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 use, 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.

Click for Study and Eligibility Details button

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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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HRI research findings featured at national addiction conference

HRI research findings were featured in three presentations at a national conference hosted in Calgary, Alberta by the Canadian Centre on Substance Use and Addiction (CCSA) in November. The Issues of Substance Conference brings together addiction experts, policy makers and researchers to mobilize knowledge in the addiction field to address substance use in Canada. HRI was pleased to share updates and findings from three major projects currently underway.

Recovery Monitoring

Dr. Jean Costello, Research and Evaluation Scientist, and Courtney Ropp, Research Associate, were selected to speak about HRI’s Recovery Monitoring System. Launched as a pilot project at Homewood Health Centre in 2015, Recovery Monitoring involves the routine collection of data from patients discharged from Homewood’s Addiction Medicine Service for up to one year post-discharge to measure and assess outcomes and better understand the process of recovery.

The Recovery Monitoring System is unique in Canada and provides a thorough, ongoing and quantifiable understanding of what happens once patients are discharged from residential care. Data can be used to evaluate program effectiveness, inform quality improvements and enhance mental health and addiction policies in Canada and beyond.

HRI’s presentation focused on key findings at one year post-discharge, including changes in quality of life, social engagement, occupational performance and life satisfaction.

View the Presentation     View Infographic with Key Findings

Patients’ Perceptions of Care

In collaboration with Homewood Health Centre and well-known mental health and addiction scientist, Dr. Brian Rush, HRI is conducting research that examines how a patient’s experience or perception of care during addiction treatment impacts recovery-oriented outcomes after discharge.

Currently there is little evidence within the Canadian addiction service field about the link between a patient’s experience and their outcomes, but HRI is working to change this.

As part of the Recovery Monitoring System implemented in the Addiction Medicine Service at Homewood Health Centre, HRI collects information about a patient’s experience during treatment. Using a standardized evidence-based tool, data is collected at the time of discharge, and again at one month post-discharge, to shed light on the relationship between perceptions of care and post-discharge outcomes in residential care.

A poster presentation at the CCSA conference outlined early findings from HRI’s research, which show that a more positive perception of care at discharge predicts greater adherence to treatment recommendations after discharge, as well as improvements in recovery outcomes such as motivation and quality of life. These findings suggest that the patient experience may have a significant impact on recovery and should be monitored regularly.

Universal Screening

HRI Senior Scientist, Dr. James MacKillop, shared findings from a project that involved screening patients who have been diagnosed with addiction for a secondary – or comorbid – diagnosis of trauma. The study focused on individuals receiving care in an inpatient treatment setting and involved more 500 participants in the Addiction Medicine Service (AMS) at Homewood Health Centre.

Dr. MacKillop’s study provided important insights into the prevalence and severity of comorbid addiction and trauma within the AMS patient population. Specifically, half of the participants reported a significant history of trauma, and a higher number of females (56%) met the threshold for Post-Traumatic Stress Disorder (PTSD) as compared to males (48%).

These findings reveal the importance of screening for comorbid disorders to better inform each patient’s care plan during inpatient treatment.

Dr. MacKillop’s presentation also highlighted the potential for improved care that can result when academic researchers and treatment providers work together more closely.

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