Development of an Instrument to Measure Recovery

Development of an Instrument to Measure Recovery
Updated June 2002

Principal Investigators: Ruth O. Ralph, Ph.D. (Edmund S. Muskie School of Public Service, University of Southern Maine), Kathryn Kidder, MA

This project aims to develop and test an instrument to measure recovery, based on the Recovery Model developed by the Recovery Advisory Group, which met by teleconference from November 1988 through May 1999, and on published and unpublished consumer/ survivor literature about recovery. This instrument would serve to measure progress toward recovery, and perhaps be of assistance in the recovery process itself.

PROJECT GOALS

To develop and test an instrument to measure recovery using an established ‘Recovery Model’ developed by Dr. Ralph in conjunction with national consumer leaders and researchers.

Recovery Model
as developed by the Recovery Advisory Group

This model defines and describes recovery through a number of stages:

anguish
awareness
insight
action plan
determination to be well
well-being/recovery

The process through these stages is not linear but involves considerable back and forth movement among its various stages. The process is both internal and external. Dimensions of the internal aspects of recovery are cognitive, emotional, spiritual and physical. External dimensions consist of a person’s actions and reactions to outside influences, and interactions with people and situations. Dimensions describing the external aspects of recovery encompass activity, self-care, social relations and social support.

This project aims to:

Develop an instrument to measure recovery as defined in the Recovery Model, and in discussion with consumer groups.

a. validate the model in terms of consumer experiences,
b. refine, modify and/or expand the model based on these experiences,
c. develop a set of items that provide means to measure recovery based on this model;

Develop a pilot instrument to be reviewed and tested by advisory and consumer groups;
Validate the model and instrument with diverse populations;
Examine the model to determine whether or how existing measures might relate to any part of the model;
Publish articles about the development and use of the model, and personal accounts that illustrate its practical functions.

RESEARCH ACTIVITIES AND RESULTS

Methods: Review of the literature indicates that instruments that attempt to measure recovery, to date, have been few in numbers, do not provide information about change over time, or about the use of the instrument as a process. In addition, cultural and geographic issues about recovery need to be included in recovery measurement development.

Instrument development will follow the organization of the concepts articulated in the Recovery Model. Items and scales for the proposed instrument will be generated through meetings with groups of consumers, based upon consumer experiences and review of other consumer-developed measures. Items newly developed or selected from other sources will be collated by the research team, reviewed by consumer groups and prepared as a pilot instrument. Attention will be paid to cultural sensitivity, language appropriateness, literacy and reading level.

The developed pilot instrument will be tested and validated with a population of 100 or more consumers/ survivors to determine the psychometric properties of the instrument. A subset of this population will be asked to complete the instrument two days in succession in order to assess reliability. Validation will take place through the use of other published scales, soliciting comments from users of the instrument, and re-administration of the instrument after six months to test whether the instrument is sensitive to change over time. By this process, items that are not clear to consumers/ survivors, or lack consistency in measuring concepts, will be revised or deleted.

Results: Consumers in various phases of recovery were recruited to collaborate in developing a measurement tool based upon the Recovery Advisory Group Recovery Model. One hundred items were developed for the blocks enumerated in the recovery model chart. The working group, consumers from different backgrounds and experiences, reviewed methods of scale construction and bonded as co-workers on this task to devise ways for other consumers to express feelings they shared. A small field test (n=7) yielded a reliability alpha coefficient of .62. Items have been revised based on this, but the new version has not so far been tested.

SIGNIFICANCE OF FINDINGS/ POLICY IMPLICATIONS

The meaning and measurement of the concept of recovery as applied to mental health outcomes are still not well agreed upon. This project involves the users of mental health services to define a model of recovery and to develop an instrument for its measurement, based on that specific model.

PLANS

We plan to further test the instrument. The Department of Mental Health in South Carolina is interested in using the measure. We are discussing plans with Center investigators in New York who are developing the measure of healing from Sexual Abuse Trauma to apply for federal funding to establish the construct and criterion validity of both measures of recovery.

Publications:

Ralph R,O. & Kidder K. (2000). What is recovery? A compendium of recovery and recovery related instruments. Cambridge, MA. Human Services Research Institute.

Ralph, RO., Risman J, Kidder K, Campbell J, Caras S, Dumont J, Fisher D, Rock Johnson J, Kaufmann C, Knight E, Loder A, Penny D, Townsend W, & Van Tosh L. (1999). Recovery advisory group recovery model, a work in progress. Washington, D. C., Presentation at the National Mental Health Statistics Conference. June, 1999.

Ralph R. O. (2000). Recovery. Psychiatric Rehabilitation Skills (in press)

Ralph, R.O. (2000) Review of recovery literature: A synthesis of a sample of recovery literature. Alexandria, VA: National Technical Assistance Center

References:

Examples of other measures reviewed include:

The Well-Being Scale (Campbell and Schraiber, 1989)

Empowerment Scale (Rogers, Chamberlin, et. al., 1997)

Crisis Hostel Healing Scale (Dumont, 1998)

Mental Health Confidence Scale (Carpinello et. al., 1995, 2000)
Recovery items developed in Canton OH (Ralph, Lambric and Steele, 1996)

Recovery Attitudes Scale (Borkin et. al, in press)

Recovery Scale (Young and Ensing, 1998)

Updated: 6/17/02

Top