Promoting Recovery in Mental Illness: A Shared Decision Making Program

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Promoting Recovery from Mental Illness: Tools for Community Programs

poster abstractThe ACT Center of Indiana is a research and training center devoted to helping promote recovery from severe mental illnesses like schizophrenia and bipolar disorder. We focus on interventions that are based on the best research evidence, and we emphasize ways to translate research into actual practice. One important way to ensure evidence-based practices in community settings is the use of reliable and valid tools to monitor program fidelity, i.e., how well programs are following a specific model of practice. We will describe fidelity monitoring tools and practices at the program level (ACT fidelity in Indiana and in the VA) and at the clinician level (Shared decision making and Illness Management and Recovery-Treatment Integrity). We will describe current research studies implementing these tools, and provide examples of the fidelity measures

RELATIONSHIP BETWEEN HOPE AND PATIENT ACTIVATION IN CONSUMERS WITH SCHIZOPHRENIA

poster abstractPatient activation (necessary knowledge and confidence to self-manage one’s illness) and hope (goal-directed thinking and action) are both im-portant in managing chronic conditions like schizophrenia. The relationship between hope and patient activation has not been clearly defined. However, hope may be viewed as a motivating factor, providing reason to be involved in treatment. Higher hope then should lead to greater involvement in care and feelings of efficacy in being able to manage illness (patient activation). The purpose of the present study was to understand the relationship be-tween hope and patient activation in a sample of adults with schizophrenia (n = 119). This study was a secondary data analysis from a study on Illness Management and Recovery (IMR) – a curriculum-based approach to help people with schizophrenia learn to manage their illness. Data were collected at baseline, prior to any intervention, and at a 9-month follow up. As pre-dicted, patient activation and hope were significantly related with each other showing a strong positive correlation (r = .57, p < .001). Comparisons of hope across stages of activation also showed a significant relationship (F (3,112) = 18.49, p < .001). Post-hoc comparisons showed that people in the lowest stage of activation had significantly lower hope than the other ac-tivation groups. Demographics and background characteristics were not sig-nificantly related to patient activation. Longitudinal analyses suggest that hope was a better predictor of subsequent patient activation than the re-verse. Our findings underline the importance of recovery based practices and instilling hope as a potential factor getting patients more engaged in treat-ment

A conceptual model of mental illness stigma constructs

poster abstractMental illness (MI) stigma negatively impacts a range of psychosocial and functional outcomes, and has yielded a significant volume of empirical literature. In a recent meta-analysis of 256 studies of mental health providers’ stigma towards their own patients, over 90 named stigma instruments were identified and 85 publications created their own instrument to be used in a single study. The exceptional number of stigma instruments in the literature raises questions about the conceptualization of stigma and limits the conclusions that can be drawn across studies. Current literature broadly conceptualizes stigma towards MI as consisting of stereotypes (beliefs), prejudice (emotions), and discrimination (actions). The current analysis expands this framework by categorizing each instrument into primary, secondary, and tertiary stigma categories to produce a model displaying the variety of constructs being assessed (briefly outlined below). Understanding the diversity of these constructs may allow for a nuanced interpretation of existing literature, and may spark discussion as to the centrality of certain constructs within MI stigma. Understanding the current stigma measurement landscape may allow for a reduction in the number of instruments currently in use, enhancing consistency and interpretability of empirical results. Stereotype instruments assess beliefs about the abilities or fundamental qualities of individuals with MI. Four secondary categories emerged. Negative Attributes measures undesirable personal characteristics of individuals with MI and contains four tertiary categories: dangerousness, personal control (i.e., MI symptoms are volitional), moral failing (i.e., symptoms are due to a weakness in character), and resistance to treatment. Prognosis measures beliefs about outcomes and future functioning of individuals with MI within two tertiary categories: optimism for treatment outcome and stability. Present Functioning requires respondents to estimate patients’ likely social integration and quality of life. Competence assesses beliefs about general intelligence, talents, and abilities of individuals with MI. Prejudice instruments assess emotion-based reactions to those with MI. The two secondary categories that emerged were Emotional Reactions and Beliefs about Managing Mental Illness. Emotional Reactions includes the tertiary categories of empathy, negative emotions (i.e., fear, disgust, anger), and professional burnout. Beliefs about Managing Mental Illness measures emotional- and value-based approaches to societal management of individuals with MI and contained four tertiary categories. Authoritarianism emphasizes individuals with MI are inferior and should be handled in a restrictive or coercive manner. Benevolence encompasses paternalistic pity and the belief that individuals with MI must be cared for like children. The prosocial view espouses a Community Mental Health Ideology, in that individuals with MI are just like anyone else and treatment should be integrated into the community and society. Finally, some instruments assess whether it is worthwhile to treat MI. Discrimination instruments assess intent or desire to treat individuals with MI differently from others. The three secondary categories that emerged were Social Distance, Willingness to Treat, and Civil Rights. Social Distance describes the desire to limit social contact with individuals with MI, while Willingness to Treat assesses whether mental health professionals are willing to care for individuals with MI. Civil Rights instruments assess restriction of patients’ human rights within four tertiary categories, including whether individuals with MI should be allowed to: engage in common social roles (e.g. parent, spouse, citizen, employee); participate in their own care; and refuse treatment. These instruments also assess whether patients should be forcibly restrained or secluded. Instruments with items that fell into at least two primary stigma categories and assessed a range of emotions, intended behavior, and beliefs about MI were categorized as General stigma

Provider Expectations for Recovery Scale: Refining a measure of provider attitudes

OBJECTIVE: The purpose of this study was to refine and test the psychometric properties of a scale to measure provider attitudes about recovery. METHODS: This was a secondary data analysis that combined survey data from 1,128 mental health providers from 3 state hospitals, 6 community mental health centers, and 1 VA Medical Center. Rasch analyses were used to examine item-level functioning to reduce the scale to a briefer, unidimensional construct. Convergent validity was assessed through correlations with related measures. RESULTS: The Provider Expectations for Recovery scale had strong internal consistency, was related to education and setting in expected ways, and was associated with lower levels of burnout and higher levels of job satisfaction. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: A 10-item scale of Provider Expectations for Recovery appears to be a useful tool to measure an important construct in recovery-oriented care. The process of refining the measure also highlights potential factors in how providers view recovery

Impact of Supervisory Support on Turnover Intention: The Mediating Role of Burnout and Job Satisfaction in a Longitudinal Study

High rates of provider turnover are problematic for our mental health system. Research indicates that supervisory support could alleviate some turnover intention by decreasing emotional exhaustion (a key component of burnout) as well as by increasing job satisfaction. However, the potential mediation mechanisms have not been rigorously tested. Longitudinal data collected from 195 direct clinical care providers at two community mental health centers identified positive effects of supervisory support on reduced turnover intention through reduced emotional exhaustion. Job satisfaction was not a significant mediator. Supervisory support may help mitigate turnover intention through work-related stress reduction

EXAMINING CONSUMER RACE, GENDER, AND AGE DIFFERENCES IN HOPE AND RECOVERY THROUGH NAMI’S IN OUR OWN VOICE PROGRAM

poster abstractThe United States mental health system is in the process of transforming mental health care from treating and reducing symptoms to a relatively new focus on education, awareness, and optimal consumer recovery. The Nation-al Alliance on Mental Illness (NAMI) developed the In Our Own Voice (IOOV) program where consumers present their mental illness and recovery stories as a direct educational and indirect anti-stigma tool. The purpose of this study was to examine the impact that NAMI’s IOOV Program has on con-sumer hope and recovery attitudes. Questionnaires were distributed to four NAMI sites throughout the United States and given to consumers (n = 118) both before and after the IOOV program. The Recovery Expectations Scale, an adaptation of the Consumer Optimism Scale, was used to measure con-sumer recovery attitudes. The Snyder State Hope Scale was used to meas-ure state level hope, with agency and pathways subscales. After the inter-vention, we hypothesized that younger consumers, females, and Caucasians would report greater increases in their hope and expectations for recovery. Contrary to hypotheses, overall state-level hope remained the same throughout the program. Examination of gender differences in hope agency reveals trends, in which females decrease and males only slightly increase after viewing the program. Trends towards significance are also indicated in hope pathways, in which African Americans reported decreased pathways and Caucasians reported increased pathways. In addition, recovery expecta-tions, improved overall, with no significant differences in improvement among demographic variables. Implications of these findings and their im-portance for consumer recovery programs are discussed

Recovery-Oriented Training and Staff Attitudes Over Time in Two State Hospitals

Recovery attitudes and concepts are often promoted to community mental health staff through educational and in-service trainings, but no study found has examined this in state hospitals. The current observational study aimed to examine the types of recovery-oriented trainings that occurred at two state hospitals over 1 year and subsequent changes in staff recovery attitudes. A total of 184 state hospital staff completed questionnaires assessing their personal optimism, consumer optimism, and agency recovery orientation at baseline and 1 year later. The types of recovery-oriented trainings staff received were categorized as general/inspirational or specific/practical training. Results found that the majority of staff at the two state hospitals received some recovery-oriented training, mostly general/inspirational training. Staff who received specific/practical training had a greater increase in agency recovery attitudes than staff who received only general/inspirational training or no training. However, the more trainings staff had, the higher their consumer optimism. These results suggest state hospitals are incorporating recovery-oriented staff trainings, but more specific trainings may be needed and all staff involved in different levels of care need to be included

Barriers and Facilitators to Work Success for Veterans in Supported Employment: A Nationwide Provider Survey

bjective: Veterans with mental illness are at serious risk of poor work outcomes and career stagnation. Supported employment (SE) is an evidence-based model of vocational services that assists persons with mental illness to obtain competitive employment. The purpose of this study was to gain a rich understanding of barriers and facilitators related to competitive work success from the perspective of a nationwide sample of U.S. Department of Veterans Affairs (VA) SE staff, supervisors, and managers. Methods: This study utilized a mixed-methods approach in which 114 VA SE personnel completed an online questionnaire consisting of a survey of work barriers and facilitators; open-ended questions elicited additional factors affecting work success. Descriptive statistics characterized factors affecting work success, and an emergent, open-coding approach identified qualitative themes describing other key elements influencing employment. Results: The most prominent work facilitators were perceived veteran motivation, job match, the assistance of SE services, and veteran self-confidence. The highest rated barriers were psychological stress and a range of health-related problems. Qualitative findings revealed additional areas affecting work success, notably, the availability of resources, the capacity of frontline staff to form strong relationships with veterans and employers, the ability of staff to adapt and meet the multifaceted demands of the SE job, and the need for additional staff and supervisor training. The impact of employer stigma was also emphasized. Conclusions: An array of elements influencing work success at the level of the veteran, staff, SE program, and employer was recognized, suggesting several implications for VA services