Effectiveness of a Collaborative Recovery Training Program in Australia in Promoting Positive Views About Recovery
2006; American Psychiatric Association; Volume: 57; Issue: 10 Linguagem: Inglês
10.1176/ps.2006.57.10.1497
ISSN1557-9700
AutoresTrevor P. Crowe, Frank P. Deane, Lindsay G. Oades, Peter Caputi, Kim G. Morland,
Tópico(s)Family Caregiving in Mental Illness
ResumoBack to table of contents Previous article Next article Brief ReportFull AccessEffectiveness of a Collaborative Recovery Training Program in Australia in Promoting Positive Views About RecoveryTrevor P. Crowe Ph.D.Frank P. Deane Ph.D., Dip.Clin.Psych.Lindsay G. Oades Ph.D., M.B.A.Peter Caputi Ph.D.Kim G. Morland M.Sc.Trevor P. Crowe Ph.D.Frank P. Deane Ph.D., Dip.Clin.Psych.Lindsay G. Oades Ph.D., M.B.A.Peter Caputi Ph.D.Kim G. Morland M.Sc.Published Online:1 Oct 2006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Anthony ( 1 ) defined recovery as "a deeply personal, unique process of changing one's attitudes, values, feelings, goals, skills, and/or roles. It is a way of living a satisfying, hopeful, and contributing life even with limitations caused by illness. Recovery involves the development of new meaning and purpose in one's life as one grows beyond the catastrophic effects of mental illness." Allott and colleagues ( 2 ) suggested that individuals should be supported in their own personal development by placing the "emphasis on building self-esteem, discerning identity, and finding a meaningful role in society. In this view, recovery does not necessarily mean restoration of full functioning without supports (including medication); it does mean building on personal strengths and resources to develop supports and coping mechanisms which enable individuals to be active participants in—as opposed to passive recipients of—their mental health care." These perspectives imply that the concept of recovery should no longer be restricted to medical model definitions (symptom management or amelioration) or rehabilitation model definitions (improved functioning) but should expand to emphasize psychological recovery processes ( 3 ). Providers of mental health services represent a very important environmental factor that can either help or hinder recovery ( 4 ). Tarrier and Barrowclough ( 5 ) demonstrated that people with psychiatric and psychological disorders are significantly affected by interpersonal interactions, including those with mental health professionals. The degree of adoption of recovery-oriented principles and practices by mental health professionals may be influenced by their attitudes and hopefulness regarding the possibility of recovery. Hugo ( 6 ) found that mental health professionals were less optimistic than the general public about prognosis and longer-term outcomes for people with schizophrenia or depression. Others have suggested that the more negative attitudes of professionals may be more realistic and in line with greater knowledge of mental disorders, but they could also be biased as a result of the proportion of contacts they have with people with chronic and recurring disorders at times when significant interventions are required ( 7 ). Rickwood ( 8 ) stated, "implementing a recovery orientation requires an attitude shift for many service providers in order to support consumer rights and provide the types of services that maximize well-being for people with mental illness." She also suggested that an understanding of the factors that affect recovery, rehabilitation, and relapse is essential. Attitudes are thought to reflect the "mental readiness" or learned "disposition" that influence actions and reactions ( 9 ). Modification of attitudes of mental health professionals and individuals with mental illness is a key component of most general mental health competencies as well as specific "recovery-oriented" competencies ( 10 ). However, it is unclear whether a recovery-based staff training program can enhance staff attitudes and level of hopefulness regarding recovery of the consumers with whom they work. The Collaborative Recovery Training Program ( 11 ) aims to train mental health professionals in the collaborative recovery model ( 12 ). The model integrates principles and skills—for example, motivational enhancement and collaborative goal setting—supporting the unique recovery processes of individuals with chronic and recurring mental illness and collaboration between mental health workers and these individuals. The program emphasizes recovery as a process that belongs to the individual with mental illness, a process that is more comprehensively defined by subjective experience than the presence of illness symptoms. The program also emphasizes issues of autonomy, hope, and individual experience that are central to the recovery movement of mental health consumers. The rationale for the program and a more detailed description has been published elsewhere ( 12 ). An appropriate recovery-oriented "attitude" from the perspective of the model involves being hopeful regarding the consumer's ability to set, pursue, and attain personal goals that facilitate recovery. It was hypothesized that after completing the program, mental health workers would show significant improvements in knowledge of recovery processes, attitudes supporting recovery, and hopefulness related to the recovery process. This hypothesis is based on the assumption that exploring recovery concepts and engaging in specific skills training might raise trainees' awareness of potential attitudinal barriers and also empower them by providing specific skills to support recovery processes of people who have mental illness.MethodsPre- and posttraining measures were collected from 248 mental health workers from nongovernment organizations (101 workers, or 41 percent) and the government health sector (147 workers, or 59 percent) who were participating in the two-day Collaborative Recovery Training Program. Trainees were employed at organizations in eastern Australia. Trainees had a mean±SD age of 40.91±9.92 years, ranging from 22 to 60 years. The mean number of years in the mental health profession was 12.01±9.87 years, ranging from one month to 38 years. A majority of the sample was female (174 persons, or 70 percent).Staff members were given the following measures immediately before and after the session. Measures were completed in ten to 15 minutes. The Recovery Attitudes Questionnaire (RAQ-7) was designed to assess attitudes reflecting beliefs that people can recover from mental illness ( 13 ). Validation of RAQ-7 has been conducted with 249 consumers, 125 mental health professionals, 58 family members, and 159 students ( 13 ). Factor analysis identified two factors comprising seven items on RAQ-7. The first factor consists of four items suggesting that "recovery is possible and needs faith" (for example, "Recovery can occur even if symptoms of mental illness are present"). The second factor consists of three items suggesting that "recovery is difficult and differs among people" (for example, "People in recovery sometimes have setbacks"). Each item is measured on a 5-point scale ranging from 1, strongly disagree, to 5, strongly agree. The test-retest reliability coefficient over a 19-day period was .67 for the full scale, .61 for factor 1, and .62 for factor 2. Cronbach's alpha coefficients for factors 1 and 2 and for the full scale were .66, .64, and .70, respectively ( 13 ). Concurrent validity was also found in that consumers who identified themselves as being in recovery, and who were in recovery for longer periods, had the most favorable attitudes ( 13 ). The collaborative recovery knowledge scale was developed for this study and comprises 13 multiple-choice items related to knowledge of the key principles and intervention characteristics that represent components of the collaborative recovery model. Sample questions follow: "Research evidence demonstrates that well-being is related to: a) achieving as many goals as possible, b) achieving autonomous goals, c) not having goals, or d) having only one goal" and "Resistance is: a) a treatment opportunity, b) always an obstacle, c) the client's fault, d) proof the client is not motivated, or e) evidence that treatment is failing." Each item that was answered correctly was scored as 1, incorrect items were scored as 0, and a sum of correct responses was used in analyses. (The correct answer for the first sample question is b, and the correct answer for the second sample question is a.) Possible scores range from 0 to 13, with higher scores indicating better knowledge. The staff attitudes to recovery scale (STARS) was also developed for this study. The scale assesses attitudes and hopefulness related to the goal striving and recovery possibilities for the consumers with whom they work. Principles and constructs that influenced item construction included the interrelatedness of hope, goal setting, and recovery. Items reflect Snyder and colleagues' ( 14 ) views of hope: "an enduring disposition that is subjectively defined as people assess their determination and strategies in relation to goals." Three items on the STARS address general hopefulness (for example, "All of these clients are capable of positive change"). Eight items were adapted from the Adult Dispositional Hope Scale ( 14 ) (for example, "There are lots of ways around any problem" became "There are lots of ways to deal with any problems that these clients have"). Each item was rated on a 5-point scale ranging from 1, strongly disagree, to 5, strongly agree. The mean of all 19 items was used in analyses. Possible scores range from 19 to 95, with higher scores reflecting more positive and hopeful attitudes. Internal consistency of the scale in the study presented here was moderate to high (Cronbach's α =.81). ResultsIndependent-samples t tests used the pretraining measures to determine whether there were any significant differences in scores between government and nongovernment employees. There were no significant differences in pretraining scores between the two groups on the knowledge scale, STARS, and the first factor of RAQ-7. However, on the second factor of RAQ-7, ratings were significantly higher for nongovernment employees than for government employees (t=-3.05, df=246, p<.01). Consequently, a 2×2 (sector, nongovernment versus government, by time, pre- and posttraining) mixed-design multivariate analysis of variance was conducted to determine whether improvements in knowledge (as measured by the collaborative recovery knowledge scale) and attitudes toward recovery (as measured by RAQ-7 and STARS) occurred over training and whether these improvements were different for the two employment groups. A significant multivariate time-by-sector interaction was found (Wilks' λ =.953, F=3.00, df=4 and 243, p<.05). Univariate tests revealed significant interactions for the attitudes as measured by STARS (F=4.85, df=1 and 246, p<.05) and by the second factor of RAQ-7 (F=5.79, df=1 and 246, p<.05). There were no significant interactions for knowledge or the first factor of RAQ-7. Table 1 provides the means and standard deviations by time and sector. The interaction on STARS was such that both government and nongovernment groups had more positive attitudes over time, but the government group showed greater improvements. The interaction for the second factor on RAQ-7 suggested that the government group tended to have slight improvements in attitudes, whereas the nongovernment group had slight reductions. Univariate tests showed that the government group showed statistically significant improvements in attitudes on the second factor of RAQ-7 over time (F=4.48, df=1 and 146, p<.05). However, there was no significant change on this measure for the nongovernment group. For the knowledge scale and the first factor of RAQ-7, there was a significant main effect for time, such that both knowledge and attitudes improved for both employment groups (F=147.37, df=1 and 246, p<.01 for the knowledge scale; F=18.91, df=1 and 246, p<.01 for the first factor of RAQ-7). Table 1 also displays the effect sizes for each group by using partial eta squared values. By using Cohen's convention ( 15 ) for specifying effect size values as small (.2), medium (.5), or large (.8), it can be seen that effects on knowledge and attitudes for those working in government organizations were closer to medium, whereas for nongovernment organizations effect sizes were small. Table 1 Pre- and posttraining ratings and effect sizes for knowledge and attitudes related to the recovery prospects of persons with enduring mental illness, by time and employment sectorTable 1 Pre- and posttraining ratings and effect sizes for knowledge and attitudes related to the recovery prospects of persons with enduring mental illness, by time and employment sectorEnlarge tableCorrelational analysis of posttraining ratings of the collaborative recovery knowledge scale with attitudes as reflected by STARS and the two factors of RAQ-7 indicated that the collaborative recovery knowledge scale is positively associated with recovery attitudes (first factor of RAQ-7, r=.41; second factor of RAQ-7, r=.39; and STARS, r=.13; p<.05 for all).Discussion The two-day Collaborative Recovery Training Program ( 11 , 12 ) provides information about recovery principles and processes as well as specific skills related to motivational enhancement, identification of consumer needs, negotiation of goals, systematic specification of tasks to achieve the goals, and monitoring of progress over time. The study presented here found that over the course of the training session, desired changes were found in trainee knowledge, beliefs, and attitudes related to recovery. Specific attitude domains included increased beliefs that recovery is possible for people with serious mental illness and can occur even if symptoms are present. Overall, our study found that after completing the training, persons demonstrated higher levels of hopefulness and belief regarding the ability of individuals with serious mental illness to set and achieve their goals. A limitation of the study was the lack of a control group to be able to rule out other potential confounds, such as social desirability factors. However, the knowledge measure was significantly related to all recovery attitudes measures, which might suggest that increased knowledge regarding recovery principles and skills is associated with an increase in recovery orientation of mental health workers. There was an interaction between improvements in knowledge and attitudes over the course of the training program and the employment sector of participants. This was a weak interaction, but it suggested that mental health workers from the government sector had more of a change in attitude toward recovery than those from the nongovernment sector. This finding might be explained in terms of different role functions and professional identities in the two employment groups. Although some participants from the nongovernment sector provided rehabilitation services, most of them were involved with providing supported housing and associated activities, for example, shopping, cooking, and recreation. Consequently, they may not have viewed themselves as taking as active role in facilitating consumers' recovery processes, thus tempering the strength of improvement in recovery attitudes. Some nongovernment workers may have felt challenged by the training to redefine their traditional role identities at work to include recognition of the potential impact that they could have on the recovery processes of those they work with. However, despite these possibilities, it is worth noting that mental health workers from both sectors had relatively positive attitudes toward recovery. For example, in this study the mean rating of the scores on the two factors of RAQ-7 were higher than mean ratings by professionals (mental health workers) reported in Borkin and colleagues' study ( 13 ). Specifically, the pretraining mean score for the first factor for the entire sample in the study presented here was 16.19±2.22 compared with a mean score of 12.60±2.55 in the study by Borkin and colleagues. Similarly, for the second factor, this study found a pretraining score of 13.25±1.39 compared with a score of 10.44±1.44 reported in the study by Borkin and colleagues. It is possible that recovery attitudes have changed since Borkin and colleagues' study was conducted in 2000 because there is currently greater awareness and acceptance of the concept of recovery. However, it may also be that RAQ-7 is limited as a pre-post measure of attitudinal change. Furthermore, because the maximum possible rating is 20 for the first factor and 15 for the second factor, the ratings in this study may have been subject to a ceiling effect. ConclusionsThis study found preliminary evidence that staff attitudes and hopefulness regarding assisting consumers with their individual recovery processes can improve with training. Along with improved recovery attitudes, mental health workers who completed the program significantly increased their knowledge regarding principles of recovery and collaboration and consumer autonomy support, motivation enhancement, needs assessment, goal striving, and homework use. For people with enduring mental health disorders to become more hopeful about their own recovery prospects, they need to have hopeful people around to encourage and support the recovery process. Sustaining positive recovery attitudes in clinical practice may be influenced by the level of recovery orientation of the service setting. Future studies could examine the extent to which positive recovery attitudes are supported at an organizational level and whether they result in changes in clinical practice and consumer outcomes.AcknowledgmentsThis study was supported by the National Mental Health and Medical Research Council Strategic Partnership Grant in Mental Health (219327). Contributing organizations to the Australian Integrated Mental Health Initiative High Support Stream of this project, in alphabetical order, include Aftercare, Illawarra Health Mental Health Service, Latrobe Regional Hospital Mental Health Service, Prince Charles Hospital Health District Mental Health Service, Neami, Psychiatric Rehabilitation Association, Richmond Fellowship Queensland and New South Wales, University of Wollongong, and Wentworth Area Health Service.The authors are affiliated with the School of Psychology, University of Wollongong, Australia. Send correspondence to Dr. Crowe at Illawarra Institute for Mental Health, Building 22, University of Wollongong, New South Wales, 2522, Australia (e-mail: [email protected]).References1. Anthony WA: Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychiatric Rehabilitation Journal 16:11-23, 1993Google Scholar2. Allott P, Loganathan L, Fulford KWM: Discovering hope for recovery. Canadian Journal of Community Mental Health 21:13-33, 2002Google Scholar3. Andresen R, Oades LG, Caputi P: The experience of recovery from schizophrenia: towards an empirically validated stage model. Australian and New Zealand Journal of Psychiatry 37:586-594, 2003Google Scholar4. Antonak RF, Livneh H: The Measurement of Attitudes Toward People With Disabilities: Methods, Psychometrics, and Scales. Springfield, Ill, Thomas, 1988Google Scholar5. Tarrier N, Barrowclough C: Professional attitudes to psychiatric patients: a time for change and an end to medical paternalism. Epidemiologia e Psichiatria Sociale 12:238-241, 2003Google Scholar6. Hugo M: Mental health professionals' attitudes towards people who have experienced a mental health disorder. Journal of Psychiatric and Mental Health Nursing 8:419-425, 2001Google Scholar7. Jorm AF, Korten AE, Jocomb PA, et al: Attitudes towards people with a mental disorder: a survey of the Australian public and health professionals. Australian and New Zealand Journal of Psychiatry 33:77-83, 1999Google Scholar8. Rickwood D: Recovery in Australia: slowly but surely. Australian e-Journal for the Advancement of Mental Health 3:1-3, 2004Google Scholar9. Haddow M, Milne D: Attitudes to community care: development of a questionnaire for professionals. Journal of Mental Health 4:289-296, 1995Google Scholar10. Coursey RD, Curtis L, Marsh DT, et al: Competencies for direct service staff members who work with adults with severe mental illnesses: specific knowledge, attitudes, skills, and bibliography. Psychiatric Rehabilitation Journal 23:378-392, 2000Google Scholar11. Oades LG, Lambert WG, Deane FP, et al: Collaborative Recovery Training Program: Workbook. Wollongong, Australia, University of Wollongong, Illawarra Institute for Mental Health, 2003Google Scholar12. Oades LG, Deane FP, Crowe TP, et al: Collaborative recovery: an integrative model for working with individuals who experience chronic and recurring mental illness. Australasian Psychiatry 13:279-284, 2005Google Scholar13. Borkin JR, Steffen JL, Ensfield LB, et al: Recovery Attitudes Questionnaire: development and evaluation. Psychiatric Rehabilitation Journal 24:95-102, 2000Google Scholar14. Snyder CR, Harris C, Anderson JR, et al: The will and the ways: development and validation of an individual differences measure of hope. Journal of Personality and Social Psychology 60:570-585, 1991Google Scholar15. Cohen J: Statistical power analysis for the behavioral sciences, 2nd ed. Hillsdale, NJ, Erlbaum, 1988Google Scholar FiguresReferencesCited byDetailsCited ByFactors affecting knowledge of recovery‐oriented practice amongst mental health nursing and medical staff working on acute mental health inpatient units12 July 2022 | International Journal of Mental Health Nursing, Vol. 31, No. 5Easier Said Than Done: The Challenge to Teach "Personal Recovery" to Mental Health Professionals Through a Short, Targeted and Structured Training Programme8 November 2021 | Community Mental Health Journal, Vol. 58, No. 5Stigma and Attitude Towards Personal Recovery from Mental Illness Among Italian Mental Health Professionals1 July 2022Exploring recovery‐focused educational programmes for advancing mental health nursing: An integrative systematic literature review6 July 2021 | International Journal of Mental Health Nursing, Vol. 30, No. S1A systematic review of measures assessing mental health professionals' perspectives of recovery15 June 2021 | International Journal of Mental Health Nursing, Vol. 30, No. 4Interventions to support autonomy, competence, and relatedness needs in organizations: A systematic review with recommendations for research and practice4 February 2021 | Journal of Occupational and Organizational Psychology, Vol. 94, No. 2Knowledge and attitudes of mental health professionals and students regarding recovery: A systematic review12 March 2020 | International Journal of Mental Health Nursing, Vol. 29, No. 3Camberwell Assessment of Need (CAN)27 March 2020 | , Vol. 33How do recovery-oriented interventions contribute to personal mental health recovery? A systematic review and logic modelClinical Psychology Review, Vol. 76File audit to assess sustained fidelity to a recovery and wellbeing oriented mental health service model: an Australian case study23 November 2019 | Archives of Public Health, Vol. 77, No. 1More Optimistic Recovery Attitudes Are Associated with Less Stigmatization of People with Mental Illness among Healthcare Professionals Working on Acute and Semi-Acute Psychiatric Wards16 May 2019 | Psychiatric Quarterly, Vol. 90, No. 3Challenges of measuring the influence of the Recovery Academy upon health professionals: considerations for quantitative researchThe Journal of Mental Health Training, Education and Practice, Vol. 14, No. 3Administration and Policy in Mental Health and Mental Health Services Research, Vol. 46, No. 2Mental Health & Prevention, Vol. 13Scandinavian Journal of Caring Sciences, Vol. 33, No. 2International Journal of Mental Health and Addiction, Vol. 17, No. 6Characteristics of mental health recovery model implementation and managers' and clinicians' risk aversionThe Journal of Mental Health Training, Education and Practice, Vol. 13, No. 1International Journal of Mental Health Systems, Vol. 12, No. 1Does training change practice? A survey of clinicians and managers one year after training in trauma-informed careThe Journal of Mental Health Training, Education and Practice, Vol. 12, No. 3Mental health workers' values and their congruency with recovery principlesThe Journal of Mental Health Training, Education and Practice, Vol. 12, No. 1Psychology and Psychotherapy: Theory, Research and Practice, Vol. 90, No. 1International Journal of Mental Health Systems, Vol. 11, No. 1Enhancing recovery orientation within mental health services: expanding the utility of valuesThe Journal of Mental Health Training, Education and Practice, Vol. 11, No. 1Australian Social Work, Vol. 69, No. 2BMC Psychiatry, Vol. 16, No. 1Evaluation of a recovery-oriented care training program for mental healthcare professionals: Effects on mental health consumer outcomes25 June 2014 | International Journal of Social Psychiatry, Vol. 61, No. 2BMJ Open, Vol. 5, No. 3Psychiatry Research, Vol. 220, No. 1-2Journal of Mental Health, Vol. 23, No. 3Implementation Science, Vol. 8, No. 1International Review of Psychiatry, Vol. 24, No. 1Journal of Mental Health, Vol. 21, No. 2References15 August 2011Assessing the Value of Existing Recovery Measures for Routine Use in Australian mental Health Services1 April 2011 | Australian & New Zealand Journal of Psychiatry, Vol. 45, No. 4BMC Psychiatry, Vol. 11, No. 1Psychiatric Quarterly, Vol. 81, No. 4Journal of Evaluation in Clinical PracticeThe Psychiatrist, Vol. 34, No. 8Psychiatric Rehabilitation Journal, Vol. 33, No. 3Journal of Mental Health, Vol. 19, No. 3International Journal of Psychiatry in Clinical Practice, Vol. 14, No. 3Journal of Evaluation in Clinical Practice, Vol. 15, No. 4Recovery-Based Practice: Do We Know What We Mean or Mean What We Know?1 January 2008 | Australian & New Zealand Journal of Psychiatry, Vol. 42, No. 3Epidemiologia e Psichiatria Sociale, Vol. 17, No. 2Journal of Psychiatric and Mental Health Nursing, Vol. 14, No. 7 Volume 57Issue 10 October, 2006Pages 1497-1500PSYCHIATRIC SERVICES October 2006 Volume 57 Number 10 Metrics PDF download History Published online 1 October 2006 Published in print 1 October 2006
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