Experiences of healthcare staff providing community-based mental healthcare as a multidisciplinary community mental health team in Central and Eastern Europe findings from the RECOVER-E project: an observational intervention study

Catharina Roth, Michel Wensing, Martina Rojnic Kuzman, Sarah Bjedov, Sara Medved, Ana Istvanovic, Danijela Stimac Grbic, Ivana Pavic Simetin, Aleksandar Tomcuk, Jovo Dedovic, Tatijana Djurisic, Raluca Ileana Nica, Tiberiu Rotaru, Antoni Novotni, Stojan Bajraktarov, Milos Milutinovic, Vladimir Nakov, Zahari Zarkov, Roumyana Dinolova, Bethany Hipple Walters, Laura Shields-Zeeman, Ionela Petrea, Catharina Roth, Michel Wensing, Martina Rojnic Kuzman, Sarah Bjedov, Sara Medved, Ana Istvanovic, Danijela Stimac Grbic, Ivana Pavic Simetin, Aleksandar Tomcuk, Jovo Dedovic, Tatijana Djurisic, Raluca Ileana Nica, Tiberiu Rotaru, Antoni Novotni, Stojan Bajraktarov, Milos Milutinovic, Vladimir Nakov, Zahari Zarkov, Roumyana Dinolova, Bethany Hipple Walters, Laura Shields-Zeeman, Ionela Petrea

Abstract

Background: Community Mental Health Teams (CMHTs) deliver healthcare that supports the recovery of people with mental illness. The aim of this paper was to explore to what extent team members of five CMHTs newly implemented in five countries perceived that they had introduced aspects of the recovery-oriented, strength-based approach into care after a training week on recovery-oriented practice. In addition, it evaluated what the team members' perceptions on their care roles and their level of confidence with this role were.

Method: An observational intervention study using a quantitative survey that was administered among 52 health professionals (21 Nurses, 13 Psychiatrists, 9 Psychologists, 8 Social Workers) and 14 peer workers including the Recovery Self-Assessment Tool Provider Version (RSA-P), the Team Member Self-Assessment Tool (TMSA), and demographic questions was conducted. The measures were self-reported. Descriptive statistics were used to calculate the means and standard deviations for continuous variables and frequencies and percentages for categorical variables (TMSA tool and demographic data). The standard technique to calculate scale scores for each subscale of the RSA-P was used. Bivariate linear regression analyses were applied to explore the impact of predictors on the subscales of the RSA-P. Predictors with significant effects were included in multiple regression models.

Result: The RSA-P showed that all teams had the perception that they provide recovery-oriented practice to a moderately high degree after a training week on recovery-oriented care (mean scores between 3.85-4.46). Health professionals with fewer years of professional experience perceived more frequently that they operated in a recovery-oriented way (p = 0.036, B = - 0.268). Nurses and peer workers did not feel confident or responsible to fulfil specific roles.

Conclusion: The findings suggest that a one-week training session on community-based practices and collaborative teamwork may enhance recovery-oriented practice, but the role of nurses and peer workers needs further attention.

Trial registration: Each trial was registered before participant enrolment in the clinicaltrials.gov database: Croatia, Zagreb (Trial Reg. No. NCT03862209 ); Montenegro, Kotor (Trial Reg. No. NCT03837340 ); Romania, Suceava (Trial Reg. No. NCT03884933 ); Macedonia, Skopje (Trial Reg. No. NCT03892473 ); Bulgaria, Sofia (Trial Reg. No. NCT03922425 ).

Keywords: Collaborative Teamwork, Role perceptions; Community mental health services; Implementation.

Conflict of interest statement

The authors declare that they have no conflict of interest.

© 2021. The Author(s).

References

    1. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Haro JM, Karam EG, Kessler RC, Kovess V, Lane MC, Lee S, Levinson D, Ono Y, Petukhova M, Posada-Villa J, Seedat S, Wells JE. Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet. 2007;370(9590):841–850. doi: 10.1016/S0140-6736(07)61414-7.
    1. Vos T, Barber RM, Bell B, Bertozzi-Villa A, Biryukov S, Bolliger I, Charlson F, Davis A, Degenhardt L, Dicker D, Duan L, Erskine H, Feigin VL, Ferrari AJ, Fitzmaurice C, Fleming T, Graetz N, Guinovart C, Haagsma J, Hansen GM, Hanson SW, Heuton KR, Higashi H, Kassebaum N, Kyu H, Laurie E, Liang X, Lofgren K, Lozano R, MacIntyre MF, Moradi-Lakeh M, Naghavi M, Nguyen G, Odell S, Ortblad K, Roberts DA, Roth GA, Sandar L, Serina PT, Stanaway JD, Steiner C, Thomas B, Vollset SE, Whiteford H, Wolock TM, Ye P, Zhou M, Ãvila MA, Aasvang GM, Abbafati C, Ozgoren AA, Abd-Allah F, Aziz MIA, Abera SF, Aboyans V, Abraham JP, Abraham B, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NME, Aburto TC, Achoki T, Ackerman IN, Adelekan A, Ademi Z, Adou AK, Adsuar JC, Arnlov J, Agardh EE, al Khabouri MJ, Alam SS, Alasfoor D, Albittar MI, Alegretti MA, Aleman AV, Alemu ZA, Alfonso-Cristancho R, Alhabib S, Ali R, Alla F, Allebeck P, Allen PJ, AlMazroa MAA, Alsharif U, Alvarez E, Alvis-Guzman N, Ameli O, Amini H, Ammar W, Anderson BO, Anderson HR, Antonio CAT, Anwari P, Apfel H, Arsenijevic VSA, Artaman A, Asghar RJ, Assadi R, Atkins LS, Atkinson C, Badawi A, Bahit MC, Bakfalouni T, Balakrishnan K, Balalla S, Banerjee A, Barker-Collo SL, Barquera S, Barregard L, Barrero LH, Basu S, Basu A, Baxter A, Beardsley J, Bedi N, Beghi E, Bekele T, Bell ML, Benjet C, Bennett DA, Bensenor IM, Benzian H, Bernabe E, Beyene TJ, Bhala N, Bhalla A, Bhutta Z, Bienhoff K, Bikbov B, Abdulhak AB, Blore JD, Blyth FM, Bohensky MA, Basara BB, Borges G, Bornstein NM, Bose D, Boufous S, Bourne RR, Boyers LN, Brainin M, Brauer M, Brayne CEG, Brazinova A, Breitborde NJK, Brenner H, Briggs ADM, Brooks PM, Brown J, Brugha TS, Buchbinder R, Buckle GC, Bukhman G, Bulloch AG, Burch M, Burnett R, Cardenas R, Cabral NL, Nonato IRC, Campuzano JC, Carapetis JR, Carpenter DO, Caso V, Castaneda-Orjuela CA, Catala-Lopez F, Chadha VK, Chang JC, Chen H, Chen W, Chiang PP, Chimed-Ochir O, Chowdhury R, Christensen H, Christophi CA, Chugh SS, Cirillo M, Coggeshall M, Cohen A, Colistro V, Colquhoun SM, Contreras AG, Cooper LT, Cooper C, Cooperrider K, Coresh J, Cortinovis M, Criqui MH, Crump JA, Cuevas-Nasu L, Dandona R, Dandona L, Dansereau E, Dantes HG, Dargan PI, Davey G, Davitoiu DV, Dayama A, de la Cruz-Gongora V, de la Vega SF, de Leo D, del Pozo-Cruz B, Dellavalle RP, Deribe K, Derrett S, Des Jarlais DC, Dessalegn M, deVeber GA, Dharmaratne SD, Diaz-Torne C, Ding EL, Dokova K, Dorsey ER, Driscoll TR, Duber H, Durrani AM, Edmond KM, Ellenbogen RG, Endres M, Ermakov SP, Eshrati B, Esteghamati A, Estep K, Fahimi S, Farzadfar F, Fay DFJ, Felson DT, Fereshtehnejad SM, Fernandes JG, Ferri CP, Flaxman A, Foigt N, Foreman KJ, Fowkes FGR, Franklin RC, Furst T, Futran ND, Gabbe BJ, Gankpe FG, Garcia-Guerra FA, Geleijnse JM, Gessner BD, Gibney KB, Gillum RF, Ginawi IA, Giroud M, Giussani G, Goenka S, Goginashvili K, Gona P, de Cosio TG, Gosselin RA, Gotay CC, Goto A, Gouda HN, Guerrant R, Gugnani HC, Gunnell D, Gupta R, Gupta R, Gutierrez RA, Hafezi-Nejad N, Hagan H, Halasa Y, Hamadeh RR, Hamavid H, Hammami M, Hankey GJ, Hao Y, Harb HL, Haro JM, Havmoeller R, Hay RJ, Hay S, Hedayati MT, Pi IBH, Heydarpour P, Hijar M, Hoek HW, Hoffman HJ, Hornberger JC, Hosgood HD, Hossain M, Hotez PJ, Hoy DG, Hsairi M, Hu H, Hu G, Huang JJ, Huang C, Huiart L, Husseini A, Iannarone M, Iburg KM, Innos K, Inoue M, Jacobsen KH, Jassal SK, Jeemon P, Jensen PN, Jha V, Jiang G, Jiang Y, Jonas JB, Joseph J, Juel K, Kan H, Karch A, Karimkhani C, Karthikeyan G, Katz R, Kaul A, Kawakami N, Kazi DS, Kemp AH, Kengne AP, Khader YS, Khalifa SEAH, Khan EA, Khan G, Khang YH, Khonelidze I, Kieling C, Kim D, Kim S, Kimokoti RW, Kinfu Y, Kinge JM, Kissela BM, Kivipelto M, Knibbs L, Knudsen AK, Kokubo Y, Kosen S, Kramer A, Kravchenko M, Krishnamurthi RV, Krishnaswami S, Defo BK, Bicer BK, Kuipers EJ, Kulkarni VS, Kumar K, Kumar GA, Kwan GF, Lai T, Lalloo R, Lam H, Lan Q, Lansingh VC, Larson H, Larsson A, Lawrynowicz AEB, Leasher JL, Lee JT, Leigh J, Leung R, Levi M, Li B, Li Y, Li Y, liang J, Lim S, Lin HH, Lind M, Lindsay MP, Lipshultz SE, Liu S, Lloyd BK, Ohno SL, Logroscino G, Looker KJ, Lopez AD, Lopez-Olmedo N, Lortet-Tieulent J, Lotufo PA, Low N, Lucas RM, Lunevicius R, Lyons RA, Ma J, Ma S, Mackay MT, Majdan M, Malekzadeh R, Mapoma CC, Marcenes W, March LM, Margono C, Marks GB, Marzan MB, Masci JR, Mason-Jones AJ, Matzopoulos RG, Mayosi BM, Mazorodze TT, McGill NW, McGrath JJ, McKee M, McLain A, McMahon BJ, Meaney PA, Mehndiratta MM, Mejia-Rodriguez F, Mekonnen W, Melaku YA, Meltzer M, Memish ZA, Mensah G, Meretoja A, Mhimbira FA, Micha R, Miller TR, Mills EJ, Mitchell PB, Mock CN, Moffitt TE, Ibrahim NM, Mohammad KA, Mokdad AH, Mola GL, Monasta L, Montico M, Montine TJ, Moore AR, Moran AE, Morawska L, Mori R, Moschandreas J, Moturi WN, Moyer M, Mozaffarian D, Mueller UO, Mukaigawara M, Murdoch ME, Murray J, Murthy KS, Naghavi P, Nahas Z, Naheed A, Naidoo KS, Naldi L, Nand D, Nangia V, Narayan KMV, Nash D, Nejjari C, Neupane SP, Newman LM, Newton CR, Ng M, Ngalesoni FN, Nhung NT, Nisar MI, Nolte S, Norheim OF, Norman RE, Norrving B, Nyakarahuka L, Oh IH, Ohkubo T, Omer SB, Opio JN, Ortiz A, Pandian JD, Panelo CIA, Papachristou C, Park EK, Parry CD, Caicedo AJP, Patten SB, Paul VK, Pavlin BI, Pearce N, Pedraza LS, Pellegrini CA, Pereira DM, Perez-Ruiz FP, Perico N, Pervaiz A, Pesudovs K, Peterson CB, Petzold M, Phillips MR, Phillips D, Phillips B, Piel FB, Plass D, Poenaru D, Polanczyk GV, Polinder S, Pope CA, Popova S, Poulton RG, Pourmalek F, Prabhakaran D, Prasad NM, Qato D, Quistberg DA, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman S, Raju M, Rakovac I, Rana SM, Razavi H, Refaat A, Rehm J, Remuzzi G, Resnikoff S, Ribeiro AL, Riccio PM, Richardson L, Richardus JH, Riederer AM, Robinson M, Roca A, Rodriguez A, Rojas-Rueda D, Ronfani L, Rothenbacher D, Roy N, Ruhago GM, Sabin N, Sacco RL, Ksoreide K, Saha S, Sahathevan R, Sahraian MA, Sampson U, Sanabria JR, Sanchez-Riera L, Santos IS, Satpathy M, Saunders JE, Sawhney M, Saylan MI, Scarborough P, Schoettker B, Schneider IJC, Schwebel DC, Scott JG, Seedat S, Sepanlou SG, Serdar B, Servan-Mori EE, Shackelford K, Shaheen A, Shahraz S, Levy TS, Shangguan S, She J, Sheikhbahaei S, Shepard DS, Shi P, Shibuya K, Shinohara Y, Shiri R, Shishani K, Shiue I, Shrime MG, Sigfusdottir ID, Silberberg DH, Simard EP, Sindi S, Singh JA, Singh L, Skirbekk V, Sliwa K, Soljak M, Soneji S, Soshnikov SS, Speyer P, Sposato LA, Sreeramareddy CT, Stoeckl H, Stathopoulou VK, Steckling N, Stein MB, Stein DJ, Steiner TJ, Stewart A, Stork E, Stovner LJ, Stroumpoulis K, Sturua L, Sunguya BF, Swaroop M, Sykes BL, Tabb KM, Takahashi K, Tan F, Tandon N, Tanne D, Tanner M, Tavakkoli M, Taylor HR, te Ao BJ, Temesgen AM, Have MT, Tenkorang EY, Terkawi AS, Theadom AM, Thomas E, Thorne-Lyman AL, Thrift AG, Tleyjeh IM, Tonelli M, Topouzis F, Towbin JA, Toyoshima H, Traebert J, Tran BX, Trasande L, Trillini M, Truelsen T, Trujillo U, Tsilimbaris M, Tuzcu EM, Ukwaja KN, Undurraga EA, Uzun SB, van Brakel WH, van de Vijver S, Dingenen RV, van Gool CH, Varakin YY, Vasankari TJ, Vavilala MS, Veerman LJ, Velasquez-Melendez G, Venketasubramanian N, Vijayakumar L, Villalpando S, Violante FS, Vlassov VV, Waller S, Wallin MT, Wan X, Wang L, Wang JL, Wang Y, Warouw TS, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Wessells KRR, Westerman R, Wilkinson JD, Williams HC, Williams TN, Woldeyohannes SM, Wolfe CDA, Wong JQ, Wong H, Woolf AD, Wright JL, Wurtz B, Xu G, Yang G, Yano Y, Yenesew MA, Yentur GK, Yip P, Yonemoto N, Yoon SJ, Younis M, Yu C, Kim KY, Zaki MES, Zhang Y, Zhao Z, Zhao Y, Zhu J, Zonies D, Zunt JR, Salomon JA, Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386(9995):743–800. doi: 10.1016/S0140-6736(15)60692-4.
    1. Kohn R, Saxena S, Levav I, Saraceno B. The treatment gap in mental health care. Bull World Health Organ. 2004;82(11):858–866.
    1. Mitchell AJ, Malone D, Doebbeling CC. Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies. Br J Psychiatry. 2009;194(6):491–499. doi: 10.1192/bjp.bp.107.045732.
    1. OECD, Union E . Health at a Glance: Europe 2018 State of Health in the EU Cycle: OECD. 2018.
    1. Gutierrez-Colosia MR, Salvador-Carulla L, Salinas-Perez JA, Garcia-Alonso CR, Cid J, Salazzari D, et al. Standard comparison of local mental health care systems in eight European countries. Epidemiol Psychiatric Sci. 2019;28(2):210–223. doi: 10.1017/S2045796017000415.
    1. Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, al-Hamzawi A, Alonso J, Andrade L, Borges G, Bruffaerts R, Bunting B, de Almeida JMC, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, Hinkov H, Karam E, Kawakami N, Lee S, Navarro-Mateu F, Piazza M, Posada-Villa J, de Galvis YT, Kessler RC. Undertreatment of people with major depressive disorder in 21 countries. Br J Psychiatry. 2017;210(2):119–124. doi: 10.1192/bjp.bp.116.188078.
    1. Kohrt BA, Asher L, Bhardwaj A, Fazel M, Jordans MJD, Mutamba BB, et al. The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies. Int J Environ Res Public Health. 2018;15(6).
    1. Pec O. Mental health reforms in the Czech Republic. BJPsych Int. 2019;16(1):4–6. doi: 10.1192/bji.2017.27.
    1. Malone D, Newron-Howes G, Simmonds S, Marriot S, Tyrer P. Community mental health teams (CMHTs) for people with severe mental illnesses and disordered personality. Cochrane Database Syst Rev. 2007;3:CD000270. doi: 10.1002/14651858.CD000270.pub2.
    1. Petrea I. Mental Health in Former Soviet Countries:From Past Legacies to Modern Practices. Public Health Rev. 2012;34(2):5. doi: 10.1007/BF03391673.
    1. Priebe S, Matanov A, Demi N, Simic J, Jovanovic S, Gajic M, et al. Community Mental Health Centres Initiated by the South-Eastern Europe Stability Pact: Evaluation in Seven Countries. Community Ment Health J. 2011;48(3):352–362. doi: 10.1007/s10597-011-9417-6.
    1. van Veldhuizen JR. FACT: a Dutch version of ACT. Community Ment Health J. 2007;43(4):421–433. doi: 10.1007/s10597-007-9089-4.
    1. Nugter MA, Engelsbel F, Bähler M, Keet R, van Veldhuizen R. Outcomes of FLEXIBLE Assertive Community Treatment (FACT) Implementation: A Prospective Real Life Study. Community Ment Health J. 2016;52(8):898–907. doi: 10.1007/s10597-015-9831-2.
    1. Nielsen CM, Hjorthøj C, Killaspy H, Nordentoft M. The effect of flexible assertive community treatment in Denmark: a quasi-experimental controlled study. Lancet Psychiatry. 2021;8(1):27–35. doi: 10.1016/S2215-0366(20)30424-7.
    1. Svensson B, Hansson L, Lexén A. Outcomes of clients in need of intensive team care in Flexible Assertive Community Treatment in Sweden. Nordic J Psychiatry. 2018;72(3):226–231. doi: 10.1080/08039488.2018.1430168.
    1. Lexén A, Svensson B. Mental health professional experiences of the flexible assertive community treatment model: a grounded theory study. J Ment Health. 2016;25(4):379–384. doi: 10.1080/09638237.2016.1207236.
    1. Khoury E. Recovery Attitudes and Recovery Practices Have an Impact on Psychosocial Outreach Interventions in Community Mental Health Care. Front Psychiatry. 2019;10:560. doi: 10.3389/fpsyt.2019.00560.
    1. Davidson L, O'Connell M, Tondora J, Styron T, Kangas K. The Top Ten Concerns About Recovery Encountered in Mental Health System Transformation. Psychiatr Serv. 2006;57(5):640–645. doi: 10.1176/ps.2006.57.5.640.
    1. Boardman J, Shepherd G. RECOVERY: Implementing recovery in mental health services. Int Psychiatry. 2012;9(1):6–8. doi: 10.1192/S1749367600002897.
    1. Osborn LA, Stein CH. Community Mental Health Care Providers' Understanding of Recovery Principles and Accounts of Directiveness with Consumers. Psychiatr Q. 2017;88(4):755–767. doi: 10.1007/s11126-017-9495-x.
    1. Hornik-Lurie T, Shalev A, Haknazar L, Garber Epstein P, Ziedenberg-Rehav L, Moran GS. Implementing recovery-oriented interventions with staff in a psychiatric hospital: A mixed-methods study. J Psychiatr Ment Health Nurs. 2018;25(9–10):569–581. doi: 10.1111/jpm.12502.
    1. Andresen R, Caputi P, Oades L. Stages of recovery instrument: development of a measure of recovery from serious mental illness. Aust N Z J Psychiatry. 2006;40(11–12):972–980. doi: 10.1080/j.1440-1614.2006.01921.x.
    1. Gillard S, Holley J. Peer workers in mental health services: literature overview. Adv Psychiatr Treat. 2018;20(4):286–292. doi: 10.1192/apt.bp.113.011940.
    1. Stratford AC, Halpin M, Phillips K, Skerritt F, Beales A, Cheng V, Hammond M, O’Hagan M, Loreto C, Tiengtom K, Kobe B, Harrington S, Fisher D, Davidson L. The growth of peer support: an international charter. J Ment Health. 2019;28(6):627–632. doi: 10.1080/09638237.2017.1340593.
    1. Chisholm J, Petrakis M. Peer Worker Perspectives on Their Potential Role in the Success of Implementing Recovery-Oriented Practice in a Clinical Mental Health Setting. J Evid Based Soc Work. 2020;17(3):300–316. doi: 10.1080/26408066.2020.1729282.
    1. Barr KR, Townsend ML, Grenyer BFS. Using peer workers with lived experience to support the treatment of borderline personality disorder: a qualitative study of consumer, carer and clinician perspectives. Borderline Personal Disord Emoti Dysregul. 2020;7(1):20. doi: 10.1186/s40479-020-00135-5.
    1. Leff J, Trieman N. Long-stay patients discharged from psychiatric hospitals: Social and clinical outcomes after five years in the community. the TAPS Project 46. Br J Psychiatry. 2000;176(3):217–223. doi: 10.1192/bjp.176.3.217.
    1. Trieman N, Leff J, Glover G. Outcome of long stay psychiatric patients resettled in the community: prospective cohort study. BMJ. 1999;319(7201):13–16. doi: 10.1136/bmj.319.7201.13.
    1. Caldas de Almeida J, Killaspy H. Long Term Mental Health Care for People with Severe Mental Disorders. 2011.
    1. Singh SP. Running an effective community mental health team. Adv Psychiatr Treat. 2018;6(6):414–422. doi: 10.1192/apt.6.6.414.
    1. Haines A, Perkins E, Evans EA, McCabe R. Multidisciplinary team functioning and decision making within forensic mental health. Ment Health Rev (Brighton) 2018;23(3):185–196. doi: 10.1108/MHRJ-01-2018-0001.
    1. Caldas Almeida J, Mateus P, Tomé G, Katschnig H, Hinkov H, Sooniste I. Joint Action on Mental Health and Well-Being, Towards Community-Based and Socially Inclusive Mental Health Care, Situation Analysis and Recommendations for Action. 2016.
    1. Bond G, Drake R, Mueser K, Latimer E. Assertive Community Treatment for People with Severe Mental Illness. Dis Management Health Outcomes. 2001;9(3):141–159. doi: 10.2165/00115677-200109030-00003.
    1. Simmonds S, Coid J, Joseph P, Marriott S, Tyrer P. Community mental health team management in severe mental illness: a systematic review. Br J Psychiatry. 2001;178(6):497–502. doi: 10.1192/bjp.178.6.497.
    1. Shields-Zeeman L, Petrea I, Smit F, Walters BH, Dedovic J, Kuzman MR, Nakov V, Nica R, Novotni A, Roth C, Tomcuk A, Wijnen BFM, Wensing M. Towards community-based and recovery-oriented care for severe mental disorders in Southern and Eastern Europe: aims and design of a multi-country implementation and evaluation study (RECOVER-E) Int J Ment Heal Syst. 2020;14(1):30. doi: 10.1186/s13033-020-00361-y.
    1. Keet R, Vetten-Mc Mahon M, Shields-Zeeman L, Ruud T, Weeghel J, Bahler M, et al. Recovery for all in the community; position paper on principles and key elements of community-based mental health care. BMC Psychiatry. 2019;19(1):174. doi: 10.1186/s12888-019-2162-z.
    1. O'Connell M, Tondora J, Croog G, Evans A, Davidson L. From rhetoric to routine: assessing perceptions of recovery-oriented practices in a state mental health and addiction system. Psychiatr Rehabil J. 2005;28(4):378–386. doi: 10.2975/28.2005.378.386.
    1. Williams J, Leamy M, Bird V, Harding C, Larsen J, Le Boutillier C, et al. Measures of the recovery orientation of mental health services: Systematic review. Soc Psychiatry Psychiatr Epidemiol. 2012;47(11):1827–1835. doi: 10.1007/s00127-012-0484-y.
    1. Salzer MS, Brusilovskiy E. Advancing Recovery Science: Reliability and Validity Properties of the Recovery Assessment Scale. Psychiatr Serv. 2014;65(4):442–453. doi: 10.1176/appi.ps.201300089.
    1. Konkoly Thege B, Ham E, Ball LC. A Factor Analytic Investigation of the Person-in-Recovery and Provider Versions of the Revised Recovery Self-Assessment (RSA-R) Eval Health Prof. 2017;40(4):505–516. doi: 10.1177/0163278716674247.
    1. Piat M, Boyer R, Fleury M-J, Lesage A, O'Connell M, Sabetti J. Resident and proprietor perspectives on a recovery orientation in community-based housing. Psychiatric Rehabil J. 2015;38(1):88–95. doi: 10.1037/prj0000104.
    1. Team building and workflow guide: University of Washington – AIMS Center 2019 [cited 2020 21. January ]. Available from: .
    1. O'Connell M. Recovery Self-Assessment (RAS): Scoring instructions and factors. 2019.
    1. Wagner WE., III . Using IBM® SPSS® statistics for research methods and social science statistics: Sage Publications. 2019.
    1. Saxena S, Funk M, Chisholm D. World Health Assembly adopts Comprehensive Mental Health Action Plan 2013-2020. Lancet. 2013;381(9882):1970–1971. doi: 10.1016/S0140-6736(13)61139-3.
    1. Sowers W, Primm A, Cohen D, Pettis J, Thompson K. Transforming Psychiatry: A Curriculum on Recovery-Oriented Care. Acad Psychiatry. 2016;40(3):461–467. doi: 10.1007/s40596-015-0445-3.
    1. Lodge AC, Kaufman L, Stevens MS. Barriers to Implementing Person-Centered Recovery Planning in Public Mental Health Organizations in Texas: Results from Nine Focus Groups. Admin Pol Ment Health. 2017;44(3):413–429. doi: 10.1007/s10488-016-0732-7.
    1. Fu SS, Roth C, Battaglia CT, Nelson DB, Farmer MM, Do T, Goldstein MG, Widome R, Hagedorn H, Zillich AJ. Training primary care clinicians in motivational interviewing: a comparison of two models. Patient Educ Couns. 2015;98(1):61–68. doi: 10.1016/j.pec.2014.10.007.
    1. Murray LK, Dorsey S, Bolton P, Jordans MJ, Rahman A, Bass J, et al. Building capacity in mental health interventions in low resource countries: an apprenticeship model for training local providers. Int J Ment Heal Syst. 2011;5(1):30. doi: 10.1186/1752-4458-5-30.
    1. Kalauz S, Orlic-Sumić M, Simunec D. Nursing in Croatia: past, present, and future. Croat Med J. 2008;49(3):298–306. doi: 10.3325/cmj.2008.3.298.
    1. Carpenter J. Working in Multidisciplinary Community Mental Health Teams: The Impact on Social Workers and Health Professionals of Integrated Mental Health Care. Br J Soc Work. 2003;33(8):1081–1103. doi: 10.1093/bjsw/33.8.1081.
    1. Vandewalle J, Debyser B, Beeckman D, Vandecasteele T, Van Hecke A, Verhaeghe S. Peer workers’ perceptions and experiences of barriers to implementation of peer worker roles in mental health services: A literature review. Int J Nurs Stud. 2016;60:234–250. doi: 10.1016/j.ijnurstu.2016.04.018.
    1. England HE. Stepping forward to 2020/21: The mental health workforce plan for England. 2017.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera