While the COVID-19 pandemic created many challenges for staff, clients, and families, The Royal continued to advance the care for clients living with schizophrenia.
One initiative implemented around goal setting has seen a dramatic improvement in quality of care, says Domenic Ielo, the director of patient care services in The Royal’s Integrated Schizophrenia Recovery Program.
To understand the mission of this program, it’s important to understand more about schizophrenia, a complex mental disorder that affects about one per cent of Canadians. In the Ottawa region alone, there are about 12,000 people living with schizophrenia. It’s a chronic disease that typically appears during late teenage years or early adulthood.
People with a serious and complex mental illness such as schizophrenia often face challenges that affect their ability to function in the community. Symptoms may include delusions, hallucinations, disorganized thinking, loss of interest in everyday activities, and social withdrawal. While there is no cure, symptoms can be managed with appropriate treatment.
The goal of The Royal’s Integrated Schizophrenia Recovery Program, is to prepare clients for living in the community as independently as possible, while understanding that each person’s path to recovery is as unique as they are.
“It’s our mission to help our clients learn the skills necessary to manage symptoms, and at the same time, live a fulfilled life,” says Ielo.
While goal setting for clients has always been a part of the recovery journey, the process was recently formalized in a way that improves accountability and outcomes for staff and clients alike.
In mental health care, goal setting is widely understood to be an important part of mental wellness. Even though goals might differ between individuals, goal setting boosts motivation, builds resilience, directs focus, and supports a sense of independence.
At The Royal’s Integrated Schizophrenia Recovery Program, an initial goal setting meeting between client and staff takes place within seven days of admission. This meeting includes the client’s primary care provider, lead nurse, and an allied staff member such as an occupational therapist or social worker, depending on the goals that are identified.
Because recovery looks different for everyone, no goal is too small or too big. Client goals might be related to nutrition (including grocery shopping and meal prep), employment and financial independence, or volunteering in the community.
“It’s our mission to help our clients learn the skills necessary to manage symptoms, and at the same time, live a fulfilled life.”Staff work with the client to draw up an action plan that includes referral to relevant therapeutic groups available at The Royal. (For example, if the client has identified a goal to get healthier, a recreational therapist may suggest walking and fitness groups.)
“The process is a roadmap to recovery, a way to really make sure that our care is addressing the needs of the client, where the client is at, and what they want to do. This is care-driven, client-led, client-centered,” says Melissa McFadden, manager of patient care services in Schizophrenia.
The first check-in happens at six weeks and then every three months to monitor progress and see if the goals have evolved or changed.
“Nothing's etched in stone because recovery is fluid,” says McFadden. “We actually love the fact that goals change because then you know they're coming out of themselves. You see that engagement, you see that drive, that commitment! It means the client is really advocating for themselves.”
This model differs from the historical “top down” model in which a physician unilaterally determined the treatment plan. Today, there is greater collaboration and decision-making with multiple disciplines and clients and families. This includes goal-setting.
Committing to regular goal-setting meetings and related recovery plan documentation sharpened the focus on the client and also improved engagement and communication between clinicians.
According to staff, the impact is noticeable. Not only has attendance increased in therapeutic groups, but when goal-setting is a regular part of the conversation clients are more motivated and focused on recovery.
McFadden says more people need to understand how important it is to have meaningful goals. And if a goal seems too overwhelming at first, it’s a good idea to bring it back to the basics.
She describes a client who was experiencing a lot of stress. In consultation with his care team, he set a goal to go for a 10-minute walk every day and incorporate some easy mindfulness practices.
“Even though it's only 10 minutes, it's still a goal. It might seem small, but it’s really significant,” says McFadden. “Here at The Royal, we’re focusing on strengths. Every single person has strengths. Everybody has a gift to offer.”
To meet some people living with or impacted by schizophrenia, please watch this video series.
