Stages of recovery instrument: development of a measure of recovery from serious mental illness.

Objective: In order to realize the vision of recovery-orientated mental health services, there is a need for a model and a method of measuring recovery as the concept is described by mental health consumers. A preliminary five-stage model based on consumer accounts was developed in an earlier study by the authors. This next stage of the research program describes the development and initial testing of a stage measure which, when validated, can be used in testing that model. Method: Existing measures of recovery were reviewed to assess their concordance with the model, and a new measure, the Stages of Recovery Instrument (STORI) was subsequently developed. A postal survey was conducted of 94 volunteers from the NISAD Schizophrenia Research Register. Participants completed the STORI and measures of mental health, psychological wellbeing, hope, resilience and recovery. Results: The STORI correlated with all of the psychological health variables, and the five stage subscales were found to be internally consistent. An ordinal relationship between the stage subscales was demonstrated by the intercorrelations of the subscale scores and the pattern of correlations between the subscales and the other measures. However, a cluster analysis of items revealed an overlap in measurement of adjacent stages, with only three clear clusters emerging. Conclusions: The results provide preliminary empirical validation of the STORI as a measure of the consumer definition of recovery. However, refinement of the measure is needed to improve its capacity to discriminate between the stages of the model. The model could then be comprehensively tested using longitudinal methods and the inclusion of objective measures

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

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

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

BACKGROUND: There is growing acceptance that optimal service provision for individuals with severe and recurrent mental illness requires a complementary focus on medical recovery (i.e., symptom management and general functioning) and personal recovery (i.e., having a ‘life worth living’). Despite significant research attention and policy-level support, the translation of this vision of healthcare into changed workplace practice continues to elude. Over the past decade, evidence-based training interventions that seek to enhance the knowledge, attitudes, and skills of staff working in the mental health field have been implemented as a primary redress strategy. However, a large body of multi-disciplinary research indicates disappointing rates of training transfer. There is an absence of empirical research that investigates the importance of worker-motivation in the uptake of desired workplace change initiatives. ‘Autonomy’ is acknowledged as important to human effectiveness and as a correlate of workplace variables like productivity, and wellbeing. To our knowledge, there have been no studies that investigate purposeful and structured use of values-based interventions to facilitate increased autonomy as a means of promoting enhanced implementation of workplace change. METHODS: This study involves 200 mental health workers across 22 worksites within five community-managed organisations in three Australian states. It involves cluster-randomisation of participants within organisation, by work site, to the experimental (values) condition, or the control (implementation). Both conditions receive two days of training focusing on an evidence-based framework of mental health service delivery. The experimental group receives a third day of values-focused intervention and 12 months of values-focused coaching. Well-validated self-report measures are used to explore variables related to values concordance, autonomy, and self-reported implementation success. Audits of work files and staff work samples are reviewed for each condition to determine the impact of implementation. Self-determination theory and theories of organisational change are used to interpret the data. DISCUSSION: The research adds to the current knowledge base related to worker motivation and uptake of workplace practice. It describes a structured protocol that aims to enhance worker autonomy for imposed workplace practices. The research will inform how best to measure and conceptualise transfer. These findings will apply particularly to contexts where individuals are not ‘volunteers’ in requisite change processes. TRIAL REGISTRATION: ACTRN: ACTRN12613000353796

The experiences of recovery from schizophrenia: development of a definition, model and measure of recovery

The traditional view of schizophrenia as having a deteriorating long-term course and an outcome of permanent disability has been challenged both anecdotally and empirically. Therefore, the consumer movement advocates that rehabilitation services become recovery-orientated. Recovery-oriented and empirically validated services have now become policy internationally. However, the meaning of recovery in a medical or research context is different than the meaning used by consumers. The objectives of this research were, therefore to (a) formulate a consumer-oriented definition of recovery; (b) develop a conceptual model of recovery to guide research and evaluation and inform clinical practice; (c) design a measure of recovery, based on the model, and (d) to seek empirical support for the model of recovery. Study One involved a review of the consumer-oriented literature on the concept of recovery, with four aims: (a) to understand the meaning of recovery used by consumers; (b) to identify the components of recovery; (c) to formulate a definition of recovery; and (d) to define the stages of recovery. An examination of consumers’ experiential accounts produced a definition of psychological recovery from the consequences of the illness. Four key processes were identified: (i) finding hope; (ii) re-establishment of identity; (iii) finding meaning in life; and (iv) taking responsibility for wellness and life generally. Five stages were synthesized from the extant qualitative research: (i) moratorium; (ii) awareness; (iii) preparation; (iv) rebuilding and (v) growth. A model of four processes developing over five stages is discussed in the light of the wider literature surrounding recovery from loss and the positive psychology literature. It is concluded that the philosophies of the positive psychology movement have much to offer in recovery-oriented approaches to treatment and research. In Study Two, a brief measure, the Self-identified stage of recovery (SISR), was designed in order to test the model. The aims were to (a) test the validity of the stage measure against continuous recovery measures; (b) to test the notion of recovery assessment as opposed to conventional measures of outcome, and (c) to seek support for the stage model of recovery. The SISR was completed by a clinical population participating in a larger study. High correlations between the recovery measures (rs = .262, p = .01 to rs = .712, p = .01) supported the validity of the SISR, while the pattern of correlations between the recovery measure subscales supported the validity of the SISR as a measure of level of recovery. Negative to low correlations between recovery and conventional measures (rs = - .375 to rs = .191) supported the divergent validity of recovery as an outcome as distinct from conventional measures. In addition, an effect of stage was found on one conventional measure (F (4,127) = 2.9, p \u3c .05) and all recovery measures (F (4, 141) = 2.87, p\u3c.05) to F (4, 141) = 4.68 (p \u3c.001), lending support to the stage model of recovery. The aims of Study Three were to (a) produce a longer, more reliable measure that would better capture the richness of the experience of recovery; (b) examine the validity and reliability of this measure; and (c) seek further support for the stage model of recovery. The Stages of Recovery Instrument (STORI) consists of 50 items, each representing a psychological process at a stage of recovery. The STORI yields five stage subscale scores. A postal survey of volunteers revealed that the STORI correlated with six psychological health variables (rs= 0.45 (p \u3c .01) to rs = 0 .62 (p \u3c .01). Correlational analysis provided support for an ordinal relationship between the stage subscales. An effect of stage was found on all recovery-related variables, (F (3,110) =10.70 (p \u3c.01) to F (3,111) = 24.44 (p \u3c .01). However, a cluster analysis of items resulted in three subscale clusters, rather than the expected five, revealing an overlap between adjacent stages. The results provide preliminary empirical validation of the STORI as a measure of the consumer definition of recovery. Although an effect of stage was found, refinement of the measure is needed to improve its capacity to discriminate between the stages. It could then be used in comprehensively testing the stage model using longitudinal methods and the inclusion of objective measures. The concept of recovery elucidated in this research underlines the importance of taking a positive stance to recovery, focusing on values, meaning and growth rather than on illness-focused approaches to care. The five-stage model has proven useful in clinical training and as a framework for research into recovery. Validation of the model with longitudinal research is planned. Further development of the STORI is underway in separate research, and when refined, the measure should provide an outcome assessment tool that is meaningful to consumers and a useful adjunct to conventional clinical measurement

Evolution and sustainability of the Helping Hands volunteer program: Consumer recovery and mental health comparisoins six years on

The Helping Hands program commenced in 1999 and partners volunteers with mental health consumers for support and to increase social contact, recreational and friendship opportunities. The aim of the present study is to describe the evolution and sustainability of the program over the first 6 years. A description of consumers accessing the program using recovery-oriented measures and traditional measures of behavioural functioning is also provided. Service data was collected on the development of the program, service utilisation, volunteer participation and funding patterns. Cross-sectional measures of recovery and baseline and follow-up Health of the Nation Outcome Scales (HoNOS) were collected on 27 participants. Results showed that the Helping Hands program has evolved significantly since start-up with the development of numerous recreational, health and support groups and 48 active volunteers and 62 active clients. Consumer feedback indicates that the service increases the quality of life of participants considerably. Current clients showed less severe disability at referral than did the original group. There were improvements in the area of relationships on the HoNOS for those who had baseline and follow-up measures. The high volunteer participation rates and positive consumer outcomes represent significant value in return for the modest level of funding

Development of a short measure of psychological recovery in serious mental illness: the STORI-30

Objective: To develop a brief measure of stage of psychological recovery from mental illness by identifying the best-performing items of the 50-item Stages of Recovery Instrument (STORI). Method: Item response modelling was used to identify a short form of the full-length STORI. The resulting items were subjected to factor analysis to further refine the subscales. A second data set was used to confirm the construct validity of the new measure. A correlational analysis was conducted to examine relationships among the five subscale scores. Results: Analyses identified 30 items that represented the five stages of the full STORI. The five stage subscale scores of the shorter measure, the STORI-30, showed a pattern of correlations that demonstrated an ordinal relationship between the stages. Conclusions: There is a need for recovery-oriented measures to augment established clinical assessment tools. The shorter version of the STORI, the STORI-30, shows promise as a brief measure of stage of recovery, more feasible for routine clinical use. Further psychometric and longitudinal testing is recommended. Qualitative research would be valuable in establishing acceptability to consumers and the clinical usefulness of the STORI-30

Do clinical outcome measures assess consumer-defined recovery?

There is an international call for mental health services to become recovery-oriented, and also to use evidence based practices. Addressing this call requires recovery-oriented measurement of outcomes and service evaluation.Mental health consumers view recovery as leading as meaningful life, and have criticised traditional clinical measures for being too disability-oriented. This study compares three measures of consumer-defined recovery fromenduring 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 subscaleswere 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 onmost clinicalmeasures 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 aimof including such measures as an adjunct in routine clinical assessment, service evaluation and research. © 2010 Elsevier Ireland Ltd. All rights reserved

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Measures of individual recovery

There is an international call for mental health services to become recovery-oriented, and also to use evidencebased 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 fromenduring 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 subscaleswere 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 onmost clinicalmeasures 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 aimof including such measures as an adjunct in routine clinical assessment, service evaluation and research