is it worth the resource allocation? · fig. 1 integrated psychological therapy (ipt) for...

Interpersonal Effectiveness: is it worth the resource allocation?

November 5th, 2019

Michael Ivany, OT Reg. (Ont.)

Let’s begin

Let’s increase the challenge

• You sit beside a new person in group and enjoy the polite conversation. They are wearing a strongly scented product. Your friend, for whom you are saving a seat on the other side of you gets migraines from scented products. There is one empty seat left on the other side of the circle. You think about asking this new person to move, otherwise the friend coming will be upset you did not save them a seat.

Objectives

• To review why we started looking at social skills training interventions

• To discuss group goals, process and outcomes

• To share success and also challenges to implementation

• To give you an idea of the group experience

What was the problem?

Clients had difficulty making and maintaining new social connections outside of staff and peers.

Components related to this included:

negative symptoms, lack of motivation, social perception, memory difficulties, verbal communication deficits, emotional regulation deficits, problem solving challenges, social skills deficits, lacking roles and lacking routine

• This affected many areas of life including work, schooling, volunteering, social roles, family connections, leisure engagement, program participation, social media involvement, victimization, volition and routines.

Prior to admission what had

clients done?• Social media groups to review use and what to

be aware of with different social media outlets

• Peer mentorship programs providing feedback to peers and helping one another build skills

• Community meetings

• Leisure and group therapeutic groups

• Volunteer, work and education programs

Still we needed something…

• Integrated Psychological Therapy is a structured group training format set to improve function in the areas of:– Cognitive Differentiation

– Social Perception

– Verbal Communication

– Social Skills

– Emotional Regulation

– Interpersonal Problem Solving

(Roder, V., Muller, D.R., Brenner, H.D.,& Spaulding, W.D. (2011).

Fig. 1 Integrated Psychological Therapy (IPT) for schizophrenia (Roder, Mueller,

Mueser, & Brenner, 2006)

More than 20 sites across Quebec have implemented it.

Fig. 2. Mean Weighted Effect sizes of the Total Sample (K=29) and of the High-Quality Studies

(K=7) of Integrated Psychological Therapy (IPT) and Control Group (CG). Significant weighted

effect size (Z>2.58, P<.01). (Roder, Mueller, Mueser, & Brenner, 2006)

Outpatient Group details

• OT and RPN facilitated

• Had resources to run it once weekly for 50 minute sessions

• 61 sessions to complete group material

• Group setting was in living room of Transitional Rehabilitation Housing Project

• 11 individuals who participated in total

• 2 moved away, 1 readmitted, 2 had 50-60% attendance

Inpatient Group details• OT and BT facilitated

• Had resources to run it twice weekly for 55 minute sessions (inpatient group ran concurrently)

• 123 sessions (more than double)

• Group setting was in group room (insert photo)

• 12 individuals who participated in total

• 1 relocated, 1 dropout and 1 had 45% attendance through all sessions

Outpatient Group Barriers• Attendance for those not in the home

including transportation

• Only one staff trained

• First time running the group

• Structured weekly group therapy was not a normal part of Maplewood programming

• Early mornings…

Inpatient Group Barriers

• Resource heavy (especially at outset)

• Readiness to engage

• Increased symptomatology

• Many had not been socialized to group programming, with multiple clients not being able to handle more than 10 minutes of structured group programming (length of time it takes to drink a model)

Outpatient Group Successes

• Increased # of non-staff, non-relative, non-patient weekly social contacts from 0.5 to 3

• Increased maintenance of work

• Increased discussion of conflicts with people in position of authority/supervisors

• Increased performance navigating difficult conversations and maintaining friendships

• Increased reliance on peers for alternative viewpoints

• Transference to volunteer roles and social conversations with other staff

Participant feedback

• “I’m better at having conversations with people because of this group.”

• “(It) helped me stay in my job and not quit…I was able to practice the conversation first.”

• “(It) helped me learn how to make new friends and solve my problems instead of fighting.”

• “I can talk to people now.”

Future considerations• Training other facilitators, this increases fidelity to the

model

• Research outcomes – facilitator experience and research support

• Collaboration with other hospital and community based programs

• Offering the group via OTN for those that start the group and move on

Future considerations (cont’d)

• Flexible group time to facilitate commitments that may be associated with outcomes we are aiming for (work/educational/social commitments)

• Module 7: Daily life

• Module 8: Projet de vie

• With a homogeneous group some sub-programs could be used for a more efficient treatment in a resource limited setting (Roder, Mueller, Mueser, & Brenner, 2006)

References

• Roder, V., Mueller, D.R., Brenner, H.D., & Spaulding, W.D. (2011). Integrated Psychological Therapy (IPT) for the Treatment of Neurocognition, Social Cognition, and Social Competency in Schizophrenia Patients. Hogrefe Publishing, Cambridge, MA.

• Roder, V. Mueller, D.R., Mueser, K.T., & Brenner, H.D. (2006). Integrated Psychological Therapy (IPT) for Schizophrenia: Is It Effective? Schizophrenia Bulletin, 32, 1, S81-S93.

• https://criusmm.ciusss-estmtl.gouv.qc.ca/fr/recherche/centres-detudes/Approche-IPT

• Briand, C., Reinharz, D., Lesage, A., Nicole, L., Stip, E., Lalonde, P., Villeneuve, K. & Planet-Sultan, S. (2010). L’implantation Québec de l’Integrated Psychological Therapy (IPT) auprès des personnnes atteintesde schizophrénie: cinq ans après. Santé mentale au Quebec, XXXV, 2, 145-162.

• Pomini, V., Neis, L., Brenner, H.D., Hodel, B., Roder, V, & Seywert, F. Thérapie psychologique des schizophrénies. Programme intégratif IPT de Brenner et collaborateurs pour la thérapie psychologique des patients schizophrènes. Version française révisée. (1998). Mardaga, Sprimont, Belgique.

• Briand, C., Bélanger, R., Hamel, V., Nicole, L., Stip, E., Reinharz, D., Lalonde, P., & Lesage, A. (2005). L’implantation multisite du programme Integrated Psychological Therapy (IPT) pour les personnes souffrant de schizophrénie. Élaboration d’une version renouvelée. Santé mentale au Quebec, XXX, 1, 73-95.

Thanks for your

participation

• Questions?

Contact:

Michael.Ivany@nbrhc.on.ca