QUALITY OF LIFE OUTCOMES OF AN ASSERTIVE OUTREACH PROGRAM IN RURAL CENTRAL ALBERTA: A 36 MONTH FOLLOW-UP STUDY Neels Ehlers, MA & Carla Prediger, RPN Addiction and Mental Health Services, Central Zone, Alberta, Canada. September 14, 2017.

We have no potential conflict of interest to report. DISCLOSURE: We have no potential conflict of interest to report.

RURAL CENTRAL ALBERTA

INTRODUCTION Since the second half of the 20th century progress in medical treatments and technology contributed a shift in focus from quantity of life (longevity) to quality of life (QOL). Health is considered “A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHOQOL Group, 1995, p. 1403). QOL pertains to individuals’ perception of their situation in life in the context of the culture and value system in which they live and in relation to their goals, expectations and standards and concerns. QOL is a concept affected in a complex way by the person’s physical health, psychological state, level of independence, social relationships, and their relationship to important features of their environment . 1

ASSERTIVE OUTREACH PROGRAM The Assertive Outreach Program (AOP) in Central Alberta provides persons with severe or persistent mental illness (Axis 1) with a community based service. Core to the AOP is the relationship between the client and clinicians, emphasizing a consumer directed partnership which is maintained over time to ensure continuity of care. AOP provides a continuum of flexible, comprehensive interventions that assist individuals to maintain a reasonable quality of life (QOL) in their own communities. An important AOP strategy is constructive engagement, aimed at recovery that focusses on the restoration of a meaningful life, of gaining a new sense of purpose in life. 2

ASSERTIVE OUTREACH FRAMEWORK AOP STAFF Registered Psychiatric Nurses 5 – 1.0 FTE 1 – 0.8 FTE 1 – 0.7 FTE Registered Nurses 1 – 1.0 FTE Mental Health Aides 4 – 1.0 FTE 2 – 0.9 FTE 1 - .08 FTE 3

METHODOLOGY Design A cross-sectional, time series design with a single group, conducting a baseline and follow-up survey during October 2013 and October 2016 in Rural Central Alberta. Objective To assess the QOL of AOP clients as a supplementary appraisal for client management and mental health services outcomes. World Health Organization Quality of Life-BREF (WHOQOL-BREF) The WHOQOL-BREF assesses individuals’ overall quality of life and generates a profile of four domains: Environment Physical Psychological Social Relationships. 4

METHODOLOGY Ethics ARECCI Ethics Guidelines (www.aihealthsolutions.ca/arecci/guidelines). Project Type: A health service evaluation. ARECCI score = 3: “The project involves minimal risk.” Data collection and analysis Data were collected by administering the WHOQOL-BREF. Data were captured, analyzed using SPSS 16.0 software by applying descriptive and non-parametric statistics. Sample October 2013 Population of 205 AOP Clients October 2016 Population of 183 AOP Clients 36 Month follow-up Sample of 61 AOP Clients 5

RESULTS Respondent demographics Prevalent Diagnosis (AXIS I): Schizophrenia (Paranoid) complicated by a combination of bi-polar and psychotic disorders and personality cluster traits. Gender: Females – 31 (51%). Males – 30 (49%). Age: x̅ = 53, SD = 11.7. Range = 27 – 73 years. 6

RESULTS Respondent demographics Marital Status: Single – 38 (62%). Separated/Divorced/Widowed – 14 (23%). Married/Living Together – 9 (15%). Neighbourhood: City (>10, 000 residents) – 22 (36%). Town (between 1,000 – 10,000 ) – 33 (54%). Village/Hamlet (<1,000) – 6 (10%). 7

RESULTS Overall Rating of Quality of Life and Satisfaction with Health M = 3.8 (SD = 1.0 M = 3.7 (SD = 1.0) 2013** 2016*** Scale* * QOL: 1=Very Poor - 5=Very Good Health: 1=Very Dissatisfied - 5=Very Satisfied ** 2013: z= -3.68, p <0.01 *** 2016: z= -2.87, p <0.01 8

RESULTS Overall Rating of Quality of Life and Satisfaction with Health Scale* M = 3.8 (SD = 1.0 M = 3.7 (SD = 1.0) 2013** 2016*** * QOL: 1=Very Poor - 5=Very Good Health: 1=Very Dissatisfied - 5=Very Satisfied ** 2013: z= -3.68, p <0.01 *** 2016: z= -2.87, p <0.01 8

RESULTS Satisfaction with Quality of Life in terms of WHOQOL-BREF Domains WHOQOL-BREF Scale (0-100) ’13 ’16 9

Percentage Increase: 2013 - 2016 WHOQOL-BREF DOMAINS Percentage Increase: 2013 - 2016 10

RESULTS Satisfaction with QOL in terms of WHOQOL-BREF Domains By Gender By Year Environment 11

RESULTS Satisfaction with QOL in terms of WHOQOL-BREF Domains By Gender By Year Environment 11

RESULTS Satisfaction with QOL in terms of WHOQOL-BREF Domains By Gender By Year Environment 11

RESULTS Satisfaction with QOL in terms of WHOQOL-BREF Domains By Age Group By Year Environment 12

RESULTS Satisfaction with QOL in terms of WHOQOL-BREF Domains By Age Group By Year Environment 12

RESULTS Satisfaction with QOL in terms of WHOQOL-BREF Domains By Marital Status Environment 13

RESULTS Satisfaction with QOL in terms of WHOQOL-BREF Domains By Marital Status Environment 13

RESULTS Satisfaction with QOL in terms of WHOQOL-BREF Domains By Marital Status Environment 13

RESULTS Satisfaction with QOL in terms of WHOQOL-BREF Domains By Community Environment 14

RESULTS Satisfaction with QOL in terms of WHOQOL-BREF Domains By Community Environment 14

RESULTS Satisfaction with QOL in terms of WHOQOL-BREF Domains By Community Environment 14

Discussion  Results should be interpreted with caution because the sample size are relatively small and the results apply only to those who participated.  QOL received a significantly higher rating than Health in 2013 and 2016 respectively.  In terms of the four WHOQOL-BREF domains participants were most satisfied with the Environment followed by the Psychological, Physical and Social Relationships domains. A slight increase was reported for each of the domains in 2016. Mean scores for all the domains were beyond the midpoint on the BREF Scale: 0 – 100. 15

Discussion  The results yielded indications of relative vulnerability among AOP clients with regard to QOL: Relative Susceptibility. Relative Insusceptibility. • Gender: Women. Men. • Age: Older age group (>=55 years). Younger age group (<=54 years). • Marital status: Separated/divorced/widowed. Single, living together/married. • Community: Towns. Cities, Villages/hamlets. • Health & QOL status: General health Overall QOL. • QOL Domains: Social Relationships, Physical Environment, Psychological. 16

Conclusion and recommendations  The study provided evidence that the AOP undoubtedly assists clients to sustain a fairly high QOL along with a relatively good Health status.  Being aware of and focusing upon different demographic needs might result in even better outcomes of the AOP.  Regular implementation of the WHOQOL-BREF will enhance proactive program strategies to assist individuals with severe/and or persistent mental illness to maintain a reasonable quality of life in their own communities.  The value of health care will be judged more and more by balancing costs and impacts on quality of life. 17

Acknowledgement A sincere appreciation to: The participating AOP clients who so willingly share their experience. The dedicated AOP staff members in Central Alberta. Health Statistics and Information Systems, WHO. www.albertahealthservices.ca neels.ehlers@ahs.ca