Promoting Positive Self-Identity of Youths With Mental Disorders: Collaboration Between Academia and a Ministry of Education.

Inclusive schools reflect the dominant approach to education, yet many youths with mental disorders still attend special education schools. Although special education schools address educational, social, and developmental needs, they may increase students' self-stigma and hinder positive identity formation. Israel's Ministry of Education and an academic community mental health department partnered to address this challenge by developing a manual-based intervention for special education school settings. About 180 teachers were trained, and approximately 400 students participated in the self-management and positive identity group intervention. This partnership demonstrates the importance and potential of collaborations to address challenges that arise in real-world settings.

Development of the UPSIDES global mental health training programme for peer support workers: Perspectives from stakeholders in low, middle and high-income countries.

BACKGROUND: Peer support in mental health is a low-threshold intervention with increasing evidence for enhancing personal recovery and empowerment of persons living with severe mental health conditions. As peer support spreads globally, there is a growing need for peer support training programmes that work well in different contexts and cultures. This study evaluates the applicability and transferability of implementing a manualised multi-national training programme for mental health peer support workers called UPSIDES from the perspective of different local stakeholders in high-, middle-, and low-income countries. METHOD: Data from seven focus groups across six study sites in Africa (Tanzania, Uganda), Asia (India, Israel), and Europe (Germany 2 sites) with 44 participants (3 service users, 7 peer support workers, 25 mental health staff members, 6 clinical directors and 3 local community stakeholders) were thematically analysed. RESULTS: 397 codes were identified, which were thematically analysed. Five implementation enablers were identified: (i) Enhancing applicability through better guidance and clarity of training programme management, (ii) provision of sufficient time for training, (iii) addressing negative attitudes towards peer support workers by additional training of organisations and staff, (iv) inclusion of core components in the training manual such as communication skills, and (v) addressing cultural differences of society, mental health services and discrimination of mental health conditions. DISCUSSION: Participants in all focus groups discussed the implementation of the training and peer support intervention to a greater extent than the content of the training. This is in line with growing literature of difficulties in the implementation of peer support including difficulties in hiring peer support workers, lack of funding, and lack of role clarity. The results of this qualitative study with stakeholders from different mental health settings worldwide emphasises the need to further investigate the successful implementation of peer support training. All results have been incorporated into the manualisation of the UPSIDES peer support training.

Facilitators and barriers in the implementation of a culturally adapted Arabic version of Illness Management and Recovery (IMR) among Palestinian Arabs in Israel.

The Illness Management and Recovery (IMR) program has been implemented in several countries including Israel. This study examines, from the perspective of Arab practitioners, facilitators and barriers in the implementation of a culturally-adapted version of the IMR intervention among Arabs with serious mental illness in Israel. Fourteen Arab practitioners who had delivered the culturally adapted IMR were interviewed. The analysis of the interviews identified facilitators and barriers, divided into universal factors found when implementing the intervention elsewhere in the world, and culture-specific ones. Facilitators included the manual on which the intervention was based, bypassing verbal communication, ongoing supervision during implementation, the group process, co-facilitation and the cultural adaptations. The barriers included three universal ones: Meeting needs beyond IMR due to service shortage, Reputation is everything: Self- and social stigma and Pulling the others back: Difficulties in reading and writing-and one that was culture-specific: family over-involvement. Identifying facilitators and barriers in the implementation of the adapted IMR can contribute to the implementation of evidence-based practices (EBPs) in the mental health area. Notably, multiple culture-specific facilitators have been identified, as opposed to only one culture-specific barrier, suggesting that cultural differences may be overcome in implementing EBPs developed in the West.

Cultural Adaptation of the Illness Management and Recovery Intervention Among Israeli Arabs.

Awareness of the need for culturally adapted mental health interventions is growing. The authors describe the cultural adaptation of an evidence-based practice (EBP), illness management and recovery (IMR), to the Arab population in Israel. The process included reviewing the literature on cultural adaptations of EBPs and interviewing Arab and IMR professionals, which helped inform modifications that reflected the norms of Arab society in Israel related to family, religion, and beliefs about mental health. The process yielded a culturally adapted IMR intervention, which was translated into Arabic and used to train Arab practitioners on implementation with Arab clients in Israel.

Implementation of NAVIGATE for first episode psychosis in Israel: Clients' characteristics, program utilization and ratings of change.

OBJECTIVE: NAVIGATE is a comprehensive treatment program for first episode psychosis developed and implemented in the US that has been found to be effective. The purpose of the present study was to describe the first initiative of NAVIGATE's implementation outside the US, and to present data collected in Israel from the first two clinics focusing on NAVIGATE clients' characteristics, components utilization and retrospective clinician ratings of change. METHODS: Administrative data for 61 NAVIGATE clients in Israel and retrospective ratings of NAVIGATE clinicians were analysed. RESULTS: The duration of untreated psychosis was 4.4 months (SD = 6.8). Clients were mostly referred to NAVIGATE from psychiatric hospitals (n = 29, 50.9%) and community mental health agencies (n = 20, 35.1%). The individualized resiliency training (IRT) component had the highest client utilization rate (n = 53, 98.1%) with a monthly average of M = 2.32 sessions (SD = 2.75). Clinicians' retrospective ratings indicated that 66% of the clients (n = 33) had improved in at least one life domain, with the most common improvement in employment (n = 28, 56%), recovery (n = 24, 50%), and symptoms severity (n = 23, 47%). CONCLUSIONS: Our findings reveal that NAVIGATE can be implemented outside the US within a different social and cultural context and different mental health system. The utilization rates of the program components and clinicians' retrospective ratings indicated positive change among most of NAVIGATE clients, pointing to the potential value of NAVIGATE above and beyond different countries and health systems.

Impact of a Culturally Adapted Version of Illness Management and Recovery on Israeli Arabs With Serious Mental Illness.

OBJECTIVE: In recent years, there has been growing awareness of the need for cultural adaptation of evidence-based practices, which is essential for successful implementation in diverse cultural contexts. This study investigated the impact of a culturally adapted version of Illness Management and Recovery (IMR), an evidence-based practice developed in the United States, on Israeli Arabs with serious mental illness. METHODS: Using a quasi-experimental design, we compared the outcomes of 86 people who completed the culturally adapted IMR version with outcomes from a matched control group (N=64) who received treatment as usual. RESULTS: Mixed repeated-measures analyses of variance demonstrated significant improvements in the domains of recovery, hope, self-efficacy, and quality of life among those who completed culturally adapted IMR. CONCLUSIONS: The culturally adapted Arabic version of IMR for Israeli Arabs was found to generate significant positive improvement. The findings are discussed with emphasis on the importance of cultural adaptation.

Implementing recovery-oriented interventions with staff in a psychiatric hospital: A mixed-methods study.

WHAT IS KNOWN ON THE SUBJECT?: Recovery-oriented care is a means of providing mental health treatment, focused on the patient's individual needs and active involvement in one's own care. However, this approach presents with challenges, particularly in psychiatric hospitals, which tend to be focused on symptom reduction. WHAT DOES THE PAPER ADDS TO EXISTING KNOWLEDGE?: This study examines the influence of three different recovery-oriented training programmes/interventions (namely, illness management and recovery, peer support, and psychiatric advance directives) on the attitudes and practice of mental health staff (including nurses) in an inpatient setting, using a mixed-methods methodology. We quantitatively assess the knowledge, attitudes and practices developed following recovery-oriented training, compared to staff not trained in these interventions. We interviewed staff exposed to the different interventions to learn about their personal views and characterized the benefits and challenges they experienced. Mainly, the illness management and recovery training created a positive change in the work attitude and some work-related practices of mental health staff and the increased presence of a person-centred approach supporting patient autonomy. However, and contrary to expectations, there was no increase in practices that support personal goals or provide individually tailored services. Peer support had an experiential impact among mental health staff, initiating a more humane, positive approach to patients. Psychiatric advance directives were reported as more challenging to implement and with limited impact. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Recovery-oriented trainings can be internalized and implemented by staff in medical model psychiatric settings. Despite recovery-oriented training, challenges do occur-notably, they are hardest to implement in acute wards/patient states and by psychiatric nurses. Using multiple recovery-oriented programmes/interventions can accelerate the momentum for change in traditional settings and promote positive practice. Ongoing comprehensive mental health staff training on recovery-oriented care programmes is essential in order to sustain change over time. Training is not enough in itself-hospital administrations need to be actively involved in promoting recovery-oriented policies. ABSTRACT: Introduction Developing person-centred recovery-oriented care is a challenge in mental health systems, particularly psychiatric hospitals. Aim To assess the knowledge, attitudes and practices developed following recovery-oriented training of nurses and other staff; to identify the benefits and challenges involved in the implementation of recovery-oriented intervention in psychiatric wards. Method A mixed-methods study compared recovery knowledge, attitudes and practices of 37 mental health ward staff trained in recovery-oriented intervention, against 35 staff not trained. Fifteen staff were interviewed about their experiences, and protocols were qualitatively analysed. Results The quantitative outcomes partially confirmed positive changes in attitudes and some practices. Qualitative interviews complemented these findings, revealing greater use of a person-centred approach and support for patient autonomy. However, we did not find differences between groups in quantitative outcomes pertaining to personal goals or providing individually tailored services. Discussion This study validates the implementation of recovery training and practices in psychiatric settings, and identifies the challenges involved. We discuss psychiatric nurse conflicts in implementation in acute wards. Implications for practice Our findings support the need for broader staff training in recovery-oriented interventions. Recruiting the support of the hospital administration for recovery-oriented intervention programmes is key, both ethically and structurally.

Routine patient reported outcomes as predictors of psychiatric rehospitalization.

OBJECTIVE: Patient reported outcome measures (PROMs) are increasingly used to measure psychiatric service consumers' progress and to provide feedback to consumers and providers. We tested whether PROMs can predict and be used to identify groups at high risk for future hospitalization. METHODS: A total of 2842 Israeli users of psychiatric rehabilitation services reported on their quality of life (QoL) and the effect of symptoms on their daily functioning. Survey data were linked with information on psychiatric hospitalization 6 and 12months after survey completion. Variables associated with each of the outcomes were tested for significance and entered into a multivariate logistic regression model. Prediction scores were developed to identify the highest-risk groups according to each model. RESULTS: QoL was found to be a significant predictor of future hospitalization within 6months (odds ratio [OR]=0.71, 95% CI: 0.59-0.86), and self-report of the impact of symptoms on functioning significantly predicted 12-month hospitalization (OR=0.83, 95% CI: 0.74-0.93), controlling for known risk factors. Positive predictive values for the 6- and 12-month risk scores were 31.1 and 40.4, respectively, for the 10% highest risk categories. CONCLUSIONS: Reports of psychiatric service consumers on their QoL and on the effect of symptoms on their functioning significantly predict of future hospitalization risk, beyond other well-known risk factors. PROMs can identify consumers at high risk for future hospitalization and thus direct interventions for those at highest risk.

Relationship Between Psychiatric-Service Consumers' and Providers' Goal Concordance and Consumers' Personal Goal Attainment.

OBJECTIVE: This study tested concordance between consumers' and providers' reports of personal goal setting and its relationship to self-reported goal attainment. METHODS: Data are from the Israeli Psychiatric Rehabilitation Patient Reported Outcome Measurement project. Consumers (N=2,885) and the providers who were most knowledgeable about their care indicated two domains from a list of ten in which consumers had set goals during the previous year. Consumers reported on goal attainment in each domain. RESULTS: A total of 2,345 consumers (82%) reported a personal goal. Overall, consumer-provider concordance reached 54%. Concordance was greatest in the employment (76%), housing (71%), and intimate relationship (52%) domains and lowest in family relationships (23%) and finances (15%). For most domains, concordance was less than 50%. On average, 75% of consumers reported having achieved their goals. Consumer-provider concordance was associated with goal attainment (p<.001). CONCLUSIONS: These findings emphasize the importance of agreed-upon goals and call for conceptualizing goal setting as an interpersonal process central to recovery.

[Therapeutic relationships that promote recovery in the mental health field. An innovate approach]. / Relaciones terapéuticas promotoras de la recuperación en el campo de la salud mental. Un enfoque innovador.

In recent decades there have been changes in the mental health feld that have also influenced the therapist-client relationship, which is seen as an essential element in the processes of recovery. Our purpose is to present a model of work reflected in therapeutic relationships in the feld of rehabilitation (RTR) that is guided by the principles of recovery. Therapeutic relationships are considered as a means through which it is possible to increase commitment and adherence of people to therapy and also participation in treatment and rehabilitation programs. There is a signifcant correlation between the strength of the therapeutic relationship and improvements in the overall functioning of the person and improvements in community life skills as well as the reduction in the severity level of the symptoms. Different characteristics constitute the RTR and contribute signifcantly to the processes of recovery and inclusion of people with mental illness: the integration between working on the practical aspects of the life of the person (the dimension of "doing") and working on the internal aspects (the dimension of the "being"), the "unconventional limits", the therapist's openness to his life, collaborative work, a "natural" communication, and hope. Professionals as well as service agencies and policy makers need to deepen their understanding of the nature and uniqueness of RTRs and develop the possibility of working through them to promote processes of change, recovery and social inclusion.

[The recovery model: One paradigm, two conceptions]. / El modelo de recuperación: un paradigma, dos concepciones.

In recent decades, new models of recovery have been developed in the feld of mental health, based on the transfer of hospital treatment to the community. Community mental health became the standard of care and treatment, and people with mental illness were able to freely congregate and support each other. The new recovery model includes broad aspects of the person and recovery became the "guiding vision" of mental health services. New defnitions of recovery were developed that focus on the difference between recovering from an illness and being in recovering, or in other words, "clinical recovery" versus "personal recovery." This important development represents a huge challenge for policy makers and planners of modern mental health systems. As is clear from this article, efforts to implement a recovery-oriented perspective that will produce a more consumerbased mental health system have just begun. The urgent need to investigate these efforts, taking into account the complexity and many meanings of "recovery", begins to manifest itself in mental health research agendas. Recovery-oriented treatments focus on preparing and training the person with mental disorders to acquire the knowledge necessary to manage their own disease and recovery process, and thus improve overall functioning, health and quality of life.

Using Routine Outcome Measures to Provide Feedback at the Service Agency Level.

The use of routine outcome measurement (ROM) to assess service effectiveness has been on the rise in mental health settings. However, there is a scarcity of information on the use of ROM data to provide feedback to teams of service providers. In this paper we review the existing literature to identify the principles that can guide the use of ROM data as feedback with the aim to improve quality of service provision in mental health settings. We present a pilot trial of 12 agencies participating in group feedback sessions. The guiding principles and core processes, the procedure and implementation in a pilot trial, lessons learned and future directions are discussed. Based on this experience we conclude that using ROM to implement group feedback among mental health stakeholders is feasible and can generate discussions and directions for improvement.

Investigating the anatomy of the helping relationship in the context of psychiatric rehabilitation: the relation between working alliance, providers' recovery competencies and personal recovery.

Professional helping relationships established with mental health consumers are vital in mental health recovery processes. However, little is known about how the constructs of alliance building and providers' recovery promoting strategies relate to each other and play a role in supporting recovery. To this end, we examined associations between consumer-reported working alliance, perceived providers' recovery competencies, and personal recovery. In a cross-sectional study design, 72 mental health consumers who established relationships with providers through a psycho-educational intervention over a period of 10 months in hourly weekly sessions were examined as part of a larger study conducted in mental health community settings in Israel. Participants filled in the Working Alliance Inventory (Tracey and Kokotovic, 1989), the Recovery Promoting Relationships Scale (Russinova et al., 2013), and Recovery Assessment Scale (Corrigan et al., 2004). Pearson correlations and linear regression analysis showed positive correlations between relational variables and recovery. A mediating model was identified whereby providers' recovery strategies positively impact the working alliance, which, in turn, positively impact consumers' recovery. Implications of the current study for future research and clinical practice are discussed, emphasizing the importance of examining recovery strategies and the working alliance with regard to the process of mental health recovery.

Adaptation and psychometric assessment of the Hebrew version of the Recovery Promoting Relationships Scale (RPRS).

Recovery is supported by relationships that are characterized by human centeredness, empowerment and a hopeful approach. The Recovery Promoting Relationships Scale (RPRS; Russinova, Rogers, & Ellison, 2006) assesses consumer-provider relationships from the consumer perspective. Here we present the adaptation and psychometric assessment of a Hebrew version of the RPRS. The RPRS was translated to Hebrew (RPRS-Heb) using multiple strategies to assure conceptual soundness. Then 216 mental health consumers were administered the RPRS-Heb as part of a larger project initiative implementing illness management and recovery intervention (IMR) in community settings. Psychometric testing included assessment of the factor structure, reliability, and validity using the Hope Scale, the Working Alliance Inventory, and the Recovery Assessment Scale. The RPRS-Heb factor structure replicated the two factor structures found in the original scale with minor exceptions. Reliability estimates were good: Cronbach's alpha for the total scale was 0.94. An estimate of 0.93 for the Recovery-Promoting Strategies factor, and 0.86 for the Core Relationship. Concurrent validity was confirmed using the Working Alliance Scale (rp = .51, p < .001) and the Hope Scale (rp = .43, p < .001). Criterion validity was examined using the Recovery Assessment Scale (rp = .355, p < .05). The study yielded a 23-item RPRS-Heb version with a psychometrically sound factor structure, satisfactory reliability, and concurrent validity tested against the Hope, Alliance, and Recovery Assessment scales. Outcomes are discussed in the context of the original scale properties and a similar Dutch initiative. The RPRS-Heb can serve as a valuable tool for studying recovery promoting relationships with Hebrew speaking population.

Comparative impact of professional mental health background on ratings of consumer outcome and fidelity in an Illness Management and Recovery program.

OBJECTIVE: Illness Management and Recovery (IMR) is a widely used evidence-based standardized psychosocial intervention. Little is known, however, about the impact of practitioner professional background on the consumer outcome. The current study aims to examine the delivery impact of practitioners who were mental health professionals, peer providers, or paraprofessionals on fidelity and consumer outcome in IMR. METHOD: Study participants were 252 persons with serious mental illness receiving psychiatric rehabilitation services in the community who received IMR (n = 210) or treatment as usual (TAU; n = 42). Study participants completed IMR groups that were delivered by either mental health professionals (n = 126), peer providers (n = 43), or paraprofessionals (n = 41). Study participants in the treatment group completed the Illness Management and Recovery scale before starting and after completing the IMR program; participants in the control group completed the same scale twice in similar time intervals. Fidelity ratings were made. RESULTS: Regardless of practitioner background, consumers who received the IMR intervention demonstrated significant improvement compared to the control group. Post hoc analyses showed no statistically significant difference on consumer outcome regardless of whether the practitioner was a professional, paraprofessional, or a peer provider. All three IMR groups had good fidelity scores. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The results demonstrate that IMR can be implemented with good fidelity and generate positive outcomes when delivered by practitioners who receive sufficient training and supervision regardless of their professional background.