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Objective: The support of the personal recovery of people with lived experience of mental illness is a major issue in clinical practice. Thus, a valid instrument to assess personal recovery is needed. The present study aimed to validate the French translation of the 22-item Questionnaire about the Process of Recovery (QPR-Fr). Method: A convenience sample of 222 participants reporting a severe mental illness diagnosis was recruited online. Psychometric properties of the QPR-Fr were evaluated. A confirmatory factor analysis was conducted for structural validity. Internal consistency and test–retest reliability were assessed. To test for convergent validity, we conducted multiple linear regression analysis to explore the QPR-Fr associations with psychological distress and the CHIME framework (with Connectedness, Hope and optimism about the future, Identity, Meaning in life, and Empowerment) proxy measures (perceived social support, hope, self-esteem, quality of life, and empowerment). Results: An adequate fit was found for a 19-item unidimensional factor structure. Internal consistency was excellent. Test reliability was good. The QPR-Fr total score was significantly positively associated with quality of life, hope, self-esteem, and social support satisfaction and negatively associated with psychological distress. No significant association was found with social support availability nor with empowerment. Conclusions and Implications for Practice: This study provides additional data to support the cross-cultural validity of the Questionnaire about the Process of Recovery. The QPR-Fr is a valid and reliable tool to assess personal recovery. Practitioners could use the QPR-Fr to assess personal recovery in collaboration with people with lived experience. Convergent validity with CHIME proxy measures supports the validity of the CHIME framework in a French cultural context. Impact and Implications: Because the present study found that the French version of the Questionnaire about the Process of Recovery (QPR-Fr) is a 19-item valid and reliable instrument to evaluate personal recovery, it can be implemented into routine practice for practitioners to collaboratively assess the personal recovery of people with lived experience. With the QPR-Fr, French researchers will also be able to investigate personal recovery and its associated factors to better understand what enhances or hinders personal recovery, paving the way to cross-cultural studies worldwide. This study constitutes a first step in the validation of the QPR-Fr. Addressing its limitations in further studies would help to render the QPR-Fr a more valuable instrument in clinical practice. It would have as implications the transformation of psychiatric practices toward a personal recovery approach and the development of national and international guidelines to assist the promotion of the personal recovery of people with a mental disorder. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the psychometric properties of the English version of the Self-Stigma Scale–Short (SSS-S), a nine-item self-report self-stigma measurement, among U.S. adults with psychiatric disabilities. Method: We obtained reliability and validity evidence from a sample of 275 adults with psychiatric disabilities. Results: Exploratory factor analysis (EFA; n = 139) yielded a two-factor solution that accounts for 64.97% of the variance. Confirmatory factor analysis (CFA; n = 136) was conducted to compare alternative solutions, including a single-factor model, a two-correlated-factor model, a three-correlated-factor model, and a bifactorial model. The CFA results supported the bifactor S·I − 1 model as a superior latent factor structure for the SSS-S. The coefficient ω of the SSS-S was.94, indicating excellent internal reliability. Concurrent validity of the SSS-S was supported by significant positive correlations with societal stigma and psychiatric symptom severity, and negative correlations with psychiatric disability acceptance, general self-efficacy, and hope. Conclusions and Implications for Practice: The overall findings concluded that the English version of the SSS-S demonstrated reliable and valid scores and a primarily unidimensional structure of self-stigma among U.S. adults with psychiatric disabilities. Given the adverse impact of self-stigma and its relationships with recovery-related constructs shown in this study, the routine use of the SSS-S is recommended in psychiatric rehabilitation settings. Impact and Implications: This study evaluated the psychometric properties of the SSS-S in a sample of U.S. adults with psychiatric disabilities. It provided reliability and validity evidence for the SSS-S as a measurement of mental illness self-stigma in U.S. adults with psychiatric disabilities. Therefore, it is in fact suitable for measuring self-stigma in psychiatric rehabilitation settings. [ABSTRACT FROM AUTHOR]

Objectives: Mental health care has been identified as a major source of mental illness stigmatization. Detailed information about these stigmatization experiences is thus needed to reduce stigma in mental health practices. The study aimed to (a) identify the most relevant stigmatizing situations in mental health care encountered by users with schizophrenia and their families; (b) characterize the relative importance of these situations in terms of frequency, experienced stigmatization, and associated suffering; and (c) identify contextual and individual factors associated with these experiences. Method: An online survey was conducted in France among users and family members to characterize situations of stigmatization in mental health care and identify associated factors. The survey content was first developed from a participative perspective, through a focus group including users. Results: A total of 235 participants were included in the survey: 59 participants with schizophrenia diagnosis, 96 with other psychiatric diagnoses, and 80 family members. The results revealed 15 relevant situations with different levels of frequency, stigmatization, and suffering. Participants with a diagnosis of schizophrenia experienced more situations of stigmatization, with a higher frequency. Moreover, contextual factors were strongly associated with experienced stigmatization, including recovery-oriented practices (negatively associated) and measures without consent (positively associated). Conclusions and Implications for Practice: These situations, as well as associated contextual factors, could be targeted to reduce stigmatization and related suffering in mental health practices. Results strongly underscore the potential of recovery-oriented practice as an instrument to fight stigma in mental health care. Impact and Implications: This study describes 15 concrete situations of stigma experienced in mental health services by users with a schizophrenia diagnosis and their relatives (e.g., discrediting somatic complaint, pessimism, stereotype of dangerousness, violent practices, infantilization, lack of collaboration, lack of social inclusion, lack of respect in intimacy, lack of information and explanations). In addition, this study focused on factors associated with less experienced stigma, such as recovery-oriented practices. [ABSTRACT FROM AUTHOR]

Objective: Recovery Colleges support recovery for adults with mental health problems, through coproduction and education principles. This study aimed to determine whether students at three Recovery Colleges in England were representative of mental health service users. Methods: Gender, age, ethnicity, diagnosis, involuntary detention, and inpatient admission were extracted from clinical records. Data for all service user students enrolled, and those who had attended 70% of a Recovery College course were compared to mental health services caseloads, using chi-square goodness-of-fit tests. Results: Clinical records were identified for 1,788 students. Significant differences were identified for gender, age, and diagnosis (p <.001). In some Colleges, more students had recent inpatient admissions or involuntary detentions. Conclusions and Implications for Practice: Service user students were largely representative of mental health service users, although some groups were underrepresented. Further research is needed to understand why, so that Recovery Colleges can continue to address inequalities. Impact and Implications: This is the first multisite investigation into the characteristics of Recovery College students. It found that students are largely representative of people using mental health services, at different stages of their recovery. However, Colleges and mental health services could work on improving access for male, younger and older service users, and individuals with certain mental health diagnoses. [ABSTRACT FROM AUTHOR]

Objective: Given the paucity of functional recovery measures for young people with psychosis, we developed and conducted psychometric testing of the Functional Outcomes Interview (FOI) and the Roles and Aspirations Among Youth scale (RAY; a much-needed patient-reported outcome measure). Method: Both measures were developed in English, Tamil, and French through discussions with professionals, participants, and families at early psychosis programs in Canada and India. The FOI assesses the number and tenure of functional roles and allows the nuanced assessment of each role in terms of performance, need for support, and quality of social contacts. The roles include work, school, household responsibilities, parenting/caregiving, and efforts to return to work/school. The RAY is a self-report of current roles and future aspirations. Test–retest reliability, internal consistency, factorial validity, and concurrent validity for the RAY; and inter-rater reliability (IRR), internal consistency, and concurrent validity for the FOI were assessed. Results: The RAY had adequate internal consistency and temporal stability and was unidimensional in factor analysis. The FOI had acceptable IRR and internal consistency, as evinced by comparable performance ratings across functional roles. Significant associations between our novel measures and well-established measures of functioning and negative symptoms indicate concurrent validity. Conclusions and Implications for Practice: The FOI and RAY were designed to be youth friendly, assess aspirations, and acknowledge individuals as desiring and holding multiple roles. They thus represent a significant advancement in assessing functional recovery in first-episode psychosis. Having been tested in two distinct settings, these measures show promise for wider deployment across geo-cultural contexts. Impact and Implications: This study advances the assessment of functional recovery in first-episode psychosis through its development and testing of measures that capture a wide spectrum of functional roles (work, school, household responsibilities, parenting/caregiving, efforts to return to work/school) and unique dimensions such as aspirations. Their youth friendliness will facilitate their broad uptake in the field as will the fact that they were tested in two culturally and economically distinct settings and three languages. [ABSTRACT FROM AUTHOR]

Objective: The inclusion of peer-delivered services in organizations providing behavioral health care has significantly increased in recent years, and substantial resources are being directed toward implementing recovery-oriented mental health services using peer-provided programs. Previous research found that participants in such programs have improved recovery outcomes. While there are demonstrated positive associations between recovery outcomes and peer-provided services, there is limited research on the effectiveness of specific peer-provided interventions. Veteran X is a peer-led program developed in the Department of Veterans Affairs in which participants serve as a recovery team for a fictitious Veteran who faces numerous social and mental health issues. This study compared the effectiveness of the Veteran X program with treatment as usual on measures of recovery wellbeing, symptoms and functioning, and risk and protective factors for substance use disorders. Methods: Participants were recruited (N = 80) over a period of ten months, and had self-selected into treatment as usual (TAU, N = 37), or treatment as usual plus Veteran X (N = 43). Results: No baseline differences were found on the pretest measures. Both groups improved on all measures after 60 days of participation, however Veteran X participants improved significantly more than TAU participants on the measures of recovery wellbeing and symptoms and functioning. Conclusions and Implications for Practice: The results of this study appear to support the positive contribution of the Veteran X program in improving recovery wellbeing and symptoms and functioning among participating veterans. Impact and Implications: Veteran X is an innovative approach to peer-led services in which participants serve as a recovery team for a fictitious Veteran with social and mental health concerns. Results of this study suggest that Veteran X is associated with gains in recovery wellbeing, symptoms and functioning, and may be a useful adjunct to traditional mental health treatment. [ABSTRACT FROM AUTHOR]

Objective: The current article describes efforts to develop and test a measure of recovery-oriented inpatient care. Method: The Recovery-oriented Acute INpatient (RAIN) scale was based on prior literature and current Veterans Health Administration (VHA) policy and resources and further revised based on data collection from 34 VHA acute inpatient units. Results: A final scale of 23, behaviorally anchored items demonstrated a four-factor structure including the following factors: inpatient treatment planning, outpatient treatment planning, group programming, and milieu. While several items require additional revision to address psychometric concerns, the scale demonstrated adequate model fit and was consistent with prior literature on recovery-oriented inpatient care. Conclusions and Implementations for Practice: The RAIN scale represents an important tool for future implementation and empirical study of recovery-oriented inpatient care. Impact and Implications: This study focused on developing a scale to measure recovery-oriented inpatient mental health care. The study found a 23-item scale matched prior literature and included four general areas of recovery-oriented inpatient care: inpatient treatment planning, outpatient treatment planning, group programming, and milieu. This scale can be used to improve the recovery orientation of inpatient programming. [ABSTRACT FROM AUTHOR]

Objective: The present study was designed to describe individuals receiving psychiatric rehabilitation (PR) service and investigate program outcomes and factors associated with progress in a multisite, descriptive evaluation across Pennsylvania. Method: Through an outcomes-monitoring process integrated into routine service delivery, survey responses from 408 individuals participating in PR were summarized. Linear mixed models were used to examine change over time in self-reported progress ratings in rehabilitation domains and factors associated with progress. Results: Significantly lower utilization of inpatient psychiatric service was observed in the 12 months after initiating PR versus the 12 months before service (15% vs. 24%; p = .002). Peer and case management service increased after initiation of PR. Specifying a domain as a goal in the service plan was associated with higher progress ratings in the learning (β = .75, p = 0001), working (β = 1.06, p = .0001), and physical wellness (β = 1.27, p = .0001) domains. Average hopefulness rating was positively and significantly associated with self-reported progress in all domains. Conclusions and Implications for Practice: The current investigation provides some evidence that individuals participating in PR decrease utilization of inpatient service. This finding and the goals and activities reported in domains over time support the added value of PR as a Medicaid-reimbursable service to managed care efforts to promote rehabilitation outcomes and recovery for individuals with psychiatric disabilities. [ABSTRACT FROM AUTHOR]

Objective: Trauma experienced by individuals with serious mental illnesses extends beyond physical and sexual abuse. This is among the first studies to examine verbal violence, both spoken and written words, experienced by individuals with serious mental illnesses. Method: Fifty individuals diagnosed with a schizophrenia-spectrum, bipolar, or major depressive disorder were recruited from community-based mental health agencies and reported on their experiences with 8 types of verbal violence identified in the literature, or related written comments, including: belittling, insulting, name-calling, teasing/ embarrassing, threatening, cursing, or yelling. They also reported on the frequency of such events and the perpetrators. Results: 82% of participants reported at least 1 type of verbal violence in their lifetime and 66% reported an incident in the past year. The most common experiences were being called names, belittled, and insulted, teased, or embarrassed in front of others. Top perpetrators were friends and parents. Conclusions and Implications for Practice: Verbal violence is a common experience with potentially devastating effects on mental health and well-being, sense of safety, and recovery and community participation among adults with serious mental illnesses. It is plausible that such comments deserve being recognized as "violence" on par with physical and sexual assaults, although further research would be useful to expand our knowledge about their effects on health, wellness, and community inclusion. New interventions that prevent, lessen, and eliminate such violence, may also be advisable. [ABSTRACT FROM AUTHOR]

Objective: Parenting is an important life domain for many people, but little research examines the parenting experience and its role in recovery for those with a severe mental illness. The current study provides preliminary evidence of how these concepts are related in a sample of individuals living with severe mental illness attending a community mental health center. We also explored potential differences between mothers and fathers, which could help better tailor services to meet the needs of parents with severe mental illness. Method: Data were obtained during baseline interviews for a study testing an intervention designed to increase shared decision making in psychiatric treatment. Participants (N = 167) were administered measures of patient activation, recovery, autonomy preference, hope, and trust in providers. We compared parents and nonparents and compared mothers and fathers using chi-square tests, t tests, and, when appropriate, analysis of covariance. Results: Parents had a significantly higher level of trust in their psychiatric care provider than nonparents. Contrary to hypotheses, parents were less active in their treatment and preferred less information-seeking autonomy than did nonparents, but did not differ on other recovery-related indices. No differences on recovery-related indices were detected between mothers and fathers. Secondary analyses revealed parents with minor children had more hope than parents of older children. Conclusions and Implications for Practice: Although parents may have higher levels of trust in their physicians, our preliminary findings suggest that parents with severe mental illness may benefit from increased efforts to help them be more active and interested in information about their illnesses. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the impact of a mental illness self-management intervention, called Wellness Recovery Action Planning (WRAP), on the use of and need for mental health services over time compared with nutrition and wellness education. Method: Participants were recruited from outpatient community mental health settings in Chicago, Illinois. Using a single-blind, randomized controlled trial design, 143 individuals were assigned to WRAP or to a nutrition education course and assessed at baseline and at 2-month and 8-month follow-up. The WRAP intervention was delivered by peers in recovery from serious mental illness who were certified WRAP educators over nine weekly sessions lasting 2.5 hrs. The nutrition education curriculum was taught by trained non-peer educators using the same schedule. Mixed-effects random regression analysis tested for differences between the two interventions in (a) self-reported use of 19 clinical, rehabilitation, peer, emergent, and ancillary services; and (b) self-reported need for these services. Results: Results of mixed-effects random regression analysis indicated that, compared with controls, WRAP participants reported significantly greater reduction over time in service utilization (total, individual, and group), and service need (total and group services). Participants in both interventions improved significantly over time in symptoms and recovery outcomes. Discussion: Training in mental illness self-management reduced the self-reported need for and use of formal mental health services over time. This confirms the importance of WRAP in an era of dwindling behavioral health service availability and access. [ABSTRACT FROM AUTHOR]

Objective: Illness Management and Recovery (IMR) is a widely used evidence-based standardized psychosocial intervention. Little is known, however, about the impact of practitioner professional background on the consumer outcome. The current study aims to examine the delivery impact of practitioners who were mental health professionals, peer providers, or paraprofessionals on fidelity and consumer outcome in IMR. Method: Study participants were 252 persons with serious mental illness receiving psychiatric rehabilitation services in the community who received IMR (n = 210) or treatment as usual (TAU; n = 42). Study participants completed IMR groups that were delivered by either mental health professionals (n = 126), peer providers (n = 43), or paraprofessionals (n = 41). Study participants in the treatment group completed the Illness Management and Recovery scale before starting and after completing the IMR program; participants in the control group completed the same scale twice in similar time intervals. Fidelity ratings were made. Results: Regardless of practitioner background, consumers who received the IMR intervention demonstrated significant improvement compared to the control group. Post hoc analyses showed no statistically significant difference on consumer outcome regardless of whether the practitioner was a professional, paraprofessional, or a peer provider. All three IMR groups had good fidelity scores. Conclusions and Implications for Practice: The results demonstrate that IMR can be implemented with good fidelity and generate positive outcomes when delivered by practitioners who receive sufficient training and supervision regardless of their professional background. [ABSTRACT FROM AUTHOR]

Objective: Illness management and recovery strategies are considered evidence-based practices. The article describes how a web-based application, CommonGround, has been used to support implementation of such strategies in outpatient mental health services and assess its impact. The specific focus of this article is Personal Medicine, self-management strategies that are a salient component of the CommonGround intervention. Method: With support from counties and a not-for-profit managed care organization, CommonGround has been introduced in 10 medication clinics, one Assertive Community Treatment (ACT) team, and one peer support center across Pennsylvania. Methods include analysis of data from the application's database and evaluation of health functioning, symptoms, and progress toward recovery. Results: Health functioning improved over time and use of self-management strategies was associated with fewer concerns about medication side effects, fewer concerns about the impact of mental health medicine on physical health, more reports that mental health medicines were helping, and greater progress in individuals' recovery. Conclusions and Implications for Practice: Using Personal Medicine empowers individuals to work with their prescribers to find a "right balance" between what they do to be well and what they take to be well. This program helps individuals and their service team focus on individual strengths and resilient self-care strategies. More research is needed to assess factors that may predict changes in outcomes and how a web-based tool focused on self-management strategies may moderate those factors. [ABSTRACT FROM AUTHOR]

Objective: Most research on the Illness Management and Recovery (IMR) program for people with severe mental illnesses has focused on individuals with stable symptoms living in the community, with less attention to persons being treated in an inpatient setting. We evaluated the feasibility and effects of an IMR program adapted for individuals with schizophrenia who were awaiting discharge into the community. Method: A randomized controlled trial was conducted at 2 hospitals in Taiwan to compare the adapted IMR program with treatment as usual (TAU). Ninety-seven individuals with schizophrenia were randomized to the adapted IMR program or TAU. Four outcome indicators including illness-management knowledge, attitudes toward medication, insight, and symptoms were assessed at baseline, posttreatment, and at a 1-month follow-up following discharge from the hospital. Results: Participants in the adapted IMR group showed significantly greater improvements at posttreatment and 1-month follow-up in illness-management knowledge, attitudes toward medication, insight, and negative symptoms on the Brief Psychiatric Rating Scale (BPRS) than individuals in the TAU group. There were no significant differences between the 2 groups on other subscales of the BPRS. Conclusions and Implications for Practice: This is the first controlled evaluation of a version of the IMR program in an East Asian culture, and the first to evaluate it in an acute care inpatient setting. Our findings support the feasibility and potential benefits of implementing an adapted IMR program, focused on the prevention of relapses and rehospitalizations, during the discharge period of an inpatient treatment stay to prepare individuals to reenter the community. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to refine and test the psychometric properties of a scale to measure provider attitudes about recovery. Method: 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 Department of Veterans Affairs (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. [ABSTRACT FROM AUTHOR]

Objective: This paper examines the types of goals being set by individuals in the context of Australian mental health services and whether goal type differs across the stages of recovery. Methods: Goal records of 144 individuals accessing services were reviewed to examine goal content, ratio of approach and avoidance oriented goals and changes across stages of psychological recovery. Results: Individuals further along in their recovery set significantly more approach goals and types of goals set appeared to reflect broader life roles. Conclusions and Implications for Practice: Setting approach goals and goals that reflect broader life roles tends to support the definition of psychological recovery as being "the movement towards" greater meaning and enhanced sense of self. [ABSTRACT FROM AUTHOR]

Objective: The promotion of recovery and quality of life is a major focus of national and local mental health system transformation efforts. There has been simultaneous interest in enhancing community participation as a facilitator of recovery. This study examines the community participation experiences of emerging adults and mature adults with serious mental illnesses and the relationship between various types of participation and recovery, quality of life, and meaning of life. Methods: Baseline data from the Consumer-Operated Service Program multisite study were utilized. The sample was recruited from traditional mental health services and consisted of 233 emerging adults and 1,594 mature adults. Ten areas of participation were examined: parenting, employment, volunteering, college student, group membership, civic engagement, peer support, friendships, intimate relationships, and engagement in religious/spiritual activities. Results: Emerging and mature adults differed in developmentally appropriate ways. Emerging adults and those who participated more had higher scores on the recovery, quality of life and meaning of life measures. Conclusions and Implications for Practice: The higher scores on the dependent variables may be explained by younger adults having greater hope and higher expectations that are typical for those at that stage of life and that living longer with a serious mental illness and being exposed longer to the mental health system may dampen hope. Participation in general, and specific areas of participation, were predictive of recovery-oriented outcomes. These results should inspire future developmentally-oriented research examining factors that facilitate recovery and provide direction to providers about participation areas that may be most beneficial in facilitating recovery. [ABSTRACT FROM AUTHOR]

Objective: The promotion of recovery and quality of life is a major focus of national and local mental health system transformation efforts. There has been simultaneous interest in enhancing community participation as a facilitator of recovery. This study examines the community participation experiences of emerging adults and mature adults with serious mental illnesses and the relationship between various types of participation and recovery, quality of life, and meaning of life. Methods: Baseline data from the Consumer-Operated Service Program multisite study were utilized. The sample was recruited from traditional mental health services and consisted of 233 emerging adults and 1,594 mature adults. Ten areas of participation were examined: parenting, employment, volunteering, college student, group membership, civic engagement, peer support, friendships, intimate relationships, and engagement in religious/spiritual activities. Results: Emerging and mature adults differed in developmentally appropriate ways. Emerging adults and those who participated more had higher scores on the recovery, quality of life and meaning of life measures. Conclusions and Implications for Practice: The higher scores on the dependent variables may be explained by younger adults having greater hope and higher expectations that are typical for those at that stage of life and that living longer with a serious mental illness and being exposed longer to the mental health system may dampen hope. Participation in general, and specific areas of participation, were predictive of recovery-oriented outcomes. These results should inspire future developmentally-oriented research examining factors that facilitate recovery and provide direction to providers about participation areas that may be most beneficial in facilitating recovery. [ABSTRACT FROM AUTHOR]