Study participants will: a) have a diagnosis of a schizophrenia spectrum disorder

1. Open Dialogue as a Recovery Based Therapeutic Approach to Psychosis: A Proposed Project Amy Novak Faculty of Social Work, University of Calgary Strategy ofInquiry Data Collection Methods Literature Review Functional Outcomes Will be measured pre-test and post-test at a 3 year follow-up a) Psychotic symptom presentation will be measured by using two scales. The Basic Psychiatric Rating Scale (BPRS) will be completed by the assessment team, and the Symptom Checklist-90-Revised (SCL-90-R) will be completed by the patient. b) Employment status information will be rated as variable (< 16 hrs/week), part-time (16-32 hrs/week), fulltime (>32 hrs/week), self-employed, with salary information. Recovery Outcomes Data will be collected from clinical records via quarterly report throughout treatment. These outcomes will monitor level of self-determination, one of the consumer determinants of recovery. a) Medication use will be tracked by the amount and class (neuroleptics, benzodiazepines & other) used. While neuroleptics are started at the beginning of treatment as a matter of course at the EPC, OD integrates meds gradually, only if required. Benzodiazepines are utilized first before progressing to neuroleptics only if no improvement to symptoms or social behaviour is seen. b) Mandated treatment will be tracked by the type of treatment prescribed, length of treatment and whether it occurred on an in-patient or out-patient basis. The dominance of a biological view of schizophrenia and psychotic illness in Alberta currently favours medication as the centre of treatment and defines recovery as a remission of symptoms. This review summarizes the position of the mental health consumers movement that recovery from serious mental illness is less about reducing the risk of relapse and more about developing one’s multi-faceted identity. A narrative perspective of psychosis developed in Finland describes identity as a self-narrative that evolves over time. Related research has found that psychotic episodes almost always involve a collapsed self-narrative, leaving only fragments of one’s identity behind (Holma & Aaltonen, 1995). This research is based on the premise that psychoses are attempts to: “make sense of experiences so difficult that it has not been possible to construct a rational spoken narrative about them” (Seikkula, 2002, p. 264). The Open Dialogue (OD) Approach to psychosis evolved from this research and is now the main modality of psychiatric crisis care and follow-up in Western Lapland, Finland. OD provides regular, intensive treatment meetings to patients and members of their social networks during the acute stages of psychosis. Dialogism, in the form of therapeutic conversation, is the main treatment intervention. It is aimed at constructing a common language to narrate problems that provides a basis for the re-construction of one’s self-narrative. Research showed that placing OD at the centre of treatment for psychosis in Western Lapland significantly reduced the need for medication use and hospitalizations, and improved overall outcomes (Seikkukla & Olson, 2003). This study will use a quasi-experimental pre-test-post-test control-group design: Group A R-----O-------X-------O (3 year follow-up) Group B R-----O----------------O (3 year follow-up) Group A represents the OD treatment group, with X being on-going treatment meetings using a dialogical approach. Group B represents the control group receiving treatment as usual through the EPC clinic (medication strategies with psycho-education, CBT, group programs, family interventions and case management techniques) These treatments will also be available to group A on an as needed basis as determined through treatment meetings. Data will be collected (O) both on assignment to treatment group and at a 3 year follow up. Treatment as Usual Open Dialogue No or MildPsychotic Symptoms Accessing Disability Benefits Medication Use The OD approach may be a viable recovery-focused alternative to the medical model that is currently favoured in Alberta. Purpose Statement Sample&Recruitment The purpose of this study is to compare outcomes of individuals diagnosed with schizophrenia receiving the Open Dialogue treatment approach to the current multi-modal treatment provided at the Early Psychosis Clinic (EPC) in Calgary, Alberta. Research questions Are functional outcomes positively affected by the dialogical approach? Are recovery outcomes addressed more effectively with the dialogical approach? Study participants will: a) have a diagnosis of a schizophrenia spectrum disorder b) be presenting with a non-affective, first episode of psychosis c) be aged between 16-50. Previous treatment variation will be controlled for by enlisting first time users of mental health services only. Participants will be selected through a convenience sample at the EPC in Calgary. Computer generated random assignment will occur over such time that n=100 for both treatment and control groups. Sample recruitment is expected to span 2 years as the EPC receives an average of 120 new referrals annually (A guide to Canadian, 2001). PotentialImplications Worldview Recent amendments to the Alberta Mental Health Act have included lowering the threshold for involuntary admission to hospital and measures allowing for mandated community treatment. The practice implications of such policy have been widely criticized by the mental health consumer movement. The OD approach in Finland seems to have allowed for consistent treatment in a cost-effective manner while at the same time reducing involuntary treatment and the use of medication. If systemically embraced, OD may work toward addressing current concerns of mental health consumers in Alberta. The purpose of this study is to determine the effect of the OD approach on tangible patient outcomes. Postpositivism acknowledges there is no one “absolute truth ….when studying the behaviour and actions of humans” (Creswell, 2009, p. 7). The nature of the answers sought in this study, however, necessitate a deterministic philosophy that seeks probable cause and effects. References • Creswell, J. (2009). Research design (3rded.). Thousand Oaks, CA: Sage. • Holma, J. & Aaltonen, J. (1995). The self-narrative and acute psychosis. Contemporary Family Therapy, 17(3), 307-316. • Seikkula, J. (2002). Open dialogues with good and poor outcomes for psychotic crisis: Examples from families with violence. Journal of Marital and Family Therapy, 28(3), 263-274. • Seikkula, J. & Olson, M. (2003). The open dialogue approach to acute psychosis: It’s poetics and micropolitics. Family Process, 42, 403-418 • A guide toCanadian early psychosis initiatives, (2001). Retrieved from httwww.cmha.ca/data/1/rec_docs/163_canadian_inititatives.pdf.