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Implementing Recovery-based Care: Tangible Guidance for SMHAs - page 26 / 44





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NASMHPD/NTAC e-Report on Recovery – Fall 2004

Increasing importance is being placed on moving mental health systems toward a recovery orientation. The need to shift the driving focus of service delivery is evident in strong recommendations made by the Surgeon General (US DHHS, 1999) and the President’s New Freedom Commission on Mental Health (2003). Given the call for such profound change, mental health administrators across the country are asking questions such as: What services and supports are important in a recovery-oriented mental health system? What recovery-facilitating practices are currently underdeveloped in our system? Where are the people we serve on their journey of recovery? How well are we facilitating people’s potential for resilience and recovery? The Recovery Enhancing Environment measure (REE) was designed to provide empirical answers to such pressing concerns.

Developing and Testing the REE Measure

REE was created in 1999. The content of the measure was developed based on: 1) an examination of first person accounts of the process of mental health recovery and the services and supports people say enhance their recovery; 2) a review of emerging promising practices that promote recovery drawn from informal literature, workshop descriptions, and progressive programs; and, 3) a literature review of factors that facilitate resilience, or that help people rebound from adversity, in general.

The REE measure was reviewed and pre-tested by Kansans involved in a Consumer-as-Provider training program, and later by persons served by a day treatment program. Items were revised, dropped, and added based on consumer input. The measure underwent technical edits and the format was refined based on the input of colleagues Allan Press and Patricia E. Deegan.

Two formal pilot tests were conducted on the REE. In 2002, the Kansas Department of Social and Rehabilitation Services funded a mail survey of those served in the seven largest community support programs in the state. It was conducted by the Kansas University Office of Mental Health Research and Training in collaboration with participating community mental health centers (Ridgway, Press, Ratzlaff, Davidson, & Rapp, 2003). More recently, Pat Deegan & Associates trained a cadre of mental health consumers to gather REE data in face-to-face interviews with nearly half of those served by a large Massachusetts mental health agency (Ridgway, Press, Anderson, & Deegan, in preparation). More than 500 people completed the REE in the two pilots. Preliminary statistical analyses indicate that the instrument is psychometrically sound.   

Content of the Measure

The REE instrument examines personal recovery by looking at the respondent’s self-perceived stage of recovery and the markers of recovery (intermediate outcomes) they currently experience. Respondents rate the degree to which 24 elements are important to their personal recovery to increase our understanding of the process, using a 5 point scale ranging from “strongly agree” to “strongly disagree.” These elements include hope, being able to manage symptoms, overall health and wellness, having one’s rights respected, being involved in and a part of the larger community, having meaningful activities,

NASMHPD/NTAC e-Report on Recovery – Fall 2004

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