Marianne Farkas

Implementing recovery oriented evidence based programs: identifying the critical dimensions.

In the decades of the 1990s many mental health programs and the systems that fund these programs have identified themselves as recovery-oriented. A program that is grounded in a vision of recovery is based on the notion that a majority of people can grow beyond the catastrophe of a severe mental illness and lead a meaningful life in their own community. First person accounts of recovery and empirical research have led to a developing consensus about the service delivery values underlying recovery. The emphasis on recovery-oriented programming has been concurrent with a focus in the field on evidence-based practices. We propose that evidence based practices be implemented in a manner that is recovery compatible. Program dimensions for evidence based practice, such as program mission, policies, procedures, record keeping and staffing should be consistent with recovery values in order for a program to be considered to be recovery-oriented. This article describes the critical dimensions of such value based practice, regardless of the service the recovery oriented mental health programs provide (e.g., treatment, case management, rehabilitation). The aim of this first attempt at conceptualizing recovery-oriented mental health programs is to both provide direction to those involved in program implementation of evidence based mental health practices, as well as providing a stimulus for further discussion in the field.

Uses and abuses of recovery: implementing recovery‐oriented practices in mental health systems

An understanding of recovery as a personal and subjective experience has emerged within mental health systems. This meaning of recovery now underpins mental health policy in many countries. Developing a focus on this type of recovery will involve transformation within mental health systems. Human systems do not easily transform. In this paper, we identify seven mis‐uses (“abuses”) of the concept of recovery: recovery is the latest model; recovery does not apply to “my” patients; services can make people recover through effective treatment; compulsory detention and treatment aid recovery; a recovery orientation means closing services; recovery is about making people independent and normal; and contributing to society happens only after the person is recovered. We then identify ten empirically‐validated interventions which support recovery, by targeting key recovery processes of connectedness, hope, identity, meaning and empowerment (the CHIME framework). The ten interventions are peer support workers, advance directives, wellness recovery action planning, illness management and recovery, REFOCUS, strengths model, recovery colleges or recovery education programs, individual placement and support, supported housing, and mental health trialogues. Finally, three scientific challenges are identified: broadening cultural understandings of recovery, implementing organizational transformation, and promoting citizenship.

Research on Evidence-Based Practices: Future Directions in an Era of Recovery

Many mental health systems are trying to promote the adoption of what has come to be known as evidence-based practices while incorporating a recovery vision into the services they provide. Unfortunately, much of the existing, published, research on evidence-based practices was conceived without an understanding of the recovery vision and/or implemented prior to the emergence of the recovery vision. As result, evidence-based practice research that has been published to date is deficient in speaking to a system being built on a recovery philosophy and mission; these deficiencies are detailed, and suggestions are advanced for new directions in evidence-based practice research.

Psychiatric rehabilitation interventions: A review

Psychiatric rehabilitation has become accepted by the mental health field as a legitimate field of study and practice. Over the last several decades various psychiatric rehabilitation programme models and procedures have been developed, evaluated and disseminated. At the same time the process of psychiatric rehabilitation has been specified and its underlying values and practitioner technology articulated. This review describes the psychiatric rehabilitation process and in so doing differentiates psychosocial interventions that can be classified as psychiatric rehabilitation interventions from other psychosocial interventions. Furthermore, the major psychiatric rehabilitation interventions are examined within a framework of the psychiatric rehabilitation process with a review of their evidence. The review concludes that psychiatric rehabilitation interventions are currently a mixture of evidence-based practices, promising practices and emerging methods that can be effectively tied together using the psychiatric rehabilitation process framework of helping individuals with serious mental illnesses choose, get and keep valued roles, and together with complementary treatment orientated psychosocial interventions, provide a broad strategy for facilitating recovery.

Impact of a case manager program on psychiatric aftercare.

Shifting the locus of aftercare planning from hospital to community can enhance continuity of care. The authors compared chronically mentally ill patients assessed and managed by community-based practitioners trained in psychiatric rehabilitation with patients whose discharge planning was arranged by inpatient staff members. They found significant differences between the two groups in aftercare needs identified, aftercare referrals made, and use of aftercare services. The authors conclude that this approach to psychiatric aftercare is superior to more traditional models if practitioners are carefully trained.

A psychiatric rehabilitation treatment program: Can i recognize one if i see one?

Over the last several decades there has been a tremendous growth in the number of community-based settings that indicate that they provide rehabilitation programming to persons with severe psychiatric disabilities. Questions can be raised, however, as to the extent to which these settings are actually providing programs that are rehabilitative in nature. Ten essential ingredients of rehabilitation programming are presented for use in discriminating between programs that are rehabilitation oriented and programs which are rehabilitation in name only. The articulation of these ten essential ingredients can serve as a guide for the continued development of community-based settings which attempt to provide comprehensive rehabilitation programming.

Psychiatric rehabilitation programs: putting concepts into practice?

Mental health settings serving the severely psychiatrically disabled or the long-term chronic client have begun developing a rehabilitation orientation in an attempt to increase their effectiveness with this group. The authors have, in an earlier work, described basic elements of a rehabilitation program. These elements have been refined. Forty rehabilitation-oriented community and hospital agencies were assessed in terms of the presence or absence of these elements of a rehabilitation approach. Results indicate that the programs in the agencies clearly value client involvement and a program focus on improving skill and resource utilization. These concepts, however, are only beginning to be systematically implemented in practice.

Professional pre-service training for working with the long-term mentally ill.

The knowledge base with respect to helping persons with long-term mental illness is expanding dramatically. Specific skills can be identified as critical for those who work with the long-term mentally ill. In contrast to in-service training, preservice (university-based) programs have been slow in offering relevant skills-based curricula. A model is proposed for describing current and future pre-service curricula. Curricula can be categorized as to whether it provides exposure, experience, or expertise in working with the long-term mentally ill. More than ever before the pre-service training programs seem ripe for the introduction of skill-based curricula relevant to helping persons who are psychiatrically disabled.

The Choose-Get-Keep Model of Psychiatric Rehabilitation: A Synopsis of Recent Studies

Objective: Comprehensive review of studies using the choose– get– keep (CGK) process model of psychiatric rehabilitation. Also, other studies are identified that have demonstrated methodologies useful in future research on the CGK model. Intervention Model: The CGK process is conceptualized as the phases through which people with psychiatric disabilities proceed as they engage in psychiatric rehabilitation. Conclusion: The CGK model is a potentially useful psychiatric rehabilitation intervention that can be implemented in a variety of service settings and that focuses on the activities of the practitioner and the service recipient. The CGK model warrants further empirical study to examine its effectiveness.

Bridging science to service: using Rehabilitation Research and Training Center program to ensure that research-based knowledge makes a difference.

The challenge of bridging science to service is increasingly visible in the healthcare field, with emphasis on the influence of evidence-based knowledge on both policy and practice. Since its inception more than 40 years ago, the Rehabilitation Research and Training Center (RRTC) program has provided grants for both research and training activities designed to ensure that research knowledge is translated into practice. The RRTC program is unique in that its mission and funding have always required that both time and money be invested in the translation and dissemination of research-generated knowledge to users in the field, i.e., decision makers and practitioners. Boston Universitys Center for Psychiatric Rehabilitation has been an RRTC for more than 25 years and provides an example of the effect of the RRTC program in bridging science to service. The Centers mission as an RRTC has been to develop and transfer research knowledge to decision makers and practitioners who can then inform change and promote progress in mental health disability policy and practice. This article reviews five basic dissemination and utilization principles for overcoming the most common barriers to effective dissemination of evidence-based knowledge and provides examples of the Centers activities related to each principle. In addition, a knowledge-transfer framework developed by the Center to organize dissemination and utilization efforts is described.