Development of Measures to Assess Personal Recovery in Young People Treated in Specialist Mental Health Services

A Brief Cognitive Analytic Therapy-Informed Approach for Young People That Have Self-Injured (CATCH-Y): A Case Series

BACKGROUND

Non-suicidal self-injury (NSSI) presents an increasingly prevalent problem for young people; however, there remains a scarce evidence base for effective, scalable treatments for adolescents. This study aimed to assess the feasibility and acceptability of a brief, cognitive analytic therapy (CAT)-informed intervention for young people who engage in NSSI (CATCH-Y).

METHODS

A case series design recruited 13 young people who met the inclusion and exclusion criteria to participate in the five-session intervention. Eligible participants were aged 13-17 years (M = 15.15, SD = 1.28) and had engaged in NSSI at least once in the previous 6 months. Feasibility and acceptability were measured via recruitment, retention, qualitative feedback and missing data. The secondary outcome measures of personal recovery and motivation were administered pre- and post-assessment, with measures of depressive symptoms and urges to self-injure.

RESULTS

The intervention was found to be largely feasible and acceptable with high rates of recruitment, retention and pre-/post-assessment data completeness. Measures showed preliminary support for positive change in rates of NSSI, urges to self-harm, low mood and personal recovery, although results were mixed. Completion rates for remote assessments were low.

CONCLUSIONS

The findings of this study support further evaluation of the CATCH-Y intervention on a larger scale. In-person assessments may be preferable to remote to ensure good completion rates.

Internet-based interventions to support recovery in youth: A systematic review

Personal recovery represents a paradigm shift in how individuals are seen to benefit from mental health interventions, from a narrow view of symptom reduction to a holistic, multi-dimensional view of well-being, functional gains and rehabilitation. Although there is a large body of evidence supporting the use of recovery-oriented care in adults, research on personal recovery amongst youth with mental health concerns is an emerging area of research. Efforts to promote youth mental health have also focussed on the use of digital applications and platforms as a means of overcoming barriers related to factors including stigma and lack of available services. This systematic review aims to review the literature on existing internet-based, youth mental health interventions with regard to (a) identifying elements of the programs that align with the personal recovery and (b) outcome measures utilised in assessing personal recovery. Eleven papers were identified that met the inclusion criteria. Five of the programs reviewed from these eleven papers showed efficacy for recovery processes. The results offer preliminary support and guidance for the use of internet-based mental health interventions in the promotion of personal recovery amongst youth. Future research and practice are suggested to further develop understanding in this area.

Review: Young people's recovery processes from mental health problems - a scoping review

BACKGROUND

Recovery from mental illness and mental health problems is relatively well-researched among adults, but evidence that focuses on the recovery experiences of young people and what characterizes it is scarce. With this in mind, this article aims to map out the existing research in order to identify prevailing knowledge about the recovery of young people between the ages of 12 and 25.

METHOD

Drawing on scoping review methodology, this article is based on an analysis of 33 articles conducted in the USA, Australia, and Europe.

RESULTS

Our findings reveal that young people express both similar and divergent lines of reasoning about recovery compared with adults. Our findings also indicate that young people often fluctuate in the way they view recovery, and that they thus tend to be ambivalent about what recovery means. Parents usually highlight the importance of professionals facilitating recovery, while care staff problematize the organizational frameworks available as aggravating circumstances for implementing personal recovery. Young people, parents, and care staff consistently describe recovery as a way to, despite lingering problems, enable a satisfying life.

CONCLUSIONS

Through this review, we outline the need for a more distinct focus on agency and participation in young people's recovery processes, at the same time as family involvement needs to be further investigated and operationalized.

'Don't abandon me': Young people's experiences of child and adolescent psychiatric inpatient care supporting recovery described in blogs

Child and adolescent psychiatric (CAP) inpatient care has the potential to support or hinder young people's mental-health recovery. Research describing inpatient care from the perspective of young people is rare. Personal blogs provide an opportunity to further understand how inpatient care relates to young people's recovery processes. This study aimed to explore young people's experiences of CAP inpatient care supporting mental-health recovery. The study is reported in accordance with the COREQ guidelines. Data were created during 2018 from twenty-seven personal blogs describing first-hand experiences of being a patient in a CAP inpatient care facility in Sweden and analysed using a method for interpretive description. Information in blogs suggests they were written by women, a majority of which had experienced eating disorders. Findings describe young people's experiences of CAP inpatient care supporting mental-health recovery in an interpretive explanation with one theme, 'Don't abandon me', and three sub-themes: 'Listen to me', 'Believe in me', and 'Allow me to feel safe'. This study adds to the growing body of empirical work suggesting the importance of the concept of recovery in young people's mental health. To support recovery, CAP inpatient care needs to focus on developing the content of care rather than minimizing the length of the stay. User experience should be at the heart of efforts aimed at improving services.

Is self-directed mental health recovery relevant for children and young people?

Consumer-directed, personal recovery-oriented mental health services are now the focus of mental health policies around the globe. However, there has been minimal debate about how the approach applies to young people. This study sought to address this gap through a Delphi approach, using three rounds of surveys, to gain a convergence of opinion from Australian Child and Adolescent Mental Health Service (CAMHS) practitioners regarding the relevance of personal recovery for children and adolescents. The findings suggest that concepts of personal recovery are appropriate for a young population. However, parents and carers are integral to the mental health recovery journeys of young people, either directly as guardian/decision-maker and/or indirectly through the impact of caring for a young person with mental health problems. Further exploration of the relevance and application of personal recovery in the context of young people is warranted, particularly from the perspectives of adolescents, younger children and carers of young people with mental health problems.

Measuring outcomes within inpatient child and adolescent mental health services: an evaluation of the Recovery Questionnaire for Young People

BACKGROUND

The notion of personal recovery has become central to the delivery of mental health services; however, no published subjective recovery measure has been validated in an inpatient adolescent mental health sample. We aimed to evaluate the psychometric properties of the Recovery Questionnaire for Young People (ReQuest-YP) in this inpatient context.

METHODS

Both cross-sectional and longitudinal self-report data were collected. The ReQuest-YP was administered to 65 adolescents (11 males, 52 females and 2 who identified as transgender) within inpatient child and adolescent mental health services (UK) along with a feedback questionnaire, to assess the face validity of the measure. The young person's Health of the National Outcome Scales (HoNOSCA) score, as rated by clinicians in inpatient services, was also obtained to assess the convergent validity of the measure.

RESULTS

The results demonstrated that the ReQuest-YP demonstrated excellent internal consistency (alpha ≥ .914), test-retest reliability (ICC = .91) and sensitivity to change (Z = -2.09). The measure did not correlate with the ratings on the HoNOSCA. Feedback indicated the ReQuest-YP was relevant and acceptable to young people. Suggestions were made about refining some questionnaire items.

CONCLUSIONS

The ReQuest-YP demonstrated clinical utility as a measure of subjective recovery in inpatient child and adolescent mental health services. Refinement of some of the questions along with further evaluation of the measure in this population is recommended. Key Practitioner Message The ReQuest-YP offers a potential tool for exploring, assessing and evaluating subjective or personal recovery for young people in inpatient units. The measure is potentially reliable, valid and acceptable to service users, and so clinicians may wish to consider use in these settings. There is indication that the questionnaire is also sensitive to change in an inpatient admission context, although further work is needed.

The lived experience of adolescent users of mental health services in Vienna, Austria: A qualitative study of personal recovery

PROBLEM

In Austria, one in four adolescents suffers from a mental health problem, yet there is a lack of adequate care structures. Therefore, the personal recovery of these adolescents is of particular interest. The aim of the study was to explore, from a Child and Adolescent Psychiatric Mental Health Nursing (CAPMHN) perspective, how adolescent users of mental health services in Vienna, Austria experienced personal recovery after a stay in hospital, and to discover what had influenced the personal recovery of adolescent users of mental health services in Vienna.

METHODS

Ten episodic interviews with adolescents were conducted. Nine of them were analyzed following the content analysis of Mayring (2015).

FINDINGS

The findings of the survey indicate that the personal recovery of the participants was influenced by personal and external factors. Personal factors were the subjective experience of illness and recovery, optimism, resources, and ambivalence. External factors were family, peers, and treatment. The findings suggest that personal recovery of adolescents with a mental health problem is affected by youth-specific aspects.

CONCLUSIONS

CAPMHNs can support the personal recovery of adolescent users of mental health services, so providing recovery-oriented care, adequate care structures, and specific nursing skills is crucial.