W4-T4 The Recovery Paradigm Flashcards
recovery key idea according to Anthony (1993)
may occur without full symptoms remission
not a linear process
define recovery according to Anthony (1993)
a deeply personal unique process of changing
someone’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.
differences between personal recovery and clinical recovery
clinical
- measured by professional
- it is an outcome/dichotomous
- observable/objective
-consistent between individual
-emphasis on symptoms
personal
- measured by service user/survivor
- is a process/continuum
-subjective
-differs between people
-emphasis placed in hope, meaning, empowerment
name 5 recovery process
Connectedness
Hope
Identity
Meaning of life
Empowerment
why recovery is a complex process Anthony (1993)
involves recovering from the consequences of
the illness (i.e. stigma, lack of opportunities, and iatrogenic effects of treatments)
recovery misconception (Slade et al., 2014)
- mental health services that hire peer workers are recovery-oriented
- recovery paradigm focuses on psychosis, or not possible in patients with severe symptoms
- treatment service encourages recovery - in fact, it can hinder the recovery process if do not promote self-determination
- compulsory treatment aids in recovery - not in life with the value of self-determination
- recovery paradigm envision closing service - recovery is not linear, service availability is essential for people who need them
- recovery means independent and normal - the same point as above
- welfare reform disrespects people with mental illness - the right to work and welfare benefits equally important
name 4 recovery promoting intervention
peer support
wellness recovery action planning
illness management and recovery
individual placement and support
define peer support
people with mental health provide support to other people with mental health ( in traditional service or peer-run service)
evidence base in peer suppot
Cochrane studies by Pitt et al. (2013)
- no difference between peer support and professional support in several outcomes such as QoL, satisfaction, symptoms
- peer support care uses less emergency service than clinician service care
meta-analysis by White et al. (2020)
- does not impact clinical outcomes but improves empowerment and recovery
- improved empowerment and recovery outcomes studied of peer support as an additional intervention
- suggest possible beneficial role peer support has as an autonomous intervention
What is wellness recovery action action plan (WRAP)
group intervention facilitated by peers with the aim of promoting the development of a recovery plan (8-10 weekly session)
provide a safe and non-judgement environment
the goal is to create a wellness toolbox with tools that promote well-being and tools that help recognise and deal with triggers and
stressors
what was WRAP evidence-based according to a study by Cook et al? (2019)
suggest benefits in symptom reduction, increase QoL and hopefulness.
describe meta analysis Canacott et al. 2019 difference between WRAP to inactive control condition
more effective in promoting recovery outcome
equally effective in reducing psychiatric symptom
—> possibility of personal recovery without an essential decrease of symptoms
define Illness management and recovery (IMR)
standardized intervention
- aims to teach people with mental illness strategies to manage their illness
- to help them achieve personal and meaningful goals
- curriculum based
- 6 month to a year
- group or individual
module includes in IMR
recovery
practical facts of mental illness
stress-vulnerability model
build social support
use medication effectively
drugs and alcohol
reduce relapses
cope with stress
cope with persistent symptoms
get you need met in mental health system
live a healthy lifestyle
IMR strategy (Meyer et al., 2010)
education, motivation, cognitive behavioural strategy (reinforcement, modelling, behaviour rehearsal and shaping)
IMR efficacy
mixed result – could be related to model fidelity (the degree of staying to the protocol) and IMR completion
Randomised Controlled Trials (RCT) 187 outpatients receiving either IMR plus treatment as usual or treatment as usual only. Findings suggested that in comparison (Roosenschoon et al., 2021):
–The IMR group demonstrated improved illness self-management and
self-esteem with the control group.
– Completing the programme and fidelity in terms of its delivery are associated with better outcomes.
define Individual placement and support (IPS)
evidence-based practice aimed at helping people with mental illness to get and keep a job in mainstream competitive market
IPS principle
focus on the goal of competitive employment
zero exclusion
attention to client preference
rapid job search
targeted job development
employment service and mental health treatment integration
personalized benefits counselling
individualized long-term support
IPS evidence based
27 / 28 RCT shows better competitive employement outcomes for people who received IPS (Bond et al., 2020)
what are the values of recovery-oriented mental health services according to Slade (2013)
to support personal recovery
to support the person’s goal
people receiving services are responsible for their own lives
define recovery-oriented practice according to Meadows (2019)
staff, clinical or other, work and relate to people who use services in a way that promotes growth and empowerment so that they can achieve their full potential.
what is REFOCUS, the goal and components
5 years programme research led by KCL (2009-2014) – the goal is to increase recovery-orientation approaches in mental health services
components:
recovery-promoting relationships
working practices include
–understanding values and treatment preferences
–assess strengths
–support goal-striving
what are the roles of the coach in REFOCUS
– to encourage the person to think about their own solutions.
– IS not aimed at fixing problems.
– guides the individual to use their strengths and resources, the person being coached is accountable for their life.
define three working practice in REFOCUS
- values and treatment preferences (care should be consistent with the person’s values) (i.e. family background, religion)
- assessing strengths – to gain a holistic understanding of the person (assess internal and external resources) (i.e. daily living conditions, occupation, finances)
- support goal-striving through GROW framework
Goal – where you want to be
Reality – where you at now
Option – option to achieve the goal
Wrap-up – agree on next step
main values in setting goal through GROW
approach goal (involve positive change) better than avoidance goal (escaping from something negative)
needs to be done sensitively
trusting relationship between service user and staff member is essential
REFOCUS evidence-based according to two articles published in the Journal,
The Lancet Psychiatry.
In the UK, results suggested that high team participation would be significantly better than low participation in terms of staff rated
recovery-promoting behaviours and patients-rated interpersonal scores –the failure of the intervention to improve the primary outcome of recovery may have to do with implementation problems.
– patient has been receiving services for more than 15 years – deeply rooted in them, maybe need more time view change
in Australia – REFOCUS-PULSAR (Principles Unite Local Services Assisting Recovery) – Recovery measured by the questionnaire – the process of recovery was significantly higher in the intervention group but the effect size was
small.
Despite the small effect size, the significant difference is encouraging since small effects are common in pragmatic trials, which means trials assessing the effectiveness of interventions in real-life conditions.
