Research Day Promises to be a Day of Discovery

For a number of reasons, I’m very thankful that we have turned the page on February and entered the month of March.

Yes, one reason for my excitement is the hope of warmer temperatures and, ultimately, the end of winter. Another reason for my excitement is what March means for everyone involved in Research and Academics at Ontario Shores Centre for Mental Health Sciences (Ontario Shores).

On Friday, March 21 Ontario Shores will host our third annual Research Day, the equilavent of the Super Bowl for us researchers.

This year’s theme is ‘Recovery in Mental  Health: Research Informed Approaches and Outcomes’, which bring  nurses, psychologists, researchers, social workers, psychiatrists, family physicians, counsellors, therapists, and mental health professionals to Ontario Shores from the province.

I’m excited to meet and listen to this year’s keynote speaker is Dr. Mike Slade, a Professor of Health Services Research, Institute of Psychiatry, King's College London, UK, and Consultant Clinical Psychologist.  Dr. Slade’s main research interests are recovery- and outcome-focused mental health services, user involvement in and influence on mental health services, staff-patient agreement on need, residential alternatives to in-patient services, and developing clinically useable outcome measures. Dr. Slade has written over 200 academic articles and nine books.

Also presenting on Research Day is Laura Burke, a mental health advocate and Peer Support Worker. Laura is a drama therapist, mental health advocate and activist, peer support worker, spoken word and theatre artist, and researcher.  Laura is currently touring Heartwood, a one-woman play she wrote about the meaning of recovery from mental illness.
Aside from our guests on Research Day, I am also very excited to showcase the wonderful research projects and initiatives taking place at Ontario Shores. As an organization we should be proud to have so many dedicated professionals presenting their work through discussion or poster presentations on Research Day.

Leading up to the big day, I am proud to provide glimpse into the speaker abstracts which will be presented by Ontario Shores’ professionals on Research Day.

Implementation of Recovery Rounds in the Prevention of Restraint and Seclusion
Dr. Ian Dawe, Physician-in-Chief

Our recovery-oriented model of care places direct emphasis on effective communication with patients and families in order to implement a proactive and collaborative approach towards care. The purpose of Recovery Rounds is to elevate the importance of restraint minimization and recovery-oriented care through witnessing of restraint and seclusion events by senior staff. The Recovery Team is comprised of representatives from Senior Management, Professional Practice (PP), Peer Support Specialists (PSS) and Ethics. On a daily basis, one member from each group attend all Code Whites and the daily Unit Recovery Rounds. Our most recent data indicates an overall reduction of incidents of mechanical restraints from 3,101 in 2006 to 180 in 2013. A more in-depth data analysis of the specific effectiveness of Recovery Rounds will be shared in the presentation. Witnessing contributes to organizational change through oversight, accountability, timely communication, and the commitment that will surround every restraint and seclusion event. It also provides an opportunity to work with teams to collectively identify strengths as well as opportunities for improvement in restraint prevention techniques. Further, the learnings from other units can be shared consistently and with transparency across the organization.

Working with Silver Linings: Applying a Positive Psychology and Anti-Oppressive Framework to Recovery from Psychosis
James Gasparini, Peer Support Specialist

Schizophrenia is currently regarded as one of the most pervasive and debilitating illnesses. Negative and disorganized symptoms of psychosis can undermine a person’s cognitive functions, as well as their ability to engage socially and enjoy activities of daily living. Although most of the literature focuses on the distressing nature of hallucinations and disturbing thought content, positive symptoms of psychosis can include artistic creativity and spiritual upliftment. Therefore, there is utility in applying a positive psychology lens when considering the holistic impacts of psychosis on well-being. Positive psychology considers that which is creative, emotionally satisfying, meaningful and adaptive for the client and seeks to cultivate strengths and virtues in order to support clients in overcoming difficult life events. For instance, experiences of spiritual significance, as part of the positive symptom profile of psychosis, may offer clients a sense of meaning, belonging and purpose, and can be used as a key coping resource. This presentation offers a theory review regarding this type of mental health practice, as well as a case study of one such client living with this diagnosis, wherein everyday experiences are interpreted as part of a mosaic of spiritual significance, rather than as a composition of persecution, inhibition, and withdrawal. This presentation offers suggestions for building strong and positive alliances with clients from an anti-oppressive framework, for working with clients from a positive psychology lens to improve their quality of life, and for creating hospital environments consistent with values of recovery.

Intimacy Recovery: Ontario Shores’ Experience Promoting Patient Relationships
Dr. Phil Klassen, VP of Medical Affairs
Ontario Shores is committed to the Recovery model of engagement with service users, including intimacy. This presentation will review the process, and the unique challenges that a hosptial wide inititiative of promoting patient intimacy recovery. The process of evolved, though, along more clinical lines, and ultimately a very committed stakeholder group was assembled, with the full support of the hospital administration. This process, with important input from persons with lived experience led to the creation of a policy supporting intimacy; regular assessment of capacity to consent to sexual relations (in the service of harm reduction); training and support for staff and patients in terms of providing information and education on relationships, intimacy and sexuality; as well as a dedicated space in hospital for use by patients seeking a sexual relationship. Additionally, this presentation will review utilization, patterns of use, and satisfaction of the intimacy suite. From the perspective of this organization, this process has been a success, and thus far there have been no untoward events. The space is being utilized, and a review of user satisfaction will help direct next steps.

Coercion in Outpatient Mental Health Care: International Perspectives of Mental Health Professionals on the Acceptability of using Covert Coercion
Rosanna Macri, Ethicist

Coercion has long been a component of psychiatry commonly used in mental health care settings across the world. The use of formal coercion, i.e., legally binding powers of compulsion, is mainly practiced in inpatient treatment settings, although it has also been introduced in outpatient care, mainly in North American and Commonwealth countries. When coercion is exercised informally, i.e., outside the regulations of the given mental health legislation, it is usually referred to as covert coercion. The notion of informal or covert coercion has gained prominence in the literature to capture the more subtle ways in which coercion is used in psychiatric settings. The purpose of this study is to explore the views and experiences of mental health professionals from different countries (i.e., Chile, Germany, Italy, Mexico, Spain, Sweden, United Kingdom and Canada) regarding the use of covert coercion through focus group methodology. The primary aim is to assess attitudes to covert coercion as it might be applied in community health care of patients with severe mental illness and gather the views of mental health care professionals (such as  case workers, nurses, social workers and psychiatrists) who currently work with or have experience working with patients populations who might also be subjected to formal coercion. We will share our preliminary comparative analysis regarding the type and level of covert coercion found acceptable to mental health professionals in different countries. Exploring the attitudes to and experiences with covert coercion of mental health professionals in different cultures may help to develop a better understanding of the role and acceptability of covert coercion in mental health care.

Predicting Successful Discharge from a Forensic Unit: The Role of Dynamic Risk Factors
Dr. Lisa Marshall, Forensic Psychiatrist

The assessment of a patient’s risk for future violence is a core responsibility for those working in forensic practice. A number of tools have been developed to assist in this process, the majority of which involve the assessment of both static and dynamic risk factors. Static risk factors are relatively stable over time, such previous history of violence and early childhood difficulties. Dynamic risk factors in contrast fluctuate over time and thus require regular reassessment. Dynamic risk factors typically considered when assessing risk for future violence include level of insight and exposure to potential destabilisers. While there is a wealth of literature demonstrating the relationship between static risk factors and future violence, research examining dynamic risk factors has been limited. This paper will discuss a prospective study which followed patients as they transitioned from a minimum security inpatient setting to community living. Participants were assessed at three distinct time points namely pre-discharge and at one and six months post-discharge. Primary outcomes under consideration included rates of rehospitalisation and levels of violent and non-violent offending and victimization. It is anticipated that greater awareness of the dynamic risk factors which impact on successful discharge from hospital, will enhance patient care and recovery, and, public safety.

Canadian Occupational Therapy Practice in Forensic Mental Health
Chantal Tacchino, Occupational Therapist

Forensic mental health is an emerging practice area for Canadian occupational therapists. In 2012, the Canadian Association of Occupational Therapists acknowledged a lack of knowledge on forensic occupational therapy services. This survey study answers the research question, “What is the current state of practice of Canadian occupational therapists in forensic mental health?” The target population was occupational therapists possessing clinical experience with service users of both the healthcare and criminal justice systems. The Canadian Practice Process Framework, an occupational therapy tool to facilitate client centred practice, was used as the guiding model for survey design to investigate occupational therapy service provision. After piloting the survey, purposive and snowball sampling was used to invite 48 Canadian occupational therapists in forensic mental health to participate in the 43-item online survey. Data was analyzed and presented using descriptive statistics and descriptive categories. Twenty-seven occupational therapists responded to the survey. The main findings were that forensic occupational therapy practice is heterogeneous; environmental factors including time constraints, legal barriers and limited access to occupational therapists influence intervention; institutional and community services/resources positively and negatively affect service provision; and forensic mental health occupational therapists and clients face challenges such as funding issues and stigma. This survey study provides novel data of the current role of Canadian occupational therapy practice in forensic mental health. It also sets the stage for future research into the growing role of occupational therapists in forensic mental health and the promotion of client-centred practice through an occupational therapy lens.

Translating Evidence Based Practice in a School Board Context
Dr. Pamela Wilansky, Research Planning Strategist

Only about 1 in 5 youth in need of mental health services receive it. Most who receive care do not see a mental health specialist. Education and primary care providers are often the main contact points for youth needing mental health care. These providers indicate a need for increased knowledge and skills regarding interventions for youth mental health. If school personnel are to provide these evidence based practices, how do we ensure: (1) that the right students receive the right treatments; and, (2) that the right service providers receive the right training and supervision. This study employed a mixed methodology design. Qualitative methods included formation of a school board personnel steering committee to develop an intervention model for delivering Cognitive Behavior Therapy (CBT) to adolescents with internalizing disorders. Next, key informant interviews and focus groups were conducted to discuss the acceptability and feasibility of the intervention model. From this data, a straw intervention model with barriers and facilitators at 3 levels of change was formulated. Also, focus groups were conducted after the intervention with both group facilitators and adolescents who participated in the program. Quantitative methods included completion of both self- and parent-report measures of adolescent symptomatology before and after participation in group CBT. Qualitative data from the focus groups and the straw intervention model will be presented discussing the barriers and facilitators to implementation. Quantitative results from 30 adolescents who provided consent and complete both pre- and post-measures are presented (i.e., 78.9% of group participants). Adolescents showed a significant decrease in self- and parent-report measures of depression and anxiety after treatment. The results will be discussed in the context of how to translate evidence based practice in a school board context and next steps in our research program. Further evaluation and possible dissemination of this intervention model is indicated.