Nicola Hancock

Peer Support Within Clubhouse: A Grounded Theory Study

Peer support facilitates recovery. However, little is known about the role of peer support within the Clubhouse model. This article reports on Clubhouse members’ experiences of peer support and the outcomes they identify from engaging in this phenomenon. Grounded theory guided the study design involving 17 semi-structured interviews conducted with 10 Clubhouse members. Constant comparison and open coding were undertaken to identify underlying concepts within transcripts. A conceptual model of peer support was derived from Clubhouse members’ experience. Four levels of peer support emerged: Social inclusion and belonging; shared achievement through doing; interdependency; and at the deepest level, intimacy. Peer support within Clubhouse is a multi-layered construct in terms of depth and nature of relationships. Clubhouse appears to contribute a unique tier within the layered construct of peer support. This tier is based on the sharing of achievement through working together on shared tasks within the work-ordered day Clubhouse structure.

Participation of mental health consumers in research: training addressed and reliability assessed.

INTRODUCTION A call for active inclusion of consumers in research; recognising and valuing the knowledge that arises through lived experience, is made in the literature. However, genuine inclusion of consumers as members of the research team remains rare. Opponents present two barriers: lack of required knowledge and skills and lack of capacity to conduct rigorous research. METHODS This study involved a collaborative process to develop training materials for consumer researchers. Reliability of self-report outcome data collected by five trained consumers was then examined. RESULTS Quantitative results suggest that trained consumers can facilitate self-report interviews to the high standard expected by the general research community. CONCLUSIONS This study provides both methods and resources to extend occupational therapy consumer-centred practice into the realm of research.

Measuring the later stages of the recovery journey: insights gained from clubhouse members.

The Recovery Assessment Scale (RAS) is a frequently used measure of recovery from mental illness but has previously been shown to poorly differentiate between more recovered consumers. This research aimed to: (1) identify components of later recovery stages; (2) ascertain the extent to which these are measured in the RAS; and (3) suggest modifications to improve the ability of the RAS to differentiate between more recovered consumers. Clubhouse members who scored high on the RAS participated in focus groups in which they discussed areas of recovery most recently or yet to be achieved. Constant comparative analysis of data indicated that later stages of recovery are characterized by: (a) accepting your illness and gaining control over symptoms (b) self love and optimism, (c) doing things for and experiencing pleasure, (d) contributing through meaningful activity, (e) having a diversity of friendships, (f) being needed and valued by others and (g) coming to terms with family relationships. Results suggest the RAS would be improved by addition of items, particularly in functional and social recovery domains.

Sources of meaning derived from occupational engagement for people recovering from mental illness

Introduction Engagement in meaningful occupations is of central importance in mental health recovery. The purpose of this study was to gain a richer understanding of the relationships between occupations, sources of meaning and recovery for people living with mental illness. Method People living with mental illness (n = 78) attending an Australian Clubhouse completed the recovery assessment scale and socially valued role classification scale. Qualitative and quantitative data were analysed using mixed methods. Findings The most meaningful occupations were those most likely to provide opportunities for social connection and being valued by others. The frequency with which these socially derived sources of meaning were identified far outweighed other sources: positive sense of self; skills/personal development; time use/routine; financial gain and fun/pleasure. Neither the occupations identified as most meaningful nor the source of meaning differed depending on level of recovery. Conclusion Irrespective of stage of recovery, socially derived aspects of meaning are most frequently prioritized by people living with mental illness. In facilitating engagement in personally meaningful occupations, occupational therapists need to understand that, for many, meaningfulness centres around inter-dependence: being with others, belonging, giving or contributing and being valued by others.

Recovery Assessment Scale – Domains and Stages (RAS-DS): Its feasibility and outcome measurement capacity

Objective: A self-report instrument of mental health recovery is needed both to facilitate collaborative, recovery-oriented practice and measure recovery-focused outcomes. The Recovery Assessment Scale – Domains and Stages (RAS-DS) has been developed to simultaneously fulfill these goals. The aim of this study was to test the feasibility and measurement properties of the RAS-DS. Method: Feasibility was examined by 58 consumer-staff pairs volunteering from 3 non-government organisations. Consumers completed the RAS-DS, discussed it with staff, and then both completed Usefulness Questionnaires. The psychometric properties were examined using Rasch analysis with the data from these consumer participants and from additional participants recruited from two Partners in Recovery programs (N=324). Results: Over 70% of consumers reported taking 15 minutes or less to complete the RAS-DS and rated the instrument as easy or very easy to use. Qualitative data from both consumers and staff indicated that, for most, the RAS-DS was an easy to use, meaningful resource that facilitated shared understandings and collaborative goal setting. However, for a very small number of consumers, the instrument was too confronting and hard to use. Rasch analysis demonstrated evidence for excellent internal reliability and validity. Raw scores were highly correlated with Rasch-generated overall scores and thus no transformation is required, easing use for clinicians. Preliminary evidence for sensitivity to change was demonstrated. Conclusions: The results provide evidence of the feasibility and psychometric strengths of the RAS-DS. Although further research is required, the RAS-DS shows promise as a potential addition to the national suite of routine outcome measures.

Parents' perspectives on the appropriateness of a parent-delivered intervention for improving the social play skills of children with ADHD

Introduction This study aimed to evaluate parents’ perspectives of the appropriateness of a parent-delivered play-based intervention, The Ultimate Guide to Making Friends. The intervention was designed to improve the social play skills of children with ADHD. Method One month post-intervention, seven parents of children with ADHD participated in individual semi-structured interviews. Interviews ranged from 40–60 minutes. Parents were asked about their perceptions of the intervention: experience, benefits, logistics that supported or hindered participation and satisfaction with the intervention for themselves and their children. Data were analysed thematically using constant comparative methods, whereby two researchers worked independently to analyse emergent themes. Findings Thematic analysis revealed a single core theme of reframing: a process whereby both parents and their children were assisted to develop new perspectives regarding their social skills and interactions. The core theme comprised three sub-themes: (1) connecting with the intervention; (2) parent and child benefits resulting from a new perspective; and (3) continued everyday use of the intervention materials and strategies. Conclusion The intervention was appropriate from parents’ perspectives. The core theme of reframing and sub-themes collectively related back to the following aspects of appropriateness: (a) a positive experience; (b) relevant and important to their/their child’s needs; (c) beneficial; (d) a socially and ecologically valid approach, fitting their everyday lives; and (e) promoting change that continued over time.

Promoting mental health and wellbeing for a young person with a mental illness: Parent occupations

BACKGROUND/AIMS Parenting is a critical and complex occupational role, requiring different occupations and abilities depending on the developmental stage and specific characteristics of each child. When a young adult child develops a mental illness, assisting and supporting them to overcome or adapt to the mental illness becomes a crucial aspect of this occupational role to which many parents devote a great deal of time and energy. The way parents respond to mental illness can have an important impact on young people. However, to date, research on these parents has focussed almost exclusively on their characteristics and personal coping rather than what they do to try to assist and support young people. The aims of this study were to identify the occupations parents currently engage in to promote mental health and wellbeing for a young person with a mental illness and to explore the perceived helpfulness of these occupations. METHOD Interviews with 26 young people (15-24 years old) and 32 parents were analysed using constant comparative analysis. RESULTS Participants reported 78 conceptually distinct mental illness related occupations aimed at promoting: appropriate treatment; positive activities and actions; positive thoughts and feelings; and an ordinary life. Importantly, few participants could evaluate with confidence the helpfulness of individual mental illness related occupations. CONCLUSION This research demonstrates the breadth of the mental illness related occupations parents employ and provides a framework for understanding their complexities. It highlights the need to establish an evidence base for various mental illness related occupations so that parents can have more knowledge and thus confidence in these critical occupations.

Routine Outcome Measurement in Mental Health: Feasibility for Examining Effectiveness of an NGO

Objective: The aim of this study was to examine the feasibility of using routine public mental health outcome data to measure the effectiveness of a non government organization (NGO), specifically Pioneer Clubhouse. Method: We retrieved data from the NSW Mental Health Outcomes and Assessment Tools (MH-OAT) database, for 31 participants who joined Pioneer Clubhouse, NSW, in 2007. Data were also sought for 31 matched control participants from within the same Area Health Service. Data collected from the adult MH-OAT instruments, Health of the Nation Outcome Scales (HoNOS), Kessler-10 (K-10) and Abbreviated Life Skills Profile-16 (LSP-16), was retrieved for 13 weeks prior to joining date and compared with 13 weeks of data 6 months after joining. Results: Twenty-four Clubhouse members were registered in the MH-OAT database. Only one of the 24 participants had data for both time periods requested. MH-OAT data collection was insufficient to allow their use for measuring effectiveness of a NGO. Conclusion: Despite the National Mental Health Plan emphasis, and extensive and expensive support for routine data collection in public mental health services, such data collection has been unsuccessful. We discuss possible reasons for this.

Is the Partners in Recovery program connecting with the intended population of people living with severe and persistent mental illness? What are their prioritised needs?

Objective The Partners in Recovery (PIR) program is an Australian government initiative designed to make the mental health and social care sectors work in more coordinated ways to meet the needs of those with severe and complex mental illness. Herein we reflect on demographic data collected during evaluation of PIR implementation in two Western Sydney sites. The aims of the present study were to: (1) explore whether two Sydney-based PIR programs had recruited their intended population, namely people living with severe and persistent mental illness; and (2) learn more about this relatively unknown population and their self-identified need priorities. Methods Routinely collected initial client assessment data were analysed descriptively. Results The data suggest that the two programs are engaging the intended population. The highest unmet needs identified included psychological distress, lack of daytime activities and company, poor physical health and inadequate accommodation. Some groups remain hard to connect, including people from Aboriginal and other culturally diverse communities. Conclusions The data confirm that the PIR program, at least in the two regions evaluated, is mostly reaching its intended audience. Some data were being collected inconsistently, limiting the usefulness of the data and the ability to build on PIR findings to develop ongoing support for this population. What is known about the topic? PIR is a unique national program funded to engage with and address the needs of Australians living with severe and persistent mental illness by facilitating service access. What does this paper add? This paper reports on recruitment of people living with severe and persistent mental illness, their need priorities and data collection. These are three central elements to successful roll-out of the much anticipated mental health component of the National Disability Insurance Scheme, as well as ongoing PIR operation. What are the implications for practitioners? Active recruitment, exploration of self-reported need priorities and routine outcome measurement are essential yet challenging work practices when working with people living with severe and persistent mental illness.

Knowing What to Do and Being Able to Do It: Influences on Parent Choice and Use of Practices to Support Young People Living with Mental Illness

A parent’s response to a young person’s mental illness can influence their recovery and wellbeing. Many parents devote considerable time and energy to supporting a young person experiencing mental illness and engage in numerous different practices to do so. Yet little is known about why parents use particular practices. This article explores this question through qualitative analysis of parent perspectives. Interviews with 32 parents of young people living with mental illness were analysed using constant comparative analysis. Findings suggest that parents’ choice of and ability to carry out particular practices are shaped by: their knowledge and beliefs; their personal resources and constraints; and their social and service networks. Further, parents took active measures to optimize these influences. By understanding the complexity of their own potential influence on both knowing what to do and being able to do it, health professionals can better enable parents to support young adults experiencing mental illness.