Mary John

Conceptualising and Measuring Personal
Recovery in Young People
Mary John, Consultant Clinical Psychologist
Dr Fiona Jeffries, Clinical Psychologist
Dr Laura Simonds, Lecturer
Collaboration between Sussex Partnership NHS Foundation Trust
University of Surrey
Other members of the research group
Dr Fiona Warren - Lecturer
Dr Nikki Stone – Clinical Psychologist
Dr Rebecca Pons – Clinical Psychologist
Dr Claire Arthern - Clinical Psychologist
Dr Marcela Acuna-Rivera – Research Officer
Laura Cotton – Graduate Psychology Student
What is Personal Recovery?
• Emphasis on developing meaning and fulfilment
in the continued presence of symptoms
• Unique to the individual; but recovery models
suggest common aspects:
social connectedness
valued activities
• The current recovery literature is narrow (adult-centric, psychosisfocused, few empirical studies)
• Politically-driven (‘survivors’ and ‘activists’)
• ‘Recovery’ is associated with cure in common parlance
This raises a number of questions and challenges:
• How do we understand whether personal recovery has relevance and
resonance in other groups of people (e.g. young people and their
• How do we understand what it means in people with conditions other
than psychosis?
• How do we understand what it means without using the term ‘recovery’
or organising data collection around pre-existing frameworks?
Aims & Methodology – Part 1
Using an inductive approach, to develop a conceptual framework of recovery
in young people and mothers
• Interviews with 10 young people, 16 mothers [11 CAMHS professionals]
• Tell us about the time before, during and after being in CAMHS
• Thematic Analysis
• Comparison with adults frameworks:
‘Loss of self’ (similar to Andresen et al.’s ‘moratorium’ and Spaniol et al.’s
‘overwhelmed by the disability’)
‘Renegotiating the self’ (similar to Andresen et al’s ‘awareness’ and Spaniol
et al’s ‘struggling with the disability’)
Little conceptual similarity with later stages of adult models regarding future
thinking and responsibility
Aims & Methodology – Part 2
To develop an initial instrument based on this conceptual
framework; to establish if scores on this instrument relate
to symptoms in a predictable way
• Content analysis of items (c200) from interviews
• Development of Request-YP (30 items), Request-P (28
items), Request-PYP (35 items)
• Administered with measures of emotional problems
(SDQ) and self-esteem (Rosenberg)
• 47 young people aged 10-18 (M 14.7, SD 2.37), 37 girls
and 10 boys, in CAMHS for an average of 2.5 years
• 55 parents aged 31-59 (M 44.1, SD 5.16), 52 mothers
and 3 fathers
• N=40 child-parent pairs
Structure & Content of Measures
Single score to reflect degree of ‘recovery’ (not stage-based)
Factor analysis not viable in small sample
0 (not at all) to 3 (completely) scaling; thinking of the past week
(young person on self)
(parent on young person)
(parent on self)
I do not see my friends
because of how I feel
My child seems to be
I realise that my child is
not the only one with
these difficulties
I cope with my problems
much better than before
My child can deal with a
lot of stressful situations
I have become stronger
and can cope with more
I do not understand my
problems at all
My child understands
why they feel the way
they do
I understand my child’s
difficulties more
Good internal reliability for all 3 measures
(Cronbachs alpha .89 - .95)
Young people scoring in the ‘normal’ range of SDQ
had significantly higher ‘recovery’ scores
• Normal vs abnormal r = -.72
• Normal vs borderline r= -.57
Request-YP scores were highly positively correlated
with self-esteem (.8)
Positive correlation between child self-report and parent
report on the child (using parent-child pairs only): r=.61
And between parent report on self and report on their
child: r=.78
There were no significant correlations between Request
measures and duration in CAMHS or child age.
Critical Discussion
Novel work – almost no other CAMHS recovery studies
• Therefore, very limited data so far
Offers more questions than conclusions?
• Is this recovery?
• Is it different to adolescent maturation? Or self esteem?
• What comprises the Request measures and might
different aspects correlate with symptoms in different
The Request measures do not tap specific anxiety/depression
symptoms but are correlated in a predictable way with the
SDQ: potential to be used in clinical evaluation and outcome
measurement alongside symptom-based measures?
Mary John: [email protected];
[email protected]
Fiona Jeffries: [email protected]
Laura Simonds: [email protected]
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