Strength-based cognitive-behavioural therapy and peer-to-peer support in the recovery process for people with schizophrenia: A randomised control trial

BACKGROUND AND AIMS

Dysfunctional cognition and negative symptoms in schizophrenia are associated with persistently low social functioning and quality of life (QoL). Recovery interventions report only a modest effect in improving social functioning and QoL. This study examined the therapeutic effects and pathways of interventions using strength-based cognitive-behavioural therapy (SBCBT) and peer-to-peer support (PSP) approaches.

METHODS

A randomised control trial compared SBCBT, PSP and TAU (treatment-as-usual) by recruiting 127 individuals with schizophrenia spectrum disorders and low social functioning.

RESULTS

The three-group comparison found SBCBT produced improved social functioning and social support at post-intervention and 6-month follow-up while PSP reported improved social QoL and defeatist beliefs, but none remained at 6-month follow-up. Unsurprising, no improvement was found in any areas for TAU, both at post-test and 6-month follow-up. Regarding mechanisms of change, improvements in hope and personal recovery consistently and significantly accounted for improvements in social functioning and many aspects of QoL of participants, thus indicating the important contribution of hope and personal recovery in strength-based interventions for people with schizophrenia.

CONCLUSION

This rigorously designed study provides the first few solid empirical evidence on the effectiveness of SBCBT and PSP in recovery from schizophrenia and provides initial evidence of the linkage between dysfunctional cognition, hope and recovery in schizophrenia.

Corrigendum: "A new hope" for positive psychology: a dynamic systems reconceptualization of hope theory

[This corrects the article DOI: 10.3389/fpsyg.2022.809053.].

Impact of Cofacilitated, Collaborative, Recovery-Oriented Practice Training on Clinical Mental Health Workforce Competencies

OBJECTIVE

The authors aimed to evaluate the impact of a staff development training program informed by the collaborative recovery model (CRM) on staff outcomes in the largest implementation of CRM undertaken by a public clinical mental health service.

METHODS

Implementation spanned community, rehabilitation, inpatient, and crisis programs for children and youths, adults, and older persons in metropolitan Melbourne, 2017-2018. The CRM staff development program was cofacilitated and coproduced by trainers with clinical and lived experience of recovery (including caregivers) and delivered to the mental health workforce (N=729, including medical, nursing, allied health, lived experience, and leadership staff). The 3-day training program was supplemented by booster training and coaching in team-based reflective practice. Pre- and posttraining measures assessed changes in self-reported CRM-related knowledge, attitudes, skills, and confidence and in the perceived importance of CRM implementation. Staff definitions of recovery were analyzed to understand changes in language related to collaborative recovery.

RESULTS

The staff development program significantly (p<0.001) improved self-rated knowledge, attitudes, and skills in applying CRM. At booster training, improvements in attitudes and self-confidence in implementing CRM were maintained. Ratings of the importance of CRM and confidence in the organization's implementation did not change. Definitions of recovery illustrated development of shared language throughout the large mental health program.

CONCLUSIONS

The cofacilitated CRM staff development program achieved significant changes in staff knowledge, attitudes, skills, and confidence and changes in language related to recovery. These results suggest that implementing collaborative, recovery-oriented practice in a large public mental health program is feasible and can result in broad and sustainable change.

Experiences of Chinese international students living in Australia: Wellbeing from "we" to "me"

Whilst there is evidence of subjective wellbeing being related to academic success, good performance within and beyond university, degree attainment, and positive subsequent physical, mental, economic, and social outcomes in the university student population, less is known on how different student populations perceive, experience, and cultivate wellbeing. The current study explored the perspectives and experiences of one such population: Chinese international students at several universities across Australia. Semi-structured interviews with 30 students indicated that participants mainly experienced wellbeing through experiences of competence, feeling supported by family and friends, low levels of pressure, and giving to others. Almost half of the participants believed that people around them had low wellbeing. Students indicated drawing upon intrapersonal activities as the primary pathway to support their own wellbeing, whereas they pointed to interpersonal activities to support other’s wellbeing. The findings show the mismatch between students’ wellbeing experiences and pathways, shed light on understanding students’ wellbeing in the higher education context, and identify some of the contextual and cultural factors that contribute to wellbeing experiences and pathways. Implications for interculturally nuanced approaches to understanding and supporting wellbeing are considered

Chinese international students’ conceptualizations of wellbeing: A prototype analysis

Wellbeing can mean different things to different people, even in the same culture with the same language. People living at the intersection of two languages and cultures, such as Chinese students studying in an English-speaking nation, not only speak a different language than their host country, but also may have different conceptualizations of wellbeing itself. This study investigated Chinese international students’ (aged 18–39, N = 123) conceptualizations of wellbeing using a modified prototype analysis, which provided insights on people’s underlying structure of the construct as revealed through language. Chinese international students’ conceptualizations of wellbeing were prototypically structured; key components of wellbeing included positive relationships, security, positivity/optimism, physical health, and self-strength. The findings broaden the understanding of layperson wellbeing conceptualizations, provide insights into the wellbeing related concepts and language that are most used by international Chinese students, and inform strategies that tertiary education institutions might adopt to effectively support Chinese international students’ wellbeing.

Toward a Unified Framework for Positive Psychology Interventions: Evidence-Based Processes of Change in Coaching, Prevention, and Training

Since 2000, research within positive psychology has exploded, as reflected in dozens of meta-analyses of different interventions and targeted processes, including strength spotting, positive affect, meaning in life, mindfulness, gratitude, hope, and passion. Frequently, researchers treat positive psychology processes of change as distinct from each other and unrelated to processes in clinical psychology. This paper presents a comprehensive framework for positive psychology processes that crosses theoretical orientation, links coherently to clinical psychology and its more dominantly "negative" processes, and supports practitioners in their efforts to personalize positive psychological interventions. We argue that a multi-dimensional and multi-level extended evolutionary approach can organize effective processes of change in psychosocial interventions, by focusing interventions on context-appropriate variation, selection, and retention of processes, arranged in terms of key biopsychosocial dimensions across psychological, biophysiological, and sociocultural levels of analysis. We review widely studied positive psychology constructs and programs and show how this evolutionary approach can readily accommodate them and provide a common language and framework for improving human and community flourishing. We conclude that Interventions should start with the person, not the protocol.

"A New Hope" for Positive Psychology: A Dynamic Systems Reconceptualization of Hope Theory

In this review of the central tenets of hope theory, we examine the meta-theoretical, theoretical, and methodological foundations of the literature base. Our analysis moves from a broad examination of the research landscape in hope theory across disciplines, to a deeper investigation of the empirical literature in university students. This review highlights the significant impact of this body of research in advancing our understanding of aspects of thriving characterized by hope. However, we also evidence several limitations that may impede the advancement of the next wave of growth in this field. To address these limitations, we argue for an interdisciplinary approach to expanding the meta-theoretical, theoretical, and methodological horizons, enabling a more dynamic systems approach to the study of hope. Drawing on the intersection of positive psychology with systems thinking, we describe a methodological approach that enables a deeper examination of the processes and interactions through which hope emerges, using an analysis of the lived experience of young people. It is proposed that this research agenda will bring to life an alternate story about the resourcefulness of our youth through their own voice, enabling us to leverage this in the design of more effective strategies to facilitate hope in the future. This research agenda provides a roadmap that will provide alternative methodologies that address the current limitations in the field of hope research and, importantly, can provide fuel to spur on the acceleration of the next wave of research and practice in the field of positive psychology more broadly.

Development and Assessment of the Personal Emotional Capital Questionnaire for Adults

(1) Background: The present study developed and evaluated a personal emotional capital questionnaire (PECQ) for adults that assessed 10 domains of personal emotional capital. (2) Method: Initially, 100 items were created and then administered to students attending Semnan University and Semnan University of Medical Sciences in Iran. Of the 700 questionnaires distributed, 527 were completed in full. Students were sampledusing the multi-stage random cluster method. Exploratory factor analyses, Cronbach’s alpha, and test–retest reliability were used to evaluate the scale. (3) Results: The ten components ofthe PECQ were confirmed. Test–retest correlations after 30 days were high, as was Cronbach’s alpha (0.94). Thecomponents highly correlatedwith overall emotional capital. The PECQ displayed convergent validity as it positively correlated with the Keyes’s Mental Health Continuum—Short Form and students’GPAs. The PECQ displayed divergent validity as it negatively correlated with measures of depression, anxiety and stress (Depression Anxiety and Stress Scale (DASS21)). Differences in overall PECQ scores and its components were examined for several variables including gender, age, marital and employment status, academic program, and field of study. PECQ scores were not sensitive to the order of administering questionnaires. (4) Conclusion: The results suggest that the PECQ is a valid and reliable measure of personal emotional capital and supports its use in adults.

Wellbeing Literacy: Conceptualization, Measurement, and Preliminary Empirical Findings from Students, Parents and School Staff

Aims: Wellbeing literacy is the intentional use of wellbeing relevant vocabulary, knowledge and language skills to maintain or improve the wellbeing of oneself, others and the world. In this study, we operationalize the human aspects of the concept of wellbeing literacy and empirically test its relationship with wellbeing and illbeing. We also assess its incremental variance in wellbeing and illbeing, after controlling for existing and well-established predictors of these constructs within education settings. Methods: We developed and empirically tested the Wellbeing literacy 6-item (Well-Lit 6) scale to assess the concept of wellbeing literacy in the education context. The scale was developed based on a working definition of wellbeing literacy, in combination with the Australian Curriculum, Assessment and Reporting Authority (ACARA)’s definition of literacy. The Well-Lit 6 was administered via a cross-sectional survey to three Australian samples that comprise different elements of Australian education systems: students (N = 1392), parents (N = 584) and school staff (N = 317). Results: Exploratory factor analysis (EFA) suggested the six items of the Well-Lit 6 form an independent construct, empirically distinguishable from other wellbeing-related constructs (e.g., general wellbeing, resilience, and emotion regulation). Convergent analyses showed wellbeing literacy was positively related to wellbeing and negatively related to illbeing. Incremental validity analyses showed wellbeing literacy predicted variance in wellbeing and illbeing after controlling for participant demographics, resilience, and emotion regulation, showing initial evidence of incremental validity. Conclusions: Our results provide preliminary evidence that wellbeing literacy is a distinct construct from wellbeing and illbeing, and it also demonstrates significant unique variance in these constructs over and above resilience and emotion regulation. The Well-Lit 6 is a useful provisional measure of wellbeing literacy, although we suggest a fruitful avenue for future research is to develop a more comprehensive scale of wellbeing literacy that denotes specific facets of communication, allowing a fuller exploration wellbeing literacy, its components, and their antecedents and consequences. We offer further recommendations for future research and discuss limitations with our approach.

Wellbeing Literacy: A Capability Model for Wellbeing Science and Practice

Wellbeing science is the scientific investigation of wellbeing, its' antecedents and consequences. Alongside growth of wellbeing science is significant interest in wellbeing interventions at individual, organizational and population levels, including measurement of national accounts of wellbeing. In this concept paper, we propose the capability model of wellbeing literacy as a new model for wellbeing science and practice. Wellbeing literacy is defined as a capability to comprehend and compose wellbeing language, across contexts, with the intention of using such language to maintain or improve the wellbeing of oneself, others or the world. Wellbeing literacy is underpinned by a capability model (i.e., what someone is able to be and do), and is based on constructivist (i.e., language shapes reality) and contextualist (i.e., words have different meanings in different contexts) epistemologies. The proposed capability model of wellbeing literacy adds to wellbeing science by providing a tangible way to assess mechanisms learned from wellbeing interventions. Moreover, it provides a framework for practitioners to understand and plan wellbeing communications. Workplaces and families as examples are discussed as relevant contexts for application of wellbeing literacy, and future directions for wellbeing literacy research are outlined.

Strengthening University Student Wellbeing: Language and Perceptions of Chinese International Students

Students at the tertiary education level in Australia are at increased risk of experiencing high levels of psychological distress, with international students at particularly high risk for poor adjustment. As mental health and wellbeing strongly correlate with students' academic performance and general overseas experience, a growing number of studies focus on what universities can do to effectively support students' wellbeing. However, assumptions are made about what wellbeing is, strategies primarily focus on treating mental ill-health, and treatment approaches fail to account for cultural differences. This study aimed to explore how Chinese international students understand wellbeing, the language used about and for wellbeing, and activities that students believe strengthen their own and others' wellbeing. Eighty-four Chinese international students completed the online survey, and a subset of 30 students participated in semi-structured interviews. Data were analysed using thematic, phenomenographic, and language analyses. Physical health and mental health appeared as the key components that participants believed defined wellbeing, and intrapersonal activities were perceived as the primary approach used to strengthen wellbeing. Findings help broaden the understanding of wellbeing concept from the population of tertiary students, identify students' perspectives of activities that strengthen their wellbeing, offer a snapshot of the language used by Chinese students around wellbeing, and provide new data of population health through a wellbeing lens.

A cluster-randomised controlled trial of values-based training to promote autonomously held recovery values in mental health workers

Background

The implementation and use of evidence-based practices is a key priority for recovery-oriented mental health service provision. Training and development programmes for employees continue to be a key method of knowledge and skill development, despite acknowledged difficulties with uptake and maintenance of behaviour change. Self-determination theory suggests that autonomy, or a sense that behaviour is self-generated, is a key motivator to sustained behaviour change, in this case practices in mental health services. This study examined the utility of values-focused staff intervention as a specific, reproducible method of autonomy support.

Methods

Mental health workers (n = 146) were assigned via cluster randomisation to either a values clarification condition or an active problem-solving control condition.

Results

Results demonstrated that a structured values clarification exercise was useful in promoting integrated motivation for the changed practice and resulted in increased implementation planning.

Conclusions

Structured values clarification intervention demonstrates utility as a reproducible means of autonomy support within the workplace. We discuss future directions for the study of autonomous motivation in the field of implementation science.

Trial registration

ACTRN12613000353796

Acceptance and Avoidance Processes at Different Levels of Psychological Recovery from Enduring Mental Illness

Objective. This study examined the use of psychological acceptance and experiential avoidance, two key concepts of Acceptance and Commitment Therapy (ACT), in the psychological recovery process of people with enduring mental illness. Method. Sixty-seven participants were recruited from the metropolitan, regional, and rural areas of New South Wales, Australia. They all presented some form of chronic mental illness (at least 12 months) as reflected in DSM-IV Axis I diagnostic criteria. The Acceptance and Action Questionnaire (AAQ-19) was used to measure the presence of psychological acceptance and experiential avoidance; the Recovery Assessment Scale (RAS) was used to examine the levels of psychological recovery; and the Scales of Psychological Well-Being was used to observe if there are benefits in utilizing psychological acceptance and experiential avoidance in the recovery process. Results. An analysis of objectively quantifiable measures found no clear correlation between the use of psychological acceptance and recovery in mental illness as measured by the RAS. The data, however, showed a relationship between psychological acceptance and some components of recovery, thereby demonstrating its possible value in the recovery process. Conclusion. The major contribution of this research was the emerging correlation that was observed between psychological acceptance and positive levels of psychological well-being among individuals with mental illness.

Hope, Meaning and Responsibility across Stages of Recovery for Individuals Living With an Enduring Mental Illness

This study reports on the relationship between stage of recovery and hope, meaning and responsibility for individuals diagnosed with severe mental illness.Methods:Seventy-seven people with a diagnosis of a psychotic disorder of at least 6 months' duration participated in the study. Participants completed the Self-Identified Stage of Recovery (SISR) scale, measures of component processes of recovery (Hope Scale; Positive Interpretation of Disease, SpREUK; Active Involvement, Personal Health Management Questionnaire (PHMQ) and the Recovery Assessment Scale-short (RAS).Results:Hope, meaning,Personal Confidence and HopeandNot Being Dominated by Symptomsvaried significantly across stages of recovery; however, neither in a parallel nor linear fashion. Hopefulness and sense of meaning in relation to the experience of mental illness increase before personal confidence and resilience in the face of setbacks.Conclusions and implications:Symptoms appear to take less prominence in individuals' lives in later stages of recovery. Greater insight into the relationship between stage of recovery and component processes may allow for more targeted recovery-oriented support for individuals at different stages of recovery.

Improving implementation of evidence-based practice in mental health service delivery: protocol for a cluster randomised quasi-experimental investigation of staff-focused values interventions

Background

There is growing acceptance that optimal service provision for individuals with severe and recurrent mental illness requires a complementary focus on medical recovery (i.e., symptom management and general functioning) and personal recovery (i.e., having a ‘life worth living’). Despite significant research attention and policy-level support, the translation of this vision of healthcare into changed workplace practice continues to elude. Over the past decade, evidence-based training interventions that seek to enhance the knowledge, attitudes, and skills of staff working in the mental health field have been implemented as a primary redress strategy. However, a large body of multi-disciplinary research indicates disappointing rates of training transfer. There is an absence of empirical research that investigates the importance of worker-motivation in the uptake of desired workplace change initiatives. ‘Autonomy’ is acknowledged as important to human effectiveness and as a correlate of workplace variables like productivity, and wellbeing. To our knowledge, there have been no studies that investigate purposeful and structured use of values-based interventions to facilitate increased autonomy as a means of promoting enhanced implementation of workplace change.

Methods

This study involves 200 mental health workers across 22 worksites within five community-managed organisations in three Australian states. It involves cluster-randomisation of participants within organisation, by work site, to the experimental (values) condition, or the control (implementation). Both conditions receive two days of training focusing on an evidence-based framework of mental health service delivery. The experimental group receives a third day of values-focused intervention and 12 months of values-focused coaching. Well-validated self-report measures are used to explore variables related to values concordance, autonomy, and self-reported implementation success. Audits of work files and staff work samples are reviewed for each condition to determine the impact of implementation. Self-determination theory and theories of organisational change are used to interpret the data.

Discussion

The research adds to the current knowledge base related to worker motivation and uptake of workplace practice. It describes a structured protocol that aims to enhance worker autonomy for imposed workplace practices. The research will inform how best to measure and conceptualise transfer. These findings will apply particularly to contexts where individuals are not ‘volunteers’ in requisite change processes.

Trial registration

ACTRN: ACTRN12613000353796.

The reconstruction of narrative identity during mental health recovery: a complex adaptive systems perspective

OBJECTIVES

1) to understand the reconstruction of narrative identity during mental health recovery using a complex adaptive systems perspective, 2) to address the need for alternative approaches that embrace the complexities of health care.

METHOD

A narrative review of published literature was conducted.

RESULTS

A complex adaptive systems perspective offers a framework and language that can assist individuals to make sense of their experiences and reconstruct their narratives during an often erratic and uncertain life transition. It is a novel research direction focused on a critical area of recovery and addresses the need for alternative approaches that embrace the complexities of health care.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

A complexity research approach to narrative identity reconstruction is valuable. It is an accessible model for addressing the complexities of recovery and may underpin the development of simple, practical recovery coaching tools.

Recovery in Australia: marshalling strengths and living values

Clear national policy now exists in Australia regarding recovery. Personal accounts of recovery often include reference to meaning, purpose and issues regarding identity. Personal strengths and expression of personal values are closely related to the development of meaning, purpose and a stable sense of self, resulting in a sense of wellbeing. These constructs fall under the research umbrella of positive psychology. By combining aspects of the recovery policy with evidence from the science of positive psychology there are increasing attempts to include strengths and values work with mental health staff and consumers. This paper describes how the collaborative recovery model (CRM) with its emphasis on strengths and values, draws on the emerging evidence based on positive psychology. CRM has now been implemented in non-government community services in each mainland state of Australia. Implementation issues of the CRM as one example of recovery-orientated service provision are then described. Potential barriers and facilitators of growth-based approaches such as CRM moving to government clinical services is then discussed. Recent national reviews of recovery measurement instruments are also summarized. Specific recommendations are then provided to further national implementation of recovery-orientated service provision in Australia.

Development of a consumer constructed scale to evaluate mental health service provision

OBJECTIVE

Most mental health outcome and satisfaction measures have been developed by academic researchers or service providers. Consumers have been limited to the role of participant or advisor. The validity and reliability of these satisfaction measures have been challenged. This paper reports the development of a consumer satisfaction questionnaire in which consumers work as collaborative researchers to increase its face validity and relevance.

METHOD

Eleven themes from a previous participatory study were used by consumer researchers and university-based researchers to generate questionnaire items, with four items reflecting each theme. The internal consistency and factor structure were examined in public and non-government mental health service centres based on data of 202 mental health consumers.

RESULTS

Principal Components Analysis with oblique rotation yielded a two-factor structure: Empowerment and Dehumanization. The two factors together explained 36.7% of the total variance. The scale demonstrated high internal consistency, with Cronbach's alpha for the total scale at 0.92, and for the two factors at 0.92 and 0.80.

CONCLUSIONS

The questionnaire was developed in accordance with an evaluation framework of consumer directed evaluation of mental health services. The final questionnaire consists of 26 items. It has satisfactory internal consistency and appeared to be useful with inpatients and outpatients. Further research will be performed to establish its test-retest reliability and criterion validity.

Hope and improvements in mental health service providers' recovery attitudes following training

BACKGROUND

Service providers' attitudes towards recovery can improve with formal training. However, it is unclear whether improvements depend on dispositional hope.

AIMS

To determine whether attitudinal improvements following formal recovery training vary depending on participants' dispositional hope.

METHOD

One hundred and three providers attended formal recovery training and completed measures of recovery knowledge, attitudes, hopefulness and optimism.

RESULTS

Training improved providers' recovery knowledge, attitudes, hopefulness and optimism. Providers with both high and low dispositional hope achieved similar gains.

CONCLUSIONS

Attitudinal improvements following formal recovery training were not dependent on baseline levels of dispositional hope. Institutions committed to recovery-oriented care should consider utilizing formal training.

Barriers to transfer of collaborative recovery training into Australian mental health services: implications for the development of evidence-based services

RATIONALE

Transfer of training (ToT) is defined as the application of competencies acquired during training into the workplace. Poor ToT to clinical practice in mental health settings has negative implications for evidence-based service provision.

AIMS AND OBJECTIVES

This study aimed to explore the variables influencing differences in ToT across mental health settings. Variables of interest included organization type, caseload and several variables related to the opportunity to use training.

METHOD

One hundred and seventy-three mental health clinicians from community-based governmental and non-governmental mental health services in eastern Australia were trained in recovery-oriented interventions. Measures of ToT included time taken until implementation of intervention protocols, assessed using a clinical audit and a questionnaire survey completed by clinicians to identify barriers to implementation 6 months after training.

RESULTS

Approximately 37% of the trained clinicians participating in the study were found to be implementing training protocols in clinical practice. In addition, the average time taken to implement the protocols was 5.6 months following training. The most frequently cited barriers were institutional constraints. Higher caseloads and more frequent client contact were related to a higher level of ToT.

CONCLUSION

ToT can be difficult to achieve in clinical practice. Greater facilitation of ToT may be achieved through better integration of the new ideology and protocols, regular monitoring of progress, staff incentives and examination of external attributions by clinicians of their responsibility to transfer training.

Do clinical outcome measures assess consumer-defined recovery?

There is an international call for mental health services to become recovery-oriented, and also to use evidence-based practices. Addressing this call requires recovery-oriented measurement of outcomes and service evaluation. Mental health consumers view recovery as leading as meaningful life, and have criticised traditional clinical measures for being too disability-oriented. This study compares three measures of consumer-defined recovery from enduring mental illness: the Recovery Assessment Scale, the Mental Health Recovery Measure and the Self-Identified Stage of Recovery, with four conventional clinical measures. Correlational analyses supported the convergent validity of the recovery measures, although certain subscales were unrelated to each other. More importantly, little relationship was found between consumer-defined recovery and the clinical measures. Analyses of variance revealed that scores on the recovery measures increased across self-identified stage of recovery, but scores on most clinical measures did not improve consistently across stage of recovery. The findings demonstrate the qualitative difference between the two types of measures, supporting the claim by consumers that clinical measures do not assess important aspects of recovery. There is a need for further research and refinement of recovery measurement, including assessment of stages of recovery, with the aim of including such measures as an adjunct in routine clinical assessment, service evaluation and research.

Australian mental health consumers contributions to the evaluation and improvement of recovery-oriented service provision

BACKGROUND

One key component of recovery-oriented mental health services, typically overlooked, involves genuine collaboration between researchers and consumers to evaluate and improve services delivered within a recovery framework.

METHOD

Eighteen mental health consumers working with staff who had received training in the Collaborative Recovery Model (CRM) took part in in-depth focus group meetings, of approximately 2.5 hours each, to generate feedback to guide improvement of the CRM and its use in mental health services.

RESULTS

Consumers identified clear avenues for improvement for the CRM both specific to the model and broadly applicable to recovery-oriented service provision. Findings suggest consumers want to be more engaged and empowered in the use of the CRM from the outset.

LIMITATIONS

Improved sampling procedures may have led to the identification of additional dissatisfied consumers.

CONCLUSIONS

Collaboration with mental health consumers in the evaluation and improvement of recovery-oriented practice is crucial with an emphasis on rebuilding mental health services that are genuinely oriented to support recovery.

Mental health consumers' perceptions of receiving recovery-focused services

RATIONALE, AIMS AND OBJECTIVES

This study examines the experiences of mental health service consumers engaged in various recovery-focused support practices as well as examining consumer valuing of these activities.

METHOD

A self-report questionnaire was developed drawing on key aspects of the Collaborative Recovery Model (CRM) (responsibility, collaboration, autonomy, motivation, needs, goals, homework). Ninety-two adult consumers from metropolitan, regional and rural non-government organizations and public mental health services in eastern Australian states completed the questionnaire.

RESULTS

Consumers using services provided by CRM-trained workers identified significant changes to service delivery in relation to frequency with which they were encouraged to take responsibility for their recovery, degree to which they collaborated with staff and the extent to which they were encouraged to complete homework activities to assist them to achieve their goals, when compared with consumers using traditional services. The key aspects of the CRM were valued by consumers. No differences were found in terms of overall ratings of clinician helpfulness in assisting recovery between the two groups.

CONCLUSIONS

Consumers are able to perceive recovery-focused service changes. Although preliminary, this is a significant step towards assessing the operationalization of recovery principles from the consumer's perspective.

Testing the validity of the Recovery Assessment Scale using an Australian sample

OBJECTIVE

Mental health services in Australia are increasingly becoming recovery orientated. However, there are varying meanings for recovery and few measures that specifically target recovery outcomes. The current study aimed to assess the construct and concurrent validity of a patient self-report measure, the Recovery Assessment Scale (RAS).

METHOD

Participants were 168 individuals with severe and persistent psychiatric disability who were participants in the Australian Integrated Mental Health Initiative (AIMhi) project. They completed self-report recovery and other mental health measures and their case workers completed the Health of the Nation Outcome Scales. Exploratory and confirmatory factor analyses were carried out to examine the factor structure of the RAS.

RESULTS

Exploratory factor analysis of the RAS produced five factors that were replicated using confirmatory techniques. Each factor has satisfactory internal reliability (Cronbach alpha range = 0.73-0.91). The factors displayed convergent validity with positive and significant correlations with other recovery measures. Concurrent validity was demonstrated with significant but lower correlations with symptoms and clinician-rated measures of psychiatric functioning.

CONCLUSION

The factors of the RAS are consistent with the consumer literature on recovery. Correlations with other variable suggest that the RAS is measuring something different from traditional symptom or functional mental health measures. Further research is needed to clarify the extent to which the RAS is able to capture the range of recovery experiences that have been described by patients.

A review of consumer involvement in evaluations of case management: consistency with a recovery paradigm

This Open Forum examines research on case management that draws on consumer perspectives. It clarifies the extent of consumer involvement and whether evaluations were informed by recovery perspectives. Searches of three databases revealed 13 studies that sought to investigate consumer perspectives. Only one study asked consumers about experiences of recovery. Most evaluations did not adequately assess consumers' views, and active consumer participation in research was rare. Supporting an individual's recovery requires commitment to a recovery paradigm that incorporates traditional symptom reduction and improved functioning, with broader recovery principles, and a shift in focus from illness to well-being. It also requires greater involvement of consumers in the implementation of case management and ownership of their own recovery process, not just in research that evaluates the practice.

Effectiveness of a collaborative recovery training program in Australia in promoting positive views about recovery

OBJECTIVE

This study examined the impact of a two-day, recovery-based training program for mental health workers on knowledge, attitudes, and hopefulness related to the recovery prospects of people with enduring mental illness.

METHODS

A self-report pre-post training repeated-measures design was used with 248 mental health workers from the community-based government health sector (N=147) and nongovernment organizations (N= 101) in eastern Australia.

RESULTS

Staff attitudes and hopefulness improved after training. Trainees significantly increased their knowledge regarding principles of recovery and belief in the effectiveness of collaboration and consumer autonomy support, motivation enhancement, needs assessment, goal striving, and homework use.

CONCLUSIONS

This preliminary evidence indicates that staff recovery orientation can improve with minimal training.

Collaborative goal technology: theory and practice

Goal striving promotes hope and enhances motivation, which is important for psychosocial rehabilitation and recovery. The Collaborative Goal Technology (CGT) is a new goal striving intervention that is used to support the autonomy and recovery processes of the person with a psychiatric disability. The CGT protocol and its utility are outlined. Theory and research from goal striving, motivation and mental health recovery domains that informed the development of CGT are described. A case example is also provided.

Challenges in implementing evidence-based practice into mental health services

This paper highlights challenges in implementing mental health policy at a service delivery level. It describes an attempt to foster greater application of recovery-orientated principles and practices within mental health services. Notwithstanding a highly supportive policy environment, strong support from service administrators, and an enthusiastic staff response to training, application of the training and support tools was weaker than anticipated. This paper evaluates the dissemination trial against key elements to promote sustained adoption of innovations. Organisational and procedural changes are required before mental health policies are systematically implemented in practice.

Interrater reliability of the Camberwell Assessment of Need Short Appraisal Schedule

OBJECTIVE

Australian mental health policy aims to introduce evidence-based practice within a community care approach. This aim requires reliable measures that can be used by a wide variety of professionals. The interrater reliability of the Camberwell Assessment of Need Short Appraisal Schedule (CANSAS) was assessed under routine conditions.

METHOD

Three interviewer-observer dyads assessed the needs of 14 inpatients and 18 day patients of a psychiatric rehabilitation unit in New South Wales, Australia.

RESULTS

Agreement on the identification of an area of need was high. However, agreement was higher on patient ratings than on staff ratings. Correlations on staff ratings of met needs were also moderate (r = 0.53), suggesting discrepancies in rating the level of need.

CONCLUSION

Differences in staff ratings may be attributed to ambiguity in the definition of need and levels of need and/or the sources of information used by the rater making the assessment. An approach to establishing an operational definition of need is suggested, and an increase in the number of levels of need is recommended. Implications for Australian mental health policy are noted.