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Leamy M, Clarke E, Le Boutillier C, Bird V, Choudhury R, MacPherson R, Pesola F, Sabas K, Williams J, Williams P, Slade M. Recovery practice in community mental health teams: national survey. Br J Psychiatry 2016; 209:340-346. [PMID: 27340113 PMCID: PMC5046739 DOI: 10.1192/bjp.bp.114.160739] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/07/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is consensus about the importance of 'recovery' in mental health services, but the link between recovery orientation of mental health teams and personal recovery of individuals has been underresearched. AIMS To investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult mental health teams in England. METHOD In six English mental health National Health Service (NHS) trusts, randomly chosen community adult mental health teams were surveyed. A random sample of ten patients, one team leader and a convenience sample of five clinicians were surveyed from each team. All respondents rated the recovery orientation of their team using parallel versions of the Recovery Self Assessment (RSA). In addition, service users also rated their own personal recovery using the Questionnaire about Processes of Recovery (QPR). RESULTS Team leaders (n = 22) rated recovery orientation higher than clinicians (n = 109) or patients (n = 120) (Wald(2) = 7.0, P = 0.03), and both NHS trust and team type influenced RSA ratings. Patient-rated recovery orientation was a predictor of personal recovery (b = 0.58, 95% CI 0.31-0.85, P<0.001). Team leaders and clinicians with experience of mental illness (39%) or supporting a family member or friend with mental illness (76%) did not differ in their RSA ratings from other team leaders or clinicians. CONCLUSIONS Compared with team leaders, frontline clinicians and service users have less positive views on recovery orientation. Increasing recovery orientation may support personal recovery.
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Affiliation(s)
- M. Leamy
- Correspondence: Mary Leamy, King's College London, National Nursing Research Unit, Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
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Wallace G, Bird V, Leamy M, Bacon F, Le Boutillier C, Janosik M, MacPherson R, Williams J, Slade M. Service user experiences of REFOCUS: a process evaluation of a pro-recovery complex intervention. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1275-84. [PMID: 27365099 DOI: 10.1007/s00127-016-1257-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 06/15/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE Policy is increasingly focused on implementing a recovery-orientation within mental health services, yet the subjective experience of individuals receiving a pro-recovery intervention is under-studied. The aim of this study was to explore the service user experience of receiving a complex, pro-recovery intervention (REFOCUS), which aimed to encourage the use of recovery-supporting tools and support recovery-promoting relationships. METHODS Interviews (n = 24) and two focus groups (n = 13) were conducted as part of a process evaluation and included a purposive sample of service users who received the complex, pro-recovery intervention within the REFOCUS randomised controlled trial (ISRCTN02507940). Thematic analysis was used to analyse the data. RESULTS Participants reported that the intervention supported the development of an open and collaborative relationship with staff, with new conversations around values, strengths and goals. This was experienced as hope-inspiring and empowering. However, others described how the recovery tools were used without context, meaning participants were unclear of their purpose and did not see their benefit. During the interviews, some individuals struggled to report any new tasks or conversations occurring during the intervention. CONCLUSION Recovery-supporting tools can support the development of a recovery-promoting relationship, which can contribute to positive outcomes for individuals. The tools should be used in a collaborative and flexible manner. Information exchanged around values, strengths and goals should be used in care-planning. As some service users struggled to report their experience of the intervention, alternative evaluation approaches need to be considered if the service user experience is to be fully captured.
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Affiliation(s)
- Genevieve Wallace
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Victoria Bird
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, UK.
| | - Mary Leamy
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Faye Bacon
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Clair Le Boutillier
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Monika Janosik
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | | | - Julie Williams
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Mike Slade
- Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK
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Yarborough BJH, Yarborough MT, Janoff SL, Green CA. Getting by, getting back, and getting on: Matching mental health services to consumers' recovery goals. Psychiatr Rehabil J 2016; 39:97-104. [PMID: 26414748 PMCID: PMC4809796 DOI: 10.1037/prj0000160] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The goal of this study was to better understand mental health recovery from the point of view of mental health consumers to identify opportunities for practice improvements that closely align services with consumer goals and consumer-preferred outcomes. METHOD As part of an exploratory study of recovery, semistructured interviews were conducted with 177 integrated health plan members diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, or affective psychosis. Transcripts of in-depth interviews were coded using Atlas.ti, and definitions of recovery were further subcoded. A qualitative analysis using a modified grounded theory approach and constant comparative method identified common themes and less common but potentially important recovery-related experiences and perspectives. RESULTS Three primary and 2 cross-cutting themes emerged. "Getting by" meant coping and meeting basic needs. "Getting back" meant learning to live with mental illness. "Getting on" meant living a life where mental illness was no longer prominent. Regaining control and recouping losses were cross-cutting themes. CONCLUSIONS/IMPLICATIONS FOR PRACTICE Mental health recovery is complex and dynamic; individuals' recovery goals can be expected to change over time. Person-centered care must accommodate changing consumer priorities, services must be flexible and responsive, and outcomes need to match consumers' objectives. Clinicians can assist in (a) identifying recovery goals, (b) monitoring progress toward and recognizing movement away from goals, (c) tailoring support to different phases/stages, and (d) supporting transitions between phases/stages. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Carla A Green
- Center for Health Research, Kaiser Permanente Northwest
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Ferrazzi P, Krupa T. Re: Mental health rehabilitation in therapeutic jurisprudence: Theoretical improvements. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 46:42-49. [PMID: 27107821 DOI: 10.1016/j.ijlp.2016.02.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Legal scholarship relevant to criminal court mental health initiatives that divert people with mental illness from prosecution to treatment has created the concept of therapeutic jurisprudence (TJ), an approach that seeks to maximize the law's potential for therapeutic outcomes. Despite recognition that TJ includes a rehabilitative response as a key animating principle and that it advocates for interdisciplinary synthesis, TJ has developed mainly from within the practice and discipline of law and without reference to the discipline of rehabilitation science, in which approaches to mental health rehabilitation (MHR) have witnessed significant developments in recent decades. In particular, concepts of MHR have shifted from a biomedical focus to a psychosocial approach, such as the recovery model, that incorporates values of self-determination, independence, and empowerment. It is argued that greater consideration of MHR will improve the theoretical validity of TJ by 1) helping define what 'therapeutic' means; 2) constructing a normative framework; and 3) broadening the scope of TJ as an interdisciplinary approach. More research is needed to ensure concepts from MHR rehabilitation science are considered in TJ legal scholarship and criminal court mental health initiatives.
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Affiliation(s)
- Priscilla Ferrazzi
- University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
| | - Terry Krupa
- Queen's University, 31 George Street, Kingston, ON, K7L 3N6, Canada.
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Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, Kulkarni J, McGorry P, Nielssen O, Tran N. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 2016; 50:410-72. [PMID: 27106681 DOI: 10.1177/0004867416641195] [Citation(s) in RCA: 502] [Impact Index Per Article: 62.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES This guideline provides recommendations for the clinical management of schizophrenia and related disorders for health professionals working in Australia and New Zealand. It aims to encourage all clinicians to adopt best practice principles. The recommendations represent the consensus of a group of Australian and New Zealand experts in the management of schizophrenia and related disorders. This guideline includes the management of ultra-high risk syndromes, first-episode psychoses and prolonged psychoses, including psychoses associated with substance use. It takes a holistic approach, addressing all aspects of the care of people with schizophrenia and related disorders, not only correct diagnosis and symptom relief but also optimal recovery of social function. METHODS The writing group planned the scope and individual members drafted sections according to their area of interest and expertise, with reference to existing systematic reviews and informal literature reviews undertaken for this guideline. In addition, experts in specific areas contributed to the relevant sections. All members of the writing group reviewed the entire document. The writing group also considered relevant international clinical practice guidelines. Evidence-based recommendations were formulated when the writing group judged that there was sufficient evidence on a topic. Where evidence was weak or lacking, consensus-based recommendations were formulated. Consensus-based recommendations are based on the consensus of a group of experts in the field and are informed by their agreement as a group, according to their collective clinical and research knowledge and experience. Key considerations were selected and reviewed by the writing group. To encourage wide community participation, the Royal Australian and New Zealand College of Psychiatrists invited review by its committees and members, an expert advisory committee and key stakeholders including professional bodies and special interest groups. RESULTS The clinical practice guideline for the management of schizophrenia and related disorders reflects an increasing emphasis on early intervention, physical health, psychosocial treatments, cultural considerations and improving vocational outcomes. The guideline uses a clinical staging model as a framework for recommendations regarding assessment, treatment and ongoing care. This guideline also refers its readers to selected published guidelines or statements directly relevant to Australian and New Zealand practice. CONCLUSIONS This clinical practice guideline for the management of schizophrenia and related disorders aims to improve care for people with these disorders living in Australia and New Zealand. It advocates a respectful, collaborative approach; optimal evidence-based treatment; and consideration of the specific needs of those in adverse circumstances or facing additional challenges.
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Affiliation(s)
- Cherrie Galletly
- Discipline of Psychiatry, School of Medicine, The University of Adelaide, SA, Australia Ramsay Health Care (SA) Mental Health, Adelaide, SA, Australia Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - David Castle
- Department of Psychiatry, St Vincent's Health and The University of Melbourne, Melbourne, VIC, Australia
| | - Frances Dark
- Rehabilitation Services, Metro South Mental Health Service, Brisbane, QLD, Australia
| | - Verity Humberstone
- Mental Health and Addiction Services, Northland District Health Board, Whangarei, New Zealand
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia (UWA), Crawley, WA, Australia
| | - Eóin Killackey
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia
| | - Jayashri Kulkarni
- The Alfred Hospital and Monash University, Clayton, VIC, Australia Monash Alfred Psychiatry Research Centre, Melbourne, VIC, Australia
| | - Patrick McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia The University of Melbourne, Melbourne, VIC, Australia Board of the National Youth Mental Health Foundation (headspace), Parkville, VIC, Australia
| | - Olav Nielssen
- Psychiatry, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Nga Tran
- St Vincent's Mental Health, Melbourne, VIC, Australia Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
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Stickley T, Higgins A, Meade O, Sitvast J, Doyle L, Ellilä H, Jormfeldt H, Keogh B, Lahti M, Skärsäter I, Vuokila-Oikkonen P, Kilkku N. From the rhetoric to the real: A critical review of how the concepts of recovery and social inclusion may inform mental health nurse advanced level curricula - The eMenthe project. NURSE EDUCATION TODAY 2016; 37:155-163. [PMID: 26687142 DOI: 10.1016/j.nedt.2015.11.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 09/29/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES This critical review addresses the question of how the concepts of recovery and social inclusion may inform mental health nurse education curricula at Master's level in order to bring about significant and positive change to practice. DESIGN This is a literature-based critical review incorporating a rapid review. It has been said that if done well, this approach can be highly relevant to health care studies and social interventions, and has substantial claims to be as rigorous and enlightening as other, more conventional approaches to literature (Rolfe, 2008). DATA SOURCES In this review, we have accessed contemporary literature directly related to the concepts of recovery and social inclusion in mental health. REVIEW METHODS We have firstly surveyed the international literature directly related to the concepts of recovery and social inclusion in mental health and used the concept of emotional intelligence to help consider educational outcomes in terms of the required knowledge, skills and attitudes needed to promote these values-based approaches in practice. RESULTS A number of themes have been identified that lend themselves to educational application. International frameworks exist that provide some basis for the developments of recovery and social inclusion approaches in mental health practice, however the review identifies specific areas for future development. CONCLUSIONS This is the first article that attempts to scope the knowledge, attitudes and skills required to deliver education for Master's level mental health nurses based upon the principles of recovery and social inclusion. Emotional intelligence theory may help to identify desired outcomes especially in terms of attitudinal development to promote the philosophy of recovery and social inclusive approaches in advanced practice. Whilst recovery is becoming enshrined in policy, there is a need in higher education to ensure that mental health nurse leaders are able to discern the difference between the rhetoric and the reality.
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Affiliation(s)
- Theodore Stickley
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Institute of Mental Health Building, Triumph Road, Innovation Park, Nottingham, NG7 2TU, United Kingdom.
| | - Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | - Oonagh Meade
- School of Health Sciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
| | - Jan Sitvast
- University of Applied Sciences HU, Bolognalaan 101, 3584CJ Utrecht, The Netherlands.
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Ireland.
| | - Heikki Ellilä
- Dep. Health and Wellbeing, Turku University of Applied Sciences, Ruiskatu 2, 20720 Turku, Finland.
| | | | - Brian Keogh
- School of Nursing and Midwifery, Trinity College Dublin 2, Ireland.
| | - Mari Lahti
- University of Applied Science Turku, Ruiskatu 8, 20810 Turku, Finland.
| | | | | | - Nina Kilkku
- Tampere University of Applied Sciences, Kuntokatu 3, 33520 Tampere, Finland.
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Slade M, Bird V, Le Boutillier C, Farkas M, Grey B, Larsen J, Leamy M, Oades L, Williams J. Development of the REFOCUS intervention to increase mental health team support for personal recovery. Br J Psychiatry 2015; 207:544-50. [PMID: 26450586 DOI: 10.1192/bjp.bp.114.155978] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 02/13/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is an emerging evidence base about best practice in supporting recovery. This is usually framed in relation to general principles, and specific pro-recovery interventions are lacking. AIMS To develop a theoretically based and empirically defensible new pro-recovery manualised intervention--called the REFOCUS intervention. METHOD Seven systematic and two narrative reviews were undertaken. Identified evidence gaps were addressed in three qualitative studies. The findings were synthesised to produce the REFOCUS intervention, manual and model. RESULTS The REFOCUS intervention comprises two components: recovery-promoting relationships and working practices. Approaches to supporting relationships comprise coaching skills training for staff, developing a shared team understanding of recovery, exploring staff values, a Partnership Project with people who use the service and raising patient expectations. Working practices comprise the following: understanding values and treatment preferences; assessing strengths; and supporting goal-striving. The REFOCUS model describes the causal pathway from the REFOCUS intervention to improved recovery. CONCLUSIONS The REFOCUS intervention is an empirically supported pro-recovery intervention for use in mental health services. It will be evaluated in a multisite cluster randomised controlled trial (ISRCTN02507940).
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Affiliation(s)
- Mike Slade
- Mike Slade, PhD, Victoria Bird, BSc, Clair Le Boutillier, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Marianne Farkas, ScD, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA; Barbara Grey, PhD, South London and Maudsley NHS Foundation Trust, London, UK; John Larsen, PhD, Rethink Mental Illness, London, UK; Mary Leamy, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Lindsay Oades, PhD, Centre for Health Initiatives, University of Wollongong, NSW, Australia; Julie Williams, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Victoria Bird
- Mike Slade, PhD, Victoria Bird, BSc, Clair Le Boutillier, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Marianne Farkas, ScD, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA; Barbara Grey, PhD, South London and Maudsley NHS Foundation Trust, London, UK; John Larsen, PhD, Rethink Mental Illness, London, UK; Mary Leamy, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Lindsay Oades, PhD, Centre for Health Initiatives, University of Wollongong, NSW, Australia; Julie Williams, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Clair Le Boutillier
- Mike Slade, PhD, Victoria Bird, BSc, Clair Le Boutillier, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Marianne Farkas, ScD, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA; Barbara Grey, PhD, South London and Maudsley NHS Foundation Trust, London, UK; John Larsen, PhD, Rethink Mental Illness, London, UK; Mary Leamy, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Lindsay Oades, PhD, Centre for Health Initiatives, University of Wollongong, NSW, Australia; Julie Williams, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Marianne Farkas
- Mike Slade, PhD, Victoria Bird, BSc, Clair Le Boutillier, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Marianne Farkas, ScD, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA; Barbara Grey, PhD, South London and Maudsley NHS Foundation Trust, London, UK; John Larsen, PhD, Rethink Mental Illness, London, UK; Mary Leamy, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Lindsay Oades, PhD, Centre for Health Initiatives, University of Wollongong, NSW, Australia; Julie Williams, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Barbara Grey
- Mike Slade, PhD, Victoria Bird, BSc, Clair Le Boutillier, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Marianne Farkas, ScD, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA; Barbara Grey, PhD, South London and Maudsley NHS Foundation Trust, London, UK; John Larsen, PhD, Rethink Mental Illness, London, UK; Mary Leamy, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Lindsay Oades, PhD, Centre for Health Initiatives, University of Wollongong, NSW, Australia; Julie Williams, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - John Larsen
- Mike Slade, PhD, Victoria Bird, BSc, Clair Le Boutillier, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Marianne Farkas, ScD, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA; Barbara Grey, PhD, South London and Maudsley NHS Foundation Trust, London, UK; John Larsen, PhD, Rethink Mental Illness, London, UK; Mary Leamy, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Lindsay Oades, PhD, Centre for Health Initiatives, University of Wollongong, NSW, Australia; Julie Williams, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Mary Leamy
- Mike Slade, PhD, Victoria Bird, BSc, Clair Le Boutillier, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Marianne Farkas, ScD, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA; Barbara Grey, PhD, South London and Maudsley NHS Foundation Trust, London, UK; John Larsen, PhD, Rethink Mental Illness, London, UK; Mary Leamy, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Lindsay Oades, PhD, Centre for Health Initiatives, University of Wollongong, NSW, Australia; Julie Williams, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Lindsay Oades
- Mike Slade, PhD, Victoria Bird, BSc, Clair Le Boutillier, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Marianne Farkas, ScD, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA; Barbara Grey, PhD, South London and Maudsley NHS Foundation Trust, London, UK; John Larsen, PhD, Rethink Mental Illness, London, UK; Mary Leamy, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Lindsay Oades, PhD, Centre for Health Initiatives, University of Wollongong, NSW, Australia; Julie Williams, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Julie Williams
- Mike Slade, PhD, Victoria Bird, BSc, Clair Le Boutillier, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Marianne Farkas, ScD, Center for Psychiatric Rehabilitation, Boston University, Boston, Massachusetts, USA; Barbara Grey, PhD, South London and Maudsley NHS Foundation Trust, London, UK; John Larsen, PhD, Rethink Mental Illness, London, UK; Mary Leamy, PhD, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; Lindsay Oades, PhD, Centre for Health Initiatives, University of Wollongong, NSW, Australia; Julie Williams, MSc, Health Service and Population Research Department, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Cabassa LJ, Stefancic A, O'Hara K, El-Bassel N, Lewis-Fernández R, Luchsinger JA, Gates L, Younge R, Wall M, Weinstein L, Palinkas LA. Peer-led healthy lifestyle program in supportive housing: study protocol for a randomized controlled trial. Trials 2015; 16:388. [PMID: 26329472 PMCID: PMC4557630 DOI: 10.1186/s13063-015-0902-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/05/2015] [Indexed: 01/28/2023] Open
Abstract
Background The risk for obesity is twice as high in people with serious mental illness (SMI) compared to the general population. Racial and ethnic minority status contribute additional health risks. The aim of this study is to describe the protocol of a Hybrid Trial Type 1 design that will test the effectiveness and examine the implementation of a peer-led healthy lifestyle intervention in supportive housing agencies serving diverse clients with serious mental illness who are overweight or obese. Methods The Hybrid Trial Type 1 design will combine a randomized effectiveness trial with a mixed-methods implementation study. The effectiveness trial will test the health impacts of a peer-led healthy lifestyle intervention versus usual care in supportive housing agencies. The healthy lifestyle intervention is derived from the Group Lifestyle Balanced Program, lasts 12 months, and will be delivered by trained peer specialists. Repeated assessments will be conducted at baseline and at 6, 12, and 18 months post randomization. A mixed-methods (e.g., structured interviews, focus groups, surveys) implementation study will be conducted to examine multi-level implementation factors and processes that can inform the use of the healthy lifestyle intervention in routine practice, using data from agency directors, program managers, staff, and peer specialists before, during, and after the implementation of the effectiveness trial. Discussion This paper describes the use of a hybrid research design that blends effectiveness trial methodologies and implementation science rarely used when studying the physical health of people with SMI and can serve as a model for integrating implementation science and health disparities research. Rigorously testing effectiveness and exploring the implementation process are both necessary steps to establish the evidence for large-scale delivery of peer-led healthy lifestyle intervention to improve the physical health of racial/ethnic minorities with SMI. Trial registration www.clinicaltrials.gov; NCT02175641, registered 24 June 2014
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Affiliation(s)
- Leopoldo J Cabassa
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Ana Stefancic
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Kathleen O'Hara
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Nabila El-Bassel
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | | | - José A Luchsinger
- Columbia University Medical Center, Presbyterian Hospital, 622 West 168th St, New York, NY, 10032, USA.
| | - Lauren Gates
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA.
| | - Richard Younge
- New York Presbyterian, Family Medicine, 610 West 158th St, New York, NY, 10032, USA.
| | - Melanie Wall
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Lara Weinstein
- Jefferson University Hospital, 833 Chestnut Street, Philadelphia, PA, 19107, USA.
| | - Lawrence A Palinkas
- University of Southern California School of Social Work, University Park, Los Angeles, CA, 90089, USA.
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Slade M, Bird V, Clarke E, Le Boutillier C, McCrone P, Macpherson R, Pesola F, Wallace G, Williams J, Leamy M. Supporting recovery in patients with psychosis through care by community-based adult mental health teams (REFOCUS): a multisite, cluster, randomised, controlled trial. Lancet Psychiatry 2015; 2:503-14. [PMID: 26360446 DOI: 10.1016/s2215-0366(15)00086-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 02/09/2015] [Accepted: 02/09/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Mental health policy in many countries is oriented around recovery, but the evidence base for service-level recovery-promotion interventions is lacking. METHODS We did a cluster, randomised, controlled trial in two National Health Service Trusts in England. REFOCUS is a 1-year team-level intervention targeting staff behaviour to increase focus on values, preferences, strengths, and goals of patients with psychosis, and staff-patient relationships, through coaching and partnership. Between April, 2011, and May, 2012, community-based adult mental health teams were randomly allocated to provide usual treatment plus REFOCUS or usual treatment alone (control). Baseline and 1-year follow-up outcomes were assessed in randomly selected patients. The primary outcome was recovery and was assessed with the Questionnaire about Processes of Recovery (QPR). We also calculated overall service costs. We used multiple imputation to estimate missing data, and the imputation model captured clustering at the team level. Analysis was by intention to treat. This trial is registered, number ISRCTN02507940. FINDINGS 14 teams were included in the REFOCUS group and 13 in the control group. Outcomes were assessed in 403 patients (88% of the target sample) at baseline and in 297 at 1 year. Mean QPR total scores did not differ between the two groups (REFOCUS group 40·6 [SD 10·1] vs control 40·0 [10·2], adjusted difference 0·68, 95% CI -1·7 to 3·1, p=0·58). High team participation was associated with higher staff-rated scores for recovery-promotion behaviour change (adjusted difference -0·4, 95% CI -0·7 to -0·2, p=0·001) and patient-rated QPR interpersonal scores (-1·6, -2·7 to -0·5, p=0·005) at follow-up than low participation. Patients treated in the REFOCUS group incurred £1062 (95% CI -1103 to 3017) lower adjusted costs than those in the control group. INTERPRETATION Although the primary endpoint was negative, supporting recovery might, from the staff perspective, improve functioning and reduce needs. Implementation of REFOCUS could increase staff recovery-promotion behaviours and improve patient-rated recovery. FUNDING National Institute for Health Research.
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Affiliation(s)
- Mike Slade
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, London, UK.
| | - Victoria Bird
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, London, UK
| | - Eleanor Clarke
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, London, UK
| | - Clair Le Boutillier
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, London, UK
| | - Paul McCrone
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, London, UK
| | - Rob Macpherson
- 2Gether NHS Foundation Trust, Rikenell, Montpellier, Gloucester, UK
| | - Francesca Pesola
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, London, UK
| | - Genevieve Wallace
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, London, UK
| | - Julie Williams
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, London, UK
| | - Mary Leamy
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, Denmark Hill, London, UK
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Dammann G. [Chances and problems of the recovery approach from a psychiatric viewpoint]. DER NERVENARZT 2015; 85:1156-65. [PMID: 24604716 DOI: 10.1007/s00115-014-4007-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The so-called recovery approach is consciously demarcated from traditional psychiatry and enforces claims to introduce a paradigmatically new view on mental healthcare. Recovery is perceived as an individual-centered activating process, enabling mentally ill persons to live with hope and meaning despite disabilities. In some countries recovery is widely used by psychiatric nurses and mental health workers and to some extent is now part of national health programs. Nevertheless, concerted discussions from a psychiatric perspective are rare and the nomenclature is sometimes vague. A brief review of the model, its theoretical roots and the discussion on whether it is novel is given. Finally, strengths and critical aspects of the approach are compared and clinical questions exemplified.
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Affiliation(s)
- G Dammann
- Psychiatrische Dienste Thurgau, Spital Thurgau AG, Psychiatrische Klinik Münsterlingen, 8596, Münsterlingen, Schweiz,
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Williams J, Leamy M, Bird V, Le Boutillier C, Norton S, Pesola F, Slade M. Development and evaluation of the INSPIRE measure of staff support for personal recovery. Soc Psychiatry Psychiatr Epidemiol 2015; 50:777-86. [PMID: 25409867 DOI: 10.1007/s00127-014-0983-0] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 11/10/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND No individualised standardised measure of staff support for mental health recovery exists. AIMS To develop and evaluate a measure of staff support for recovery. DEVELOPMENT initial draft of measure based on systematic review of recovery processes; consultation (n = 61); and piloting (n = 20). Psychometric evaluation: three rounds of data collection from mental health service users (n = 92). RESULTS INSPIRE has two sub-scales. The 20-item Support sub-scale has convergent validity (0.60) and adequate sensitivity to change. Exploratory factor analysis (variance 71.4-85.1 %, Kaiser-Meyer-Olkin 0.65-0.78) and internal consistency (range 0.82-0.85) indicate each recovery domain is adequately assessed. The 7-item Relationship sub-scale has convergent validity 0.69, test-retest reliability 0.75, internal consistency 0.89, a one-factor solution (variance 70.5 %, KMO 0.84) and adequate sensitivity to change. A 5-item Brief INSPIRE was also evaluated. CONCLUSIONS INSPIRE and Brief INSPIRE demonstrate adequate psychometric properties, and can be recommended for research and clinical use.
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Affiliation(s)
- Julie Williams
- Health Service and Population Research Department (Box P029), Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK,
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Schön UK, Svedberg P, Rosenberg D. Evaluating the INSPIRE measure of staff support for personal recovery in a Swedish psychiatric context. Nord J Psychiatry 2015; 69:275-81. [PMID: 25377024 DOI: 10.3109/08039488.2014.972453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Recovery is understood to be an individual process that cannot be controlled, but can be supported and facilitated at the individual, organizational and system levels. Standardized measures of recovery may play a critical role in contributing to the development of a recovery-oriented system. The INSPIRE measure is a 28-item service user-rated measure of recovery support. INSPIRE assesses both the individual preferences of the user in the recovery process and their experience of support from staff. AIM The aim of this study was to evaluate the psychometric properties of the Swedish version of the INSPIRE measure, for potential use in Swedish mental health services and in order to promote recovery in mental illness. METHOD The sample consisted of 85 participants from six community mental health services targeting people with a diagnosis of psychosis in a municipality in Sweden. For the test-retest evaluation, 78 participants completed the questionnaire 2 weeks later. RESULTS The results in the present study indicate that the Swedish version of the INSPIRE measure had good face and content validity, satisfactory internal consistency and some level of instability in test-retest reliability. CONCLUSIONS While further studies that test the instrument in a larger and more diverse clinical context are needed, INSPIRE can be considered a relevant and feasible instrument to utilize in supporting the development of a recovery-oriented system in Sweden.
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Affiliation(s)
- Ulla-Karin Schön
- Ulla-Karin Schön, School of Health and Social Work, Dalarna University , Sweden
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Piat M, Boyer R, Fleury MJ, Lesage A, O'Connell M, Sabetti J. Resident and proprietor perspectives on a recovery orientation in community-based housing. Psychiatr Rehabil J 2015; 38:88-95. [PMID: 25559078 PMCID: PMC4835231 DOI: 10.1037/prj0000104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Stable housing is a fundamental human right, and an important element for both mental health recovery and social inclusion among people with serious mental illness. This article reports findings from a study on the recovery orientation of structured congregate community housing services using the Recovery Self-Assessment Questionnaire (RSA) adapted for housing (O'Connell, Tondora, Croog, Evans, & Davidson, 2005). METHODS The RSA questionnaires were administered to 118 residents and housing providers from 112 congregate housing units located in Montreal, Canada. RESULTS Residents rated their homes as significantly less recovery-oriented than did proprietors, which is contrary to previous studies of clinical services or Assertive Community Treatment where RSA scores for service users were significantly higher than service provider scores. Findings for both groups suggest the need for improvement on 5 of 6 RSA factors. While proprietors favored recovery training and education, and valued resident opinion and experience, vestiges of a traditional medical model governing this housing emerged in other findings, as in agreement between the 2 groups that residents have little choice in case management, or in the belief among proprietors that residents are unable to manage their symptoms. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This study demonstrates that the RSA adapted for housing is a useful tool for creating recovery profiles of housing services. The findings provide practical guidance on how to promote a recovery orientation in structured community housing, as well as a novel approach for reaching a common understanding of what this entails among stakeholders. (PsycINFO Database Record
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Affiliation(s)
- Myra Piat
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University
| | - Richard Boyer
- Department of Psychiatry, Mental Health University Institute of Montreal, University of Montreal
| | - Marie-Josée Fleury
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University
| | - Alain Lesage
- Department of Psychiatry, Mental Health University Institute of Montreal, University of Montreal
| | - Maria O'Connell
- Department of Psychiatry, Center for Community Health and Recovery, Yale University
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Raeburn T, Schmied V, Hungerford C, Cleary M. Clubhouse model of psychiatric rehabilitation: how is recovery reflected in documentation? Int J Ment Health Nurs 2014; 23:389-97. [PMID: 24698159 DOI: 10.1111/inm.12068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recovery-oriented models of psychiatric rehabilitation, such as the Clubhouse model, are an important addendum to the clinical treatment modalities that assist people with chronic and severe mental illness. Several studies have described the subjective experiences of personal recovery of individuals in the clubhouse context, but limited research has been undertaken on how clubhouses have operationalized recovery in practice. The research question addressed in this paper is: How are recovery-oriented practices reflected in the documentation of a clubhouse? The documents examined included representative samples of key documents produced or utilized by a clubhouse, including public health-promotion materials and policy and membership documents. Data were subjected to content analysis, supported by the Recovery Promotion Fidelity Scale. The recovery categories identified in the documents included collaboration (27.7%), acceptance and participation (25.3%), quality improvement (18.0%), consumer and staff development (14.5%), and self-determination (14.5%). These categories show how the clubhouse constructs and represents personal recovery through its documentation. The findings are important in light of the role that documentation can play in influencing communication, relationships, and behaviour within organizations. The findings can also be used to inform future research related to recovery-oriented practices in clubhouse settings.
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Affiliation(s)
- Toby Raeburn
- School of Nursing & Midwifery, University of Western Sydney, Sydney, New South Wales, Australia
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Bird V, Leamy M, Tew J, Le Boutillier C, Williams J, Slade M. Fit for purpose? Validation of a conceptual framework for personal recovery with current mental health consumers. Aust N Z J Psychiatry 2014; 48:644-53. [PMID: 24413806 DOI: 10.1177/0004867413520046] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mental health services in the UK, Australia and other Anglophone countries have moved towards supporting personal recovery as a primary orientation. To provide an empirically grounded foundation to identify and evaluate recovery-oriented interventions, we previously published a conceptual framework of personal recovery based on a systematic review and narrative synthesis of existing models. Our objective was to test the validity and relevance of this framework for people currently using mental health services. METHOD Seven focus groups were conducted with 48 current mental health consumers in three NHS trusts across England, as part of the REFOCUS Trial. Consumers were asked about the meaning and their experience of personal recovery. Deductive and inductive thematic analysis applying a constant comparison approach was used to analyse the data. The analysis aimed to explore the validity of the categories within the conceptual framework, and to highlight any areas of difference between the conceptual framework and the themes generated from new data collected from the focus groups. RESULTS Both the inductive and deductive analysis broadly validated the conceptual framework, with the super-ordinate categories Connectedness, Hope and optimism, Identity, Meaning and purpose, and Empowerment (CHIME) evident in the analysis. Three areas of difference were, however, apparent in the inductive analysis. These included practical support; a greater emphasis on issues around diagnosis and medication; and scepticism surrounding recovery. CONCLUSIONS This study suggests that the conceptual framework of personal recovery provides a defensible theoretical base for clinical and research purposes which is valid for use with current consumers. However, the three areas of difference further stress the individual nature of recovery and the need for an understanding of the population and context under investigation.
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Affiliation(s)
- Victoria Bird
- King's College London, Institute of Psychiatry, London, UK
| | - Mary Leamy
- King's College London, Institute of Psychiatry, London, UK
| | - Jerry Tew
- University of Birmingham, Edgbaston, Birmingham, UK
| | | | - Julie Williams
- King's College London, Institute of Psychiatry, London, UK
| | - Mike Slade
- King's College London, Institute of Psychiatry, London, UK
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Rabenschlag F, Konrad A, Rueegg S, Jaeger M. A recovery-oriented approach for an acute psychiatric ward: is it feasible and how does it affect staff satisfaction? Psychiatr Q 2014; 85:225-39. [PMID: 24307177 DOI: 10.1007/s11126-013-9285-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
To evaluate professionals' attitudes to recovery and coercion, as well their satisfaction with working conditions before and after the implementation of a recovery-oriented ward concept on an admission ward. Longitudinal study design with two measurement times of the study sample, with a control group assessed at study end. Evaluating the implementation of the recovery concept, attitudes towards recovery, coercion, perceptions of the ward and working satisfaction were assessed with questionnaires and computed using Chi square and ANOVA variance analyses. The members of the intervention ward (n = 17) did not differ from the control group (n = 21), except that control group members were younger. The recovery-orientation of the study ward (ROSE questionnaire) increased significantly (alpha level = 0.05) from study begin to study end (p = 0.003), and compared to the control group (p = 0.002). The attitudes towards coercion did not change significantly in the intervention group, but did so compared to the control group. The contentedness (GMI) and the satisfaction with working conditions (ABB) of the intervention group members compared to control group was significantly higher (GMI: p = 0.004, ABB subscale working conditions: p = 0.043, satisfaction: p = 0.023). The study indicates that recovery-oriented principles can be implemented even in an acute admission ward, increasing team satisfaction with work, while attitudes towards coercion did not change significantly within this single-unit project.
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Abstract
Assessing the outcomes of interventions in mental health care is both important and challenging. The aim of this paper is to advance the field of outcomes research by proposing a taxonomy of the decisions that clinicians and researchers need to consider when evaluating outcomes. Our taxonomy has eight components, framed as decisions: Whose outcome will be considered? Which scientific stage is being investigated? What outcome domain(s) matter? What level of assessment will be used? Will clinical and/or recovery outcomes be assessed? Whose perspective will be considered? Will deficits and/or strengths be the focus? Will invariant or individualized measures be preferred? We propose a future focus on understanding what matters most to people using mental health services, and on the use of measures rated by service users as the primary approach to evaluating outcome.
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Affiliation(s)
- Graham Thornicroft
- King's College London, Health Service and Population Research Department; Institute of Psychiatry; Denmark Hill London SE5 8AF UK
| | - Mike Slade
- King's College London, Health Service and Population Research Department; Institute of Psychiatry; Denmark Hill London SE5 8AF UK
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68
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Chandler D, Wilson S. Measuring the Capacity of Staff Culture to Further Recovery from Psychiatric Disabilities. J Behav Health Serv Res 2014; 41:153-66. [PMID: 23794124 PMCID: PMC3944429 DOI: 10.1007/s11414-013-9348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Three linked instruments for measuring the recovery-orientation of mental health program culture are introduced as the Recovery Centered Measures (RCM). Two scales assess the views of staff and of consumers, respectively, regarding staff–consumer interactions. A third scale measures staff culture. The RCM scales are quick, easy to understand (reading level of grade 5.4), and internally consistent. Test–retest correlations ranged from 0.81 to 0.67. Convergent validity with three related instruments was appropriate. The scales discriminate ACT from residential programs. The RCM scales show strong potential to be useful to program administrators and researchers working to increase the recovery-orientation of programs.
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Affiliation(s)
- Daniel Chandler
- 436 Old Wagon Road, Trinidad, CA 95570 95570 USA
- Telecare Corporation, 1080 Marina Village Parkway, Alameda, CA 95570 94501 USA
| | - Stephen Wilson
- Telecare Corporation, 1080 Marina Village Parkway, Alameda, CA 95570 94501 USA
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Slade M, Amering M, Farkas M, Hamilton B, O'Hagan M, Panther G, Perkins R, Shepherd G, Tse S, Whitley R. Uses and abuses of recovery: implementing recovery-oriented practices in mental health systems. World Psychiatry 2014; 13:12-20. [PMID: 24497237 PMCID: PMC3918008 DOI: 10.1002/wps.20084] [Citation(s) in RCA: 436] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
An understanding of recovery as a personal and subjective experience has emerged within mental health systems. This meaning of recovery now underpins mental health policy in many countries. Developing a focus on this type of recovery will involve transformation within mental health systems. Human systems do not easily transform. In this paper, we identify seven mis-uses ("abuses") of the concept of recovery: recovery is the latest model; recovery does not apply to "my" patients; services can make people recover through effective treatment; compulsory detention and treatment aid recovery; a recovery orientation means closing services; recovery is about making people independent and normal; and contributing to society happens only after the person is recovered. We then identify ten empirically-validated interventions which support recovery, by targeting key recovery processes of connectedness, hope, identity, meaning and empowerment (the CHIME framework). The ten interventions are peer support workers, advance directives, wellness recovery action planning, illness management and recovery, REFOCUS, strengths model, recovery colleges or recovery education programs, individual placement and support, supported housing, and mental health trialogues. Finally, three scientific challenges are identified: broadening cultural understandings of recovery, implementing organizational transformation, and promoting citizenship.
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Affiliation(s)
- Mike Slade
- King's College London, Health Service and Population Research Department, Institute of Psychiatry, Denmark Hill, London, SE5 8AF, UK
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Green CA, Estroff SE, Yarborough BJH, Spofford M, Solloway MR, Kitson RS, Perrin NA. Directions for future patient-centered and comparative effectiveness research for people with serious mental illness in a learning mental health care system. Schizophr Bull 2014; 40 Suppl 1:S1-S94. [PMID: 24489078 PMCID: PMC3911266 DOI: 10.1093/schbul/sbt170] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Measuring recovery: validity of the "Recovery Process Inventory" and the "Recovery Attitudes Questionnaire". Psychiatry Res 2013; 210:363-7. [PMID: 23859131 DOI: 10.1016/j.psychres.2013.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 05/23/2013] [Accepted: 06/04/2013] [Indexed: 11/24/2022]
Abstract
Considerable lack of publications and inconsistent results on construct validity make it difficult to choose an appropriate instrument to measure recovery. The aim of the present study was to evaluate additional psychometric aspects of two established measures of personal recovery with differing focuses. Bivariate associations of the recovery measures with personal, clinical and subjective factors were conducted as indicators of concurrent (convergent and divergent) validity. The scales were also tested concerning internal consistency. The sample comprised of 81 inpatients on an acute psychiatric ward (main diagnoses: 27% substance-related disorders, 27% schizophrenic disorders, 25% affective disorders, 10% neurotic or stress-related disorders, and 11% personality disorders). The "Recovery Attitudes Questionnaire (RAQ)" has to be reevaluated before further administration due to serious psychometric shortcomings concerning internal consistency and concurrent validity. The "Recovery Process Inventory (RPI)" total scale showed acceptable concurrent and within-scale validity and can be recommended in order to measure the personal recovery process for clinical and scientific purposes.
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72
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Adegbaju DA, Olagunju AT, Uwakwe R. A comparative analysis of disability in individuals with bipolar affective disorder and schizophrenia in a sub-Saharan African mental health hospital: towards evidence-guided rehabilitation intervention. Soc Psychiatry Psychiatr Epidemiol 2013; 48:1405-15. [PMID: 23385802 DOI: 10.1007/s00127-013-0654-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 01/08/2013] [Indexed: 02/05/2023]
Abstract
PURPOSE Bipolar affective disorder (BAD) and schizophrenia are two severe psychotic conditions that are associated with disability. The present study was designed to compare the pattern of disability between clinically stable individuals with BAD and schizophrenia in a sub-Saharan mental health facility. METHODS A total of 200 consecutive participants (made up of 100 each among clinically stable individuals with BAD and schizophrenia) were recruited. All participants had their diagnoses confirmed using Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID), after which the designed questionnaire and the 36-item World Health Organisation Disability Assessment Schedule interview (WHODAS II) were administered to them. RESULTS In this study, the level of disability among participants with BAD was better compared to those with schizophrenia as determined by mean WHODAS score of 24.93 and 27.02, respectively. Similarly, there was a significant difference between participants with BAD and schizophrenia with respect to four domains of the WHODAS-II, viz, self-care (p < 0.001), getting along with others (p < 0.001), life activities (p < 0.001) and participation in the society (p < 0.001). The factors that were significantly associated with disability in the two groups (BAD and schizophrenia) were: unemployment status (p < 0.001) and remittance source of income (p < 0.001), while those that spent not more than ₦2,000 (13 dollars) per month on treatment (p = 0.004) were observed to be less disabled. CONCLUSIONS Overall, participants with BAD fared better in the level of disability and most of the measured domains of disability in comparison with those with schizophrenia. Both socio-demographic and treatment-related factors seem to define the pattern disability among participants. Thus, evidence-guided preventive and rehabilitative treatment strategies directed against functional impairment using prioritized model among individuals with BAD and schizophrenia are advocated.
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Gilburt H, Slade M, Bird V, Oduola S, Craig TKJ. Promoting recovery-oriented practice in mental health services: a quasi-experimental mixed-methods study. BMC Psychiatry 2013; 13:167. [PMID: 23764121 PMCID: PMC3683325 DOI: 10.1186/1471-244x-13-167] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Accepted: 06/10/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Recovery has become an increasingly prominent concept in mental health policy internationally. However, there is a lack of guidance regarding organisational transformation towards a recovery orientation. This study evaluated the implementation of recovery-orientated practice through training across a system of mental health services. METHODS The intervention comprised four full-day workshops and an in-team half-day session on supporting recovery. It was offered to 383 staff in 22 multidisciplinary community and rehabilitation teams providing mental health services across two contiguous regions. A quasi-experimental design was used for evaluation, comparing behavioural intent with staff from a third contiguous region. Behavioural intent was rated by coding points of action on the care plans of a random sample of 700 patients (400 intervention, 300 control), before and three months after the intervention. Action points were coded for (a) focus of action, using predetermined categories of care; and (b) responsibility for action. Qualitative inquiry was used to explore staff understanding of recovery, implementation in services and the wider system, and the perceived impact of the intervention. Semi-structured interviews were conducted with 16 intervention group team leaders post-training and an inductive thematic analysis undertaken. RESULTS A total of 342 (89%) staff received the intervention. Care plans of patients in the intervention group had significantly more changes with evidence of change in the content of patient's care plans (OR 10.94. 95% CI 7.01-17.07) and the attributed responsibility for the actions detailed (OR 2.95, 95% CI 1.68-5.18). Nine themes emerged from the qualitative analysis split into two superordinate categories. 'Recovery, individual and practice', describes the perception and provision of recovery orientated care by individuals and at a team level. It includes themes on care provision, the role of hope, language of recovery, ownership and multidisciplinarity. 'Systemic implementation', describes organizational implementation and includes themes on hierarchy and role definition, training approaches, measures of recovery and resources. CONCLUSIONS Training can provide an important mechanism for instigating change in promoting recovery-orientated practice. However, the challenge of systemically implementing recovery approaches requires further consideration of the conceptual elements of recovery, its measurement, and maximising and demonstrating organizational commitment.
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Affiliation(s)
- Helen Gilburt
- King's College London, Addictions Department, Institute of Psychiatry, London, UK.
| | - Mike Slade
- King’s College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK
| | - Victoria Bird
- King’s College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK
| | - Sheri Oduola
- King’s College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK
| | - Tom KJ Craig
- King’s College London, Health Service and Population Research Department, Institute of Psychiatry, London, UK
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Teo AR, Lerrigo R, Rogers MAM. The role of social isolation in social anxiety disorder: a systematic review and meta-analysis. J Anxiety Disord 2013; 27:353-64. [PMID: 23746493 DOI: 10.1016/j.janxdis.2013.03.010] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 02/01/2013] [Accepted: 03/26/2013] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Social isolation in the context of social anxiety disorder has not been closely examined. This study aimed to describe the role and measurement of social isolation in those with social anxiety disorder. METHOD A systematic review and meta-analyses were conducted using a prospectively prepared protocol for search strategy, selection criteria, and data extraction. DerSimonian-Laird random effects models were used to calculate pooled estimates of effect. RESULTS Thirty-four studies, containing 20 formal instruments and four other measures of social isolation, were included. Most formal instruments were utilized in single studies, whereas simple structural measures (e.g., living alone) were used most frequently. The pooled score was 38.1 on the Loneliness and Social Dissatisfaction Questionnaire, 33.1 on the Liebowitz Social Anxiety Scale (avoidance subscale), and 21.1 on the Social Avoidance and Distress Scale. CONCLUSIONS Social isolation is common in social anxiety disorder but assessed by a heterogeneous mix of measures.
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Affiliation(s)
- Alan R Teo
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
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Abstract
Consumer recovery is now enshrined in the national mental health policy of many countries. If this construct, which stems from the consumer/user/survivor movement, is truly to be the official and formal goal of mental health services, then it must be the yardstick against which evidence-based practice (EBP) is judged. From a consumer-recovery perspective, this paper re-examines aspects of services chosen for study, methodologies, outcomes measures, and standards of evidence associated with EBP, those previously having been identified as deficient and in need of expansion. One of the significant differences between previous investigations and the present study is that the work, writing, perspectives, and advocacy of the consumer movement has developed to such a degree that we now have a much more extensive body of material upon which to critique EBP and inform and support the expansion of EBP. Our examination reinforces previous findings and the ongoing need for expansion. The consumer recovery-focused direction, resources, frameworks, and approaches identified through the present paper should be used to expand the aspects of services chosen for study, methodologies, outcomes measures, and standards of evidence. This expansion will ultimately enable services to practice in a manner consistent with the key characteristics of supporting personal recovery.
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Affiliation(s)
- Sarah E Gordon
- Department of Psychological Medicine, University of Otago Wellington, New Zealand.
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76
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Affiliation(s)
- MIKE SLADE
- King’s College London, Health Service
and Population Research Department, Institute of Psychiatry, Denmark Hill,
London SE5 8AF, UK
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