www.schizophrenia.on.ca
Presented by Sheila DeightonSchizophrenia Society of Ontario
Addictions & Mental Health ConferenceMay 29, 2018
Cognitive Behavioural Therapy for Psychosis (CBT-p)Informed Caring Training for Caregivers: A New Initiative
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Agenda
Addressing a Need: The Context
What is Cognitive Behavioural Therapy (CBT)?
The Current CBT Environment
Caregiver Training
The Outcomes
SSO’s Direction
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Context & Addressing a Need
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About the Schizophrenia Society of Ontario
Ontario's largest not-for-profit charitable health organization supporting individuals, families, caregivers and communities impacted by schizophrenia and psychosis province-wide for almost 40 years.
One of very few organizations in Ontario that provide schizophrenia- and psychosis-specific supports, filling a critical service gap when individuals and families have nowhere else to turn. SSO also provides system navigation and training for professionals who work in the mental health field.
SSO was first to bring front and centre the critical role families and caregivers play in supporting a relative with schizophrenia or psychosis towards recovery.
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Did You Know?
Without the right supports, caregiving can be challenging.
67% of caregiving who responded to a national survey (Schizophrenia Society of Canada) reported that caregiving had negatively impacted their emotional health.
75% expressed some difficulties coping with their caregiving role, with one in ten expressing regularly feeling overwhelmed and stressed out.
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Caregivers as Partners in Care
Caregivers play an important role supporting and advocating for their relatives living with mental illness.
Yet, support for caregivers to help fulfill their caregiving responsibilities and sustain their own well-being is rarely integrated into the healthcare system.
Caregivers are often left to fend for themselves while at the same time taking care of their own mental health and well-being.
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Identifying Caregiver Needs
Caregivers need ongoing access to information, guidance and support to fulfill their caregiving responsibilities effectively and to minimize the risk to their own well-being.
Well-supported caregivers can play an active role in the recovery journey of their ill relative, in the improvement of their quality of life and in their inclusion in all aspects of community life.
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What is CBT?
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What is CBT?
CBT is a form of psychotherapy that helps a person become more conscious of their beliefs and patterns of thinking to help them execute strategies to reshape these patterns to achieve a positive outcome.
CBT-p, in addition to antipsychotic medication, can reduce symptom severity and re-hospitalization rates in people with schizophrenia.
o Despite evidence for its effectiveness, not easily accessed in Canada.
o Practitioners are limited and the treatment is costly for people to access.
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CBT – Current Environment
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CBT for Psychosis as part of Quality Standard for Schizophrenia – Care for Adults in Hospitals.
CBT for Psychosis as part of Quality Standard for Schizophrenia – Care for Adults in the Community Quality Standard. (Launches Summer 2018)
Quality Standards – Health Quality Ontario
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CBT-p – Health Technology Assessment
Health Quality Ontario (HQO) recently posted a draft recommendation that evidence-based structured Cognitive Behavioural Therapy (CBT) for psychosis by non-physicians be publicly funded for patients with a primary diagnosis of schizophrenia (including related disorders such as schizoaffective disorder).
Draft recommendations are posted on HQO’s website for public feedback. Final recommendations are approved by HQO’s board and then shared with the Ministry of Health and Long-Term Care.
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Funding – Structured Psychotherapy
On Feb. 8 2017, Dr. Eric Hoskins, former Minister of Health and Long-Term Care, announced that Ontario is supporting evidenced-based psychotherapy such as Cognitive Behavioural Therapy:
o Applies to conditions like anxiety and depression.
o Province is working with HQO and other provincial stakeholders to develop a provincial structured psychotherapy program while also supporting the expansion of structured psychotherapy offered through existing partners.
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CBT-p-Informed Training for Caregivers:A Tailored Solution
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About CBT-p Caregiver Training
To provide caregivers CBT-p-informed skills in relating and caring for an individual with a diagnosis of schizophrenia or psychosis towards the support of their recovery.
A specialized training developed for caregivers based on CBT-p-informed techniques adapted for a non-professional audience.
First of its kind in Canada to deliver cutting-edge evidence-based support for caregivers.
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The Partnership
Developed and delivered in collaboration with Insight CBT Partnership and led by Dr. Douglas Turkington, professor of psychosocial therapy at Newcastle University.
Collaboration on a new and exciting initiative for caregivers, which has culminated in the creation of a one-of-a-kind, practical skills-building program.
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The Objective
To equip caregivers with practical skills in an evidence-based therapy so that they are able to promote the recovery trajectory of their relatives and friends with psychosis in the community as well as to prevent or improve problems in their own mental health.
SSO’s ultimate goal is to provide the CBT-p caregiver initiative across Canada.
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SSO has delivered 3 CBT-p Informed Caring for Caregiver trainings in Ontario, facilitated alongside Dr. Turkington in:
Spring and Fall 2016
o Offered through a 2-day introductory-level workshop and a 5-day intensive workshop providing family members with new skills and tools which can improve caregiver support, resilience and enhance communication with their family member.
Fall 2017
o The training was offered through a 2-day introductory-level workshop.
Upcoming trainings: 2-day CBT-p Informed Caring for Caregivers:
o Ottawa – Sept. 8 & 9, 2018
o Hamilton – Oct. 13 & 14, 2018
2-Day Training for Caregivers
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Target Audience
The 2-day workshop is appropriate for people who care for those living with schizophrenia and psychosis.
Through lecture, interactive demonstrations and small group discussion, caregivers learn CBT principles and tools to enhance effective communication with their loved one.
Caregivers also learn self-care and coping strategies as a partner of care in their loved one's recovery.
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Learning Schedule
Day 1:
Background Key Caring Principles Normalizing Making Sense of Psychosis
Day 2:
Working with Medication Coping and Testing Things Out Negative Symptoms and Cognitive Problems Red Flags
CBT-p-Informed Training for Caregivers
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5-Day Advanced CBT-p Training for Caregivers
Advanced 5-day interactive training helps caregivers and families understand and apply key CBT-p principles and techniques.
Skills and insights learned can be used to help participants more effectively care for their family member with schizophrenia and psychosis.
Expands on the 2-day introductory workshop; is proven effective for improving and maintaining the well-being of the person they care for as well as the participants.
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1-Day CBT-p Training for Professionals
Uses a variety of teaching formats to update participants on current strategies and practice of CBT in order to improve medication adherence and treatment of negative symptoms.
Covers three major themes:
1) CBT to treat hallucinations and links to trauma.
2) CBT for delusions big and small.
3) Metacognitive and compassion-based CBT.
An add-on workshop for professionals, provides skills to enhance their practice in assisting and supporting clients.
Upcoming CBT-p Training for Professionals:
o Hamilton – Oct. 15 & 16, 2018
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The Outcomes
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2-Day Introductory Training
Following the 2-day training, results showed a statistically significant increase in mental well-being felt by caregivers:
3-point significant increase of well-being (WEMWBS) – 1/3 SD
Warwick Edinburgh Mental Wellbeing Scale
Depression and anxiety symptoms, as measured by the HADS, were reduced.
Hospital Anxiety and Depression Scale
3-point significant reduction of anxiety/depression (HADS) – ½ SDHospital Anxiety and Depression Scale
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5-Day Advanced Caregiver Training
4 in 9 participants reported a 10% or more improvement in their family member’s functioning.
3 in 9 participants reported improved well-being by at least 10% immediately after completing the course.
This improved level of well-being was sustained for 2 out of 3 participants.
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Caregiver Feedback
Addressing a critical need, caregivers told us that the training provided them practical skills and tools, which they can now apply to their own circumstances and goals.
Newfound knowledge and skills have helped them to have more empathy for their family member; learn how to be a more effective listener and make sense of the experiences of their family member.
Caregivers also told us that they experienced a sense of empowerment and hope for the future.
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Research Initiative
This product/initiative is under the sole ownership of SSO and our aspirations are to scale it across Canada.
Research is an integral component of this initiative.
Dr. Turkington is leading the research for us in Canada.
We are seeking research investment for this initiative.
Dr. Turkington and SSO are in the early stages of this ground-breaking initiative.
Dr. Turkington is reporting that preliminary outcomes are significant and very exciting.
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Where is SSO Going?
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Recovery in Action (RIA)
A pilot, 7-week psychosocial education program for adults living with schizophrenia and other severe chronic mental illness and interested in optimizing their wellness and recovery.
Teaches skills building and cognitive behavioural strategies that help participants take positive and responsible ownership of their recovery.
Facilitated by a healthcare professional.
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RIA (cont’d)
Program is based on the principles of CBT and CBT-p as developed by Dr. Turkington.
RIA’s objective is to enhance daily functioning, symptom management and the reduction of hospitalization and crisis situations.
Based on the mental health recovery model.
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RIA (cont’d)
Clients learn:
o Coping with symptoms such as hearing voices.
o Goal setting and problem solving.
o Communicating with others.
o Building a supportive social and community network.
o Self-care
o Relapse and crisis prevention.
Topics presented in group sessions:
o Recovery and resiliency.
o Self-advocacy
o Planning for the future.
o Increased daily activity.
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RIA Program Referral & Intake
Referral sources:
o Self-referral, ACT teams, hospital outpatient, community services, youth workers, family members, addictions workers, Salvation Army, shelters…
Intake process:
o Phone intake
o In-person interview in the office – 45 minutes.
o Check-in with client at mid-point of program.
o Provide individual counselling as necessary throughout the program.
o After completion provide a follow-up with client if required.
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RIA Client profile
From Nov. 2016 – Mar. 2018:
Completed 5 RIA cycles reaching 40 clients.
Majority of RIA clients have no CBT-p experience.
Maximum of 9 – 10 clients per cycle.
Client drop-out – 3
Families served – 3 (family member of a RIA client supported by SSO)
Client relapse – 1
Participation – 50 % Female = 50% male
Age range – early 20s – mid 70s
Lived experience was very broad from 5 years – 50 years.
Level of individual wellness ranges from low functioning to high functioning.
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RIA Moving Forward
The RIA program is ongoing and will be delivered in SSO’s Toronto office.
SSO is in the process of evaluating its effectiveness and developing a standardized curriculum, developing a manual and a formal evaluation.
More evaluation is required in order to determine what aspect of CBT-p contributes to a successful experience.
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Questions?
