Recovery Oriented Research Articles

A multi-level intervention to reduce the stigma of substance use and criminal involvement: a pilot feasibility trial protocol

BackgroundStigma associated with substance use and criminal involvement is pervasive and creates a barrier to evidence-based addiction care within the criminal legal system. Research has yet to examine a multi-level stigma intervention which targets the intersection of these stigmas among both criminal legal staff and legally-involved clients.MethodsThis paper presents the protocol for a non-randomized trial of a multi-level stigma intervention called Combatting Stigma to Aid Reentry and Recovery (CSTARR) that involves two interventions: (1) training for criminal legal staff to address public stigma and (2) group-based acceptance and commitment therapy to address self-stigma among legally-involved adults enrolled in substance use treatment. Staff and client participants are engaged with a program called the Tennessee Recovery Oriented Compliance Strategy in 6 East Tennessee counties. This study examines the feasibility, acceptability, and preliminary effectiveness of CSTARR using a type 1 hybrid implementation/effectiveness trial with pre to post follow-up.DiscussionStigma must be addressed in the criminal legal system to facilitate the uptake of evidence-based addiction care. This study is the first to evaluate a stigma intervention designed for the criminal legal setting and results will be used to inform a larger, randomized controlled trial. The rationale for this study, research design and measures, as well as potential implications for the field are described.Trial registrationThis clinical trial is registered at clinicaltrials.gov with the identifier NCT05152342. Registered 11/5/2021 at https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000BIN8&selectaction=Edit&uid=U0005X4C&ts=2&cx=-u3wsbx.

Utility of the Global Appraisal of Individual Needs Recommendation and Referral Report for Substance Use Diagnosis, Treatment Planning, and Placement.

This study aims to evaluate the utility of the Global Appraisal of Individual Needs Recommendation and Referral Report (GRRS) as guided by American Psychiatric Association diagnosis criteria and American Society of Addiction Medicine guidelines for treatment planning and placement. Global Appraisal of Individual Needs data were gathered between March 2018 and June 2020 from a total of 82 agencies and 245 clinicians as part of a program evaluation of agencies receiving public funding through the Mid-State Health Network under contract with the Michigan Department of Health and Human Services and the Office of Recovery Oriented Systems of Care. Of the 1395 patients 18 years or older, 1027 GRRS reports were produced by clinical staff. κ And ρ analyses were used to measure rates of clinician agreement with the recommendations produced by the GRRS report based on patient interviews. Clinicians agreed with the GRRS preliminary diagnostic recommendations 88% to 100% of the time, with κ scores indicating excellent agreement by ranging from 0.6 to 0.9. For an average patient, 41 of 46 treatment planning statements generated by the GRRS were used by clinicians, with moderate to high correlation indicated by ρ scores ranging from 0.62 to 0.82. The percent agreement for all American Society of Addiction Medicine dimension ratings was greater than 99%, with κ scores of 0.98 and higher. This study demonstrates the utility and efficiency of the GRRS as a clinical decision support system to support diagnosis, treatment, and placement in routine practice.

Can employment in a café change Clientele Attitude towards the staff when they are Persons with Mental Illness?

Clientele's attitude toward Persons with Mental Illness (PwMI) changes over a period of time. The aim of this study was to explore and understand how and whether perception about PwMI changes when they are seen working like persons without mental illness among those availing services of ROSes café at NIMHANS, Bengaluru. The descriptive research design was adopted with purposive sampling. Community Attitude toward Mentally Ill (CAMI) a self -administered questionnaire of was administered to measure the clientele attitude towards staff with mental illness in ROSes Café (Recovery Oriented Services). A total of 256 subjects availing services from the ROSes café recruited in the study. Chi-square and Mann-Whitney U test was computed to see the association and differences on selected variables. The present study results showed that subjects had a positive attitude seen in health care professionals in the domains of benevolence (BE) (28.68 ± 3.00) and community mental health ideology (CMHI) (31.53 ± 3.19), whereas non-health care professionals had showed negative attitude in the domain of authoritarianism (AU) (30.54 ± 3.42) and social restrictiveness (SR) (30.18 ± 3.05). Education, employment, marital, income, and working status were significantly associated with CAMI domains. PwMI also can work like people without mental illness when the opportunities are provided. The community needs to regard mental illness in the same manner as chronic physical illness diabetes mellitus and allow PwMI to live a life of dignity by creating and offering opportunities to earn livelihood which would help them recover with their illnesses.

Application Cognitive Behavioral Therapy for Psychosis to Recovery Oriented and Collaborative Medical Care

Application Cognitive Behavioral Therapy for Psychosis to Recovery Oriented and Collaborative Medical Care

Recovery-oriented practice: Participant observations of the interactions between patients and health professionals in mental health inpatient settings.

Despite an increasing attention towards recovery orientation in the mental health services, the provision of recovery-oriented practice is challenged in the inpatient wards. Moreover, the existing research within this area is modest and we currently have limited knowledge of how recovery-oriented practice is integrated into inpatient settings. A cornerstone of recovery-oriented practice is the collaboration, patient involvement, and choices, particularly when deciding and planning treatment options. Thus, this ethnographic study aimed to explore how recovery-oriented practice is reflected in the interactions between patients and health professionals around treatment in two mental health inpatient wards in Denmark. Participant observations were conducted in two mental health inpatient wards from November 2014 to January 2015. The Recovery Self-Assessment scale inspired the observation guide and the initial data analysis. Field notes were analysed deductively and inductively using qualitative content analysis. One theme with four subthemes emerged showing that interactions were characterized by an 'as-if collaboration' where 'negotiating on limited grounds' was an important feature of interactions, in which health professionals seemed to have superiority, acting on behalf of 'competing demands'. Patients had to navigate in a field of 'inconsistent guidance and postponed decisions' and faced tendencies of 'control and condescending communication'. The results suggest that recovery oriented values such as equal collaboration, choice and patients' personal preferences are reflected rhetorically in the interactions between patients and health professionals. However, they are negotiated within organizational logics and often overruled by competing demands.

Going Online Together: The Potential for Mental Health Workers to Integrate Recovery Oriented E-Mental Health Resources Into Their Practice

Background: The Internet offers a growing range of e-mental health resources for people experiencing severe mental illness. How these resources may be used in face-to-face interactions with consumers in mental health practice is not well understood. Aim: This article explores mental health workers’ current use of online resources and their views about integrating e-mental health resources for promoting self-management and recovery into community-based practice. Method: A total of 37 mental health workers from six services attended focus groups to discuss their views about using online and e-mental health resources in face-to-face interactions with consumers. Data were analyzed using qualitative content analysis. Results: Participants described accessing Internet information but having little opportunity to use online resources with consumers. Limited access to mobile technology and perceptions that consumers lacked technological experience constrained current use. Three approaches to using e-mental health resources were perceived: directing, collaborating, and empowering. Access to mobile technology within worker–consumer interactions was identified as a potential catalyst for creating recovery-oriented therapeutic relationships. Conclusion: Mental health workers are ready to grasp opportunities to use e-mental health resources with consumers. This has the potential to develop and strengthen collaborative, partnership-based relationships if mental health services support workers and consumers to use online resources together.

Effects of the Personalized Recovery Oriented Services (PROS) Program on Hospitalizations.

Though the recovery model has been implemented widely in outpatient mental health settings, there are no large sample evaluations of recovery oriented psychiatric rehabilitation programs that address both serious mental illness (SMI) and co-occurring disorders (COD) using a more comprehensive Medicaid reimbursable approach. This study examined preliminary hospitalization outcomes, for adults with SMI and COD enrolled in the NYS Personalized Recovery Oriented Services (PROS) program. McNemar's chi-square test was used to examine changes in hospitalization rates from pre-PROS admission to post-PROS discharge in a sample of 12,006 adults discharged from PROS. Negative binomial regression models were used to calculate adjusted rates of hospitalizations and hospital days. Demographic, psychosocial, and diagnosis predictor variables were extracted from the OMH web-based Child and Adult Integrated Reporting System. Hospitalization data were extracted from the Mental Health Automated Recordkeeping System, and Medicaid. From pre-admission to post-discharge, psychiatric hospitalization rate decreased significantly, from 24% to 14%. Substance related hospitalizations also decreased significantly, from 5% to 3%. Average number of hospitalizations and number of days hospitalized decreased even after adjusting for sociodemographic factors. PROS serves a high number of COD patients, and the number of psychiatric and substance related hospitalizations decreased after an episode of PROS, as did the number of days hospitalized. Findings support the maintenance of psychiatric rehabilitation models that include recovery oriented components. Further analyses with control samples are proposed.

Relentless Incrementalism: Shifting Front-Line Culture from Institutional to Recovery-Oriented Mental Healthcare.

St. Joseph's Health Care London is a publicly funded hospital that has led mental health service system transformation in south west Ontario following directives from the Health Services Restructuring Commission (HSRC). This paper documents how provincial policy, HSRC directives, organizational planning, research projects, quality initiatives and change management activities drove, shaped and accomplished a cultural shift at the front line to recovery-focused care. Simultaneous to these activities, beds and related ambulatory services were divested to four other hospitals, beds and employment services were closed and two new, state-of-the-art facilities were constructed, adding considerable complexities to achieving cultural change. This paper documents the incremental steps that were taken to achieve that change.

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.

Discursive Processes Creating Team Culture and Recovery Orientation Among Housing First Providers

A recovery orientation is imperative in mental health services. While structural aspects of programs can influence service providers’ orientation to recovery principles, team culture as exemplified by staff attitudes, values, and beliefs is central to the incorporation of recovery principles in everyday practice. Using Fine's (1979) idioculture framework, this study examined the discursive process in team meetings at a housing first program. Researchers observed team meetings and conducted in-depth, semistructured interviews with case managers from two assertive community treatment teams. Open coding identified categories indicating discursive processes grounded in the recovery language and higher-level coding derived intersubjective themes related to the use of recovery oriented culture during team meetings. Discursive processes included giving benefit of the doubt, withholding judgment, celebrating small things, and accentuating the positive and softening the negative. Using these discursive practices, ...

Embedding a Recovery Orientation into Neuroscience Research: Involving People with a Lived Experience in Research Activity.

This paper highlights the importance and value of involving people with a lived experience of mental ill health and recovery in neuroscience research activity. In this era of recovery oriented service delivery, involving people with the lived experience of mental illness in neuroscience research extends beyond their participation as "subjects". The recovery paradigm reconceptualises people with the lived experience of mental ill health as experts by experience. To support this contribution, local policies and procedures, recovery-oriented training for neuroscience researchers, and dialogue about the practical applications of neuroscience research, are required.

ACT and Recovery: What We Know About Their Compatibility.

While assertive community treatment (ACT) is a widely implemented evidence-based practice, the extent of its recovery orientation has been debated. A literature search identified 16 empirical articles studying recovery and ACT. These 16 studies were classified as involving stakeholder perceptions, interventions, or fidelity measurement. Stakeholders generally viewed ACT as being recovery oriented; research on both interventions and fidelity measurement showed promising approaches. Overall the literature yielded encouraging findings regarding ACT and recovery, though there remains a dearth of research on the topic. We discuss future directions for research and practice to ensure that ACT programs skillfully support recovery.

The recovery-orientation of three mental health units

Purpose– The purpose of this paper is to measure service user and staff views of the recovery orientation of three mental health rehabilitation units; two “open” and one “locked”. It identified elements of recovery that were important to service users. It measured the units’ performance on domains of recovery, attending to differences between staff members’ and service users’ perceptions and between the locked and open units.Design/methodology/approach– A cross-sectional design was used. Staff and service users completed the “Developing Recovery Enhancing Environment Measure (DREEM)”.Findings– Findings revealed some differences between staff and service user views. Service users in the locked unit reported the organisational climate to be more recovery oriented on some domains than those in the open units. Service users’ responses highlighted potential areas for service improvement.Research limitations/implications– The sample was small but reflected the applied setting. Some service users were not invited to participate because of significant communication or cognitive difficulties and it is recognised that they may have had alternative views that remain unrepresented.Practical implications– The DREEM provided valuable information about current practice and potential for service development. Both locked and open units can provide recovery-oriented environments. Services should be aware of discrepant views between staff and service users.Originality/value– To the knowledge, this is the first study to use the DREEM to evaluate the recovery orientation of a locked recovery unit and to compare locked and unlocked units.

Social recovery and the move beyond deficit models of depression: A feminist analysis of mid-life women's self-care practices

In Australia, like other advanced liberal democracies, the adoption of a recovery orientation was hailed as a major leap forward in mental health policy and service provision. We argue that this shift in thinking about the meaning of recovery requires further analysis of the gendered dimension of self-identity and relationships with the social world. In this article we focus on how mid-life women constructed meaning about recovery through their everyday practices of self-care within the gendered context of depression. Findings from our qualitative research with 31 mid-life women identified how the recovery process was complicated by relapses into depression, with many women critically questioning the limitations of biomedical treatment options for a more relational understanding of recovery. Participant stories revealed important tacit knowledge about recovery that emphasised the process of realising and recognising capacities and self-knowledge. We identify two central themes through which women's tacit knowledge of this changing relation to self in recovery is made explicit: the disciplined self of normalised recovery, redefining recovery and depression. The findings point to the need to reconsider how both recovery discourses and gendered expectations can complicate women's experiences of moving through depression. We argue for a different conceptualisation of recovery as a social practice through which women realise opportunities to embody different 'beings and doings'. A gendered understanding of what women themselves identify is important to their well-being, can contribute to more effective recovery oriented policies based on capability rather than deficit.

Isis - recovery orientated Peer Mentor Program

This initiative is the first of this kind in Australia and supports the development of a trained volunteer mentoring network, offering opportunities for people in early recovery to develop supportive mutually beneficial mentoring relationships through regular contact with someone who has lived through and recovered from body image or eating issues for a minimum six month mentoring contract. Recovery Mentors at Isis- The Eating Issues Centre Inc. receive Peer Mentor Training that focusses on awareness of mentoring role, boundaries, skills, risk management and self- care, developing social networks and becoming a non-professional ‘buddy’. Mentoring is provided as an additional support alongside the mentees current contact with professional medical and mental health support. This poster will outline aims and components of the Isis Recovery Oriented Peer Mentor Program that has been trialled at Isis from late 2012 to present, and includes qualitative results and identified areas for further development. This project values lived experiences of recovery and seeks to build capacity to provide effective mentoring support, reflect on the mentoring journey and factors that contribute to recovery. Preliminary results show the program is effective in reducing social isolation, increases hope in the possibility of recovery and provides linkages back to community.

Partners in Change: Bringing People in Recovery into the Process of Evaluating Recovery Oriented Services

Involving people in all aspects of recovery, including the program evaluation process, can not only produce quality outcomes, but can also successfully promote recovery and recovery oriented services (Garverich, Simon, Grudinskas, McDonald, & Grillo, 2008). This article focuses on how involvement in program evaluation promotes recovery by utilizing SAMHSA's Fundamental Components of Recovery. Based on a review of the literature and the experiences at a psychosocial resource center for veterans, the process of involving people in recovery in program evaluation is illustrated with respect to several key recovery components including empowerment, responsibility, hope, peer support, holistic approach, individualized and person-centered care, respect, nonlinear course, strengths-based orientation, and self-direction. Challenges involving people in recovery in the program evaluation process and promoting this process to other staff members are described. Last, lessons learned from the authors' own experiences i...

Care clusters in mental health and co‐production of care – towards a more lay friendly set of cluster descriptions

PurposeThis paper aims to critically examine the care clusters descriptors now being introduced in mental health care in England and to discuss them in the context of trying to further approaches to co‐production (and related concepts), and social inclusion and recovery. The paper seeks to introduce a revised set of cluster descriptors that are more lay friendly and that, hence, would be likely to encourage more service user engagement in care.Design/methodology/approachThe care cluster descriptors are critically examined within the context of desires to engage service users in care and encourage staff to explicitly consider individual strengths as well as needs, i.e. co‐production of care between active service users and providers.FindingsThe implementation of care clusters and the development of new organisations of care based on these present opportunities to further develop in progressive ways how care is planned and developed. The cluster descriptors, however, are not an ideal basis for this. Being designed for one purpose the descriptors do not encourage thinking about individual strengths nor are they very lay friendly. They are not seen as an ideal basis for more actively engaging individuals in the planning and organisation of their care packages. Hence, revised descriptors felt to be more suited to this are presented.Practical implicationsFurthering more recovery oriented and socially inclusive practice in mental health care requires that each part of the system encourages all individuals involved to think in these ways. As the starting point for thinking about care, it is essential that cluster descriptors also work in this way. Services need to consider how the existing cluster descriptors impact on how individual care is thought of and delivered and consider using revised ones for some purposes, especially for engaging individuals in their care.Originality/valueThe care clusters being introduced in mental health care in England need to support progressive developments in care. This is the first time the cluster descriptors have been critiqued from the perspectives of recovery orientation and co‐production.

Implementation of strengthened recovery orientation in the Department of Social Psychiatry in the City of Aarhus - experiences and results

Background/Objectives: The Department of Social Psychiatry in Aarhus, Denmark's second largest municipality, has since 2006 worked on a large quality development programme with the purpose of ensuring that users are met with a recovery oriented approach. The reorientation embraces the entire Department of Social Psychiatry in the City of Aarhus. From 2007–2009 the implementation was guided by a centrally managed master plan. The period from 2009–2011 is then dedicated to anchoring and supporting the local managers. During 2011 the sturdiness of the implementation will be evaluated.

Assessing the Value of Existing Recovery Measures for Routine Use in Australian mental Health Services

The concept of recovery has been recognized as important in the treatment of mental illness. A number of specific instruments exist which are designed to: (i) measure recovery at an individual level; and (ii) assess the recovery orientation of services. The current review aimed to identify these and evaluate their potential for routine use in Australian public sector mental health services. We identified potential instruments by drawing on existing reviews, searching MEDLINE and PsycINFO, and consulting with experts. We used a hierarchical criterion-based approach to assess whether given instruments might be candidates for measuring recovery in the Australian context. We identified 33 instruments: 22 designed to measure individuals' recovery and 11 designed to assess the recovery orientation of services (or providers). Four of the former (Recovery Assessment Scale; Illness Management and Recovery Scales; Stages of Recovery Instrument; Recovery Process Inventory) and four of the latter (Recovery Oriented Systems Indicators Measure; Recovery Self Assessment; Recovery Oriented Practices Index; Recovery Promotion Fidelity Scale) were identified as promising candidates for routine use in Australian public sector mental health services. Further work is required, however, to determine which, if any, might best be used for this purpose; the possibility that modifications to existing instruments or the development of new instruments might be required should not be ruled out. It might be desirable to invest in two instruments: one designed to measure individuals' recovery and one designed to measure the recovery orientation of services. If Australia were to go down this path, it would make sense to align indicators in each as far as possible, and to ensure that they were consistent with existing endeavours aimed at monitoring and improving recovery-focused aspects of service quality.

Implementing recovery: an analysis of the key technologies in Scotland.

BackgroundOver the past ten years the promotion of recovery has become a stated aim of mental health policies within a number of English speaking countries, including Scotland. Implementation of a recovery approach involves a significant reorientation of mental health services and practices, which often poses significant challenges for reformers. This article examines how four key technologies of recovery have assisted in the move towards the creation of a recovery-oriented mental health system in Scotland.MethodsDrawing on documentary analysis and a series of interviews we examine the construction and implementation of four key recovery 'technologies' as they have been put to use in Scotland: recovery narratives, the Scottish Recovery Indicator (SRI), Wellness Recovery Action Planning (WRAP) and peer support.ResultsOur findings illuminate how each of these technologies works to instantiate, exemplify and disseminate a 'recovery orientation' at different sites within the mental health system in order to bring about a 'recovery oriented' mental health system. They also enable us to identify some of the factors that facilitate or hinder the effectiveness of those technologies in bringing about a change in how mental health services are delivered in Scotland. These finding provide a basis for some general reflections on the utility of 'recovery technologies' to implement a shift towards recovery in mental health services in Scotland and elsewhere.ConclusionsOur analysis of this process within the Scottish context will be valuable for policy makers and service coordinators wishing to implement recovery values within their own national mental health systems.