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Objective: Traumatic experiences are prevalent among people with serious mental illness and can significantly worsen outcomes. This study aimed to identify an urban cluster of trauma types, compare continuous distress ratings versus categorical experience of trauma for predicting outcomes such as depression and quality of life, and investigate the mediating role of recovery orientation in the impact of trauma exposure on outcomes. Method: Data came from an intervention study on African Americans with serious mental illness living in a large urban area; 212 participants completed baseline self-report measures of past trauma experiences, related distress levels, recovery, depression, and quality of life. Data were assessed using correlations and regressive path modeling. Results: Overall, 56.6% of participants reported experiences with trauma. Analyses suggested an urban cluster of trauma types that was self-reported by over 25% of participants. Distress due to trauma strongly correlated with greater depression as well as reduced quality of life and recovery. Interestingly, the categorical presence of trauma history (yes/no) had no significant relationship with any outcomes. Path analyses revealed that recovery mediated the impact of trauma distress on depression and quality of life, specifically implicating the recovery subfactor of hope. Conclusions and Implications for Practice: Results suggested that cognitive reframing focused on positive appraisals of overall recovery, and the hope subfactor can have a positive influence on trauma outcomes. The study supported the role of recovery in posttraumatic growth and suggests that hope can be used to help patients process trauma healthily. Impact and Implications: This study identified a cluster of traumas commonly experienced by urban African Americans with serious mental illness. Distress ratings—but not categorical presence of trauma history—predicted outcomes of depression and reduced quality of life, mediated by cognitive appraisal of recovery and specifically the hope subfactor of hope. Practitioners might use cognitive reframing toward schemas of recovery and hope to facilitate posttraumatic growth and improve patient outcomes. Research should further examine trauma clusters and their impact on outcomes. [ABSTRACT FROM AUTHOR]

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]

Objective: Evidence concerning strengths model of case management (SMCM) remains mixed. This study aimed to test the hypotheses that higher fidelity to SMCM is associated with improved quality of life (QoL), hope, community participation, community functioning, more days of competitive employment and of independent living, and fewer days of hospitalization. Methods: SMCM was implemented over a 3-year period, at seven sites in the Canadian provinces of Newfoundland and Labrador, Québec, and Ontario. Independent assessors visited 14 teams at the seven sites to evaluate fidelity at baseline and 6, 12, 18, 24, and 36 months later. Participants (N = 311) answered standardized questionnaires at 4.5-month intervals up to 18 months. Fidelity assessments were interpolated so they could be associated with questionnaire responses. Linear mixed-effects models and generalized linear models were estimated. Results: Fidelity increased significantly, with all sites except one achieving or approaching good fidelity within 36 months. Fidelity was not significantly associated with any of the outcome measures, although all estimated directions of relationships were consistent with our hypotheses. Conclusions and Implications for Practice: In a pragmatic study of real-world implementation of the strengths model at seven sites, no statistically significant relationships between fidelity and outcomes were found. Low variation in fidelity across individuals, modest sample size, and limited ability to detect change over 18 months, may have contributed to these null findings. Impact and Implications: Implementation of strengths model of case management (SMCM) was largely successful at seven sites in three Canadian provinces, but higher fidelity was not significantly associated with improved client outcomes. The sample size of 311 may have been insufficient. Given mixed findings from previous studies, and the compatibility of SMCM with a recovery orientation, further research, with strong designs and large sample sizes, is needed. [ABSTRACT FROM AUTHOR]

Objective: The narrative enhancement and cognitive therapy (NECT) intervention aims to reduce self-stigma among people with severe mental illness. Based on previous studies that showed the intervention's beneficial outcomes, we conducted an uncontrolled pilot study of NECT in the Netherlands to assess both feasibility in delivering NECT and outcomes of the intervention for self-stigma, hope, recovery, and self-concept clarity. Methods: Feasibility was assessed through uptake and implementation data that included an assessment of enhancing and impeding factors according to surveys with NECT facilitators, and interviews with participants. Outcomes of NECT were studied through scales that assess self-stigma, self-concept clarity, hope, personal recovery, and quality of life. Results: Forty-one participants from five treatment sites participated in the pilot study, among whom 78% were considered "exposed" (i.e., attended at least six sessions). The analysis of enhancing and impeding factors indicated that support from the organization, sense of ownership, expectations of outcomes, and content of the intervention were reported as important in the implementation process. Participants reported decreases in self-stigma and increases in hope during the intervention. Conclusions and Implications for Practice: Assessments of feasibility provided valuable insights regarding ways to improve implementation of the intervention (such as increasing facilitators' sense of ownership of the intervention). Outcomes of NECT showed a decrease in self-stigma and improvement of hope among participants in this pilot study, supporting the previously found positive effects of the intervention. Impact and Implications: In this pilot study, NECT was found to be feasible and effective in reducing stigma and increasing hope among people with serious mental illness. The study highlights important factors related to feasibility including facilitators' and contextual factors. Results support the effectiveness of NECT. Accordingly, this pilot study gives important implications for policy makers, mental health clinicians, and peer workers in the Netherlands to further dissemination of NECT. [ABSTRACT FROM AUTHOR]

Objective: The primary purpose of the study was to explore and identify how components of recovery are associated with occupational performance and health among peer support specialists. Methods: One hundred and twenty-one peer support specialists were recruited from statewide peer certification training programs and the International Association of Peer Supporters. Study respondents completed a survey package including demographic questions and psychometrically sound self-report measures. Two hierarchical multivariable linear regression models were conducted to evaluate whether the recovery components of the process of recovery, social support for recovery, and work self-determination (i.e., work autonomy, work competence, and work relatedness) were associated with indicators of occupational performance (i.e., work engagement) and health (i.e., job satisfaction). Results: Work autonomy was associated with the occupational performance indicator, while the process of recovery and social support for recovery were the only recovery components associated with the indicator for occupational health. Conclusions and Implications for Practice: Findings support the importance of work self-determination and social support and recovery for occupational performance and health among peer support specialists. Mental health and rehabilitation professionals should address these key components of recovery when working with and supporting the work well-being of peer support specialists. Impact and Implications: Our findings indicated key components of recovery are linked to work well-being among peer support specialists. Despite the promotion of recovery among service users, there has been limited focus on the recovery process experienced by peer support specialists employed in mental health systems. These findings underscore the need for service providers, employers, and supervisors of peer support specialists to address both recovery and work well-being among peer support specialists. [ABSTRACT FROM AUTHOR]

Objective: Recovery from severe mental illnesses (SMI) has been described as an outcome (end state where persons are symptom free) or as a process (despite symptoms, people can pursue life goals). Less clear is whether recovery as a process has credibility in the substance use disorders (SUD) community. We examined how public perceptions and expectations of outcome and process between SMI and SUD differed. A severity effect within SMI and SUD categories was also examined. Method: Participants (N = 195) read definitions of SMI and SUD and completed an online survey of their agreement on: perceptions of recovery from SMI and SUD as outcome and process, and expectations of recovery as outcome and process. Participants were then given more and less severe SMI (i.e., schizophrenia vs. depression) and SUD (opiate vs. alcohol use) definitions. They then responded to recovery items SMI and SUD conditions with low and high severity. Results: For SMI, perceptions and expectations of recovery as process were endorsed more than outcome. Severity effect led to greater increases in perceptions and expectations about recovery as process. Specifically, differences between outcome and process for schizophrenia were significantly larger than for depression. For SUD, expectations of process were significantly lower than outcome ratings. One negative interaction was found for SUD expectations; difference scores for opiate users were smaller than for alcohol. Conclusions and Implications for Practice: We discussed implications for interventions that enhance recovery for people with SMI and SUD. This study shows that recovery as a process (symptom management) is more endorsed for persons with severe mental illnesses (SMI) whereas recovery as an outcome (symptom free) is more endorsed for people with substance use disorders (SUD). Distinction between process and outcome perspectives across two communities will shape individuals' recovery experience and inform good treatment practices. [ABSTRACT FROM AUTHOR]

Objective: This study examined the psychometric properties of a Chinese language version of the Recovery-Promoting Relationship Scale (RPRS) scale in a sample of persons with severe mental illness in Taiwan. Method: Five hundred ninety-two participants from 32 community psychiatric rehabilitation centers in Taiwan agreed to participate in this study. Principal component factor analysis with oblique rotation was performed. Internal consistency and external construct validity were also examined. Results: The results revealed a 2-factor solution that differed from the structure of the original RPRS. The first factor (F1) comprised 7 items in the Core Relationship Index and 7 items in the Recovery-Promotion Strategies Index of the original RPRS. The second factor (F2) comprised 8 items in the Recovery- Promotion Strategies Index and 1 item (I5) in the Core Relationship Index of the original RPRS. The reliability of F1 and F2 was 0.961 and 0.941, respectively. The entire scale and subscales all had a significant and moderate correlation with recovery and service use. Conclusions and implications for practice: This study provides initial psychometric support for a Chinese language version of the RPRS. Additionally, the use of core interpersonal skills was correlated with recovery-promoting strategies. The findings support the use of the RPRS as a guide to promote recovery-oriented services in Taiwan. [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: Consumer-oriented recovery has been discussed for more than two decades in the mental health field. Although there some qualitative recovery studies have shown important findings, few quantitative studies of this concept currently exist. This study examined the relationship between recovery and associated social-environmental and individual factors. Method: A total of 159 people with psychiatric disabilities receiving services from a large community mental health agency participated in the study. Participants completed a self-report survey that assessed individual recovery status, social support, perceived recovery-oriented service quality, psychiatric symptoms, and demographics. One hundred twenty-four surveys were analyzed. Hierarchical multiple regression analysis was conducted to examine the relationship between recovery and associated factors. Results: Social support and perceived recovery-oriented service quality had significant positive relationships with recovery; psychiatric symptoms had a significant negative relationship with recovery. The final regression model accounted for 58% of the variance in recovery, F(9, 114) = 17.72, p < .001. Conclusion and Implications for Practice: Social-environmental factors play an important role in people's recovery, even after taking into account psychiatric symptoms. Namely, people with psychiatric disabilities can pursue recovery with symptoms as long as they receive appropriate support and services. Mental health professionals should provide services adhering to recovery principles in order to help their clients achieve personal recovery. [ABSTRACT FROM AUTHOR]

Objective: Peer providers experience unique recovery and growth processes. This study examines the relationship of these processes with multiple occupational characteristics related so peer work. Outcomes are examined using positive psychology concepts: psychological well-being, posttraumatic growth, and generatively, as well as established recovery and empowerment measures. Method: Thirty peer providers employed in s variety of mental-health agencies participated in the study and completed standardized measures of recovery and growth processes. Multiple past and present occupational characteristics were identified and coded based on a semistructured interview and a background questionnaire. Results: Multivariate analyses revealed a significant association between participants' generatively and past participation in peer-support/self-help groups, as well as past work in a helping profession. No associations were found between the characteristics of participants' present peer jobs and the examined recovery and growth processes. Conclusions and implications for Practice: The present findings have implications for the expansion of the peer-provider workforce, They suggest that encouraging and enabling peer-support groups and peer-run organizations may have positive impact on the generatively of peer providers, and may draw generative individuals to thin emerging occupational modality of mental- health recovery oriented service. Study findings underscore the need for future research on recovery processes from the perspective of positive psychology and highlight the value of peer exposure as a catalyst of recovery and growth. [ABSTRACT FROM AUTHOR]

Objective: Patient-centered communication has been linked to patient satisfaction, treatment adherence and outcomes. Shared decision making (SDM) has been advocated as an important and ethically essential aspect of patient-centered care, but SDM has received relatively little attention in mental health care, despite studies indicating that consumers want to be involved in making decisions. This is particularly important in a recovery-oriented system, where consumers are active participants in their treatment and rehabilitation. Because medication management is a key component of recovery from severe mental illnesses, this study explores how consumers and providers make decisions in medication management consultations. Methods: Four providers (3 psychiatrists, 1 nurse practitioner) and 40 consumers with severe mental illness (10 consumers per provider) were recruited from a community mental health center with a recovery-oriented focus. We directly observed 40 medication management appointments. Observations were audio recorded and transcribed. We used emergent thematic analysis to characterize decision making processes. Results: Providers initiated most decisions, although they often invited consumers to participate in decision making. Decisions initiated by consumers elicited a greater degree of discussion and disagreement, but also frequently resulted in consumers' preferences prevailing. Consultations generally exhibited more characteristics of person-centeredness than SDM. Conclusions and Implications for Practice: While we observed a high degree of person-centeredness, SDM was not prevalent. Interventions helping consumers to take greater initiative when working with service providers may be helpful. For example, programs using tools such as peer instruction, Internet-based software, and individual case-manager instruction all have shown promise for enhancing SDM in mental health treatment. Further research is needed to determine the degree of SDM in other settings (e.g., with case managers) and the impact of SDM on consumers' recovery. [ABSTRACT FROM AUTHOR]

Objective: Hope is a critical aspect of the recovery process for persons with serious mental illnesses. The goal of this pilot study was to assess the relationship between hope and symptoms for a cohort of individuals with mental illnesses receiving supported employment services. Method: A total of 74 participants enrolled in supported employment were assessed on their level of hopefulness, hopelessness and psychiatric symptoms. Correlations were performed to determine the relationship between hope and psychiatric symptoms, and hopelessness and psychiatric symptoms. Results: The findings indicated a significant inverse relationship between hope and symptoms, and a significant positive relationship between hopelessness and symptoms. Conclusions and Implications for Practice: Hope and symptoms were inversely related, highlighting the importance of developing a wellness strategy that addresses managing symptoms as part of one's recovery process. Additionally, this finding highlights the critical role of PsyR providers in supporting people in recovery with developing a wellness strategy that will both help ameliorate symptoms and increase hope. [ABSTRACT FROM AUTHOR]

Objective: With the use of a qualitative approach, this study focuses on service providers' experiences and perspectives on recovery-oriented reform. Methods: Nine focus groups were conducted with a sample of 68 service providers recruited from three Canadian sites. Results: Three major themes were identified: 1) positive attitudes towards recovery-oriented reform; 2) skepticism towards recovery-oriented reform; and 3) challenges associated with implementing recovery-oriented practice. These challenges pertained to conceptual uncertainty and consistency around the meanings of recovery; application of recovery-oriented practice with certain populations and in certain contexts; bureaucratization of recovery-oriented tools; limited leadership support; and, societal stigma and social exclusion of persons with mental illnesses. Conclusions and Implications for Practice: The findings point towards challenges that might arise as system planners move ahead in their efforts toward implementing recovery within the mental health system. In this regard, we offer several recommendations for the planning of organizational and educational practices that support the implementation of recovery-oriented practice. [ABSTRACT FROM AUTHOR]

Objective: Veterans commonly experience both psychiatric and substance abuse problems following their reintegration into the community postwar. The present study describes a sample of veterans residing in self-governed recovery homes. Methods: A subsample of 24 veterans within a large national study were examined using demographic data and psychiatric and substance abuse measures. Participants were evaluated at baseline and at a one-year follow-up. Results: Abstinence rates for the veteran subsample were high. Additionally, results suggested that participants experienced a reduction in anxiety and depression over time. Conclusions and Implications for Practice: The psychiatric and substance use improvements of this veteran subsample provide incentive for further research of this at-risk population as residents of self-governed recovery homes. [ABSTRACT FROM AUTHOR]

Objective: Certified peer specialists (CPSs) are an emerging workforce across the United States and are a critical component of recovery-oriented mental health systems. This study examined possible benefits of working as a CPS. Method: A statewide survey of trained CPSs in Pennsylvania was conducted in Winter/Spring 2010. A total of 271 CPSs responded to the online survey. Data from 154 working CPSs were analyzed. Results: Forty-one respondents (28.7%) were not working prior to their CPS employment and 60% of all respondents reported a decrease in Social Security entitlements. Statistically significant reductions were reported in case management, crisis services, and inpatient hospitalizations. Finally, respondents overwhelmingly reported personal, recovery-oriented benefits, and felt that they have a positive impact on their agencies. Conclusion and Implications for Practice: CPS initiatives appear to benefit the individual CPS worker and may result in societal cost savings. These results further expand the potential value of peer-support services. [ABSTRACT FROM AUTHOR]