No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Convergent and Concurrent Validity between Clinical Recovery and Personal-Civic Recovery in Mental Health
Abstract
Several instruments have been developed by clinicians and academics to assess clinical recovery. Based on their life narratives, measurement tools have also been developed and validated through participatory research programs by persons living with mental health problems or illnesses to assess personal recovery. The main objective of this project is to explore possible correlations between clinical recovery, personal recovery, and citizenship by using patient-reported outcome measures. All study participants are currently being treated and monitored after having been diagnosed either with (a) psychotic disorders or (b) anxiety and mood disorders. They have completed questionnaires for clinical evaluation purposes (clinical recovery) will further complete the Recovery Assessment Scale and Citizenship Measure (personal-civic recovery composite index). Descriptive and statistical analyses will be performed to determine internal consistency for each of the subscales, and assess convergent-concurrent validity between clinical recovery, citizenship and personal recovery. Recovery-oriented mental health care and services are particularly recognizable by the presence of Peer Support Workers, who are persons with lived experience of recovery. Upon training, they can personify personalized mental health care and services, that is to say services that are centered on the person’s recovery project and not only on their symptoms. Data from our overall research strategy will lay the ground for the evaluation of the effects of the intervention of Peer Support Workers on clinical recovery, citizenship and personal recovery.
... Notably, the 2nd RCT did not collect follow-up employment outcome data and were not included in the predictive validity analyzes. In our validity analyzes, statistically significant correlation magnitudes of >0.3 in absolute value were required (88,89). Notably, we accounted for factors that could potentially influence the strength of validity coefficients, including skewness, scale and criterion scale reliability, timing, range restriction, and method variance. ...
... Evidence from our validity analyzes suggests there is some initial support for the construct validity of the A-MIRS. Notably, self-reported job interview skills (r = 0.341, p = 0.001) and pragmatic social skills (r = 0.605, p < 0.001) were both significant and met the minimum r = 0.30 threshold (88,89). The findings regarding the convergent validity of the A-MIRS were inconclusive, as only one variable (intrinsic motivation to practice interviewing) demonstrated a significant correlation (r = 0.318, p = 0.007) that met the required threshold of 0.30 in magnitude. ...
... future employment in the study groups separately to remove potential bias created by using the virtual interview training. In the Pre-ETS + VIT-TAY group, the relationship between post-test A-MIRS and competitive employment within 6 months was both significant and met the 0.30 threshold (r = 0.312, p = 0.033) providing initial evidence of predictive validity (88,89). Moreover, this result is consistent with the findings from the psychometric evaluation of the original MIRS that observed a relationship between the post-test MIRS score and job offers received (28). ...
Background
Employment is a major contributor to quality of life. However, autistic people are often unemployed and underemployed. One potential barrier to employment is the job interview. However, the availability of psychometrically-evaluated assessments of job interviewing skills is limited for autism services providers and researchers.
Objective
We analyzed the psychometric properties of the Mock Interview Rating Scale that was adapted for research with autistic transition-age youth (A-MIRS; a comprehensive assessment of video-recorded job interview role-play scenarios using anchor-based ratings for 14 scripted job scenarios).
Methods
Eighty-five transition-age youth with autism completed one of two randomized controlled trials to test the effectiveness of two interventions focused on job interview skills. All participants completed a single job interview role-play at pre-test that was scored by raters using the A-MIRS. We analyzed the structure of the A-MIRS using classical test theory, which involved conducting both exploratory and confirmatory factor analyzes, Rasch model analysis and calibration techniques. We then assessed internal consistency, inter-rater reliability, and test–retest reliability. Pearson correlations were used to assess the A-MIRS’ construct, convergent, divergent, criterion, and predictive validities by comparing it to demographic, clinical, cognitive, work history measures, and employment outcomes.
Results
Results revealed an 11-item unidimensional construct with strong internal consistency, inter-rater reliability, and test–retest reliability. Construct [pragmatic social skills (r = 0.61, p < 0.001), self-reported interview skills (r = 0.34, p = 0.001)], divergent [e.g., age (r = −0.13, p = 0.26), race (r = 0.02, p = 0.87)], and predictive validities [competitive employment (r = 0.31, p = 0.03)] received initial support via study correlations, while convergent [e.g., intrinsic motivation (r = 0.32, p = 0.007), job interview anxiety (r = −0.19, p = 0.08)] and criterion [e.g., prior employment (r = 0.22, p = 0.046), current employment (r = 0.21, p = 0.054)] validities were limited.
Conclusion
The psychometric properties of the 11-item A-MIRS ranged from strong-to-acceptable, indicating it may have utility as a reliable and valid method for assessing the job interview skills of autistic transition-age youth.
... Meanwhile, job interview skills would negatively correlate with psychopathology (for convergent validity). In our validity analyses, correlations should be >0.3 in absolute value and statistically significant (72,73). In regard to the validity coefficient analysis, we took note of the factors known to affect the strength of construct and convergent validity coefficients, including scale and criterion scale reliability, skewness, range restriction, timing, and method variance. ...
... Regarding validity, our evidence lends initial support for the MIRS' construct and convergent validities, as several significant correlations met the minimal r = 0.30 threshold (72,73). Specifically, these variables included an independent role-play measure of general social competence for construct validity and multiple markers of neuropsychological function (i.e., processing speed, working memory, reasoning, and problem solving) and the perceived value and utility of job interview training for convergent validity. ...
... Specifically, these variables included an independent role-play measure of general social competence for construct validity and multiple markers of neuropsychological function (i.e., processing speed, working memory, reasoning, and problem solving) and the perceived value and utility of job interview training for convergent validity. Notably, measures of social cognition and attention were significantly correlated with the MIRS at r = 0.28 or higher, but did not meet the r = 0.30 threshold to support convergent validity (72,73). There were some non-significant correlations in the expected direction with lower magnitudes (e.g., verbal learning, psychopathology). ...
Background
Over the past 10 years, job interview training has emerged as an area of study among adults with schizophrenia and other serious mental illnesses who face significant challenges when navigating job interviews. The field of mental health services research has limited access to assessments of job interview skills with rigorously evaluated psychometric properties.
Objective
We sought to evaluate the initial psychometric properties of a measure assessing job interview skills via role-play performance.
Methods
As part of a randomized controlled trial, 90 adults with schizophrenia or other serious mental illnesses completed a job interview role-play assessment with eight items (and scored using anchors) called the mock interview rating scale (MIRS). A classical test theory analysis was conducted including confirmatory factor analyses, Rasch model analysis and calibration, and differential item functioning; along with inter-rater, internal consistency, and test-retest reliabilities. Pearson correlations were used to evaluate construct, convergent, divergent, criterion, and predictive validity by correlating the MIRS with demographic, clinical, cognitive, work history measures, and employment outcomes.
Results
Our analyses resulted in the removal of a single item (sounding honest) and yielded a unidimensional total score measurement with support for its inter-rater reliability, internal consistency, and test-retest reliability. There was initial support for the construct, convergent, criterion, and predictive validities of the MIRS, as it correlated with measures of social competence, neurocognition, valuing job interview training, and employment outcomes. Meanwhile, the lack of correlations with race, physical health, and substance abuse lent support for divergent validity.
Conclusion
This study presents initial evidence that the seven-item version of the MIRS has acceptable psychometric properties supporting its use to assess job interview skills reliably and validly among adults with schizophrenia and other serious mental illnesses.
Clinical Trial Registration
NCT03049813.
... Recurring themes such as "treatment plans," "network meetings," and "medication management" point to a discourse centered on clinical outcomes and structured processes. This language reflects a medicalized approach to care, deeply ingrained in hospital-based services (Davidson 2019;Macpherson et al. 2016;Pelletier et al. 2020;Waters et al. 2015;Whitwell et al. 2017). This contrasts with the more holistic, patient-centered discourse typical of community-based services, which emphasizes long-term support and individualized care (Mead and Bower 2000). ...
This study investigates the role of language in cross‐sector collaboration between mental health hospitals and municipalities, focusing on the challenges of maintaining continuity of care and integrating patient‐centered approaches. Using Fairclough's framework for critical discourse analysis, we examined focus group interviews with 21 healthcare professionals, including nurses, social workers, and psychiatrists, to identify key themes and patterns in how cross‐sector collaboration is discussed. The analysis revealed a dominant medicalized discourse in hospital settings, which often emphasized structured care processes like treatment plans and medication management, overshadowing more flexible, patient‐centered approaches common in community‐based services. Power dynamics were evident, with hospital professionals frequently positioned as active agents, while patients and community‐based workers were portrayed in more passive roles. Although efforts to involve patients in decision‐making were noted, these were often controlled by professionals, reflecting a mediated approach to patient empowerment. The findings highlight the cultural and structural divides between hospital and community services and suggest the need for improved communication strategies, integrated care pathways, and a shift toward more inclusive, patient‐centered care models. Addressing these discursive barriers is crucial for achieving more effective, integrated, and patient‐centered care, ultimately improving outcomes for patients.
... O recovery costuma ser um processo complexo e demorado 13 . (p. 527, tradução nossa) Essa noção, reconhecida na literatura internacional como personal recovery, contrapõe-se à noção de clinical recovery, associada aos objetivos de remissão sintomática, aumento da funcionalidade, retorno ao estado pré-mórbido, uso de psicofármacos e de psicoterapia de forma passiva 14 . ...
Articulamos o tema da recuperação pessoal (recovery) com conceitos de saúde e doença de Georges Canguilhem e Donald Winnicott, em diálogo com registros autobiográficos de Patricia Deegan, pesquisadora e ativista do movimento do recovery. Originada na década de 1970, em movimentos sociais de usuários de Saúde Mental, a recuperação pessoal vem sendo incorporada a espaços acadêmicos, serviços e políticas, como expressa sua inclusão no Plano de Ação em Saúde Mental da Organização Mundial da Saúde (OMS). Reconhecendo sua utilidade como ferramenta conceitual e lógica de cuidado ainda pouco difundida no Brasil, buscamos contribuir com sua consolidação reafirmando que a experiência intersubjetiva é substrato fundamental para a avaliação da saúde, e considerando a dimensão psicossocial da Reforma Psiquiátrica que orienta a Política de Saúde Mental brasileira.
... These results are consistent with multiple researchers' discoveries that engaging patients actively in shared decisionmaking, which involves tapping into both group wisdom and personal experiences, is in harmony with the principles of the recovery-oriented approach. This approach aims to create the best possible environment for cultivating relationships, nurturing optimism, pursuing objectives, and encouraging empowerment (Davidson, 2016a;Leamy et al., 2011;Pelletier et al., 2020). ...
Patient participation in mental health care is recognized as essential for achieving positive outcomes. However, the complexities and challenges inherent in this process necessitate further investigation.
Aim: This scoping review aims to synthesize findings from fourteen selected articles to provide a comprehensive understanding of patient participation in mental healthcare.
Method: The review analyzed articles employing various qualitative methodologies, including interviews and observations, to explore patient and healthcare professional perspectives. Articles were selected based on their relevance to the topic of patient participation in mental health care.
Results: The analysis revealed diverse perspectives on patient participation. Patients’ preferences varied, with some preferring shared decision-making while others preferred minimal involvement. Barriers to shared decision-making included fear of judgment and substance misuse concerns. Strategies to manage disagreements and foster trusting relationships were identified. Challenges in implementing patient and public involvement in mental health services were noted, including stigma and inadequate professional training. Interprofessional collaboration was deemed fundamental, although fragmented care pathways and communication breakdowns persisted. Structural conditions and professional expectations significantly influenced patient participation, with a paternalistic approach perpetuating power imbalances.
Conclusion: Despite challenges, the findings underscored the importance of empowering patients in treatment decision-making, promoting collaborative relationships, and addressing barriers to
enhance patient-centered care in mental health settings. Insights from this review contribute to the discourse on patient-centered care, emphasizing the need for holistic approaches prioritizing patient dignity and well-being.
... The limited overlap between personal recovery and clinical recovery is consistent with several recent systematic reviews concluding that personal and clinical recovery remain distinct constructs (Leendertse et al., 2021;Leonhardt et al., 2017;Van Eck et al., 2017;van Weeghel et al., 2019). Nevertheless, our understanding of these recovery constructs and their relationship may be improved by a promising project currently exploring convergent and concurrent validity between them (Pelletier et al., 2020), as well as investigations of other related factors such as attachment style (van Bussel et al., 2021). The overlap we found between personal recovery and emotional wellbeing rather than clinical recovery is in line with the robust findings that personal recovery predicts subjective wellbeing above and beyond that of clinical recovery (Chan et al., 2017). ...
Background
More knowledge about positive outcomes for people with first-episode psychosis (FEP) is needed. An FEP 10-year follow-up study investigated the rate of personal recovery, emotional wellbeing, and clinical recovery in the total sample and between psychotic bipolar spectrum disorders (BD) and schizophrenia spectrum disorders (SZ); and how these positive outcomes overlap.
Methods
FEP participants ( n = 128) were re-assessed with structured clinical interviews at 10-year follow-up. Personal recovery was self-rated with the Questionnaire about the Process of Recovery-15-item scale (total score ⩾45). Emotional wellbeing was self-rated with the Life Satisfaction Scale (score ⩾5) and the Temporal Experience of Pleasure Scale (total score ⩾72). Clinical recovery was clinician-rated symptom-remission and adequate functioning (duration minimum 1 year).
Results
In FEP, rates of personal recovery (50.8%), life satisfaction (60.9%), and pleasure (57.5%) were higher than clinical recovery (33.6%). Despite lower rates of clinical recovery in SZ compared to BD, they had equal rates of personal recovery and emotional wellbeing. Personal recovery overlapped more with emotional wellbeing than with clinical recovery (χ ² ). Each participant was assigned to one of eight possible outcome groups depending on the combination of positive outcomes fulfilled. The eight groups collapsed into three equal-sized main outcome groups: 33.6% clinical recovery with personal recovery and/or emotional wellbeing; 34.4% personal recovery and/or emotional wellbeing only; and 32.0% none.
Conclusions
In FEP, 68% had minimum one positive outcome after 10 years, suggesting a good life with psychosis. This knowledge must be shared to instill hope and underlines that subjective and objective positive outcomes must be assessed and targeted in treatment.
... Finally, international colleagues have added knowledge and guidance regarding citizenship practice working from the U.S. measure Pelletier et al., 2020); the sociological context of psychosocial interventions and transferring principles and practice to different sociocultural contexts (Eiroa-Orosa, 2018b; Eiroa-Orosa & Rowe, 2017); identification by persons experiencing mental health challenges of barriers to citizenship , and inclusion of citizenship in national health policy planning (MacIntyre et al., 2019). ...
... As the person makes the depressive experience his/her own, from the moment it is named or diagnosed (Vásquez et al., 2020), he/she starts to slowly integrate it in a new narrative of the self that incorporates the depressive experience as one more aspect of his/her identity. This process may entail a continuous and deep transformation of the self (Pelletier et al., 2020;Slade, 2009). ...
Depression has a high prevalence throughout the world, and its management and recovery still constitute a challenge for mental health professionals.
Objective
: The aim of the study was to characterize the subjective experience of recovery from depression based on the perspective of those who suffer from it.
Method
: Forty participants from two South American countries, who had been or were currently being treated for depression, took part in semi-structured and in-depth interviews. Most participants were female (78%), with ages ranging from 22 to 63 years. Interviews were analyzed using Grounded Theory, creating a hierarchy of categories that represent participants’ experience of recovery. The categories were subsequently organized around an emergent central phenomenon.
Results
: “Transformation of the experience of the depressed self” was constructed as the main phenomenon that accounts for the subjective understanding of recovery. This transformation consists in an increase in self-acceptance, self-appreciation, and auto-biographical contextualization, coupled with an increase in agency and empowerment.
Conclusion
: Recovery is experienced as a multidimensional process that goes beyond the absence of symptoms. Change is experienced as a result of active self-management and commitment. The relevance of person-centered perspectives and their subjectivity for managing depression is discussed.
... Aujourd'hui, c'est tout un mouvement collectif vers un changement de paradigme où des experts (universitaires, per-sonnes en rétablissement, décideurs, gestionnaires, intervenants), de partout dans le monde, défendent des services, des systèmes et des communautés axés vers le rétablissement et le bien-être pour tous (Implementing Recovery through Organisational Change [ImRoc], https:// imroc.org/). Toute une littérature et des outils pratiques (Pelletier et al., 2020), soutiennent la mise en pratique du rétablissement à l'intérieur et hors des services de santé (Commission de la santé mentale du Canada [CSMC], 2015;Shepherd et al., 2008Shepherd et al., , 2010. Le Plan d'action en santé mentale du Québec [PASM] 2015-2020 intitulé Faire ensemble et autrement propose comme premier principe directeur des soins et services orientés vers le rétablissement. ...
... It was reported that any such tool must be manageable in terms of length and that training on how to use the tool is essential. (Hamer et al., 2019;Harper et al., 2017;Pelletier et al., 2020). We believe that the SCM, whilst developed within the Scottish context, has wider applicability. ...
There has been increasing interest and research attention towards citizenship‐based practices and care within health and social care settings. A framework for implementing citizenship‐based interventions has helped support the participation in society of persons who have experienced major life disruptions. Yet, having ways to measure the impact of citizenship ‘in action’ within specific socio‐cultural contexts has proved challenging. We report on the development of the Strathclyde Citizenship Measure (SCM) which seeks to establish a psychometrically sound measure of citizenship that is relevant to the Scottish context. We outline the three phases of developing the SCM: (1) item generation, (2) item reduction and piloting, and (3) measure validation. Having generated items for the SCM using concept mapping techniques, we piloted it with 407 participants who completed an online survey of a 60‐item version of the SCM. The aims were to assess the validity of the items and reduce the number of items using principal components analysis for the final measure. This resulted in a 39 item SCM. We then sought to establish the psychometric properties of this shorter version of the SCM through testing its reliability, convergent, concurrent and discriminant validity. The 39 item SCM was administered online to 280 Scottish residents along with additional measures including the Warwick‐Edinburgh Mental Well‐being Scale (WEMWBS), the Depression, Anxiety and Stress Scale (DASS21), the Sense of Belonging Instrument (SOBI‐A); the Big Five Personality Inventory (Shortened Version; BFI‐10) and the Personal Social Capital Scale (PSCS‐16). The factor structure and dimensionality of the SCM was examined using exploratory factor analysis and it was found to be reliable and valid. This paper explores the potential for the application of the SCM across health and social care settings and identifies future work to develop citizenship tools to facilitate dialogues about citizenship across health and social care practice settings.
... In the context of substance use and mental health, numerous accounts of experiences of marginalisation and social exclusion suggest that persons with substance use or mental health problems are not afforded full citizenship (e.g., Blank et al., 2016;Hamer et al., 2014;Mezzina et al., 2006;Vervliet et al., 2019). In recent years, there has been an increasing emphasis on the potential relevance of citizenship for recovery, highlighted by scholars in the United States and Canada (e.g., Pelletier et al., 2020;, and in Europe (e.g., Mezzina et al., 2006;Vervliet et al., 2019). It has been suggested that citizenship and recovery are intersecting concepts, and that citizenship may provide a foundation for the recovery process . ...
Background. The promotion of recovery and quality of life among persons
with co-occurring substance use and mental health problems is an important
objective. In Norway, many persons with co-occurring problems are
residents in supported housing, yet little is known about self-reported
recovery and quality of life within this population and about how core issues
in supported housing and in the community context relate to and may
promote recovery and quality of life. Several barriers to recovery have been
identified in the literature, including unsatisfactory housing conditions,
inflexible support, restricted opportunities for participation in occupations,
and limited citizenship. At the same time, issues such as staff support,
housing satisfaction, and sense of home have been highlighted as important
factors in the supported housing context, while issues related to participation
in occupations, sense of engagement in occupations, and citizenship have
been emphasized as essential factors in the community context. The
importance of addressing these issues through recovery-oriented practices
has been accentuated, particularly through collaborative approaches.
Aims. As a part of a large research project focused on recovery-oriented
practice development in supported housing, the purpose of this doctoral
research was to explore the relevance of core issues in supported housing
and the community context for recovery among residents with co-occurring
problems and to examine if addressing these issues through a recovery-oriented
practice based on a collaborative approach could promote recovery
and citizenship. The thesis consists of four papers. The aim of Paper 1 was
to investigate the psychometric properties of a translation of the Citizenship
Measure. The aim of Paper 2 was to explore and examine the associations
between the core issues in supported housing, namely staff support, housing
satisfaction and sense of home, and recovery. The aim of Paper 3 was to
explore and examine the associations between core issues in the community
context, namely participation in occupations, sense of engagement in
occupations, and citizenship, and recovery. Finally, the aim of Paper 4 was
to examine the potential benefits of employing a collaborative approach to
recovery-oriented practice development for recovery and citizenship.
Methods. Two research designs were adopted: a cross-sectional research
design (Paper 1, Paper 2, and Paper 3) and a prospective comparative design
(Paper 4). In addition, as a part of the preparatory work for the thesis, the
Citizenship Measure was translated and adapted to Norwegian (Paper 1).
The cross-sectional study was conducted with 104 residents at 21 supported
housing sites across six Norwegian cities. The prospective comparative
study was based on a subset of the cross-sectional sample at pre-test
(Autumn 2018), followed up at post-test (Autumn 2019). The study
compared residents at the project site, where there was an ongoing recoveryoriented
practice development, with residents at reference sites following
practice as usual. In both approaches, self-report measures of demographic
characteristics, recovery (the Recovery Assessment Scale Revised,
Corrigan et al., 1999; Giffort et al., 1995), quality of life (the Manchester
Short Assessment of Quality of Life, Priebe et al., 1999; positive and
negative affect, Nes et al., 2018), staff support (the BRIEF Inspire, Williams
et al., 2015), sense of engagement in occupations (the Engagement in
Meaningful Activity Survey, Goldberg et al., 2002), and citizenship (the
Citizenship Measure, Rowe et al., 2012) were used. In addition to
descriptive statistics, linear regression analyses, mediation analyses, onesample
t-tests, and independent samples t-tests were used to examine the
relationships between the variables.
Results. The results that are reported in Paper 2 showed that core issues in
supported housing, namely staff support, housing satisfaction, and sense of
home, were positively associated with recovery in terms of confidence,
seeking support, goals for the future, and reliance on other people. In
addition, these core issues in supported housing were associated with life
satisfaction and satisfaction with different life domains. The results
described in Paper 1 imply that citizenship may be understood as having a
relational and inclusive dimension and a more formal dimension connected
to rights and resources. Furthermore, the results imply that citizenship and
recovery are related yet distinct concepts. The results that are reported in
Paper 3 demonstrated that core issues in the community context, which refer
to sense of engagement in occupations and citizenship, were consistently
associated with recovery across domains as well as with life satisfaction and
satisfaction with life domains and negatively associated with negative affect.
In addition, participation in occupations was associated with recovery
through the relational domains of citizenship, namely caring for others and
community participation. The results that are reported in Paper 4 showed
consistency as well as some, albeit limited, group differences in change in
favor of the residents at the project site. The results showed that the
collaborative approach to recovery-oriented practice development had some
modest benefits in promoting recovery and citizenship. This included an
increased willingness to ask for help for the residents at the project site as
well as stability in civil rights, legal rights, and staff support. For the
residents at the reference sites, there was a decrease in these domains.
Conclusion. Based on the findings, core issues in supported housing and the
community context can be argued to hold great relevance for the promotion
of recovery and quality of life among residents with co-occurring problems.
Keywords: Tenants, dual diagnosis, co-occurring substance use and mental
health problems, recovery, quality of life, citizenship, social inclusion,
supported housing
... In the context of substance use and mental health, numerous accounts of experiences of marginalisation and social exclusion suggest that persons with substance use or mental health problems are not afforded full citizenship (e.g., Blank et al., 2016;Hamer et al., 2014;Mezzina et al., 2006;Rowe et al., 2001;Vervliet et al., 2019). In recent years, there has been an increasing emphasis on the potential relevance of citizenship for recovery, highlighted by scholars in the United States and Canada (e.g., Pelletier et al., 2015;Pelletier et al., 2020;Rowe & Davidson, 2016;, and in Europe (e.g., Mezzina et al., 2006;Vandekinderen et al., 2012;Vervliet et al., 2019). It has been suggested that citizenship and recovery are intersecting concepts, and that citizenship may provide a foundation for the recovery process (Pelletier et al., 2015;Rowe & Davidson, 2016). ...
Citizenship is considered intertwined with recovery, and may be a useful perspective for advancing quality of life among marginalised groups. Yet, matters of citizenship among persons with co-occurring substance use and mental health problems both in research and practice.
Aims
In order to measure citizenship among persons with co-occurring problems in a Norwegian study, a measure of citizenship was translated from English to Norwegian. The aims of the study were to 1) translate and adapt the Citizenship Measure, developed by Rowe and colleagues at the Yale Program for Recovery and Community Health, to Norwegian, and 2) to assess the internal consistency and convergent validity of the Norwegian translated measure.
Methods
The translation process was carried out using forward and back translation procedures. To examine measurement properties, a convenience sample of 104 residents with co-occurring problems living in supported housing completed the measure.
Results
Two factors were identified, related to rights, and to relational citizenship. The Norwegian translation of the Citizenship Measure showed has high internal consistency and adequate convergent validity.
Conclusions
We argue that the measure can be useful in assessing perceived citizenship, and in initiating efforts to support citizenship among persons with co-occurring problems.
... In this article (Part 2), the focus is on recovery understood as a process. This calls for a reminder of a discussion over several years on whether recovery should be understood as a process, as an outcome, or as a combination of both [1][2][3] Davidson and colleagues argued that recovery as a process needs to be understood on its own terms and not necessarily linked to outcomes [2]. Rather, recovery as a process has to do with leading full lives in the face of mental illness and within traditional a variety of experiences and a wide range of knowledge as key partners in research. ...
Recovery, a prominent concern in mental health care worldwide, has been variously defined , requiring further clarification of the term as processual. Few studies have comprehensively addressed the nature of recovery processes. This study aims to explore the nature and characteristics of experiences of recovery as processual. The method used is a form of qualitative meta-synthesis that integrates the findings from 28 qualitative studies published during the past 15 years by one research group. Three meta-themes were developed: (a) recovery processes as step-wise, cyclical, and continuous, (b) recovery as everyday experiences, and (c) recovery as relational. These themes describe how recovery is intertwined with the way life in general unfolds in terms of human relationships , learning, coping, and ordinary everyday living. This meta-synthesis consolidates an understanding of recovery as fundamental processes of living in terms of being, doing, and accessing. These processes are contextualized in relation to mental health and/or substance abuse problems and highlight the need for support to facilitate the person's access to necessary personal, social, and material resources to live an ordinary life in recovery.
... Such personal recovery is distinct from the conceptualization of clinical recovery, which signifies the amelioration of symptoms (Chan et al., 2018;Enrique et al., 2020). Pelletier et al. (2020), for example, state that within the clinical recovery paradigm 'the role of the ill person is mainly to follow the instructions of professionals and comply with prescribed treatments', whereas personal recovery encompasses 'the empowerment of the persons, their ownership and authorship of their own history, autonomy, and independence in living' (p. 2). ...
The Recovery Assessment Scale - Domains and Stages (RAS-DS) is a 38-item self-report instrument measuring recovery from serious mental illness. We explored the suitability of the RAS-DS for individuals with anxiety disorders. A parsimonious short-form of the scale was developed. Participants with anxiety disorder symptoms (N = 295) completed the RAS-DS, DASS-21 and GAD-7. Confirmatory factor analysis supported the expected four-factor structure. Associations with related scales exhibited the expected pattern supporting construct validity in this population. The Recovery Assessment Scale-Short Form (RAS-SF) was derived by inspection of factor loadings and modification indices, yielding a 20-item scale with five items per subscale. Strong correlations between subscales confirmed the total score represented a valid overarching measure of recovery. The present study indicates that recovery is pertinent to individuals with anxiety disorders. Development of the short form RAS-SF affords opportunity for routine measurement of recovery in populations with anxiety and other high prevalence conditions.
Résumé
Objectif
Il existe peu d'outils capables de mesurer le rétablissement des individus présentant des troubles mentaux en tenant compte des différentes dimensions du rétablissement. Cependant, le rétablissement englobe plusieurs objectifs au niveau de l'autonomie, des relations interpersonnelles positives, de la santé mentale et physique, de l'acceptation de soi, du domaine professionnel, ainsi que de la conception d'un projet de vie. Une équipe d'intervenants et de chercheurs provenant de quatre pays (Canada, Belgique, France et Suisse) a adapté l'outil CASIG dans le but de mesurer de façon plus précise ces différents aspects du rétablissement personnel. Cette étude a pour but de valider la version révisée de la CASIG (CASIG-rev) en français.
Méthode
Un total de 272 individus ont été recrutés en ligne pour répondre à la CASIG-rev, ainsi qu'à la mesure du bien-être de Ryff, la Recovery Assessment Scale, et le WHODAS. Un sous-groupe a répondu de nouveau à la CASIG-rev après un mois (pour la stabilité temporelle), puis à six mois (pour la sensibilité au changement).
Résultats
L'analyse factorielle confirmatoire suggère un modèle à cinq facteurs, très similaire au modèle initial proposé. La validité de convergence a été démontrée entre les sous-échelles des outils mesurant des concepts similaires, et la fidélité test-retest a été prouvée pour la majorité des échelles. La version révisée de la CASIG semble également sensible aux changements cliniques ou de rétablissement, notamment au niveau du projet de vie.
Conclusion
Cette étude appuie l'utilisation de la CASIG-rev en français pour mesurer le rétablissement des personnes souffrant de troubles psychiques, ainsi que pour soutenir les intervenants dans l'évaluation de leurs programmes et interventions. Les limites de l'étude ainsi que la pertinence de cet outil sont aussi présentées. Une validation anglaise de l’outil est en cours.
Recovery is real and has had a transformative impact on mental health policies and services, including shifting the focus from chronicity and symptom management to the realization that individuals with mental health issues can lead meaningful lives. However, recovery has been defined, described, understood, and measured in a wide variety of ways that may account for misuses and abuses in its application and possible stagnation in its impact. It is argued that the mental health field must now build upon the strong foundations of recovery by integrating a well-established rights-oriented framework. While recovery emphasizes personal growth and hope, a rights-based perspective underscores inherent dignity, autonomy, and opportunities for acceptance and embrace in engaging in valued social roles. The addition of a rights-based framework – community inclusion, to conversations involving recovery, is aligned with the origins of recovery and how it is commonly understood, and also connects the mental health field to the dramatic positive impacts that have emerged from the longstanding centrality of this concept in the broader disability community.
Lived experience research related to mental health recovery is advancing, but there remains a lack of narrative material from the perspectives of people from under-represented, non-dominant cultural backgrounds in this domain. This study aimed to explore the lived experiences of mental health recovery in people of culturally and linguistically diverse (CALD) backgrounds in the Australian context. The current study involved a secondary analysis of audio and visual data collected during the digital storytelling project Finding our way in Melbourne, Australia. Thematic analysis was used to understand the lived experience narratives of nine participants in relation to mental health recovery. Five themes were identified through an iterative process of analysis, including Newfound opportunities and care , Family as key motivators and facilitators , Coping and generativity , Cultivating self-understanding and resilience , and Empowerment through social engagement . First person lived experience narratives offer deep insight into understanding the ways in which individuals of marginalised communities conceptualise and embody recovery. These findings further the literature and understanding on how to better serve the needs of people with mental health challenges from CALD communities through informed knowledge of what may be helpful to, and meaningful in, individuals’ recoveries.
Reconnue comme la référence en matière de bonnes pratiques en santé mentale, l’approche du rétablissement (AR) implique une considération pour le processus de rétablissement personnel de l’individu et l’adoption de pratiques axées vers le rétablissement (Commission de la santé mentale du Canada, 2015; Shepherd et al., 2008, 2010). Le modèle de développement humain et du processus de production du handicap (MDH-PPH) conçoit que la participation sociale des personnes résulte de l’interaction entre les facteurs personnels et les caractéristiques de l’environnement, ces domaines étant d’égale importance dans la compréhension des situations de handicap vécues par une personne, ou par un groupe ou une communauté partageant des caractéristiques personnelles communes dans un même contexte (Fougeyrollas, 2010). Nous présentons dans cet article une analyse des ressemblances philosophiques entre l’AR et le MDH-PPH et amorçons une réflexion sur l’apport mutuel de ces approches dans la lutte contre les obstacles sociaux qui nuisent à la participation sociale des personnes en situation de vulnérabilité/handicap. Pour ce faire, une analyse philosophique de nature herméneutique a été réalisée. Cinq angles d’analyse ont été choisis : 1) anthropologique; 2) environnemental; 3) axiologique; 4) éthique; 5) politique. Quatorze éléments de ressemblances ont été décelés entre les deux approches pour l’ensemble des angles analysés justifiant un apport mutuel dans la compréhension des situations de ces personnes.
Background: In times of pandemics, social distancing, isolation and quarantine have precipitated depression, anxiety and substance misuse. Scientific literature suggests that patients living with mental health problems or illnesses (MHPIs) who interact with Peer Support Workers (PSWs) will not only feel the empathy and connectedness that comes from similar life experiences, but that this interaction also fosters hope in the possibility of a recovery. However, it is the effect of mental health teams or programs where there are PSWs that has been evaluated. Data will be collected for a future Randomized Controlled Trial by determining an effect size that would be specifically attributable to PSWs.
Objective: The five principal research questions are whether this online intervention will have an impact in terms of (Q1) personal-civic recovery and (Q2) clinical recovery , (Q3) how these recovery potentials can be impacted by the COVID-19 pandemic, (Q4) how the lived experience of persons in recovery can be mobilized to cope with such a situation, and (Q5) how sex and gender considerations can be taken into account for the pairing of PSWs with service users, beyond considerations based solely on psychiatric diagnoses or specific MHPIs.
Methods: Intervention: During the transitional and controlled online peer support groups, PSWs will simulate a typical unformal peer support group. They will have a personal-civic recovery focus, and they will be scripted with a fixed, predetermined duration (a series of 10 weekly 90-minute online workshops). There will be two experimental sub-groups: patients diagnosed with (1) psychotic disorders (n=10), and (2) anxiety or mood disorders (n=10), compared to a control group (n=10). Intervention Model: Parallel Assignment Allocation: Randomized Ratio: 2:1.
Results: Measures: Several instruments have been developed by clinicians and academics to assess clinical recovery. Based on their life narratives and to assess personal-civic recovery, measurement tools have also been developed through community-based participatory research; for instance the Recovery Assessment Scale and the Citizenship Measure questionnaires (personal-civic recovery). This pre-post research feasibility study of a trial is proposed to evaluate the outcomes on personal-civic recovery (primary outcome); and to assess its effects in terms of clinical recovery and stress- or anxiety-related responses to the COVID-19 (secondary outcomes). The COVID Stress Scales and the measures of personal-civic recovery will be repeated, along with the following measures of clinical recovery: (i) Anxiety State-Trait Anxiety Inventory Form Y6, (ii) Depression Patient Health Questionnaire, (iii) Alcohol Use Disorders Identification Test, (iv) Drug Abuse Screening Test, (v) Psychosis Screening Questionnaire, and (vi) World Health Organization Disability Assessment Schedule. Change will be compared between groups from baseline to intervention vs. control group in the study outcome measures using the Student paired sample t test. Results are expected for December 2020.
Conclusions: Integrated Knowledge Translation: Study results will provide reliable evidence on a web-based intervention provided by Peer Support Workers. The investigators, with key decision makers and patient partners, will ensure knowledge translation throughout and the Massive Online Open Course (MOOC) on the Fundamentals of Recovery will be updated with the evidence and new knowledge generated by this feasibility study.
Clinicaltrial: ClinicalTrials.gov Identifier: NCT04445324.
Objectives:
To lay the groundwork for the arrival of Recovery Mentors (RMs) in some of its multidisciplinary teams, a Continuing Professional Development (CPD) conference was organized in a large public agency in the province of Quebec, Canada. The aim was to come up collectively with recommendations to improve access to recovery-oriented care and services for this vulnerable population by recognizing the epistemic value of their lived experience.
Methods:
A series of workshops were organized among health professionals to reflect on their practice and to discuss the role of RMs for improving epistemic equity and recognition of the experiential knowledge. In preparation for these workshops participants completed the Recovery Self-Assessment (RSA). The RSA is a 32-item questionnaire designed to gauge the degree to which programs implement recovery-oriented practices, which should notably include RMs in multidisciplinary teams (five-point Likert scale: 1= strongly disagree ; 5 = strongly agree). The interactive workshops were hosted by RMs as trainers who first shared their lived experience and understanding of recovery.
Results:
Eighty-height of the 105 participants completed the RSA. The highest score on the RSA was for the item Staff believe in the ability of program participants to recover (mean = 4.2/5). The lowest score was for the item People in recovery are encouraged to attend agency advisory boards and management meetings (mean = 2.2/5). Based on the average inter-item correlation, a reliability test confirmed an excellent internal consistency for the French RSA scale, with a Cronbach's Alpha of .9. Means and standard deviation for each item of the RSA questionnaires were calculated. The results did not differ by participant characteristics. Results to the RSA and results from the workshops that were co-hosted by RMs were reported in the plenary session and further discussed. The workshops, the RSA and the whole CPD conference raised awareness among health professionals about stigmatizing attitudes and epistemic inequity in actual service provision.
Conclusion:
RMs could be invited to actively participate and attend advisory boards and management meetings more frequently and on a more regular basis for ongoing quality improvement towards better access to recovery-oriented practices. This CPD conference has shown the acceptability and feasibility of including RMs as trainers for better recognition of the epistemic value of the experiential knowledge of recovery. They can help health professionals to recognize and better appreciate service users as knowers and potential contributors to knowledge.
Objective:
The aim of this study was to test the feasibility of a therapeutic educational program in oral health (TEPOH) for persons with schizophrenia (PWS).
Design:
In a qualitative study, we explored the representation of oral health before and after a TEPOH. Clinical Setting: PWS are at greater risk of decayed and missing teeth and periodontal diseases. In a previous publication, we described the different steps in building a TEPOH by taking into account the experiences of PWS concerning oral health quality of life. This TEPOH aimed at promoting a global health approach. Participants: Voluntary PWS and their caregivers were recruited during face-to-face interviews at "Les Boisseaux" (a psychiatric outpatient centre) in Auxerre (France) and were included in the study between November and December 2016. Intervention: We explored the experiences of participants and their perceptions of oral health before and after the TEPOH with focus group meetings.
Results:
Four females and three males participated in the study, and the mean age was 29.4 ± 5. Before the TEPOH, the PWS produced 28 ideas about oral health perception and 37 after the TEPOH. After the TEPOH, elements relating to the determinants of oral health (smoking and poor diet) emerged.
Conclusions:
These results show an evolution in oral health representation, and after some adjustments to the TEPOH, the second step will be to test this program in a large sample to generate a high level of evidence of the impact of TEPOH in the long term.
Educative attitude is an essential, if implicit, aspect of training to acquire competency in therapeutic patient education (TPE). With multiple (or nonexistent) definitions in the literature, however, the concept needs clarification. The primary aim of this study was to analyze the representations and transformations experienced by health care professionals in the course of TPE training in order to characterize educative attitude. We conducted an exploratory qualitative study using several narrative research-based tools with participants of two TPE continuing education courses. We then performed an inductive thematic analysis. Thirty-three people participated in the study; the majority were women (n=29), nurses (n=17) working in a hospital setting (n=28). Seven categories of statements were identified: time-related (“the right moment, how much time it takes”), the benefits of TPE (to health care professionals’ personal well-being), emotions and feelings (quality of exchanges, sharing), the professional nature of TPE (educational competencies required), the holistic, interdisciplinary approach (complexity of the person and value of teamwork), the educational nature of the care relationship (education an integral part of care) and the ethical dimension (introspection essential). The first three components appear fairly innovative, at least in formulation. The study’s originality rests primarily in its choice of participants – highly motivated novices who expressed themselves in a completely nontheoretical way. Health models see attitude as critical for adopting a behavior. Best TPE practices should encourage personal work on this, opening professionals to the social, experiential and emotional aspects of managing chronic illness.
In 2008, the National Institute of Mental Health (NIMH) announced that in the next few decades, it will be essential to study the various biological, psychological and social ‘signatures’ of mental disorders. Along with this new ‘signature’ approach to mental health disorders, modifications of DSM were introduced. One major modification consisted of incorporating a dimensional approach to mental disorders, which involved analyzing, using a transnosological approach, various factors that are commonly observed across different types of mental disorders. Although this new methodology led to interesting discussions of the DSM5 working groups, it has not been incorportated in the last version of the DSM5. Consequently, the NIMH launched the ‘Research Domain Criteria’ (RDoC) Framework in order to provide new ways of classifying mental illnesses based on dimensions of observable behavioral and neurobiological measures. The NIMH emphasizes that it is important to consider the benefits of dimensional measures from the perspective of psychopathology and environmental influences, and it is also important to build these dimensions on neurobiological data. The goal of this paper is to present the perspectives of DSM5 and RDoC to the science of mental health disorders and the impact of this debate on the future of human stress research. The second goal is to present the ‘Signature Bank’ developed by the Institut Universitaire en Santé Mentale de Montréal (IUSMM) that has been developed in line with a dimensional and transnosological approach to mental illness.
Background
Concerns about fragmented community mental health care have led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require those people receiving mental health services to have a care co-ordinator, a written care plan and regular reviews of their care. Care planning and co-ordination should be recovery-focused and personalised, with people taking more control over their own support and treatment.
Objective(s)
We aimed to obtain the views and experiences of various stakeholders involved in community mental health care; to identify factors that facilitated, or acted as barriers to, personalised, collaborative and recovery-focused care planning and co-ordination; and to make suggestions for future research.
Design
A cross-national comparative mixed-methods study involving six NHS sites in England and Wales, including a meta-narrative synthesis of relevant policies and literature; a survey of recovery, empowerment and therapeutic relationships in service users (n = 449) and recovery in care co-ordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117); and a review of care plans (n = 33).
Review methods
A meta-narrative mapping method.
Results
Quantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and the framework method. Our study found significant differences for scores on therapeutic relationships related to positive collaboration and clinician input. We also found significant differences between sites on recovery scores for care co-ordinators related to diversity of treatment options and life goals. This suggests that perceptions relating to how recovery-focused care planning works in practice are variable across sites. Interviews found great variance in the experiences of care planning and the understanding of recovery and personalisation within and across sites, with some differences between England and Wales. Care plans were seen as largely irrelevant by service users, who rarely consulted them. Care co-ordinators saw them as both useful records and also an inflexible administrative burden that restricted time with service users. Service users valued their relationships with care co-ordinators and saw this as being central to their recovery. Carers reported varying levels of involvement in care planning. Risk was a significant concern for workers but this appeared to be rarely discussed with service users, who were often unaware of the content of risk assessments.
Limitations
Limitations include a relatively low response rate of between 9% and 19% for the survey and a moderate level of missing data on one measure. For the interviews, there may have been an element of self-selection or inherent biases that were not immediately apparent to the researchers.
Conclusions
The administrative elements of care co-ordination reduce opportunities for recovery-focused and personalised work. There were few shared understandings of recovery, which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work.
Future work
Research should be commissioned to investigate innovative approaches to maximising staff contact time with service users and carers; enabling shared decision-making in risk assessments; and promoting training designed to enable personalised, recovery-focused care co-ordination.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
Background:
Two discourses exist in mental health research and practice. The first focuses on the limitations associated with disability arising from mental disorder. The second focuses on the possibilities for living well with mental health problems.
Discussion:
This article was prompted by a review to inform disability policy. We identify seven findings from this review: recovery is best judged by experts or using standardised assessment; few people with mental health problems recover; if a person no longer meets criteria for a mental illness, they are in remission; diagnosis is a robust basis for characterising groups and predicting need; treatment and other supports are important factors for improving outcome; the barriers to receiving effective treatment are availability, financing and client awareness; and the impact of mental illness, in particular schizophrenia, is entirely negative. We selectively review a wider range of evidence which challenge these findings, including the changing understanding of recovery, national mental health policies, systematic review methodology and undertainty, epidemiological evidence about recovery rates, reasoning biased due to assumptions about mental illness being an illness like any other, the contested nature of schizophrenia, the social construction of diagnoses, alternative explanations for psychosis experiences including the role of trauma, diagnostic over-shadowing, stigma, the technological paradigm, the treatment gap, social determinants of mental ill-health, the prevalence of voice-hearing in the general population, and the sometimes positive impact of psychosis experience in relation to perspective and purpose.
Conclusion:
We propose an alternative seven messages which are both empirically defensible and more helpful to mental health stakeholders: Recovery is best judged by the person living with the experience; Many people with mental health problems recover; If a person no longer meets criteria for a mental illness, they are not ill; Diagnosis is not a robust foundation; Treatment is one route among many to recovery; Some people choose not to use mental health services; and the impact of mental health problems is mixed.
We assessed the Chinese version of the Drug Abuse Screening Test (DAST-10) for identifying illicit drug use during pregnancy among Chinese population. Chinese pregnant women attending their first antenatal visit or their first unbooked visit to the maternity ward were recruited during a 4-month study period in 2011. The participants completed self-administered questionnaires on demographic information, a single question on illicit drug use during pregnancy and the DAST-10. Urine samples screened positive by the urine Point-of-Care Test were confirmed by gas chromatography-mass spectrometry. DAST-10 performance was compared with three different gold standards: urinalysis, self-reported drug use, and evidence of drug use by urinalysis or self-report. 1214 Chinese pregnant women participated in the study and 1085 complete DAST-10 forms were collected. Women who had used illicit drugs had significantly different DAST-10 scores than those who had not. The sensitivity of DAST-10 for identify illicit drug use in pregnant women ranged from 79.2% to 33.3% and specificity ranged from 67.7% to 99.7% using cut-off scores from ≥1 to ≥3. The ~80% sensitivity of DAST-10 using a cut-off score of ≥1 should be sufficient for screening of illicit drug use in Chinese pregnant women, but validation tests for drug use are needed.
Validation of the psychometric properties of a new measure of citizenship was required for a research project in the province of Quebec, Canada. This study was meant to study the interplay between recovery- and citizenship-oriented supportive employment. As recovery and citizenship were expected to be two related concepts, convergent validity between the Citizenship Measure (CM) and the Recovery Assessment Scale (RAS) was tested.
Study objectives were to: 1) conduct exploratory factor analyses on the CM and confirmatory factor analysis on the RAS tools (construct validity), 2) calculate Cronbach's alphas for each dimension emerging from objective 1 (reliability), and 3) calculate correlations between all dimensions from both tools (convergent validity). Data were collected from 174 individuals with serious mental illness, working in social firms. Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder and borderline personality disorder.
Five factors emerged from the exploratory factor analysis of the CM, with good reliability. Confirmatory factor analyses showed that the short and the long versions of the RAS present satisfactory results. Finally, the correlation matrix indicated that all dimensions from both tools are significantly correlated, thus confirming their convergent validity.
This study confirms the validity and reliability of two tools, CM and RAS. These tools can be used in combination to assess citizenship and recovery, both of which may be combined in the new concept of civic-recovery.
The concept of "recovery" from mental disorder is widely used in the national conversation
about youth and adult mental health treatment as if everyone is on the same page about what it means. Fundamental disagreements among researchers and practitioners exist, however, on a variety of issues related to the precise nature and meaning of recovery from mental, emotional and behavioral disorder generally. Among these issues are: 1. The meaning of recovery; 2. The possibility of full recovery; 3. Effective support for recovery. After reviewing diverging responses for each issue, we then trace practical implications of competing interpretations for treatment and recovery itself. As demonstrated throughout, the stance taken on these questions can have profound and life-long consequences for youth and children in treatment.
Structural equation modeling (SEM) is a vast field and widely used by many applied researchers in the social and behavioral sciences. Over the years, many software pack-ages for structural equation modeling have been developed, both free and commercial. However, perhaps the best state-of-the-art software packages in this field are still closed-source and/or commercial. The R package lavaan has been developed to provide applied researchers, teachers, and statisticians, a free, fully open-source, but commercial-quality package for latent variable modeling. This paper explains the aims behind the develop-ment of the package, gives an overview of its most important features, and provides some examples to illustrate how lavaan works in practice.
Objective:
This review assessed the level of evidence and effectiveness of peer support services delivered by individuals in recovery to those with serious mental illnesses or co-occurring mental and substance use disorders.
Methods:
Authors searched PubMed, PsycINFO, Applied Social Sciences Index and Abstracts, Sociological Abstracts, Social Services Abstracts, Published International Literature on Traumatic Stress, the Educational Resources Information Center, and the Cumulative Index to Nursing and Allied Health Literature for outcome studies of peer support services from 1995 through 2012. They found 20 studies across three service types: peers added to traditional services, peers in existing clinical roles, and peers delivering structured curricula. Authors judged the methodological quality of the studies using three levels of evidence (high, moderate, and low). They also described the evidence of service effectiveness.
Results:
The level of evidence for each type of peer support service was moderate. Many studies had methodological shortcomings, and outcome measures varied. The effectiveness varied by service type. Across the range of methodological rigor, a majority of studies of two service types--peers added and peers delivering curricula--showed some improvement favoring peers. Compared with professional staff, peers were better able to reduce inpatient use and improve a range of recovery outcomes, although one study found a negative impact. Effectiveness of peers in existing clinical roles was mixed.
Conclusions:
Peer support services have demonstrated many notable outcomes. However, studies that better differentiate the contributions of the peer role and are conducted with greater specificity, consistency, and rigor would strengthen the evidence.
he implementation of deinstitutional- ization in the 1960s and 1970s, and the increasing ascendance of the com- munity support system concept and the practice of psychiatric rehabilitation in the 1980s, have laid the foundation for a new 1990s vision of service delivery for people who have men- tal illness. Recovery from mental illness is the vision that will guide the mental health system in this decade. This article outlines the fundamental services and assumptions of a recov- ery-oriented mental health system. As the recovery concept becomes better understood, it could have major implications for how future mental health systems are designed. The seeds of the recovery vision were sown in the aftermath of the era of deinstitutionalization. The failures in the imple- mentation of the policy of deinstitutionalization confronted us with the fact that a person with severe mental illness wants and needs more than just symptom relief. People with severe
"This paper advocates a validational process utilizing a matrix of intercorrelations among tests representing at least two traits, each measured by at least two methods. Measures of the same trait should correlate higher with each other than they do with measures of different traits involving separate methods. Ideally, these validity values should also be higher than the correlations among different traits measure by the same method." Examples from the literature are described as well as problems in the application of the technique. 36 refs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Proposes a cross-cultural validation methodology that allows for the validation of French versions of English psychological scales. The 7 basic steps in the method are described: (1) preparation of a preliminary French version; (2) evaluation and modification of the preliminary version; (3) evaluation of the experimental French version in a pretest; (4) evaluation of content and concomitant validity; (5) evaluation of reliability; (6) evaluation of construct validity; and (7) preparation of norms for the French version. Examples of each step are presented. (English abstract) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This study used participatory methods and concept-mapping techniques to develop a greater understanding of the construct of citizenship and an instrument to assess the degree to which individuals, particularly those with psychiatric disorders, perceive themselves to be citizens in a multifaceted sense (that is, not in a simply legal sense).
Participants were persons with recent experience of receiving public mental health services, having criminal justice charges, having a serious general medical illness, or having more than one of these "life disruptions," along with persons who had not experienced any of these disruptions. Community-based participatory methods, including a co-researcher team of persons with experiences of mental illness and other life disruptions, were employed. Procedures included conducting focus groups with each life disruption (or no disruption) group to generate statements about the meaning of citizenship (N = 75 participants); reducing the generated statements to 100 items and holding concept-mapping sessions with participants from the five stakeholder groups (N = 66 participants) to categorize and rate each item in terms of importance and access; analyzing concept-mapping data to produce citizenship domains; and developing a pilot instrument of citizenship.
Multidimensional scaling and hierarchical cluster analysis revealed seven primary domains of citizenship: personal responsibilities, government and infrastructure, caring for self and others, civil rights, legal rights, choices, and world stewardship. Forty-six items were identified for inclusion in the citizenship measure.
Citizenship is a multidimensional construct encompassing the degree to which individuals with different life experiences perceive inclusion or involvement across a variety of activities and concepts.
This study examined whether employing mental health consumers as consumer-providers in assertive community treatment teams can enhance outcomes for clients with severe mental illness.
In a prospective longitudinal study, presence of consumer-providers and outcomes of 530 clients with severe mental illness in 20 outpatient teams were assessed at baseline and at one-year and two-year follow-ups. Measures included the Health of the Nation Outcome Scales (HoNOS), the Camberwell Assessment of Need Short Assessment Schedule (CANSAS), the Working Alliance Scale, the number of hospital days, and the number of days of homelessness. Multilevel regression was used with the independent variables consumer-provider presence, time of measurement, and their interaction.
A positive association was found between consumer-provider presence and improvements in functioning on the HoNOS (p = .020), met needs in relation to personal recovery (p=.044), unmet needs in relation to personal recovery (p = .008), and number of homeless days (p<.001). A negative association was found for consumer-provider presence and the number of hospital days (p = .019).
Consumer-providers are important participants in outpatient teams serving clients with severe mental illnesses, although integrating these providers as part of a team is a slow process.
While the term "recovery" is routinely referenced in clinical services and health policy, few studies have examined the relationship between recovery-oriented service provision and client outcomes. The present study was designed to examine the relationship between recovery-orientation of service provision for persons with severe mental illnesses and outcomes in Assertive Community Treatment (ACT).
Client, family, staff, and manager ratings of service recovery-orientation and outcomes across a range of service utilization and community functioning indicators were examined among 67 ACT teams in Ontario, Canada.
Significant associations were found between ratings of recovery-oriented service provision and better outcomes in the domains of legal involvement, hospitalization days, education involvement, and employment. Results were not uniformly positive or consistent, however, across stakeholder Recovery Self-Assessment (RSA) ratings or outcomes.
These findings provide some preliminary support for an association between recovery-oriented service delivery for persons with severe mental illnesses and better outcomes. In line with the current practice commentary, this association would suggest the importance of evaluating and cultivating recovery-oriented values and practices in ACT contexts. This is a particularly salient point given that ACT standards minimally address key domains of recovery-oriented service provision. Further study is required, however, to determine if these findings apply to the implementation of ACT in other jurisdictions or generalize to other community support programs.
To evaluate the clinical, methodological and reporting aspects of systematic reviews and meta-analyses in order to determine the efficacy of therapeutic patient education (TPE).
A thorough search of the medical and nursing literature recorded in MedLine database from 1999 to August 2009 was conducted using the keywords: patient education, efficacy, diabetes, asthma, COPD, hypertension, cardiology, obesity, rheumatology, and oncology.
Thirty five relevant meta-analyses were identified and initially selected for critical analyses (598 studies concerning approximately 61,000 patients). The detailed description of the educative intervention was present in 4% of articles whereas in 23% the interventions were briefly described. In the majority of studies, the educative interventions were only named (49%) or totally absent (24%). The majority of studies reported improvement of patient outcomes due to the TPE (64%), 30% of studies reported no effect of TPE and 6% of the analysed reviews and meta-analyses reported worsening of measured outcomes.
Patient education could improve patient outcomes. The high benefit from TPE was shown by articles with detailed description of educational intervention as well as by those who report multidimensional and multidisciplinary educational intervention.
The impact of therapeutic patient education on health outcomes is 50-80%.
This article offers one theoretical perspective of peer support and attempts to define the elements that, when reinforced through education and training, provide a new cultural context for healing and recovery. Persons labeled with psychiatric disability have become victims of social and cultural ostracism and consequently have developed a sense of self that reinforces the "patient" identity. Enabling members of peer support to understand the nature and impact of these cultural forces leads individuals and peer communities toward a capacity for personal, relational, and social change. It is our hope that consumers from all different types of programs (e.g. drop-in, social clubs, advocacy, support, outreach, respite), traditional providers, and policy makers will find this article helpful in stimulating dialogue about the role of peer programs in the development of a recovery based system.
The Recovery Self Assessment (RSA) was developed to gauge perceptions of the degree to which programs implement recovery-oriented practices. Nine hundred and sixty-seven directors, providers, persons in recovery, and significant others from 78 mental health and addiction programs completed the instrument. Factor analysis revealed five factors: Life Goals, Involvement, Diversity of Treatment Options, Choice, and Individually-Tailored Services. Agencies were rated highest on items related to helping people explore their interests and lowest on items regarding service user involvement in services. The RSA is a useful, self-reflective tool to identify strengths and areas for improvement as agencies strive to offer recovery-oriented care.
This article follows up on earlier research examining the factor structure of a measure of recovery from serious mental illness.
Exactly 1,824 persons with serious mental illness who were participating in the baseline interview for a multistate study
on consumer-operated services completed the Recovery Assessment Scale (RAS) plus measures representing hope, meaning of life,
quality of life, symptoms, and empowerment. Results of exploratory and subsequent confirmatory factor analyses of the RAS
for random halves of the sample yielded five factors: personal confidence and hope, willingness to ask for help, goal and
success orientation, reliance on others, and no domination by symptoms. Subsequent regression analyses showed that these five
factors were uniquely related to the additional constructs assessed in the study. We compared these findings with those of
other studies to summarize the factor structure that currently emerges on recovery.
Measuring the process of delivering recovery oriented services is a necessary complement to measuring recovery outcomes. Programs that are recovery oriented promote partnerships with consumers, emphasize consumer choice, and instill hope. This study examined the psychometric properties of the provider version of the Recovery Self Assessment (RSA) in a sample of hospital workers. The RSA demonstrated good to excellent internal consistency, test-retest reliability, and adequate convergent and discriminant validity. The RSA may be a reliable and valid measure of recovery orientation that can be used to assess a variety of mental health programs.
Background:
One-to-one peer support is a resource-oriented approach for patients with severe mental illness. Existing trials provided inconsistent results and commonly have methodological shortcomings, such as poor training and role definition of peer supporters, small sample sizes, and lack of blinded outcome assessments.
Methods:
This is a randomised controlled trial comparing one-to-one peer support with treatment as usual. Eligible were patients with severe mental illnesses: psychosis, major depression, bipolar disorder or borderline personality disorder of more than two years' duration. A total of 216 patients were recruited through in- and out-patient services from four hospitals in Hamburg, Germany, with 114 allocated to the intervention group and 102 to the control group. The intervention was one-to-one peer support, delivered by trained peers and according to a defined role specification, in addition to treatment as usual over the course of six months, as compared to treatment as usual alone. Primary outcome was self-efficacy measured on the General Self-Efficacy Scale at six-month follow-up. Secondary outcomes included quality of life, social functioning, and hospitalisations.
Results:
Patients in the intervention group had significantly higher scores of self-efficacy at the six-month follow-up. There were no statistically significant differences on secondary outcomes in the intention to treat analyses.
Conclusions:
The findings suggest that one-to-one peer support delivered by trained peer supporters can improve self-efficacy of patients with severe mental disorders over a one-year period. One-to-one peer support may be regarded as an effective intervention. Future research should explore the impact of improved self-efficacy on clinical and social outcomes.
lessons learned from previous efforts with the goal of "getting it right" this time. In response to the common refrain that we know about and 'do' recovery already, the authors set the recovery movement within the conceptual framework of major thinkers and achievers in the history of psychiatry, such as Philippe Pinel, Dorothea Dix, Adolf Meyer, Harry Stack Sullivan, and Franco Basaglia. The book reaches beyond the usual boundaries of psychiatry to incorporate lessons from related fields, such as psychology, sociology, social welfare, philosophy, political economic theory, and civil rights. From Jane Addams and the Settlement House movement to Martin Luther King, Jr., and Gilles Deleuze, this book identifies the less well-known and less visible dimensions of the recovery concept and movement that underlie concrete clinical practice. In addition, the authors highlight the limitations of previous efforts to reform and transform mental health practice, such as the de-institutionalization movement begun in the 1950s, in the hope that the field will not have to repeat these same mistakes. Their thoughtful analysis and valuable advice will benefit people in recovery, their loved ones, the practitioners who serve them, and society at large. Foreword by Fred Frese, Founder of the Community and State Hospital Section of the American Psychological Association and past president of the National Mental Health Consumers' Association.
Recovery is a concept which has emerged from the experiences of people with mental illness. It involves a shift away from traditional clinical preoccupations such as managing risk and avoiding relapse, towards new priorities of supporting the person in working towards their own goals and taking responsibility for their own life. This book sets an agenda for mental health services internationally, by converting these ideas of recovery into an action plan for professionals. The underlying principles are explored, and five reasons identified for why supporting recovery should be the primary goal. A new conceptual basis for mental health services is described-The Personal Recovery Framework - which gives primacy to the person over the illness, and identifies the contribution of personal and social identity to recovery. These are brought to life through twenty-six case studies from around the world.
Objective:
The promotion of recovery is the driving philosophy underlying national, state, and local mental health systems. Although numerous recovery-oriented measures have been developed in response, the scientific assessment of recovery measures has lagged behind. The purpose of this literature review was to review the psychometric properties of the Recovery Assessment Scale (RAS), which is arguably the most commonly used measure of recovery in the published literature. Such information is critical for advancing recovery science.
Methods:
A thorough literature search using the search term "Recovery Assessment Scale" was conducted in August 2012, yielding a total of 222 articles published from around the world. A total of 77 articles that included psychometric data on the RAS were used in this review.
Results:
Means and standard deviations across studies were fairly consistent. Overall, the studies indicate very good results for internal consistency, test-retest reliability, and interrater reliability. A number of studies also reported consistent factor structures for the measure. The RAS was found to have positive associations with other related constructs and negative associations with constructs such as symptoms. Finally, the RAS appears to be sensitive to change over time.
Conclusions:
The review found significant evidence to support the use of the RAS in recovery science as a means to measure recovery and to include it in mental health research.
G*Power (Erdfelder, Faul, & Buchner, 1996) was designed as a general stand-alone power analysis program for statistical tests commonly used in social and behavioral research. G*Power 3 is a major extension of, and improvement over, the previous versions. It runs on widely used computer platforms (i.e., Windows XP, Windows Vista, and Mac OS X 10.4) and covers many different statistical tests of the t, F, and chi2 test families. In addition, it includes power analyses for z tests and some exact tests. G*Power 3 provides improved effect size calculators and graphic options, supports both distribution-based and design-based input modes, and offers all types of power analyses in which users might be interested. Like its predecessors, G*Power 3 is free.
Although valuable research has been undertaken in the United States little is yet known about the processes engaged in by supported employment projects for people with mental health problems. The study reported here explored these processes using semistructured interviews with employment project clients, their project workers and workplace managers. Of five projects involved in the research, two exemplified radically different approaches, one implicitly underpinned by a clinical model of recovery and the other by a social recovery model. In this article we draw on data from the seven cases studied from these projects to describe the two approaches and to consider their strengths and limitations. We conclude that approaches based on the social recovery model hold more promise, although such approaches would be enhanced through greater liaison with mental health professionals. In addition, funding structures are required that take account of job retention rates, rather than placement rates alone.
OBJECTIVE Mental health systems internationally have adopted a goal of supporting recovery. Measurement of the experience of recovery is, therefore, a priority. The aim of this review was to identify and analyze recovery measures in relation to their fit with recovery and their psychometric adequacy. METHODS A systematic search of six data sources for articles, Web-based material, and conference presentations related to measurement of recovery was conducted by using a defined search strategy. Results were filtered by title and by abstract (by two raters in the case of abstracts), and the remaining papers were reviewed to identify any suitable measures of recovery. Measures were then evaluated for their fit with the recovery processes identified in the CHIME framework (connectedness, hope, identity, meaning, and empowerment) and for demonstration of nine predefined psychometric properties. RESULTS Thirteen measures of personal recovery were identified from 336 abstracts and 35 articles. The Recovery Assessment Scale (RAS) was published most, and the Questionnaire About the Process of Recovery (QPR) was the only measure to have all items map to the CHIME framework. No measure demonstrated all nine psychometric properties. The Stages of Recovery Instrument demonstrated the most psychometric properties (N=6), followed by the Maryland Assessment of Recovery (N=5), and the QPR and the RAS (N=4). Criterion validity, responsiveness, and feasibility were particularly underinvestigated properties. CONCLUSIONS No recovery measure can currently be unequivocally recommended, although the QPR most closely maps to the CHIME framework of recovery and the RAS is most widely published.
Describes the initial development and evaluation of the Psychosis Screening Questionnaire (PSQ). 90 interviews were conducted with attenders at general practice, followed by interviews with 50 psychiatric inpatients and 50 outpatients. The interview was composed of 2 parts. In Part 1 of the interview, the interviewer read out all the questions in the PSQ and recorded the answers. In Part 2, the interviewer interviewed the Ss, using parts of the Schedules for Clinical Assessment in Neuropsychiatry that were relevant to the diagnosis of psychosis and the registration of symptoms of hypomania. The PSQ had a sensitivity of 96.9%, a specificity of 95.3%, a positive predictive value of 91.2%, and a negative predictive value of 98.4%. Despite the overall excellent performance of the PSQ, given a true prevalence of 1%, 6 people would have to be interviewed to identify 1 case of psychosis. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
OBJECTIVE: While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity.
MEASUREMENTS: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients.
RESULTS: As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score ≥10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples.
CONCLUSION: In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
A general formula (α) of which a special case is the Kuder-Richardson coefficient of equivalence is shown to be the mean of
all split-half coefficients resulting from different splittings of a test. α is therefore an estimate of the correlation between
two random samples of items from a universe of items like those in the test. α is found to be an appropriate index of equivalence
and, except for very short tests, of the first-factor concentration in the test. Tests divisible into distinct subtests should
be so divided before using the formula. The index
[`(r)]ij\bar r_{ij}
, derived from α, is shown to be an index of inter-item homogeneity. Comparison is made to the Guttman and Loevinger approaches.
Parallel split coefficients are shown to be unnecessary for tests of common types. In designing tests, maximum interpretability
of scores is obtained by increasing the first-factor concentration in any separately-scored subtest and avoiding substantial
group-factor clusters within a subtest. Scalability is not a requisite.
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.
Two studies are reported describing the development of a short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI) for use in circumstances where the full-form is inappropriate. Using item-remainder correlations, the most highly correlated anxiety-present and anxiety-absent items were combined, and correlated with scores obtained using the full-form of the STAI. Correlation coefficients greater than .90 were obtained using four and six items from the STAI. Acceptable reliability and validity were obtained using six items. The use of this six-item short-form produced scores similar to those obtained using the full-form. This was so for several groups of subjects manifesting a range of anxiety levels. This short-form of the STAI is therefore sensitive to fluctuations in state anxiety. When compared with the full-form of the STAI, the six-item version offers a briefer and just as acceptable scale for subjects while maintaining results that are comparable to those obtained using the full-form of the STAI.
The study examined whether employing mental health consumers as peer specialists in an intensive case management program can enhance outcomes for clients with serious mental illness.
A quasiexperimental, longitudinal, nonequivalent control group design was used to compare outcomes of clients assigned to three case management conditions: teams of case managers plus peer specialists, teams of case managers plus nonconsumer assistants, and case managers only. Outcomes were measured at baseline and at three six-month intervals. Repeated-measures analysis of variance was used to assess between-group differences.
Complete data were available for 104 clients. Compared with clients in the other two groups, clients served by teams with peer specialists demonstrated greater gains in several areas of quality of life and overall reduction in the number of major life problems experienced. They also reported more frequent contact with their case managers and the largest gains of all three groups in the areas of self-image and outlook and social support. No differences in outcomes were found between clients served by teams with nonconsumer assistants and those served by case managers only.
Integration of peer specialists into intensive case management programs appears to lead to enhanced quality of life for clients and more effective case management.
Sample-size determination is often an important step in planning a statistical study---and it is usually a difficult one. Among the important hurdles to be surpassed, one must obtain an estimate of one or more error variances, and specify an effect size of importance. There is the temptation to take some shortcuts. This paper offers some suggestions for successful and meaningful sample-size determination. Also discussed is the possibility that sample size may not be the main issue, that the real goal is to design a high-quality study. Finally, criticism is made of some ill-advised shortcuts relating to power and sample size. Key words: Power; Sample size; Observed power; Retrospective power; Study design; Cohen's effect measures; Equivalence testing; # I wish to thank Kate Cowles, John Castelloe, Steve Simon, two referees, an editor, and an associate editor for their helpful comments on earlier drafts of this paper. Much of this work was done with the support of the Obermann ...
No Health without Mental Health. Delivering Better Mental Health Outcomes for People of All Ages
- Hm Government
HM Government. No Health without Mental Health. Delivering Better Mental Health Outcomes for People of All
Ages; Department of Health: London, UK, 2011.
New Freedom Commission on Mental. Health Achieving the Promise: Transforming Mental Health Care in America, Final Report; Department of Health and Human Services
New Freedom Commission on Mental. Health Achieving the Promise: Transforming Mental Health Care in
America, Final Report; Department of Health and Human Services: Rockville, MD, USA, 2003. [CrossRef]
- La Ministère De
Ministère de la Santé et des Services sociaux du Québec. Plan D'action En Santé Mentale 2005-2010: La Force
Des Liens; Government of Quebec: Quebec City, QC, Canada, 2005.
Guidelines for the Practice and Training of Peer Support, Mental Health Commission of Canada
- K Sunderland
- W Mishkin
Sunderland, K.; Mishkin, W. Guidelines for the Practice and Training of Peer Support; Mental Health Commission
of Canada: Calgary, AB, Canada, 2013.
The Contribution of the Recovery Self Assessment to the Measurement of Illness Management and Recovery
- P Knupp
Knupp, P. The Contribution of the Recovery Self Assessment to the Measurement of Illness Management
and Recovery. Ph.D. Thesis, Drake University, Des Moines, IA, USA, 2013.
AUDIT Guidelines for Use in Primary Care, World Health Organization
- T Babor
- J Higgins-Biddle
- J Saunders
- M Monteiro
Babor, T.; Higgins-Biddle, J.; Saunders, J.; Monteiro, M. AUDIT Guidelines for Use in Primary Care, 2nd ed.;
World Health Organization: Geneva, Switzerland, 2001.
- W Revelle
- Psych
Revelle, W. psych: Procedures for Personality and Psychological Research. Northwestern University,
Evanston. R package version 1 (1). 2014. Available online: https://www.scholars.northwestern.edu/en/
publications/psych-procedures-for-personality-and-psychological-research (accessed on 25 September 2020).
Signature medical/Psychological Data and Human Biological Materials Bank
- M H Parizeau
- S Lupien
- N François
- G Larocque
- Management
- Framework
Parizeau, M.H.; Lupien, S.; François, N.; Larocque, G. Management Framework: Signature
medical/Psychological Data and Human Biological Materials Bank. Available online: https://www.
banquesignature.ca/ (accessed on 28 September 2013).
Do clinical outcome measures assess consumer-defined recovery?
- Andresen
An R package for structural equation modeling
- Lavaan