the consequences of disease’. This relation to disease is
stressed at the beginning of the introduction: the ICIDH is ‘concerned
with dimensions of health-related experience complementary to those
embraced by the concept of disease’ (p. 7). The ICIDH was meant to
classify information not included in the international classification of
disease, which ‘fails to reflect the full range of problems that lead people
to make contact with a health care system’ (p. 10). Indeed, the very first
sentences of the introduction states that one purpose of the ICIDH is
to contribute to the improvement of health care systems: ‘the ability–
capability gap, the discrepancy between what health care systems can
do and what they might do, constitutes one of the greatest challenges
for those concerned with health care and welfare. The International
Classification of Functioning, Disability and Health is a book of 300
pages. It is therefore likely that only specialists will study it thoroughly.
A summarized presentation will be useful before discussing the
environment in the ICF
Principles of the ICF
The ICF is based upon principles that differ from those of the
ICIDH. First, while the ICIDH provided a classification of what may be
a problem, the ICF is a classification of neutral components of health.
The ‘ICF has moved away from being a ‘‘consequences of disease’’
classification to become a ‘‘components of health’ classification’ (p. 4).
In other words, the ‘ICF encompasses all aspects of human health and
some health-relevant components of well-being and describes them in

2. Page 2 of 4
Citation: Thabet AM (2018) The Impact of Therapeutic Intervention on Increasing Capabilities and Efficiency of Patients Referred to Gaza Community
Mental Health Center. Clin Exp Psychol 4: 182. doi: 10.4172/2471-2701.1000182
Volume 4 • Issue 1 • 1000182
Clin Exp Psychol, an open access journal
ISSN: 2471-2701
terms of ‘‘health domains’’ and ‘‘health-related domains’’’ (p. 7). When
using the classification for coding, one has to specify with a qualifier
whether there is or there is not a problem. Another important feature
of the ICF is universalism: ‘there is a widely held misunderstanding that
ICF is only about people with disabilities; in fact it is about ‘‘all people’’.
The health and health-related states associated with all health conditions
can be described using the ICF. ICF has a universal application’ (p. 7)
[2].
Because of the importance of the therapeutic process and it’s active
role in alleviate the individuals’ suffering in the Palestinian territories,
and because of increasing the Clients of the programme’s clinics
during the last period, and because of the important role which Gaza
Community Mental Health Programme play in this field, a team from
Gaza Community Mental Health Programme and members of research
department asserted the importance of observing the Clients of the
programme’s clinics and how to alleviate their suffering in order to
engage them as a normal individuals in the community to help their
family to live in appropriate mental health.
TheaimofthestudywastothetherapeuticandGuidanceprocedures
using in increasing the individuals’ capabilities and efficiency who
received service at the three Gaza Community Mental Health Program
centers using International Classification of Function (ICF).
Methodology
Subjects
The sample included all new adult patients aged 16 and above years
referred for the first time to the three community mental health centers
(GCMHP) with total number of 170 new cases had completed the three
phases of evaluation scale (ICF). There age range between (18 to 67)
years with age average 31.3 years, (SD=11.6).
Instrument
The International Classification of Functioning, Disability and
Health (ICF). From the book of 300 pages. It is therefore likely that only
specialists will study it thoroughly. A summarized presentation will be
useful before discussing the environment in the ICF.
Structure of the ICF
The ICF is a classification of human functioning: ‘functioning
is an umbrella term encompassing all body functions, activities and
participation; similarly, disability serves as an umbrella term for
impairments, activity limitations or participation restrictions’ (p. 3).
The structure of the classification is as follows: ‘the ICF has two parts,
each with two components: part 1. Functioning and disability: (a) body
functions and structures, and (b)activities and participation; part 2.
Contextual factors: (c) environmental factors, and (d) personal factors.
Each component can be expressed in both ‘‘positive’’ and ‘‘negative’’
terms. Each component consists of various domains and, within
each domain, categories, which are units of classification. Health and
health-related states of an individual can be recorded by selecting the
appropriate category code or codes and the adding ‘‘qualifiers’’, which
are numeric codes that specify the extent or the magnitude of the
functioning or disability in that category, or the extent to which an
environmental factor is a facilitator or barrier’ (pp. 10–11). However,
‘personal factors are not classified in the ICF because of the large
social and cultural variance associated with them’ (p. 8). We used the
Arabic version of selected 8 items after one year discussion with the
professionals working at GCMHP and RCT on choosing items which
could be the best items used in Arabic culture.
Procedure
A team from Gaza Community Mental Health Programme _
Research Department- under the Convention between the CPD and
research department- investigate the inward data of the cases from
January to June 2009, which carried out weekly when individuals’
data entry, taking in the consideration the amendment and control
of any technical problems, and deal with the missing values based on
statistical standards.
These data are collected from the centers as an electronic versions
using SPSS, and then surveying it, monitoring it, collected it in one total
file, Coding it, and finally the renumbering process comes before the
analysis and presentation of results.
Results and Discussion
Soicodemographic data of study sample individuals
There were 43 males and 42 were females from Gaza, 41 new cases
were males 7 and 34 females from Deir El Balah Center, 16 male from
and 28 females from Khan Younis center (Table 1).
The results showed that most of the cases in the three community
centers in Gaza Community Mental Health Programme were married
and equal 53 of cases were single, while 110 cases were not married 4
were widows, and 3 cases are divorced (Table 2).
The education level of clients who received treatment in the
GCMHP clinics
It is clearly noted during analysis that 3cases were uneducated
(illiterate), while 20cases completed the primary school, 29cases
completed the prep school, 29 cases completed secondary school, and
51 cases have a university degree (Table 3).
The therapeutic and guidance role in increasing clients’
capabilities and efficiency to GCMHP clinics after the first,
second, and third visits
Capabilities and efficiency scale consists of 8 paragraphs for their
daily personal abilities in dealing with crises they suffer from. The scale
Center Male Female Total
Gaza 43 42 85
Dier-Al-Balah 7 34 41
Khan Younis 16 28 44
Total 66 104 170
Table 1: The percentage of the cases' number in the programme's clinics
concerning to.
Center Single Married Widow Divorced Total
Gaza 26 58 0 1 85
Dier-Al-Balah 14 24 2 1 41
Khan Younis 13 28 2 1 44
Total 53 110 4 3 170
Table 2: The percentage of the cases' number in the GCMHP clinics concerning
to the social statusTT.
Center Non Primary Prep. Secondary
University
and other
Total
Gaza 2 13 17 17 24 85
Dier-Al-Balah 1 3 7 7 15 41
Khan Younis 0 4 5 5 12 44
Total 3 20 29 29 51 170
Table 3: The percentage of the cases' number in the GCMHP clinics concerning
to education level.

3. Page 3 of 4
Citation: Thabet AM (2018) The Impact of Therapeutic Intervention on Increasing Capabilities and Efficiency of Patients Referred to Gaza Community
Mental Health Center. Clin Exp Psychol 4: 182. doi: 10.4172/2471-2701.1000182
Volume 4 • Issue 1 • 1000182
Clin Exp Psychol, an open access journal
ISSN: 2471-2701
consists of three responses; (1= rarely to 3 =always). The results of the
first visit also show that 29.4% were able to start the conversation with
others and continue with them, but the ratio increased after the second
visit and became 39.6% and in the third visit 68.2%. They were able
to continue their normal life despite the pressures and the emergency
crises changed from the first to second to third visit (18.8% - 30.2%-
56.8%). They have the ability to realize knowledge and use the previous
experience in dealing with everyday problems and alleviate suffering
(17.6% - 32.3% - 52.3%) they cooperate with their family and relatives
cordially (30.6%- 34.4% - 75%), they were able to participate in social
and general events (21.2% - 30.2% -65.9%), they were able to do daily
activities appropriately (29.4% - 30.2% - 65.9%), they were able to
express my feelings appropriately and care about the feelings of others
(27.6% - 38.5% - 59.1%), and they had sleep enough hours continuously
and rising relaxed without addressing any tranquillizers (12.4 – 29.2%
- 52.3%) (Table 4).
Therapeutic process
To determine the extent of Therapeutic process and its impact on
increasing the capacity of individuals attending the clinics after the first
visit and the second visit, “T” independent test was conducted. The
result of the test between the first and second visit showed Parried t-test
= -6.90, P-value<0.01), and this showed that the individuals’ personal
and daily capacity and Efficiency was increased after the second visit, as
the difference mean reach 3.38 with standard deviation SD= 4.6. Since
the scale had eight paragraphs, it was noted that “T” independent test
value for all scale’s paragraphs has statistically significant between the
first and third visit (Parried t-test= -5.22, P-value<0.01), and this gives
an indication that the therapeutic and guidance process had an active
role in increasing clients’ capabilities and efficiency after the third visit
(Table 5 and Figure 1).
Conclusion
The results showed an improvement in the Capabilities and
Efficiency of the individuals who received a therapeutic service after
the second visit. The result of the test between the first and second visit
showed that the individuals’ personal and daily capacity and efficiency
was increased after the second visit. The results showed there was
statistically significant differences toward the third visits (improvement)
between the first and third visit, and this gives an indication that the
therapeutic and guidance process had an active role in increasing
First Visit Second Visit Third Visit
Always Sometimes Rarely Always Sometimes Rarely Always Sometimes Rarely
1. I am able to start the conversation with
others and continue with them
29.4 46.5 24.1 39.6 53.1 7.3 68.2 27.3 4.5
2. I am able to continue my normal life
despite the pressures and the emergency
crises
18.8 41.8 39.4 30.2 62.5 7.3 56.8 34.1 9.1
3. I have the ability to realize knowledge and
use the previous experience in dealing with
everyday problems and alleviate suffering
17.6 47.6 34.7 32.3 54.2 13.5 52.3 40.9 6.8
4. I cooperate with my family and relatives
cordially
30.6 40.6 28.8 34.4 61.5 4.2 75 20.5 4.5
5. I am able to participate in social and
general events
21.2 46.5 32.4 30.2 59.4 10.4 63.6 31.8 4.5
6. I am able to do daily activities appropriately 29.4 42.9 27.6 30.2 59.4 10.4 65.9 29.5 4.5
I am able to express my feelings appropriately
and care about the feelings of others
27.6 42.9 29.4 38.5 55.2 6.3 59.1 38.6 2.3
8. I sleep enough hours continuously and
rising relaxed without addressing any
tranquillizers
12.4 37.1 50.6 29.2 60.4 10.4 52.3 43.2 4.5
Table 4: Descriptive statistics for capabilities and efficiency scale after the visit to community centers.
Scale ICF Mean diff STD t P-value CI 95%
First- Second -3.38 4.96 -6.67 0.001** -4.38 -2.37
First-Third -4.98 5.59 -5.91 0.001** -6.68 -3.28
Second-third -3 4.18 -4.76 0.001** -4.27 -1.73
Table 5: The results of paired t-test to study the impact of the Therapeutic process in increasing clients' capabilities and efficiency after the second visit.
Figure 1: Means of the three visits in ICF scale.

4. Page 4 of 4
Citation: Thabet AM (2018) The Impact of Therapeutic Intervention on Increasing Capabilities and Efficiency of Patients Referred to Gaza Community
Mental Health Center. Clin Exp Psychol 4: 182. doi: 10.4172/2471-2701.1000182
Volume 4 • Issue 1 • 1000182
Clin Exp Psychol, an open access journal
ISSN: 2471-2701
clients’ capabilities and efficiency after the third visit.
Recommendations
It’s recommended that:
1. It’s important to increase the number of the therapeutic and
guidance meetings since it have an active impact in increasing
the efficiency and capacity of clients to continue their daily life
normally in compared with others.
2. It’s important to increase the number of Clients ‘ visits to GCMHP
clinics to receive more guidance to help them to increase their
abilities to the best.
References
1. World Health Organisation (1980) Reprint 1988 International Classification of
Impairments, Disabilities and Handicap. A Manual of Classification Relating to
the Consequences of Disease. World Health Organisation, Geneva.
2. World Health Organisation (2001) International Classification of Functioning,
Disability and Health. World Health Organisation, Geneva.