The recovery model suggests that treatment goals should encompass more than the reduction of symptoms for people with serious mental and substance use disorders (Dumont, Ridgway, Onken, Dornan, & Ralph, 2006). Recovery perspectives encourage clients to work for improvements in many areas of their lives including housing, employment, education and social relationships. Providers who work in a recovery framework also need to have expectations that clients can and will experience improvements across these life dimensions (Grusky et al., 1989). Though there has been progress in developing recovery-oriented, evidence-based treatments for people with co- occurring disorders, there is a dearth of research examining the attitudes of providers who use such treatment approaches. Optimism for recovery is the provider’s attitude that clients can achieve recovery and integration into the community and achieve more than merely symptom reduction. Building on the recovery model, social learning and cognitive behavioral theories, the aims of this study are to explore individual and team characteristics that are associated with levels of provider optimism about consumer recovery.
Methods: This study used a non-experimental, cross-sectional design to gather
information from mental health providers working in intensive, multi-disciplinary teams in agencies using Integrated Dual Disorder Treatment (IDDT) and/or Assertive Community Teams (ACT) across five states. Data were collected using an anonymous self-report questionnaire with a convenience sample of 241 mental health providers working in 44 teams in five states (Ohio, Michigan, North Dakota, Wisconsin, and Colorado). Teams in the study were limited to those which had implemented IDDT and/or ACT, enrolled clients and completed a baseline fidelity assessment in the implementation of IDDT and/or ACT from the Center on Evidence Based Practices at Case Western Reserve University. The response rate from these surveys was 68%.
Hierarchical linear modeling (HLM) was used to address a nested (clustered) structure to examine the impact of team membership on individual and team level perceptions of team cohesion, access to resources, and optimism about consumer recovery, controlling for age, gender, education, and job function.
Findings: None of the specified hypotheses in this study were fully supported. The significant findings were limited to associations among selected variables and concept subscales. The hypothesis stating a positive relationship between optimism for consumer recovery and levels of team cohesion after controlling for age, gender, job function and educational level was not supported. However, at the individual analysis level, there were positive, statistically significant relationships between the subscales of newly created professional activities and provider optimism. At the team level of analysis, four of the subscales of team cohesion (newly created professional activities, flexibility, collective ownership of goals, and reflection on process) were significantly associated with levels of provider optimism.
The hypothesis stating a positive relationship between individual tenure, team tenure and team cohesion controlling for age, gender, job function and educational level was not supported. However, job function of the case manager was significantly associated with a higher score on the team cohesion subscale of interdependence than the supervisor. Longer job tenure at the individual level was associated with lower scores on the team cohesion subscale of newly created professional activities. There was no difference in the mean scores on the 16-80 point scale for optimism for consumer recovery (44.42 for individuals and 44.26 for the teams).
Strengths and Limitations: Strengths of the study include the use of standardized measures for the concepts of team cohesion and provider optimism and a sample of mental health providers known to work in intensive, multidisciplinary teams and to use IDDT and/or ACT recovery based model. The sample size of 241 met the requirements for the statistical analysis strategy. However, significant limitations to the generalizability of the results include the response rate of 68%, the inability to evaluate the differences between the sample responders and the non-responders and the fact the sample was drawn from a specific group of agencies working closely with one university center on evidence based practices and fidelity assessment.
Implications: The study findings raise more questions for future explorations about the role of individual and team characteristics in levels of provider optimism for consumer recovery. The roles of individual and team characteristics provide some direction for additional studies that explore how providers think about consumer recovery, in general, and what role optimism about recovery may play in teams using the IDDT and/or ACT frameworks. The findings at the team level indicate that further explorations into the workings of the team process may be fruitful in understanding provider optimism towards consumer recovery in agency settings using IDDT and/or ACT models.