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Homelessness is growing internationally, and resources to guide occupational therapy practice in this area are needed.To identify competencies needed for occupational therapists to support individuals during and following homelessness.We conducted a three-round Delphi study with occupational therapy practitioners and researchers with expertise in homelessness.Of 35 potential participants,This study represents the first to identify the competencies needed for occupational therapists working in the area of homelessness. Practitioners and educators are encouraged to view the identified competencies as a guide for the professional development of occupational therapists in this context. Stakeholders consulted for this study were able to communicate in English and situated in middle to high-income countries. As such, the competencies identified in this study only apply to these sociocultural contexts.

Background Engaging youth in research provides substantial benefits to research about youth‐related needs, concerns and interventions. However, researchers require training and capacity development to work in this manner. Methods A capacity‐building intervention, INNOVATE Research, was co‐designed with youth and adult researchers and delivered to researchers in three major academic research institutions across Canada. Fifty‐seven attendees participated in this research project evaluating youth engagement practices, attitudes, perceived barriers, and perceived capacity development needs before attending the intervention and six months later. Results The intervention attracted researchers across various career levels, roles and disciplines. Participants were highly satisfied with the workshop activities. Follow‐up assessments revealed significant increases in self‐efficacy six months after the workshop (P = .035). Among possible barriers to youth engagement, four barriers significantly declined at follow‐up. The barriers that decreased were largely related to practical knowledge about how to engage youth in research. Significantly more participants had integrated youth engagement into their teaching activities six months after the workshop compared to those who were doing so before the workshop (P = .007). A large proportion (71.9%) of participants expressed the need for a strengthened network of youth‐engaged researchers; other future capacity‐building approaches were also endorsed. Conclusions The INNOVATE Research project provided improvements in youth engagement attitudes and practices among researchers, while lifting barriers. Future capacity‐building work should continue to enhance the capacity of researchers to engage youth in research. Researchers notably pointed to the need to establish a network of youth‐engaged researchers to provide ongoing, sustainable gains in youth engagement.

Background There is increasing emphasis on engaging youth in research about youth, their needs, experiences and preferences, notably in health services research. By engaging youth as full partners, research becomes more feasible and relevant, and the validity and richness of findings are enhanced. Consequently, researchers need guidance in engaging youth effectively. This study examines the experiences, needs and knowledge gaps of researchers. Methods Eighty‐four researchers interested in youth engagement training were recruited via snowball sampling. They completed a survey regarding their youth engagement experiences, attitudes, perceived barriers and capacity development needs. Data were analysed descriptively, and comparisons were made based on current engagement experience. Results Participants across career stages and disciplines expressed an interest in increased capacity development for youth engagement. They had positive attitudes about the importance and value of youth engagement, but found it to be complex. Participants reported requiring practical guidance to develop their youth engagement practices and interest in a network of youth‐engaged researchers and on‐going training. Those currently engaging youth were more likely to report the need for greater appreciation of youth engagement by funders and institutions. Conclusions Engaging youth in research has substantial benefits. However, skills in collaborating with youth to design, conduct and implement research have to be learned. Researchers need concrete training and networking opportunities to develop and maximize these skills. They also need mechanisms that formally acknowledge the value of engagement. Researchers and those promoting youth engagement in research are encouraged to consider these findings in their promotion and training endeavours.

Background: Although homeless or precariously housed populations have a high prevalence of depression, the suitability of existing symptom measurement tools remains unknown. The present study explores the psychometric properties and correlates of the Beck Depression Inventory (BDI) in a community-based sample. Methods: 475 participants recruited from an impoverished neighbourhood in Canada completed the BDI, as well as multiple other clinical assessments. Validity, reliability, and change sensitivity were assessed, and a receiver operating characteristic (ROC) curve was analysed to determine a threshold score for clinical depression. Relationships between BDI scores and psychiatric diagnoses, gender, age, and functional outcomes were studied. Results: A wide range of BDI scores (0–58) was found among participants across psychiatric diagnoses. Convergent validity with psychopathology scores was present (r = 0.659, p

Background Occupational therapists support individuals experiencing homelessness in traditional roles, and occupational therapy positions focussed specifically on homelessness appear to be growing. Objectives To develop and refine a framework to guide occupational therapy practice and research in homelessness. Method We developed a framework and refined it through a stakeholder consultation process conducted with 17 international occupational therapy experts using an online survey. In this survey, we presented an initial framework and requested qualitative feedback. We analyzed this qualitative data using content analysis. Results Stakeholder feedback was categorized into eight recommendations: (1) Revision to the 'four processes'; (2) Emphasizing social justice and systems-level advocacy; (3) Reflecting intersectionality; (4) Emphasizing meaningful activity; (5) Emphasizing peer support; (6) Incorporating a focus on independent living skills; (7) Increasing a focus on an activity for addressing substance misuse; and (8) Acknowledging cognitive and physical health. Each of these recommendations was incorporated into a refined version of this framework. These recommendations and a refined version of the framework are presented in this paper. Conclusions We have developed and refined a framework aimed at guiding practice and research in occupational therapy in homelessness that will be evaluated in future research. Significance Though a range of frameworks exists for guiding the practice of occupational therapists more generally, this framework represents the first that is focussed specifically on guiding occupational therapy practice and research with individuals who experience homelessness. Research and practice implications are discussed.

Foundry is an integrated service network delivering services to young people across British Columbia, Canada. To better understand the needs of transgender and gender nonconforming young people accessing Foundry—this study compares rates of mental health distress between transgender and gender nonconforming young people and cisgender young people accessing services and examines the extent to which race may have amplified the association between transgender and gender nonconforming identity and mental health distress. We analyzed the difference using a two-sample t-test. We used stratified simple linear regression to test the association of race with transgender and gender nonconforming identity and mental health distress. Participants were recruited from a network of community health centers in British Columbia, Canada. The quantitative sample (n = 727) had a mean age of 21 years (SD = 2), 48% were non-white, 51% were white, and 77% were from Metro Vancouver. Compared to cisgender young people, transgender and gender nonconforming young people reported significantly higher levels of mental health distress. Transgender and gender nonconforming youth were more distressed than cisgender youth across both race strata but non-white transgender and gender nonconforming young people were not more distressed than white transgender and gender nonconforming young people. The findings from this study emphasize the need for increased education and understanding of transgender and gender nonconforming concepts and health concerns as well as on promoting intersectoral collaboration of social services organizations beyond simply health care.

Background Opioid use is one of the most critical public health issues as highly potent opioids contribute to rising rates of accidental opioid-related toxicity deaths. This crisis has affected people from all age groups, including youth (ages 15–24) who are in a critical developmental period where the stakes of opioid use are especially high. Efforts to reduce the significant harms of opioid use have focused on the expansion of evidence-based treatments, including medications for opioid use disorder (e.g. buprenorphine). While these treatments are unequivocally life saving, recent evidence suggests that they may not align with youths’ needs. Accordingly, the ‘Improving Treatment Together’ (ITT) project has been designed with the aim to improve youths’ opioid treatment service experiences and outcomes by co-developing, implementing, and measuring youth-centred opioid use treatment service innovations. This manuscript describes the protocol for this multi-phase project. Methods The ITT project follows community-based participatory research (CBPR) and strategically integrates co-design processes throughout its four phases. Upon establishing a project partnership between national, provincial and community-based organizations, Phase 1 follows four core elements of human-centred co-design (empathy, needs identification, ideation, prototyping) in nine separate workshops. These workshops will be held in four diverse communities with youth, caregivers and service providers who have accessed or delivered opioid treatment services. Phase 1 will culminate in the co-production of opioid treatment service innovations to be considered by the project’s partners for further co-development, pilot testing, and wider implementation during the remaining phases of the project. Throughout each phase, the project will collect and analyse both qualitative and quantitative research and evaluation data to determine the project’s impact. Discussion This protocol provides a detailed description of the ITT project, with an emphasis on the project’s application of co-design and CBPR processes, the planned research and implementation procedures, and the establishment of a unique partnership. To our knowledge, this is one of the first projects to integrate these participatory processes to the design, implementation and measurement of youth-centred opioid treatment services. Embedding these processes throughout each phase of the project will strengthen the relevance and feasibility of the project’s service delivery innovations.

Background: Emerging literature suggests that boredom is a frequent problem experienced by homeless persons that may influence their health and well-being. Purpose: The range and breadth of literat...

Aim To capture pandemic experiences of people with opioid use disorder (OUD) to better inform the programs that serve them. Design We designed, conducted, and analyzed semi-structured qualitative interviews using grounded theory. We conducted interviews until theme saturation was reached and we iteratively developed a codebook of emerging themes. Individuals with lived experience of substance use provided feedback at all steps of the study. Setting We conducted phone or in-person interviews in compliance with physical distancing and public health regulations in outdoor Vancouver parks or well-ventilated indoor spaces between June to September 2020. Participants Using purposive sampling, we recruited participants (n = 19) who were individuals with OUD enrolled in an intensive community outreach program, had visited one of two emergency departments, were over 18, lived within catchment, and were not already receiving opioid agonist therapy. Measurements We audio-recorded interviews, which were later transcribed verbatim and checked for accuracy while removing all identifiers. Interviews explored participants’ knowledge of COVID-19 and related safety measures, changes to drug use and healthcare services, and community impacts of COVID-19. Results One third of participants were women, approximately two thirds had stable housing, and ages ranged between 23 and 59 years old. Participants were knowledgeable on COVID-19 public health measures. Some participants noted that fear decreased social connection and reluctance to help reverse overdoses; others expressed pride in community cohesion during crisis. Several participants mentioned decreased access to housing, harm reduction, and medical care services. Several participants reported using drugs alone more frequently, consuming different or fewer drugs because of supply shortages, or using more drugs to replace lost activities. Conclusion COVID-19 had profound effects on the social lives, access to services, and risk-taking behaviour of people with opioid use disorder. Pandemic public health measures must include risk mitigation strategies to maintain access to critical opioid-related services.

Background. Few studies have examined boredom and meaningful activity during the transition from homeless to housed, and those that exist are retrospective. Purpose. To prospectively examine how meaningful activities and boredom are experienced during the process of leaving homelessness. Method. Using a mixed-methods case study design, we interviewed 13 homeless participants at baseline using a 92-item quantitative interview, followed by a semi-structured qualitative interview. Two participants were located six months later and were interviewed again using the same protocol. Quantitative data are presented descriptively. Qualitative data were analyzed using narrative analysis. Findings. Qualitative data revealed two unique narratives of boredom and meaningful activity engagement in the transition from homeless to housed, with opportunities for engagement in meaningful activity limited largely by the social and housing environments in which both participants were situated. Quantitative data indicates that boredom and meaningful activity changed little before and after homelessness. At both baseline and follow-up, boredom scores for both participants were comparable to a sample of participants who were exposed to a “boredom” condition in an experimental study ( Hunter, Dyer, Cribbie, & Eastwood, 2016 ). Implications. Formerly homeless persons may struggle to engage in meaningful activity, and boredom may negatively affect mental well-being. Research with larger samples is needed.

Background: While considerable progress is being made to understand the health and self-management needs of youth with mental health disorders, little attention has focused on the mental health and recovery needs that the youth themselves identify—this despite a national priority to incorporate patient-oriented research into the development and assessment of mental health services. To address this gap, estimates of the extent to which existing patient-reported outcome measures (PROMs)—originally developed for use amongst adult populations—are clinically meaningful and psychometrically fit for use among youth are needed. In tandem, a recovery profile for youth can be constructed incorporating the youth perspective of the services provided within a community mental health setting. Methods/design: This study will utilize a mixed methods design incorporating qualitative focus group interviews and cross-sectional survey. Our process will begin with the hiring of a youth peer research partner who will provide lived experience expertise through all phases of the study. We will advertise, recruit, and conduct four focus groups with youth who receive services from the Foundry Vancouver Granville located in British Columbia, Canada. In the first two focus groups, we will recruit youth aged 15–18 years (n = 10). In the second two focus groups, we will recruit young adults aged 19–24 years (n = 10). In parallel, we will conduct a cross-sectional survey of the recovery and mental health needs of youth, informed by ten widely used and validated PROM. Thematic analysis techniques will guide the identification of predominant thematic trends in the qualitative focus group data. We will use Classical and Rasch measurement methods to test and analyze the reliability and validity of selected PROM measures for youth populations. Discussion: The proposed study has the potential to produce a preliminary conceptual and measurement model for understanding the mental health and recovery needs of youth with mental health disorders. This evidence will inform how youth mental health services can grow, support, and sustain the capacity for a collaborative, interdisciplinary and innovative patient-oriented research environment. Findings will also contribute much needed evidence to improve the standard of care for youth who experience mental health disorders in Canada and beyond.

Health solutions for Aboriginal children should be guided by their community and grounded in evidence. This manuscript presents a prospective cohort study protocol, designed by a community-university collaborative research team. The study’s goal is to determine whether community-based screening and triage lead to earlier identification of children’s emotional health needs, and to improved emotional health 1 year later, compared to the standard referral process. We are recruiting a community-based sample and a clinical sample of children (ages 8 to 18 years) within one Canadian First Nation. All participants will complete the Aboriginal Children’s Health and Well-being Measure (ACHWM)© and a brief triage assessment with a local mental health worker. All participants will be followed for 1 year. Children with newly identified health concerns will be immediately connected to local services, generating a new opportunity to improve health. The development of the research design and its execution were impacted by several events (e.g., disparate worldviews, loss of access to schools). This manuscript describes lessons learned that are important to guide future community-based research with First Nations people. The optimal research design in an Aboriginal context is one that responds directly to local decision makers’ needs and respectfully integrates Aboriginal ways of knowing with Western scientific principles. Such an approach is critical because it will generate meaningful results that will be rapidly adopted, thus reducing the knowledge-to-action gap.

Rumination is a symptom of depression that refers to intense, distraction-resistant thinking. Although rumination is widely considered maladaptive, the analytical rumination hypothesis (ARH) proposes that rumination is an adaptive cognitive process where depression first promotes rumination on the causes of problems ("causal analysis"), which in turn promotes rumination on solving problems ("problem-solving analysis"). Effective problem-solving then feeds back to reduce depressive symptoms. To test this cyclical model, a scale with both problem-solving and causal analysis components is required. There are two candidates: (1) the widely used Ruminative Responses Scale (RRS); and (2) the Analytical Rumination Questionnaire (ARQ)—a new scale based on the ARH. These instruments were administered to five samples (Total N =1414) from two different cultures (Canada, Czech Republic) with different clinical statuses (nonclinical, hospitalized). Latent factor analysis of the ARQ supported the existence of both causal analysis and problem-solving analysis factors, making it suitable for testing ARH predictions. Using the ARQ, we found consistent support for the predicted covariance pattern between depression, causal analysis, and problem-solving analysis. However, we found no evidence that either of the RRS factors were related to problem-solving. Moreover, we were systematically unable to detect the predicted covariance pattern between depression and the RRS factors. We conclude that the ability to detect functional relationships between depression and rumination requires the researcher to consider both function (a correct hypothesis for how rumination and depression are adaptively related to each other) and form (valid measures of those constructs). Understanding rumination as a two-stage problem-solving process may help explain why most depressive episodes eventually resolve without treatment.

Personal recovery is an overarching goal that underpins mental health community support and clinical services in Canada. Surprisingly, little information is available about the personal recovery needs of community-dwelling Canadians with mental illness. The purpose of this study is to describe these needs in a sample of adults living in a large urban centre. We performed a multi-site cross-sectional survey of adults who receive community-based mental health services in an urban setting. Participants were asked to complete six patient-reported outcome (PRO) measures about personal recovery, hope, mastery, and depression. We used descriptive and correlational analyses to summarize the data according to an established evidence-based theoretical conceptualization of recovery. Two hundred and twenty-eight individuals participated in the study. Participants indicated high levels of self-reported empowerment and hope and optimism about the future. In contrast, participants reported low levels of perceived connec...

Background: Studies exploring the occupational experiences of homeless persons have grown in the past twenty years, and there is a need to identify, evaluate, and aggregate existing studies to direct future research. Objectives: To capture the scope and quality of literature exploring the occupational experiences of homeless persons in high-income countries, and to aggregate the findings of these studies to inform future research efforts. Method: Using Joanna Briggs Institute (JBI) guidelines, we conducted a systematic review including a critical appraisal, and meta-aggregation of themes in existing qualitative literature. Results: Fifteen studies were included and were of high quality (Mdn = 8/10; IQR = 2). Meta-aggregation resulted in four themes (n = 335 participants) describing the occupational experiences of homeless persons: 1) Restrictions on time use and activity engagement; 2) Activity as a means of belonging; 3) Institutional processes as determining time use; and 4) Transcending the self through doing. Conclusions: Homeless persons in high-income countries face multiple challenges to engaging in meaningful activity, which we argue is a disabling experience. Simultaneously, homeless persons demonstrate resilience by finding ways to engage in activities of meaning, and opportunities to connect with others in the face of multiple barriers. Significance: Implications for research and practice are discussed.

BackgroundSensory modulation rooms (SMRs) are therapeutic spaces that use sensory modulation concepts and strategies to assist service users to self-regulate and modulate arousal levels. SMRs are increasingly being explored as strength-based and person-centered adjuncts to care for people receiving inpatient psychiatry services. The aim of this study is to understand health provider and inpatient service user perceptions on the use of SMRs on acute psychiatric units.MethodsWe conducted semi-structured interviews with ten service users and nine health providers (four occupational therapists and five nurses) regarding their experiences of the SMRs located on three acute inpatient units in a large urban tertiary care hospital. We audio recorded and transcribed the focus groups and used thematic analysis to analyze the data.ResultsOur results suggested four common themes amongst health provider and service user experiences of sensory modulation rooms: (1) service user empowerment through self-management, (2) emotional regulation, (3) an alternative to current practices, and (4) health provider and service user education.ConclusionOur study supports the ecological utility of SMRs as person-centred adjunct therapeutic space viewed positively by both service users and health providers. This understanding of SMRs is critical for future service design, research and policy aimed at improving the service user experience and care for this population. Future research is needed to validate the experience of the SMRs with other patient groups and health providers.

Purpose The aim of this study is to illustrate an example application of Rach Measurement Theory (RMT) in the evaluation of patient-reported outcome (PRO) measures. RMT diagnostic methods were applied to evaluate the PROMIS® Depression items as part of a series of papers applying different psychometric paradigms in parallel to the same data. Methods RMT was used to examine scale-to-sample targeting, scale performance and sample measurement of two PROMIS depression item pools including respectively 28 and 51- items. Results Sub-optimal but improved targeting was displayed in the 51-item pool which covered 27% of the range of depression measured in the sample compared to only 15% in the 28-item bank, further reducing the sample percentage with lower depression not covered by the scale (28% Vs 34%). Satisfactory scale performance was observed by the 28-item bank with marginal item misfit. However, deviations from the RMT criteria in the 51-itempool were observed including: 9 reversed thresholds; 12 misfitting items and 12 item-pairs displaying dependency. Overall reliability was good for sets of items (Person Separation Index = 0.93 and 0.95), but sub-optimal sample measurement (17% Vs 19% fit residuals outside of the recommended range). Conclusions The RMT approach in this exercise provided evidence that compared to the 28-item bank, the extended 51-item version of the PROMIS depression, improved sample-to-scale targeting. However, targeting in the lower end of the concept of interest remained sub-optimal and scale performance deteriorated. There may be a need to improve the conceptual breadth of the construct under investigation to ensure the inclusion of items that capture the full range of the concept of interest for this context of use.

The influence of subliminal priming (behavior outside of awareness) in humans is an interesting phenomenon and its understanding is crucial as it can impact behavior, choices, and actions. Given this, research about the impact of priming continues to be an area of investigative interest, and this paper provides a technical overview of research design strengths and issues in subliminal priming research. Efficient experiments and protocols, as well as associated electroencephalographic and eye movement data analyses, are discussed in detail. We highlight the strengths and weaknesses of different priming experiments that have measured affective (emotional) and cognitive responses. Finally, very recent approaches and findings are described to summarize and emphasize state-of-the-art methods and potential future directions in research marketing and other commercial applications.

This study examined the process of establishing post homeless lives among 51 recently homeless youth in two major urban centers in Canada. A mixed methods strategy was employed to characterize this process. Quantitatively, a range of mental health, community integration, and quality of life measures were employed four times over the course of 1 year to describe how these indicators of wellbeing shifted in this period. It was found that over the course of 1 year gains were not made in community integration, quality of life and mental health were highly variable, and hope declined significantly. Further, it was found that youth in supported housing arrangements experienced better mental health and community integration. Qualitatively, we identified three major stages in the process of exiting homelessness. These stages included a period of substantial fluctuation and instability, a period of gaining a basic level of stability but being demoralized due to difficulties making progress with life goals, and a period of making some gains with life goals which cultivated a sense of hope. Progress across these stages, which took place in a timeframe considerably longer than 1 year, was characterized by a range of setbacks, individual and systemic challenges, and trauma which were addressed through a persistent effort facilitated by youth resilience and key supports.

Valid and precise quantification of clinical variables is essential for appropriate interpretation to inform healthcare decision making. The outcomes produced from different measurement procedures and instruments, purporting to quantify the same measurand, should be directly comparable. This ensures the appropriate application and widespread adoption of clinical research findings. Metrology provides a framework for the development of a common language of reference measurement systems, which have the potential to improve the accuracy and comparability of patients' results.However, the practices, procedures and instruments used in social measurement are currently excluded from any formal metrological framework. In this paper, we build on previous arguments, and propose a new international body to bring together metrology, psychometrics, philosophy, and clinical management to support the global comparability and equivalence of measurement results in patient centred outcome measurement to improve healthcare.

Objective: In psychiatry, the recovery paradigm is increasingly identified as the overarching framework for service provision. Currently, the Recovery Self-Assessment (RSA), a 36-item rating scale, is commonly used to assess the uptake of a recovery orientation in clinical services. However, the consumer version of the RSA has been found challenging to complete because of length and the reading level required. In response to this feedback, a brief 12-item version of the RSA was developed (RSA-B). This article describes the development of the modified instrument and the application of traditional psychometric analysis and Rasch Measurement Theory to test the psychometrics properties of the RSA-B. Methods: Data from a multisite study of adults with serious mental illnesses (n 1256) who were followed by assertive community treatment teams were examined for reliability, clinical meaning, targeting, response categories, model fit, reliability, dependency, and raw interval-level measurement. Analyses were performed using the Rasch Unidimensional Measurement Model (RUMM 2030). Results: Adequate fit to the Rasch model was observed ( 2 112.46, df 90, p .06) and internal consistency was good (r .86). However, Rasch analysis revealed limitations of the 12-item version, with items covering only 39% of the targeted theoretical continuum, 2 misfitting items, and strong evidence for the 5 option response categories not working as intended. Conclusions: This study revealed areas for improvement in the shortened version of the 12-item RSA-B. A revisit of the conceptual model and original 36-item rating scale is encouraged to select items that will help practitioners and researchers measure the full range of recovery orientation.

Date Presented 04/06/19 Boredom is an under-acknowledged phenomenon in the literature on homelessness, and of particular relevance to OT and occupational science. This study explores boredom experienced by homeless persons, confirming that it is a serious challenge faced by this population that imposes a negative impact on mental health and well-being. Future research with larger sample sizes will allow a finer analysis of the ways in which boredom impacts homeless persons. Primary Author and Speaker: Carrie Anne Marshall Contributing Authors: Lisa Davidson, Andrea Li, Rebecca Gewurtz, Laurence Roy, Skye Barbic, Bonnie Kirsh, Rosemary Lysaght

Boredom has been reported as a frequent problem experienced by homeless persons, with implications for mental and social well-being.This study aimed to explore the nature and impact of boredom in the lives of homeless and formerly homeless persons.A mixed-methods design was used to engage 13 participants in a structured 92-item quantitative interview using six standardized measures, followed by a semistructured qualitative interview. Correlational analyses were performed with the data compiled from the quantitative interviews, and grounded theory strategies were used to analyze our qualitative data. The two analyses were integrated at the stage of interpretation.Boredom was described as a profound and pervasive experience for homeless persons, imposing deleterious impacts on mental well-being and driving substance use. A strong positive correlation between meaningful activity and mental well-being (Boredom is a critical topic of study for occupational therapy in the area of homelessness. Future research is needed to design and test interventions to optimize the mental well-being, participation, and social connectedness of this population.

Background: Research is undertaken to answer important questions yet often the question is poorly expressed and lacks information on the population, the exposure or intervention, the comparison, and the outcome. An optimal research question sets out what the investigator wants to know, not what the investigator might do, nor what the results of the study might ultimately contribute. Objective: The purpose of this paper is to estimate the extent to which rehabilitation scientists optimally define their research questions. Methods: A cross-sectional survey of the rehabilitation research articles published during 2008. Two raters independently rated each question according to pre-specified criteria; a third rater adjudicated all discrepant ratings. Results: The proportion of the 258 articles with a question formulated as methods or expected contribution and not as what knowledge was being sought was 65%; 30% of questions required reworking. The designs which most often had poorly formulated research questions were randomized trials, cross-sectional and measurement studies. Conclusion: Formulating the research question is not purely a semantic concern. When the question is poorly formulated, the design, analysis, sample size calculations, and presentation of results may not be optimal. The gap between research and clinical practice could be bridged by a clear, complete, and informative research question.

In psychiatry, there is a call for clinicians to use patient-centred outcome data routinely at the point of care to help tailor treatment plans to meet patient preferences and needs. Given that many decisions in psychiatry are constructed from patient narratives, it is critical that the conceptual, empirical, and measurement structure underlying patient reported outcome measures is robust and patient-centred. Here, we argue for the systematic accruement of patient-centred data in psychiatry to meaningfully enhance the treatment of mental disorders. Specifically, we suggest three crucial considerations for system transformation: (1) the engagement of international patient research partners to conceptualize and prioritize outcomes; (2) the application of modern test theory to develop and evaluate patient-centred outcome measures; and (3) funding allocation accountable to evidence-based services prioritized by patients.

Emotional vitality may play an important role in determining whether informal caregivers are able to successfully adopt and persist in their roles. This study describes a content validation of a conceptual model of emotional vitality in informal caregivers.A secondary content analysis was performed on transcripts of 30 caregivers who were interviewed about their quality of life in relation to assuming the role of informal caregiver for a family member who had experienced a recent stroke. Caregivers discussed changes in their own health, relationships, roles, finances, participation, and mood after assuming the caregiving role. Using a thematic inductive approach, two raters independently coded the presence and frequency of physical, emotional, and social impacts associated with the caregiving role in order to further develop and validate a conceptual model of caregiver emotional vitality.The interviews provided information that affirmed the relevance of four themes relevant to caregiver emotional vitality previously identified: physical health and well-being; mood regulation; sense of control/mastery of new skills; and participation in meaningful activity. An additional theme of support and recognition from others also emerged.Adopting the informal caregiving role results in major impacts to the caregiver's physical, emotional, and social health. Five core domains appear to meaningfully contribute to emotional vitality of caregivers and may influence their ability to persist in this role over time. Many of the factors that influence emotional vitality in caregivers are potentially modifiable. This new model offers new opportunities for rehabilitation specialists and allied health professionals to develop skill-building interventions that may help caregivers successfully adapt and thrive in the caregiving role.

Objective: To describe the practical steps in identifying items and evaluating scoring strategies for a new measure of emotional vitality in informal caregivers of individuals who have experienced a significant health event. Design: The psychometric properties of responses to selected items from validated health-related quality of life and other psychosocial questionnaires administered four times over a one-year period were evaluated using Rasch Measurement Theory. Setting: Community. Subjects: A total of 409 individuals providing informal care at home to older adults who had experienced a recent stroke. Main measures: Rasch Measurement Theory was used to test the ordering of response option thresholds, fit, spread of the item locations, residual correlations, person separation index, and stability across time. Results: Based on a theoretical framework developed in earlier work, we identified 22 candidate items from a pool of relevant psychosocial measures available. Of these, additional evaluation resulted in 19 items that could be used to assess the five core domains. The overall model fit was reasonable (χ2 = 202.26, DF = 117, p = 0.06), stable across time, with borderline evidence of multidimensionality (10%). Items and people covered a continuum ranging from −3.7 to +2.7 logits, reflecting coverage of the measurement continuum, with a person separation index of 0.85. Mean fit of caregivers was lower than expected (–1.31 ±1.10 logits). Conclusion: Established methods from the Rasch Measurement Theory were applied to develop a prototype measure of emotional vitality that is acceptable, reliable, and can be used to obtain an interval level score for use in future research and clinical settings.

Cognitive adaptation training (CAT) is a home-based, manualized treatment that utilizes environmental supports to improve target behaviors and functional outcomes in persons with schizophrenia. Although clinical trials have shown CAT to be effective across functional, clinical, and treatment adherence domains, when the intervention is withdrawn clients experience significant declines. The aim of the current study was to test a modified version of CAT, which decreases the duration of intensive CAT intervention while utilizing ongoing case management-supported CAT to maintain the fundamental components of the treatment. Twenty-three people participated in an outcome study of the modified version of CAT, evaluating improvements after 4 months of CAT specialist intervention and after an additional 5 months of case manager support. Analysis revealed significant improvements in adaptive functioning, psychiatric symptomatology, and goal attainment, which were maintained throughout case management follow-up. This suggests that an intervention that has previously demonstrated good functional outcomes in randomized trials might sustain its impacts in an abbreviated format with support from existing case managers.

BACKGROUND: Diagnosis and management of depression occurs frequently in the primary care setting. Current diagnostic and management of treatment practices across clinical populations focus on eliminating signs and symptoms of depression. However, there is debate that some interventions may pathologize normal, adaptive responses to stressors. Analytical rumination (AR) is an example of an adaptive response of depression that is characterized by enhanced cognitive function to help an individual focus on, analyze, and solve problems. To date, research on AR has been hampered by the lack of theoretically-derived and psychometrically sound instruments. This study developed and tested a clinically meaningful measure of AR. METHODS: Using expert panels and an extensive literature review, we developed a conceptual framework for AR and 22 candidate items. Items were field tested to 579 young adults; 140 of whom completed the items at a second time point. We used Rasch measurement methods to construct and test the item set; and traditional psychometric analyses to compare items to existing rating scales. RESULTS: Data were high quality (0.81; evidence for divergent validity). Evidence of misfit for 2 items suggested that a 20-item scale with 4-point response categories best captured the concept of AR, fitting the Rasch model (χ2 = 95.26; df = 76, p = 0.07), with high reliability (rp = 0.86), ordered response scale structure, and no item bias (gender, age, time). CONCLUSION: Our study provides evidence for a 20-item Analytical Rumination Questionnaire (ARQ) that can be used to quantify AR in adults who experience symptoms of depression. The ARQ is psychometrically robust and a clinically useful tool for the assessment and improvement of depression in the primary care setting. Future work is needed to establish the validity of this measure in people with major depression.

Objectives To (1) provide a framework for the conceptualization of emotional vitality as an important construct for rehabilitation professionals; (2) outline the existing scope and breadth of knowledge currently available regarding the definition and measurement of emotional vitality in persons with chronic health conditions; and (3) identify the extent to which the components can be mapped to the International Classification of Functioning, Disability and Health (ICF). Design Activities included a scoping review of the literature, and a Delphi mapping exercise using the ICF. Setting Not applicable. Participants Not applicable. Intervention Not applicable. Main Outcome Measure Not applicable. Results The results of this study suggest that emotional vitality is a complex latent construct that includes (1) physical energy and well-being, (2) regulation of mood, (3) mastery, and (4) engagement and interest in life. Existing literature supported the presence of all 4 components of the construct. The mapping exercise showed that 3 of these components could be readily mapped to the Body Function chapter of the ICF (energy, mood, mastery). Conclusions Emotional vitality may influence both the physical and emotional adaptation to living with a chronic illness or disability and should be included in both assessment and treatment planning to optimize rehabilitation outcomes. Future research is needed to refine the definition and identify optimal methods of measuring this construct.