Recovery Orientation Of Services Research Articles

User-Led Mental Health Service Evaluation: The Contribution of User-Focused Monitoring to Recovery-Oriented Quality Development

User-focused monitoring (UFM) is a method of user-led mental health service evaluation that focuses on strengthening user involvement and developing the quality of services. Despite an increased emphasis on user involvement and the recovery orientation of services, scientific knowledge remains limited regarding how such goals can be realised. In this study, our aim is to explore UFM with a specific focus on how recovery processes are examined through the method in order to discuss how UFM can be developed in order to support a recovery orientation in mental health service evaluation. We sampled 20 Swedish UFM reports for qualitative analysis, and we found that UFM is a promising method for integrating a personal recovery perspective in service evaluations. By being performed peer-to-peer, the method has the unique ability to gather experiential knowledge regarding the situation of service users. UFM especially contributes to exploring service users’ experiences related to social connectedness and user involvement in services. We also discuss how the method can be developed to further support a recovery orientation in UFM. This might be achieved by integrating a process-oriented approach in the evaluations and by including the user informants’ own goals and views on what constitutes meaningful support in UFM. Suggestions for future developments concern incorporating personal recovery perspectives in the training of user monitors and creating structures for aggregating the knowledge produced through UFM.

Mutual learning: exploring collaboration, knowledge and roles in the development of recovery-oriented services. A hermeneutic-phenomenological study

ABSTRACT Purpose The concept of recovery is commonly described as multifaceted and contested in the field of mental health and substance abuse. The aim of this study is to explore how understandings of recovery and recovery orientation of services are developed through daily practices and collaboration between service users and professionals. Methods Eight pairs of participants were interviewed together, in accordance with the dyadic interview method. The dyads/pairs consisted of service users and professional helpers. A collaborative hermeneutic-phenomenological analysis was used to analyse data. Results Data were analysed into three overarching and entangled themes, exploring how recovery-oriented collaboration and knowledge encompasses (a) recovery as relational processes. These processes are entangled with (b) recovery as situated in time and place. Furthermore, relational processes and dimensions of time and place are situated in and supported or hindered by (c) recovery orientation as part of the municipal policies, understood as the regulations, frameworks and decisions guiding mental health and substance abuse services in the municipality. Conclusions The further development of recovery-oriented services should focus on facilitating open-ended and flexible ways of developing practices and relationships. This involves recognizing how relationships contribute to the development of knowledge and practices.

Cross-cultural adaptation of the recovery self-assessment instrument (RSA–R) person in recovery version to Brazilian Portuguese (Pt/Br)

Purpose The Recovery Self-Assessment (RSA–R) in Revised Version is an instrument designed to assess the degree to which mental health programs and services implement recovery-oriented practices. The purpose of this paper is to conduct a cross-cultural adaptation of the RSA–R instrument for use in local mental health services in the city of Campinas, State of São Paulo, Brazil. Design/methodology/approach This method for cross-cultural adaptation of the instrument included a series of iterative steps including preparation, translation, back translation, harmonization, expert evaluation, focus groups, in-depth interviews, expert opinion and pilot study. Findings A multi-rater assessment of the equivalence of content between the original RSA–R and the translated version revealed that each of the 32 items achieved at least 88% agreement in terms of equivalency. A multi-step harmonization process revealed additional suggestions for improvements in readability, comprehension and applicability to Brazilian context. An expert in youth and adult education provided additional stylistic recommendations. Combined, this iterative approach to cross-cultural translation resulted in an adapted version of the instrument that was well understood, culturally appropriate and adequate for further verification of psychometric properties. Originality/value The recovery process in Brazil and in the USA has culturally determined differences in terms of the way mental disorders are understood, diagnosed and treated. Moreover, there are different notions of what constitutes desirable results of recovery, health care and welfare. At the present time, there are few, if any, available cross-cultural instruments to assess the recovery-orientation of services between Brazil and the USA.

How is evaluated mental health recovery?

IntroductionThere is an increasingly recognition of the concept of recovery in the treatment of mental illness. Recovery defined as living a fulfilling, rewarding life, even in the ongoing presence of a mental illness. Consequently, a number of instruments have been designed to assess recovery-oriented outcomes.ObjectiveThe objective of the study was to conduct a systematic revision of the instruments used to assess recovery with appropriate psychometric properties.MethodA systematic review of the literature has been realized. The adequacy of the instruments utilization, the content validity and psychometrics properties were gathered and analyzed.Results/discussionAfter a systematic review, it has been obtained 25 different instruments for measuring personal recovery and 17 for assessing the orientation of recovery in mental health services. As a consequence of the lack of consensus that exists in the conceptualization of recovery; several instruments have been developed and used to assess the different recovery domains. But it is essential to select scales that match with the recovery model and assess adequately the individual's recovery, and also, the recovery orientation of services. Moreover, those instruments should have appropriate psychometric properties and should be suitable to be introduced in routinely clinical settings.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Mediation analysis of severity of needs, service performance and outcomes for patients with mental disorders.

Needs and service performance assessment are key components in improving recovery among individuals with mental disorders. To test the role of service performance as a mediating factor between severity of patients' needs and outcomes. A total of 339 adults with mental disorders were interviewed. A mediation analysis between severity of needs, service performance (adequacy of help, continuity of care and recovery orientation of services) and outcomes (personal recovery and quality of life) was carried out using structural equation modelling. The structural equation model provided a good fit with the data. An increase in needs was associated with lower service performance and worse outcomes, whereas higher service performance was associated with better outcomes. Service performance partially mediated the effect of patient needs on outcomes. Poorer service performance has a negative impact on outcomes for patients with the highest needs. Ensuring more efficient services for patients with high needs may help improve their recovery and quality of life.

A Cross-Diagnostic Investigation of the Differential Impact of Discrimination on Clinical and Personal Recovery.

Although the negative association between discrimination and recovery has been established, only a few studies have attempted to investigate the underlying mechanism of how perceived discrimination dampens both clinical and personal recovery among people with psychiatric disorders. This study aimed to examine the mediating roles of self-stigma and mental health service engagement in the relationship between perceived discrimination and recovery. A total of 374 people (half men and half women; mean±SD age=43.47±12.76) living in Hong Kong and in recovery with a primary diagnosis of a psychotic disorder, mood disorder, or substance use disorder responded to a cross-sectional questionnaire on discrimination, self-stigma, mental health service adherence, recovery orientation of services, clinical recovery, and personal recovery. Multisample structural equation modeling was conducted to examine whether the hypothesized model for perceived discrimination and recovery produced results that could be generalized across people with various psychiatric diagnoses. Findings indicated that respondents perceived discrimination from the general public and from health care professionals, which was positively associated with self-stigmatization and service disengagement and was negatively associated with clinical and personal recovery across three different types of psychiatric disorder. This study showed that the influence of perceived discrimination on recovery was universal and could be generalized across people with different psychiatric diagnoses. Multipronged stigma reduction interventions targeting the general public, health care professionals, and people in recovery, along with policies that avert discrimination and uphold human rights in health care settings and beyond, should be implemented.

Preliminary evaluation of the Italian version of the INSPIRE measure of staff support for personal recovery

IntroductionSupporting personal recovery has become the main aim for mental health services in many countries nowadays. In particular, the relationship between individual service users and staff members can be the key issue in supporting recovery and this requires specific measures in order to identify and evaluate the orientation of services in this process of change. INSPIRE is a standardized questionnaire developed by King's College, London that represents a service user-rated measure of staff support for personal recovery in the UK.ObjectiveAlthough there is a number of instruments aimed at monitoring recovery in the clinical and functional features, there is still lack of measures for personal recovery and recovery orientation of services in the Italian background.AimsThe aim of this study is to evaluate the psychometric properties of the Italian version of INSPIRE as it is applied in the Italian mental health services.MethodsTwo rounds of data were collected from a sample of 79 inpatients and outpatients of rehabilitation centers and consultant service of the municipality of Ravenna. Analysis was undertaken using SPSS. The main issues investigated were internal consistency, test-retest reliability and exploratory factor analysis.ResultsThe results in the present studies indicate that the Italian version of the INSPIRE measure had a very good internal consistency and a satisfactory test-retest reliability.ConclusionsWhile further studies testing the instrument in larger and more diverse clinical contexts are needed, INSPIRE can be considered a relevant and feasible instrument to use in supporting the development of a recovery-oriented system in Italy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Establishing a recovery orientation in mental health services: Evaluating the Recovery Self-Assessment (RSA) in a Swedish context.

Although there has been an emphasis on developing knowledge regarding recovery in Sweden, it is unclear to what extent this has been translated into a recovery orientation in the provision of mental health services. Instruments, which present the components of recovery as measurable dimensions of change, may provide a framework for program development. Involving users is an essential factor in the utilization of such tools. The purpose of this study was to evaluate the psychometric properties of the Recovery Self-Assessment (RSA) measure and its potential for being utilized in a Swedish context. The sample consisted of 78 participants from 6 community mental health services targeting people with serious mental illnesses in a municipality in Sweden. They completed the RSA at the study baseline and two weeks later. User panels participated in the translation and administration of the RSA and the reporting of results. The Swedish version of the RSA had good face and content validity, satisfactory internal consistency, and a moderate to good level of stability in test-retest reliability. The user panels contributed to establishing validity and as collaborators in the study. Establishing the RSA as a valid and reliable instrument with which to focus on the recovery orientation of services is a first step in beginning to study the types of interventions that may effect and contribute to recovery oriented practice in Sweden.

The CORE study protocol: a stepped wedge cluster randomised controlled trial to test a co-design technique to optimise psychosocial recovery outcomes for people affected by mental illness in the community mental health setting

IntroductionUser engagement in mental health service design is heralded as integral to health systems quality and performance, but does engagement improve health outcomes? This article describes the CORE study protocol,...

Supporting Recovery by Improving Patient Engagement in a Forensic Mental Health Hospital

Mental health services are shifting toward approaches that promote patients' choices and acknowledge the value of their lived experiences. To support patients' recovery and improve their experiences of care in a Canadian forensic mental health hospital, an intervention was launched to increase patient engagement by establishing a peer support program, strengthening a patient advisory committee, and creating a patient-led research team. The effect of the intervention on patient- and system-level outcomes was studied using a naturalistic, prospective, longitudinal approach. Quantitative and qualitative data were gathered from inpatients and service providers twice during the 19-month intervention. Despite succeeding in supporting patients' participation, the intervention had minimal impacts on internalized stigma, personal recovery, personal empowerment, service engagement, therapeutic milieu, and the recovery orientation of services. Peer support demonstrated positive effects on internalized stigma and personal recovery. Strengthening patient engagement contributes toward improving experiences of care in a forensic hospital, but it may have limited effects on outcomes.

A tale of two cultures: examining patient-centered care in a forensic mental health hospital

Several questions remain unanswered regarding the extent to which the principles and practices of patient-centered care are achievable in the context of a forensic mental health hospital. This study examined patient-centered care from the perspectives of patients and providers in a forensic mental health hospital. Patient-centered care was assessed using several measures of complementary constructs. Interviews were conducted with 30 patients and surveys were completed by 28 service providers in a forensic mental health hospital. Patients and providers shared similar views of the therapeutic milieu and recovery orientation of services; however, providers were more likely to perceive the hospital as being potentially unsafe. Overall, the findings indicated that characteristics of patient-centered care may be found within a forensic mental health hospital. The principles of patient-centered care can be integrated into service delivery in forensic mental health hospitals, though special attention to providers’ perceptions of safety is needed.