News

Examining the Role of Therapeutic Alliance in Patient Recovery

The quality of the relationship between patient and therapist is known as therapeutic alliance. Therapeutic alliance describes the level of trust and engagement between a patient and members of his or her treatment team. Research on therapeutic alliance examines the bond between patient and therapist, the level of agreement between both parties on treatment goals and therapeutic tasks, and how these factors influence treatment success.

Therapeutic alliance is specifically important to the recovery process among those seeking treatment for addiction and mental illness. Research has shown that the development of a strong therapeutic relationship predicts better treatment outcomes.

As part of HRI’s outcome monitoring system, our research team has been measuring therapeutic alliance in patients of the Addiction Medicine Service at Homewood Health Centre for more than two years.

Prior to discharge, participants are asked to rate six statements relating to mutual respect and mutual agreement on goals and therapeutic tasks. Overall, ratings of therapeutic alliance were strong among participants. When contacted 30 days after discharge, those who rated their therapeutic alliance the strongest were significantly more likely to report high levels of confidence (also referred to as “self-efficacy”) in their ability to work on their recovery. In addition, those who reported higher ratings of therapeutic alliance also reported higher levels of self-perceived mental health and physical health at one month post-discharge.

What does this mean?

Strong therapeutic alliance is linked to higher levels of self-efficacy, and research has shown that self-efficacy is an important factor in achieving enduring behaviour change, such as reduced substance use. So these early findings suggest that a strong therapeutic alliance helps to set people up for success.

Where will this research go?

In November 2017, HRI will share detailed findings of our research on therapeutic alliance at the Issues of Substance Conference, hosted by the Canadian Centre on Substance Use and Addiction, in Calgary, Alberta.
In future analyses, HRI will investigate whether participants’ ratings of therapeutic alliance at discharge are related to ongoing recovery at later time points after discharge. We also plan to monitor therapeutic alliance during treatment so that steps can be taken to ensure that this alliance is as strong as possible, as a way to improve care and outcomes.

HRI Senior Scientist is Lead Editor of Influential Guide to Addiction Treatment

The volume and complexity of addiction research can be challenging for healthcare providers to navigate when determining best treatment practices for individuals with addictive disorders.

A new book, co-edited by HRI Senior Scientist and Peter Boris Chair in Addiction Research at McMaster University, James MacKillop, will help treatment professionals arrive at solutions more quickly.

Book cover - Integrating Psychological and Pharmacological Treatments for Addictive Disorders

The book covers a comprehensive range of addictive disorders, including alcohol, tobacco, opioid, stimulant and cannabis addiction, as well as gambling disorder, dual diagnosis, and co-morbid psychopathology.

Preliminary reviews from the medical community have praised the book as an invaluable resource for a range of professionals, from early-career practitioners to seasoned experts. Medical experts anticipate that Integrating Psychological and Pharmacological Treatments for Addictive Disorders will advance addiction treatment and empower primary care physicians to better support patients suffering from alcohol and drug addiction.

Dr. MacKillop is the lead editor of the volume, which features chapters authored by leading experts from McMaster, Harvard Medical School, Stanford University, Brown University, University of Cambridge, University of Chicago, University of Toronto and UCLA, among others.

Integrating Psychological and Pharmacological Treatments for Addictive Disorders will be available July 4th and can be pre-ordered online from Routledge, Taylor & Francis Group.

Mental Health Community Comes Together for PTSD Research

On May 1, HRI kicked off Mental Health Week 2017 with an evening of music, comedy and community spirit at our first fundraising event in beautiful downtown Guelph.

Sharron Matthews performs

Sharron Matthews performs GIRL CRUSH

Guests enjoyed a one-of-a-kind concert experience by musical comedienne, Sharron Matthews, whose award-winning cabaret, GIRL CRUSH, celebrates diversity, self-acceptance and the importance of supporting one another – a fitting theme for such an event. A pre-show Penny Social featured a variety of incredible prizes, and an auction held after the performance saw two lucky guests go home with travel adventures, generously donated by VIA Rail Canada and WestJet.

We are thrilled to announce that we exceeded our fundraising goal. As a direct result of this support from our community, sponsors and donors, HRI is now able to recruit a Doctoral or Post-Doctoral Fellow, who will be dedicated specifically to trauma research.

HRI has initiated the development of several research projects related to Post-Traumatic Stress Disorder (PTSD), and we look forward to sharing the details of these projects with you in a future newsletter.

We extend our sincere thanks to our Presenting Sponsor, Homewood Health Centre, and to KPMG, Wes and Christine Gee, Mathews, Dinsdale & Clark LLP, CIBC and Linamar, whose sponsorship made this event possible. We are also grateful to the Guelph Chamber of Commerce and Guelph Today, who provided media sponsorship for this event.

And finally, thanks to our community, our supporters and our followers. Because of you, HRI is leading an effort to advance care in mental health.

Sharron Matthews

Sharron Matthews had guests in stitches with her musical comedy, GIRL CRUSH

Guelph Honour Guard at fundraising event

Members of the Guelph Police Service Honour Guard were in attendance

Andy MacDonald

Andy MacDonald, General Manager of Emergency Services for the City of Guelph, discusses the impact of PTSD on first responders and their families

Dr. Roy Cameron

HRI Executive Director, Dr. Roy Cameron, discusses HRI’s unique approach to mental health and addiction research

We’re Making a Scene for Mental Health: An Evening with Shelley Marshall

Click image to visit www.supporthri.caTo celebrate Mental Health Week 2017, Homewood Health Centre proudly presents a special event to raise funds for the vital research that the Homewood Research Institute (HRI) is conducting to address the mounting crisis of mental illness related to Post-Traumatic Stress Disorder (PTSD).

On May 1, please join us for an unforgettable one-night-only showing of Hold Mommy’s Cigarette, a hilarious, heartbreaking and ultimately uplifting one-woman play by acclaimed actor and comedienne, Shelley Marshall. Shelley takes audiences on a raucous adventure through her real-life experience growing up in a dysfunctional environment fraught with depression, trauma and suicide, and her remarkable journey toward a life of purpose and fulfillment. An unrelenting mental health advocate, Shelley gives hope to audiences and inspires positive change everywhere she goes.

This performance takes place at Guelph’s beautiful downtown venue, River Run Centre, and will raise funds for the Shelley Marshall Scholarship, a fund named in Shelley’s honour that will support applied research aimed at improving the lives of people living with PTSD.

Tickets are available now through the River Run Centre Box Office.

For further information, including show time, and details about a pre-show fundraiser, HRI’s PTSD research team, sponsorship opportunities, and a profile of our Honorary Chair, Andy MacDonald, General Manager of Emergency Services at the City of Guelph, please visit the event website, www.supportHRI.ca.

We hope you will join us for this enlightening evening in downtown Guelph, as we work toward improvements in mental health practice and to improve care for all Canadians.

This performance contains adult content.

Presenting Sponsor:
Homewood Health Centre logo

 

 

 

Click for a full list of our generous sponsors

HRI Releases Early Findings from Post-Discharge Outcome Evaluation

Does mental health and addiction treatment really work?

This is one of the most common questions that clinicians, patients and families have when considering admission to a treatment facility. And this is why HRI, in collaboration with Homewood Health Centre, has developed an outcome monitoring system – the first of its kind in Canada — to measure the outcomes of patients who receive treatment at the Health Centre. Through our research and evaluation studies, we aim to answer this question and – more importantly – to inform continuous improvement efforts in mental health and addiction treatment.

Treatment success can be measured in a number of ways. For patients seeking treatment in the Addiction Medicine Service (AMS) at Homewood Health Centre, one method is to examine how alcohol consumption changes over a defined period of time.

To do this, HRI has implemented a comprehensive outcome monitoring system in the AMS at the Health Centre. We collect and analyze data from patients who have agreed to complete questionnaires at the time of admission, again at discharge and at one, three, six and 12 months post-discharge. Patients who choose to participate answer questions relating to many different life domains, including substance use; psychological, physical, social, and occupational wellness; daily life functioning; engagement in continuing care activities; and overall quality of life or life satisfaction.

To generate initial findings about changes in alcohol consumption, we examined the percentage of days that participants abstained (PDA) from alcohol, comparing pre-treatment to post-treatment data in order to explore how drinking behaviours change from before admission to post-discharge.

The figure below (Figure 1) presents PDA from alcohol in the 90 days prior to admission and PDA in the past 30 days at each follow-up time-point. Participants who did not consume alcohol in the 90 days prior to treatment or in the past 30 days at a follow-up time point were considered 100 percent days abstinent.PDO figure

Figure 1 shows that PDA from alcohol greatly increased from before treatment to one-month post-discharge (i.e., that participants reported consuming alcohol on significantly fewer days following treatment). PDA remained high at all subsequent follow-up time points.

These early findings represent data collected from AMS patients who participated in the outcome monitoring system in fiscal year 2016. Evaluations are ongoing and will be rolled out in other programs. A unique system in Canadian healthcare, HRI’s outcome evaluation project allows for continued, rigorous evaluation of the quality and effectiveness of mental health and addiction treatment at Homewood.

As HRI’s outcome monitoring evaluations advance, we will continue to share findings from other domains. If you would like to receive future research updates, please subscribe to our quarterly newsletter, HRI Connects.

Partnership Will Fund Research to Aid Military Members and Veterans

Individuals with post-traumatic stress disorder (PTSD) often experience difficulties in performing tasks that rely on cognitive ability, such as memory, attention, or learning. Such difficulties undermine treatment efforts and have also been associated with poor functional outcomes, including difficulty returning to work.

Trauma-related mental illness is of particular relevance to military, where urgent calls exist to address the mounting crisis of mental illness, and in particular PTSD, in these populations.

FRN_0662v2

Left to right: Roy Cameron, Executive Director, Homewood Research Institute; Margaret McKinnon, Associate Co-Chair, Research, Department of Psychiatry and Behavioural Neurosciences, McMaster University and Homewood Senior Scientist; Theresa Hacking, President, Military Casualty Support Foundation; Rob Schlegel, CFO Schlegel Health Care Inc.; Heather McLachlin, President, Cowan Insurance Group.

In 2016, representatives of The Cowan Foundation, Schlegel Health Care Incorporated, the Military Casualty Support Foundation and Homewood Research Institute identified a shared priority for research on interventions that could improve transitions from military to civilian employment. A partnership between the four organizations was established to fund a study proposed by Homewood Senior Scientist, Dr. Margaret McKinnon, which will examine the efficacy of a novel cognitive training program called Goal Management Training (GMT) in improving cognitive functioning among military members and veterans with PTSD.

GMT aims to help participants build skills in performing behaviours that rely on basic cognitive processes, such as planning, organization and achieving goals for everyday functioning. As part of this research study, a nine-week course of Goal Management Training will be offered free of charge to military members and veterans. Pre-and post-testing will examine the impact of GMT on cognitive functioning, psychological status and functional outcomes.

“This novel form of treatment extends beyond traditional approaches,” explains Dr. McKinnon.

“GMT focuses on memory, attention and other cognitive functions that typically go unaddressed following the onset of PTSD.”

Longer-term impacts of Dr. McKinnon’s research may include the application of similar clinical interventions to address PTSD in police and first responders. This study is helping to launch a national network lead by HRI, to further advance the development of novel treatment approaches for those with PTSD.

If you would like to receive future research updates, please subscribe to our quarterly newsletter, HRI Connects.

Give Back to Mental Health Research on GivingTuesday

By now, most of us are familiar with Black Friday and Cyber Monday. But the true opening day of the annual holiday season is GivingTuesday, a national day of giving, and a time when Canadians come together to support charities and non-profit organizations that make our lives and our nation better each day. Founded in 2013 by the GIV3 Foundation and CanadaHelps, GivingTuesday is a grassroots movement that is now celebrated in 71 countries. This year, GivingTuesday falls on Tuesday, November 29.

As a registered charity and an organization that gives back to the health and well-being of Canadians each day through vital mental health and addictions research, the Homewood Research Institute invites you to celebrate the season of giving by supporting our efforts to improve mental health and addiction treatment outcomes for all Canadians.

When you donate to HRI, you support research that will advance both practice and science in the field of mental health and addictions. We engage patients, families, clinicians, treatment providers and scientific experts in solution-focused studies that will improve care for those struggling with mental health and addiction problems. Our vision is clear: no life held back or cut short by mental illness or addiction. And our vision can be achieved through the collaboration, knowledge exchange and robust scientific research that your donations support each day.

Donations can be made in honor or in memory of someone special and can be designated to a priority area of research that is most meaningful to you as a donor, such as addiction, trauma and post-traumatic stress disorder, or to the Shelley Marshall Scholarship Fund.

HRI is grateful to our past and current donors, without whom we would not be able to continue making a difference in the lives of Canadians.

Donate Now Through CanadaHelps.org!

HRI Evaluation Studies Are Receiving National and International Attention

HRI is working with Homewood Health Centre clinicians and patients to develop a rigorous approach to program evaluation to guide improved treatment and enhance outcomes.  This evaluation work has started in the Addiction Medicine Service (AMS), in collaboration with AMS leaders Dr. Harry Vedelago and Wendi Woo and the patients they serve.

This article highlights initial findings by describing two presentations made at the joint meeting of the Canadian Society of Addiction Medicine (CSAM) and the International Society of Addiction Medicine (ISAM), which attracted experts from more than 30 countries to Montreal from October 20 to 23. There is also a link below to a related paper HRI published in the Canadian Journal of Addiction.

James MacKillop

The first CSAM-ISAM paper was presented by Homewood Senior Scientist, Dr. James MacKillop, who is Boris Chair in Addictions Research, Director of the Boris Centre for Addictions Research, and Professor of Psychiatry and Behavioural Neurosciences at McMaster University.

To improve our understanding of links between substance abuse and trauma among patients admitted to the Addiction Medicine Service at Homewood Health Centre, he systematically screened 540 patients. A high proportion of these patients reported traumatic life events. Dr. MacKillop’s ongoing research program will clarify the relationship between trauma and substance abuse, and how to use the emerging findings to improve personalized care and to guide program development based on a deeper understanding of the needs of individual patients and the population of patients served by the program.

Sarah Sousa

At the CSAM-ISAM meeting, HRI Senior Research Coordinator, Sarah Sousa, delivered a presentation entitled Development and Early Findings from the Homewood Post-Discharge Outcome Monitoring System in the Addiction Medicine Service.  Homewood and HRI are jointly developing this ground-breaking system to understand recovery and to measure treatment outcomes.

This research, done in collaboration with Dr. Brian Rush as well as Homewood clinicians and patients, will be used to inform clinical practice in the Addiction Medicine Service at Homewood Health Centre and provide a model for outcome monitoring. In her presentation, Sarah introduced Homewood’s outcome monitoring protocol, which involves a series of self-reported questionnaires administered to patients at admission to Homewood Health Centre, at discharge, and again at one month, three months, six months and 12 months post-discharge.

Over the past 1.5 years, HRI has engaged approximately 700 patients in the initiative. Preliminary findings based on 167 patients who provided data at admission, and again at one month post-discharge, show that they experienced very encouraging overall improvements, both in terms of abstinence and in several life domains, such as mental health, physical health, occupational performance and quality of life. We will report more detailed outcome information in future newsletters.

HRI’s Post-Discharge Monitoring System will continue to examine and deepen our understanding of the short- and long-term impacts of inpatient addiction and mental health treatment.

Recently Dr. Jean Costello, HRI Research and Evaluation Scientist, and her colleagues published a peer-reviewed article in the Canadian Journal of Addiction detailing the development and implementation of HRI’s Outcome Monitoring System at Homewood. This paper appeared in a Special Issue of the journal, Co-Edited by Dr. Brian Rush, who collaborates in the development of the outcome evaluation system, and Dr. Costello.

We are grateful to the Homewood Addiction Medicine Service patients and clinical staff, especially Dr. Harry Vedelago and Wendi Woo, and to Dr. Rush for their collaboration in this work.