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Objective: Increasing service user involvement and collaboration with providers has become an important facet of the recovery movement. This study explored perspectives on the implementation and delivery of an intervention (Just Do You [JDY]) designed to improve treatment engagement among marginalized young adults diagnosed with serious mental illnesses. Method: Informed by the Consolidated Framework for Implementation Research (CFIR), we conducted in-depth interviews (N = 11) with nine participants that included agency leaders, clinical providers, and researchers involved with the planning, delivery, and evaluation of JDY. We used grounded theory coding techniques and constant comparison to develop themes that capture the data on implementation and collaboration related to the delivery of JDY. Results: Two broad themes emerged: (a) collaboration between the clinician and person with lived experience and (b) collaborative culture within and between organizations. Findings capture how collaboration occurred between providers within the clinical encounter (e.g., combined strengths of clinicians and peers) and within and between organizations, clustering around several CFIR domains (e.g., inner setting, process, characteristics of individuals, intervention characteristics). Findings speak to the importance of a "culture of collaboration" in which collaboration is occurring across multiple levels of an organization to support the delivery and implementation of JDY. Conclusions and Implications for Practice: JDY can complement other collaborative approaches given its focus on improving initial engagement. Findings point to the perceived benefits of interventions that are facilitated by a clinician and a person with lived experience along with how their combined expertise can support recovery. Impact and Implications: This study examines the perspectives of agency leaders, clinical providers, and researchers on the implementation and delivery of an engagement intervention for young adults diagnosed with serious mental illnesses. Results point to the benefits of initial engagement interventions that are facilitated by a clinician and a person with lived experience, as a step toward participation in more long-term treatment decision making. Their combined expertise can support recovery and can complement other treatments. [ABSTRACT FROM AUTHOR]

Objective: Individuals with severe mental illness often face (anticipated) discrimination and (criminal) victimization, which have severe consequences for their social participation. The aim of the present study is to assess the effectiveness of a new intervention to manage and prevent revictimization, and to support safe participation by recognizing and acknowledging the impact of their victimization experiences. Method: A multicenter cluster randomized controlled trial was performed by following clients from four intervention teams and four teams providing care as usual. The primary outcomes were social participation, victimization, and discrimination. The secondary outcomes were acknowledgment of difficulties, self-efficacy and empowerment, quality of life, and psychosocial functioning. Data were collected at baseline, and after 10- and 20-month follow-ups. The data were analyzed according to the intention-to-treat principle using linear mixed models and generalized estimating equations. In total, 400 clients were included in the analyses: 216 in the intervention group and 184 in the control group. Results: For experienced discrimination and acknowledgment of difficulties and recovery support, we found small but significant time by condition interactions after 20 months. Both experienced and anticipated discrimination, and self-efficacy increased slightly in both groups. No significant differences were found for other outcome measures. Conclusions and Implications for Practice: The intervention had no effect on victimization and participation, but there were indications that it was successful in moderating experienced discrimination. The clients also felt significantly more acknowledged and supported in their recovery process. Further development of the intervention is needed, and future research should focus on improving implementation. Impact and Implications: Our study offers insights into how to reduce the uncertainty around discussing victimization that hampers participation, by assessing an intervention to support mental health practitioners to initiate the conversation on victimization with individuals with mental illness. This intervention had no effects on participation and victimization. It was found to successfully moderate experienced discrimination. Clients felt that their victimization experiences were acknowledged and that they were supported in their recovery process. [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: 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: 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]

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]