Promoting Patient-Oriented Research

Recovery from addiction can mean different things to different people. A recent publication by HRI Research and Evaluation Scientist, Dr. Jean Costello, highlights the importance of incorporating insights from people with lived experience when building systems for measuring treatment success.

How to Measure Addiction Recovery? Incorporating Perspectives of Individuals with Lived Experience was published in the June 2018 edition of the International Journal of Mental Health and Addiction. Co-authored by Senior Research Associates, Courtney Ropp and Sarah Sousa, and HRI Senior Scientist, Dr. Brian Rush, the article outlines a study conducted between December 2014 and March 2015. Study participants were recruited from the Addiction Medicine Service Aftercare/Relapse-Prevention Program at Homewood Health Centre.

Group discussionThrough a series of focus groups and interviews, researchers identified four major themes related to how participants perceived recovery:

  1. Recovery is a process.
  2. Abstinence is an important aspect of recovery, but not sufficient.
  3. Recovery is multidimensional.
  4. Recovery requires ongoing commitment.

The authors conclude that recognizing recovery as a life-long process reinforces the need to measure and monitor outcomes well after treatment is completed. Further, input from individuals with lived experience helped to identify a number of important indicators of recovery that should be measured as part of a comprehensive outcome-monitoring system.

This study promotes the concept of human-centred design, which incorporates insights from end users during the development of a product or service. In this instance, patients are helping to shape research that will be meaningful to others experiencing addiction.

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Leading Evaluation Expert Joins HRI Team

We are pleased to announce that Dr. Brian Rush, Scientist Emeritus with the Centre for Addiction and Mental Health, has joined the HRI team as Senior Scientist.

Dr. Brian RushDr. Rush is a leading international expert in program and policy evaluation. With a research career that spans nearly 40 years, he has a particular interest in performance-measurement systems for substance abuse, problem gambling and mental health services. Dr. Rush will play an integral role in further developing the Recovery Journey Project at HRI.

The Recovery Journey Project is a rigorous data-collection system that allows for the ongoing evaluation of mental health and addiction treatment at Homewood Health Centre in Guelph, Ontario. The system holds great potential for guiding improvements to care in Canada and beyond.

Led by Dr. Jean Costello, Research and Evaluation Scientist, the Recovery Journey Project is a flagship model that can be adapted for use in a range of treatment settings to measure recovery outcomes. Dr. Rush will work alongside Dr. Costello as the Recovery Journey Project expands.

Recovery Journey Project Highlights:

  • One of Canada’s only longitudinal studies measuring mental health and addiction recovery success
  • Helps us monitor and evaluate treatment quality and effectiveness
  • Generates knew knowledge about the recovery process
  • Can help determine how best to use limited resources to help as many people as possible
  • Adaptable to fit other treatment domains and settings

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Multi-year research study sheds light on addiction recovery

Since 2015, Homewood Research Institute (HRI) has partnered with Homewood Health Centre to collect data from patients who receive treatment in the Centre’s Addiction Medicine Service (AMS).

Originally known as Post-Discharge Outcomes Monitoring or PDO, this data-collection system is led by HRI researchers and was piloted to allow for the rigorous and ongoing evaluation of the quality and effectiveness of Homewood’s program by collecting and analyzing data from patients as they navigate their first year of recovery after treatment.

HRI is pleased to announce that, as of April 30, 2018, the PDO system has a new name and has been embedded into regular practice within the Addiction Medicine Service. Clinical data is collected by AMS staff while patients are receiving inpatient treatment. Following discharge, patients are then invited by HRI to take part in research on the recovery process.

Recovery Journey Project feature imageNow known as the Recovery Journey Project, this collaborative effort is one of the only longitudinal studies in Canada designed to measure key indicators of recovery over time. The Recovery Journey Project will help us better understand the recovery process among those who receive mental health and addiction treatment. In this way, it will guide improvements to programs and lead the way to measurement-based services – at Homewood and beyond.

To mark the launch of the Recovery Journey Project as a fully integrated research study at Homewood, HRI has created a microsite outlining the project’s key features and findings. Updates and knowledge translation activities will be shared as the study progresses.

What’s Next?

The potential impact of the Recovery Journey Project is vast: this framework can be utilized to measure recovery outcomes across a range of treatment domains. Currently, the system is being refined for implementation within other Homewood Health programs.

For updates on the Recovery Journey Project, subscribe to HRI Connects or visit

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Dr. Margaret McKinnon honoured as inaugural chairholder

Dr. McKinnon welcomed to new role

Dr. Paul O’Byrne welcomes Dr. McKinnon (Photo credit: JD Howell)

On Monday, April 16, guests from McMaster University, Homewood Research Institute (HRI), Homewood Health and St. Joseph’s Healthcare Hamilton gathered to honour Dr. Margaret McKinnon as she stepped into her new role as Homewood Research Chair in Mental Health and Trauma.

The role marks the strategic partnering of McMaster, HRI, Homewood Health and St. Joseph’s in a joint effort to advance treatment for trauma-related mental illness and addiction.

Leaders from partnering organizations were present to congratulate Dr. McKinnon and discuss the impact of building a national network – known as the Homewood-McMaster Trauma Research Network – to advance treatment for trauma.

President and Vice-Chancellor of McMaster University, Dr, Patrick Deane, spoke about the importance of collaboration in academic settings to advance healthcare research. Dr. Kevin Smith, CEO of St. Joseph’s Health System, and Dr. Paul O’Byrne, Dean and Vice-President of the Faculty of Health Sciences at McMaster, shared details about the novel partnership, which aims to merge existing clinical expertise in applied clinical research with new treatment ideas, research, evaluation and knowledge exchange to improve treatment and outcomes for people experiencing PTSD.

Dr. Ron Schlegel, Chair of the HRI Board, discussed the value of funding research initiatives that invite collaboration – particularly among leading researchers and institutions in the field – to advance common goals in mental health and addiction treatment.

Dr. McKinnon is developing a Trauma Research Program at HRI and will play a key role in building the Homewood-McMaster Trauma Research Network, which will have its foundations in Ontario and expand across Canada in a multi-year process.

Margaret McKinnon speaking

Dr. Margaret McKinnon speaks about her research and the importance of investing in solutions for people struggling with trauma (Photo credit: JD Howell)

Group photo

L-R: Dr. Patrick Deane, Dr. Paul O’Byrne, Dr. Margaret McKinnon, Dr. Kevin Smith and Dr. Ron Schlegel (Photo credit: JD Howell)

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Moral injury: Exploring the consequences of a wounded conscience

A Vietnam veteran was once asked about his struggle to make eye contact with others since returning from war.

“I can’t look anyone in the eye for fear that they will see the stain on my soul for what I’ve done in Vietnam,” he replied.

This powerful statement summarizes the experience of many veterans and military members. And, in large part, it summarizes what it means to suffer a moral injury.

A moral injury occurs when a person has to witness, fails to prevent, or engages in an event that violates their personal moral beliefs. For example, military members may encounter situations or be forced to make choices that conflict with their own ethical standards.

Exposure to morally injurious situations has been linked to adverse outcomes, including post-traumatic stress disorder (PTSD). The concept of moral injury in relation to PTSD has emerged in the past decade and has been identified as a vital area of study for mental health researchers – particularly those working with military members and veterans.

Currently we have a very limited understanding of how the brain and body respond to moral injury, but one HRI Scientist is looking for answers.

Finding answers through innovative research

“We can only understand how to treat moral injury if we understand the mechanisms underlying it,” says Ruth Lanius, MD, PhD and HRI Associate Clinical Scientist.

Dr. Lanius is Professor of Psychiatry, Director of the PTSD Research Unit and the Harris-Woodman Chair in Mind-Body Medicine at the Schulich School of Medicine and Dentistry at Western University. Her research interests focus on the neurobiology of PTSD and the development of new treatments.

In collaboration with colleagues Chantelle Lloyd, Charlene O’Connor and Dr. Margaret McKinnon, Dr. Lanius is leading groundbreaking research that uses neuroimaging to explore how the brain processes morally injurious events.

“PTSD is often thought to be the primary mental health concern for individuals returning from war,” says Dr. Lanius.

“But moral injury is an emerging and highly important consideration. Moral injury brings profound shame, anguish and guilt that can severely disrupt quality of life and daily function. We need to better understand how moral injury develops and how our bodies process moral injury in order to help people recover successfully.”

Still in its early stages, Dr. Lanius’s research aims to do just that: gain insight into the wounded conscience and learn how to treat those wounds.

To learn more as Dr. Lanius’s research develops, subscribe to HRI Connects or follow HRI on Twitter, Facebook and LinkedIn.

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Dr. Margaret McKinnon named Homewood Research Chair in Mental Health and Trauma

New role marks partnership to improve treatment for trauma

Homewood Research Institute extends its sincere congratulations to Dr. Margaret McKinnon, who has been named the inaugural Homewood Research Chair in Mental Health and Trauma.

Dr. McKinnon’s new role marks the strategic partnering of four organizations dedicated to improving the lives of people suffering from trauma-related mental illness and addiction.

McMaster University, Homewood Research Institute (HRI), St. Joseph’s Healthcare Hamilton and Homewood Health have partnered to establish the position, as well as a network of researchers, evaluators and clinicians working to advance clinical practice and outcomes in the treatment of post-traumatic stress disorder (PTSD) and related illnesses. The collaborative network will have its foundations in Ontario and will expand across Canada and beyond in a multi-year process.

Dr. McKinnon will play a key role in building the national network – known as the Homewood-McMaster Trauma Research Network – and will lead the development of a Trauma Research Program at HRI.

A personal connection to trauma

Dr. McKinnon is well-known for authoring a novel study about PTSD vulnerability based on findings in a group of airline passengers – herself included – who experienced a traumatic event on Air Transat Flight 236 when their plane ran out of fuel over the Atlantic Ocean in 2001. The study revealed important risk factors that could predict PTSD vulnerability.

Dr. McKinnon has made significant contributions to the field of trauma research, leading the development of a clinical research and knowledge translation program at HRI and working alongside leaders in military mental health to advance PTSD research involving military members, veterans and first responders.

Col. Rakesh Jetly, Senior Psychiatrist and Special Mental Health Advisor to the Surgeon General of the Canadian Armed Forces, recently voiced his support of Dr. McKinnon’s appointment: “Dr. McKinnon brings a wealth of experience with her. I look forward to our continuing collaboration.”

Partner logosA partnership that will benefit Canada

The partnership between McMaster, HRI, Homewood Health and St. Joseph’s aims to merge existing expertise in applied clinical research with new treatment interventions, clinical innovation, research, evaluation and knowledge exchange to optimize care and outcomes for people experiencing PTSD.

“Dr. McKinnon will be leading the development of a national research enterprise that none of our organizations could build alone,” says Ron Schlegel, chair of HRI.

Jagoda Pike, president and CEO of Homewood Health, says: “Under Dr. McKinnon’s leadership, the national Trauma Research Network represents the future of PTSD research and treatment in Canada.”

A ceremony to honour McKinnon’s appointment will be held on Monday, April 16 at McMaster University.

For updates on this and other developing news, subscribe to HRI’s quarterly newsletter, HRI Connects.

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HRI tests cognitive training program to improve symptoms of PTSD

People diagnosed with Post-Traumatic Stress Disorder (PTSD) often experience changes in cognitive functioning, such as difficulty with memory, attention, concentration, planning and organization.

Despite the fact that these challenges can severely disrupt functioning at work, school, home, or in social settings, few studies have investigated treatments aimed specifically at improving thinking skills among individuals with PTSD.

A new study led by Homewood Research Institute (HRI) and McMaster University is examining the utility of cognitive skills training in reducing symptoms of PTSD, particularly among veterans, military members and first responders. In this study, a cognitive training program called Goal Management Training (GMT) is being offered to people with PTSD for the first time.

GMT has been used successfully in other populations, including people with brain injuries, to improve concentration, memory, and organization. GMT aims to teach individuals how to stop automatic responding, monitor progress on tasks and goals, and achieve those goals.

Early research among inpatients being treated for PTSD at Homewood Health Centre suggested that GMT helps to improve thinking speed, memory and the pursuit of personal goals. GMT also led to reductions in depression and self-reported cognitive difficulties.

The next phase of research is underway. GMT is now being tested among individuals in the community with a history of military-related trauma and those who have worked as public safety personnel, such as firefighters, paramedics or police officers. Researchers predict similar results among this outpatient population. Based on studies to date, GMT holds great promise for improving quality of life and cognitive function for individuals with PTSD.

This work is generously supported by the Cowan Foundation, the Military Casualty Support Foundation, Schlegel Healthcare and the Bickell Foundation.

Do you know someone who could benefit from GMT?

HRI has announced a call for participants in Guelph and the Greater Toronto Area. An experimental trial of GMT will begin in April 2018 at the Homewood Clinic in Mississauga, Ontario.

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New research explores subconscious effects of trauma triggers

Post-traumatic Stress Disorder (PTSD) can occur after a person experiences a traumatic event. Symptoms of PTSD can be debilitating and are often brought on by trauma triggers, or experiences in daily life that cause an individual to recall or re-live a traumatic memory.

Current therapies for trauma-related disorders are designed to treat people who respond to trauma triggers on a conscious level. But what if an individual isn’t aware of his or her trauma triggers? And how does the body respond when trauma triggers or threats are perceived on a subconscious level?

New research led by Dr. Daniela Rabellino, a postdoctoral fellow working alongside Dr. Ruth Lanius, Associate Clinical Scientist at Homewood Research Institute, has uncovered some answers to these important questions. And the findings may have significant implications for the field of trauma treatment.

Dr. Rabellino’s study, Neural and Autonomic Correlates of Post-Traumatic Stress Disorder During Processing of Trauma-Related Stimuli, explores the effects of trauma triggers that are presented to people with PTSD for only a few milliseconds and are thus perceived below the threshold of conscious awareness.

The subconscious processing of trauma triggers had a striking effect on both heart rate – an important measure of emotion regulation – and on the activation of midbrain structures that have been proposed to form the body’s innate “alarm system”. In other words, individuals react reflexively to trauma triggers, even when they are not consciously aware of those triggers.
Dr. Rabellino’s study has important implications for the future of trauma treatment; specifically, treatment must incorporate interventions that directly address the effects of trauma triggers that are not consciously perceived.

Body-oriented interventions, such as mindfulness practices and neurofeedback training – which can target the subconscious processing of trauma – are now being explored as adjunctive treatments for PTSD and other trauma-related disorders.

Read Dr Rabellinos Publication

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