Recovery in long-term mental health care: The development, implementation and impact of the Active Recovery Triad (ART) model

The focus of this thesis is the development, implementation and impact of the Active Recovery Triad (ART) model, a care model developed to foster the recovery process of people with serious mental illnesses who are admitted in long-term mental health care. This thesis has three objectives: (1) to describe the collaborative development process and the content of the ART model, (2) to provide insight into the implementation of the ART model in practice, and (3) to investigate the impact of the ART model in practice. Chapter 2 presents the collaborative development process and the key characteristics of the ART model. The ART model combines an active (A) role for professionals, service users and significant others, a focus on recovery (R), and cooperation between service user, significant others and professional in the triad (T). In addition, a model fidelity scale has been developed: the ART monitor. Chapter 3 reports the evaluation of the ART monitor, based on peer-to-peer audits and feedback meetings. The evaluation of the content validity, construct validity and inter-rater reliability provided fruitful input, resulting in a feasible and useful instrument for research purposes and mental health care practice. Chapter 4 provides insight into key factors influencing the implementation process of the ART model, based on group interviews with teams. Eleven themes were identified, related to different phases of implementation, including the start, during the implementation process and striving for sustainable implementation. In Chapter 5 it is shown that compliance to the principles of the ART model is related to recovery-oriented care, measured with the ROPI-R. Although overall ART fidelity is not associated with outcomes regarding recovery or service user satisfaction, particular elements of the ART model are related to meaningful recovery outcomes. Chapter 6 provides insight into the perspectives of service users and significant others on care and support of teams working with the ART model. We found that service users feel motivated, work actively on personal recovery goals and have dreams for the future. Also, they indicated specific conditions for recovery-oriented care and how different dimensions of recovery were addressed in care and support. Furthermore, the social support system, contact with care workers and with other service users were regarded as important. Chapter 7 addresses a general discussion and conclusion. The ART model has introduced a new perspective in long-term mental health care. The collaborative development process ensured that the content of the ART model was based on the perspectives of the triad. It also provided the basis for a national learning network. The research methods created an environment of collaborative learning. In the implementation process it appeared important to pay attention to the commitment and involvement of all stakeholders both in the organization and on a national level, and to develop strategies for sustainability. The ART model has impact on recovery-oriented care and specific elements of the ART model are related to meaningful recovery outcomes. Experiences and views of service users and significant others created a basis for further elaboration and specification of the model.