"It Makes You Feel Good to Help!": An Exploratory Study of the Experience of Peer Mentoring in Long-Term Care.

Social isolation and loneliness in long-term care settings are a growing concern. Drawing on concepts of social citizenship, we developed a peer mentoring program in which resident mentors and volunteers formed a team, met weekly for training, and paired up to visit isolated residents. In this article, we explore the experiences of the resident mentors. As part of a larger mixed-methods study conducted in 10 sites in Canada, we interviewed mentors (n = 48) and analysed data using inductive thematic analysis. We identified three inter-related themes: Helping others, helping ourselves described the personal benefits experienced through adopting a helping role; Building a bigger social world encapsulated new connections with those visited, and; Facing challenges, learning together described how mentors dealt with challenges as a team. Our findings suggest that a structured approach to mentoring benefits residents and helps them feel confident taking on a role supporting their isolated peers.

Participation in Community Gardening: Sowing the Seeds of Well-Being: Participation au jardinage communautaire : pour semer les graines du bien-être.

BACKGROUND.: Sustaining well-being challenges people with serious mental health issues. Community gardening is an occupation used to promote clients' well-being, yet there is limited evidence to support this intervention. PURPOSE.: This paper examines how facilitated community gardening programs changed the subjective well-being and social connectedness of people living with mental health issues. METHOD.: A community-based participatory research approach and qualitative methods were used with 23 adults living in supported housing and participating in supported community gardening programs. A constructivist approach guided inductive data analysis. FINDINGS.: Participation in community gardening programs enhanced well-being through welcoming places, a sense of belonging, and developing positive feelings through doing. The connection to living things and responsibility for plants grounded participants in the present and offered a unique venue for learning about gardening and themselves. IMPLICATIONS.: Practitioners and service-users should collaborate to develop leadership, programs, places, and processes within community gardens to enhance well-being.

The Impact of Peer Mentoring on Loneliness, Depression, and Social Engagement in Long-Term Care.

Loneliness, depression, and social isolation are common among people living in long-term care homes, despite the activities provided. We examined the impact of a new peer mentoring program called Java Mentorship on mentees' loneliness, depression, and social engagement, and described their perceptions of the visits. We conducted a mixed-methods approach in 10 homes in Ontario, Canada, and enrolled residents as mentees (n = 74). We used quantitative surveys and qualitative interviews to understand their experience. After 6 months, mentees (n = 43) showed a 30% reduction in depression (p = .02, d = .76), a 12% reduction in loneliness (p = .02, d = .76), and a 60% increase in the number of monthly programs attended (p = .01, d = .37), with small-to-medium effect sizes. The analysis of mentee's interviews revealed positive perceptions. This program offers an innovative, nonpharmacological alternative to the treatment of loneliness and depression.

'It makes life worthwhile!' Peer mentoring in long-term care-a feasibility study.

Objectives: Loneliness and depression are of increasing concern in long-term care homes made more urgent by viral outbreak isolation protocols. An innovative program called Java Mentorship was developed that engaged community volunteers and resident volunteers (mentors) as a team. The team met weekly, received education, and provided visits and guidance in pairs to socially disengaged residents (mentees). The purpose of this study was to assess the feasibility of conducting a larger study.Method: We conducted a mixed-methods pre-post study to evaluate the program. We collected feasibility data associated with the program implementation, including assessment of the sample and ability to recruit; procedures for data collection; retention, program adherence and acceptability; and residents' responses including loneliness, depression, purpose in life, social identity and sense of belonging outcomes. We enrolled community mentors (n = 65), resident mentors (n = 48) staff facilitators (n = 24) and mentees (n = 74) in 10 Canadian sites.Results: Most feasibility objectives were met, and adherence and acceptability were high. Some resource challenges and low retention rates among resident mentors were noted. We found a 29% reduction in depression scores (p = .048; d = .30) and 15% reduction in loneliness scores (p = .014; d = .23). Purpose in life, social identity and sense of belonging were unchanged. Interviews among participants indicated high acceptability and positive perceptions of the program.Conclusion: The study findings reveal a potential role for mentorship as a viable approach to reducing loneliness and depression in long-term care settings and lay the groundwork for future research.

Multiple sclerosis self-management model: Personal and contextual requirements for successful self-management.

OBJECTIVE: To explore self-management strategies used by people with multiple sclerosis (MS) with aim of developing a MS self-management model. METHODS: A grounded theory approach guided development of a MS self-management model. Eighteen individuals living with MS for three or more years and self-identifying as successfully managing their MS were interviewed twice using semi-structured face-to-face or telephone interviews six months apart. Demographic and disease characteristics were descriptively analyzed. Field notes and interview data were qualitatively analyzed to identify concepts and categories. RESULTS: The emerging model revealed six person-related categories describing self-management strategies: adjusting outlook, managing stress, managing symptoms, healthy lifestyle, effective communication, and setting priorities and planning. Three context-related categories that required successful navigation for self-management were also identified: physical environment, personal social network, and community services and resources. CONCLUSIONS: The emerging self-management model that is grounded in the perspective of people with MS includes person and context-related strategies that can be used concurrently to guide self-management in the variety of challenges experienced by people with MS. PRACTICAL IMPLICATIONS: A self-management model of MS is useful to service providers, health professionals, advocacy organizations and people with MS to draw upon an organized and comprehensive approach to self-management.

Effective self-management strategies for bipolar disorder: A community-engaged Delphi Consensus Consultation study.

BACKGROUND: Self-management represents an important complement to psychosocial treatments for bipolar disorder (BD), but research is limited. Specifically, little is known about self-management approaches for elevated mood states; this study investigated self-management strategies for: (1) maintaining balance in mood, and (2) stopping progression into hypomania/mania. METHODS: To identify the common components of BD self-management, Delphi Consensus Consultation methods were combined with a Community-Based Participatory Research (CBPR) approach across five study phases: (1) Qualitative dataset content analysis; (2) Academic/grey literature reviews; (3) Content analysis; (4) Two Delphi rounds (rating strategies on a 5-point Likert scale, Very Unhelpful-Very Helpful), and; (5) Quantitative analysis and interpretation. Participants were people with BD and healthcare providers. RESULTS: Phases 1 and 2 identified 262 and 3940 candidate strategies, respectively; 3709 were discarded as duplicates/unintelligible. The remaining 493 were assessed via Delphi methods in Phase 4: 101 people with BD and 52 healthcare providers participated in Round 1; 83 of the BD panel (82%) and 43 of the healthcare provider panel (83%) participated in Round 2-exploratory factor analysis (EFA) was conducted on Round 2 results. LIMITATIONS: EFA was underpowered and sample was not ethnically diverse, limiting generalizability. DISCUSSION: High concordance was observed in ratings of strategy effectiveness between the two panels. Future research could usefully investigate the provisional discovery here of underlying factors which link individual strategies. For example, 'maintaining hope' underpinned strategies for maintaining balance, and 'decreasing use of stimulants' underpinned strategies to interrupt hypo/manic ascent. There is merit in combining CBPR and Delphi methods.

The need for a social revolution in residential care.

Loneliness and depression are serious mental health concerns across the spectrum of residential care, from nursing homes to assisted and retirement living. Psychosocial care provided to residents to address these concerns is typically based on a long-standing tradition of 'light' social events, such as games, trips, and social gatherings, planned and implemented by staff. Although these activities provide enjoyment for some, loneliness and depression persist and the lack of resident input perpetuates the stereotype of residents as passive recipients of care. Residents continue to report lack of meaning in their lives, limited opportunities for contribution and frustration with paternalistic communication with staff. Those living with dementia face additional discrimination resulting in a range of unmet needs including lack of autonomy and belonging-both of which are linked with interpersonal violence. Research suggests, however, that programs fostering engagement and peer support provide opportunities for residents to be socially productive and to develop a valued social identity. The purpose of this paper is to offer a re-conceptualization of current practices. We argue that residents represent a largely untapped resource in our attempts to advance the quality of psychosocial care. We propose overturning practices that focus on entertainment and distraction by introducing a new approach that centers on resident contributions and peer support. We offer a model-Resident Engagement and Peer Support (REAP)-for designing interventions that advance residents' social identity, enhance reciprocal relationships and increase social productivity. This model has the potential to revolutionize current psychosocial practice by moving from resident care to resident engagement.

Peer support as a catalyst for recovery: a mixed-methods study.

BACKGROUND: Peer support involves people in recovery from mental illness supporting their peers. PURPOSE: This mixed-methods pilot randomized control trial with qualitative interviews aimed to (a) compare peer support worker (PSW) and mental health worker (MHW) client outcomes and (b) provide estimates to inform the design of a larger study. METHOD: Fifteen adults living with a mental illness and receiving services at a community health team were randomly assigned to a PSW or a MHW group. The Quality of Life Interview-Brief Version was administered at baseline and after 6 months of intervention. Participants completed a semi-structured exit interview. FINDINGS: While both groups improved from baseline to 6 months, the PSW group did not improve more than the MHW group. Interviews highlighted therapeutic alliance and boundaries. IMPLICATIONS: This research adds to existing literature that PSWs produce outcomes similar to nonpeer staff and struggle with boundaries related to their unique role.

Spirituality in bedlam: exploring patient conversations on acute psychiatric units.

BACKGROUND: Spirituality is a complex yet vital aspect of care on acute psychiatric units. Occupational therapists play a role in engaging their clients regarding spirituality as a resource for recovery. PURPOSE: This manuscript reports on Part I of a research study that explored the experience of spiritual conversations for patients (Part I) and mental health professionals (Part 2) on acute psychiatric units. METHOD: Community-based participatory research framed the project philosophically and relationally, and interpretive description defined the data collection, data analysis, and dissemination methods. FINDINGS: Seven inpatients on acute psychiatric units participated in interviews or focus groups. Authentic spiritual conversation that was not associated with mental illness symptoms proved difficult to initiate on inpatient psychiatric units. Participants desired direct questioning and the provision of optional spiritual resources. IMPLICATIONS: Therapists can make a range of spirituality educational resources available for clients. They can also advocate for clients' spiritual needs in the acute context.

Spirituality in bedlam: exploring professional conversations on acute psychiatric units.

BACKGROUND: The inclusion of spiritual conversations in occupational therapy is congruent with the Canadian Model of Occupational Performance and Engagement, which identifies spirituality as the core of every human being. Research indicates that spirituality can be a resource for mental health recovery. PURPOSE: This manuscript reports on Part 2 of a research study that explored the experience of spiritual conversations for patients (Part I) and mental health professionals (Part 2) on acute psychiatric units. METHOD: Eight acute-based mental health professionals (MHPs)/participants, representing a variety of disciplines, participated in a focus group or individual interview. Community-based participatory research, appreciative inquiry, and interpretive description provided methodological and analytic guidance. FINDINGS: MHP/participants described challenges in setting boundaries related to spirituality conversations and discerning spiritual experience from psychosis. MHPs/participants emphasized the importance in providing an empathetic presence while also engaging in spiritual networking. IMPLICATIONS: Therapists can incorporate spiritual conversations with patients in acute psychiatric settings by taking specific actions to enhance their openness and engaging in spiritual networking.

Meanings of well-being from the perspectives of youth recently diagnosed with psychosis.

BACKGROUND: The phenomenon of well-being has attracted a surge of attention in mental health policy, clinical practice and research internationally. Yet, the definitions of well-being remain elusive, and there is limited understanding on its meanings from the perspectives of youth mental health service users. OBJECTIVE: This study explored the meanings of well-being from the perspectives of youth mental health service users diagnosed with psychosis in the past 3 years. METHODS: Using a qualitative approach, we conducted semi-structured interviews and participant-photography elicited focus groups with 17 youth recruited from an early intervention program for psychoses and a mental health program specializing in the delivery of psychiatric services to street youth. Analysis combined the methods of constructivist grounded theory and narrative inquiry. FINDINGS: The findings illustrate five key themes in participants' conceptualizations of well-being: multidimensionality; active oriented states; social environment; identity; and normality. Dimensions of well-being identified in participants' accounts include: psychological, physical, emotional, moral/virtuous, financial/material, spiritual, and social aspects. CONCLUSIONS: Our heuristic framework for conceptualizing well-being, grounded in the narrative accounts of youth participants, can inform the future planning and design of interventions, research, and outcome measures pertaining to the well-being of youth recently diagnosed with psychosis.

Well-being and engagement in valued activities: experiences of young people with psychosis.

The purpose of this study was to understand how engagement in valued activities contributes to the well-being of young people diagnosed as having psychosis within the past 3 years. Using a qualitative approach, the authors conducted semi-structured interviews and photography-elicited focus groups with 17 participants between the ages of 18 and 24 years who were recruited from an early intervention program for psychoses and a psychiatric service specializing in providing care to street youth. Analysis combined the methods of constructivist grounded theory and narrative inquiry. Participants derived six well-being enhancing experiences from engaging in highly valued activities: making meaning; expressing thoughts and emotions; changing physical, emotional, and cognitive states; cultivating skills, strengths, and virtues; connecting and belonging; and making a contribution. These findings highlight the importance of identifying activities that young people perceive as being valuable to their well-being, the meanings and experiences derived from these activities, and how best to support engagement in them. [OTJR: Occupation, Participation and Health. 2013;33(4):190-197.].

A scoping review of the Photovoice method: implications for occupational therapy research.

BACKGROUND: Photovoice is a participatory action research method combining photography and group work to give people an opportunity to record and reflect on their daily lives. PURPOSE: To review the use of Photovoice in health research and consider the implications for occupational therapy research. METHODS: Literature review, guided by a scoping framework, reveals the purposes, rationales and populations with whom Photovoice has been used. FINDINGS: From 351 documents retrieved, 191 original studies were surveyed; 68% were peer-reviewed. The majority of studies (76%) occurred within the public health domain and a smaller percentage (24%) with individuals experiencing a specific illness and/or disability, with very few (2%) documented in the occupational therapy literature. IMPLICATIONS: Photovoice provides a useful framework to apply a participant-centred research approach on occupational participation. It is important to consider and further examine ethical and methodological issues related to stigma, physical and cognitive capacities, mobility and technical accessibility related to using this method.

Religious and/or spiritual practices: extending spiritual freedom to people with schizophrenia.

BACKGROUND: It continues to be a challenge to define and utilize spirituality in client-centred occupational therapy practice. Dialogue about spirituality is especially problematic for occupational therapists working with people with schizophrenia. PURPOSE: To explore the meaning of religion and/or spirituality for people living with a diagnosis of schizophrenia. METHODS: Nine community-based individuals with schizophrenia engaged in interviews about the meaning of religion and/or spirituality and demonstrated self-defined spiritual practices. Phenomenology, hermeneutic theory, and a symbolic interactionism framework provided methodological and analytic guidance. FINDINGS: Participants employed religious and/or spiritual practices to cope with schizophrenia symptoms and make meaning of their lives. Individuals used multiple systems of meaning to explain their experiences. Religious and/or spiritual agency, an individual's sense of freedom to choose among the spiritual options, renewed their sense of empowerment. IMPLICATIONS: Therapists can engage in spiritual negotiation with clients by using well-worded empowering questions toward a common goal of life enhancement.

Directions for advancing the study of work transitions in the 21st century.

OBJECTIVES: The purpose of this article is to share the details, outcomes and deliverables from an international workshop on work transitions in London, Ontario, Canada. PARTICIPANTS: Researchers, graduate students, and community group members met to identity ways to advance the knowledge base of strategies to enhance work participation for those in the most disadvantaged groups within society. METHODS: A participatory approach was used in this workshop with presentations by researchers and graduate students. This approach included dialogue and discussion with community members. In addition, small group dialogue and debate, world cafe discussions, written summaries of group discussion and reflection boards were used to bring new ideas to the discussion and to build upon what we know. FINDINGS: Two research imperatives and six research recommendations were identified to advance global dialogue on work transitions and to advance the knowledge base. Occupational justice can be used to support future research directions in the study of work transitions. CONCLUSIONS: Moving forward requires a commitment of community of researchers, clinicians and stakeholders to address work disparities and implement solutions to promote participation in work.

'It's something that I manage but it is not who I am': reflections on internalized stigma in individuals with bipolar disorder.

Bipolar disorder (BD) is a complex chronic condition associated with substantial costs, both at a personal and societal level. Growing research indicates that experiences with stigma may play a significant role in contributing to the distress, disability, and poor quality of life (QoL) often experienced in people with BD. Here, we present a sub-set of findings from a qualitative study of self-management strategies utilized by high functioning Canadian individuals with BD. Specifically, we describe a theme relating to participants' experiences and understandings of internalized stigma. Descriptive qualitative methods were used including purposeful sampling and thematic analysis. High functioning individuals with BD type I or II (N = 32) completed quantitative scales to assess symptoms, functioning and QoL, and participated in an individual interview or focus group to discuss the self-management strategies that they use to maintain or regain wellness. Thematic analysis identified several themes, including one relating to internalized stigma. Within this, four additional themes were identified: stigma expectations and experiences, sense of self/identity, judicious disclosure, and moving beyond internalised stigma. One of the more unique aspects of the study is that it involves a participant sample that is managing well with their illness, which differs from the norm in biomedical research that typically focuses on pathology, problems and dysfunction.

Self-management strategies used by 'high functioning' individuals with bipolar disorder: from research to clinical practice.

INTRODUCTION: Bipolar disorder (BD) is a complex mental illness that results in substantial costs, both at a personal and societal level. Research into BD has been driven by a strongly medical model conception, with a focus upon pathology and dysfunction. Little research to date has focused upon strategies used to maintain or regain wellness in BD. Here, we present results from a qualitative study of self-management strategies used by a Canadian sample of 'high-functioning' individuals with BD. The aims of the present paper are two-fold: (1) To provide a description of the self-management strategies identified as effective by this sample of high functioning individuals and 2) to explore these results from a clinical perspective. METHODS: High functioning (determined as a score of either 1 or 2 on the objectively-rated Multidimensional Scale of Independent Functioning) individuals with BD type I or II (N = 33) completed quantitative scales to assess depression, mania, psychosocial functioning and quality of life, and underwent either an individual interview or focus group about the self-management strategies they used to maintain or regain wellness. RESULTS: The specific self-management strategies that individuals enacted are contained within the following categories: (1) sleep, diet, rest and exercise; (2) ongoing monitoring; (3) reflective and meditative practices; (4) understanding BD and educating others; (5) connecting to others and (6) enacting a plan. These strategies are discussed in the context of current treatment interventions and research findings, offering clinicians a broad range of potential techniques or tools to assist with their efforts to support individuals with BD in maintaining or regaining wellness. CONCLUSIONS: The strategies adopted by a sample of people coping well with their BD show remarkable overlap with the targets of existing adjunctive psychosocial interventions for BD. The clinician can use this information to motivate clients to engage with such strategies. The present findings also serve to remind the clinician of significant individual differences in the personal meaning and concrete application of superficially similar strategies.

Growing older with cerebral palsy: insiders' perspectives.

PURPOSE: Research has shown that adults with cerebral palsy (CP) lose functional abilities earlier than persons who are able-bodied. Because CP is a lifespan disability, developmental therapists should be aware of these changes. METHODS: We used descriptive phenomenology to understand the unique, lived experiences of adults growing older with CP. Data were gathered through in-depth, semistructured interviews. Open-ended questions asked what it was like to age with CP, how these experiences were understood, how strategies were used to cope with changes, and what are the meanings of these experiences. RESULTS: A theme, Awareness, Acceptance, and Action, emerged from the data analysis. Participants were aware that their bodies were deteriorating quicker than those of peers who are able-bodied. They developed acceptance that hastened actions toward improving their quality of life. CONCLUSIONS: These findings provide insights for pediatric therapists who work with children with CP about what may be important to their clients as they grow older.

Ageing with cerebral palsy: psychosocial issues.

BACKGROUND: although much has been written about biomedical concerns in adults ageing with cerebral palsy (CP), few studies or reviews have addressed psychosocial aspects. OBJECTIVE: the purpose of this narrative review is to critically examine studies that have addressed needs for social support, as well as issues affecting morale, self-efficacy, health attitudes, employment and sense of coherence (SOC) in adults ageing with CP. DESIGN: a systematic and detailed search of the literature was conducted. METHODS: searches of CINAHL (1982-present), ERIC, PubMed (1950-present), MEDLINE (Ovid) and Web of Science databases, as well as the American Academy of Cerebral Palsy and Developmental Medicine website, were conducted. Key search terms included 'cerebral palsy and ageing', 'adults with cerebral palsy', 'secondary conditions', 'functional loss', 'health' and 'psychosocial'. Nine studies were recovered that described psychosocial consequences of living with a lifespan disability. We used McMaster University's Guidelines for Critical Review Form--Quantitative and Qualitative Studies to evaluate the studies. RESULTS: psychosocial issues of concern to adults ageing with CP include the need for social support, self-acceptance and acceptance by others; the need for accommodations in the workplace and the environment; and SOC of adults ageing with CP. CONCLUSIONS: several studies concluded that adults with CP need greater knowledge and understanding to enhance decision-making processes about their health. The studies reviewed also provide knowledge for healthcare and social service providers who care for adults with CP to better understand how psychosocial health can be preserved during the ageing process.