Method

1. Principles of Recovery: An Evaluation of Consumer Inclusion and Recovery Outcomes in Nebraska Emily B. H. Treichler, B.S., Feiyu Li, B.A., & William D. Spaulding, Ph.D. University of Nebraska – Lincoln Results Introduction Recent state and federal reforms of the public mental health system have focused on developing recovery-oriented services and increasing consumer involvement in service planning and advocacy. Mental health recovery is defined as the development of new meaning and purpose in one’s life, beyond the impact of mental illness. The most common elements that are included in this notion are: the importance of renewing hope and meaning; overcoming stigma and other sources of trauma associated with serious mental illnesses; and assuming control over one’s life. The evolving notion of consumer involvement, including becoming meaningful members of their community and impact the delivery of services they receive, is considered to be essential to quality of life. However, little research has been conducted to understand how these two constructs are related to each other in the context of consumers’ lives, including their interactions with service systems. This study examined how consumers view their own involvement and recovery at this point in Nebraska’s mental health reform, and how secondary aspects of a consumer’s life and mental health service system impacts their recovery experience. Figure 1. Table 1. Correlations among recovery and related constructs Method • Participants • 266 consumers of public mental health services in the state of Nebraska participated in the study. • The participants included 123 men and 143 women ranging in age from 20-69 (M= 44.77 , SD=11.48), 50.8% of whom were from rural areas. • Measures • Demographics, including general service use and crisis service use • Recovery Assessment Scale (RAS; Giffort, Schmook, Woody, Vollendorf, & Gervain, 1995) • Empowerment Scale(ES;Rogers, Chamberlin, Ellison, & Crean, 1997) • Community Integration Measure (CIM, used here as a measure of psychological involvement; McColl, Davies, Carlson, Johnston, & Miannes, 2001) • Community Integration Questionnaire (CIQ, used here as a measure of physical and social involvement; Willer, Rosenthal, Kreutzer, & Gordon, 1993 ) • 10 item Connor-Davidson Resilience Scale (10-item CD-RISC; Campbell-Sills & Stein, 2007) • Procedures • Participants completed surveys at 10 sites, including 8 day facilities and 2 community settings (i.e., public library) Discussion and Implications Correlation analyses were performed in preparation for the multiple regressions presented below (see Table 1). A stepwise multiple regression examined the relationship between recovery and constructs found to be correlated with recovery. Results revealed that empowerment, resilience and CIM significantly predicted recovery, R2 = .532, F (3, 258) = 97.861, p < .001. A further regression model including the interactions among those factors revealed that the interaction between resilience and CIM significantly predicted recovery(Figure 1). This interaction improved the variance accounted for the model, R2∆ = .007, F change (1, 257) = 4.135, p < .05 (Table 2). According to the final model, empowerment and the interaction between resilience and consumer involvement significantly predicted recovery. The findings revealed that as individuals report feeling more empowered, they also report feeling more recovered. Additionally, there was an interaction between resilience and consumer involvement such that among consumers with high resilience feeling more connected to their community was related to feeling more recovered; whereas among consumers with low resilience feeling more connected to their community was related to feeling less recovered. **. Correlation is significant at the 0.01 level (2-tailed) • Feeling more empowered is related to feeling more recovered • Feelings of autonomy, community activism, optimism and righteous anger are important to consumer’s recovery experience • There is a complex relationship between recovery, psychological involvement, and resilience • Psychological involvement is positively related to recovery for those who are high in resilience • However, for consumers who are low in resilience, feeling more involved is related to feeling less recovered • For many consumers, resilience and psychological involvement affect their recovery experience • Empowerment can be increased through treatment and by creating empowering service environments • Resilience can also be increased through treatment and through improved social support • Identifying aspects of consumers’ communities that are related to decreases in their feelings of recovery can be used to create changes • This may include structuring services toward recovery, increasing resources and consumer’s autonomy in using resources, as well as education about self-stigma and other aspects of mental illness • This study only included service users of day facilities, which does not account for all ranges of service use and severity of illness. Additionally, researchers did not have access to diagnosis and related functional issues, which could have affected outcomes. Considering a greater population and taking into account diagnosis in future studies will assist in examining how these constructs interact in consumers’ recovery experiences. Table 2. Notable stepwise multiple regression results