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Martinelli A, Bonetto C, Pozzan T, Procura E, Cristofalo D, Ruggeri M, Killaspy H. Exploring gender impact on collaborative care planning: insights from a community mental health service study in Italy. BMC Psychiatry 2023; 23:834. [PMID: 37957583 PMCID: PMC10644654 DOI: 10.1186/s12888-023-05307-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Personal recovery is associated with socio-demographic and clinical factors, and gender seems to influence the recovery process. This study aimed to investigate: i) differences in the recovery goals of men and women users of a community mental health service in Italy; ii) any differences by gender in recovery over six months using the Mental Health Recovery Star (MHRS). METHODS Service users and staff completed the MHRS together at recruitment and six months later to agree the recovery goals they wished to focus on. Socio-demographic and clinical characteristics and ratings of symptoms (BPRS), needs (CAN), functioning (FPS), and functional autonomy (MPR) were collected at recruitment and six months follow-up. Comparisons between men and women were made using t-tests. RESULTS Ten women and 15 men completed the MHRS with 19 mental health professionals. Other than gender, men and women had similar socio-demographic, and clinical characteristics at recruitment. Women tended to choose recovery goals that focused on relationships whereas men tended to focus on work related goals. At follow-up, both men and women showed improvement in their recovery (MHRS) and women were less likely to focus on relationship related goals, perhaps because some had found romantic partners. There were also gains for both men and women in engagement with work related activities. Ratings of functional autonomy (MPR) improved for both men and women, and men also showed improvement in symptoms (BPRS) and functioning (FPS). CONCLUSIONS Our findings suggest that collaborative care planning tools such as the MHRS can assist in identifying individualized recovery goals for men and women with severe mental health problems as part of their rehabilitation.
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Affiliation(s)
| | - Chiara Bonetto
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tecla Pozzan
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Elena Procura
- Mental Health Center, Isola Della Scala, Ospedale Di Bussolengo, Verona, Italy
| | - Doriana Cristofalo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Mirella Ruggeri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
- Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Helen Killaspy
- Division of Psychiatry, University College London, London, UK
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Branjerdporn G, Gillespie KM, Dymond A, Reyes NJD, Robertson J, Almeida-Crasto A, Bethi S. Development of an Interprofessional Psychosocial Interventions Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085495. [PMID: 37107777 PMCID: PMC10138946 DOI: 10.3390/ijerph20085495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 05/11/2023]
Abstract
To meet the increasingly complex needs of mental health consumers, it is essential for multidisciplinary clinicians to have capabilities across a range of psychosocial interventions. Despite this, there is scant evidence investigating the existing levels of knowledge and skills of specialties within multidisciplinary mental health teams. The purpose of this paper was to describe the self-reported capabilities of mental health clinicians, and to provide a rationale for the Psychosocial Interventions Framework Assessment (PIFA), which aims to enhance the access to, and quality of, evidence-informed practice for consumers of mental health services (MHSs) by strengthening workforce capabilities and leadership for psychosocial therapies. Using the Delphi method, the team developed a 75-item survey based on the 10-point Mental Health Recovery Star (MHRS). Participants completed a self-administered survey indicating their perceived capabilities in the PIFA items. The findings revealed lower-than-expected average scores between 'novice' and 'proficient', highlighting the need for further development of specific training and education modules for individual teams. This is the first framework of its nature to use the Recovery StarTM to determine the psychosocial areas and domains for the assessment of practitioners' strengths and needs for skill development.
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Affiliation(s)
- Grace Branjerdporn
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast 4215, Australia
- Correspondence:
| | - Kerri Marie Gillespie
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast 4215, Australia
- School of Clinical Sciences, Queensland University of Technology, Kelvin Grove 4059, Australia
| | - Alex Dymond
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast 4215, Australia
| | - Neil Josen Delos Reyes
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast 4215, Australia
| | - Julia Robertson
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast 4215, Australia
| | - Alice Almeida-Crasto
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast 4215, Australia
| | - Shailendhra Bethi
- Mental Health and Specialist Services, Gold Coast Hospital and Health Service, Gold Coast 4215, Australia
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Improvements in Hope, Engagement and Functioning Following a Recovery-Focused Sub-Acute Inpatient Intervention: a Six-Month Evaluation. Psychiatr Q 2021; 92:1611-1634. [PMID: 34125366 DOI: 10.1007/s11126-021-09934-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
Few studies have examined the post-discharge benefits associated with recover-oriented programs delivered in inpatient and sub-acute mental health settings. The aim of this study was to evaluate the medium-term outcomes of a 6-week sub-acute inpatient intervention program for 27 service users with a diagnosis of serious mental illness (mean age = 33.22 years, 70.4% with a psychosis diagnosis). Recovery data were collected on admission, at discharge, and at 3- and 6-months post-discharge using self-report, collaborative and clinical measures. The three clinician-rated measures (assessing therapeutic engagement, functioning, and life skills) revealed linear improvements from admission to 6-month follow-up (with mean z-change ranging from 0.72 to 1.35), as did the self-reported social connection measure (Mental Health Recovery Star, MHRS; mean z-change: 1.05). There were also curvilinear improvements in self-determination and self-reported MHRS symptom management and functioning scores; however, only modest changes were detected in hope (Herth Hope Index) and MHRS self-belief scores. Change scores based on self-reported and clinician-rated measures tended to be uncorrelated. An exploration of client-level outcomes revealed three recovery trajectory subgroups: transient (21.7%), gradual (34.8%), or sustained (43.5%) improvement; with members of the latter group tending to have longer illness durations. The study's findings are encouraging, to the extent that they demonstrate recovery-focused sub-acute inpatient programs can promote clinical recovery and aspects of personal recovery. However, they also suggest that recovery perspectives differ between clients and clinicians, and that far more work is required to understand the psychological factors that generate and sustain the hope that recovery is possible.
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Sly KA, Lewin TJ, Frost BG, Tirupati S, Turrell M, Conrad AM. Care pathways, engagement and outcomes associated with a recovery-oriented intermediate stay mental health program. Psychiatry Res 2020; 286:112889. [PMID: 32114210 DOI: 10.1016/j.psychres.2020.112889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/20/2020] [Accepted: 02/20/2020] [Indexed: 10/25/2022]
Abstract
This study examined care pathways, program engagement, and key outcomes associated with a sub-acute inpatient stay in a 20-bed stand-alone Intermediate Stay Mental Health Unit (ISMHU; NSW, Australia). A 6-week evidenced-based tailored intervention program was offered, utilizing a recovery-oriented model of care. Service data from multiple record systems were combined, including admissions and service contacts 2-years prior to and following the index admission. During the initial 16-months there were 146 index admissions with a length of stay greater than 7 days. The majority (75.3%) were transfers from acute-care, with an average ISMHU stay of 50.3 days. Service and clinical outcomes were examined in relation to care pathways, recovery needs, program engagement and benefits achieved. Substantial engagement was detected (e.g., 74.0% >10 intervention types), together with significant improvements on self-report and clinician rated measures (e.g., social connection, symptoms, and self-belief). Logistic regression analyses revealed that arrival category was the strongest outcome predictor, with community referrals experiencing the largest reduction in subsequent acute mental health admissions (58.3% to 16.7%), followed by involuntary inpatient referrals (80.3% to 60.7%). Potential recovery-focused benefits are not limited to community treatment settings, while pathways to care may help identify clients with differing needs and opportunities for treatment.
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Affiliation(s)
- Ketrina A Sly
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW 2300, Australia; Centre for Brain and Mental Health Research (CBMHR), The University of Newcastle, Callaghan, NSW 2308, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute (HMRI), New Lambton, NSW, 2305, Australia.
| | - Terry J Lewin
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW 2300, Australia; Centre for Brain and Mental Health Research (CBMHR), The University of Newcastle, Callaghan, NSW 2308, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute (HMRI), New Lambton, NSW, 2305, Australia.
| | - Barry G Frost
- Hunter Medical Research Institute (HMRI), New Lambton, NSW, 2305, Australia; School of Psychology, Faculty of Science and Technology, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Srinivasan Tirupati
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW 2300, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia.
| | - Megan Turrell
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW 2300, Australia.
| | - Agatha M Conrad
- Hunter New England Mental Health Service, PO Box 833, Newcastle, NSW 2300, Australia; Centre for Brain and Mental Health Research (CBMHR), The University of Newcastle, Callaghan, NSW 2308, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia; Hunter Medical Research Institute (HMRI), New Lambton, NSW, 2305, Australia.
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Burgess RA, Fonseca L. Re-thinking recovery in post-conflict settings: Supporting the mental well-being of communities in Colombia. Glob Public Health 2019; 15:200-219. [DOI: 10.1080/17441692.2019.1663547] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Rochelle Ann Burgess
- Faculty of Population Health Sciences, UCL Institute for Global Health, London, UK
- Centre for Primary Health and Social Care, School of Social Professions, London Metropolitan University, London, UK
| | - Laura Fonseca
- Psychology Department, Universidad de La Sabana, Chia, Colombia
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Craven MP, Goodwin R, Rawsthorne M, Butler D, Waddingham P, Brown S, Jamieson M. Try to see it my way: exploring the co-design of visual presentations of wellbeing through a workshop process. Perspect Public Health 2019; 139:153-161. [PMID: 30955447 PMCID: PMC6595544 DOI: 10.1177/1757913919835231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS A 10-month project funded by the NewMind network sought to develop the specification of a visualisation toolbox that could be applied on digital platforms (web- or app-based) to support adults with lived experience of mental health difficulties to present and track their personal wellbeing in a multi-media format. METHODS A participant co-design methodology, Double Diamond from the Design Council (Great Britain), was used consisting of four phases: Discover - a set of literature and app searches of wellbeing and health visualisation material; Define - an initial workshop with participants with lived experience of mental health problems to discuss wellbeing and visualisation techniques and to share personal visualisations; Develop - a second workshop to add detail to personal visualisations, for example, forms of media to be employed, degree of control over sharing; and Deliver - to disseminate the learning from the exercise. RESULTS Two design workshops were held in December 2017 and April 2018 with 13 and 12 experts-by-experience involved, respectively, including two peer researchers (co-authors) and two individual-carer dyads in each workshop, with over 50% of those being present in both workshops. A total of 20 detailed visualisations were produced, the majority focusing on highly personal and detailed presentations of wellbeing. DISCUSSION While participants concurred on a range of typical dimensions of wellbeing, the individual visualisations generated were in contrast to the techniques currently employed by existing digital wellbeing apps and there was a great diversity in preference for different visualisation types. Participants considered personal visualisations to be useful as self-administered interventions or as a step towards seeking help, as well as being tools for self-appraisal. CONCLUSION The results suggest that an authoring approach using existing apps may provide the high degree of flexibility required. Training on such tools, delivered via a module on a recovery college course, could be offered.
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Affiliation(s)
- M P Craven
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Triumph Road, Nottingham NG7 2TU, UK.,Bioengineering Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - R Goodwin
- The Oliver Zangwill Centre, Cambridgeshire Community Services NHS Trust, Ely, UK
| | - M Rawsthorne
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East Midlands, Institute of Mental Health, Nottingham, UK
| | - D Butler
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Nottingham, UK
| | - P Waddingham
- The Oliver Zangwill Centre, Cambridgeshire Community Services NHS Trust, Ely, UK
| | - S Brown
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham Innovation Park, Jubilee Campus, Nottingham, UK.,Division of Psychiatry and Applied Psychology, University of Nottingham, Jubilee Campus, Nottingham, UK
| | - M Jamieson
- Institute of Health and Wellbeing, Administration Building, Gartnavel Royal Hospital, Glasgow, UK
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Rose D. A hidden activism and its changing contemporary forms: Mental health service users / survivors mobilising. JOURNAL OF SOCIAL AND POLITICAL PSYCHOLOGY 2018. [DOI: 10.5964/jspp.v6i2.952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
This commentary concerns how the organisation of State welfare benefits in the UK have changed over the last 20 years, arguing that this has had harmful, even fatal, consequences for people with disabilities and particularly those with mental distress of psychosocial disabilities. This current situation may be called that of austerity. The paper describes how a ‘hidden activism’ has emerged to contest this situation and explains why it is, and to a degree, must be hidden. I then focus on the discourse of responsibilisation where every citizen must take responsibility for embodying the virtues of the good, working person. To ensure this, unemployment has been framed as a psychological problem and psychologists are now employed to ‘treat’ this problem in order that everybody might enter the world of work. I argue that in current conditions this is not possible for all with mental distress. Engaging then with community psychology, I address the issue of allies and how the absence of attention to mental distress might be remedied by this form of work. I draw on the emerging field of user / survivor-led research in mental health and argue that collaboration with community psychology will not be without problems.
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Abstract
BACKGROUND One goal within positive psychiatry is to support the personal recovery of persons with mental illness and providing opportunities for well-being. AIM The current article aims to introduce readers to the concept of personal recovery and the potential and importance of recovery-oriented services and measures. METHODS A literature review was conducted to help consider the domains of 'personal recovery', 'recovery-oriented services/interventions', and 'measures'. A database search was complemented with a web-based search. Both medical subject heading (MESH) terms and free-text search terms were used. RESULTS Literature from research journals, grey literature, and websites were included. Within this context, recovery does not refer to a cure but involves a process in which a person acts as an agent to develop new goals and meaning in life, despite and beyond limitations posed by the illness and its consequences. A positive focus on recovery is in sharp contrast to historical deterministic and pessimistic concepts of mental illnesses. Recovery-oriented services such as peer support, assertive community treatment, supported employment/education/housing, illness self-management, and decreasing self-stigma are highlighted. A review of 27 measures that focus on personal recovery and promotion of well-being are also discussed. CONCLUSIONS The literature overview presents perspectives and knowledge of how to develop positive psychiatry, how mental health services and their partner organizations may become more recovery oriented and help persons reach well-being and a better quality of life. This study is limited to a narrative review and may precede future systematic reviews.
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Affiliation(s)
- Ulrika Bejerholm
- a Department of Health Sciences/Mental Health, Activity and Participation , Lund University , Lund , Sweden.,b Center for Evidence-based Psychosocial Interventions (CEPI) , Lund University , Lund , Sweden
| | - David Roe
- c Department of Community Mental Health , University of Haifa , Haifa , Israel.,d Department of Medicine , Aalborg University , Aalborg , Denmark
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O'Donnell P, O'Donovan D, Elmusharaf K. Measuring social exclusion in healthcare settings: a scoping review. Int J Equity Health 2018; 17:15. [PMID: 29391016 PMCID: PMC5796599 DOI: 10.1186/s12939-018-0732-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 01/24/2018] [Indexed: 12/05/2022] Open
Abstract
Background Social exclusion is a concept that has been widely debated in recent years; a particular focus of the discussion has been its significance in relation to health. The meanings of the phrase “social exclusion”, and the closely associated term “social inclusion”, are contested in the literature. Both of these concepts are important in relation to health and the area of primary healthcare in particular. Thus, several tools for the measurement of social exclusion or social inclusion status in health care settings have been developed. Methods A scoping review of the peer-reviewed and grey literature was conducted to examine tools developed since 2000 that measure social exclusion or social inclusion. We focused on those measurement tools developed for use with individual patients in healthcare settings. Efforts were made to obtain a copy of each of the original tools, and all relevant background literature. All tools retrieved were compared in tables, and the specific domains that were included in each measure were tabulated. Results Twenty-two measurement tools were included in the final scoping review. The majority of these had been specifically developed for the measurement of social inclusion or social exclusion, but a small number were created for the measurement of other closely aligned concepts. The majority of the tools included were constructed for engaging with patients in mental health settings. The tools varied greatly in their design, the scoring systems and the ways they were administered. The domains covered by these tools varied widely and some of the tools were quite narrow in the areas of focus. A review of the definitions of both social inclusion and social exclusion also revealed the variations among the explanations of these complex concepts. Conclusions There are several definitions of both social inclusion and social exclusion in use and they differ greatly in scope. While there are many tools that have been developed for measuring these concepts in healthcare settings, these do not have a primary healthcare focus. There is a need for the development of a tool for measuring social inclusion or social exclusion in primary healthcare settings. Electronic supplementary material The online version of this article (10.1186/s12939-018-0732-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrick O'Donnell
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
| | - Diarmuid O'Donovan
- School of Medicine, Clinical Science Institute, National University of Ireland, Room 342, Galway, Ireland
| | - Khalifa Elmusharaf
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
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10
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Monger B, Hardie SM, Ion R, Cumming J, Henderson N. The Individual Recovery Outcomes Counter: preliminary validation of a personal recovery measure. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.112.041889] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodThe Individual Recovery Outcomes Counter (I.ROC) is to date the only recovery outcomes instrument developed in Scotland. This paper describes the steps taken to initially assess its validity and reliability, including factorial analysis, internal consistency and a correlation benchmarking analysis.ResultsThe I.ROC tool showed high internal consistency. Exploratory factor analysis indicated a two-factor structure comprising intrapersonal recovery (factor 1) and interpersonal recovery (factor 2), explaining between them over 50% of the variance in I.ROC scores. There were no redundant items and all loaded on at least one of the factors. The I.ROC significantly correlated with widely used existing instruments assessing both personal recovery and clinical outcomes.Clinical implicationsI.ROC is a valid and reliable measure of recovery in mental health, preferred by service users when compared with well-established instruments. It could be used in clinical settings to map individual recovery, providing feedback for service users and helping to assess service outcomes.
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Frost BG, Turrell M, Sly KA, Lewin TJ, Conrad AM, Johnston S, Tirupati S, Petrovic K, Rajkumar S. Implementation of a recovery-oriented model in a sub-acute Intermediate Stay Mental Health Unit (ISMHU). BMC Health Serv Res 2017; 17:2. [PMID: 28049472 PMCID: PMC5210223 DOI: 10.1186/s12913-016-1939-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 12/08/2016] [Indexed: 01/11/2023] Open
Abstract
Background An ongoing service evaluation project was initiated following the establishment of a new, purpose-built, 20-bed sub-acute Intermediate Stay Mental Health Unit (ISMHU). This paper: provides an overview of the targeted 6-week program, operating within an Integrated Recovery-oriented Model (IRM); characterises the clients admitted during the first 16 months; and documents their recovery needs and any changes. Methods A brief description of the unit’s establishment and programs is initially provided. Client needs and priorities were identified collaboratively using the Mental Health Recovery Star (MHRS) and addressed through a range of in-situ, individual and group interventions. Extracted client and service data were analysed using descriptive statistics, paired t-tests examining change from admission to discharge, and selected correlations. Results The initial 154 clients (165 admissions, average stay = 47.86 days) were predominately male (72.1%), transferred from acute care (75.3%), with schizophrenia or related disorders (74.0%). Readmission rates within 6-months were 16.2% for acute and 3.2% for sub-acute care. Three MHRS subscales were derived, together with stage-of-change categories. Marked improvements in MHRS Symptom management and functioning were identified (z-change = −1.15), followed by Social-connection (z-change = −0.82) and Self-belief (z-change = −0.76). This was accompanied by a mean reduction of 2.59 in the number of pre-action MHRS items from admission to discharge (z-change = 0.98). Clinician-rated Health of the Nation Outcome Scales (HoNOS) improvements were smaller (z-change = 0.41), indicative of illness chronicity. Staff valued the elements of client choice, the holistic and team approach, program quality, review processes and opportunities for client change. Addressing high-levels of need in the 6-week timeframe was raised as a concern. Conclusions This paper demonstrates that a recovery-oriented model can be successfully implemented at the intermediate level of care. It is hoped that ongoing evaluations support the enthusiasm, commitment and feedback evident from staff, clients and carers. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1939-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Barry G Frost
- School of Psychology, Faculty of Science and Technology, University of Newcastle, Callaghan, NSW, 2308, Australia.,Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Megan Turrell
- Hunter New England Mental Health, Newcastle, NSW, 2300, Australia
| | - Ketrina A Sly
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.,MH-READ Unit, Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Terry J Lewin
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter New England Mental Health, Newcastle, NSW, 2300, Australia. .,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia. .,MH-READ Unit, Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Agatha M Conrad
- Centre for Brain and Mental Health Research, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.,MH-READ Unit, Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Suzanne Johnston
- Hunter New England Mental Health, Newcastle, NSW, 2300, Australia
| | - Srinivasan Tirupati
- Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Kerry Petrovic
- Nurse Unit Manager (2010-2015), ISMHU, Hunter New England Mental Health, Newcastle, NSW, 2300, Australia
| | - Sadanand Rajkumar
- Hunter New England Mental Health, Newcastle, NSW, 2300, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
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Adamou M, Graham K, MacKeith J, Burns S, Emerson LM. Advancing services for adult ADHD: the development of the ADHD Star as a framework for multidisciplinary interventions. BMC Health Serv Res 2016; 16:632. [PMID: 27821125 PMCID: PMC5100092 DOI: 10.1186/s12913-016-1894-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder is prevalent in adulthood, resulting in serious impairment across multiple domains of living. Despite clinical guidance recommendations, the relative infancy of research on service provision for adults with ADHD, along with the evidence transfer gap, means that there is a lack of specific frameworks for service delivery. Igniting research and developing service delivery frameworks within adult ADHD is an essential step in the provision of effective services for adults with ADHD. METHOD Following the methodology used in previous related research that utilises a Participatory Action Research approach, we gathered data from clinicians and service users on the domains of living in which they wish to create change, and the steps and end point of the change process. This data was utilised, alongside data gathered from previous research and policies, to develop the domains of assessment for the ADHD Star, and the scale on which change is assessed. RESULTS The resulting tool, the ADHD Star, consists of eight domains: understanding your ADHD, focus and attention, organising yourself, friends and social life, thinking and reacting, physical health, how you feel and meaningful use of time. Each domain is rated on a five-point scale, the 'ladder of change', ranging from 'stuck' to 'choice'. CONCLUSIONS The ADHD Star offers a guiding framework for the development of care pathways and subsequent service provision for adults with ADHD, based on multi-disciplinary, holistic and person-centred care.
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Affiliation(s)
- Marios Adamou
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, Portobello Road, WF1 5PN, UK.
- University of Huddersfield, School of Human Health Sciences, Queensgate, HD13DH, UK.
| | - Katharine Graham
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Joy MacKeith
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Sara Burns
- Triangle Consulting Social Enterprise, The Dock Hub, Wilbury Villas, Hove, BN3 6AH, UK
| | - Lisa-Marie Emerson
- Manygates Clinic, South West Yorkshire Partnership NHS Foundation Trust, Wakefield, Portobello Road, WF1 5PN, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
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Roe D, Lapid L, Baloush-Kleinman V, Garber-Epstein P, Gornemann MI, Gelkopf M. Using Routine Outcome Measures to Provide Feedback at the Service Agency Level. Community Ment Health J 2016; 52:1022-1032. [PMID: 27324903 DOI: 10.1007/s10597-016-0039-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 06/15/2016] [Indexed: 11/30/2022]
Abstract
The use of routine outcome measurement (ROM) to assess service effectiveness has been on the rise in mental health settings. However, there is a scarcity of information on the use of ROM data to provide feedback to teams of service providers. In this paper we review the existing literature to identify the principles that can guide the use of ROM data as feedback with the aim to improve quality of service provision in mental health settings. We present a pilot trial of 12 agencies participating in group feedback sessions. The guiding principles and core processes, the procedure and implementation in a pilot trial, lessons learned and future directions are discussed. Based on this experience we conclude that using ROM to implement group feedback among mental health stakeholders is feasible and can generate discussions and directions for improvement.
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Affiliation(s)
- David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, 31905, Haifa, Israel.,Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Liron Lapid
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, 31905, Haifa, Israel. .,Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
| | | | - Paula Garber-Epstein
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Miriam Isolde Gornemann
- Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, 31905, Haifa, Israel.,Center for Community Mental Health, Research, Practice and Policy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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An intensive personalised support approach to treating individuals with psychosis and co-morbid mild intellectual disability. Ir J Psychol Med 2016; 34:99-109. [PMID: 30115213 DOI: 10.1017/ipm.2016.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To evaluate the clinical benefits and associated cost effectiveness of an intensive personalised support (IPS) approach for clients suffering from psychosis and co-morbid mild intellectual disability (ID). METHOD Four individuals with a psychotic disorder and co-morbid mild ID participated in an 18-month IPS rehabilitative intervention. Biopsychosocial measures were used to evaluate clinical effectiveness. A cost analysis was undertaken to examine the cost effectiveness of the intervention. RESULTS Reductions in psychopathology including anxiety symptoms were noted in all individuals. In addition, increased functioning and quality of life were demonstrated in all cases. Overall cost reductions were noted in inpatient care, accommodation and legal/emergency expenses. CONCLUSION The IPS approach was clinically effective particularly in addressing individual's psychosocial needs, psychological functioning, daily living skills and overall quality of life. Costs had decreased for three of the four individuals, ranging from a 17% to 46% savings. The findings highlight that the intervention was cost effective in most cases at this early stage. However, further research is necessary in order to ascertain if cost savings occur over time.
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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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16
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Williams B, Chard G. Using the Evaluation of Social Interaction (ESI) with men in a low secure forensic unit. Br J Occup Ther 2016. [DOI: 10.1177/0308022615615890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Statement of context This practice analysis explored the utility of the Evaluation of Social Interaction (ESI) in a 12-bedded male in-patient low secure forensic unit in England. The ESI is a standardised observational assessment of the person engaging in two social exchanges in naturalistic settings with real social partners. Critical reflection on practice The ESI helped identify specific social interaction skills that supported and skills that limited competent quality of social interaction. This enabled the men to better understand why they had social interaction problems, thus improve their motivation to engage in planning their own treatment and resulted in positive re-enforcement during the intervention. Implications for practice The ESI is suitable to use in forensic and mental health settings. Unexpected outcomes included a more productive team, a more settled atmosphere and reduced levels of frustration for both staff and clients.
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Affiliation(s)
- Belinda Williams
- Independent Occupational Therapist, Lavender OT Ltd, Hampshire, UK
| | - Gill Chard
- Professor of Occupational Therapy (retired) and Research Director, AMPS UK and Ireland, Lancaster, UK
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Hancock N, Scanlan JN, Honey A, Bundy AC, O’Shea K. Recovery Assessment Scale – Domains and Stages (RAS-DS): Its feasibility and outcome measurement capacity. Aust N Z J Psychiatry 2015; 49:624-33. [PMID: 25526940 PMCID: PMC4941096 DOI: 10.1177/0004867414564084] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A self-report instrument of mental health recovery is needed both to facilitate collaborative, recovery-oriented practice and measure recovery-focused outcomes. The Recovery Assessment Scale - Domains and Stages (RAS-DS) has been developed to simultaneously fulfill these goals. The aim of this study was to test the feasibility and measurement properties of the RAS-DS. METHOD Feasibility was examined by 58 consumer-staff pairs volunteering from 3 non-government organisations. Consumers completed the RAS-DS, discussed it with staff, and then both completed Usefulness Questionnaires. The psychometric properties were examined using Rasch analysis with the data from these consumer participants and from additional participants recruited from two Partners in Recovery programs (N=324). RESULTS Over 70% of consumers reported taking 15 minutes or less to complete the RAS-DS and rated the instrument as easy or very easy to use. Qualitative data from both consumers and staff indicated that, for most, the RAS-DS was an easy to use, meaningful resource that facilitated shared understandings and collaborative goal setting. However, for a very small number of consumers, the instrument was too confronting and hard to use. Rasch analysis demonstrated evidence for excellent internal reliability and validity. Raw scores were highly correlated with Rasch-generated overall scores and thus no transformation is required, easing use for clinicians. Preliminary evidence for sensitivity to change was demonstrated. CONCLUSIONS The results provide evidence of the feasibility and psychometric strengths of the RAS-DS. Although further research is required, the RAS-DS shows promise as a potential addition to the national suite of routine outcome measures.
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Affiliation(s)
- Nicola Hancock
- The University of Sydney, Sydney, Australia,Nicola Hancock, The University of Sydney, Cumberland Campus C42, PO Box 170, Lidcombe, NSW 1825, Australia.
| | | | - Anne Honey
- The University of Sydney, Sydney, Australia
| | | | - Katrina O’Shea
- Richmond Fellowship of Queensland, Brisbane, Queensland, Australia
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Primary-care-based social prescribing for mental health: an analysis of financial and environmental sustainability. Prim Health Care Res Dev 2015; 17:114-21. [DOI: 10.1017/s1463423615000328] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AimTo assess the effects of a social prescribing service development on healthcare use and the subsequent economic and environmental costs.BackgroundSocial prescribing services for mental healthcare create links with support in the community for people using primary care. Social prescribing services may reduce future healthcare use, and therefore reduce the financial and environmental costs of healthcare, by providing structured psychosocial support. The National Health Service (NHS) is required to reduce its carbon footprint by 80% by 2050 according to the Climate Change Act (2008). This study is the first of its kind to analyse both the financial and environmental impacts associated with healthcare use following social prescribing. The value of this observational study lies in its novel methodology of analysing the carbon footprint of a service at the primary-care level.MethodAn observational study was carried out to assess the impact of the service on the financial and environmental impacts of healthcare use. GP appointments, psychotropic medications and secondary-care referrals were measured.FindingsResults demonstrate no statistical difference in the financial and carbon costs of healthcare use between groups. Social prescribing showed a trend towards reduced healthcare use, mainly due to a reduction in secondary-care referrals compared with controls. The associations found did not achieve significance due to the small sample size leading to a large degree of uncertainty regarding differences. This study demonstrates that these services are potentially able to pay for themselves through reducing future healthcare costs and are effective, low-carbon interventions, when compared with cognitive behavioral therapy or antidepressants. This is an important finding in light of Government targets for the NHS to reduce its carbon footprint by 80% by 2050. Larger studies are required to investigate the potentials of social prescribing services further.
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Mental illness self-management: a randomised controlled trial of the Wellness Recovery Action Planning intervention for inpatients and outpatients with psychiatric illness. Ir J Psychol Med 2015; 33:81-92. [PMID: 30115140 DOI: 10.1017/ipm.2015.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Wellness Recovery Action Planning (WRAP) is a cross-diagnostic, patient-centred, self-management intervention for psychiatric illness. WRAP utilises an individualised Wellness Toolbox, a six part structured monitoring and response system, and a crisis and post-crisis plan to promote recovery. The objective of this study was to evaluate the effect of WRAP on personal recovery, quality of life, and self-reported psychiatric symptoms. METHOD A prospective randomised controlled trial, based on the CONSORT principles was conducted using a sample of 36 inpatients and outpatients with a diagnosis of a mental disorder. Participants were randomly allocated to Experimental Group or Waiting List Control Group conditions in a 1:1 ratio. Measures of personal recovery, personal recovery life areas, quality of life, anxiety, and depression were administered at three time points: (i) pre-intervention, (ii) post-Experimental Group intervention delivery, and (iii) 6-month follow-up. Data was analysed by available case analysis using univariate and bivariate methodologies. RESULTS WRAP had a significant effect on two personal recovery life areas measured by the Mental Health Recovery Star: (i) addictive behaviour and (ii) identity and self-esteem. WRAP did not have a significant effect on personal recovery (measured by the Mental Health Recovery Measure), quality of life, or psychiatric symptoms. CONCLUSIONS Findings indicate that WRAP improves personal recovery in the areas of (i) addictive behaviour and (ii) identity and self-esteem. Further research is required to confirm WRAP efficacy in other outcome domains. Efforts to integrate WRAP into recovery-orientated mental health services should be encouraged and evaluated.
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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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Sklar M, Groessl EJ, O'Connell M, Davidson L, Aarons GA. Instruments for measuring mental health recovery: a systematic review. Clin Psychol Rev 2013; 33:1082-95. [PMID: 24080285 DOI: 10.1016/j.cpr.2013.08.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/27/2013] [Accepted: 08/05/2013] [Indexed: 11/29/2022]
Abstract
Persons in recovery, providers, and policymakers alike are advocating for recovery-oriented mental health care, with the promotion of recovery becoming a prominent feature of mental health policy in the United States and internationally. One step toward creating a recovery-oriented system of care is to use recovery-oriented outcome measures. Numerous instruments have been developed to assess progress towards mental health recovery. This review identifies instruments of mental health recovery and evaluates the appropriateness of their use including their psychometric properties, ease of administration, and service-user involvement in their development. A literature search using the Medline and Psych-INFO databases was conducted, identifying 21 instruments for potential inclusion in this review, of which thirteen met inclusion criteria. Results suggest only three instruments (25%) have had their psychometric properties assessed in three or more unique samples of participants. Ease of administration varied between instruments, and for the majority of instruments, development included service user involvement. This review updates and expands previous reviews of instruments to assess mental health recovery. As mental health care continues to transform to a recovery-oriented model of service delivery, this review may facilitate selection of appropriate assessments of mental health recovery for systems to use in evaluating and improving the care they provide.
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Affiliation(s)
- Marisa Sklar
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 9500 Gilman Drive, San Diego, CA 92093-0994, United States.
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