System Level Performance Measures of Recovery
Updated: January 27, 2003

Principal Investigators: Steven Onken, Ph.D., Jeanne Dumont, Ph.D. Investigators: Priscilla Ridgeway, MSW, Doug Dornan, MSW, Ruth Ralph, Ph.D.

PROJECT GOALS

To develop an instrument to measure how well a mental health system facilitates recovery in the people it serves.
This project aims to learn from the experience of persons who live with psychiatric disabilities how systems help and hinder in recovery. Information gained will be used to develop performance measures that will be comparable across state and local systems.

RESEARCH ACTIVITIES AND RESULTS

Methods: In Phase One, ten focus groups were conducted across nine states involving 115 consumers/survivors discussing what helped and hindered them in the recovery process. The transcripts of each focus group were coded for unique concepts and critical themes. Coders first analyzed the data from individual transcripts of the focus groups, and the analyzed across all focus group transcripts. Transcript reports were developed that were used by the states to check back with their focus group participants to confirm initial findings (member check) and gather data on participant priorities.

What Helps:

Basic resources such as a livable income, affordable and safe housing and reliable transportation;
Positive attitudes, self-care and self advocacy where persons believe that recovery is possible for everyone;
A sense of meaning and purpose, for many hope or spiritual faith;
Choice in whether and what treatment to use and life options in general;
Relationships such as family and friends that sustain regular activities including fun;
Meaningful activities involving employment, education and/or volunteer and advocacy work;
Peer support in the form of groups, programs and role models;
Access to formal mental health services oriented toward the whole person where respectful staff partner with each person in achieving agreed upon goals.

What Hinders:

The lack of helping factors and the resulting conditions e.g., poverty, apathy, isolation and hopelessness;
Stigma (internalized and external);
Discrimination;
Situations and structures which deny persons’ choices and control over their life;
Tenaciousness of the disorder itself;
Abuse and trauma.

Results: A common codebook based on the unique concepts from each transcript was developed, as well as a revised codebook organizing the unique concepts according to critical themes. A report on Phase One findings was produced and available at the NTAC Web site at http://www.nasmhpd.org/ntac/reports/index.html. Member check priority data has been incorporated into the revised codebook and summarized by item as well as category.

SIGNIFICANCE OF FINDINGS/ POLICY IMPLICATIONS

People with serious and disabling mental illness make strides in managing and overcoming their disabilities, yet formal helping services may or may not help them in the process. Performance indicators that establish accountability to consumer can help shape services and service systems so that policies of recovery become practice realities.

PHASE ONE POLICY AND PRACTICE IMPLICATIONS

Bolster or at least not undermine self agency and self-determination;
Promote well-being and the provision of resources and supports to meet basic needs;
Support choice and personal decision-making and seek to avoid coercion;
Individualize services when possible and accommodate ethnic and cultural diversity;
Counter stigma and misinformation about the potential for recovery;
Support collaboration and partnership among and with professionals, administrators and consumers.

INCLUSION OF GENDER AND MINORITY SUBJECTS

	Amer Indian Alaska Native	Asian, Pacific Islander	Black, not Hispanic	Hispanic	White, not Hispanic	Unknown Origin	TOTAL
Female							67(59%)
Male							44(39%)
Missing	8 (7%)	2 (2%)	14 (12%)	5 (4%)	79 (70%)		4
Total	8	2	14	5	79	4	115

PLANS

Phase Two activities are underway: we are using the results from Phase One to create indicators of mental health systems that facilitate or hinder recovery. A measure containing these indicators will be proto-tested in conjunction with HSRI and state participants. In Phase Three the resulting measures will be pilot tested across multiple sites.

REPORT

Onken, S. J., Dumont, J. M., Ridgway, P., Dornan, D. H., & Ralph, R. O. (2002). Phase One Research Report: A National Study of Consumer Perspectives on What Helps and Hinders Mental Health Recovery. National Association of State Mental Health Program Directors (NASMHPD) National Technical Assistance Center (NTAC), Alexandria, VA.

To obtain up to 10 free copies of the Phase One Report, contact:

AIeshia Haynie
National Technical Assistance Center for State Mental Health Planning
66 Canal Center Plaza, Suite 302, Alexandria, VA 22314
Phone: (703) 739-9333; Fax: (703) 548-9517
General inquiries: ntac@nasmhpd.org

Bulk copies of 11 or more are available at $10/copy. The report is also available at the following Website <http://www.nasmhpd.org/ntac/reports/index.html> in PDF format under the October 2002 listing. (Appendices available only in print versions).

PRESENTATIONS

Onken, S. J. Mental Health Recovery: What Helps and What Hinders? A National Research Project for the Development of Recovery Facilitating System Performance Indicators. Fifth Annual International Inter-Centre Network for Evaluation of Social Work Practice Workshop, Columbia University, New York, NY, October 3-4, 2002.

Dumont, J. M. & Ridgway, P. Mental Health Recovery: What Helps and What Hinders? Breakout Session, 44^th Annual Southern Regional Conference on Mental Health Statistics, New Orleans, LA, September 22-25, 2002.

Dornan, D. H., & Ridgway, P. Mental Health Recovery: What Helps and What Hinders? Institute, ALTERNATIVES 2002 Conference, Atlanta, Georgia, September 18-22, 2002.

Ridgway. P. What Helps and What Hinders Recovery? The Adult Systems of Care Partnership Conference "Thinking Outside the Box," San Mateo, CA, September 5, 2002.

*Onken, S. J., Dumont, J. M. & Ridgway, P. Mental Health Recovery: What Helps and What Hinders? A National Research Project for the Development of Recovery Facilitating System Performance Indicators. Concurrent Session, 51^st Annual National Conference on Mental Health Statistics, Washington, D.C., May 2002.

Onken, S. J. Mental Health Recovery: What Helps and What Hinders? A National Research Project for the Development of Recovery Facilitating System Performance Indicators. Invited Speaker, National Association of State Mental Health Program Directors, Alexandria, VA, April 2002.

Onken, S. J. Recovery and Consumer involvement. Plenary, Colorado Mental Health Services Conference on Evaluating Mental Health Performance, Denver, CO, April 2002.

Onken, S. J. New Developments in MHSIP: The National Research Project for the Development of Recovery Facilitating System Performance Indicators. Plenary Panel, 50th Annual National Conference on Mental Health Statistics, Washington, D.C., May 2001.

Entered: 6/17/02
Updated: 11/18/02