[Le programme Participe-présent auprès d'aînés vivant avec une problématique de santé mentale ou des difficultés psychosociales affectant leur participation communautaire : résultats d'une étude pilote sur sa faisabilité].

Les aînés qui vivent avec des problèmes de santé mentale ou des difficultés psychosociales sont souvent isolés et marginalisés. Le programme Participe-présent a été développé dans le but de promouvoir leur participation communautaire. Les objectifs de cette étude étaient de 1) décrire la pertinence, l'acceptabilité, et la faisabilité du programme lors de sa mise à l'essai et 2) d'explorer les bienfaits et les effets à court-terme du programme pour les participants. Vingt-trois aînés, quatre animateurs et trois responsables provenant de quatre organismes ont participé à l'étude. Les aînés ont été satisfaits de leur expérience de participation au programme et ont rapporté une meilleure connaissance des ressources et une plus grande satisfaction à l'égard de leur vie sociale. Les animateurs et les responsables d'organismes ont souligné l'adaptabilité de Participe-présent aux besoins de leur clientèle et à leur contexte de pratique, et ont identifié les facilitateurs et les obstacles à sa mise en œuvre. D'autres études mèneront à des recommandations favorisant le succès de la mise en œuvre de Participe-présent dans différents contextes.

An Exploration of the Occupational Adaptation of Older Adults Living in Low-Income Housing During the Pandemic.

Health restrictions enacted during the COVID-19 pandemic made it difficult for older adults living in low-income housing (hereinafter referred to as residents) to maintain a routine. The study aimed to explore the ways in which residents carried on, experienced and adapted their activities during the pandemic. An action research study, conducted in cooperation with a community partner, involved nineteen residents who participated in semi-structured interviews inspired by an occupation focused health promotion model. Qualitative data obtained was analyzed using thematic and cross-case analyses. Two thirds of the sample reported a high level of change in their daily routine. The need to connect with others and to live moments of pleasure and joy were the least satisfying dimensions of experience while performing their activities, which was not surprising. Three occupational adaptation profiles were identified based on the residents' perception of changes in routine and their degree of satisfaction with time spent in the different dimensions of experience. Among strategies and resources reported for overcoming the impact of the pandemic on their daily lives, having a supportive social network, access to communication technologies and a positive attitude seemed to be key to residents' successful occupational adaptation.

Challenges and Strategies to Adapt the Provision of Support Services to Older Adults and Caregivers During the COVID-19 Pandemic: The Perspective of Community Organizations.

This study documented the provision of services and issues experienced by community organizations supporting older adults and caregivers in the province of Quebec during the coronavirus disease (COVID-19) pandemic, as well as promising strategies to adapt the provision of services in this context. A cross-sectional electronic survey using open- and closed-ended questions was conducted in July 2020. Almost three-quarters of the 307 respondents (71.4%) reported having maintained services at least partially throughout the lockdown, and the majority (85.3%) adapted their services. Among key challenges, participants reported difficulties identifying and supporting older adults at greater risk of vulnerability (54.8%), managing health risks for service users (60.2%), and recruiting volunteers (59.5%). Promising strategies included strategies to reach out to older adults and understand their needs (e.g., systematic phone calls) in addition to direct interventions supporting them (e.g., activities promoting social ties); implementing prevention and protection measures; accessing and using technologies; human resources management (e.g., recruiting new volunteers); finding financial support for their organization; developing intersectoral partnerships (e.g., multisectoral crisis cell); and promoting a positive view of older adults. The integration of multiple perspectives from different stakeholders may help identify strategies potentially transferable to other crises in order to meet older adults' needs.

The Integrated Psychological Treatment for Individuals With Schizophrenia in Correctional and Forensic Psychiatric Settings: An Implementation Study.

This study aims to identify the factors that need to be considered in the implementation of the integrated psychological treatment (IPT), a cognitive-behavioral group approach for individuals with schizophrenia, in correctional and forensic psychiatric settings. To meet this objective, a multiple case study (n = 2) was conducted. Stakeholders involved in the implementation were interviewed. Findings showed that IPT is relevant and can be delivered in correctional and forensic psychiatric settings. However, several issues impeded its implementation and sustainability, some of which were more specific to secure settings (i.e., the legal and clinical picture of the clientele, security requirements, interdisciplinary collaboration, and recognition of IPT in national correctional programming). Adaptations and additional considerations for implementation of IPT in correctional and forensic psychiatric settings are discussed further.

An exploration of the ecological validity of the Virtual Action Planning-Supermarket (VAP-S) with people with schizophrenia.

People with schizophrenia often have functional limitations that affect their daily activities due to executive function deficits. One way to assess these deficits is through the use of virtual reality programmes that reproduce real-life instrumental activities of daily living (IADLs). One such programme is the Virtual Action Planning-Supermarket (VAP-S). This exploratory study aimed to examine the ecological validity of this programme, specifically, how task performance in both virtual and natural environments compares. Case studies were used and involved five participants with schizophrenia, who were familiar with grocery shopping. They were assessed during both the VAP-S shopping task and a real-life grocery shopping task using an observational assessment tool, the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis. The results show that when difficulties were present in the virtual task, difficulties were also observed in the real-life task. For some participants, greater difficulties were observed in the virtual task. These difficulties could be explained by the presence of perceptual deficits and problems remembering the required sequenced actions in the virtual task. In conclusion, performance on the VAP-S by these five participants was generally comparable to the performance in a natural environment.

Modelizing home safety as experienced by people with mental illness.

RATIONALE: As more individuals with mental disorders now live in the community and as the custodial care housing model has shifted to supported housing, home safety has become a rising issue, however, not well documented. OBJECTIVES: To describe the phenomenon of home safety for people with a mental disorder as well as its contributing factors. METHODS: A descriptive qualitative design was used. Individual interviews were conducted with persons with a mental disorder (n = 8), while focus groups were conducted with relatives, health and social service providers and community stakeholders (n = 21). The data were analyzed with the grounded theory analysis as described by Paillé (1994). RESULTS: Findings suggest that home safety implies risk and protective factors, which are associated with (1) the person's characteristics; (2) the quality of the home environment; (3) the nature of the activities in which the individual engages. These dimensions are interrelated so that home incidents arise from a dynamic interaction between risk and protective factors. CONCLUSIONS: Home incidents therefore occur when the interaction between these dimensions is altered. Considering this situation, Occupational Therapists are well positioned to play a leading role and act as key contributors in the area of home safety in people with mental disorders.

[Co-construction of a program to promote community participation among seniors living with psychosocial issues, with or without mental health problems]. / Participe-présent : co-construction d'un programme visant la participation communautaire des aînés qui vivent des difficultés psychosociales.

Objectives A significant proportion of Quebec seniors are living with mental health problems or psychosocial issues such as isolation, bereavement, and psychological distress. These people face many forms of exclusion and are likely to have limited social participation. This paper describes the co-construction steps of a program aimed at promoting community participation among this population.Methods A method for the co-construction of innovative practices in health promotion was used to develop a program that is relevant, rigorous and feasible in diverse settings. The process included several steps, notably: need analysis among seniors and practitioners, development of a logical model for the program, preparation of the leader's manual, validation of the manual by experts, and pilot testing of the program among groups of seniors.Results The goal of the Count me in! program is to promote utilization of the resources of the community that can provide seniors living with mental health conditions or psychosocial issues with activities and positive social contact. The intervention is based on the Strength Model. It includes an individual interview, an eight-meeting workshop, visits to community resources, and collective production of media communication.Conclusion A co-construction process allowed the program to be continuously adjusted in response to stakeholders' feedback. The most important lever for the co-construction was the reconciliation of the partners' practical, conceptual, and experiential expertise. However, contextual factors such as the organization and the availability of mental health services for seniors constituted important barriers to the process.

[Home safety and severe mental disorders: Developing an evaluation tool]. / Sécurité a domicile et troubles mentaux graves: elaboration d'un outil d'evaluation.

BACKGROUND: Home safety evaluation is an important issue within the context of current perspectives on accommodation for people with a serious mental illness who favour a more independent way of life. PURPOSE: This paper describes the development and content validation of the Evaluation de la sécurité a domicile et de la gestion des risques (ESGR), an occupational therapy assessment tool for people with a serious mental illness. METHOD: The ESGR was developed from scientific knowledge and clinical experience. Assessing content validity was done in two phases and involved the consultation of 11 experts. FINDINGS: In its current form, the ESGR includes 67 items organized into three categories (environment, occupation, person). IMPLICATIONS: According to the experts consulted, there is a clinical interest in using the ESGR to support occupational therapists in the assessment of home safety for people with serious mental illness. The statements are clear and representative of the concept and the target audience.

Antipsychotic-induced parkinsonism is associated with working memory deficits in schizophrenia-spectrum disorders.

In view of the significant cognitive deficits in schizophrenia and their impact on patients' social and occupational functioning, and considering that the influence potential influence of antipsychotic-induced extrapyramidal symptoms on cognition in schizophrenia remains poorly understood, the current study sought to identify the clinical, socio-demographic and neurologic predictors of the cognitive performance of schizophrenia patients. Eighty-two schizophrenia-spectrum (DSM-IV criteria) outpatients were recruited. Psychiatric symptoms were evaluated with the Positive And Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia. Extrapyramidal symptoms were evaluated with the Extrapyramidal Symptoms Rating Scale, while spatial working, planning abilities and visual paired associates learning were evaluated with the CAmbridge Neuropsychological Tests Automated Battery. The Stroop test was also administered. Multivariate hierarchic linear regression analyses were performed. We found that negative symptoms were associated with cognitive flexibility, planning, visual learning and working memory performance in schizophrenia. Age, sex, number of hospitalizations and antipsychotic type also emerged as significant predictors. More importantly, we found a significant association between antipsychotic-induced parkinsonism and working memory performance. The fact that negative symptoms and socio-demographic variables predicted cognitive performance in schizophrenia is consistent with the previous literature on the topic. The finding of an association between parkinsonism and working memory may have clinical implications, since working memory deficits are considered putative endophenotypes of schizophrenia and are known to impair patients' social and occupational functioning. Our results will need to be replicated in longitudinal studies involving larger samples of patients.

A cross-cultural adaptation of the Upper Limb Functional Index in French Canadian.

STUDY DESIGN: Clinical measurement. INTRODUCTION: The Upper Limb Functional Index (ULFI) is a self-report questionnaire assessing activity limitations/participation restrictions resulting from an upper limb musculoskeletal disorder (UL-MSD). It is suitable for use in a rehabilitation context where clinicians have important time constraints due to a heavy caseload. However, no French version was available until now. PURPOSE/METHODS: To perform a cross-cultural adaptation of the ULFI in French Canadian and examine the psychometric properties and clinical applicability of the adapted version (ULFI-FC) among 50 bilingual patients. RESULTS: The ULFI-FC showed high internal consistency (Cronbach α = 0.93), good convergent validity with the original ULFI (r = 0.85) and with the French Canadian version of the Disabilities of the Arm, Shoulder and Hand (r = -0.85) and good applicability. CONCLUSION: This study supports the suitability of the ULFI-FC for use in a busy rehabilitation setting for French-speaking patients with UL-MSD. LEVEL OF EVIDENCE: N/A.

Predictors of community functioning in schizophrenia and substance use disorder patients.

Community functioning is a broad term that encompasses various 'real world' measures of disability among schizophrenia patients. It includes outcomes such as independent living, social competence and behavioural problems-all of which are priorities for treatment among schizophrenia patients, mental health care providers, and family members. An important goal for rehabilitation programs is to identify predictors of community functioning which, in turn, could be used as targets for intervention. The present case-control study examined socio-demographic and substance use disorder (SUD) variables as well as psychiatric, extrapyramidal, and cognitive symptoms as predictors of community functioning in schizophrenia patients with (DD patients; n=31) and without comorbid SUDs (SCZ patients; n=31), and non-psychosis substance abusers (SUD patients; n=39). Psychiatric and extrapyramidal symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia and the Extrapyramidal Symptoms Rating Scale. Cognition was evaluated using the Cambridge Neuropsychological Test Automated Battery (speed of processing, explicit and working memory). In SCZ patients, community functioning was predicted by explicit memory performance. In DD patients, community functioning was predicted by substance abuse, depression and speed of processing. In SUD patients, community functioning was predicted by substance abuse, positive symptoms and education. Our results suggest that cognition should be among the top treatment priorities in SCZ patients, whereas the key treatment targets in DD patients should be substance abuse and depression. Future studies will need to replicate the current findings, using prospective research designs.

Daily functioning and information-processing skills among persons with schizophrenia.

OBJECTIVES: This study aimed to describe the limitations in information-processing skills observed among persons with schizophrenia performing daily tasks and to explore whether subgroups of participants have similar profiles based on these functional limitations. METHODS: Eighty-two participants with schizophrenia living in the community were assessed during their performance of a daily activity (meal preparation). Measures included a performance-based assessment for evaluating information-processing skills-the Perceive, Recall, Plan, and Perform System of Task Analysis-community functioning and symptom assessments, and neuropsychological tests from the Cambridge Neuropsychological Test Automated Battery. Research participants were classified as having high efficiency or low efficiency according to their score on the performance-based assessment and were compared on the functional, cognitive, and symptoms variables. RESULTS: Participants committed various errors, and functional limitations, namely problematic information-processing skills in the perceive, recall, and plan quadrants, were observed during the daily task performance. Participants from the high-efficiency group were more independent in their living skills and more successful in attaining residential independence compared with participants from the low-efficiency group. The only cognitive test that differentiated both groups was the visuospatial associative learning test. No differences were found in the severity of symptoms. CONCLUSIONS: Findings suggest that both performance in a daily task and memory-and specifically associative learning capacity-provide key information for the level of residential independence. Interventions aiming for the efficient use of information-processing skills during daily tasks among persons with schizophrenia should be carried out accordingly.

Daily activities, cognition and community functioning in persons with schizophrenia.

OBJECTIVE: This cross-sectional study explored the relationships between daily activity performance, attention, memory, executive functions and community functioning in people with schizophrenia. More specifically, this study attempted to verify the hypothesis that functional limitations in the performance of daily activities negatively affect community functioning in people with schizophrenia. METHODS: Eighty-two individuals with schizophrenia living in the community were recruited for the study. The Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis was used to assess participants' functional capacity during a meal preparation task. Visuo-spatial associative memory, spatial working memory, planning, visuo-motor coordination, and selective attention were evaluated as well. Community functioning was assessed with the Independent Living Skills Survey (ILSS) and the Multnomah Community Ability Scale (MCAS). RESULTS: Correlations revealed significant associations between functional capacity and visuo-spatial associative learning, spatial working memory, planning and negative symptoms. Planning skills during meal preparation were found to be associated with MCAS. After regression analyses, only visuo-spatial memory, negative symptoms, education and familiarity with meal preparation explained variation in functional capacity. CONCLUSIONS: The findings of the current study suggest that visuo-spatial associative learning, negative symptoms, education and familiarity with task are among the important factors for functional capacity. Planning skills necessary for efficient task performance were also found to be those most determinant for community functioning. Rehabilitation interventions should consider these underlying strength and deficits when developing strategies to help people with schizophrenia build functional skills essential for community living.

Use of the Perceive, Recall, Plan and Perform System of Task Analysis for persons with schizophrenia: a preliminary study.

BACKGROUND/AIM: Task analysis that targets information processing skills is an essential tool to understanding difficulties encountered by people with schizophrenia in their daily activities. The purpose of this preliminary study was to explore the use of the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis for this clientele. The specific objectives were to describe information processing difficulties as measured by the PRPP and to examine preliminary evidence of construct validity and interrater reliability. METHODS: In the first part of this study, 10 participants with schizophrenia living in the community were assessed using the PRPP during both a simple and a complex meal preparation task. Community functioning was measured using the Independent Living Skills Survey. In the second part, interrater reliability was appraised using three trained raters, who scored 15 participants preparing the complex meal preparation task. RESULTS: Analysis of performance demonstrates that people with schizophrenia have difficulties especially in the Perceive and Plan quadrants of the PRPP and are more challenged in the complex task. The PRPP total score for the complex task is strongly related to the community functioning score. Results indicate good interrater reliability for the PRPP total score and moderate interrater reliability for the quadrant scores. CONCLUSION: Despite the small sample size, results from this preliminary study support the use of the PRPP System of Task Analysis to further explore the impact cognitive deficits have on daily task performance and thus on community functioning in people with schizophrenia.

[Kitchen and schizophrenia: a crossroad activity of an ecological, occupational and neuropsychological assessment]. / Cuisine et schizophrénie: activité carrefour d'une évaluation écologique, ergothérapique et neuropsychologique.

In this exploratory study, the authors examine the various occupational and neuropsychological assessments used to analyze deficits qualitatively and quantitatively in patients with schizophrenia. Considering that it is necessary to further explore their repercussion on the performance of activity of daily living (ADL) and domestic activities (DA), they thus attempt to verify if the distinction between two levels of functional autonomy could translate at the cognitive and clinical levels in (25) 23 patients included in a program destined to young adults (schizophrenia spectrum DSM-IV criteria) in Montréal. These patients had the opportunity, within the clinical program, to submit to neuropsychological evaluations as well as evaluations offered by the occupational therapy service thanks to a tool frequently used by occupational therapists entitled Assessment of Motor and Process Skills (AMPS). The objective of this article is to conjugate two possible perspectives, drawn from two different disciplines, on a very current human activity such as "preparing meals" in people suffering from schizophrenia and which functioning of daily life is disturbed.

[The significance of daily activities in persons with severe mental disorders]. / La signification des activités quotidiennes chez les personnes souffrant de troubles mentaux graves.

Severe mental disorders affect the daily activities and lifestyles of people suffering from these problems. A descriptive study was conducted in order to determine the meaning that people with severe mental disorders give to their daily activities. In this study, the meaning of the activities was defined based on Kielhofner's Human Occupation Model, using three indicators: sense of competence, importance and pleasure. These indicators were measured for each daily activity through a semi-structured interview of 45 people suffering from severe mental disorders, using the Occupational Questionnaire. In general, the activities included in the categories of hygiene and self-care, meals and sleep, scored the highest average for each indicator, i.e. sense of competence, importance and pleasure. Work, however, stands out in terms of the importance it is given as an activity, while social activities are valued through their association with pleasure. An analysis of the results underlines the importance that occupational therapists have an improved understanding of the meaning that people suffering from mental disorders give to their daily activities in order to support their efforts in developing a more positive perception of the way they occupy their time.