Psychometric Adequacy of Recovery Enhancing Environment (REE) Measure: CHIME Framework as a Theory Base for a Recovery Measure.

PURPOSE: The aim of this study was to assess to what extent the recovery elements of the Recovery Enhancing Environment (REE) instrument measured the dimensions proposed by the CHIME framework, (Connectedness, Hope and optimism about future, Identity, Meaning in life and Empowerment dimensions), so as to evaluate personal recovery in people with severe mental illness. METHODS: Two processes were conducted. Firstly, five experts matched the elements of recovery evaluated by the REE items with the CHIME domains and subdomains. Then, the resulting structure from those experts agreement was analyzed with different confirmatory factor analyses (CFA) using responses to the recovery elements dimension of the REE of 312 mental health service users. RESULTS: The percentage of agreements and the kappa coefficients were adequate taking into account the CHIME dimensions (κ = 0.57 to 0.69, total κ = 0.74); however, lower agreement was found at the subdimensions level. Some indexes of the CFA were acceptable for a second order factor analysis [χ 2 (242)= 346.03, p < 0.001, CFI= 0.931, RMSEA= 0.037 (0.028 to 0.046)] and the most adequate solution was obtained from the bi-factorial structure (χ 2 (223)=233.19, p=0.306, CFI= 0.993, RMSEA= 0.012 [0.000 to 0.027]). CONCLUSIONS: Despite the subjective and complex nature of the personal recovery construct, the REE measure can be a valid instrument to verify the existing CHIME conceptual framework, since two of the models tested have resulted in adequate indexes and were also congruent with the theoretical framework and the statistical solution. Thus, REE can be used to obtain a global index of Personal Recovery dimension, and the five indicators proposed by the CHIME framework.

Evidence of psychometric adequacy of the Spanish Adaptation of REE: Recovery Enhancing Environment.

INTRODUCTION: In this study we present the process and results of the Spanish adaptation and validation of REE (Recovery Enhancing Environment), an instrument designed to assess the personal process of recovery and the recovery orientation of mental health services. METHODOLOGY: The Spanish REE version has been completed by a representative sample of the Severe Mental Disorder (SMD) program users in the Mental Health Services of Biscay (n=312). RESULTS: The validity evidence of each section (importance of recovery elements, experience of recovery elements, organizational climate and recovery markers) of the REE has shown unidimensionality of the scale, with suitable indexes in the factorial analyses and Cronbach alphas greater than .90 for each dimension. Moreover, significant correlations have been found between REE and its dimensions, and with other instruments that measure severity, functionality and quality of life. CONCLUSIONS: The adequacy of the psychometric properties of the REE make it an interesting instrument to assess the different indicators related to the recovery model, especially if the scarcity of available instruments is taken into account.

Evidencias de adecuación psicométrica de la adaptación española del REE: Cuestionario de Evaluación del Desarrollo de Entornos Favorables para la Recuperación / Evidence of psychometric adequacy of the Spanish Adaptation of REE: Recovery Enhancing Environment

INTRODUCCIÓN: En el presente estudio se presentan el proceso y los resultados de la adaptación al castellano y la validación de REE (Recovery Enhancement Environment), una herramienta diseñada para evaluar tanto el proceso personal como la orientación de los servicios asistenciales hacia la recuperación. METODOLOGÍA: La versión española de REE fue completada por una muestra representativa de usuarios atendidos en el programa Trastorno Mental Grave (TMG) de la Red de Salud Mental de Bizkaia (n = 312). RESULTADOS: Las evidencias de validez de cada una de las secciones (importancia de los componentes de recuperación, experiencia de los componentes de recuperación, clima organizacional y marcadores de recuperación) del REE han mostrado unidimensionalidad con índices adecuados en los análisis factoriales, siendo las puntuaciones de consistencia interna de cada una de las dimensiones superiores a 0,90. Asimismo, se han encontrado correlaciones significativas entre el REE y sus dimensiones, y con otros instrumentos que evalúan gravedad, funcionalidad y calidad de vida. CONCLUSIONES: La adecuación del comportamiento de las evidencias psicométricas del REE lo convierten en un instrumento de interés para la evaluación de diferentes indicadores en relación al modelo de recuperación, más aún dada la escasez de herramientas disponibles

INTRODUCTION: In this study we present the process and results of the Spanish adaptation and validation of REE (Recovery Enhancing Environment), an instrument designed to assess the personal process of recovery and the recovery orientation of mental health services. METHODOLOGY: The Spanish REE version has been completed by a representative sample of the Severe Mental Dis-order (SMD) program users in the Mental Health Services of Biscay (n = 312). RESULTS: The validity evidence of each section (importance of recovery elements, experience of recovery elements, organizational climate and recovery markers) of the REE has shown unidimensionality of the scale, with suitable indexes in the factorial analyses and Cronbach alphas greater than .90 for each dimension. Moreover, significant correlations have been found between REE and its dimensions, and with other instruments that measure severity, functionality and quality of life. CONCLUSIONS: The adequacy of the psychometric proper-ties of the REE make it an interesting instrument to assess the different indicators related to the recovery model, especially if the scarcity of available instruments is taken into account

Considering DSM-5: the personal experience of schizophrenia in relation to the DSM-IV-TR criteria.

Previous analyses have suggested that the personal experience of schizophrenia might be different from its depiction in the DSM-IV-TR. In this study, 17 people with schizophrenia or schizoaffective disorder were interviewed about their experiences of the DSM-IV-TR diagnostic criteria for schizophrenia. Descriptive phenomenological analysis was used to analyze the ways in which the personal experiences of the people in this study were similar to or different from the depiction of schizophrenia in the DSM-IV-TR. The personal experience of schizophrenia was similar in some way to each of the five diagnostic criteria for schizophrenia. Participants' personal experiences also went beyond the DSM-IV-TR criteria. Specifically, participants described strong emotional reactions to their symptoms, including fear, sadness, embarrassment, and alienation. Also, participants described intense interest but severe disruptions in goal-directed behavior due to their hallucinations being engrossing, confusing, and distracting. Further, participants described not sharing their experiences in order to avoid social stigma. These findings suggest that the description of schizophrenia in DSM-5 may benefit from a change to DSM-IV-TR criteria to incorporate more of the personal experience of schizophrenia. Further research is needed to establish the representativeness, reliability, and validity of the qualitative findings described here.

Applying stages of change models to recovery from serious mental illness: contributions and limitations.

Research on recovery has proliferated in recent years. Some investigators have advanced stages of change models that segment the overall process of recovery into discrete and sequential phases, through which a person progresses from being overwhelmed by mental illness to taking on an increasingly active role in understanding, managing and overcoming the impact of psychiatric disability. The authors review this body of literature, and reflect on the contributions and limitations of stages of change approaches to understanding mental health recovery. They conclude that stages of change models need to more accurately reflect the non-linear nature of recovery, the fact that processes are influenced by person-disorder-environment interactions, and the fact that the persons own motivations for change and decisions in this regard while of central importance are by no means exclusive factors in recovery, as they do not take into account sufficiently such issues as discrimination and the presence or absence of crucial resources and supports. A richer set of concepts is needed as we continue to deepen our understanding of the complex, dynamic and ongoing process of mental health recovery.

Self-efficacy and self-care: missing ingredients in health and healthcare among adults with serious mental illnesses.

To help inform the design of a self-management intervention for improving the physical health of adults with serious mental illnesses, we conducted focus groups about their perceived medical care and physical health needs. Adults with serious mental illnesses participated in four semi-structured focus groups conducted at a transitional living facility, a social club, and a Hispanic outpatient mental health clinic. Questions included their recent experiences of seeking medical care, the effect of having a mental illnesses diagnosis, strategies for active self-care, and perceived barriers to better physical health. In addition to various systemic barriers to better medical care, participants articulated limited knowledge and self-efficacy regarding active self-management of their physical health. Despite their interest in learning more about health promotion, most participants expressed a sense of personal futility and powerlessness in improving their health. These data suggest that any effort to improve the wellbeing of these adults will need to address self-efficacy in the hope of improving self-care for their physical health needs.

Using qualitative research to inform mental health policy.

This article offers examples of the ways in which qualitative methods have informed, and may inform, mental health policy in Canada and beyond. Three initial uses of these methods are identified: to generate hypotheses to be tested by other means; to explore the subjective experiences and everyday lives of people with mental illnesses; and to investigate processes of recovery and the active role of the individual in recovery. Given the recent focus in mental health policy in Canada, the United States, and around the world on transforming mental health systems to promote recovery and the emphasis recovery places on the individual's own first-hand perspective, we argue that qualitative methods will become increasingly useful as psychiatry shifts away from symptom reduction to enabling people to live satisfying, hopeful, and meaningful lives in the community.

An analysis of the definitions and elements of recovery: a review of the literature.

As mental health recovery gains traction, many people have put forward varying definitions. Few attempts have been made to create a dimensional analysis of the recovery literature that assesses the growing consensus about what recovery is or what its definition should entail. This paper incorporates an ecological framework to take the individual's life context into account while emphasizing both the reestablishment of one's mental health (i.e., first order change) and the mitigation of the oppressive nature of barriers imposed by the greater community (i.e., second order change) so that people may experience social integration and community inclusion.