Research reports

Context

In September 2019, TVA Nouvelles filmed the enthusiastic proposal by the director and members of CAPVISH of a possible application for people with disabilities to find themselves adapted housing that meets their own needs. In other words, an innovative solution to the problem of finding housing that promotes self-determination. It’s an integrated web platform to improve the search for accessible or adapted housing in the Greater Quebec City area. There are no studies on measuring the residential autonomy of people with physical disabilities.

Objectives

The aim of the partnership with the researchers was to meet CAPVISH’s need to document the usability of their adapted integrated web platform in the Greater Quebec City area. The research objectives were 1) to explore the impact of using the integrated web platform on the self-determination of people with disabilities in relation to residential autonomy; and 2) to explore the impact of using the integrated web platform on the practices of CAPVISH employees and their collaborators involved.

Method

A mixed methodology based on a non-experimental, cross-sectional, intervention-evaluation design was chosen. The intervention consisted in the use of the AppLoad platform by 10 people with disabilities, housing developers and support organizations offering various services. Based on the 4 variables of Wehmeyer’s self-determination model, three data collection tools were developed. To document “abilities” and “perceptions”, a 12-item satisfaction questionnaire was adapted from the ÉSAT 2.0 (Satisfaction with technical aids). To measure “support”, a questionnaire on the effectiveness of using the web platform was to be completed by people who had found accommodation. To document “opportunities suggested by the environment”, an observation grid was created to measure the efficiency of the web platform (6 items) and the self-determination of people with disabilities (5 items).

Results

There were four participants: a respondent with a motor disability, a respondent representing a disability rights organization (AEXQUO), the director and the project manager of the partner organization (CAPVISH). At least one of the two respondents is “not very satisfied” with the information contained on the platform, the efficiency of the platform (finding housing that meets the need) and the configuration of the platform. One respondent was “not at all satisfied” with the filters in the Locate section, as few were active. The two respondents who did not find accessible housing rated the platform’s effectiveness as “negative or moderate or NA” for 5 of the 6 items. Only one item scored “very satisfied”, and that was the speed with which the ability profile was completed. Self-determination scores were low (10/15 and 8/20). As for efficiency, the usage data available are: 8,567 pages visited in 2021 and for half of 2022. Interviews with the last two participants highlighted the technological aspects of the platform, aspects associated with AppLoad services, and promotion to raise awareness and invite people with disabilities to use the platform to find accommodation or related services.

Conclusion

Although it was not possible to demonstrate the platform’s usability (satisfaction, effectiveness, efficiency), the data collected nevertheless made it possible to document the 4 variables of self-determination of people with disabilities for their residential autonomy. The platform can now be accessed at https://www.appload.ca/. The pandemic made it impossible to visit apartments and produce detailed housing files, which partly explains the lack of information on AppLoad, but also the difficulty of recruiting nine respondents with motor disabilities during the funding period. During the pandemic, housing sheets were produced over the telephone by occupational therapy trainees, and other tools, such as the Home Help Reference Bank, were integrated.

Lists of figures and tables available in the 54-page report:

Figure 1. representation of dwelling types according to the degree of community in which they are found and the degree of facilities and services available.
Figure 2: Theoretical framework of the Functional Model of Self-Determination (Wehmeyer, 1999)
Figure 3: Evaluation of the level of autonomy
Figure 4. headings in the Get informed section
Figure 5. Access to filters when searching for information
Figure 6. The 5 tabs of the Appload
Figure 7. Access to the Location section of the home page
Figure 8. A) Sample file at the time of the interview. B) Example of current form
Figure 9. Accessing the Moving section on the home page
Figure 10. Lists of diagnoses in the self-assessment section
Table 1. Satisfaction with various aspects of the Appload platform to promote access to accessible housing for people with disabilities (ÉSAT; n = 2)
Table 2. Effectiveness of the Appload platform in promoting access to accessible housing for people with disabilities (n = 2)*.
Table 3. Personal benefits (self-determination) associated with the use of the Appload platform to promote access to accessible housing for people with disabilities (n = 2)*.

Context
According to the World Health Organization, dementia is a syndrome in which there is a deterioration of memory, reasoning, behavior and the ability to carry out daily activities. There are 55 million people with dementia worldwide and nearly 10 million new cases appear each year. Dementia has physical, psychological, social and economic consequences for people with the disease, but also for carers, families and society at large.

There was evidence of the use of service dogs by people with dementia on the websites of health organizations in Scotland and a few service dog training schools (e.g. Wilderwood Service Dogs, 2022). It was also mentioned that dogs could also support caregivers who live with people with dementia. On the other hand, there was no research data on the actual use of neurological service dogs in 2019.

Objective
We explored how “neurological” service dogs can help caregivers and people with dementia at home, through interviews, questionnaires and activity monitors. We confirmed 2 hypotheses out of 4.

Results
From 2019 to 2021, 112 participants were recruited, forming 56 pairs of people with dementia and caregivers. Of those 56 pairs, 28 had a companion dog, 23 had no dog, and 5 had a neurological service dog. The neurological service dog can play 5 roles and tasks in the lives of people with dementia. In addition, 7 benefits and 5 considerations were highlighted regarding the use of a neurological service dog (see infographics).

Our qualitative analyzes confirm our first two hypotheses that the presence of a neurological service dog or a companion dog 1) has a positive impact on both the person with dementia and their caregiver (e.g. reduced stress and increased independence), and 2) increases human presence around the person with dementia and opportunities for social engagement (e.g. more outings).

Our quantitative analyzes do not confirm our 3^rd hypothesis. Indeed, it has not been shown that neurological service dogs are a cost-effective or value-added alternative to companion dogs, nor that companion dogs are a cost-effective alternative to not having a dog.

Finally, our 4^th hypothesis is partially confirmed. It has been shown that the level of exercise and the quality of sleep are better in the group of neurological service dogs from a qualitative point of view only. Indeed, the activity monitors did not demonstrate enough statistical difference for the level of physical activity and the quality of sleep to be better than a companion dog or not having a dog.

The attached infographic was given to associations and organizations helping people with dementia or supporting caregivers. It illustrates the roles and tasks of the neurological service dog, the positive impacts following the use of such a dog as well as certain considerations to consider.

In addition, the attached summary of results was given to project participants. It contains a presentation of the project, the population, the measurement tools and the most important results.

Read the article published in Sage Journals: Roles and usages of neuro service dogs for caregivers living at home with persons with dementia: An exploratory comparative case study

Finally, check out the webinar hosted by the Alzheimer Society of Canada as part of their Dementia Talks – Summer 2023.

Funding agency: The Alzheimer Foundation of Canada

Background
Prior to this study there was a rise in popularity of psychiatric service dogs for veterans with chronic post-traumatic stress disorder (PTSD). Since no scientific evidence linked to the effectiveness of psychiatric service dogs, veteran support organizations were reluctant to fund this costly investment of time and money. Additionally, clinicians, such as psychiatrists, were hesitant to recommend psychiatric service dogs because no guidelines existed.

Objective
We have measured the effects of the acquisition of an assistance dog on psychiatric symptoms, sleep, mobility, psychosocial impact and quality of life, compared to the 6 months preceding the acquisition of the dog. Six of the 8 hypotheses were confirmed.

Results
There were 31 veterans registered for a service dog at 7 dog training schools in Canada and the United States. Eventually, 23 veterans acquired a psychiatric service dog, and of these, 18 completed all follow-ups (of 18 months). Analyzes have shown that the arrival of the psychiatric service dog correlates with 1) a decrease in nightmares, 2) an improvement in sleep, 3) a significant decrease in symptoms of PTSD, 4) a decrease in depressive symptoms, 5) an improvement in getting around in the community and 6) an improvement in the quality of life. No change was observed 7) in medication use and 8) in the level of burden felt by caregivers.

The attached simplified report was sent to participating veterans: it shows the purpose of the project, the target population recruited, the measurement tools used and the most important results.

Funding: The Canadian Institute for Military and Veteran Health Research and the Department of Veterans Affairs

Background: Driving is a central activity of daily living in the Western way of life, promoting autonomy and social participation. Learning to drive is a particularly important challenge for people with disabilities. The Driving School of the Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN) offers an adapted driving learning program for people with an intellectual disability, an autism spectrum disorder or a physical disability. After several years of existence, the Driving School aims to better understand the profile and journey of its users in order to continuously improve the services offered.

Objectives: This partnership research project had four objectives: (1) to describe the profile and journey of users of the CIUSSS-CN Driving School program; (2) document the link between cognitive functioning and program success; (3) assess driving status and behaviours after the end of the programme; and (4) explore the program’s contribution to user self-determination and social participation.

Funding: This partnership research project was funded by the Intersectoral Inclusive Society Initiative

Background

Tele-neuropsychology presents particular challenges related to the context of remote assessment of cognitive functions, which include the conditions of clients’ videoconferencing environment, the safety and protection of psychometric tests, and the limitation of qualitative observations in relation to face-to-face clinical activities. Several organizations, including the Ordre des psychologues du Québec (OPQ) and the Association québécoise des neuropsychologues (AQNP) have published recommendations related to tele-neuropsychology in the context of COVID-19. However, the state of play regarding the perceptions and use of tele-neuropsychology in Quebec remains poorly documented. In a rapidly changing context, it is essential to better understand the needs, barriers and facilitators for the use of tele-neuropsychology, and to study the factors that influence access and effectiveness of such services.

Objective

A survey was sent to Quebec neuropsychologists in the summer of 2020 to understand their needs and examine the feasibility and acceptability of tele-neuropsychology for the evaluation and treatment of cognition. This report, based on the results of this survey, documents the benefits, limitations, facilitators, barriers and challenges related to the use of tele-neuropsychology and provides recommendations.

Conclusion

Tele-neuropsychology is not a panacea and will never completely replace face-to-face direct contact activities. However, it is essential to continue to accumulate knowledge and experiential knowledge in order to use tele-neuropsychology wisely. The development of hybrid models of care, combining remote and face-to-face services, could prove to be an effective solution to improve access and reduce the direct and indirect costs associated with health services.