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Objective: The Clubhouse model (CM) for serious mental illness is a recovery-oriented and member-driven program that aims to facilitate functional recovery. Efficacy evaluation of the CM is limited by lack of uniform functional disability assessment. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0) is a widely accepted measure of functional disability, but its psychometric properties have yet to be examined within the CM. Method: This research sought to confirm the generic six-factor structure of the 12-item WHODAS-2.0 using retrospective administrative data from 339 adults with serious mental illness from an accredited Clubhouse. A second-order confirmatory factor analysis was conducted, followed by secondary known-groups analyses to examine whether the WHODAS-2.0 differentiates between subgroups with varying degrees of disability. Results: The WHODAS-2.0 demonstrated good overall reliability. The generic six-factor structure produced nonsignificant loadings due to lack of independence between the "participation" and "getting along" factors. The items of these two factors were combined into a five-factor model, which displayed excellent fit, with all significant paths and adequate-to-strong loadings, and no correlation among errors. The WHODAS-2.0 significantly differentiated members by receipt of public assistance, employment status, and number of medical comorbidities, supporting construct validity. Conclusions and Implications for Practice: These results provide initial support for the use of the 12-item WHODAS-2.0 as a CM-related outcome measure and encourage future research of the full 36-item version. The intentional community approach of the CM is unique and may require adjustments to the factor structure of the WHODAS-2.0 by merging the "participation" and "getting along" domains. Impact and Implications: The Clubhouse model of psychosocial rehabilitation for serious mental illness is an effective approach for the treatment of functional disability, but continued efficacy research is limited by lack of a psychometrically sound outcomes assessment. This research lends support for the utility of the 12-item World Health Organization Disability Assessment Schedule 2.0 as a reliable and potentially valid outcome assessment, but adjustment of the generic structure of this measure may be required in this unique therapeutic setting. [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: 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: 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: This study investigated the mediating roles of self-esteem and self-efficacy on the relationship between family social networks and personal recovery among Chinese people with mental illness in Hong Kong. Methods: One hundred and twenty-five Chinese adults with mental illness from community mental health centers in Hong Kong were recruited for this study. Data were collected using a structured questionnaire. Results: Study results indicated that a large family network size was indirectly related to high levels of personal recovery through high self-efficacy. High perceived family support was directly related to high levels of personal recovery. In addition, high family criticalness was related to low levels of personal recovery directly and indirectly through low self-esteem. Conclusions and Implications for Practice: These findings suggest that using a family approach to enhance individuals' self-esteem and self-efficacy might promote personal recovery among people with mental illness in the Chinese context. Impact and Implications: This study found that family network size is indirectly related to personal recovery, via the effect of self-efficacy. Self-esteem mediates the relationship between family criticalness and personal recovery. Study findings underscore the importance of incorporating strategies to enhance self-esteem and self-efficacy into family interventions aiming to promote personal recovery among people with mental illness in the Chinese context. [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 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]

Objectives: Although recovery for people with serious mental illness (SMI) has received considerable attention, there is a research gap on the related topics of well-being and happiness—subjects that have been widely studied in the general population. The objective of this study was to explore the experiences of happiness, well-being, and recovery from the perspectives of persons with SMI, and to examine similarities and differences among these constructs. Method: This qualitative study used semistructured interviews with a purposive sample of 30 adults with SMI to explore experiences of happiness, well-being, and recovery. Reflexive thematic analysis was applied to generate themes related to each concept. Results: Happiness was facilitated through relationships with natural and professional supports, engaging in meaningful activities that conferred a sense of accomplishment, using coping skills to reduce distress, engaging in recreational activities, and meeting basic material needs. Well-being was promoted through self-care activities and enhanced through relationships with professional supports. However, nearly one-fourth of participants expressed uncertainty about what well-being meant to them. Recovery was characterized as a process of overcoming illness or adversity through which personal control over symptoms and stressors is increased; recovery is also facilitated by supportive professional relationships. Conclusions and Implications for Practice: Most factors relating to the happiness of people with SMI are also factors that have been identified in theory and research as facilitating the happiness of the general population. Findings suggest that happiness should be considered an important new area of research, policy, and practice in the fields of psychiatric rehabilitation. Impact and Implications: Happiness, well-being, and recovery are important and fulfilling experiences for persons with serious mental illness. However, it is unclear how these concepts overlap or diverge from one another. Our findings suggest significant similarities but also important distinctions between happiness and recovery and that promoting happiness should be a priority area for mental health professionals, policymakers, and researchers. [ABSTRACT FROM AUTHOR]

Objective: The literature on the experience of mental health providers (MHPs) working with people with serious mental illness (SMI) in community-based mental health programs related to sex, sexuality, and intimacy is scarce. The purpose of the present study was to explore the situations, thoughts, feelings, dilemmas, and challenges experienced by MHPs around these issues. Method: Semistructured interviews were conducted with 13 MHPs working with people with SMI in six different community mental health programs in Israel. Results: Four main themes emerged: (a) lack of professional training and skill sets to discuss clients' sexuality and intimacy issues, (b) ambivalence regarding the status and appropriateness of sexual relationships and intimacy as recovery-related goals, (c) discomfort discussing sexuality as a barrier to shared decision making and person-centered care, and (d) distinct programmatic and structural barriers to discussing and addressing needs and preferences related to sexuality and intimacy. Discussion: The study highlights challenges experienced by MHPs working with people with SMI when confronted with sexual activities, relationships, and intimacy issues raised by service users. The development and implementation of trainings and resources designed to bolster MHPs' skill sets addressing sexuality and intimacy should be a priority for the field of psychiatric rehabilitation. Conclusions and Implications for Practice: MHPs who work with people with SMI in community-based settings often experience complex thoughts, feelings, dilemmas, and challenges related to clients' desire for or involvement in intimate and sexual relationships. Our study indicates a need to develop and implement stronger training and supervision to support MHPs to respond effectively to these complex situations and associated challenges. Impact and Implications: Mental health providers (MHPs) who work with people with serious mental illness (SMI) in community-based settings often experience complex thoughts, feelings, dilemmas, and challenges related to clients' desire for or involvement in intimate and sexual relationships. Our study indicates a need to develop and implement stronger training and supervision to support MHP to respond effectively to these complex situations and associated challenges. [ABSTRACT FROM AUTHOR]

Background: Recovery-oriented, strengths-based intervention engages service users' strengths and resources to support their recovery process. This model was developed in an American context and has been applied in Hong Kong. It is important to formulate an understanding of strengths better fit to Hong Kong Chinese. Aims: This exploratory qualitative study examined Hong Kong Chinese service users' views on strengths and preferred translation for the word strengths, along with its cultural nuances. Method: Twenty-six people with serious mental illnesses were individually interviewed at a mental health center in Hong Kong, based on a photo-elicitation technique and reflection on Chinese terms related to strengths. Analysis of data employed the constant comparative method. Results: Participants reported that social factors, such as support by helping professionals and engagement in family roles, as well as spiritual beliefs and practices, are important for recovery. These insights and their preferred translations of strengths generate a culturally nuanced understanding of strengths. Conclusions & Implications for Practice: The strengths model applied in Hong Kong can be enhanced by a more culturally nuanced perspective, for example, including the importance of family-based identity and filial piety, beliefs related to harmony and fate, and practices such as a temple or church attendance. Impact and Implications: This study investigates how Hong Kong Chinese people view strengths in facilitating recovery from mental illnesses. The term "strengths" in recovery was deemed synonymous with the terms ability (néng lì; 能力) and expertise (zhuān cháng; 專長) in Chinese. This study sheds light on how Chinese conceptualizations of "strengths" in recovery may be applied in interventions. [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: A growing body of literature indicates that mobile health (mHealth) interventions that utilize smartphones for illness management are feasible, acceptable, and clinically promising. In this study, we examine how individuals with serious mental illness use a mHealth intervention--FOCUS--to selfmanage their illnesses. Additionally, we explored participant perceptions of the intervention's impact on their subjective illness experience. Method: We analyzed qualitative data from 30 individuals with serious mental illness who participated in 1 of 2 community-based, 3-month trials of FOCUS. In Study 1, weekly calls were conducted by a mHealth specialist to facilitate and enhance intervention use. In Study 2, researchers conducted qualitative interviews to gather detailed perspectives of intervention use. Data were sampled from the weekly call notes and qualitative interviews and analyzed using a thematic and collaborative approach. Results: Thematic analyses revealed 6 recurring themes. Three themes emerged in regard to participants' ongoing daily use of FOCUS: "back-up" support, symptom management, and self-awareness. Another 3 themes emerged related to the intervention's impact on participants' recovery processes: acceptance of symptoms, motivation and supporting positive outlook. Conclusions and Implications for Practice: This qualitative study offers insight into how individuals with serious mental illness made use of a mHealth intervention designed to support illness self-management. Our findings suggest that individuals may benefit differently from mHealth interventions depending on where they are in the recovery process. As mHealth interventions become increasingly popular in clinical settings, it is important to understand consumers' short-term and long-term benefits from these interventions. [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: 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: To explore mental health consumer and provider responses to a computerized version of the Illness Management and Recovery (IMR) program. Method: Semistructured interviews were conducted to gather data from 6 providers and 12 consumers who participated in a computerized prototype of the IMR program. An inductive-consensus-based approach was used to analyze the interview responses. Results: Qualitative analysis revealed consumers perceived various personal benefits and ease of use afforded by the new technology platform. Consumers also highly valued provider assistance and offered several suggestions to improve the program. The largest perceived barriers to future implementation were lack of computer skills and access to computers. Similarly, IMR providers commented on its ease and convenience, and the reduction of time intensive material preparation. Providers also expressed that the use of technology creates more options for the consumer to access treatment. Conclusions and Implications for Practice: The technology was acceptable, easy to use, and well-liked by consumers and providers. Clinician assistance with technology was viewed as helpful to get clients started with the program, as lack of computer skills and access to computers was a concern. Access to materials between sessions appears to be desired; however, given perceived barriers of computer skills and computer access, additional supports may be needed for consumers to achieve full benefits of a computerized version of IMR. [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: 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]