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| Measuring Consumer-defined Recovery |
Measuring Consumer-defined Recovery
Measures of consumer-oriented outcomes go only part of the way to the goal of ensuring that services promote recovery. What is required are measures of recovery as it has been defined by consumers (Davidson et al., 2006). However, given that recovery is represented as a unique, personal journey, there has been a reluctance to define it as an outcome, as this is seen as prescribing what recovery should be for all consumers (Torrey et al., 2005). Torrey and colleagues noted that the outcome goals identified by consumers are usually those things commonly sought by everyone, such as a home, a partner or work. While this is true, measures based on a specified set of goal domains would be contrary to the recovery movement’s drive for empowerment and self-determination (Torrey et al., 2005). One approach to clinical work that incorporates individualized goal setting and measurement can be found in the Collaborative Recovery Model (CRM; Oades et al., 2005). The CRM enables clients to identify their personal, values-based goals, and to monitor and measure progress towards these goals (Clarke et al., 2006).
In the past decade or so, researchers have been working to develop outcome measures that reflect the consumer definition of recovery. Some of these utilize existing subjective outcome measures which assess aspects of the recovery process.
Writing from the perspective of psychopharmacologists wishing to work within the recovery model, Noordsy and colleagues (Noordsy et al., 2000, 2002), moved towards a consumer definition of recovery by identifying three intrapersonal criteria for recovery from the literature – hope, taking responsibility and ‘getting on with life’ – consisting of four components: identity through life roles, relationships, work or structured activity and recreation. They offered examples of eight existing assessment tools to cover various components of these three aspects, embracing spirituality, illness management, healthy lifestyle, identity, relationships, work and recreation. Importantly, Noordsy and colleagues (2002) suggested that these quantitative measures would need to be augmented by the subjective experience of recovery, and stressed that objective measures should be coupled with measures of the value and meaningfulness of the item to the consumer.
A number of other measures of specific aspects of recovery have been used, including hope, resilience, self-efficacy, empowerment and wellbeing (Ralph, Kidder and Phillips, 2000). Resnick et al. (Resnick et al., 2005) conducted a study aimed at identifying aspects of existing outcome measures which could be used to measure a ‘recovery orientation’. Using data from the Schizophrenia Patient Outcomes Research Team (PORT) Client Survey (Lehman et al., 1998), they factor analysed items which assessed subjective aspects of recovery, and identified four aspects of a recovery orientation: Knowledge, Empowerment, Hope and Optimism, and Life Satisfaction. They suggested that, although recovery is described as a process, an empirical conceptualization could be used to assess recovery as an outcome (Resnick et al., 2005). Resnick and colleagues note that a limitation of their operationalization was its dependence on items from an existing outcomes database, rather than being based in theory. The items, although subjective, focus largely on opinion about services received. For example, the first item in the Empowerment– Self Agency factor is: How much do your opinions and ideas count in which services you get? This does not reflect the sense of personal responsibility for one’s life and wellbeing found in the consumer literature.
The first measure of recovery as a psychological construct with published psychometric properties was the Recovery Assessment Scale (RAS; Corrigan et al., 1999b). Items of the RAS were based on qualitative work with consumers, and later factor analysed to reveal five factors: Personal confidence and hope; Willingness to ask for help; Goal and success orientation; Reliance on others and No domination by symptoms (Corrigan et al., 2004). The Mental Health Recovery Measure (MHRM; Young, Ensing and Bullock, 1999), was based on Young and Ensing’s conceptual model of recovery (Young and Ensing, 1999). The original version assessed the six aspects of recovery described in the model: Overcoming Stuckness; Self-Empowerment; Learning and Self-Redefinition; Basic Functioning; Overall Well-Being; and New Potentials. Later, the domains of Spirituality and Advocacy/Enrichment were added.
A collection of recovery and recovery-related measures has been compiled by Campbell-Orde et al. (2005). A distinction is made between measures of ‘individual recovery’ and ‘recovery-promoting environments’. Of the eight measures of individual recovery in the volume that have been tested, only the RAS andMHRMcould be considered measures of psychological recovery. The remainder incorporate ‘external’ factors of recovery, such as satisfaction with service or measure a single aspect such as illness management. Some were designed to evaluate a specific service or programme.
Measures of consumer-oriented outcomes go only part of the way to the goal of ensuring that services promote recovery. What is required are measures of recovery as it has been defined by consumers (Davidson et al., 2006). However, given that recovery is represented as a unique, personal journey, there has been a reluctance to define it as an outcome, as this is seen as prescribing what recovery should be for all consumers (Torrey et al., 2005). Torrey and colleagues noted that the outcome goals identified by consumers are usually those things commonly sought by everyone, such as a home, a partner or work. While this is true, measures based on a specified set of goal domains would be contrary to the recovery movement’s drive for empowerment and self-determination (Torrey et al., 2005). One approach to clinical work that incorporates individualized goal setting and measurement can be found in the Collaborative Recovery Model (CRM; Oades et al., 2005). The CRM enables clients to identify their personal, values-based goals, and to monitor and measure progress towards these goals (Clarke et al., 2006).
In the past decade or so, researchers have been working to develop outcome measures that reflect the consumer definition of recovery. Some of these utilize existing subjective outcome measures which assess aspects of the recovery process.
Writing from the perspective of psychopharmacologists wishing to work within the recovery model, Noordsy and colleagues (Noordsy et al., 2000, 2002), moved towards a consumer definition of recovery by identifying three intrapersonal criteria for recovery from the literature – hope, taking responsibility and ‘getting on with life’ – consisting of four components: identity through life roles, relationships, work or structured activity and recreation. They offered examples of eight existing assessment tools to cover various components of these three aspects, embracing spirituality, illness management, healthy lifestyle, identity, relationships, work and recreation. Importantly, Noordsy and colleagues (2002) suggested that these quantitative measures would need to be augmented by the subjective experience of recovery, and stressed that objective measures should be coupled with measures of the value and meaningfulness of the item to the consumer.
A number of other measures of specific aspects of recovery have been used, including hope, resilience, self-efficacy, empowerment and wellbeing (Ralph, Kidder and Phillips, 2000). Resnick et al. (Resnick et al., 2005) conducted a study aimed at identifying aspects of existing outcome measures which could be used to measure a ‘recovery orientation’. Using data from the Schizophrenia Patient Outcomes Research Team (PORT) Client Survey (Lehman et al., 1998), they factor analysed items which assessed subjective aspects of recovery, and identified four aspects of a recovery orientation: Knowledge, Empowerment, Hope and Optimism, and Life Satisfaction. They suggested that, although recovery is described as a process, an empirical conceptualization could be used to assess recovery as an outcome (Resnick et al., 2005). Resnick and colleagues note that a limitation of their operationalization was its dependence on items from an existing outcomes database, rather than being based in theory. The items, although subjective, focus largely on opinion about services received. For example, the first item in the Empowerment– Self Agency factor is: How much do your opinions and ideas count in which services you get? This does not reflect the sense of personal responsibility for one’s life and wellbeing found in the consumer literature.
The first measure of recovery as a psychological construct with published psychometric properties was the Recovery Assessment Scale (RAS; Corrigan et al., 1999b). Items of the RAS were based on qualitative work with consumers, and later factor analysed to reveal five factors: Personal confidence and hope; Willingness to ask for help; Goal and success orientation; Reliance on others and No domination by symptoms (Corrigan et al., 2004). The Mental Health Recovery Measure (MHRM; Young, Ensing and Bullock, 1999), was based on Young and Ensing’s conceptual model of recovery (Young and Ensing, 1999). The original version assessed the six aspects of recovery described in the model: Overcoming Stuckness; Self-Empowerment; Learning and Self-Redefinition; Basic Functioning; Overall Well-Being; and New Potentials. Later, the domains of Spirituality and Advocacy/Enrichment were added.
A collection of recovery and recovery-related measures has been compiled by Campbell-Orde et al. (2005). A distinction is made between measures of ‘individual recovery’ and ‘recovery-promoting environments’. Of the eight measures of individual recovery in the volume that have been tested, only the RAS andMHRMcould be considered measures of psychological recovery. The remainder incorporate ‘external’ factors of recovery, such as satisfaction with service or measure a single aspect such as illness management. Some were designed to evaluate a specific service or programme.
