PSR Recovery in Action Paper

As a practitioner, my primary goal is to empower individuals with anxiety disorders to lead meaningful lives. I employ evidence-based strategies, drawing from both my experience and relevant competencies. Practicing as a PSR/RPS practitioner, I emphasize a holistic approach to treatment, guided by the 2017 PSR/RPS Canada Competencies for Recovery-Oriented PSR Practitioners.

Recovery in Action Paper

Title

Reducing Service Wait Times and Active Service Delivery Time: A Recovery-Oriented Approach to Support People with Anxiety Disorders

Introduction

Anxiety disorders are a growing concern in Canada and the world, with an estimated one in five Canadians experiencing an anxiety disorder in any given year. As a practitioner, my goal is to help people with anxiety disorders live meaningful lives. My approach to helping clients with anxiety involves using evidence-based strategies such as CBT and relaxation techniques, as affirmed by Kaczkurkin and Foa (2022). The Recovery in Action paper seeks to illustrate how PSR practitioners can apply the 2017 PSR during practice.

Discussion

Reducing service wait times and active service delivery time is crucial in recovery-oriented Psychosocial Rehabilitation (PSR) for individuals with anxiety disorders. Long waiting times for treatment or diagnosis impose costs on patients, as their suffering persists while they wait as long service wait times lead to a corresponding decrease in health gains from the intervention and deteriorate health conditions (Biya et al., 2022). The “Canadian Occupational Performance Measure (COPM)” (Law et al.,1990) is a valuable tool for PSR practitioners to assess client needs, identify areas of difficulty, and develop interventions that align with client goals (COPM, n.d.). Some of these practical and evidence-based approaches include Competency A.2: Client-Centered Practice, Competency B.2: Person-centered Communication, Competency C.8: Collaboration, Competency C.4: Evidence-Informed Practice, and Competency A.1: Attitudes and Values, Competency, D.2. Supporting and enabling advocacy with individuals and competency E.1.Promoting application of recovery-oriented PSR.

Client-centered practice is essential for Recovery-oriented Psychosocial Rehabilitation (PSR) to reduce wait times and enhance active service delivery for those with anxiety disorders. Taneja and Wagne (2021) emphasize self-determination, individual autonomy, and patient involvement in the recovery process. Consistent with indicator A.2.1, I invest significantly in the collection of distinct cultural information about my client through face-to-face conversation during the consultation and utilize this knowledge to inform intervention. Additionally, Hiraga et al. (2019) observe that following COPM guidelines helps practitioners address the physical and psychological needs of the patient in time. For example, by understanding diversity in line with A.3.2, it is easy to address culture-bound conditions like “Attack of the Nerves” (ADN) in the Hispanic population. I achieve this goal by collecting socio-cultural data of my clients, developing their cultural profiles, and storing them in a database. This information can then be used to optimize care in the future by reducing the amount of time waiting. Conclusively, for timely and effective services in recovery-oriented PSR, it is essential to integrate client-centered practice (A.2.1), appreciate cultural sensitivity (A.2.2), and foster a supportive environment for patients (A.2.2).

Similarly, client-centered communication is essential for PSR practitioners to effectively interact and form supportive relationships with clients (B.2). In my practice, I depend highly on active listening, especially through paraphrasing, summarizing, clarification, and reflection during practitioner-patient interaction, in order to foster trust (Allinson & Chaar, 2016). This way, I have been able to comprehend underlying anxieties and use these clues to adjust to the right mode of communication for the client (Luigi et al., 2020). Establishing trust between the client and practitioner encourages open expression of anxieties, further reducing wait times because practitioners can construct targeted approaches by understanding the root causes of anxiety. For instance, by comprehensively analyzing the client’s life history, the practitioner develops an understanding of the health condition, hence better service delivery. This can be achieved by deploying appropriate data collection techniques such as interviews reinforced with open-ended and probing questions to encourage the patient to share more details about their condition as consistent with B.2.2.

In addition, collaboration is essential for providing comprehensive, evidence-based care for patients with anxiety disorders. Competency C2 requires that practitioners share resources and information and coordinate care with multiple providers during practice (Jenkins, 2019). PSR competencies emphasize the importance of collaborating with multiple parties to boost care quality through appropriate engagement (C.2.3). My approach to PSR focuses on developing meaningful relationships between the patient, the practitioner, and the client’s family achieved through scheduled meetings to foster a healthy degree of engagement needed for effective collaboration hence the prospects of minimizing wait times and guaranteeing comprehensive care.

Evidence-informed practice (EIP) is also useful in reducing wait times and active service delivery time for individuals with anxiety disorders. EIP allows practitioners to deduce the basis of anxiety and customize interventions to the needs of each client while also measuring the degree of success (Sammells et al., 2023). To this end, I utilize the COPM to assess client functioning and conduct a comprehensive scientific literature review to identify applicable research evidence and translate the evidence into practice (B.4.2), and ensure quality improvement through rigorous research efforts (B.4.3). This results in the execution of individualized strategies for therapy (Hoge et al., 2023; Ringeisen et al., 2017, p.197). A feasible way to achieve this goal is through establishing partnerships with educational research groups. Such partnerships can be useful in aligning care with credible and updated evidence from research, hence improving the quality of the intervention.

PRS practitioners must prioritize positive attitudes and values because mental healthcare oftentimes requires a compassionate and unbiased approach. Kirmayer and Jarvis (2019) observe that this may involve an active effort to listen, understand, and respect the stories and experiences of the client without imposing personal prejudices or existing beliefs. In this regard, I have invested time and effort into empathy training by enrolling in a suitable course to prime my ability to demonstrate these qualities.

As a PSR practitioner, I have also encouraged social participation and provided leadership in line with PSR Domains D and E, respectively. For example, I stretch the bounds of mental health intervention beyond the healthcare facility setting by encouraging recovering clients to join advocacy against mental health conditions through seminars and workshops (D.2.3). Besides, in line with Domain E, I assume the role of stimulating and facilitating change in the facility by encouraging my colleagues to adopt and apply PSR competencies and principles during practice (E.1.1) by taking the lead in PSR training and encouraging facilities to invest in the acquisition of learning materials needed to educate practitioners about recovery-based PSR. In these ways, my role as a practitioner traverses the bounds of the healthcare setting to satisfy the demands of these PSR principles.

Results

Applying the PSR competencies has effectively reduced service wait times and active service delivery time for people with anxiety disorders. By employing client-centered practice, person-centered communication, collaboration, and evidence-informed practice, and practicing positive attitudes and values, I have created individualized treatment plans tailored to the client’s needs and circumstances. This way, I assess the client’s needs effectively, develop personalized interventions, and evaluate the effectiveness of the interventions. The positive outcomes are affirmed by increased patient satisfaction, reduced wait times, and increased intention to refer my services. Self-reported perception questionnaires were used to assess patient satisfaction, while average wait time was tracked by a queue management software. The questionnaire was focused on tracking patient satisfaction before and after the deployment of PSR principles among clients whose interventions took long gestation periods. In total, 23 participants volunteered for the study, and n=21 agreed that their satisfaction was based on how long they had to wait for service after an appointment. Also, n=19 agreed that they noted a progressive change in the quality of service across the period of deployment (6 months). These results have been corroborated by the decreasing wait times across the six-month period in Table 1 below. The number of return clients, that is, individuals who have returned to the facility for follow-up appointments, also increased from 19 to 24 across the period. Furthermore, I have networked with more than five stakeholder groups, such as families, research organizations, community-based organizations, donors, and other healthcare facilities. These collaborations have eased access to information, services, and resources necessary in practice.

Table 1

Conclusion

To improve service delivery times and minimize wait times for those suffering from an anxiety disorder, PSR practitioners must identify the source of the anxiety and adopt targeted interventions. The PSR competencies guide practitioners to support clients in their recovery. Using the COPM, practitioners may precisely diagnose client needs and pinpoint the necessary interventions (Skelley et al., 2020). The overarching lesson is that person-centered communication, collaboration, evidence-based practice, client-centered practice, and professionalism are important mental care. In integrating these competencies into practice, I learned that inpatient admissions, length of stay, and practitioner-to-patient ratio determine the waiting times of a patient.

References

Allinson, M., & Chaar, B. (2016, November 15). How to build and maintain trust with patients. The Pharmaceutical Journal. https://pharmaceutical-journal.com/article/ld/how-to-build-and-maintain-trust-with-patients

Biya, M., Gezahagn, M., Birhanu, B., Yitbarek, K., Getachew, N., & Beyene, W. (2022). Waiting time and its associated factors in patients presenting to outpatient departments at Public Hospitals of Jimma Zone, Southwest Ethiopia. BMC Health Services Research, 22(1), 107. Retrieved May 17, 2023, from https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-07502-8

Hiraga, Y., Hisano, S., Nomiyama, K., & Hirakawa, Y. (2019). Effects of using activity diary for goal setting in occupational therapy on reducing pain and improving psychological and physical performance in patients after total knee arthroplasty: A non-randomised controlled study. Hong Kong Journal of Occupational Therapy, 32(1), 53-61.

Hoge, E. A., Bui, E., Mete, M., Dutton, M. A., Baker, A. W., & Simon, N. M. (2023). Mindfulness-based stress reduction vs. escitalopram for treating adults with anxiety disorders: A randomized clinical trial. JAMA Psychiatry, 80(1), 13-21. Retrieved March 6, 2023, from https://pubmed.ncbi.nlm.nih.gov/36350591/.

Jego, M., Debaty, E., Ouirini, L., Carrier, H., & Beetlestone, E. (2019). Caring for patients with mental disorders in primary care: a qualitative study on French GPs’ views, atittudes and needs. Family Practice, 36(1), 72-76. Retrieved May 17, 2023, from https://academic.oup.com/fampra/article/36/1/72/5140111

Jenkins, R. (2019). Implementing mental health promotion approaches in mental health services. In Implementing Mental Health Promotion, pp. 533–562. Retrieved March 6, 2023, from https://www.researchgate.net/publication/336953352_Implementing_Mental_Health_Promotion_Approaches_in_Mental_Health_Services.

Kirmayer, L. J., & Jarvis, G. E. (2019). Culturally responsive services as a path to equity in mental healthcare. HealthcarePapers, 18(2), 11-23.

Kaczkurkin, A. N., & Foa, E. B. (2022). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in Clinical Neuroscience. Retrieved May 17, 2023, from https://www.tandfonline.com/doi/full/10.31887/DCNS.2015.17.3/akaczkurkin?scroll=top&needAccess=true&role=tab

Law M, Baptiste S, McColl M, Opzoomer A, Polatajko H, Pollock N. The Canadian occupational performance measure: an outcome measure for occupational therapy. Can J Occup Ther. 1990 Apr;57(2):82-7, from The Canadian Occupational Performance Measure: a research and clinical literature review – PubMed (nih.gov)

Luigi, M., Rapisarda, F., Corbière, M., De Benedictis, L., Bouchard, A. M., Felx, A., … & Lesage, A. (2020). Determinants of mental health professionals’ attitudes towards recovery: A review. Canadian Medical Education Journal, 11(5), e62-e73. Retrieved March 6, 2023, from https://pubmed.ncbi.nlm.nih.gov/33062092/.

Moscelli, G., Gravelle, H. S. E., & Siciliani, L. (2016). Market structure, patient choice and hospital quality for elective patients. CHE Research Paper 139, 1-34. Retrieved September 19, 2023, from https://eprints.whiterose.ac.uk/135416/1/CHERP139_market_structure_patient_choice_hospital_quality.pdf.

Ringeisen, H., Langer Ellison, M., Ryder-Burge, A., Biebel, K., Alikhan, S., & Jones, E. (2017). Supported education for individuals with psychiatric disabilities: State of the practice and policy implications. Psychiatric Rehabilitation Journal, 40(2), 197. Retrieved March 6, 2023, from https://pubmed.ncbi.nlm.nih.gov/28182470/.

Skelley, J. W., Deas, C. M., Curren, Z., & Ennis, J. (2020). Use of cannabidiol in anxiety and anxiety-related disorders. Journal of the American Pharmacists Association, 60(1), 253–261. Retrieved March 6, 2023, from https://doi.org/10.1016/j.japh.2019.11.008.

Sammells, E., Logan, A., & Sheppard, L. (2023). Participant Outcomes and Facilitator Experiences Following a Community Living Skills Program for Adult Mental Health Consumers. Community Mental Health Journal, 59(3), 428-438, from Participant Outcomes and Facilitator Experiences Following a Community Living Skills Program for Adult Mental Health Consumers – PubMed (nih.gov)

Taneja, A., & Wagner, W. (2021). Transforming Opioid Addictions Care in New Mexico: Combining Medication Treatment with Patient Autonomy, Civic Engagement and Integrative Healing. In Leading Community Based Changes in the Culture of Health in the US-Experiences in Developing the Team and Impacting the Community, from https://cdn.intechopen.com/pdfs/77358.pdf