Nine-Month Longitudinal Impact of Peer Support Workers' Recovery Attributes on Service Users' Recovery in Hong Kong.

OBJECTIVE: In this study, the authors investigated the longitudinal effect of the recovery attributes of peer support workers (PSWs) on users of mental health services in Hong Kong over a 9-month period. METHODS: Recovery attributes were measured among PSWs (N=26) employed by four local nongovernmental organizations before their commencement of service. The recovery-related outcomes of regular service users (N=181) were measured every 3 months for 9 months. Multilevel mixed-effects linear regression analyses with restricted maximum likelihood were used to analyze the possible association of PSWs' qualities on service users' recovery outcomes. The Holm-Bonferroni method was used to adjust for p values to account for multiple comparisons. RESULTS: Results showed that levels of hope and self-esteem among PSWs were statistically significantly associated with improvements in hope and empowerment among service users over time. CONCLUSIONS: PSWs' recovery attributes may benefit service users' personal recovery. Future exploration on the specific pathways of recovery attributes of PSWs on service users' recovery is suggested.

A pilot study on the effectiveness of low-intensity cognitive behavioural therapy (LiCBT) for common mental disorders in Hong Kong.

BACKGROUND: To cope with the rising demand for psychological treatment, evidence-based low-intensity cognitive behavioural therapy (LiCBT) delivered by trained para-professionals was introduced internationally. AIMS: This pilot study aimed at examining the effectiveness of LiCBT in Hong Kong. METHOD: This study was of an uncontrolled pre- and post-treatment design, testing LiCBT at a local community mental health centre in Hong Kong. Two hundred and eighty-five Chinese adult help-seekers to the centre attended two or more sessions of LiCBT delivered by trained para-professionals. These participants also rated their depression and anxiety on the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Scale-7 (GAD-7), respectively, at pre- and post-treatment. RESULTS: Comparison of the pre- and post-treatment PHQ-9 and GAD-7 scores of 285 participants indicated significant improvements in depression and anxiety with large effect sizes (depression: d = 0.87; anxiety: d = 0.95). For those participants reaching the clinical level of either depression and/or anxiety at pre-treatment (n = 229, 80.4%), they reported even larger effect sizes (depression: d = 1.00; anxiety: d = 1.15). The recovery rate was 55.9% with a reliable improvement rate of 63.9%. An average of 5.6 sessions was offered to the participants with each session spanning a mean of 42 minutes. The baseline clinical conditions and participants' educational level were predictive of post-treatment recovery. CONCLUSIONS: The results supported the effectiveness and cost-efficiency of LiCBT for depression and anxiety at a Hong Kong community mental health centre. The effect sizes and the recovery and reliable improvement rates achieved were comparable to those reported from countries such as the UK and Australia.

Brief Psychoeducation Program to Enhance Recovery Knowledge and Attitudes of Mental Health Service Providers and Users: Randomized Controlled Trials.

Recovery-oriented transformation of mental health service systems not only necessitates changes in mental health policies and practices, it also requires an adoption of recovery-oriented mindset, which includes knowledge and attitudes, among service providers. It is also important that service users are informed about the changes and can fully participate in the process. The present study developed and evaluated the efficacy of a recovery psychoeducation program in enhancing recovery-oriented knowledge and attitudes among mental health service providers and users in Hong Kong. In study 1, 111 service providers were randomly assigned to 2-day psychoeducation group or control group. Results showed that participants in psychoeducation group had significantly better recovery knowledge and more positive attitudes towards recovery after the intervention than the control counterparts. The effect of the recovery psychoeducation program on recovery attitudes was fully mediated by the improvement in recovery knowledge. In study 2, 93 people with mental illness were randomized into 2-week psychoeducation group or control group. Participants in the psychoeducation group had a significant improvement in the level of recovery-oriented knowledge immediately after the workshops, but the effect could not be sustained at follow-up. To transform into a recovery-oriented service system, having an effective program to orient service providers and users to recovery is essential. This study provided initial support to the use of a brief psychoeducational program for recovery-oriented knowledge enhancement. Given the short-term efficacy and feasibility of the interventions, service leaders and managers in different clinical and social service settings should consider implementing the programs as part of staff and users' service orientation to build a recovery-supporting workforce and empower their service users early in the recovery process.

Development and validation of Attitudes towards Recovery Questionnaire across Chinese people in recovery, their family carers, and service providers in Hong Kong.

Considering the lack of existing measures on attitudes toward personal recovery and the need to acknowledge the cultural milieu in recovery attitude assessment, the present study developed and validated the Attitudes towards Recovery Questionnaire (ARQ) in a sample of people in recovery of mental illness, family carers, and mental health service providers in Hong Kong. The ARQ was developed based on existing literature and measures of recovery, and focus group discussions with various stakeholders. Findings of the multi-sample confirmatory factor analyses supported a five-factor structure: (1) resilience as a person in recovery, (2) self-appreciation and development, (3) self-direction, (4) family involvement, and (5) social ties and integration. The ARQ was positively correlated with recovery outcomes, empowerment, recovery knowledge, and recovery orientation of mental health services. As a tool for examining recovery attitudes, the ARQ informs us of the mindset across stakeholders and areas that need enhancement to facilitate the recovery process.

Validating a Culturally-sensitive Social Competence Training Programme for Adolescents with ASD in a Chinese Context: An Initial Investigation.

Previous studies on social skills training on ASD were done almost exclusively in the West with children as the main subjects. Demonstrations of the applicability of social interventions in different cultures and age groups are warranted. The current study outlined the development and preliminary evaluation of a CBT-context-based social competence training for ASD (CBT-CSCA) developed in Hong Kong for Chinese adolescents with ASD. Twenty-five adolescents (aged 12-17 years, with a FSIQ above 80) were recruited. Significant improvements in social competence, autistic symptoms and general psychopathology at post-training and 3-month follow-up were reported by the parents. The study provided initial evidence support to the applicability of social competence training for adolescents with ASD in a different culture.

A one-year longitudinal qualitative study of peer support services in a non-Western context: The perspectives of peer support workers, service users, and co-workers.

This study explored the changing views of key stakeholders (peer support workers, their co-workers, and service users) about peer support services in a non-Western community, using a longitudinal qualitative approach. Five trainee peer support workers (PSWs), 15 service users, and 14 co-workers were interviewed over a 12-month period, under the auspices of the Peer Support Workers Project (also known as the Mindset project) in Hong Kong. A total of 77 interviews were transcribed and thematic analyses were conducted across the participant groups at three different time points (training, work placements, and employment). During the initial implementation of the services, uncertainty about the role of the PSWs were reported. However, trusting and beneficial relationships with service users were gradually built, showing growing resilience and confidence over time. The participants realized that PSWs' experiences of mental illnesses were a unique asset that could help service users to alleviate their own somatic symptoms and improve their connections with others. Our findings highlight that the perceptions of peer support services changed from confusion to viewing PSWs as an asset, to an awareness of the importance of family support, and to the belief that implementing such a program will benefit both service users and PSWs.

Validation of the Recovery Assessment Scale for Chinese in recovery of mental illness in Hong Kong.

OBJECTIVE: Given the absence of well-validated measures to measure personal recovery in the Chinese communities, this study translated the 24-item Recovery Assessment Scale (RAS-24) into Chinese, investigated its psychometric properties, and confirmed its five-factor structure, as proposed by Corrigan et al. (Schizophr Bull 30(4):1035-1041, 2004), among a sample of people in recovery of mental illness in Hong Kong. METHODS: A sample of 596 people in recovery was recruited for scale validation. The RAS-24 was translated into traditional Chinese, and its factor structure was tested by confirmatory factor analysis. Cronbach's alpha coefficients were used to assess the internal consistency of the Chinese version of the RAS-24 (RAS-C). Concurrent and construct validity were examined by investigating the correlation of the RAS-C with Recovery Markers Questionnaire (RMQ), Test's Life Satisfaction Scale, Self-Stigma Scale, and Behavior and Symptom Identification Scale. RESULTS: The RAS-C full scale and subscales yielded good internal consistency (Cronbach's α = .73-.93). The finding supported the five-factor solution proposed by Corrigan et al. (2004), χ2(242) = 783.81, p < .001, CFI = .91, RMSEA = .06, SRMR = .05. The RAS-C has established concurrent validity with RMQ and demonstrated construct validity with life satisfaction, self-stigma, as well as symptoms and functional difficulties. CONCLUSION: The Chinese version of the RAS-24 was found to have promising psychometric properties in assessing the subjective perception of recovery among Hong Kong Chinese. The validation of RAS-C among Chinese enables its usage to gauge personal recovery outcomes among Chinese in recovery. In addition, the validated measure can contribute to the comparison of recovery across English-speaking and Chinese-speaking samples.

A Brief Strengths Scale for individuals with mental health issues.

Using their strengths and virtues enables individuals to build resilience and alleviate mental health issues. However, most existing instruments for measuring strengths are too lengthy to provide effective assessment for clinical screening. A brief instrument with good factorial and ecological validity is needed to measure strengths, especially among individuals with mental health issues. In this study, the authors developed a brief inventory, the Brief Strengths Scale-12 (BSS-12), to assess 3 strengths: Temperance Strength, Intellectual Strength, and Interpersonal Strength. Two studies were conducted. Study 1 was conducted in Hong Kong. Service recipients (n = 149) from a psychiatric rehabilitation organization were recruited to establish the factor structure and construct validity of the BSS-12. In Study 2, 203 university undergraduates from mainland China were recruited to examine the factorial invariance of the BSS-12 in a different culture and population. Each factor demonstrated satisfactory internal consistency, content validity, and discriminant validity. The BSS-12 may be a useful tool for assessing strengths in clinical and nonclinical settings for service planning and the evaluation of intervention effectiveness. (PsycINFO Database Record

Recovery in Hong Kong: service user participation in mental health services.

This article provides an overview of mental health services (MHS) and the application of the recovery concept in Hong Kong, focusing on user participation. It presents stakeholders' views of the recovery movement in a round-table discussion format, demonstrating agreement that user participation merits more public and official attention. Some of the present difficulties with the movement are also reviewed. Social identity theory (SIT) is then analysed as a potentially useful framework for theorizing how service users' identities change as they become service providers. The paper then provides an overview of the current financial and political position of MHS, and identifies signs that the recovery approach is becoming accepted. It also addresses the cultural meanings of the concept, and sets out examples of its implementation in the health and social welfare sectors. Lastly, it summarizes the challenges facing service providers and users and concludes that as the recovery movement is still in its infancy in Hong Kong, more coordinated efforts are needed to establish the organizational support and policy framework, so that sustainable and evidence-based service provision can be achieved.