recovery domains for care planning and everyday practice: clinicians’ views and service directions...

Recovery domains for care planning and everyday practice: Clinicians’ views andservice directionsTerry J. Lewin, Ketrina A. Sly, Agatha M. Conrad, Barry Frost,Megan Turrell, Suzanne Johnston, Sadanand Rajkumar,Kerry Petrovic, Tirupati Srinivasan

CTNMH

“Learning Objectives” (As stated in Abstract)

Learning Objective One:

Improved understanding of rehabilitation and recovery domains, and variation across service groups in recovery oriented practice.

Learning Objective Two:

Greater appreciation of potential collaborative client/clinician assessment tools for care planning (e.g., Recovery Star). While generalist and specialist mental health (MH) teams may differentially impact upon the various recovery domains, we need to develop a consistent, balanced, integrated, and consumer-focused approach to care planning across our services – hopefully using complementary measures.

Assessment and Evaluation Framework (1)

• A consensus is starting to emerge in the Mental Health literature that seeks to strike a better balance between “clinical recovery” (e.g., symptom reduction, relapse prevention, risk management) and “personal recovery” (e.g., promoting social and personal identity, goals, hope, and responsibility) (Slade, 2010).

• “… Quantitative approaches are needed to evaluate interventions that support recovery, and to understand the relationship between changes in recovery domains … and clinical domains of outcome” (Slade et al., 2012).

• “… More broadly, best available evidence drawn from international guidelines suggests that mental health systems can support recovery in relation to four domains of practice: promoting citizenship, organisational commitment, supporting personally defined recovery and working relationships (Le Boutillier et al. 2011)” (Slade et al., 2012).


• “… Recovery is an individual and dynamic process, and [this review] is not intended to be a rigid definition of what recovery ‘is’, but rather a resource to inform future research and clinical practice … (Slade et al., 2012).

• Within the Australian context, preliminary attempts have been made to assess the value of existing recovery measures for routine use in mental health services, both as tools for “monitoring recovery status and change” (by individual consumers), and the “recovery orientation of services” (Burgess et al., 2011); however, gold standard measures are not yet available (Williams et al., 2012).

“Assessing the value of existing recovery measures for routine use in Australian mental health services”

Philip Burgess, Jane Pirkis, Tim Coombs, Alan Rosen

Australian and New Zealand Journal of Psychiatry 2011; 45:267–280 Instruments designed to measure

Individuals’ Recovery (9 Criteria)

Instruments designed to measure the Recovery Orientation of Services

(6 Criteria)

1: Explicitly measures domains related to personal recovery

1: Measures domains directly relevant to the recovery orientation of services

2: Is brief and easy to use (≤ 50 items) 2: Is manageable and easy to use in terms of administration (≤ 100 items)

3: Takes a consumer perspective 4: Includes a consumer perspective 4: Yields quantitative data 3: Has undergone appropriate processes

of development, piloting and documentation, and ideally been scientifically scrutinized

5: Has been scientifically scrutinized 6: Demonstrates sound psychometric

properties (e.g., of internal consistency, validity, reliability and sensitivity to change)

7: Is applicable to the Australian context 5: Is applicable to the Australian context 8: Is acceptable to consumers 6: Is acceptable to consumers 9: Promotes dialogue between

consumers and providers

“Assessing the value of existing recovery measures for routine use in Australian mental health services”

Philip Burgess, Jane Pirkis, Tim Coombs, Alan Rosen

Australian and New Zealand Journal of Psychiatry 2011; 45:267–280 Instruments designed to measure

Individuals’ Recovery (9 Criteria)

Instruments designed to measure the Recovery Orientation of Services

(6 Criteria)

1: Explicitly measures domains related to personal recovery

1: Measures domains directly relevant to the recovery orientation of services

2: Is brief and easy to use (≤ 50 items) 2: Is manageable and easy to use in terms of administration (≤ 100 items)

3: Takes a consumer perspective 4: Includes a consumer perspective 4: Yields quantitative data 3: Has undergone appropriate processes

of development, piloting and documentation, and ideally been scientifically scrutinized

5: Has been scientifically scrutinized 6: Demonstrates sound psychometric

properties (e.g., of internal consistency, validity, reliability and sensitivity to change)

7: Is applicable to the Australian context 5: Is applicable to the Australian context 8: Is acceptable to consumers 6: Is acceptable to consumers 9: Promotes dialogue between

consumers and providers

Considerable variability in domains assessed

Crawford et al. (2011) - Table II. Features of an appropriate outcome measure according to group members.

Should be based on patient rather than staff-rated judgements

Includes ‘positive’ as well as ‘negative’ items

Is comprehensive – neither too long nor too short

Avoids questions that are intrusive about private issues such as sex life

Makes note of the time and place where the outcome is measured

Includes space for ‘added comments’

Should be used by staff who have good interpersonal skills and have been

properly trained in the use of the outcome measure

If self completed, is presented in a professional manner

“Selecting outcome measures in mental health: the views of service users”Crawford et al. (2011) Journal of Mental Health, 20(4): 336–346

Service users views of outcome measures

Consensus Domains ?

A decade ago, initial attempts were made to develop a comprehensive‘consensus cognitive battery (for schizophrenia)’ for assessing cognitive change in clinical trials- Resulting in the selection of ten existing tests covering seven domains- Known as the MATRICS Consensus Cognitive Battery (MCCB)

MATRICS domains:Speed of processing (e.g., trail making, symbol coding, category fluency)Attention/vigilanceWorking memory (verbal and nonverbal)Verbal learningVisual learningReasoning and problem solvingSocial cognition GREEN MF, NUECHTERLEIN KH, GOLD JM, BARCH DM, COHEN J, ESSOCK S, FENTON WS, FRESE F, GOLDBERG TE, HEATON RK, KEEFE RSE, KERN RS, KRAEMER H, STOVER E, WEINBERGER DR, ZALCMAN S, MARDER SR. Approaching a consensus cognitive battery for clinical trials in schizophrenia: the NIMH-MATRICS conference to select cognitive domains and test criteria. Biological Psychiatry 2004;56:301-307.KERN RS, NUECHTERLEIN KH, GREEN MF, LAADE LE, FENTON WS, GOLD JM, KEEFE RSE, MESHOLAM-GATELY R, MINTZ J, SEIDMAN LJ, STOVER E, MARDER SR. The MATRICS consensus cognitive battery, part 2: Co-norming and standardization. American Journal of Psychiatry 2008;165:214-220.

http://www.researchintorecovery.com/

Slade et al. (2012) .“International differences in understanding recovery: systematic review”, Epidemiology and Psychiatric Sciences, 21: 353-364.

Conceptual framework coding for recovery conceptualisations – by Country


Conceptual framework


RECOVERY PROCESS

(CHIME)

(Other super-ordinate categories:

Characteristics of the Recovery Journey, Recovery Stages)

Connectedness

Peer support and support groups Relationships Support from others Being part of the community

Hope and optimism about the future

Motivation to change Belief in possibility of recovery Positive thinking and valuing success Having dreams and aspirations Hope-inspiring relationships

Identity Dimensions of identity Rebuilding/redefining positive identity Over-coming stigma

Meaning in life

Meaning of mental illness experiences Spirituality Quality of life Meaningful life and social roles Meaningful life and social goals Rebuilding of life

Empowerment Personal responsibility Control over life Focusing upon strengths

International Journal of Mental Health Nursing (2013) 22, 3–14

Recovery of evidence-based practice Sarah E. Gordon and Pete M. Ellis

“… More specifically, studies from different nations reflect consistency in the components, across 12

potentially discrete and independent domains that consumers identify as important” … (Gordon et al. 2004; Graham et al. 2001; Miller et al. 2003; Ohio Department of Mental Health 2009):

1. Relationships, trust, connectedness, social

support, interdependence. 2. Day-to-day functioning, coping, and managing,

including work (having the ability to work). 3. Connection to one’s culture, cultural identity,

drawing strength from one’s culture. 4. Physical health and health risks. Includes

alcohol and drug use, side-effects of medications, sleeping, and eating.

5. Quality of life, life satisfaction, enjoying the environment, feeling alert and alive, able to enjoy pastimes/hobbies.

6. Illness symptoms.

7. Coping with and recovering from illness, self-managed care, staying out of the mental health system, understanding of illness.

8. Hope, journey from alienation to purpose, reawakening of hope after despair.

9. Empowerment, being in control, exercising choice, positive sense of self, self-determination.

10. Spiritual strength, increased spirituality. 11. Resources, basic needs (e.g. food, money,

accommodation, transport). 12. Satisfaction with services (including cultural

relevance of services)

Illustrative recovery goals identified by participants with ‘psychiatric disability’ (N = 144)

Clarke, Oades & Crowe (2012). Psychiatric Rehabilitation Journal, 35:297-304

Conceptualization that includes:

multiple domains,individualized

processes,stages of

change/recovery.

MH Recovery – “Movement towards”

well-being and meaning

(versus avoidance of symptoms)

•Five stage model of psychological recovery based on Andresen et al. (2003)

•Seven overarching value domains(based on the Recovery Goal Taxonomy)

Flexibility: Different goals for different stages of recovery

Clarke, Oades & Crowe (2012). Psychiatric Rehabilitation Journal, 35:297-304

“… Individuals further along in their recovery set significantly more approach goals and types of goals set appear to reflect broader life roles”

(p. 297)

MH Recovery – “Movement towards”

well-being and meaning

(versus avoidance of symptoms)


• In the Hunter region, we have begun to explore the utility of the Mental Health Recovery Star (MacKeith and Burns, 2010), both as a collaborative assessment and recovery planning tool for working with individuals, and as a framework for examining clinicians’ current views and practices.

• “The Mental Health Recovery Star was commissioned in the UK by the voluntary sector umbrella body the Mental Health Providers Forum (MHPF). … Considerable user involvement and extensive mental health service user feedback were integral to the development of the tool. … Recovery Star is predicated on an underlying model of a ‘ladder of change’ comprising five stages: being stuck, accepting help, believing, learning and self-reliance.” (Dickens et al., 2012)

Sample Ladder

Sample Ladder

(Detail)

Possible ‘higher-order clusters’ within Recovery Star

• Managing mental health

• Physical health & self-care

• Addictive behaviour

• Living skills

• Work

• Responsibilities

• Social networks

• Relationships

• Identity and self-esteem

• Trust and hope

A: Mental/Physical Health

C: Networks

B: Activities & Functioning

D: Self-image

(Consistent with Factor 2 from

Dickens et al. 2012)

Possible ‘higher-order clusters’ within Recovery Star

• Managing mental health

• Physical health & self-care

• Addictive behaviour

• Living skills

• Work

• Responsibilities

• Social networks

• Relationships

• Identity and self-esteem

• Trust and hope

A: Mental/Physical Health

C: Networks

B: Activities & Functioning

D: Self-image

(Consistent with Factor 2 from

Dickens et al. 2012)

Connectedness Hope and Optimism about

the future &Identity

Meaning in life &

Empowerment

“RECOVERY PROCESS”(CHIME) – Slade et al. (2012)

Recovery Star – Clinical Outcome Tool vs. Collaborative Care Planning

Several Criticisms:•IRR based on staff only ratings;•Collaborative nature of tool not ‘unusual’ or a major limitation;•Poor choice of comparator;•Need different approaches to validation;•Not designed to be an ‘objective outcome measure’ – but a tool for care planning and change.

• “The ‘work’ item proved to be one of the least amenable to change … there may be a need to clarify the item descriptor to allow for a range of interpretations of ‘work’.”

• Responsive to change• Two factors: internal vs. external

management/ relationships

(Likely to be highly dependent on nature of sample and timeframes)

Intermediate Stay Mental Health Unit (ISMHU)

• 20 bed non-acute inpatient unit located on the James Fletcher Hospital campus in Newcastle

• Opened: November, 2010

• Stand alone unit – separated from acute unit by approx. 9 km

• Admissions planned and co-ordinated – utilising rehabilitation co-ordinators providing liaison across inpatient and community services

• Recovery/rehabilitation focused model of care – program based - approx. 6 week length of stay

• Recovery model underpinned by Recovery Star framework and associated, locally devised resources and training materials

Staff Survey

(Baseline)

Staff Survey (Follow-

up)

2010 2011 2012 ... N D J F M A M J J A S O N D J F M A M J J A … Review of First 12 Months – (Nov. 2010 to Nov. 2011)

Unit opened 22nd Nov. 2010 Establishment, achievements and challenges Descriptive analyses (N = 123 admissions to 22/11/11) Re-admissions review (N = 48 discharges to 22/5/11)

Formal Service Audit – (April 2011 to March 2012) Unit fully operational (20 beds) All new admissions during 12 month period (N = 132) Ongoing admissions (April, May 2012), allowing for

minimum 3 month follow-up Data extraction (end of August 2012) Focus: client characteristics; episode details; clinical

symptomatology; diagnosis; intervention/activity codes; clinical outcomes; service utilisation/ engagement and Recovery Star data

Client profiles and relationships among key indices

Ongoing

Adm.

Minimum 3 Month

Follow-up

Adm. 4 6 6 3 15 11 13 13 10 14 7 12 13 8 12 7 12 Additional components: Ongoing service profiles (vs.

comparable clients without ISMHU admissions) – during prior and subsequent 2 years (future project)

ISMHU Evaluations – Components & Timelines

Participant Characteristics (1)

Primary Role

BaselineSurvey

(N = 194)

Follow-upSurvey

(N = 200)

Combined(N = 394)

Clinical role Nursing 74 (38.1%) 71 (35.5%) 145 (36.8%) Allied Health 67 (34.5%) 61 (30.5%) 128 (32.5%) Other – Medical, Director 25 (12.9%) 24 (12.0%) 49 (12.4%)Non-clinical role 28 (14.4%) 44 (22.0%) 72 (18.3%)

Note: 77.2% of participants were female (304/394)Average age = 44.1 years

Moderate overlap across phases: At follow-up, only 32% reported baseline participation and 29% were ‘unsure’

Participant Characteristics (2)

Primary Work Location (Clinician sub-categories)

BaselineSurvey

(N = 166)

Follow-upSurvey

(N = 156)

Combined(N = 322)

Long Stay Unit 18 (10.8%) 11 (7.1%) 29 (9.0%) Acute Inpatient Unit 44 (26.5%) 45 (28.8%) 89 (27.6%)

Intermediate Stay Unit 25 (15.1%) 17 (10.9%) 42 (13.0%)

Community MH 79 (47.6%) 83 (53.2%) 162 (50.3%)

Analysis Strategy

• The major analyses focused on overall comparisons between clinicians from different work locations, whilst statistically controlling for gender and clinical role effects.

• Three-step hierarchical regression analyses were used:o Step 1: Gender, Clinical Role (2 contrast coded variables)o Step 2: Survey Phase, Work Location (see below)o Step 3: Phase by Work Location interactions

(To minimise the number of statistical tests) • Three Work Location related planned orthogonal contrasts were examined:

o Long Stay Unit clinicians Vs. the Rest;o Acute Inpatient Unit clinicians Vs. Intermediate Stay and Community MH clinicians; ando Intermediate Stay Unit clinicians Vs. Community MH clinicians

• Outcome variables:o Importance placed by unit/service on recovery-oriented practice [Follow-up Only]o Importance given to specific recovery domains in care planningo Perceived impact of current treatment practices

• Threshold for statistical significance: p < 0.01

Recovery-oriented practice

Question 12 from Follow-up Survey:

“How much importance does your unit/service place on recovery-oriented practice - e.g., encouraging self-determination and self management, strengths-based care, promoting personal goals and aspirations, addressing multiple factors impacting on wellbeing, carer involvement, supporting social inclusion and participation?”

High

Considerable

Moderate

Some

None

Acute < Community MH and ISMHU (p < 0.001)

Importance placed on recovery-oriented practice

Key survey questions for all mental health clinicians Selected questions from:

Rehabilitation and Recovery Survey Recovery Domains

Importance for Care Planning (Baseline: Q10; Follow-up: Q11) “In developing care plans for clients, how much importance does your unit/service place on each of the following recovery domains?” Perceived impact of current treatment practices (Baseline: Q9; Follow-up: Q10) “How much impact (for clients) do you feel our current treatment practices are likely to have on each of these recovery domains?” Rating scale: 1: None 2: Some 3: Moderate 4: Considerable 5: High

Managing Mental Health (e.g. managing symptoms & encouraging self-reliance)

Self-care and Physical Health (e.g. managing physical health & self-care)

Living Skills (e.g. ability to live independently, shop, cook, clean, budget)

Social Networks (e.g. encouraging participation and community activities)

Work (e.g. full or part-time work, studying or volunteering)

Relationships (e.g. developing closeness with family, friends or partner)

Addictive Behaviour (e.g. developing coping strategies to reduce potential harm)

Choice of recovery domains: Several survey questions were framed in terms of the ten recovery domains used in the Mental Health Recovery Star client/clinician assessment and recovery planning tool, which was developed in the UK by Triangle Consulting and is available for use under a Creative Commons licence (see www.outcomestar.org.uk)

Responsibilities (e.g. self-managing daily responsibilities - i.e. bills, neighbours)

Identity and Self Esteem (e.g. liking who they are, satisfying sense of self)

Trust and Hope (e.g. having a sense of hope, and trusting in self and others)

On-line Survey (Zoomerang/Survey Monkey)

Importance for Care Planning

Perceived impact of current treatment practices

“How much impact (for clients) do you feel our current treatment practices are likely to have on each of these recovery domains?”

Mean Rating 1: None; 2: Some; 3: Moderate 4: Considerable; 5: High

Ratings by Clinicians

from across MH services

(N = 313)

Managing Mental Health 3.74 Living Skills 3.54 Trust & Hope 3.39 Social Networks 3.32 Identity & Self-Esteem 3.32 Self-Care & Physical Health 3.31 Relationships 3.26 Responsibilities 3.23 Addictive Behaviour 3.16 Work 3.13

Likely intervention benefits

“For the typical client, how likely are xxxx interventions to produce positive changes on each of these recovery domains?”

Mean Rating 1: No at all; 2: Somewhat; 3: Moderately 4: Very; 5: Extremely

ISMHU Clinicians (n = 38) Individual

Interventions (e.g., MH education; medication management; motivational interviewing; ADL education; individual counselling; CBT; healthy lifestyle education; computer and Internet access; social skills training; relapse prevention)

Group Interventions

(e.g., MH education; skill development; anger management; drug and alcohol education; family interventions; healthy lifestyle; relaxation; social skills)

Living Skills 4.21 3.76 * Trust & Hope 4.06 3.74 * Managing Mental Health 4.03 4.06 Social Networks 4.00 3.80 Self-Care & Physical Health 3.94 3.43 * Identity & Self-Esteem 3.91 3.62 * Relationships 3.89 3.60 Work 3.85 3.21 ** Responsibilities 3.63 3.43 Addictive Behaviour 3.54 3.43

Comparison with Individual Interventions: p <.01; ** p<.001

Interventions

• Comprehensive Individualised rehabilitation program (together with a mixture of Group programs) that aim to enhance:

• Symptom control• Resilience and coping skills• Living skills• Personal relationships• Community integration• Social inclusion

• Programs available across the whole week

• Key worker utilises a collaborative goal setting tool (Recovery Star) to assist in the development and implementation of the care plan

Intervention Log (using existing Code Sets)

This log allows for the documentation and electronic recording of key interventions provided to each client admitted to ISMHU. Please tick all group programs that the client, carer or family member successfully participated in. For individual tailored interventions, tick only those interventions provided in addition to the group programs targeted at identified clinical goals or specific recovery domains.

TICK INTERVENTIONS CODE

GROUP PROGRAMS: Managing Mental Health 96079-00

Medication 96141-00

Goal Setting/Goal Review 96086-00

Shopping/Meal Planning 96143-00

Healthy Lifestyles 96140-00

Budgeting 96144-00

Relaxation/Advanced Relaxation 96090-00

Social Skills/Community Access – BBQ, Hobby Starters 96148-00

Consumer Consultant – Wellness Plan 96089-00

Recovery Star 96151-00

Another group program not listed above, please specify: 96164-00

FAMILY/CARER GROUP PROGRAMS: Family Connection – Family Session 1 95550-01

Mental Health Education and Support – Family Session 2 96102-00

INDIVIDUAL TAILORED INTERVENTIONS: Mental Health Education 96076-00

Medication Education 96072-00

Cognitive Behavioural Therapy (CBT) 96101-00

Motivational Interviewing/Goal Setting, Counselling 96082-00

Drug and Alcohol Education/Therapy re: substance use 96073-00

QUIT interventions (e.g. smoking cessation) 92010-00

Relapse Prevention Education and Planning 96176-00

Personal Self Care/ Well being – Education/Skills 96075-00

ADL Education/Skills (e.g. meal plan/preparation, living skills) 96077-00

Healthy Lifestyle Education (e.g. diet, exercise, etc.,) 96066-00

Budgeting Skills 96078-00

Home Visit – Environmental Assessment 96168-00

Family Intervention 96081-00

Social Skills (e.g. inclusion exercises, activity participation) 96177-00

Communication skills training- Assertiveness/Anger management 96137-00

Personal Skill Development (e.g. stress management, relaxation) 96001-00

Counselling/Therapy (e.g. confidence, self-esteem, coping skills) 96185-00

Neuropsychological Assessment/Education 95550-10

Cognitive Remediation 96114-00

Linkages with Specialised MH & NGO Services 96108-00

PRA - Linkages with the community 96107-00

Engagement with VETE 96146-00

Linkages with other appropriate Community Services 95550-11

Another individual intervention not listed above, please specify: 96180-00

Staff member authorising completed log

Print Name Designation Signature Date

HUNTER NEW ENGLAND LOCAL HEALTH DISTRICT

Intermediate Stay Mental Health Unit

Intervention Log

DMHS(T)11/04

PLEASE USE GUMMED LABEL IF AVAILABLE

SURNAME UNIT NUMBER

OTHER NAMES

ADDRESS

DATE OF BIRTH MO

O

bse

rvat

ion

O

bse

rvat

ion

Inte

rve

nti

on

Lo

g

O

bse

rvat

ion

O

bse

rvat

ion

This log allows for the documentation and electronic recording of key interventions provided to each client admitted to ISMHU.

Please tick all group programs that the client, carer or family member successfully participated in.

For individual tailored interventions, tick only those interventions provided in addition to the group programs targeted at identified clinical goals or specific recovery domains.

Preliminary Recovery Star Outcomes(ISMHU, N = 102)

• 82% of consumers showed an improvement on the Recovery Star as a result of an admission to ISMHU.

• Of those who had shown an improvement, 61% had made a substantial improvement, and 21% a small improvement.

• Less than 1 in 5 showed either no improvement (11%) or a decrease (7%).

• The areas of need that showed the largest positive improvements were: Managing Mental Health (76%), Physical Health & Self Care (68%), Identity and Self Esteem (68%), Social Networks (66%), Living Skills (65%), Trust and Hope (65%), and Relationships (61%).

• The areas with the least number of consumers making a positive change were: Work (53%), Addictive Behaviour (50%), and Responsibilities (49%) – which correspond with the domains experiencing the least change reported by Dickens et al. (2012).

Conclusions - Rehabilitation and Recovery Domains:

• There is considerable variability in the domains assessed by current ‘recovery-related’ measures.

• We need to develop a ‘flexible consensus’ – a small number of broad (upper-level) domains (≤ 6), with a larger set of sub-domains that can adequately represent individualised (or system-level) recovery processes and goals, and different stages of change/recovery.

• Existing and proposed qualitative/quantitative measures can then be mapped onto those domains (and sub-domains) – and evaluated (e.g., acceptability, consistency, sensitivity, utility, etc). Measures may vary but the terminology and goals need to be coherent.

• Realistic timeframes need to be set for evaluating the effectiveness of programs – say, a minimum of 3- or 6-monthly assessments over 2 years (e.g., ‘hope’ and ‘identity’ may change relatively slowly).

Collaborative Client/Clinician Assessment Tools:

• The Recovery Star has been well-received by clients/clinicians within our health service and is reflecting improvements across the course of an ISMHU admission.

• Knowledge about its strengths and weaknesses is (slowly) accumulating.

• Particularly positive feature – underpins recovery model and interventions in ISMHU.

• Needs better integration with electronic records – across inpatient/community settings.

Survey findings:

• There was reasonable variation within our services in the ‘recovery orientation’ of clinicians – with a greater emphasis on recovery among our non-acute and community based staff.

• Not surprisingly, ISMHU affiliated clinicians tended to view all of the identified recovery domains as important for care planning; however, they only differed from Community MH clinicians in the importance attached to Living Skills and Self-Care & Physical Health.

• While generalist and specialist teams may differentially impact upon the various recovery domains, we need a consistent, balanced, integrated, and consumer-focused approach to care planning across our services – so that (at the very least) we are all talking the same language.

• Many of the recovery domains associated with the largest differences between clinician sub-groups could be viewed as elements of ‘personal recovery’ (e.g., Work, Social Networks, Identity & Self-esteem, and Trust & Hope) – suggesting that a greater (service-wide) emphasis may also need to be placed on these domains.

Survey findings (Continued):

• The perceived impact of current treatment practices was lowest for the recovery domains of Addictive Behaviours and Work.

• Group interventions are perceived as less likely to produce positive changes (than individual interventions) – but not for domains relating to Managing Mental Health and Connectedness (social networks, relationships).

• Many clinicians (approx. 50%) also expressed a desire for additional skills training (beyond refresher courses) in providing interventions, particularly in relation to Addictive Behaviours, Trust & Hope, and Identity & Self-esteem.

• Thank you for listening, and to everyone who participated in the Rehabilitation and Recovery Surveys – and to the ISMHU Evaluation Committee/Team.

Thank YouCTNMH

recovery domains for care planning and everyday practice: clinicians’ views and service directions...

Documents

clinical recovery

personal recovery

defined recovery

recovery star

various recovery domains

recovery oriented practice

monitoring recovery

domains of practice