Poster Presentations to be Highlighted on Research Day
Our third annual Research Day is set for Friday, March 21 at Ontario Shores Centre for Mental Health Sciences (Ontario Shores).
This year’s theme is ‘Recovery in Mental Health: Research Informed Approaches and Outcomes’ Dr. Mike Slade, a Professor of Health Services Research, Institute of Psychiatry, King's College London, UK, and Consultant Clinical Psychologist, is our keynote speaker. 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.
In addition, Ontario Shores will be well represented with poster presentations. Below is a complete list of poster presentations which will be presented by Ontario Shores’ professionals on Research Day.
Concurrent Eating Disorders and Substance Use: The Association Between Alcohol Use, Eating Disorder Symptoms and Symptom Severity
Immaculate Antony, University of Toronto; psychology intern at Ontario Shores
Several previous studies have documented that individuals with concurrent disorders (i.e. substance use and another mental health disorder) are at a heightened risk for negative consequences compared to those with a substance use disorder (SUD) alone. The present study examines the relationship between alcohol use, eating disorder symptoms, and symptom severity among individuals with concurrent SUD and Eating Disorders (ED). Additionally, the goal of the current study is to further elucidate some of the differences between individuals with concurrent SUD and ED and those with an ED alone. Participants were 72 clients (91.7% female) between the ages of 18-56 who were receiving residential treatment for an ED with or without a concurrent SUD. The results indicate that individuals with a concurrent ED and SUD had significantly higher symptom severity and greater nicotine dependence compared to those with an ED alone. Contrary to our hypothesis, frequency of alcohol use, total drinking and severity of disordered eating were not significantly different among the two groups; however, both groups had a high frequency of weekly alcohol use over the past 6 months. These results suggest that individuals with a concurrent SUD and ED diagnosis experience greater difficulty on several dimensions, yet individual’s with an ED alone may also demonstrate high rates of alcohol use. These results provide valuable information for clinicians and treatment providers to inform treatment and suggest an integrated treatment approach which addresses correlates specific to this population.
The Categorization of Anger and its Impact on Treatment Among Forensic Clients
Dr. Joanne Coutts, Psychologist
The current research focused on the treatment needs of patients with respect to anger management within minimum and medium secure forensic units. The purpose of the study is to categorize different aspects of anger for forensic clients at various stages of recovery in order to make relevant treatment recommendations. It is hypothesized that forensic inpatients differ with respect to the nature of and ability to manage anger at different security levels. This categorization of anger and stages of recovery is is relevant for planning anger management treatment in this population. Anger management, in turn, is part of the general risk assessment as well as influential in a patients’ journey of recovery. The implications of this research will be disucssed as it relates to the tailoring of anger management programs to the specific needs of forensic patients at different stages of recovery.
Interprofessional Collaboration to Maximize System Processes for Residents in Long Term Care
Joanna Holley, Rehabilitation Therapist
Residents in long term care are presenting with more complex physical and mental health needs than ever before. Nursing home residents with complex behavioural and psychiatric conditions can often leave staff from Long Term Care Facilities (LTCFs) feeling overwhelmed and unable to manage these challenging residents , resulting in potentially preventable and often unproductive emergency room admissions. New and innovative strategies for coordinating and maximizing the impact of available resources is one ways in which staff at LTC can be supported in their provision of safe and meaningful care. The poster will outline an algorithm of service provision and collaboration between agencies. A case study will demonstrate this process. The results of this **is poster outlines a collaborative approach between agencies resulting in caregivers feeling supported, confident and able to manage these residents. Further, this collaborative approach leads to residents themselves appearing more settled in the environment. The results will be discussed in light of how enhanced collaborative and interdependent relationships between services are a necessary and vital part of positive resident outcomes.
Understanding the Intention to Engage: A Secondary Analysis of Homeless Youth Engagement in a DBT Intervention
Michelle Lynk, Registered Nurse
Street-involved youth are a vulnerable population facing health disparities that include increased risk for suicide, substance abuse, and predisposition to mental illness. Engagement of street-involved youth in clinical interventions is problematic for multiple reasons including mistrust, access to resources, and droping out of treatment. Using the Comprehensive Health Seeking and Coping Paradigm (CHSCP) as a theoretical framework, this secondary analysis identified factors associated with the engagement of homeless youth in Dialectical Behaviour Therapy (DBT), an evidence-based mental health intervention. Three groups of youth were identified: (1) those who expressed intent to engage in the 13-week DBT intervention but did not start (n=16); (2) youth who started the DBT intervention but subsequently dropped out (n=20); and, (3) youth who completed the intervention (n=50). Both engaged youth and youth who dropped out during the intervention experienced significantly more depressive symptoms at baseline than youth who did not begin the intervention. The engaged group also reported higher levels of education, shorter periods of time since entering the street, and higher levels of suicidal ideation compared to non-initiators. To maximize engagement of street-involved youth in mental health interventions, factors impacting their engagement need to be addressed in program design and policy development.
Telemedicine as a Tool to Mitigate Cardiometabolic Risk Associated with Serious Mental Illness
Jason Moores, Nurse Practitioner
This study evaluated the effectiveness of telemedicine as a modality for providing cardiometabolic risk management services compared to In-person care. A retrospective chart review was conducted in order to compare changes in Body Mass Index, systolic blood pressure, and triglycerides before and after telemedicine and In-person service. While an overall effect of treatment was found in Body Mass Index, there were no significant differences between the groups on outcome measures. Accordingly, we conclude that Telemedicine may provide an effective tool to enhance cardiometabolic services for individuals with serious mental illness.
Assessing Illness and Non-Illness Based Motivations for Violence in Persons with Major Mental Illness
Dr. Andrew Morgan, Psychiatrist
Research on violence perpetrated by individuals with major mental illness (MMI) rarely focuses on the presence of specific psychotic symptoms at the time of the violent act. This approach does not distinguish whether symptoms actually motivate the violence or were merely present at the material time. It also does not consider the possibility that non-illness related factors (e.g. anger and substance use), or multiple motivations, may have been operative in driving aggression. This poster describes a coding instrument designed by the authors to assess the motivation for offending behaviour in individuals with MMI. Information was collected retrospectively from reports submitted to the court to assist in determining criminal responsibility. We found that we could reliably code various motivations for offending at a satisfactory level. Motivations were considered in the following categories: command hallucination, delusion/hallucination theme, thought/behavioural disorganization, major mood episode, substance use, and conventional motives (auch as anger and lust). Disentangling symptom-based offending from violent and antisocial behaviors that may have other motives can help to determine legal issues, better define the nature of each person’s offending and treatment needs, as well as provide a more fine-grained analysis of the drivers behind the growth experienced by the forensic systems in many international jurisdictions.
Exploring the Role of Personality Factors in the Link between Childhood Maltreatment and Adolescent Substance Use
Preeyam Parikh, Psychologist
Childhood maltreatment (CM) is a significant public health concern, with adolescent survivors of abuse and neglect frequently experiencing multiple negative outcomes, including substance use and substance-related problems. Individuals with histories of CM often display higher levels of impulsivity, anxiety sensitivity, and sensation seeking compared to the general population and these same personality factors are associated with elevated and problematic substance use patterns (Caspi et al., 1996; Sher, Bartholow, & Wood, 2000). The current study examined the role of personality factors (i.e., impulsivity, anxiety sensitivity, sensation seeking, and hopelessness) as mediators of the relationship between CM and alcohol and marijuana use in a sample of adolescents involved with the child welfare system. Results from multiple mediation analyses indicated that hopelessness significantly mediated the relationship between CM and past-year alcohol and marijuana use; however, impulsivity was not found to mediate this relationship. These findings have important implications for the role of personality factors in intervention and prevention programs for substance abuse.
Revisiting a Falls Prevention Strategy at a Mental Health Sciences Centre
Kim Ritchie, Clinical Nurse Specialist
Falls within all patient populations have increased in frequency and severity over the past several years. As a result, corporate goals and objectives often include falls prevention strategies to reduce the number of falls occuring at a hospital. However, there is little literature on falls in the mental health population. Accordingly, this research project attempts to find strategies to reduce the falls risk in this population. Four themes emerged from the trial: (1) there is a need to process existing challenges hindering effective interprofessional communication regarding a patient’s risk for falls; (2) creating a care path helped to formalize the need to support falls prevention; (3) creating care pathways did not create new tasks in patient care; rather, the pathway articulated the care already provided; and, (4) consideration for an individual’s ‘right to fall’ within their mental health care is important. This project demonstrates the importance of articulating patient care processes to both ensure consistent quality of care as well as a identify previously unknown challenges. Further, this project brings to attention the importance of re-evaluating existing organizational strategies as a means of quality assurance.
Implementing Concurrent Disorders Screening, Assessment and Treatment: Effectiveness of a Pilot Program
Dr. Pamela Wilansky, Research Planning Strategist
Mental health and substance use disorders frequently co-occur among young adults. Substance use in those with mental health diagnoses can exacerbate symptoms and reduce treatment effectiveness. Despite the high rates of concurrent disorders (CD), integrated services are often scarce in part due to lack of training. The purpose of the current study is to increase the capacity of staff to identify and treat young adults with CD by providing staff with training in the assessment and treatment of CD. The effectiveness of the program was assessed by evaluating effects on clients and treatment providers. The results from this study provide important information for the first steps in developing sustainable, effective identification of patients with CD, to be used as a model for other units at the hospital, and provide information for knowledge translation to the wider mental health community.